Assessment Of Osteoporotic Fracture Risk Research Articles

FRAX calculation with and without bone mineral density for assessment of osteoporotic fracture risk in patients of rheumatic disease: a cross-sectional study.

A cross-sectional was conducted at outpatient Department of Rheumatology. Eighty-one Patients of more than 40 years of age having either sex. Diagnosed case of Rheumatic diseases were according to American College of Rheumatology (ACR) /European Alliance of Associations for Rheumatology (EULAR) criteria were included in our study. FRAX score without BMD was calculated and information was recorded in proforma. These patients were advised dual energy X-ray absorptiometry Scan and after that FRAX with BMD was calculated, after which comparison between result of two scores was made. The data were analyzed by SPSS software version 24. Effect modifiers were controlled by stratification. Post-stratification χ2 test were applied. P value less than 0.05 was considered as significant. This study consisted of 63 participants, who were assessed for osteoporotic risk fracture, with and without BMD. Data analysis revealed a significant association between the type of fracture and age (p value=0.009), previous fracture (p value=0.25), parent fractured hip (p values) and treatment with bone mineral dismissal. There was no statistically significant association seen of fractures with bone deterioration with sex, weight, height, or current smoking. FRAX may be crucial in rural areas where dual energy X-ray absorptiometry scanning is not available since it is a readily available instrument. FRAX is a useful substitute for estimating osteoporosis risk when funds are scarce. Given the possible effect it will have on healthcare costs, this is extremely pertinent.

IL-6 and Leptin Are Potential Biomarkers for Osteoporotic Fracture Risk Assessment and Prediction of Postmenopausal Women with Low Bone Mass: A Follow-Up Study Using a Regional Sample Cohort.

Osteoporotic fracture, a major complication which is known as the outcome postmenopausal osteoporosis, seriously threatens the health of postmenopausal women. At present, the traditional osteoporotic fracture prediction methods are characterized by inconvenient application and time-consuming statistical results, while predictive serum biomarkers can make up for this shortcoming. Accurate and advanced risk prediction of osteoporotic fracture is meaningful to early prevention and intervention, effectively avoiding the risk of this disease and the secondary fracture in the surgical treatment. In this study, based on the BEYOND cohort, a 2-year follow-up study was conducted after subjects participated to survey if OF occurred. Independent sample t-test and Mann–Whitney U-test were used to analyze the differences of bone metabolism biomarkers between the OF and non-OF group. Cox proportional hazard model was used to screen the potential biomarkers might be used to predict OF risk. ROC curves and AUCs were used to analyze the predictive accuracy, and the Delong's test was used to compare the differences between the AUCs. 15 postmenopausal women with low bone mass and OF were found, and other 60 subjects without OF were matched with 1 : 4, age, and BMI classification as control group. The serum IL-6 (OR = 1.139, 95%CI = 1.058 − 1.226) and leptin (OR = 0.921, 95%CI = 0.848 − 1.000) were found as OF risk predictive biomarkers for postmenopausal women with low bone mass with high accuracy (IL − 6 = 0.871) (leptin = 0.813) and accuracy enhanced when they were combined (AUC = 0.898). The results of Delong's test showed that the difference of AUC between leptin and IL-6&Leptin was meaningful (P = 0.024) but meaningless between IL-6 and leptin (P = 0.436), IL-6 and IL-6&Leptin (P = 0.606). To sum up, IL-6 and leptin are the predictive biomarkers of OF for postmenopausal women with low bone mass. The IL-6 can improve the prediction accuracy of leptin (P = 0.024), but not vice versa (P = 0.606). Trial Information. Registered on the Chinese Clinical Trial Registry already. (Registration Number: ChiCTR-SOC-17013090).

Accuracy of the Fracture Risk Assessment Tool for judging pharmacotherapy initiation for primary osteoporosis.

