Assessment Of Bone Density Research Articles

Assessment of bone density in edentulous maxillae using cone beam computed tomography (CBCT)

IntroductionIn edentulous maxillae, the anterior maxilla is the region of interest for implant placement due to posterior bone resorption and sinus pneumatization. This study aimed to assess variations in bone density in different regions of the edentulous maxilla according to sex and age, using cone beam computed tomography (CBCT). Materials and methods69 CBCT from edentulous maxilla were analyzed. Six virtual implants were planned between the maxillary sinuses at incisor, canine, and premolar sites. Bone densities (in Hounsfield units HU) were recorded at six points on the neck, body, and apex of the buccal and lingual areas of each virtual implant. We used the two-sample t-test to compare male and female bone densities, and the Spearman correlation coefficient to analyze the correlation between mean bone density and age. One-way analysis of variance with post hoc pairwise t-tests was used to analyze the differences in density between three sites of the edentulous maxilla and the differences in density between three parts of the implant. The significance level was set at 5%. ResultsMean bone density in males was significantly higher than in females. There was a significant correlation between mean bone density and age in females. Incisor sites showed the highest mean bone density, followed by canine and premolar sites. There was a significant decline in bone density from the neck to the apex. ConclusionsBone density varied within and among edentulous maxillae. Bone density of the edentulous maxilla seemed to be influenced by age in women and by sex.

Vitamin D Deficiency in Pediatric Oncology Patients: A Single-Center Experience in Saudi Arabia.

Background There is a lack of local studies on vitamin D deficiency in children with cancer. This study aims to estimate the prevalence of vitamin D deficiency in the pediatric oncology population at King Abdul-Aziz Medical City (KAMC) in Jeddah, addressing knowledge gaps for improved clinical practice and future research. Methods This retrospective observational studywas conducted from 2016 to 2021 at the pediatric oncology clinic in National Guard Hospital, Jeddah. The study focused on children aged 14 or younger at cancer diagnosis, data encompassed patient demographics, cancer details, and treatment information, including serum measurements of vitamin D (25(OH)D, calcium, phosphate, alkaline phosphatase). Vitamin D levels were categorized as deficient (<25 ng/ml), insufficient (25-49 ng/ml), sufficient (≥50- 125 ng/ml), or hypervitaminosis (>125 ng/ml), based on our center reference range and the validation of the assay. Results In this retrospective study of 155 pediatric oncology patients, the majority aged 0 to 10 years (78%), findings reveal a male preponderance (54.2%) and a more prevalent in patients with hematological malignancies (85%). Chemotherapy was administered to 98%, with 7% underwent radiotherapy, and 89% received steroids. Analysis of serum 25-OH vitamin D levels indicated an overall deficiency and insufficiency at diagnosis (63%) and post-therapy (43%). Age and gender had a significant influence on vitamin D levels at diagnosis, with older children and females exhibiting lower concentrations. However, these differences diminished by the end of therapy. Notably, hematological malignancy patients often presented insufficient vitamin D levels, while solid tumor patients frequently had sufficient levels. Clinical outcomes showed a high survival rate (90.7%), limited bone density assessments (18.1%), and a 14.2% prevalence of hypervitaminosis. Conclusion In summary, our study reveals that over two-thirds of pediatric oncology patients experience vitamin D deficiency and insufficiency at the time of diagnosis, particularly notable in females and older children. Notably, those with solid tumors exhibit higher baseline 25-OH vitamin D concentrations compared to counterparts with hematological malignancies. The findings underscore the importance of educating both patients and caregivers on supplementation and sun exposure to mitigate the prevalence of deficient and insufficient vitamin D levels in pediatric oncology cases.

The Use of Platelet Concentrates in the Reconstruction of the Alveolar Cleft Defect: A Systematic Review and Meta-Analysis.

