Bone Density Scores Research Articles

12366 The Association Between Obstructive Sleep Apnea And Bone Health: A Systematic Review And Meta-analysis

Abstract Disclosure: C. Teo: None. Y. Chan: None. J. Tay: None. C. Cheong: None. Importance: Obstructive sleep apnea (OSA) is a globally prevalent yet underdiagnosed sleep disorder with well-known metabolic consequences. However, the relationship between OSA and bone health, especially osteoporosis, remains poorly understood. Given that both OSA and osteoporosis are highly prevalent chronic conditions with significant public health indications, elucidating the relationship between these conditions is important. Objective: To investigate the association of OSA with bone health, specifically if individuals with OSA had a higher risk of developing osteoporosis, and discuss its clinical implications. Data Sources: A systematic search of MEDLINE (via PubMed), Embase and Cochrane Library from inception to 22 November 2023. Keywords related to obstructive sleep apnea, osteoporosis and bone density were included. Study Selection: Studies that reported on the association between OSA and osteoporosis in adults aged 18 years and above were included. Outcomes of interest included any markers of osteoporosis or bone mineral density. Data Extraction and Synthesis: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and data extracted independently by two observers. Meta-analysis across studies was pooled using a random-effects model. Main Outcome(s) and Measure(s): Correlation of OSA with bone mineral density, as well as the mean difference in bone density scores and the risk of developing osteoporosis among between individuals with OSA and without OSA. Results: We identified 15 studies comprising 158,273 individuals. All studies had low or moderate risk of bias. The presence of OSA was negatively correlated with bone mineral density on meta-analysis (pooled correlation = -0.30; 95% CI -0.42 – -0.17; N = 8). Individuals with OSA also had poorer bone mineral density scores (mean difference = -0.58, 95% CI, -1.15 – 0.01; N = 8), and had significantly higher risk of developing osteoporosis (adjusted odds ratio = 2.18; 95% CI, 1.14–4.136; N = 4). Notably, both body mass index (BMI) and age were not significant effect modulators in the correlation of OSA and bone density. Conclusions and Relevance: OSA is associated with diminished bone health and a significant risk in developing osteoporosis. Further studies are required to determine if treatment of OSA may have the potential to mitigate these risks. Presentation: 6/3/2024

Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures

ObjectivesTo evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures. MethodsThis is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts. ResultsIn total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database. ConclusionsOSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.

Machine Learning Models Can Define Clinically Relevant Bone Density Subgroups based on Patient Specific Calibrated CT 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.

Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures

ObjectivesTo evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures. MethodsThis is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts. ResultsIn total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database. ConclusionsOSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.

Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age.

Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in womenthus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.

Bone Density and Trabecular Bone Score Decline Rapidly in the First Year After Bone Marrow Transplantation with a Marked Increase in 10-Year Fracture Risk.

As outcomes from allogeneic bone marrow transplantation (BMT) have improved, prevention of long-term complications, such as fragility fractures, has gained importance. We aimed to assess areal bone mineral density (aBMD) and trabecular bone score (TBS) changes post BMT, and determine their relationship with fracture prevalence. Patients who attended the Royal Melbourne Hospital (RMH) BMT clinic between 2005-2021 were included. Patient characteristics and dual-energy X-ray absorptiometry (DXA) values were collected from the electronic medical record and a survey. TBS iNsight™ was used to calculate TBS for DXA scans performed from 2019 onwards. 337 patients with sequential DXAs were eligible for inclusion. Patients were primarily male (60%) and mean age ± SD was 45.7 ± 13.4 years. The annualised decline in aBMD was greater at the femoral neck (0.066g/cm2 (0.0038-0.17)) and total hip (0.094g/cm2 (0.013-0.19)), compared to the lumbar spine (0.049g/cm2 (-0.0032-0.16)), p < 0.0001. TBS declined independently of aBMD T-scores at all sites. Eighteen patients (5.3%) sustained 19 fractures over 3884 person-years of follow-up post-transplant (median follow-up 11 years (8.2-15)). This 5.3% fracture prevalence over the median 11-year follow-up period is higher than what would be predicted with FRAX® estimates. Twenty-two patients (6.5%) received antiresorptive therapy, and 9 of 18 (50%) who fractured received or were on antiresorptive therapy. In BMT patients, aBMD and TBS decline rapidly and independently in the first year post BMT. However, FRAX® fracture probability estimates incorporating these values significantly underestimate fracture rates, and antiresorptive treatment rates remain relatively low.

