Bone Density Measurements Research Articles

Standardization of bone morphometry and mineral density assessments in zebrafish and other small laboratory fishes using x-ray radiography and micro-computed tomography.

Zebrafish and other small laboratory fishes are emerging as important animal models for investigating human skeletal development and diseases. In recent years, there has been a notable increase in research publications employing x-ray radiography and micro-computed tomography to analyze the skeletal structures of these animals. However, evaluating bone morphology and mineral density in small laboratory fish poses unique challenges compared to well-established small rodent models. The varied approaches to image acquisition, analysis, and reporting across studies have led to substantial obstacles in interpreting and comparing research findings. This article addresses the urgent need for standardized reporting of parameters and methodologies related to image acquisition and analysis, as well as the adoption of harmonized nomenclature. Furthermore, it offers guidance on anatomical terminology, units of measurement, and the establishment of minimal parameters for reporting, along with comprehensive documentation of methods and algorithms used for acquisition and analysis. We anticipate that adherence to these guidelines will enhance the consistency, reproducibility, and interpretability of reported measurements of bone density and morphometry in small fish models. These advancements are vital for accurately interpreting phenotypes and gene functions, particularly in the context of multi-center studies.

Associations of ethnicity, skin tone, and genome-wide sequencingwith bone mineral density in adolescents.

Dual-energy x-ray absorptiometry reference data designate Black and non-Black categories, as higher BMD has been documented among Black youth. We examined associations of race, skin tone, and genetic factors with bone mineral density (BMD). 557 adolescents were followed longitudinally. Exposures included race, skin tone, and principal components (PC) from genome-wide arrays. Total body BMD Z-score (BMD-Z) was the primary outcome using linear regression. 359 adolescents identified as non-Hispanic White (NHW) and 75, non-Hispanic Black (NHB). BMD-Z was higher in NHB vs. NHW (β: 0.92 units, 95% CI: 0.64, 1.19) or those with darker skin (0.79, 95% CI: 0.49, 1.08 for brown vs. medium). The first genetic PC (PC1) correlated with identification as NHB. PC1 was associated with higher BMD-Z (0.09, 95% CI: 0.06, 0.12), even after including race (0.07, 95% CI: 0.00, 0.14) or skin tone (0.10, 95% CI: 0.05, 0.15); both race (0.26, 95% CI: -0.49, 1.01 for NHB vs. NHW) and skin tone (-0.08, 95% CI: -0.59, 0.44 for brown vs. medium) no longer predicted BMD-Z after adjustment for PC1. Genetic similarity was robustly associated with BMD, prompting a reevaluation of adolescent BMD reference data to exclude the consideration of race. Current bone density reference databases include a binary assignment of patients into "Black" and "non-Black" categories, as a higher BMD has been documented among those identifying as Black compared with individuals of other racial and ethnic backgrounds. This study found genetic similarity to be more strongly associated with bone density by dual-energy x-ray absorptiometry than race or skin tone. These data emphasize a need to reevaluate how bone density measurements are interpreted, including exploring reference data that exclude the consideration of race.

Changes in peripheral quantitative computed tomography measured bone density, size and strength in Zimbabwean children with and without HIV over one year: a cohort study.

Understanding bone accrual in adolescents may inform approaches to improve skeletal health and reduce adult fracture risk. We investigated the effect of HIV on bone mineral accrual assessed by peripheral Quantitative Computed tomography (pQCT). Children with HIV (CWH) on ART for ≥2years, and children without HIV (CWOH), aged 8-16years (n = 609), had tibial pQCT scans at 0 and 12months. Linear regression estimated sex stratified differences in change (∆) and mean pQCT bone density (trabecular and cortical), size (total cross-sectional area [CSA]) and strength (SSI) between CWH and CWOH, adjusting for socio-economic status (SES) and orphanhood and incorporating an interaction term for baseline pubertal status (Tanner 1-2[pre/early] vs 3-5[mid/late]). Structural equation modelling tested whether baseline height-for-age-Z-scores (HAZ) mediate the effect of HIV on ∆bone outcomes. CWH were more likely than CWOH to be orphans (44% vs 7%), of lower SES (43% vs 27%) and be stunted (30% vs 8%); but similar in age. At baseline and follow up, CWH had lower trabecular density, CSA and SSI than CWOH. After adjustment, bone density and strength increased similarly in CWH and CWOH. CWH in mid/late puberty at baseline had greater 12months increases in CSA than CWOH, particularly males (mean difference [31.3(95%CI:-3.1, 65.6) mm2 in mid/late puberty vs. -2.04(-23.8, 19.7) mm2 in pre/early puberty; interaction P-value = 0.013]. HAZ mediated the effect of HIV on ∆bone outcomes only in females as follows: indirect pathways from HIV to ∆trabecular density [-1.85(-3.5, -0.2) mg/cm3], ∆cortical density [-2.01(-3.9, -0.01) mg/cm3], ∆CSA [-2.59(-4.7, -0.5) mm] and ∆SSI [-18.36(-29.6, -7.2) mm3]. In conclusion, CWH show bone deficits at follow up. Investigations of bone mineral accrual earlier in life and post-puberty to peak bone mass are needed.