This study aimed to determine whether the Fracture Risk Assessment Tool (FRAX®) is useful in assessing the criteria for the initiation of pharmacotherapy for primary osteoporosis based on the current diagnostic criteria in Japan. We enrolled 614 patients aged ≥ 40years (average, 77.0years) who were eligible for primary osteoporosis evaluation. Bone mineral density measurements of the lumbar spine, total hip, and femoral neck using ALPHYS LF (FUJIFILM, Tokyo, Japan) and imaging studies involving the lumbar spine were obtained and the FRAX® scores of each patient were calculated with and without the T-score of the femoral neck. The receiver operating characteristic curve analysis method was used to calculate the cut-off FRAX® scores with reference to the criteria for initiating pharmacotherapy for osteoporosis; the accuracies of both FRAX® scores were compared. The FRAX® score calculated with the T-score was more accurate for hip fracture risk assessment [cut-off value 5.5%; the area under the curve (AUC) 0.946] than for major osteoporotic fracture risk assessment (cut-off value 17.0%; AUC 0.924) in judging the criteria (p = 0.001). Conversely, the FRAX® score calculated without the T-score was equally accurate for hip fracture risk assessment (AUC 0.796) and major osteoporotic fracture risk assessment (AUC 0.806) (p = 0.23). The FRAX® score can accurately assess the criteria for initiating pharmacotherapy for primary osteoporosis based on the current Japanese diagnostic criteria, especially when the T-score is used.

Osteoporosis Screening and Fracture Risk Assessment Tool: Its Scope and Role in General Clinical Practice.

Osteoporosis is a widely prevalent condition among postmenopausal women characterized by low bone mass and skeletal fragility that increases the risk of fractures specifically in the hip, spine, wrist, humerus, and pelvis. It has become a major public health problem around the world. An osteoporotic fracture affects one in every three women and one in every five men aged 50 and above. Hip and spine fractures are linked to a higher death rate and can cause ambulation problems, depression, chronic pain, independence loss, and persistent discomfort. It not only puts a lot of strain on the individual but also causes a significant cost to society. Osteoporosis is a silent disease that goes unrecognized until a patient develops a pathological fracture. Diagnosis of osteoporosis is based on bone mineral density (BMD) estimation by dual-energy x-ray absorptiometry (DXA) as defined by WHO. However, in many resource-constrained and underdeveloped or low-middle income countries, it is not widely available. There are a number of questionnaire-based techniques available to identify such postmenopausal women and older men who may be at risk of having low BMD and osteoporosis. Our aim of the study is to search and compile such simple yet useful and validated screening and assessment tools for osteoporosis that can help to identify people at risk of having low BMD and the potential candidate who can benefit from BMD estimation in a resource-restricted geographical area or low/middle-income countries and benefit from treatment. Though these tools are not diagnostic can have broader applicability in general clinical practice and usefulness in identifying high-risk individuals and may prove cost-effective. Although it has limitations, FRAX is a widely used osteoporotic fracture risk assessment tool around the globe and when used with femoral neck BMD it has greater accuracy.

Usefulness of the Trabecular Bone Score in Assessing the Risk of Vertebral Fractures in Patients with Cirrhosis.

The trabecular bone score (TBS), a surrogate measure of bone microarchitecture, provides complementary information to bone mineral density (BMD) in the assessment of osteoporotic fracture risk. This cross-sectional study aimed to determine whether TBS can identify patients with liver cirrhosis that are at risk of vertebral fractures. We enrolled 275 patients who completed evaluations for lumbar BMD, TBS, and vertebral fractures between November 2018 and April 2021. BMD was measured using dual-energy X-ray absorptiometry (DXA), TBS was calculated by analyzing DXA images using TBS iNsight software, and vertebral fractures were evaluated using Genant’s semi-quantitative method with lateral X-ray images. Factors associated with vertebral fractures and their correlation with the TBS were identified using regression models. Of the enrolled patients, 128 (47%) were female, the mean age was 72 years, and 62 (23%) were diagnosed with vertebral fractures. The prevalence of vertebral fractures was higher in women than in men (33% vs. 14%; p < 0.001). The unadjusted odds ratio (OR) of the vertebral fractures for one standard deviation decrease in TBS and BMD was 2.14 (95% confidence interval [CI], 1.69–2.73) and 1.55 (95% CI, 1.26–1.90), respectively. After adjusting for age, sex, and BMD, the adjusted OR of the vertebral fractures in TBS was 2.26 (95% CI, 1.52–3.35). Multivariate linear regression analysis showed that TBS was independently correlated with age (β = −0.211), body mass index (β = −0.251), and BMD (β = 0.583). TBS can help identify patients with cirrhosis at risk of vertebral fractures.

