Assessment Of Bone Mineral Density Research Articles

Impact of dairy supplementation on bone acquisition in children's limbs: a 12-month cluster-randomized controlled trial and meta-analysis.

This study evaluated the impact of dairy supplementation on bone acquisition in children's limbs through a cluster-randomized controlled trial and a meta-analysis. The trial involved 315 children (4-6year) from Northwest China, randomized to receive either 390ml of milk daily (n = 215) or 20-30g of bread (n = 100) over 12months. We primarily assessed bone mineral density (BMD) and content (BMC) changes at the limbs, alongside bone-related biomarkers, measured at baseline, the 6th and 12th months. The meta-analysis aggregated BMD or BMC changes in the forearm/legs/calcaneus from published randomized trials involving children aged 3-18years supplemented with dairy foods (vs. control group). Of 278 completed the trial, intention-to-treat analysis revealed significant increases in BMD (4.05% and 7.31%) and BMC (4.69% and 7.34%) in the left forearm at the 6th and 12th months in the milk group compared to controls (P < 0.001). The calcaneus showed notable improvements in BMD (2.01%) and BMC (1.87%) at 6months but not at 12months. Additionally, milk supplementation was associated with beneficial changes in bone resorption markers, parathyroid hormone (- 12.70%), insulin-like growth factor 1 (6.69%), and the calcium-to-phosphorus ratio (2.22%) (all P < 0.05). The meta-analysis, encompassing 894 children, indicated that dairy supplementation significantly increased BMD (SMD, 0.629; 95%CI: 0.275, 0.983) and BMC (SMD, 0.616; 95%CI: 0.380, 0.851) (P < 0.05) in the arms, but not in the legs (P > 0.05). Milk supplementation significantly improves bone health in children's forearms, underscoring its potential as a strategic dietary intervention for bone development. Trial registration NCT05074836.

Ultra-low dose hip CT-based automated measurement of volumetric bone mineral density at proximal femoral subregions.

Forty to fifty percent of women and 13%-22% of men experience an osteoporosis-related fragility fracture in their lifetimes. After the age of 50 years, the risk of hip fracture doubles in every 10 years. x-Ray based DXA is currently clinically used to diagnose osteoporosis and predict fracture risk. However, it provides only 2-D representation of bone and is associated with other technical limitations. Thus, alternative methods are needed. To develop and evaluate an ultra-low dose (ULD) hip CT-based automated method for assessment of volumetric bone mineral density (vBMD) at proximal femoral subregions. An automated method was developed to segment the proximal femur in ULD hip CT images and delineate femoral subregions. The computational pipeline consists of deep learning (DL)-based computation of femur likelihood map followed by shape model-based femur segmentation and finite element analysis-based warping of a reference subregion labeling onto individual femur shapes. Finally, vBMD is computed over each subregion in the target image using a calibration phantom scan. A total of 100 participants (50 females) were recruited from the Genetic Epidemiology of COPD (COPDGene) study, and ULD hip CT imaging, equivalent to 18 days of background radiation received by U.S. residents, was performed on each participant. Additional hip CT imaging using a clinical protocol was performed on 12 participants and repeat ULD hip CT was acquired on another five participants. ULD CT images from 80 participants were used to train the DL network; ULD CT images of the remaining 20 participants as well as clinical and repeat ULD CT images were used to evaluate the accuracy, generalizability, and reproducibility of segmentation of femoral subregions. Finally, clinical CT and repeat ULD CT images were used to evaluate accuracy and reproducibility of ULD CT-based automated measurements of femoral vBMD. Dice scores of accuracy (n=20), reproducibility (n=5), and generalizability (n=12) of ULD CT-based automated subregion segmentation were 0.990, 0.982, and 0.977, respectively, for the femoral head and 0.941, 0.970, and 0.960, respectively, for the femoral neck. ULD CT-based regional vBMD showed Pearson and concordance correlation coefficients of 0.994 and 0.977, respectively, and a root-mean-square coefficient of variation (RMSCV) (%) of 1.39% with the clinical CT-derived reference measure. After 3-digit approximation, each of Pearson and concordance correlation coefficients as well as intraclass correlation coefficient (ICC) between baseline and repeat scans were 0.996 with RMSCV of 0.72%. Results of ULD CT-based bone analysis on 100 participants (age (mean±SD) 73.6±6.6 years) show that males have significantly greater (p<0.01) vBMD at the femoral head and trochanteric regions than females, while females have moderately greater vBMD (p=0.05) at the medial half of the femoral neck than males. Deep learning, combined with shape model and finite element analysis, offers an accurate, reproducible, and generalizable algorithm for automated segmentation of the proximal femur and anatomic femoral subregions using ULD hip CT images. ULD CT-based regional measures of femoral vBMD are accurate and reproducible and demonstrate regional differences between males and females.