Bone density measurement in patients with spinal metastatic tumors using chest quantitative CT deep learning model

ObjectiveThis study aims to develop a deep learning model using the 3DResUNet architecture to predict vertebral volumetric bone mineral density (vBMD) from Quantitative Computed Tomography (QCT) scans in patients with spinal metastatic tumors, enhancing osteoporosis screening capabilities. Methods749 patients with spinal metastatic tumors underwent QCT vertebral vBMD measurements. The dataset was randomly split into training (599 cases) and test sets (150 cases). The 3DResUNet model was trained for vBMD classification and prediction using QCT images processed with automated bone segmentation and ROI extraction. ResultsThe deep learning model demonstrated strong performance with Spearman correlation coefficients of 0.923 (training set) and 0.918 (test set) between predicted and QCT-measured vBMD values. Bland-Altman analysis showed a slight bias of −1.42 mg/cm3 (training set) and −1.14 mg/cm3 (test set) between the model predictions and QCT measurements. The model achieved an area under the curve (AUC) of 0.977 (training set) and 0.966 (test set) for diagnosing Osteoporosis based on vBMD. ConclusionThe developed deep learning model using 3DResUNet effectively predicts vertebral vBMD from QCT scans in patients with spinal metastatic tumors. It provides accurate and automated vBMD measurements, potentially facilitating widespread osteoporosis screening in clinical practice, mainly where DXA availability is limited.

9397 Shatter Proofing Bones: Revamping Osteoporosis Screening

Abstract Disclosure: R. Subramani: None. T. Gupta: None. M. Anwar: None. J. Pamula: None. Background: Osteoporosis is a common disease characterized by low bone mass, structural deterioration of bone tissue, and increased risk of fractures. The World Health Organization (WHO) has defined osteoporosis based on bone density measurements. According to their definition, osteoporosis is diagnosed when the bone density at the hip or spine is at least 2.5 standard deviations (SDs) below the mean bone density of a reference population of young, healthy women (T score ≤ -2.5). According to NHANES data from 2017-2018, the overall prevalence of osteoporosis among adults over 50 was found to be 12.6%. It was observed that the prevalence of osteoporosis was higher among women (19.6%) compared to men (4.4%). According to US Preventative Services Task Force (USPSTF), the guidelines for screening are as follows: BMD Testing (DEXA) for all women aged 65 and older, postmenopausal women younger than 65 with clinical risk factors for fracture including advancing age, previous fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, secondary osteoporosis. BMD Testing for Men is not recommended. The most used bone measurement test to screen for osteoporosis is central DXA which measures BMD at the hip and lumbar spine. Goal: To improve the osteoporosis screening using DXA scan in the outpatient internal medicine resident patient panel by 5% Study Design:Subjects were identified by an EPIC report and will include retrospective chart review of records from July 2022 and prospective screening until April 2024 for the outpatient IM clinic list of patients including both resident panel. Methods: Pre-intervention data analysis of current rates; Educating residents about appropriate screening; Utilization of osteoporosis screening as care-gap in EPIC ;Calling patients who are due for screening from IM residents patient panels; Post-interventional data analysis Results: The total number of patients on the residents panel was 196. Before interventions, screening rate for osteoporosis were 71.2% among residents' patients. After intervention, screening rates increased to 75.5%. There was a 4.3 % improvement in screening rate. Conclusion: Resident education, addressing Osteoporosis care gaps in EPIC and patient outreach are effective interventions to improve screening rates. Discussion: Osteoporosis screening remains an area of needed improvement in IM clinic. EPIC system should not only take age for prompting osteoporosis screening but also other factors such as family history, pre-mature fractures, steroid use, etc. Adding osteoporosis screening into the metric system are few steps to be considered for future directions. Presentation: 6/3/2024

Photon-counting CT for forensic death investigations-a glance into the future of virtual autopsy.