A non-cardiac applications of T1-mapping

T1-mapping has proven to be a valuable tool in cardiac imaging. While mainly used in cardiac MRI, it is investigated for usage and application of T1-mapping to imaging of other organs and systems, including abdominal imaging, musculoskeletal imaging or neuroradiology, resulting in potential new prospects for medical imaging. T1-mapping provides numerical data on an inherent, physical property of imaged tissue – enabling quantitative and comparative assessment of tissue characterization f.ex. fibrosis, amyloid contents, fatty transformation, myelinization or contrast enhancement as well as lesion characterization.&#x0D; Reports of application of T1-mapping in assessment of liver, kidney or pancreas fibrosis create perspectives of reducing the number of invasive diagnostic procedures, such as biopsies, as well as monitoring treatment response or disease progression. Furthermore T1-mapping can potentially replace MR elastography in assessment of liver fibrosis or used in thyroid fibrosis to define degree of destruction in AIT or other thyroid diseases. In neuroradiology T1-mapping is promising in the spine imaging, enabling better characterization of spinal cord lesions also has a potential to evaluate effectiveness of conservative or operative treatment. There are also successful reports of employing T1-mapping in orbital imaging, such as in predicting steroid resistant diplopia in Graves’ disease or in evaluation of diabetic cataracts. In musculoskeletal imaging, T1-relaxation could be a possible biomarker of bone quality that could play a role in osteoporotic fracture risk assessment.&#x0D; In conclusion, T1-mapping shows promise as a quantitative method complementary to standard MR imaging beyond cardiac MRI, and needs further research and validation efforts to establish its place in standard diagnostic protocols.

Ukrainian FRAX version in the male osteoporosis management

Background. At present, FRAX is a well-known and widely-used risk assessment tool for major osteoporotic fractures. The Ukrainian version of the FRAX algorithm was presented in 2016; with the “intervention threshold” for additional DXA examination and antiosteoporotic treatment of the Ukrainian women published in 2019. However, the data on its possible uses in men are limited. The purpose of the study was to evaluate the possibilities of using the previously developed criteria of the Ukrainian FRAX algorithm in Ukrainian men. Materials and methods. We examined 653 outpatients aged 40–88 years (mean age (M±SD)— 60.5±11.8 years). We analyzed the results both in the general group and in the age subgroups; in particular, with an account of low-trauma fractures, included in the FRAX calculation, and compared them with the corresponding indices of the Ukrainian women. Results. The most frequent (26.6 %) risk factor for osteoporotic fractures in the group of Ukrainian men was a history of low-trauma fracture (the corresponding index in women was 51.3 %), its presence being the reason for antiosteoporotic treatment initiating. Following upon the risk of major osteoporotic fractures calculated by FRAX, only 6.7 % of men without previous fractures were found to require additional DXA examination in order to re-evaluate the osteoporotic fracture risk, and none had a high fracture risk. 73 % of men without fractures did not have any risk factor included in the FRAX algorithm. Conclusions. This study showed a greater need for both antiosteoporotic treatment without DXA assessment and additional densitometric examination for the osteoporotic fracture risk assessment for the Ukrainian women rather than men, along with a special attention to the presence of previous fractures in men, and consideration of other risk factors for osteoporosis, even those not included in this FRAX algorithm.

Automated opportunistic osteoporotic fracture risk assessment using computed tomography scans to aid in FRAX underutilization

Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3-6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 50-90 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 2012-2017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8.