Bone density and trabecular bone score to predict fractures in adults aged 20-39years: a registry-based study.

Trabecular bone score (TBS), a bone texture measurement, is associated with fracture risk independent of bone mineral density (BMD) in older adults. In adults aged 20-40years, TBS remains stable and its role in fracture risk assessment is unclear. We utilized the Manitoba Bone Density Registry to explore the relationship of fracture risk with BMD and TBS in younger adults. Women and men aged 20-39years referred for DXA testing were studied. Incident major and any fractures were captured from health records. Categories based on WHO BMD T-score classification and TBS tertile were considered using Cox regression models to estimate covariate-adjusted (including sex) hazard ratios (aHR, 95%CI) for incident fracture by category, and each SD decrement in BMD and TBS. The study included 2799 individuals (77% female, mean age 32years). Mean (SD) minimum T-score was - 0.9 (1.1) and TBS 1.355 (0.114); 7% had osteoporosis and 13% were in the lowest TBS tertile. Incident major osteoporotic fracture (MOF) and any fracture risk was elevated in those with osteopenia (aHRs 1.20/1.45) and osteoporosis (aHRs 4.60/5.16). Fracture risk was unrelated to TBS tertile. Each SD decrement in BMD was associated with increased MOF risk (aHR 1.64) and any fracture (aHR 1.71); lower TBS was unrelated to fractures. In young adults, low BMD, but not low TBS, was predictive of MOF and any fracture. Routine clinical TBS measurement is not recommended for young adults. Further study is indicated to evaluate whether TBS is beneficial in subsets of younger adults.

A Randomized Controlled Trial to Assess the Effects of Oral Alkali Therapy in Patients with Diabetic Kidney Disease

Background: To analyze the effects of oral alkali therapy on renal function, nutritional status and bone density in patients of diabetic kidney disease. Material &amp; Methods: A randomized controlled trial was conducted on 60 patients of age&gt;18 years with diabetic kidney disease who were not on dialysis and had plasma bicarbonate levels between 16 and 20 mmol/l. Patients were randomly divided into two groups: Test group (n=30) which received oral alkali therapy as sodium bicarbonate and control group (n=30) who did not receive oral alkali therapy. The patients were followed for 12 months to compare the improvement. Results: In comparison to controls, test group showed a significant improvement in the Hb (0.7 vs. 0.25, P =0.003), significantly less decrease in eGFR (-2.25 vs. -2.9, P=0.049), non-significant less increase in creatinine (-0.26 ± 0.4 vs. -0.43 ± 0.33, P=0.09), significant improvement in bicarbonate levels (7.5 vs. 1, p&lt;0.0001), significant restoration of albumin (0.32 vs. 0.05, P&lt;.0001), significant fall in iPTH levels (50 vs. 25, p=0.007) and ALP levels (32 vs. 12, p=0.015). Bone density (0.28 ± 0.17 vs. 0.01 ± 0.13, P&lt;.0001) and clinical well-being VAS scores improved significantly among the cases (9.83 ± 5.65 vs. -1.67 ± 7.11, P&lt;.0001). Conclusion: In conclusion, oral alkali therapy slows the rate of decline of renal function and the development of end stage renal disease in patients with advanced stages of CKD. This cheap and simple strategy, which is in line with current renal consensus documents, also improves the nutritional status of patients and bone density.

