Bone Mineral Density Measurements Research Articles

Insight into the potential of bone turnover biomarkers: integration in the management of osteoporosis and chronic kidney disease-associated osteoporosis.

Disturbances in mineral and bone metabolism occurring in osteoporosis and chronic kidney disease-associated osteoporosis place patients at high risk of fracture making these conditions a major public health concern. Due to the limited use of bone histomorphometry in clinical practice, the gold standard for assessing bone turnover, extensive efforts have been made to identify bone turnover markers (BTMs) as noninvasive surrogates. Since the identification of certain commonly used markers several decades ago, considerable experience has been acquired regarding their clinical utility in such bone disorders. Mounting evidence suggested that BTMs represent a simple, low-risk, rapid and convenient way to obtain data on the skeletal health and that they may be useful in guiding therapeutic choices and monitoring the response to treatment. BTMs could provide clinicians with useful information, independent from, and often complementary to bone mineral density (BMD) measurements. They have proven valuable for monitoring the effectiveness of osteoporosis therapy, as well as promising for discriminating low and high turnover states. Improved performance is observed when BTMs are combined, which may be useful for selecting treatments for chronic kidney disease-bone mineral disorders (CKD-MBD).

The Prevalence and Risk Factors of Low Bone Mineral Density in the Population of the Abay Region of Kazakhstan

Osteoporosis is considered a serious public health problem that particularly affects the postmenopausal period. In 2018, in the Republic of Kazakhstan, the prevalence of osteoporosis was 10.0, and the incidence was 3.7 new cases, per 100,000 adults, respectively. The objective of this study was to assess the prevalence of osteoporosis and indicate the main factors affecting low bone mineral density by screening the adult population of the Abay region, Kazakhstan. The target group comprised 641 respondents aged between 18 and 65 years old, from a Kazakh population, who had been living in the Abay region since birth. All participants filled out a questionnaire and were subjected to a bone mineral density measurement by means of dual-energy X-ray absorptiometry (DXA) between 15 July 2023 and 29 February 2024. Logistic regression analysis was conducted to assess the association between low bone mineral density and key demographic characteristics, such as lifestyle factors and nutritional habits. We identified the prevalence of low bone mass (osteopenia) and osteoporosis to be 34.1%, with the highest prevalence of 48.3% being found in the older population group (50+ years). The regression analysis revealed a number of indicators associated with the likelihood of bone sparing. However, only four of these showed significance in the final multivariate model (R2 = 22.4%). These were age (adjusted odds ratio (AOR) 1.05) and fracture history (AOR 1.64) directly associated with the likelihood of low bone density. Meanwhile, the body mass index (AOR 0.92) and the consumption of nuts and dried fruits (AOR 0.48) reduced the chance of bone tissue demineralization. Additional studies examining the prevalence and any emerging risk factors for osteoporosis are needed to advance clinical epidemiological knowledge and implement public health programs.

Low Bone Mineral Density as a Predictor of Mortality and Infections in Stroke Patients: A Hospital-based Study.

Low bone mineral density (BMD) has been linked to elevated risks of mortality and infections in the general population; however, its association with these outcomes in stroke patients remains unclear. This study aims to investigate the correlation between low BMD and risks of mortality and infections among stroke patients in a Taiwanese cohort. In this single-centered retrospective cohort study, 905 stroke patients from a Taiwanese database (2000-2022) were analyzed. Patients were divided based on BMD measurements of the femur and spine. The primary outcome was all-cause mortality, and secondary outcomes included urinary tract infection (UTI) and pneumonia. Accelerated failure time regression model analyses evaluated the association between BMD and these outcomes, while the Kaplan-Meier method and log-rank test assessed survival differences between groups. Among the participants (average age 76.1 years, 70.5% female), 33.82% had osteopenia and 55.25% had osteoporosis. Stroke patients with lower spine and right femur BMD had significantly reduced survival rates, especially when the BMD value fell below 0.842 g/cm2 (spine), and 0.624 g/cm2 (right femur), respectively. Regarding secondary outcomes, lower spine BMD was significantly associated with an increased risk of UTI. Low BMD, particularly in the femur and spine, is a significant predictor of mortality and UTI in stroke patients. These findings highlight the importance of assessing and managing BMD in stroke patients to improve outcomes and reduce complications.