Evaluate quantitative and qualitative outputs when comparing the incidence of platelet concentrates (PCs) combined with autogenous bone grafts to an autograft control group for the reconstruction of alveolar cleft defects. Systematic review and meta-analysis. Randomized and nonrandomized controlled clinical trials where PCs were used in the reconstruction of alveolar cleft defects. Use of PCs in combination with autogenous bone graft in the experimental group and autogenous bone graft alone in the control group. Average bone formation and bone density were evaluated, mean differences were calculated and pooled by a meta-analysis technique. Additionally, clinical outcomes such as wound dehiscence, closure of the oronasal fistula, pain, swelling, discharges, infections, and bleeding were considered in the qualitative synthesis. After an evaluation of forty-nine articles, nineteen were considered for the review. The qualitative assessment of bone density, bone formation, and clinical outcomes showed no differences between groups in most of the included studies. The meta-analysis showed no statistical differences between PCs groups when compared to the control group in bone density at three months (mean difference 45.67 HU, P = .23) and six months (mean difference 48.57 HU, P = .64). Neither were statistical differences in the percentage of regenerated bone volume at six months (mean difference 6.39%, P = .15) and the volume of newly formed bone at 12 months (mean difference 0.37 mm3, P = .99). There were no significant differences in terms of bone formation, bone density, and clinical outputs between groups.

Preoperative 3-dimensional computed tomography bone density measures provide objective bone quality classifications for stemless anatomic total shoulder arthroplasty

Reproducible methods for determining adequate bone densities for stemless anatomic total shoulder arthroplasty (aTSA) are currently lacking. The purpose of this study was to evaluate the utility of preoperative computed tomography (CT) imaging for assessing the bone density of the proximal humerus for supportive differentiation in the decision making for stemless humeral component implantation. It was hypothesized that preoperative 3-dimensional (3-D) CT bone density measures provide objective classifications of the bone quality for stemless aTSA. A 3-part study was performed that included the analysis of cadaveric humerus CT scans followed by retrospective application to a clinical cohort and classification with a machine learning model. Thirty cadaveric humeri were evaluated with clinical CT and micro-CT (μCT) imaging. Phantom-calibrated CT data were used to extract 3-D regions of interest and defined radiographic scores. The final image processing script was applied retrospectively to a clinical cohort (n=150) that had a preoperative CT and intraoperative bone density assessment using the "thumb test," followed by placement of an anatomic stemmed or stemless humeral component. Postscan patient-specific calibration was used to improve the functionality and accuracy of the density analysis. A machine learning model (Support vector machine [SVM]) was utilized to improve the classification of bone densities for a stemless humeral component. The image processing of clinical CT images demonstrated good to excellent accuracy for cylindrical cancellous bone densities (metaphysis [ICC=0.986] and epiphysis [ICC=0.883]). Patient-specific internal calibration significantly reduced biases and unwanted variance compared with standard HU CT scans (P<.0001). The SVM showed optimized prediction accuracy compared with conventional statistics with an accuracy of 73.9% and an AUCof0.83 based on the intraoperative decision of the surgeon. The SVM model based on density clusters increased the accuracy of the bone quality classification to 87.3% with an AUC of 0.93. Preoperative CT imaging allows accurate evaluation of the bone densities in the proximal humerus. Three-dimensional regions of interest, rescaling using patient-specific calibration, and a machine learning model resulted in good to excellent prediction for objective bone quality classification. This approach may provide an objective tool extending preoperative selection criteria for stemless humeral component implantation.

The effect of myelography dye on bone density measurements utilizing Hounsfield units on CT.

Hounsfield unit (HU) measurements of bone density on CT are increasingly used for preoperative planning in spine surgery. Postmyelogram CT is another common preoperative diagnostic study. However, there is no current literature evaluating whether HU measurements on CT are affected by the presence of myelography dye. The purpose of the current study was to determine if the presence of myelography dye affects HU measurements of bone density in CT studies. Twenty-nine preoperative spine surgery patients who underwent both standard and postmyelography CT performed within 6 months of each other were identified. HU measurements were obtained from an elliptical region of interest using the available software on a standard PACS. Measurements were obtained on the axial cut at the midvertebral body on all lumbar vertebrae on three separate occasions and an average value was calculated for comparative analysis. A 6-week gap was used between measurements of the CT scans and the CT myelograms to diminish bias. The mean age of the cohort was 69 years and the average BMI was 32 kg/m2. Five patients were male and 24 were female. Six of the patients had instrumentation placed prior to the initial CT scan. The average HU measurements for CT levels L1-5 were 165, 171, 145, 154, and 225, respectively, whereas HU measurements for CT myelography of levels L1-5 were 168, 177, 148, 170, and 239, respectively. Strong correlations were noted between the HU measured on CT and CT myelography for L1 (r2 = 0.951), L2 (r2 = 0.966), L4 (r2 = 0.820), and L5 (r2 = 0.900), and moderate for L3 (r2 = 0.668). The presence of myelography dye had no clear effect on CT HU measurements of bone density. The results of this study support the use of CT myelograms for bone density assessment in the absence of standard CT images.