The Relationship between Skeletal Muscle Mass and Bone Mass at Different Sites in Older Adults

Introduction: It has been well recognized that sarcopenia is closely related with osteoporosis, while the relationship between bone mass at different sites and muscle mass remains largely unexplored. This study aims to explore the relationship between bone mass at different sites and skeletal muscle mass in older adults. Methods: A total of 228 patients over 65 years old were enrolled in this study, and then 180 valid participants with accessible dual-energy X-ray absorptiometry (DXA) scanning data and absence of malignant tumors, mobility disorders, serious liver and kidney disease, and cardiac insufficiency were selected (138 male and 42 female). These individuals were further divided into control group and low skeletal muscle mass index (SMI) group. DXA scanning was used to access skeletal muscle mass and bone mass. SMI or body mass index was defined as appendicular muscle mass or weight divided by squared height, respectively. Low SMI <7.0 kg/m2 in male or <5.4 kg/m2 in female was defined as low SMI; while the bone density score at or below 2.5 standard deviations (T-score) below normal peak bone values, was regarded as osteoporosis. Results: The average age of enrolled patients was 82.72 years; the ratios of osteoporosis, low SMI, and low SMI with osteoporosis were 48.8%, 23.3%, and 15.0%, respectively. Compared with the control group, the prevalence of osteoporosis was higher, and the total bone mass and bone mass at various sites including limbs, spine, and pelvis, were all lower in low SMI group. Correlation analysis showed that SMI was positively related with total bone mass and bone mass at various sites. Covariance analysis showed that only total bone mass and appendicular bone mass decreased with decreasing SMI. After multiple adjustment, osteoporosis was positively related with the prevalence of low SMI, as evidenced by logistic regression analysis (odds ratio = 1.33, 95% confidential interval: 1.04–3.24, p = 0.045). Furthermore, compared with the highest quartile of appendicular bone mass, the lowest quartile was related with the increasing prevalence of low SMI (odds ratio = 7.29, 95% confidential interval: 1.21–67.45, p = 0.042). Conclusion: Compared with the other sites, the bone mass reduction at limbs of older adults was positively associated with skeletal muscle loss. It may be more beneficial to increase bone mass at the limbs for improved sarcopenia prevention and therapy. Further investigations are needed to explore the effects of other confounders (e.g., energy, calcium and vitamin D intake, and physical activity) on the osteoporosis and sarcopenia in older adults.

The association of opioid consumption and osteoporosis in old men: Bushehr Elderly Health (BEH) program.

Limited evidence suggest a relationship between opioid consumption and osteoporosis. This study aims to investigate the possible association of osteoporosis and drug use among older adult men of Bushehr, Iran. In this study, 1156 men aged ≥ 60years of Bushehr Elderly Health (BEH) were included. Bone density and trabecular bone score (TBS) were measured using dual-energy X-ray absorptiometry. Total osteoporosis was noted based on osteoporosis at either site of the lumbar spine, femoral neck, and total hip densitometry. Drug use was defined as a self-reported current use of opioid drugs, either regular (daily) use or irregular consumption. Multivariable modified Poisson regression analysis was used for investigating the association of opioids and osteoporosis, reporting the adjusted prevalence ratio (APR) with 95% confidence interval (CI). The association between drug use and TBS was evaluated using a linear regression model. Opioid drug use was reported by 4.1% (n = 47) of participants. Among drug users, opium was the most prevalent consuming drug (83%). In all, 38.3% of drug users and 22.4% of non-users had osteoporosis (p-value = 0.011). Multivariable analysis showed that adjusting by age, education, smoking, alcohol consumption, body mass index, diabetes, and physical activity, a positive and significant association was detected between opioid drug use and the likelihood of osteoporosis (APR: 1.46, 95%CI: 1.02-2.10). Considering the potential confounders, the results also showed a negative association between drug consumption and TBS (β: - 0.027, 95%CI: - 0.053, - 0.001). Opioid drug use has a positive association with osteoporosis in elderly men, independent of other conventional risk factors. Elderly drug users might be at a higher risk for osteoporotic fractures, given the effect of substance use on cognition. So, osteoporosis among drug users would be of importance, especially in countries where opium consumption is prevalent.