This article explores the potential of photon-counting computed tomography (CT) in forensic medicine for a range of forensic applications. Photon-counting CT surpasses conventional CT in several key areas. It boasts superior spatial and contrast resolution, enhanced image quality at low x-ray energies, and spectral imaging capabilities that enable more precise material differentiation. These advantages translate to superior visualization of bone structures, foreign bodies, and soft tissues in postmortem examinations. The article discusses the technical principles of photon-counting CT detectors and highlights its potential applications in forensic imaging, including high-resolution virtual autopsies, pediatric forensic CT, trauma analysis, and bone density measurements. Furthermore, advancements in vascular imaging and soft tissue contrast promise to propel CT-based death investigations to an even more prominent role. The article concludes by emphasizing the immense potential of this new technology in forensic medicine and anthropology.

Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts.

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ -2.5, whereas 53% had T-scores between -1.0 and -2.5 and 37% had T-scores ≥-1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range.

ОСТЕОПОРОЗ КАК ФАКТОР РИСКА СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ

Cardiovascular disease and bone fractures caused by osteoporosis are the leading causes of death in older adults. The purpose of this study was to demonstrate the correlation between overall risk of cardiovascular events and low bone density in postmenopausal women, and its impact on the incidence of major cardiovascular events. Our prospective study included 300 postmenopausal women. All those examined were divided into three groups depending on the measured bone tissue density: Group I – 84 examined with osteoporosis; Group II – 115 patients with osteopenia; and group III – 101 subjects with normal bone density. For all subjects, the overall ten-year risk of a fatal cardiovascular event was calculated using the SCORE system tables. Results. After 36 months of observation, cardiovascular diseases occurred in 19 (6.3%) subjects. Significant differences in the incidence of cardiovascular events were demonstrated between patients with osteoporosis, osteopenia and normal bone density (x2=28.7; p<0.001), as well as between patients with high and low cardiovascular risk (x2=22, 6; p). <0.001). Multivariate logistic regression analysis showed that smoking (2.23; 95% CI: 1.02–6.19; p=0.035) and an increase in total cardiovascular score (1.36; 95% CI: 1.17–1 .58; p<0.001) are related. with an increased risk of cardiovascular events, while an increase in T-score was associated with a decreased risk of cardiovascular events (0.42; 95% CI: 0.25 to 0.73; p=0.002). Measurement of bone density with a standardized assessment of overall cardiovascular risk may be useful in selecting women in need of intensive prevention and treatment of atherosclerosis.

Osteosarcopenia in Finland: prevalence and associated factors

SummaryThis cross-sectional study investigated osteosarcopenia prevalence and its correlates among 2142 adults aged 55 and older in Finland. Findings show 3.9% had osteosarcopenia, while 13.8% and 11.1% had probable sarcopenia only or osteoporosis only, respectively. Osteosarcopenia was associated with low BMI, impaired mobility, ADL limitations and depression. Sarcopenia appeared to drive these associations more than osteoporosis. Osteosarcopenia may be a risk factor for functional decline, hospitalization, and institutionalization, warranting further research.PurposeOsteosarcopenia is a disorder consisting of concurrent osteoporosis and sarcopenia. This cross-sectional study using nationally representative data from Finland in 2000 aimed to determine the prevalence of osteosarcopenia in Finland. In addition, associations of sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers with osteosarcopenia were examined.MethodsThe study included 2142 subjects aged 55 and over (mean age 68.0 years, SD 9.0). Probable sarcopenia was defined as grip strength < 27 kg for men and < 16 kg for women. Osteoporosis was defined as either ultrasound-based bone density measurement of T < -2.5, or self-reported, pre-existing diagnosis of osteoporosis. Participants were categorized into 4 groups: no sarcopenia and no osteoporosis, probable sarcopenia only, osteoporosis only, and osteosarcopenia. Information on sociodemographic, lifestyle, anthropometric, physical and mental function indicators, chronic conditions and various biomarkers were collected via structured interview, questionnaires, clinical examination, and blood and urine samples.ResultsThe prevalence of probable sarcopenia, osteoporosis and osteosarcopenia was 13.8%, 11.1%, and 3.9%, respectively. Osteosarcopenia was associated with low BMI, slow gait speed, impaired mobility, impaired ability in the activities of daily living and depression. Of the two components, probable sarcopenia appeared to contribute to these associations more than osteoporosis.ConclusionAccording to representative population-based study, about every fifth person with probable sarcopenia also has osteoporosis. Mobility and ADL limitations were more common among people with osteosarcopenia than those with osteoporosis or probable sarcopenia alone. Future studies are needed to examine osteosarcopenia as an independent risk factor for functional decline, hospitalization, and institutionalization.