Knowledge and Practice toward DEXA Scan among Women in Jazan City, Saudi Arabia.

Background: Osteoporosis, characterized by reduced bone mass and increased fracture risk, presents a significant public health challenge. Dual-energy X-ray Absorptiometry (DEXA) scans offer a reliable means of assessing bone mineral density (BMD) and detecting osteoporosis. The aim of this study is to assess awareness, attitude, and practice of women in the Jazan region toward DEXA scan. Methods: Data were collected through a self-administered online questionnaire. Statistical analysis was conducted using SPSS version 29.0. The total knowledge scores of participants were calculated to assess potential associations with sociodemographic data. A p-value of less than 0.05 was considered statistically significant. Results: Among 400 women, 230 (57.5%) had low knowledge scores primarily due to poor knowledge of the DEXA scan procedure. Merely 39 women had undergone a DEXA scan mainly due to medical prescription (n = 22, 56.4%). Total knowledge scores were significantly higher among women with high monthly incomes (p = 0.019) and those working in medical-related jobs (p = 0.017). Conclusions: This study underscores the need for targeted interventions to improve awareness of DEXA scans among women in Jazan City. Additionally, the findings suggest that socioeconomic factors may influence awareness levels, emphasizing the importance of tailored educational strategies to reach diverse demographics.

Using a panoramic radiographic study, the Panoramic Mandibular Index (PMI), Mandibular Cortical Width (MCW) or Mental Index (MI) are used to assess bone mineral density (BMD) in postmenopausal women and identify sexual dimorphism

Using a panoramic radiographic study, the Panoramic Mandibular Index (PMI), Mandibular Cortical Width (MCW) or Mental Index (MI) are used to assess bone mineral density (BMD) in postmenopausal women and identify sexual dimorphism

CT in musculoskeletal imaging: still helpful and for what?

Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology.

Bone mineral density assessment in patients with cystinuria.

Cystinuria is a rare genetic disease characterized by impaired tubular transport of cystine. Clinical features of cystinuria mainlyinclude nephrolithiasis and its complications, although cystinuric patients may present with other comorbidities. There are currently no data on bone features of patients with cystinuria. Our aim is to characterize bone mineral density (BMD) in cystinuria. Our study included adult cystinuric patients with estimated glomerular filtration rate (eGFR) ≥ 60mL/min/1.73m2 followed at 3 specialized outpatient clinics in Italy (Rome, Naples and Verona). Markers of bone turnover were analyzed in a centralized laboratory. Clinical, biochemical and dual-energy X-ray absorptiometry (DEXA) data were collected from September 2021 to December 2022. Linear regression models were used to evaluate statistically significant deviations from zero of Z-scores. Twenty-seven patients were included in the study. Mean (SD) age was 37 (15) years, 41% were women. Mean estimated glomerular filtration rate was 99mL/min/1.73m2. Serum parameters associated with bone turnover (parathyroid hormone, FGF23, calcium and phosphate) were all in the normal range, with only 4 patients showing mild hypophosphatemia. Prevalence of low bone mineral density, defined as Z-score ≤ - 2 at any site, was 15%. Average Z-scores were negative across most sites. Our study suggests that cystinuric patients have lower bone mineral density compared with individuals of the same sex and age, even when theirkidney functionis normal.