Radiological and Microbiological Evaluation of the Efficacy of Alveolar Bone Repair Using Autogenous Dentin Matrix—Preliminary Study

Dental procedures for alveolar bone augmentation may be carried out using autologous bone graft material derived from the patient’s own tooth. The material obtained is subjected to strict procedures aimed at reducing the amount of bacteria in the autograft. The aim of this study was the evaluation of the efficacy of the autogenous dentine matrix produced by grinding the patient’s own tooth for the augmentation of maxillary bone defects and the evaluation of the microbiological status of the material obtained. Alveolar bone repair was performed with an autogenous dentin matrix in four patients. In each case, an autogenous bone graft substitute obtained by grinding the patient’s own tooth was used. The tooth-derived material was then used for alveolar augmentation. The obtained material was tested to assess its microbiological profile. For the purpose of comparison, other materials and tissues were also subjected to microbiological testing. Bone healing was assessed by CBCT (cone beam computed tomography) scanning before and 6 months after surgery using the Hounsfield scale and the ImageJ software. Analysis of the bone regeneration process based on the bone density score in Hounsfield units showed significant differences in measurements on CBCT scans carried out on the treatment site, before surgery, and 6 months after it, using ImageJ software. All bacteria detected in the bone augmentation material constituted the patient’s bacterial flora. The microorganisms present in the augmentation material were also present in the patient’s bone and soft tissues. The use of an autogenous dentin matrix for alveolar bone repair ensures that the proper volume is obtained and that alveolar bone shape is preserved and does not introduce pathogenic microorganisms into the patient. The procedure for preparing and using an autogenous dentin matrix is described based on one clinical case.

Comparison of nano-hydroxyapatite/polyamide 66 bioactive support and autologous iliac bone in bone grafting and fusion for elderly patients with lumbar tuberculosis

To investigate the safety of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive support in bone grafting and fusion for elderly patients with lumbar tuberculosis, and to analyze its effectiveness and advantages by comparing with autologous iliac bone grafting. A retrospective analysis was performed on 48 elderly patients with lumbar tuberculosis who met the selection criteria between January 2017 and January 2020. The patients all underwent one-stage posterior pedicle screw internal fixation combined with anterior lesion removal and bone grafting and fusion, of which 23 cases applied n-HA/PA66 bioactive support+allogeneic bone graft (n-HA/PA66 group) and 25 cases applied autologous iliac bone graft (autologous iliac bone group). There was no significant difference between the two groups in gender, age, bone density, disease duration, lesion segment, and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Cobb angle ( P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as the VAS score, JOA score, American Spinal Injury Association (ASIA) spinal cord injury grading, Cobb angle, and bone fusion were recorded and compared between the two groups. The operations were completed successfully in both groups. n-HA/PA66 group had significantly less operation time and intraoperative blood loss than the autologous iliac bone group ( P<0.05). All patients were followed up 12-24 months, with an average of 15.7 months. And the difference in follow-up time between the two groups was not significant ( P>0.05). Postoperative complications occurred in 3 cases (13%) in the n-HA/PA66 group and 10 cases (40%) in the autologous iliac group, and the difference in the incidence of complications between the two groups was significant ( χ 2=4.408, P=0.036). The postoperative VAS scores and JOA scores significantly improved when compared with the preoperative scores in both groups ( P<0.05), and the difference was significant ( P<0.05) between 2 weeks after operation and the last follow-up. The difference in VAS score at 2 weeks after operation was significant between the two groups ( P<0.05), and there was no significant difference ( P>0.05) at the other time points. At last follow-up, according to the ASIA grading, the effective improvement rate was 86% (18/21) in the n-HA/PA66 group and 90% (18/20) in the autologous iliac group, with no significant difference ( χ 2=0.176, P=0.675). Imaging review showed that grade Ⅰ bony fusion was obtained in both groups, and the fusion time of bone graft in the n-HA/PA66 group was significantly longer than that in the autologous iliac bone group ( P<0.05). There was no significant difference in the Cobb angle at each time point between the two groups ( P>0.05). No recurrence of tuberculosis, loosening or fracture of the internal fixator, or displacement of the bone graft was observed during follow-up. In elderly patients with lumbar spine tuberculosis, the n-HA/PA66 bioactive support combined with allogeneic bone graft can effectively restore and maintain the fusion segment height and physiological curvature of the lumbar spine, and the fusion rate of bone graft is similar to that of autologous iliac bone, which can achieve better effectiveness.