Assessing bone density on MRI: comparison between routine MRI sequences and DEXA scans.

Magnetic Resonance Imaging (MRI) is frequently utilised to aid in the comprehensive assessment of back pain, while dual-energy x-ray absorptiometry (DEXA) is the gold standard test for the assessment of bone density. Assessing bone density on MRI could reduce costs and avoid exposing patients to ionising radiation. The aim of this paper is to investigate whether the relative signal intensity of vertebral bodies compared to other structures can detect osteoporosis on MRI. 100 patients that had undergone both a lumbar spine MRI and a DEXA scan were identified. The T1 and T2 signal intensity of L1-L4 vertebral bodies (VB), cerebro-spinal fluid (CSF), and psoas muscle were measured within a 1-cm2 region of interest (ROI), and the signal intensity ratios were calculated. The ratios were stratified as normal, osteopenic, or osteoporotic based on DEXA T-scores. The T1 VB /T1 CSF ratio was significantly higher in the osteoporotic group than the normal and osteopenic groups (p < 0.001). The T1 VB /T1 CSF ratio had excellent discrimination (AUC = 0.841) for the presence of osteoporosis. The Pearson correlation coefficient between the DEXA T-score and the T1VB/T1CSF ratio was -0.474 (p < 0.001). The intra-observer (ICC = 0.910, 95% CI = 0.757-0.966) and inter-observer reliability (ICC = 0.927, 95% CI = 0.824-0.970) were excellent. In our cohort, a T1 VB / T1 CSF ratio of greater than 4 is 66.7% sensitive but 90.0% specific for the presence of osteoporosis. A high T1VB/T1CSF ratio suggests osteoporosis on MRI. Prospective validation is needed to confirm these findings.

Предоперационное планирование артропластики тазобедренного сустава

Preoperative planning of hip arthroplasty provides surgeons with a unique opportunity of thorough investigation of the patient’s anatomy, allows them to determine optimal implant size and position, as well as to prevent potential complication. Advances in digital technology enable expansion of opportunities of preoperative planning due to using three-dimensional modeling. The study was aimed to compare precision of the three-step preoperative planning of hip arthroplasty and the standard method. Methods: The study involved 224 patients with various forms of degenerative and dystrophic diseases of the hip joint, who were divided into the index and control groups based on the planning method. In the index group, preoperative planning of arthroplasty was conducted in three steps: assessment of bone density in the zones of fixation based on CT; virtual design involving the use of automated programs; 3D model construction based on the computer model. X-ray images and endoprosthesis templates were used in the comparison group. The results showed that there were no significant differences between planning methods in patients with osteoarthrosis and avascular necrosis of the femoral head (p &gt; 0.05), in contrast to the group with traumatic hip joint pathology showing significant differences (рс = 0.002). Conclusions: the three-step algorithm for preoperative planning of hip arthroplasty showed higher efficacy in patients with various nosological forms of degenerative and dystrophic diseases of the hip joint compared to the standard method.

Sex differences in the accuracy of vertebral bone quality score assessing bone density in patients undergoing lumbar spinal fusion.

Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides a tool for primary screening of bone density. The validity of this score as a predictor across sexes has not been investigated. This study aimed to explore the effect of sex on the diagnostic efficacy of the VBQ in predicting osteopenia/osteoporosis and whether a sex-specific threshold exists. In this retrospective cohort study, patients who underwent lumbar fusion at a tertiary care center were reviewed. VBQ was obtained by noncontrast T1-weighted MRI. Patients were stratified according to sex and bone density. Data were analyzed between the groups. Pearson correlation analysis and linear regression were used to analyze the correlation between the VBQ and DEXA T values. Receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC) calculation, was used to evaluate the predictive performance of VBQ for low BMD in both sexes. A total of 271 patients (92 male, 179 female patients) were analyzed. The correlation coefficient between VBQ and the lowest T value was -0.40 for male and -0.554 for female patients. In comparing the bone density subgroups, among male patients a significant difference in the VBQ scores was observed only between the normal and osteoporosis subgroups (p = 0.012). VBQ demonstrated statistically significant differences among female patients across all three subgroups (p < 0.001). The ROC analysis revealed that the predictive performance of VBQ in detecting low BMD was more consistent with the gold-standard DEXA results in female than in male patients (AUC 0.647 vs AUC 0.823, p = 0.02). The optimal thresholds were similar in both sexes. Compared with male patients, VBQ has better discrimination between female patients with low BMD and those with normal bone density. Although the correlation between VBQ and bone density is weaker in male than in female patients, the optimal thresholds are similar in both sexes.