A Preliminary Protocol of Radiographic Image Processing for Quantifying the Severity of Equine Osteoarthritis in the Field: A Model of Bone Spavin

Osteoarthritis (OA) of the tarsal joint, also known as bone spavin, is a progressive joint disease that increases in severity with age. It is a significant cause of hind limb lameness, leading to a deterioration in the quality of life of horses, particularly in old age. In this study, the tarsal joints of 20 older horses aged 15 to 35 years were radiographically imaged and processed using the computed digital absorptiometry (CDA) method for bone mineral density (BMD) assessment. The radiological signs of bone spavin were scored on a scale ranging from normal (0) to severe OA (3), and the examined joints were grouped according to the severity of OA. The percentage of color pixels (%color pixels), representing successive steps on the scale of X-ray absorption by a density standard, differed between the steps in a BMD characteristic manner for each group. Furthermore, two examined ranges of relative density allowed for the distinction of joints affected by severe OA from other joints, while another two ranges allowed for the differentiation of joints affected by moderate and severe OA from normal joints. The proposed color annotation-assisted decomposition of radiological images based on the CDA protocol shows promise for advancing research on the quantification of radiological signs of OA. This approach could be valuable for monitoring the progression of the disease in older horses.

Value of Hounsfield units measured by chest computed tomography for assessing bone density in the thoracolumbar segment of the thoracic spine.

A retrospective study. To investigate the correlation between Hounsfield unit (HU) values measured by chest computed tomography (CT) and dual-energy Xray absorptiometry (DXA) T-scores. HU-based thoracolumbar (T11 and T12) cutoff thresholds were calculated for a cohort of Chinese patients. For patients with osteoporosis, the incidence of fractures in the thoracolumbar segment is significantly higher than that in other sites. However, most current clinical studies have focused on L1. This retrospective study analyzed patients who underwent chest CT and DXA at our hospital between August 2021 and August 2022. Thoracic thoracolumbar segment HU values, lumbar T-scores, and hip T-scores were computed for comparison, and thoracic thoracolumbar segment HU thresholds suggestive of potential bone density abnormalities were established using receiver operating characteristic curves. In total, 470 patients (72.4% women; mean age, 65.5±12.3 years) were included in this study. DXA revealed that of the 470 patients, 90 (19%) had osteoporosis, 180 (38%) had reduced osteopenia, and 200 (43%) had normal bone mineral density (BMD). To differentiate osteoporosis from osteopenia, the HU threshold was established as 105.1 (sensitivity, 54.4%; specificity, 72.2%) for T11 and 85.7 (sensitivity, 69.4%; specificity, 61.1%) for T12. To differentiate between osteopenia and normal BMD, the HU threshold was 146.7 for T11 (sensitivity, 57.5%; specificity, 84.4%) and 135.7 for T12 (sensitivity, 59.5%; specificity, 80%). This study supports the significance of HU values from chest CT for BMD assessment. Chest CT provides a new method for clinical opportunistic screening of osteoporosis. When the T11 HU is >146.7 or the T12 HU is >135.7, additional osteoporosis testing is not needed unless a vertebral fracture is detected. If the T11 HU is <105.1 or the T12 HU is <85.7, further DXA testing is strongly advised. In addition, vertebral HU values that fall faster than those of the T11 and L1 vertebrae may explain the high incidence of T12 vertebral fractures.

Bone mineral density in osseointegration implant surgery: A review of current studies (Review).

Osseointegration implant (OI) surgery is the latest rehabilitation technology for amputees, where a bone-anchored implant obviates the limitations of traditional socket prostheses. The bone mineral density (BMD) in the periprosthetic and other anatomical regions can be used to assess bone remodelling following OI surgery. Currently, limited studies have used BMD measurements in reporting post-operative OI outcomes and the association between the maintenance of BMD and implant efficacy has remained elusive. This review captured and analysed all studies that have reported the BMD as an objective outcome measure in patients with trans-femoral or trans-tibial OI. The PubMed, Medline, Scopus and Web of Science databases were searched using the terms 'amputation', 'osseointegration' and 'bone mineral density'. A total of 6 studies involving human participants were included for analysis. All studies used dual X-ray absorptiometry and/or X-rays for measuring BMD. Rehabilitation of trans-femoral or trans-tibial amputation using OI may help restore healthy BMD by enabling physiological bone loading. However, there is a low correlation between the BMD around the OI and the success of OI surgery or the risk of periprosthetic fractures. This review summarises the current evidence on BMD assessment in OI for lower limb amputee rehabilitation. Despite the great variability in the results, the available evidence suggests that OI may help restore BMD following surgery. The limited evidence calls for further investigation, as well as the development of a standard BMD measurement protocol.