Radiomic Modeling of Bone Density and Rib Fracture Risk After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer

PurposeOur purpose was to determine whether bone density and bone-derived radiomic metrics in combination with dosimetric variables could improve risk stratification of rib fractures after stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC). Methods and MaterialsA retrospective analysis was conducted of patients with early-stage NSCLC treated with SBRT. Dosimetric data and rib radiomic data extracted using PyRadiomics were used for the analysis. A subset of patients had bone density scans that were used to create a predicted bone density score for all patients. A 10-fold cross validated approach with 10 resamples was used to find the top univariate logistic models and elastic net regression models that predicted for rib fracture. ResultsA total of 192 treatment plans were included in the study with a rib fracture rate of 16.1%. A predicted bone density score was created from a multivariate model with vertebral body Hounsfield units and patient weight, with an R-squared of 0.518 compared with patient dual-energy x-ray absorptiometry T-scores. When analyzing all patients, a low predicted bone density score approached significance for increased risk of rib fracture (P = .07). On competing risk analysis, when stratifying patients based on chest wall V30 Gy and bone density score, those with a V30 Gy ≥30 cc and a low bone density score had a significantly higher risk of rib fracture compared with all other patients (P < .001), with a predicted 2-year risk of rib fracture of 28.6% (95% confidence interval, 17.2%-41.1%) and 4.9% (95% confidence interval, 2.3%-9.0%), respectively. Dosimetric variables were the primary drivers of fracture risk. A multivariate elastic net regression model including all dosimetric variables was the best predictor of rib fracture (area under the curve [AUC], 0.864). Bone density variables (AUC, 0.618) and radiomic variables (AUC, 0.617) have better predictive power than clinical variables that exclude bone density (AUC, 0.538). ConclusionRadiomic features, including a bone density score that includes vertebral body Hounsfield units and radiomic signatures from the ribs, can be used to stratify risk of rib fracture after SBRT for NSCLC.

Comparative Evaluation of Implant Stability, Insertion Torque, and Implant Macrogeometry in Different Bone Densities Using Resonance Frequency Analysis

Evaluation and comparison of insertion torque (IT) and the implant stability of two different implant macrogeometry in different bone densities using resonance frequency analysis. A total of 48 implants (with two implant types having regular and novel macrogeometry) were classified into 4 groups with 12 samples in each group. Group A regular implant without surface treatment, group B regular implant with surface treating, group C novel implant deprived of surface treating, and group D was new dental implant with surface treatment were used. Implant stability quotient (ISQ), implant IT, removal torque (RT) percentage, and torque reduction percentage were calculated. The mean ± SD ISQ value of bone 1 in group A was 56.7 ± 3.2, in group B was 58.6 ± 2.4, in group C was 57.1 ± 3.5, and in group D was 59.3 ± 2.9. In bone 2, the value was 57.8 ± 1.4, 59.5 ± 1.5, 58.2 ± 2.6, and 59.5 ± 2.4 among A, B, C, and D groups correspondingly. In bone 3, it was 59.4 ± 2.4, 60.3 ± 2.3, 60.4 ± 2.8, and 62.7 ± 2.5 among A, B, C, and D groups correspondingly. In bone 4, it was 67.2 ± 3.4, 69.5 ± 2.7, 68.7 ± 2.4, and 69.4 ± 2.3 among A, B, C, and D groups correspondingly. There was a substantial difference in IT and nonsignificant difference in RT in different groups. There was a low IT value with new implant macrogeometry as compared to regular implant macrogeometry. There was absence of association between IT and implant stability. Calculation of torque insertion score helps in implant placement. Higher bone density scores produce a higher option of decreasing the initial torque. Low IT of new implant types is useful to reduce failure.

New insights into the metabolic-bone crosstalk in active acromegaly.