Osteoporosis as Perceived by Saudi Physicians: A Cross-Sectional Study of Quality of Practice and Current Barriers in Management.

Background Osteoporosis (OP) is a state of abnormal bone quality and architecture that leads to fragility fractures, with lifetime costs reaching 16.27 billion Saudi Arabian Riyal (SAR). Methods An electronic survey was distributed to physicians from July 2020 to May 2021 to assess the quality of the practice of physicians towardOP and barriers in OP management in Saudi Arabia. Specialties included were endocrinology, general medicine, family medicine, primary care, orthopedic surgery, rheumatology, obstetrics and gynecology, and geriatrics. Results A total of 177 surveys were eligible (55.9% female and 44.1% male). The majority were family consultants (42.9%). In terms of knowledge, 18.1% of our sample recognized all risk factors, and 24.9% recognized all indications to assess bone density. A central dual-energy X-ray absorptiometry (DEXA) was accessible to only 49.4% of the sample. Over 80% of the sample performed comprehensive laboratory workup. Although 68.4% of participants were aware of fracture risk assessment (FRAX), 53.7% used it in their practice. The most cited barrier was a lack of physicians' awareness (80.2%), followed by a lack of patients' awareness (63.6%). The specialty was significantly associated with the awareness of the densitometry certificate (P-value < 0.0001) and the use of FRAX (P-value = 0.0001). Conclusion Our results revealed a below-satisfactory quality of practice among Saudi physicians towardOP. Additionally, our results identified many gaps in knowledge and many barriers to optimal care.

The impact of 4R Care Delivery Model on timing and sequence of bone density screening among patients with breast cancer.

553 Background: Bone loss is common in patients with breast cancer and can impact treatment decisions related to endocrine therapy. Hence, bone density assessment prior to starting endocrine therapy is highly important, especially because endocrine therapy is the first line adjuvant treatment for patients with ER+ breast cancer. Implementing timely bone density assessment is challenging, particularly in the early care trajectory when there are many tests and procedures taking place. We conducted a care delivery optimization in a large health system to implement bone density testing and referral for bone health consultation prior to endocrine therapy. The optimization was conducted as part of implementing the 4R Oncology model (Right Info, Right Care, Right Patient, at the Right Time), a novel approach to improving patient-facing care planning, team-based delivery and patient self-management. Here we describe the impact of this intervention. Methods: A cohort of 278 women with breast cancer who were in the 4R intervention (the 4R cohort) was compared to a historical control cohort of 201 women who received care pre-4R. Demographic, bone health history, and oncologic care data were abstracted from chart review and clinical databases. The prevalence of bone loss and timing of bone density consultation request was compared between the 4R and historical control cohorts. Results: The age, race/ethnicity and rate of ER+ cancer were similar between cohorts. Patients in the 4R cohort were significantly more likely to have received a consultation for bone density screening prior to the start of endocrine therapy (see Table). They were also more likely to receive a bone density test result during their care (Table). These findings remained significant when data were restricted to those ≥ 50 years (as a proxy for postmenopausal status) and those with ER-positive breast cancer. The rates of osteopenia and osteoporosis were similar between the cohorts: control 47%, 24%; 4R cohort: 46%, 23% respectively (data not shown). Conclusions: Care optimization using the 4R Oncology Model was associated with a significant improvement in the timing of bone density testing before initiation of endocrine therapy. The 4R Oncology Model can lead to more informed decision making in adjuvant endocrine therapy for patients with breast cancer. Additional optimizations to improve the rates of bone density tests and referrals will be beneficial.[Table: see text]

THU409 Relationship Between Bone Loss And Oral Health Among Post-menopausal Women With And Without Diabetes