Bone mineral density and geometric morphometrics: Indicators of growth in the immature pars basilaris

The pars basilaris forms a central component of the immature basicranium and owing to its resilience to post-mortem and taphonomic changes, holds significance across evolutionary, clinical, and forensic contexts. While size and shape parameters of the pars basilaris have been investigated, little is known about the influence of the underlying bone mineral density on the morphometry of this bone during growth. This study aimed to investigate the development and growth of the pars basilaris with specific reference to changes in bone density patterning and development of osteological features, during the prenatal and early postnatal periods of life. A total of 109 pars basilari were sourced from the Johannesburg Forensic Paediatric Collection, University of the Witwatersrand, South Africa. The study sample was subdivided into early prenatal (<30 gestational weeks), prenatal (30–40 gestational weeks) and postnatal (birth to 7.5 months) groups and micro-CT scanned to assess bone mineral density patterns across seven regions of interest. Size and shape changes were analysed using 11 digitized landmarks and geometric morphometrics. When comparing across age groups, the assessed dimensions increased with growth manifesting as a deepening at the anterior border of the foramen magnum, development of the lateral angles and widening of the bone at the lateral projections and spheno-occipital synchondrosis. However, no significant changes in the distribution of bone mineral density were observed. An appreciation of morphological changes and bone quality at specific growth sites in the pars basilaris is essential when analyzing remains of unknown provenance for the purposes of identification in disaster victim settings.

Investigating the utility of HR-pQCT for the assessment of joint space and bone mineral density in hand osteoarthritis

ObjectiveOsteoarthritis affects joints of the hand and is radiographically characterized by joint space narrowing and changes in volumetric bone mineral density (vBMD). High-resolution peripheral computed tomography (HR-pQCT) allows for three-dimensional analysis of joint space width (JSW) changes but has yet to be applied to hand OA (HOA). The purpose of this study was to assess the utility of HR-pQCT in quantifying JSW and vBMD changes in HOA. DesignThe 2nd and 3rd distal interphalangeal (DIP2, DIP3) and trapeziometacarpal (TMC) joints of 20 women (10 controls, 10 HOA) were scanned using HR-pQCT. The Diseases of the Arm, Shoulder, and Hand (DASH) questionnaire and the Jebsen Hand Function Test (JHFT) were obtained. Radiographs were scored using the Eaton-Littler classification. We assessed between-group differences in HR-pQCT outcomes, and relationships between HR-pQCT outcomes and patient and radiographic characteristics. ResultsJSW maximum (JSW.Max) was higher in OA patients in the DIP2 (OA median [interquartile rage]: 2.07 mm [1.90–2.18], controls: 1.88 mm [1.84–1.89]) and DIP3 joints (OA: 2.01 mm [1.89–2.24], controls: 1.86 mm [1.82–1.95]). DIP3 JS volume was higher in OA (30.36 mm3, 19.35–34.57 mm3, controls: 17.05 mm3, 15.53–18.52 mm3). DASH scores were positively associated with DIP2 JSW asymmetry (JSW.AS), and JHFT times were positively associated with DIP3 JSW.Max, JSW.AS, and proximal DIP2 vBMD. Worsening radiographic TMC OA was associated with first metacarpal vBMD, JSW minimum, JSW.Max, and JSW.AS. ConclusionsThese preliminary findings suggest that HR-pQCT may be useful in investigating JS changes in HOA and warrants further investigation.