Body composition (BC) and adipokines share bone active properties and display an altered profile in acromegaly. The fibroblast growth factor 23 (FGF23)/α-Klotho system, also involved in bone metabolism, is upregulated in growth hormone (GH) excess states. Hence, we aimed to investigate their impact on bone in active acromegaly, compared to controls. BC, bone mineral density (BMD) (via dual X-ray absorptiometry), serum adipokines (leptin, adiponectin, resistin), parathyroid hormone (PTH), FGF23, α-Klotho, and osteocalcin were assessed in a cross-sectional study enrolling 35 patients with active acromegaly (Acro), compared to 35 sex, age, and body mass index (BMI) one-to-one matched healthy controls (CTL). The Acro group had higher bone density scores (p < 0.05), lower visceral fat depots (p = 0.011), and lower serum leptin (p < 0.001) but elevated adiponectin (p < 0.001) and resistin (p = 0.001) concentrations when compared to the CTL group. α-Klotho was not related to the GH/IGF1 axis in the Acro group. Resistin was higher in both diabetic and non-diabetic Acro compared to CTL (p < 0.05). Age and BC were the main independent BMD predictors in regression analysis in both groups, while IGF1 was a positive predictor of osteocalcin levels in the Acro (β = 0.48, p = 0.006). The correlations between adipokines, the FGF23/α-Klotho system, and bone parameters, respectively, were lost after adjusting for age and BC. Age and BC were the main independent BMD predictors in the acromegalic patients with active disease, while IGF1 was independently associated with serum osteocalcin concentrations. The role of α-Klotho in evaluating acromegaly and the associated osteopathy in the long-term appears to be limited. Our study is among the first to report significant serum resistin changes in patients with active acromegaly, opening new insights in the GH-mediated insulin resistance. The GH-resistin relationship merits further investigations.

Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study.

BackgroundKidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients.Patients-methodPatients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD.ResultsOne hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX.ConclusionExploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

Relationship between body type (somatotype) and bone density in perimenopause women

Along with increasing age in women, there will be a decrease of estrogen levels and changes in the size, structure, and composition of the body, so those will affect bone density. This study aimed to analyze the relationship between body type (somatotype) and bone density in perimenopause women. This study was a cross-sectional study held in Ngemplak, Simongan, West Semarang with forty-two women subjects aged 31-50 years. Their bone density was estimated using QUS on calcaneal. Somatotype was measured using skinfold caliper, medline and sliding caliper. Bivariate analysis used Pearson Correlation and Rank-Spearman correlation test. Multivariate analysis used multiple regression test. All body types were grouped as endomorph, mesomorph, and ectomorph. Most subjects have mesomorph type were 71.4% (n = 30). Subjects with osteopenia were 4.8% (n = 2). There was a positive correlation between endomorph values, mesomorph values and body fat percentage with bone density scores in bivariate analysis. There was correlation between mesomorph values, body fat percentage and body mass index with bone density scores in subjects (SC = 0.533; p = 0.037, SC = 0.590; p = 0.011, SC = - 0.643; p = 0.037) in multivariate analysis. In conclusion, there were significant correlations between mesomorph values with bone density scores.

Treatment of proximal humerus fractures in geriatric patients - Can pathological DEXA results help to guide the indication for allograft augmentation?

IntroductionReconstruction of proximal humerus fracture continues to represent a challenge, especially in severe osteopenia. However, there still is a lack of consensus and clear indication on use of allograft augmentation. Therefore, this study aims to investigate outcome after osteosynthesis with and without allograft augmentation. It focuses on bone density results obtained by DEXA as potential examination that might help decision-making.MethodsThis study included patients aged 65 years and older that were treated at one Level 1 trauma center between 2007 and 2018. Inclusion criteria: Proximal humerus fracture treated with or without allograft, conclusive data-sets. Exclusion criteria: prior surgical treatment of the proximal humerus, open fracture with bone loss, neurological damage. Patients were stratified according to the use of allograft augmentation in two groups: Group NA (no allograft augmented PHILOS) and Group A (PHILOS with allograft augmentation). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Fractures were graded according to the classification by Neer. Radiographic union was analyzed at 6 weeks, 12 weeks, and at year follow up. Complications include surgical site infection, implant failure, humeral head necrosis, or delayed union. Allograft was used in cases of 1inch/3cm3 bone-loss or an egg-shell situation, where the patient refused arthroplasty.ResultsThis study included 167 patients, with 143 (85%) in the Group NA, and 24 (15%) in the Group A. There were no significant differences in age, gender, injury distribution, and distribution of Neer classification or CCI. Patients in Group A had significantly lower T-scores preoperatively (-2.87 ± 1.08 versus -0.9 ± 2.12, p = 0.003). No difference occurred in any of the complications. At one-year follow-up, the range of motion was comparable in both groups.ConclusionIn patients with allograft augmentation and severe osteopenia, similar clinical and radiological results were obtained when compared with patients with better preoperative bone density scores (T-scores, DEXA). In view of a lack of guidelines indicating the indication for the use of allograft, this difference may be worth further study.