Compressive effect and collapse behavior of three different transsacral implants in sacral fragility fractures - a retrospective analysis of 106 cases.

The aim of this study were the retrospective evaluation of the compressive effect and complication rates of transsacral stabilization of osteoporosis-associated sacral fragility fractures in 106 patients using three different implants (6.0mm sacral bar, n = 32; 7.3mm screw, n = 26; 7.5mm ISG-Rod System, n = 48) with regard to the image morphological and clinical-perioperative outcome. For this purpose, the sacral width was determined preoperatively and postoperatively using multiplanar CT reconstructions and correlated with the measured bone density (HU). The results were compared with each other on an implant-specific basis. A significant compressive effect was found for all implants (6.0mm sacral bar 7.1 ± 3.4mm, 7.3mm screw 6.9 ± 1.8mm, 7.5mm ISG-Rod System 8 ± 2.4mm). No implant-specific difference in compression could be detected. Overall, the washers broke into the iliac cortex in 9% of cases. The subgroups did not differ significantly in this respect (6.0mm sacral bar: 4 [13%], 7.3mm screw 1 [1%], 7.5mm ISG-Rod System (5 [10%], p = 0.581). A correlation between the degree of osteoporosis and the compressive effect could not be demonstrated. Significant implant-specific differences were found in the incision-suture time, with only ø0:39 ± 0:13h required for implantation of the 7.5mm ISG Rod System (6.0mm sacral bar: ø1:09 ± 0:22h, 7.3mm screw: ø0:55 ± 0:20h). The fluoroscopy time was significantly lower with the 7.3mm screw (ø0:57 ± 0:23min) and the 7.5mm ISG Rod System (ø0:42 ± 00:17min) than with the 6.0mm sacral bar (ø1:36 ± 0:46min). A significant compressive effect was demonstrated with all three implants. No implant-specific complications or surgical site complications were identified in either the overall cohort or the subgroups. The 7.5mm ISG Rod System shows advantages with regard to the duration of surgery and fluoroscopy.

Exploring bone density analysis on routine CT scans as a tool for opportunistic osteoporosis screening

The primary aim of this study was to evaluate computed tomography (CT)-based bone density analysis at the level of thoracic vertebra 12 (Th12) as a screening method for decreased bone density in patients admitted to the intensive care unit (ICU). Interobserver variability was analyzed. Secondary aims were to assess the prevalence of CT-based low bone density upon ICU admission in a cohort of COVID-19 patients and to assess the potential effect of long-term ICU stay on bone density in these patients. Retrospective single-center cohort study. ICU of the Leiden University Medical Center (LUMC), the Netherlands. Patients admitted to the ICU of the LUMC between March 1st, 2020 and February 1st, 2022 with a diagnosis of COVID-19, and a length of ICU stay of ≥ 21 days. In the included patients both baseline chest CT scans (obtained upon ICU admission) and follow-up chest CT scans (obtained ≥ 21 days after ICU admission) were available for analysis. A total of 118 CT scans in 38 patients were analyzed. There was a good interobserver variability, with an overall mean absolute difference (between measurements of three observers) of 9.7 Hounsfield Units (HU) and an intraclass correlation coefficient (ICC) of 0.93 (95% CI 0.88–0.96). The effect of intravenous contrast administration on bone density measurements was small (+ 7.5 HU (95% CI 3.4–11.5 HU)) higher in contrast enhanced CT images compared to non contrast enhanced CT images). Thirty-seven percent of patients had a bone density < 140 HU, suggestive of osteoporosis. No significant difference was found between bone density upon ICU admission and bone density at follow-up (≥ 21 days after ICU admission). Vertebral CT-based bone density analysis using routine CT scans is an easily applicable method to identify ICU patients with decreased bone density, which could enable enrollment in osteoporosis prevention programs. A high prevalence of low bone density was found in our cohort of ICU patients. There were no changes observed in bone density between baseline and follow-up measurements.