Hounsfield unit for assessing bone mineral density distribution within lumbar vertebrae and its clinical values

Hounsfield unit for assessing bone mineral density distribution within lumbar vertebrae and its clinical values

Accuracy of Volumetric Bone Mineral Density Measurement in Weight Bearing, Cone Beam Computed Tomography

Background: Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded. Grey-scale values indicative of X-ray attenuation that are output from cone beam CT are challenging to calibrate, and their use for bone mineral density (BMD) measurement remains debatable. To determine whether WBCT can be reliably used for cortical and trabecular BMD assessment, we sought to establish the accuracy of BMD measurements at the knee using modern WBCT by comparing them to measurements from conventional CT.Methods: A hydroxyapatite phantom with three inserts of varying densities was used to systematically quantify signal uniformity and BMD accuracy across the acquisition volume. We evaluated BMD in vivo (n = 5, female) using synchronous and asynchronous calibration techniques in WBCT and CT. To account for variation in attenuation along the height (z-axis) of acquisition volumes, we tested a height-dependent calibration approach for both WBCT and CT images.Results: Phantom BMD measurement error in WBCT was as high as 15.3% and consistently larger than CT (up to 5.6%). Phantom BMD measures made under synchronous conditions in WBCT improved measurement accuracy by up to 3% but introduced more variability in measured BMD. We found strong correlations (R = 0.96) as well as wide limits of agreement (-324 mgHA/cm3 to 183 mgHA/cm3) from Bland-Altman analysis between WBCT and CT measures in vivo that were not improved by height-dependent calibration.Conclusion: Whilst BMD accuracy from WBCT was found to be dependent on apparent density, accuracy was independent of the calibration technique (synchronous or asynchronous) and the location of the measurement site within the field of view. Overall, we found strong correlations between BMD measures from WBCT and CT and in vivo measures to be more accurate in trabecular bone regions. Importantly, WBCT can be used to distinguish between anatomically relevant differences in BMD, however future work is necessary to determine the repeatability and sensitivity of BMD measures in WBCT.

Bone mineral density and osteoporosis related risk factors in type 2 diabetes mellitus

Diabetes mellitus negatively affects bone tissue and unfavourably impacts bone mineral density (BMD), therfore increasing the probability of fractures through pathological mechanisms. This study aimed to explore the factors associated with BMD and osteoporosis risk in individuals with a diagnosis of type 2 diabetes mellitus (T2DM). An investigation was undertaken involving 49 patients diagnosed with T2DM who fulfilled the specified criteria. These individuals underwent BMD assessment as part of a cross-sectional study. The analysis encompassed both univariate and bivariate approaches, utilizing the Chi-square test (X2) and binary logistic regression methods. A total of 30 participants (61%) have decreased BMD. Among the participants aged 60 years and above, 83.4% exhibited a decreased BMD status (osteopenia and osteoporosis), in contrast to the under 60 years age group, in which 40% displayed decreased BMD status. Older age (&amp;gt;60 years) is a risk factor for decreasing bone density onset of diabetes mellitus (DM) diagnosis, duration of DM, glycemic control, body mass index (BMI), use of thiazolidinediones (TZD) drugs, kidney function, were not associated with lower BMD in T2DM patients.

MRI-based vertebral bone quality score as a novel bone status marker of patients with adolescent idiopathic scoliosis

To investigate the application of MRI-based vertebral bone quality (VBQ) score in assessing bone mineral density (BMD) for patients with adolescent idiopathic scoliosis (AIS). We reviewed the data of AIS patients between January 2021 and October 2023 with MRI, whole-spine plain radiographs, quantitative computed tomography (QCT) and general information. VBQ score was calculated using T1-weighted MRI. Univariate analysis was applied to present the differences between variables of patients with normal BMD group (QCT Z-score > − 2.0) and low BMD group (QCT Z-score ≤ − 2.0). The correlation between VBQ score and QCT Z-score was analyzed with Pearson correlation test. A multivariate logistic regression model was used to determine the independent factors related to low BMD. Receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic performance of VBQ score in distinguishing low BMD. A total of 136 AIS patients (mean age was 14.84 ± 2.10 years) were included, of which 41 had low BMD. The low BMD group had a significantly higher VBQ score than that in normal group (3.48 ± 0.85 vs. 2.62 ± 0.62, P < 0.001). The VBQ score was significantly negative correlated with QCT Z score (r = − 0.454, P < 0.001). On multivariate analysis, VBQ score was independently associated with low BMD (OR: 4.134, 95% CI 2.136–8.000, P < 0.001). The area under the ROC curve indicated that the diagnostic accuracy of the VBQ score for predicting low BMD was 81%. A sensitivity of 65.9% with a specificity of 88.4% could be achieved for distinguishing low BMD by setting the VBQ score cutoff as 3.18. The novel VBQ score was a promising tool in distinguishing low BMD in patients with AIS and could be useful as opportunistic assessment for screening and complementary evaluation to QCT before surgery.