Abstract Disclosure: S. Ahmad: None. R. Nauman: None. K. Batra: None. A. Gupta: None. K.E. Izuora: Research Investigator; Self; Novo Nordisk. Background: There is a high prevalence of periodontal disease (PD) and bone loss (osteopenia and osteoporosis) among patients with diabetes. Understanding the relationship between these conditions in the context of type 2 diabetes (T2DM) as a risk factor will help better understand their pathophysiology and provide guidance for more appropriate care. Methods: This was a cross-sectional study that enrolled post-menopausal women presenting for routine bone density evaluation. Following informed consent, we obtained information about their demographics, diabetes status, and dental history using an investigator-administered questionnaire. We measured their height and weight with a stadiometer and inspected their oral cavity for teeth loss and PD. We then obtained their bone density assessment after interpretation by the radiologist. Data were analyzed using chi-square and logistic regression tests with the significance level set at 5%. Results: Among 66 eligible participants, the mean age and body mass index (BMI) were 67.67 ± 8.1 years and 29.76 ± 5.45 kg/m2 respectively. Twelve participants (18.2%) had T2DM, 19 (28.8%) had &amp;lt; 20 natural teeth and 17 (25.8%) had normal bone mineral density. Using a binary logistic regression, significant predictors of bone loss included age (OR 1.217, p=0.008), BMI (OR 0.827, p=0.04), and a diagnosis of T2DM (OR 0.056, p=0.033). The number of natural teeth, number of broken or decayed teeth, and presence of periodontal disease were not associated with bone loss. Conclusion: Among our population of post-menopausal women, clinical variables associated with bone loss included older age and lower BMI. Having T2DM was associated with a higher bone mineral density which does not translate to stronger bones according to previous reports. Oral health outcomes were not associated with bone loss and may reflect the similarity in the risk factors for the two conditions. Presentation: Thursday, June 15, 2023

FRI681 OsteoboostTm Is Effective In Preserving Bone Strength And Density Of The Spine In Women With Low Bone Mass

Abstract Disclosure: L.D. Bilek: Grant Recipient; Self; Bone Health Technologies. Stock Owner; Self; Bone Health Technologies. L.E. Flores: Employee; Self; Bone Health Technologies. N. Waltman: None. L.R. Mack: None. K. Smith: None. D. Hillstrom: Employee; Self; Bone Health Technologies. M. Griffin: Consulting Fee; Self; Bone Health Technologies. Stock Owner; Self; Bone Health Technologies. L. Yecies: Employee; Self; Bone Health Technologies. Stock Owner; Self; Bone Health Technologies. M. Jaasma: Consulting Fee; Self; Bone Health Technologies. Stock Owner; Self; Bone Health Technologies. Introduction: Fragility fractures result in significant morbidity and mortality, which is of particular concern in postmenopausal women who are at high risk of fractures due to loss of estrogen. Pharmaceutical interventions are effective but have low uptake and adherence and are generally not indicated for patients with osteopenia. Vibration has the potential to prevent bone loss and holds promise as an effective, yet minimal risk, treatment. The Osteoboost, a novel wearable device delivering targeted vibration to the lumbar spine and hips, is designed to improve bone strength and bone density. Thus, this study aims to evaluate the efficacy of a 12-month intervention with the OsteoboostTM on preserving strength of the first lumbar vertebrae in postmenopausal women with low bone mass. Methods: This double-blinded, randomized controlled trial enrolled postmenopausal women with low bone mass who were not taking bone-active medications. Women had a bone density DXA and assessment of thyroid function to screen for eligibility Those who qualified were randomized to receive Osteoboost treatment 5x/week for 12 months with the belt in either the active or sham setting. The sham device created a sound but did not deliver vibration. Compressive strength (N) and volumetric density of the 1st lumbar vertebra (L1) was analyzed using Finite Element Analysis (FEA) of computed tomography (CT) scans of lumbar spine by ON Diagnostics. Results: 126 women (64 Active, 62 Sham) with low bone mass participated in the study, with an average age of 62.1 years (SD ± 5.8) and 60.6 years (± 5.3) in the Active and Sham groups, respectively. Most participants were of White race (98%) and non-Hispanic (96%). There were no significant differences in baseline demographics between the sham and active groups. Intent to treat analysis revealed no significant difference in percent change in vertebral bone strength between the Active and Sham groups over time (baseline to 12 months). When stratified by age category, significant differences in percent change in vertebral bone strength were present in the 50-60 year old category; the Sham group lost 3.4% of their vertebral bone strength compared to a 0.5% loss in the Active group (p=0.018). While bone was preserved in the active group relative to the sham in the women over 60, it was not significant (p=0.20). With analysis of those who met the compliance criterion of 3x/week, the Sham group lost 2.84% compared to 0.48% in the Active group (p=0.014); representing a 5 times greater loss in the Sham group. Additionally, the Osteoboost treatment preserved volumetric bone density of L1, with the Active treatment group losing 0.29% BMD relative to a 1.97% loss in the Sham group; representing a 6.8 times greater loss in the Sham group (p=0.008). Conclusion: The Osteoboost holds promise as a therapeutic intervention for women with low bone mass to prevent decline to osteoporosis and reduce fracture risk. Presentation: Friday, June 16, 2023