#1763 Risk factors and clinical prediction models for osteoporosis in predialysis chronic kidney disease patients

Abstract Background and Aims The research concerning osteoporosis among individuals with predialysis chronic kidney disease (CKD) has been relatively neglected in existing literature. Furthermore, the risk factors for osteoporosis in this demographic have not been adequately investigated. The objective of this study was to explore the risk factors associated with osteoporosis in predialysis CKD patients and to construct a predictive model capable of estimating the likelihood of osteoporosis in these individuals. Method A retrospective study was conducted on 326 predialysis CKD patients. Relevant clinical examination results and measurements of bone mineral density (BMD) using dual-energy X-ray absorptiometry were collected. Binary logistic regression was utilized to explore the risk factors associated with osteoporosis and to develop predictive models. Results In male predialysis CKD patients, age represents a risk factor, while 25-(OH)-Vitamin D acts as a protective factor against osteoporosis. Among female patients, age, underweight status, NBAP, and advanced CKD (G5) are significant risk factors for osteoporosis, whereas PTH serves as a protective factor. In pre-dialysis CKD patients in stages CKD1-4, age, underweight status, and NBAP are identified as risk factors for osteoporosis. For G5 predialysis patients, advanced age and NBAP pose a high risk of osteoporosis, while 25-(OH)-Vitamin D and PTH exhibit protective effects. Additionally, nomogram models illustrating the risk of osteoporosis in pre-dialysis patients of different genders and renal function stages were created. Conclusion Age, underweight, severity of renal dysfunction, NBAP, PTH, and 25-(OH)-vitamin D are strongly associated with osteoporosis in predialysis CKD patients.

#1648 Chronic kidney disease-mineral bone disorder and fractures in predialysis patients

Abstract Background and Aims Chronic Kidney Disease (CKD) patients have a complex physiopathology of bone fragility given the development of mineral bone disorder (CKD-MBD) and are at increased fracture risk [1]. Bone turnover, mineralization, and volume (TMV) classification, as proposed by Kidney Disease Improving Global Outcomes (KDIGO), defines different subtypes of renal osteodystrophy (ROD), and is evaluated through bone biopsies and respective histomorphometric analysis. The impact of these parameters and of different ROD subtypes in fracture occurrence has not been evaluated. We aim to evaluate the incidence of fractures in patients with predialysis CKD and the relationship of ROD subtypes and the impact of bone volume with the occurrence of fractures. Method We conducted a retrospective study that enrolled 54 patients (40-89 years old) followed in a predialysis clinic between 2014-2023. Blood tests, bone biopsies and histomorphometric analysis were performed at the beginning of follow-up. Data from dual x-ray absorptiometry (DXA) scan were collected if available. Information regarding clinical evident fractures was recorded from analysis of clinical registries. Radiographies of the thoracic and/or lumbar spine were evaluated to detect asymptomatic vertebral fractures. Results Median follow-up time was 7.5 ± 3 years. Mean age at the time of bone biopsy was 65.4 ± 9.8 years old and most patients were male (n = 43, 79.6%). The majority had CKD stage 4 (53.7%). During follow-up, 20 (37%) patients progressed to kidney replacement therapy and 5 (9.3%) died. DXA scan was performed in 19 patients (35.2%). Of these, 5 had osteoporosis (T-score ≤-2,5). The histomorphometric analysis showed that 40.7% (n = 22) patients had normal bone histology, 37% (n = 20) low bone turnover with normal mineralization (adynamic bone disease) and 22.3% (n = 12) high bone turnover with normal mineralization (hyperparathyroid bone disease). Two patients sustained clinical evident fractures. Radiographies of 51 patients were reviewed and asymptomatic vertebral fractures were identified in 3 (5.9%). The group that suffered fractures had higher phosphorus levels and these differences were statistically significant (4.1 mg/dL vs 3.5 mg/dL, p = 0.047). None of the patients with osteoporosis diagnosed by DXA scan fractured and bone mineral density (BMD) by DXA was similar between the groups (−1.05 vs −1.04, p = 0.530). The different histomorphometric subtypes and circulating biomarkers did not correlate with the incidence of fractures. Patients with fractures had more frequently low bone volume (40%) than patients who do not sustained fractures (25.5%) but this difference was not significant (p = 0.579). BV/TV was lower in the group that sustained fractures during follow-up (16.1 (11.9-17.2) vs 19.0 (16.2-23.6)) and this achieved borderline significance (p = 0.052). Femoral neck BMD measures in the patients who had an available DXA scan did not show any correlation with BV/TV (r = 0.039, p = 0.874). Conclusion No relationship was found between different ROD subtypes and the incidence of fractures. However, when considering bone volume isolated (but not BMD assessed by DXA), a marginally significant association was found between a low BV/TV value and the occurrence of fractures. High phosphorus levels also associated with fractures and have been previously described as a possible risk factor for fractures not only in CKD patients but also general population [2, 3]. Further studies with a larger population are needed to validate these conclusions with statistical power.