Osteoporotic fracture risk prediction tools

The therapeutic approach of the osteoporosis aims an impact not only on the bone mineral density (BMD), but also on the fracture risk. Fracture risk is defined as a 10-year absolute risk in %. The principles for fracture risk assessment are defined. Age and BMD are initial points of its calculation. A 10-year absolute risk of fractures is assessed on the basis of a table or nomogram. Each serious risk factor such as pre-existing fracture (vertebral or hip), low body mass index (below 20 kg/m2), heredity for hip fractures, high doses of corticosteroid therapy, etc. is accompanied by a doubling of the absolute fracture risk. The process of osteoporotic fracture risk assessment involves several stages: depth anamnesis, physical examination, BMD test, X-ray analysis of vertebral fractures and laboratory tests to exclude secondary cause of osteoporosis. The obtained data can be input into each of the methods for assessing the risk of fractures. Simple screening tools for fracture prediction are OST, ORAI, OSIRIS, SCORE and age alone. Other widely used methods are FRAX®, a Garvan risk calculator and QFracture®. Diff erences in the introduced variables create significant variations in calculated risks from each calculator. The decision on the type of the risk calculator can be made on the basis of country-specific features, although it is necessary for the physician to be aware of the limitations of the chosen method. The complex infl uence on the fracture risk can be achieved through an integrated multidisciplinary approach. The aim is achievement of real outcomes in the prevention of osteoporosis before the occurrence of the first osteoporotic fracture to reduce the expansion of the disease and its negative effects.

High prevalence of risk factors for low bone mineral density and estimated fracture and fall risk among elderly medical inpatients: a missed opportunity.

(1) To calculate the absolute fracture risk by using the fracture risk assessment (FRAX) model among elderly medical inpatients; (2) to assess the risk of falls, especially among patients with increased risk of fractures; and (3) to design and implement a bone health protocol to improve the assessment of fracture risk. The study participants were all inpatients admitted to the medical wards at University Hospital Kerry, Ireland. All consecutive eligible patients aged ≥ 65years were prospectively evaluated to populate clinical risk factor variables used in the FRAX model and the fall assessment was made by using Fracture Risk Questionnaire. Consecutive 465 medical inpatients were screened, and 200 eligible medical inpatients were evaluated. The mean age of the cohort was 73.8 ± 9years and 56% were male. The body mass index of the cohort was 27 ± 5, and only 21% (n = 42) of patients reported having ever had a DXA scan. Previous personal history of low fragility fracture was present in 20.5% (n = 41) of the patients. The absolute 10-year risk of major osteoporotic and hip fracture was 15 ± 12 and 7.6 ± 11, respectively, and 25.5% (n = 51) and 64.5% (n = 129) respectively of the cohort had fracture risks exceeding the National Osteoporosis Federation (NOF) thresholds for treatment. High fall risk was noted in 63% of the cohort. A very high prevalence of fracture and fall risk was noted. A medical inpatient stay offers a window of opportunity for assessment of osteoporotic fracture risk. With these findings, a bone health protocol has been developed.

Estimation of mechanical stiffness by finite element analysis of ultrasound computed tomography (UCT-FEA); a comparison with X-ray µCT based FEA in cancellous bone replica models

The mechanical integrity of a bone is determined by its quantity and quality. Conventional mechanical testing is the ‘gold standard’ for assessing bone strength, although not applicable in vivo since it is inherently invasive and destructive. A mechanical test measurement of stiffness (N mm−1) provides an accurate estimate of strength, although again inappropriate in vivo. Several non-destructive, non-invasive, in vivo techniques have been developed and clinically implemented to serve as surrogates for bone strength assessment including dual-energy X-ray absorptiometry along with axial and peripheral quantitative computed tomography, and quantitative ultrasound. Finite element analysis (FEA) is a computer simulation method that predicts the behaviour of a structure such as a bone under mechanical loading, being previously combined with in vivo bone imaging, reporting higher predictions of mechanical integrity than imaging alone.We hypothesised that ultrasound computed tomography (UCT) may be combined with FEA, thereby predicting the stiffness of bone. The objective of this study was to apply finite element analysis to UCT derived attenuation images of trabecular bone replica samples, thereby providing an estimate of mechanical stiffness that could be compared with both a gold standard mechanical test and a surrogate X-ray µCT-FEA.Replica bone samples were 3D-printed from four anatomical sites (femoral head, lumbar spine, calcaneus and iliac crest), with two cylindrical volumes of interest extracted from each sample. Each replica sample was scanned by X-ray µCT and a bespoke UCT system, from which finite element analysis was performed to estimate mechanical stiffness. The samples were then mechanically tested, yielding the gold standard stiffness value.The coefficient of determination (R2) to estimate mechanical test derived stiffness was 99% for µCT-FEA and 84% for UCT-FEA. In conclusion, UCT-FEA is a promising tool for estimating the mechanical integrity of a bone. This study demonstrated that UCT-FEA, based upon quantitative attenuation images, provided a comparable estimation of gold standard mechanical-test stiffness and therefore has significant potential clinical utility for osteoporotic fracture risk assessment and quantitative assessment of musculoskeletal tissues.