Low Bone Density Predictability of CBCT and Its Relation to Primary Stability of Tapered Implant Design: A Pilot Study.

Research regarding bone density assessment using cone beam computed tomography (CBCT) in low bone density regions is sparse. This in vitro study aimed to evaluate the predictability of CBCT for low bone density regions and its correlations with primary implant stability when placing tapered design implants with a stepped osteotomy. Eighteen porcine mandibular condyles were used as simulated low bone density regions. Hounsfield units (HU), obtained via multislice computed tomography, and gray values (GVs), obtained via CBCT, were measured 3 times at 1-month intervals. The maximum implant insertion torque (MIT) and implant stability quotient (ISQ) were recorded as the taper design implants were placed using a stepped osteotomy. Hounsfield units and GV were measured as 335.05-803.07 and 389.98-906.40, respectively. For repeated measurements of HU and GV, the intraclass correlation coefficients were 0.989 and 0.980; the corresponding value for mean HU and GV was 0.768. Bland-Altman plots showed a mean difference between HU and GV of -78.15. Pearson correlation coefficients revealed a strong correlation between HU and GV (r = 0.91, P < .01). The mean ± SD values for MIT and ISQ were 36.44 ± 6.64 Ncm and 80.85 ± 2.03, respectively, but no statistically significant correlations were found with GV and HU. Within the study's limitations, GV showed similar bone density estimation compared with HU in soft bones. Tapered implant placement with a stepped osteotomy achieved stable primary implant stability in soft bones. However, these in vitro results need to be approved in further clinical studies.

Association between resolved hepatitis B virus infection and femoral and spinal bone mineral density in American adults: a cross-sectional study.

Hepatitis B virus (HBV) infection is a global health concern that can potentially affect bone health. However, the specific association between resolved HBV infection and bone mineral density (BMD) remains unclear. This cross-sectional study aimed to investigate the potential association between resolved HBV infection and femoral and spinal BMD in adults in the United States. This cross-sectional study included participants aged 20-79 years with negative HBV surface antigen (HBsAg) from the 2005-2010, 2013-2014, and 2017-2018 cycles of the National Health and Nutrition Examination Survey. Resolved HBV infection was defined as negative HBsAg with positive HBV core antibody. BMD was measured using dual-energy X-ray absorptiometry. Propensity score matching (PSM) was performed to balance baseline characteristics. A total of 10,333 eligible participants were identified and matched, of whom 737 (7.1%) had resolved HBV infection. Men with resolved HBV infection had significantly lower femoral and spinal BMD compared to those with no HBV infection, both before and after PSM. In the matched population, resolved HBV infection in men was negatively associated with femoral BMD (β= -0.024, 95% CI: -0.047 to -0.002, p = 0.0332) and spinal BMD (β= -0.025, 95% CI: -0.048 to -0.002, p = 0.0339). Postmenopausal women exhibited similar trends to men, while premenopausal women showed a tendency towards higher BMD, although statistical significance was not consistently achieved. Subgroup and sensitivity analyses supported the robustness of the findings. The study suggests a negative association between resolved HBV infection and femoral and spinal BMD in adult men in the United States. It highlights the importance of routine bone density assessments and the consideration of anti-osteoporotic therapy, if necessary, in individuals with resolved HBV infection.