The assessment of canal flare index and proximal femoral bone density can improve stem selection for peri-prosthetic bone maintenance after total hip arthroplasty.

Bone maintenance after total hip arthroplasty (THA) is important for implant success. This study aimed to investigate the relationship between patient characteristics and periprosthetic bone maintenance after THA for better implant selection. This retrospective cohort study enrolled 112 consecutive patients who underwent THA using full hydroxyapatite (HA) compaction with short (n = 55) or short-tapered wedge (n = 61) stems. Periprosthetic bone mineral density (BMD) was compared between the two groups after propensity score matching, and the relationship between periprosthetic BMD changes and patient background was analyzed. Both groups showed similar periprosthetic BMD changes after adjusting for patient background using propensity score matching. Canal flare index > 3.7 in patients that underwent THA using tapered-wedge stem (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.3-7.9, p = 0.013) and baseline zone 1 BMD > 0.65 in patients that received with short HA compaction stems (OR, 430.0; 95% CI 1.3-1420, p = 0.040) were associated with proximal periprosthetic bone maintenance after THA. Considering their predictive value, canal flare index and zone 1 BMD assessment might be useful strategies for implant selection during THA.

Impact of Pheochromocytoma or Paraganglioma on Bone Metabolism: A Systemic Review and Meta-analysis

Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap. Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP). Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05--0.03); p < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08-0.17); p < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30-2.64); p = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02-0.07); p < 0.0001]. A decrease in CTx has been documented post-surgery. Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis is essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted.

Vertebral and Femoral Bone Mineral Density (BMD) Assessment with Dual-Energy CT versus DXA Scan in Postmenopausal Females.

This study aimed to demonstrate the potential role of dual-energy CT in assessing bone mineral density (BMD) using hydroxyapatite-fat material pairing in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using a HAP-fat material pair. Statistical analysis was performed using the Bland-Altman method to assess the agreement between DXA and DECT HAP-fat measurements. Mean BMD, vertebral, and femoral T-scores were obtained. For vertebral analysis, the Bland-Altman plot showed an inverse correlation (R2: -0.042; RMSE: 0.690) between T-scores and DECT HAP-fat values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) was found for measurements at the femoral neck. In conclusion, we demonstrate the enhanced importance of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis

BackgroundMalnutrition is common in patients with cirrhosis, eventually leading to sarcopenia and loss of bone mass. AimsThe aims of this study was the assessment of body composition (BC) and bone mineral density (BMD) in patients with decompensated cirrhosis and the prognostic impact on survival after transjugular intrahepatic portosystemic shunt (TIPS) implantation. MethodsBMD and BC of 107 patients with cirrhosis undergoing TIPS implantation were prospectively analyzed by dual-energy X-ray absorptiometry. The prevalence and predisposing risk factors for reduced BMD and sarcopenia were assessed. Impact on 12-month survival after TIPS implantation was evaluated. ResultsSarcopenia was diagnosed in 48.6 % of the patients with a predominance of male patients (58.7% vs. 25.0 %, p = 0.001). 67.2 % had reduced BMD. Low BMI was independently associated with sarcopenia (OR 0.751 (95 % CI: 0.662;0.852), p < 0.001) and reduced BMD (OR 0.851 (0.773;0.937), p = 0.001). Patients with reduced BMD, but not sarcopenia, had impaired 12-month survival after TIPS-implantation (61.2% vs. 82.9 %, p = 0.030). Subgroup analysis showed that this was especially valid for female patients. ConclusionsSarcopenia and reduced BMD are frequently observed in patients with decompensated cirrhosis. Reduced BMD negatively affects post-TIPS survival. Since malnutrition is a leading cause, assessment of nutritional status and specific treatment should be included in clinical practice.

Sagittal Section Hounsfield Units of the Upper Instrumented Vertebrae as a Predictor of Proximal Junctional Vertebral Fractures Following Adult Spinal Deformity Surgery.

A retrospective observational study. This study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs). CT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear. This retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative. PJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05). Measurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.