Spinal Sagittal Alignment, Hospital Anxiety and Depression Scale Scores, and Patient-Reported Outcome among People with Sporting Activity.

Study DesignRetrospective cohort study.PurposeThis study aimed to investigate how participation in sporting activity affects patient-reported outcome (PRO), including Neck Disability Index (NDI), in males and females.Overview of LiteraturePreviously, our study reported that factors with a negative influence on the NDI in females were a lack of sporting activities. However, it was still unclear why it affected poor scores of NDI.MethodsThe subjects were 473 volunteers. They were divided into two groups (activity and non-activity) according to participation or non-participation in sporting activities using a self-filled questionnaire. The evaluation items were height, weight, grip strength, bone density, Hospital Anxiety and Depression Scale (HADS) score, standing radiographic parameters, PRO (evaluated by EuroQol-5 dimension [EQ-5D], Oswestry Disability Index [ODI]), and NDI.ResultsThere were 101 males in the non-activity group and 69 in the activity group and 178 females in the non-activity group and 125 in the activity group. For the males, the evaluation items with significant influence were cervical lordosis (non-activity group:activity group, 17°:22°) and T1 slope minus cervical lordosis (10°:6°, p<0.05). For the females, the evaluation items with significant influence were sagittal vertical axis (28:14 mm), HADS (10.4:8.4), EQ-5D (0.79:0.86), ODI (17:12), and NDI (12:9, p<0.01). HADS and PRO in the females were significantly correlated with the EQ-5D (−0.40), ODI (0.43), and NDI (0.55).ConclusionsMales who participated in sporting activities had better cervical spine alignment but no effect on PRO. Females with sporting activities had better spinal global alignment and less mental stress. It is suggested that sporting activity in females might be associated with PRO because HADS highly correlates with PRO.

Good long-term glycemic compensation is associated with better trabecular bone score in postmenopausal women with type 2 diabetes.

Osteoporosis is an increasingly widespread disease, as well as diabetes mellitus. It is now accepted that osteoporotic fractures are a serious co-morbidity and complication of diabetes. Despite of good bone mineral density in Type 2 Diabetes (T2DM) patients is the fracture risk elevated. It is due to reduced bone quality. To determine the effect of glycemic compensation on bone density and trabecular bone score (TBS) in T2DM. We analyzed a cohort of 105 postmenopausal women with T2DM. For all patients, central bone density (spinal and lumbar spine) was tested by DXA methodology, glycemic control parameters were assessed, and anthropometric parameters were measured. Bone quality was analyzed using TBS software. The results were statistically processed. Good glycemic compensation with glycated hemoglobin (A1c) value <7.0 % DCCT did not lead to BMD changes in patients with T2DM. However, patients with HbA1c <7 % DCCT had significantly better TBS (1.254±0.148 vs. 1.166±0.094, p=0.01). There was a negative correlation between TBS and glycated hemoglobin (r= -0,112, p<0.05) with glycemic fasting (r= -0.117, p<0.05). The optimal effect on TBS is achieved when all three markers of glycemic compensation (glycated hemoglobin, fasting plasma glucose and postprandial glycemia) are in optimal range. By using ROC curves glycated hemoglobin has the most significant effect on TBS. Optimal glycemic compensation, evaluated by glycated hemoglobin, does not lead to changes in BMD but has a beneficial effect on TBS in T2DM. Good glycemic control is required also for reduction of the risk of osteoporosis and osteoporotic fractures.