Understanding patient views and acceptability of predictive software in osteoporosis identification

IntroductionResearch into patient and public views on predictive software and its use in healthcare is relatively new. This study aimed to understand older adults' acceptability of an opportunistic bone density assessment for osteoporosis diagnosis (IBEX BH), views on its integration into healthcare, and views on predictive software and AI in healthcare. MethodsFocus groups were conducted with participants aged over 50 years, based in South West England. Data were analysed using thematic analysis. Analysis was informed by the theoretical framework of acceptability. ResultsTwo focus groups were undertaken with a total of 14 participants. Overall, the participants were generally positive about the IBEX BH software, and predictive software's in general stating ‘it sounds like a brilliant idea’. Although participants did not understand the intricacies of the software, they did not feel they needed to. Concerns about IBEX BH focussed more on the clinical indications of the software (e.g. more scans or medications), with participants expressing less trust in results if they indicated medication. Questions were also raised about how and who would receive the results of this software. Individual choice was evident in these discussions, however most indicated the preferences for spoken communication ‘But I would expect that these results would be given by a human to another human.’ ConclusionsFocus group participants were generally accepting of the use of predictive software in healthcare. Implications for practiceThought and care needs to be taken when integrating predictive software into practice. Focusses on empowering patients, providing information on processes and results are key.

Computed tomography assessment of pelvic bone density: Associations with age and pelvic fracture in motor vehicle crashes

Motor vehicle crash (MVC) occupants routinely get a computed tomography (CT) scan to screen for internal injury, and this CT can be leveraged to opportunistically derive bone mineral density (BMD). This study aimed to develop and validate a method to measure pelvic BMD in CT scans without a phantom, and examine associations of pelvic BMD with age and pelvic fracture incidence in seriously injured MVC occupants from the Crash Injury Research and Engineering Network (CIREN) study. A phantom-less muscle-fat calibration technique to measure pelvic BMD was validated using 45 quantitative CT scans with a bone calibration phantom. The technique was then used to measure pelvic BMD from CT scans of 252 CIREN occupants (ages 16+) in frontal MVCs who had sustained either abdominal or pelvic injury. Pelvic BMD was analyzed in relation to age and pelvic fracture incidence. In the validation set, phantom-based calibration vs. phantom-less muscle-fat calibration yielded similar BMD values at the anterior superior iliac spine (ASIS; R2 = 0.95, p < 0.001) and iliac crest (R2 = 0.90, p < 0.001). Pelvic BMD was measured in 150 female and 102 male CIREN occupants aged 16–89, and 25% of these occupants sustained pelvic fracture. BMD at the ASIS and iliac crest declined with age (p < 0.001). For instance, iliac crest BMD decreased an average of 25 mg/cm3 per decade of age. The rate of iliac crest BMD decline was 7.6 mg/cm3 more per decade of age in occupants with pelvic fracture compared to those not sustaining pelvic fracture. Findings suggest pelvic BMD may be a contributing risk factor for pelvic fracture in MVCs.

Hounsfield Unit for Evaluating Bone Mineral Density and Strength: Variations in Measurement Methods

To assess the consistency and accuracy of various measurements of the Hounsfield unit (HU) in lumbar vertebrae. The study reviewed lumbar spine computed tomography images of 60 postmenopausal women aged >50years. A total of 240 vertebrae were measured and analyzed for the variations of HU values in different sections and regions. Investigated the relationship between HU values of the lumbar spine under different measurements and dual-energy X-ray absorptiometry results and the ability to identify patients with osteoporosis. HU values measured in midsagittal (r=0.763), midcoronal (r=0.768), and midaxial (r=0.786) sections exhibited a strong positive correlation with dual-energy X-ray absorptiometry T-scores. HU values measured in midsagittal and midaxial sections of the vertebral body were in good agreement (P>0.1), but decreased in the midcoronal (P<0.001). HU values in the middle of the vertebral body were significantly higher than in the near end plate (P<0.001). HU values varied between L1 and L4 vertebrae, but all had a good ability to identify osteoporosis and did not differ significantly in screening ability (P>0.05). An averaged HU value in axial multilevel is a comprehensive assessment of vertebral bone density. Using the HU value of the lumbar spine can help identify patients with osteoporosis, and the screening ability does not differ significantly across vertebral segments.