Correlation study: Bone density and circulating inflammatory markers in postmenopausal patients.

This study aims to investigate the correlation between changes in bone mineral density (BMD) in postmenopausal women and circulating inflammatory markers. This retrospective study focused on postmenopausal women admitted to the orthopedic department of Suzhou Benq Medical Center from June 2022 to December 2023, following predetermined inclusion and exclusion criteria. We retrospectively collected data on initial blood routine test results and bone density measurements for all study subjects upon admission, including parameters such as white blood cell count (WBC), C-reactive protein, interleukin-6 (IL-6), and procalcitonin (PCT). Additionally, the systemic immune-inflammation index (SII) was calculated using neutrophil count, lymphocyte count, and platelet count. Statistical analyses using SPSS and GraphPad software were performed to assess the correlation between bone density and inflammatory markers. Patients were classified into three groups based on BMD results, including 60 individuals in the osteoporosis (OP) group, 127 individuals in the osteopenia group, and 37 individuals in the Normalgroup, respectively. Principal component analysis analysis suggested that WBC, SII, and postmenopausal OP(PMOP) held significant feature values. Correlation analysis indicated a correlation between WBC (p = 0.021), IL-6 (p = 0.044), SII (p = 0.034), and PMOP. One-way ANOVA analysis revealed significant differences in IL-6 (p = 0.0179), SII (p = 0.0210), and PCT (p = 0.0200) among the three groups. Finally, ROC curve analysis demonstrated that SII (area under the curve = 0.716) has predictive value for PMOP. This study identified a certain predictive value for PMOP through the assessment of inflammatory markers in peripheral blood using routine blood tests.

Machine learning models can define clinically relevant bone density subgroups based on patient-specific calibrated computed tomography scans in patients undergoing reverse shoulder arthroplasty

Reduced bone density is recognized as a predictor for potential complications in reverse shoulder arthroplasty (RSA). While humeral and glenoid planning based on preoperative computed tomography (CT) scans assist in implant selection and position, reproducible methods for quantifying the patients' bone density are currently not available. The purpose of this study was to perform bone density analyses including patient specific calibration in an RSA cohort based on preoperative CT imaging. It was hypothesized that preoperative CT bone density measures would provide objective quantification of the patients' humeral bone quality. This study consisted of three parts, (1) analysis of a patient-specific calibration method in cadaveric CT scans, (2) retrospective application in a clinical RSA cohort, and (3) clustering and classification with machine learning models. Forty cadaveric shoulders were scanned in a clinical CT and compared regarding calibration with density phantoms, air muscle, and fat (patient-specific) or standard Hounsfield unit. Post-scan patient-specific calibration was used to improve the extraction of three-dimensional regions of interest for retrospective bone density analysis in a clinical RSA cohort (n=345). Machine learning models were used to improve the clustering (Hierarchical Ward) and classification (Support Vector Machine (SVM)) of low bone densities in the respective patients. The patient-specific calibration method demonstrated improved accuracy with excellent intraclass correlation coefficients (ICC) for cylindrical cancellous bone densities (ICC>0.75). Clustering partitioned the training data set into a high-density subgroup consisting of 96 patients and a low-density subgroup consisting of 146 patients, showing significant differences between these groups. The SVM showed optimized prediction accuracy of low and high bone densities compared to conventional statistics in the training (accuracy=91.2%; AUC=0.967) and testing (accuracy=90.5 %; AUC=0.958) data set. Preoperative CT scans can be used to quantify the proximal humeral bone quality in patients undergoing RSA. The use of machine learning models and patient-specific calibration on bone mineral density demonstrated that multiple 3D bone density scores improved the accuracy of objective preoperative bone quality assessment. The trained model could provide preoperative information to surgeons treating patients with potentially poor bone quality.

Microstructure of the radial head: Insights into anatomical variations and implications for advanced interventions.