Methionine and one carbon metabolism as a regulator of bone remodeling with fasting.

Caloric restriction improves metabolic health, but is often complicated by bone loss. We studied bone parameters in humans during a 10-day fast and identified candidate metabolic regulators of bone turnover. P1NP, a bone formation marker, decreased within 3 days of fasting. Whereas dual-energy X-ray absorptiometry measures of bone mineral density were unchanged after 10 days of fasting, high-resolution peripheral quantitative CT demonstrated remodeling of bone microarchitecture. Pathway analysis of longitudinal metabolomics data identified one-carbon metabolism as fasting-dependent. In cultured osteoblasts, we tested the functional significance of one-carbon metabolites modulated by fasting, finding that methionine - which surged after 3 days of fasting - impacted markers of osteoblast cell state in a concentration dependent manner, in some instances exhibiting a U-shaped response with both low and high concentrations driving putative anti-bone responses. Administration of methionine to mice for 5 days recapitulated some fasting effects on bone, including a reduction in serum P1NP. In conclusion, a 10-day fast in humans led to remodeling of bone microarchitecture, potentially mediated by a surge in circulating methionine. These data support an emerging model that points to a window of optimal methionine exposure for bone health.

Generation and Validation of Normative, Age-Specific Reference Curves for Bone Strain Index in Women.

Bone Strain Index (BSI), based on dual-energy X-ray absorptiometry (DXA), is a densitometric index of bone strength of the femur and lumbar spine. Higher BSI values indicate a higher strain applied to bone, predisposing to higher fracture risk. This retrospective, multicentric study on Italian women reports the BSI normative age-specific reference curves. A cohort of Caucasian Italian women aged 20 to 90 years was selected from three different clinical centres. Bone mineral density (BMD) and BSI measurements were obtained for the lumbar spine vertebrae (L1-L4) and for the femur (neck, trochanter and intertrochanter) using Hologic densitometers scans. The data were compared with BMD normative values provided by the densitometer manufacturer. Then, the age-specific BSI curve for the femur and lumbar spine was generated. No significant difference was found between the BMD of the subjects in this study and BMD reference data provided by Hologic (p = 0.68 for femur and p = 0.90 for lumbar spine). Spine BSI values (L1-L4) increase by 84% between 20 and 90 years of age. The mean BSI of the total femur increases about 38% in the same age range. The BSI age-specific reference curve could help clinicians improve osteoporosis patient management, allowing an appropriate patient classification according to the bone resistance to the applied loads and fragility fracture risk assessment.