FRAX predictior with and without BMD for assessment of osteoporotic fracture risk in the Himalayan state of India: A comparative study

Objective: BMD (bone mineral density) testing facilities are not available in every places in India. We compare the predictive ability of FRAX with BMD and FRAX without BMD for major osteoporotic and hip fracture in Himalayan population. Materials and methods: a hospital based cross sectional study was conducted on patients attending the outpatient Department of orthopaedics of SGRRIMHS, and others for a period of 2 years from Aug 2015 to July 2017. A total no. of 125 patients (104 F+ 21M) in the age group 40 -90 years were selected randomly for study. Exclusion criteria were age less than 40 and more than 90 years, confirmed cases of osteoporosis, patients on antiresorptive treatment, cases of surgically removed ovary and uterus, bone metastasis. Dual Energy X-ray Absorptiometry (DXA) scans were obtained to assess presence of low BMD. FRAX calculations with and without addition of femoral neck BMD were done in all patients. Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. Results: Hip fracture probabilities (6.00±10.47% 5.03±10.26%) and MO fracture probabilities (11.34±12.85% 11.89±12.87%) were similar with or without inclusion of BMD in FRAX tool respectively. Conclusion: FRAX may be used to assess for 10 year hip and major osteoporotic fracture probabilities status in the absence of DXA facilities or avoiding unnecessary DXA scanning.

Relationship of Number of Missing Teeth to Hip Fracture in Elderly Patients: A Cohort Pilot Study.

To determine the relationship between the number of missing natural teeth or remaining natural teeth and osteoporotic hip fracture in elderly patients and to determine the relationship between the number of missing teeth or remaining teeth and osteoporotic fracture risk assessment (FRAX) probability. Number of missing teeth was determined by clinical oral exam on a total of 100 subjects, 50 with hip fractures and 50 without. Ten-year fracture risk and hip fracture risk probabilities were calculated using the FRAX tool. Statistical analyses were performed to determine strength of associations between number of missing natural teeth and likelihood of experiencing a fracture. Degree of correlation between number of missing natural teeth and FRAX probabilities were calculated. There appears to be an association between the number of missing natural teeth and hip fractures. For every 5-tooth increase in the number of missing teeth, the likelihood of being a subject in the hip fracture group increased by 26%. Number of missing natural teeth was positively correlated with FRAX overall fracture and hip fracture probability. Number of missing natural teeth may be a valuable tool to assist members of medical and dental teams in identifying patients with higher FRAX scores and higher likelihood of experiencing a hip fracture. Additional research is necessary to validate these findings.

30 years of DXA technology innovations

As the successor of Dual Photon Absorptiometry (DPA), Dual X-ray Absorptiometry (DXA) has seen 30years of continuous technological innovations. Implementation of measures for standardization and quality assurance made DXA a reliable and clinically useful approach. Its use in clinical multicenter drug studies in osteoporosis lead to general acceptance as the standard technique of bone densitometry. The limitations of DXA are well established. As a measure of areal bone mineral density (aBMD) it depends on bone size and is biased by overlaying soft tissue and calcified structures. To some extent these errors can be reduced by estimation of bone depth and/or lateral imaging. DXA based aBMD can be supplemented by additional information obtainable from DXA scans: geometric indices such as hip axis length or complex models like 2-D finite element analysis have been developed and tested. Given the drastic improvement in image quality current DXA scans can be used for Vertebral Fracture Analysis (VFA) or grading of Abdominal Aortic Calcifications. A textural measure, Trabecular Bone Score (TBS) provides independent information on fracture risk. DXA devices can also be used for assessments beyond bone density. Periprosthetic aBMD changes can be monitored to study the mechanical fitting of bone implants. Total body composition measurements are increasingly being used in studies on nutrition, obesity, and sarcopenia.30years after its inception DXA is the undisputed standard imaging technique for the assessment of osteoporotic fracture risk with new applications beyond bone densitometry adding to its value.