Appropriate management of radial head fractures is integral to prevent long-term consequences like chronic pain and loss of motion. Advanced imaging systems, like micro-computed tomography (μCT), are valuable for understanding radial head fracture patterns as they utilize micrometer scale resolution to define important parameters of bone health like cortical density and trabecular thickness. The purpose of this study was to identify and describe the structural morphology of the radial head utilizing μCT. Nine fresh-frozen cadaveric human radii were divided into four equal quadrants, based, and labeled as posteromedial, posterolateral, anteromedial, and anterolateral. Quadrants were scanned with a SCANCO MicroCT40 with both cortical and cancellous bone density measurements at a resolution of 36.0 μm. Bone density, direct trabecular number, and trabecular thickness were recorded as milligrams of hydroxyapatite/cm3. A one-way repeated measures ANOVA was performed to compare the bone densities, trabecular number, and trabecular thickness of each of the four quadrants (p < 0.05). The posteromedial quadrant contained substantially more bone than other quadrants. Significantly greater bone densities were found in the posteromedial quadrant (148.1 mg of HA/cm3) compared to the anteromedial quadrant (54.6 mg of HA/cm3), posterolateral quadrant (137.5 mg of HA/cm3) compared to the anteromedial quadrant (54.6 mg of HA/cm3), and posterolateral quadrant (137.5 mg of HA/cm3) compared to the anterolateral quadrant (58.1 mg of HA/cm3). The trabecular number was not significantly different between quadrants. Trabecular thickness was significantly lower in the anterolateral (0.1417 mg of HA/cm3) and anteromedial (0.1416 mg of HA/cm3) quadrants compared to the posteromedial (0.1809 mg of HA/cm3) quadrant. The posterior half of the radial head was found to have a higher density of columns and arches compared to the anterior half. The microstructure of trabecular bone in the distal radius forms columns, struts, and arches, which allow for efficient transmission of stress through the bone. The microstructure of the radial head has similar microarchitecture to the distal radius with the present study identifying the presence of columns and arches in the radial head. These structures, along with trabecular density, in the posterior radial head may explain the lower incidence of fractures involving the posterior half of the radial head. Furthermore, our study supports the idea that the high incidence of fractures involving the anterolateral quadrant is due to microarchitecture characteristics and the relative lack of supportive structures compared to other areas. The novel insight gained from this study will aid in the development of advanced interventions for preventative measures and better treatment of radial head fractures like more satisfactory purchase when screws are directed towards the denser posteromedial quadrant.

Prevalence and associated factors of low bone mineral density in people living with HIV: a cross-sectional study.

HIV infection and antiretroviral therapy (ART) have been shown to contribute to lower BMD, resulting in an increased susceptibility to osteopenia and osteoporosis. However, there is limited knowledge about the prevalence of reduced BMD and its associated factors among Chinese PLWH. In this cross-sectional study, we aimed to investigate the prevalence and factors associated with low BMD among PLWH in China. We retrospectively enrolled PLWH and non-HIV volunteers who underwent dual-energy X-ray absorptiometry (DXA) scans to measure bone density. Demographic information, laboratory test results, ART regimens, and treatment duration were collected. Univariate and multiple regression analyses were performed to identify factors influencing abnormal bone mass in PLWH. A total of 829 individuals were included in this study, comprising the HIV group (n = 706) and the non-HIV group (n = 123). The prevalence of low BMD among all PLWH was found to be 13.88% (98 out of 706). However, among PLWH aged 50years and above, the prevalence increased to 65.32% (81 out of 124). In contrast, control subjects in the same age group had a prevalence of 38.21% (47 out of 123). After adjusting for age and BMI, older PLWH still demonstrated a higher prevalence of low BMD compared to the non-HIV group (68.24% vs 34.94%, P < 0.001). Multivariate analysis revealed that older age was strongly associated with a higher risk of low BMD among PLWH, with an odds ratio (OR) of 6.28 for every 10-year increase in age in the ART-naïve population (95% confidence intervals [CIs], 3.12-12.65; P < 0.001) and OR of 4.83 in the ART-experienced population (3.20-7.29, P < 0.001). Within the ART-experienced group, current LPV/r treatment was associated with an increased risk of low BMD (OR = 3.55, 1.24-10.14, P < 0.05), along with lower BMI (OR = 0.84, 0.75-0.95, P < 0.05), and elevated alkaline phosphatase (OR = 1.02, 1.01-1.03, P < 0.01). The prevalence of low BMD is higher among PLWH aged 50years and above compared to non-HIV individuals. The use of LPV/r for ART is associated with reduced BMD. These findings emphasize the importance of regular monitoring of BMD in older PLWH and the need for appropriate interventions to mitigate the risks of osteopenia and osteoporosis in this population.