Recommendations for High-resolution Peripheral Quantitative Computed Tomography Assessment of Bone Density, Microarchitecture, and Strength in Pediatric Populations.

The purpose of this review is to summarize current approaches and provide recommendations for imaging bone in pediatric populations using high-resolution peripheral quantitative computed tomography (HR-pQCT). Imaging the growing skeleton is challenging and HR-pQCT protocols are not standardized across centers. Adopting a single-imaging protocol for all studies is unrealistic; thus, we present three established protocols for HR-pQCT imaging in children and adolescents and share advantages and disadvantages of each. Limiting protocol variation will enhance the uniformity of results and increase our ability to compare study results between different research groups. We outline special cases along with tips and tricks for acquiring and processing scans to minimize motion artifacts and account for growing bone. The recommendations in this review are intended to help researchers perform HR-pQCT imaging in pediatric populations and extend our collective knowledge of bone structure, architecture, and strength during the growing years.

Clinico-Radiographic Research Evaluating Crestal Bone Level and Bone Density Surrounding Dental Implants.

Planning the surgical operation, choosing the type of implant, and the effectiveness of the implant all heavily rely on the quantity and quality of the accessible bone. This study's goal was to determine how promptly inserted dental implants affected postoperative changes in bone density and crestal bone level by Cone bean computed tomography (CBCT) gray-scale value during a follow-up of three to six months. A prospective clinical-radiographic investigation was conducted. Twenty participants with a partly edentulous arch who were also systemically healthy were chosen from the OPD of the Department of Periodontics and Oral Implantology. Each patient's oral hygiene status was noted, and a preoperative CBCT was performed to assess bone density. The following clinical parameters were noted before surgical procedures: plaque index (PI) (Silness and Loe, 1964), gingival index (GI) (Loe and Sillness, 1964), probing pocket depth (PPD), and primary stability. A weak connection between Hounsfield unit (HU) in three months and six months was found. Moreover, a slender positive connection between baseline primary stability and three months was found. PI was shown to have a statistically significant difference between the means at several follow-ups (P value of 0.0001). PI and probing depth were not statistically different between baseline and six months (P values = 0.0001) or between three months and six months (P values = 0.050), respectively. The main outcome of this study shows that insertion torque is directly proportional to bone density and crestal bone level.

The impact of 4R Care Delivery Model on timing and sequence of bone density screening among breast cancer patients.

e24061 Background: Bone loss is common in patients with breast cancer and can impact treatment decisions related to endocrine therapy. Hence, bone density assessment prior to start of endocrine therapy is highly important, especially because endocrine therapy is recommended as the first line of adjuvant treatment in patients with ER+ breast cancer. However, implementing bone density assessment in a timely manner is challenging, particularly early in the care trajectory, which involves many specialties and includes many other tests and procedures. We conducted a care delivery optimization in a large health system to implement bone density testing and referral for bone health consultation prior to endocrine therapy. The optimization was conducted as part of implementing the 4R Oncology model (Right Info, Right Care, Right, Right Patient, at the Right Time), a novel approach to optimizing patient-facing care planning, team-based delivery and patient self-management. Here we describe the impact of this optimization. Methods: A cohort of 278 women with breast cancer who were in the 4R intervention (the 4R cohort) was compared to a historical control cohort of 201 women who received care pre-4R. Demographic, bone health history, and oncologic care data were abstracted from chart review and clinical databases. The prevalence of bone loss and timing of bone density consultation request was compared between the 4R and historical control cohorts. Results: The age, race/ethnicity and rate of ER+ cancer were similar between the cohorts. Patients in the 4R cohort were significantly more likely than those in the control cohort to have received a consultation for bone density screening prior to the start of endocrine therapy. They were also more likely to receive a bone density test result during their care. These findings remained significant when data were restricted to those ≥ 50 years (as a proxy for postmenopausal status) and those with ER-positive breast cancer. The rates of osteopenia and osteoporosis were similar between the cohorts: control 47%, 24%; 4R cohort: 46%, 23% respectively (data not shown). Conclusions: Care optimization using the 4R Oncology Model was associated with a significant improvement in the timing of bone density test before initiation of endocrine therapy. The 4R Oncology Model can lead to more informed decision making in adjuvant endocrine therapy for patients with breast cancer. Additional optimizations to improve the rates of bone density tests and referrals will be beneficial. [Table: see text]