Characterization of a new ultrasound device designed for measuring cortical porosity at the human tibia: A phantom study

Quantitative ultrasound (QUS) measurements of trabecular bone are a useful tool for the assessment of osteoporotic fracture risk. However, cortical bone properties (e.g. porosity) have an impact on bone strength as well and thus current research is focused on QUS assessment of cortical bone properties. Simulation studies of ultrasound propagation through cortical bone indicate that anisotropy, calculated from the ratio of the velocities in axial and tangential directions, is correlated with porosity. However, this relationship is affected by error sources, specifically bone surface curvature and variability of probe positioning. With the aim of in vivo estimation of cortical porosity a new ultrasound device was developed, which sequentially measures velocities in 3 different directions (axial=0° and ±37.5°) using the axial transmission method. Measurements on planar porosity phantoms (0–25%) were performed to confirm the results of the afore mentioned simulation studies. Additionally, measurements on cylindrical phantoms without pores (min. radius=34mm for strongest curvature) were performed to estimate the influence of surface curvature on velocity measurements (the tibia bone surface is fairly flat but may show surface curvature in some patients). The velocities in the axial and ±37.5° directions were used to calculate an anisotropy index. The velocities measured on the porosity phantoms showed a decrease by −6.3±0.2m/s and −10.1±0.2m/s per percent increase in porosity in axial and ±37.5° directions, respectively. Surface curvature had an effect on the velocities measured in ±37.5° directions which could be minimized by a correction algorithm resulting in an error of 5m/s. The anisotropy index could be used to estimate porosity with an accuracy error of 1.5%. These results indicate that an estimation of porosity using velocity measurements in different directions might be feasible, even in bones with curved surface. These results obtained on phantom material indicate that the approach tested may be suited for porosity measurements on human tibia bone.

Osteoporotic Fracture Risk Assessment Using Bone Mineral Density in Korean: A Community-based Cohort Study.

BackgroundFracture-risk assessment tool (FRAX) using just clinical risk factors of osteoporosis has been developed to estimate individual risk of osteoporotic fractures. We developed prediction model of fracture risk using bone mineral density (BMD) as well as clinical risk factors in Korean, and assessed the validity of the final model.MethodsTo develop and validate an osteoporotic FRAX, a total of 768 Korean men and women aged 50 to 90 years were followed for 7 years in a community-based cohort study. BMD as well as clinical risk factors for osteoporotic fracture including age, sex, body mass index, history of fragility fracture, family history of fracture, smoking status, alcohol intake, use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis were assessed biannually.ResultsDuring the follow-up period, 86 osteoporotic fractures identified (36 in men and 50 in women). The developed prediction models showed high discriminatory power and had goodness of fit.ConclusionsThe developed a Korean specific prediction model for osteoporotic fractures can be easily used as a screening tool to identify individual with high risk of osteoporotic fracture. Further studies for validation are required to confirm the clinical feasibility in general Korean population.

Prediction of fracture risk in patients with osteoporosis: a brief review.

Osteoporosis, a well-defined and growing public health problem, is a disease characterized by increased bone turnover and decreased bone mass with associated skeletal fragility, resulting in an increased risk of fracture. It is often unrecognized until the late stages when fragility fractures have occurred. In adults, early recognition of the disease prior to the occurrence of fractures followed by timely and efficient initiation of appropriate treatment can reduce fracture risk. In this article, we review clinical modalities available to effectively predict fracture risk in patients with osteoporosis. Bone mineral density and presence of clinical risk factors may be combined to provide a more comprehensive osteoporotic fracture risk assessment. Use of FRAX may serve as a general guideline for clinical management and deciding a threshold for cost-effective pharmacological intervention. Elevated bone turnover markers are predictive of high fracture risk and can provide additional clinical information as well.

Fractal lacunarity of trabecular bone and magnetic resonance imaging: New perspectives for osteoporotic fracture risk assessment.

Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density (BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture (TBA) during aging and osteoporosis. Magnetic resonance imaging (MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest fractal analysis as a promising approach to quantify morpho-functional changes in both aging and pathology. In this particular context, fractal lacunarity seems to be the proper tool to characterize TBA texture as it is able to describe both discontinuity of bone network and sizes of bone marrow spaces, whose changes are an index of bone fracture risk. In this paper, an original method of MRI texture analysis, based on TBA fractal lacunarity is described and discussed in the light of new perspectives for early diagnosis of osteoporotic fractures.

Assessment of 10-Year Major Osteoporotic and Femur Fracture Risk of Postmenopausal Women Using FRAX®

Amac: Bu calismanin amaci, postmenopozal kadinlarda osteoporoz (OP) risk faktorlerini ve Dunya Saglik Orgutu (DSO) kirik risk degerlendirme skalasi (FRAX) kullanilarak 10 yillik major OP ile kalca kirigi riskini degerlendirmektir. Gerec ve Yontemler: Kesitsel tipteki bu analitik arastirma 340 postmenopozal kadinda yapildi. Katilimcilarin risk faktorleri ile kemik mineral yogunluklarini (KMY) goz onunde bulundurarak ve FRAX risk degerlendirme skalasi kullanilarak 10 yillik major osteoporotik ve kalca kirigi riskleri hesaplandi. Bulgular: Calismamizda kadinlarin yas ortalamalari 57,5±7,8 idi. Katilanlarin 47’si (%13,8) osteoporotik, 177’si (%52,1) osteopenik, 116’si (%34,1) normal olarak bulundu. Yas arttikca OP sikligi artarken (p<0,001), beden kitle indeksi (BKI) arttikca OP sikligi azaliyordu (p<0,001). Osteoporoz varligi goz onune alindiginda, KMY kullanilarak veya kullanilmadan hesaplanan major osteoporotik ve kalca kirigi riskleri arasinda istatistiksel olarak anlamli derecede onemli bir iliski vardi (p<0,001). Kemik mineral yogunluklari kullanilarak hesaplanan major osteoporotik kirik riski katilanlarin %94,7’sinde dusuk, %5’inde orta ve %0,3’unde yuksek idi. Osteoporoz risk faktorleri incelendiginde; 2 ve daha az klinik risk faktoru olanlarda OP sikligi %12,8 iken, 3 veya 4 risk faktoru olanlarda bu siklik %28,0 idi. Sonuc: Bu calismada, 10 yillik osteoporotik kirik riskini degerlendirmede KMY kullanilsin ya da kullanilmasin FRAX risk degerlendirme skalasinin onemli, maliyet etkin ve kullanmasi kolay bir degerlendirme kriteri oldugu sonucuna varilmistir. Anahtar Kelimeler: Osteoporoz, postmenopozal kadin, klinik risk faktorleri, FRAX® Abstract

Using Anisotropic 3D Minkowski Functionals for Trabecular Bone Characterization and Biomechanical Strength Prediction in Proximal Femur Specimens.

The ability of Anisotropic Minkowski Functionals (AMFs) to capture local anisotropy while evaluating topological properties of the underlying gray-level structures has been previously demonstrated. We evaluate the ability of this approach to characterize local structure properties of trabecular bone micro-architecture in ex vivo proximal femur specimens, as visualized on multi-detector CT, for purposes of biomechanical bone strength prediction. To this end, volumetric AMFs were computed locally for each voxel of volumes of interest (VOI) extracted from the femoral head of 146 specimens. The local anisotropy captured by such AMFs was quantified using a fractional anisotropy measure; the magnitude and direction of anisotropy at every pixel was stored in histograms that served as a feature vectors that characterized the VOIs. A linear multi-regression analysis algorithm was used to predict the failure load (FL) from the feature sets; the predicted FL was compared to the true FL determined through biomechanical testing. The prediction performance was measured by the root mean square error (RMSE) for each feature set. The best prediction performance was obtained from the fractional anisotropy histogram of AMF Euler Characteristic (RMSE = 1.01 ± 0.13), which was significantly better than MDCT-derived mean BMD (RMSE = 1.12 ± 0.16, p<0.05). We conclude that such anisotropic Minkowski Functionals can capture valuable information regarding regional trabecular bone quality and contribute to improved bone strength prediction, which is important for improving the clinical assessment of osteoporotic fracture risk.