Poster 218: Localized Acetabular Bone Density Distributions Are Altered in Unilateral Femoral Acetabular Impingement

Objectives: Femoral acetabular impingement (FAI) can lead to bony and cartilage changes at the joint, and it has been suggested that changes in bone mineral density in the acetabulum may correlate with osteoarthritic degeneration of the hip. In this study, we aimed to use opportunistic quantitative computed tomography (QCT) to map density distributions across the acetabular region in patients with unilateral FAI and determine if there were differences between the affected and unaffected side. Furthermore, we assessed if these differences in density distributions were associated with radiographic measures of FAI. Methods: Twenty patients (age 31.9 (SD 9.2), 13 female) who underwent surgery for unilateral FAI and had an associated CT scan of both hips were included in this retrospective study. Both sides of the pelvis were segmented, and 3D models were created. Estimated bone density values were mapped across the bone models via QCT. A thin-spline semi-landmarking approach was used to allow density values at equivalent anatomical points to be compared within patients and across the group. With the contralateral side used as the control, differences in bone density between sides were calculated. A mixed effect linear regression model was used to determine if there were associations between the localized bone density and radiographic measures of Tonnis grade, alpha angle, lateral center edge angle (LCEA), and cross over sign, while controlling for age and sex. To visualize the data, density changes and statistical results were color-mapped to the bone models. Results: Overall, several regions of the acetabulum were found to have increased bone density in the affected side compared to the contralateral (Figure 1). Specifically, the anterior-superior parts of the acetabular rim appeared to be most affected, along with the posterosuperior region (Figure 2). Limited associations were found between localized density and the clinical variables, with the most notable finding being a region of the superior rim that was found to be associated with the alpha angle (Figure 3). Conclusions: FAI leads to distinct patterns of bone density changes around the acetabulum, although there is still variability at the level of the individual patient. It is unclear whether these changes in bone density may be related to the underlying condition, alterations in the patient’s mechanics due to pain, or a combination of these factors. Providing detailed density maps of the bony anatomy may also assist surgical providers in planning interventions. Further research may elucidate the relationship between bone density changes and long-term degeneration of the joint.

Vitamin D prophylaxis in persons with epilepsy?

Limited guidelines exist regarding osteoporosis prevention in the general population. Despite being a subject of controversy, the majority of research suggests that decreased vitamin D levels correlate with increased bone turnover, that is, an important risk factor for osteoporosis development. In most guidelines, daily vitamin D supplementation is recommended. In persons with epilepsy (PWE), the situation is more complex, as other factors can increase the chance of being vitamin D deficient. Currently, there are no internationally accepted guidelines regarding monitoring bone health in PWE. Our aim was to review the existing evidence in PWE on: (1) risk factors for vitamin D deficiency, (2) the identification of higher risk groups, and (3) the optimal ways to monitor bone health. Our narrative review shows that: (1) anti-seizure medication (ASM) use, especially enzyme-inducing ASM (EIASM) and valproic acid, is identified as an important risk factor for impaired bone health (e.g., increased risk for osteoporosis/fractures and/or vitamin D deficiency); (2) higher risk groups within the PWE population are present: intellectual or physical disability, institutionalized patients, puberty, early onset epilepsy and developmental epileptic encephalopathies, postmenopausal women, and use of multiple ASM/concomitant drugs (e.g. corticosteroids); and (3) a monitoring scheme can be suggested including laboratory tests, bone density measurements, managing of risk factors, and/or vitamin D supplementation. Overall, regular vitamin D measurement in PWE is a cost-effective and practical method for monitoring vitamin D deficiency, whereas in high-risk patients the combination of vitamin D measurement and bone densitometry is recommended. There is not enough evidence to advocate continuous vitamin D supplementation in all PWE. Children with epilepsy should receive the recommended daily intake of vitamin D for age and additional monitoring and supplementation if at higher risk of deficiency. There is a need for prospective trials exploring the potential benefit of vitamin D supplementation in PWE.

IDEAL-IQ combined with intravoxel incoherent motion diffusion-weighted imaging for quantitative diagnosis of osteoporosis

BackgroundOsteoporosis (OP) is a common chronic metabolic bone disease characterized by decreased bone mineral content and microstructural damage, leading to increased fracture risk. Traditional methods for measuring bone density have limitations in accurately distinguishing vertebral bodies and are influenced by vertebral degeneration and surrounding tissues. Therefore, novel methods are needed to quantitatively assess changes in bone density and improve the accurate diagnosis of OP.MethodsThis study aimed to explore the applicative value of the iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron (IDEAL-IQ) sequence combined with intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the diagnosis of osteoporosis. Data from 135 patients undergoing dual-energy X-ray absorptiometry (DXA), IDEAL-IQ, and IVIM-DWI were prospectively collected and analyzed. Various parameters obtained from IVIM-DWI and IDEAL-IQ sequences were compared, and their diagnostic efficacy was evaluated.ResultsStatistically significant differences were observed among the three groups for FF, R2*, f, D, DDC values, and BMD values. FF and f values exhibited negative correlations with BMD values, with r=-0.313 and − 0.274, respectively, while R2*, D, and DDC values showed positive correlations with BMD values, with r = 0.327, 0.532, and 0.390, respectively. Among these parameters, D demonstrated the highest diagnostic efficacy for osteoporosis (AUC = 0.826), followed by FF (AUC = 0.713). D* exhibited the lowest diagnostic performance for distinguishing the osteoporosis group from the other two groups. Only D showed a significant difference between genders. The AUCs for IDEAL-IQ, IVIM-DWI, and their combination were 0.74, 0.89, and 0.90, respectively.ConclusionsIDEAL-IQ combined with IVIM-DWI provides valuable information for the diagnosis of osteoporosis and offers evidence for clinical decisions. The superior diagnostic performance of IVIM-DWI, particularly the D value, suggests its potential as a more sensitive and accurate method for diagnosing osteoporosis compared to IDEAL-IQ. These findings underscore the importance of integrating advanced imaging techniques into clinical practice for improved osteoporosis management and highlight the need for further research to explore the full clinical implications of these imaging modalities.

A comparative radiographic study of bone density changes around titanium implants in the posterior mandible, preoperative, and postoperative

Background: Implant success and the state of the surrounding bone require multiple measures, especially in humans, and this study aimed to identify the development of the state of the latter by means of radiographic examination performed during the period of osseointegration as well as investigate the changes in bone density that occur after implant installation and 2 months after functional loading. Implant success rates are affected by bone density at the implant site. Therefore, understanding changes in bone density after dental implant placement is essential, as it correlates with subsequent implant success. Materials and methods: Digital radiographs of 28 implants were taken and evaluated at four intervals: preoperatively, 1 and 3 months postoperatively, and 2 months following placement of the permanent prosthesis. Gray values were measured in different areas around the implants through analyzing X-ray images and measuring bone density around the implants using EzDent – 2D software. The aim of this study was to investigate changes in bone density around implants in three regions: apex, neck, and body, as well as to record average density values during the observation period by measuring digital image gray levels (the gray values of the digital radiographs). This was conducted to determine local bone densities in dental implant recipient sites and to study changes in local bone densities at different intervals, preoperatively and postoperatively and after placement of the prosthesis. Results: A decrease was observed in gray values proportional to reference values 1-month after implant insertion, but these increased at 3 months after insertion and continued to rise 2 months after placement of the prosthesis in the apical, body, and neck regions of the implant. Conclusion: Sensor-tuned radiography can be used as an effective method to support clinical follow-ups as well as measure changes in bone densities around implants in critical cases.

The relationship between bone health and type of intracranial internal carotid calcifications in patients with ischemic stroke

IntroductionVascular calcifications, primarily in the aorta and its proximal branches, are commonly observed among subjects with impaired bone health. In this study, we sought to determine if a comparable association holds true for the calcifications in the intracranial internal carotid arteries (IICA), in general and also for particular calcification patterns. MethodsA consecutive series of ischemic stroke patients were prospectively enrolled into the study, where computed tomography angiography source images were used to determine the presence and type of IICA calcifications, and dual-energy X-ray absorptiometry was used to determine the bone mineral density in the left femoral neck region. IICA calcifications were categorized as none, intimal, medial, and mixed types based on previously validated classification schemes. Their relationships with femoral bone T-scores were evaluated by bivariate and multivariate analyses. ResultsFemoral neck T-score was highest among patients without any vascular calcifications (n=65), when compared to the bone density measures among patients with any type of calcification (n=185) (p<0.001). After adjustment for age, gender, vascular risk factors, and serum biomarkers related to bone health, the T-score remained significantly associated only with the pattern of intimal calcification [OR 0.63 (0.42 – 0.95), p=0.028]. ConclusionsOur findings suggest that the intracranial vasculature, in particular the internal carotid arteries, is not immune to the interplay between suboptimal bone health and vascular calcifications. This association was most robust for an intimal type of IICA calcification pattern, while no such relationship could be demonstrated for other types of vascular calcifications.