Achieving osteoporosis treat-to-target goals with teriparatide or alendronate: sub-analysis of Japanese Osteoporosis Intervention Trial-05 (JOINT-05).

The purpose of this study was to evaluate whether bone mineral density (BMD) ≥ -2.5 SD could be used as the treat-to-target (T2T) goal when treating osteoporosis with teriparatide (TPTD) and alendronate (ALN), and to investigate the relationship with incident vertebral fracture by re-analyzing data from a randomized, controlled trial (JOINT-05) involving postmenopausal Japanese women at high fracture risk. Participants received sequential therapy with once-weekly TPTD for 72weeks, followed by ALN for 48weeks (TPTD-ALN group) or ALN monotherapy for 120weeks (ALN group). BMDs were measured at the lumbar spine (L2-4), total hip, and femoral neck at 0, 24, 48, 72, and 120weeks by dual-energy X-ray absorptiometry. The T2T goal was BMD ≥ -2.5 SD, and the endpoint was the proportion of participants with baseline BMD < -2.5 SD in three measurement sites achieving BMD ≥ -2.5 SD. A total of 559 participants were selected. BMD ≥ -2.5 SD at 120weeks in the L2-4, total hip, and femoral neck sites was achieved in 20.5%, 23.1%, and 5.9%, respectively, in the TPTD-ALN group and 22.2%, 11.7%, and 7.3%, respectively, in the ALN group. Incident vertebral fractures occurred in areas of both lower and high BMD. During the 1.5-year treatment period, more than 20% of participants achieved BMD ≥ -2.5 SD as a T2T goal at L2-4. Since the achievement level differed depending on the BMD measurement site, the appropriate site should be selected according to the baseline BMD level.

Persistent changes in calcium-regulating hormones and bone turnover markers in living kidney donors more than 20 years after donation

Abstract In a previous study, we observed decreased 1,25-dihydroxyvitamin D levels, secondary hyperparathyroidism, and increased bone turnover markers in living kidney donors (LKDs) at 3 months and 36 months after kidney donation. In our recent survey-based study, we found no increased risk of fractures of all types but observed significantly more vertebral fractures in LKDs compared to matched controls. To elucidate the long-term effects of kidney donation on bone health, we recruited 139 LKDs and 139 age and sex matched controls from the survey-based participants for further mechanistic analyses. Specifically, we assessed whether LKDs had persistent abnormalities in calcium and phosphorus-regulating hormones and related factors, in bone formation and resorption markers, and in density and microstructure of bone compared with controls. We measured serum markers, bone mineral density (BMD), bone microstructure and strength (via high-resolution peripheral quantitative computed tomography and micro-finite element analysis [HRpQCT]), and advanced glycation end-products (AGEs) in donors and controls. LKDs had decreased 1,25-dihydroxyvitamin D concentrations (donors mean 33.89 pg/mL vs. controls 38.79 pg/mL, percent difference = -12.6%; P &amp;lt; 0.001), increases in both parathyroid hormone (PTH when corrected for ionized calcium; donors mean 52.98 pg/mL vs. controls 46.89 pg/mL,% difference 13%; P = 0.03) and ionized calcium levels (donors mean 5.13 mg/dL vs. controls 5.04 mg/dL; P &amp;lt; 0.001) and increases in several bone resorption and formation markers versus controls. LKDs and controls had similar measures of BMD; however, HRpQCT suggested that LKDs have a statistically insignificant tendency towards thinner cortical bone and lower failure loads as measured by micro-finite element analysis. Our findings suggest that changes in the hormonal mileu after kidney donation and the long-term cumulative effects of these changes on bone health persist for decades after kidney donation and may explain later-life increased rates of vertebral fractures.

Fracture Risk Associated with Different Numbers and Combinations of Lumbar Vertebrae: The Manitoba BMD Registry

Bone mineral density (BMD) is widely used for assessment of fracture risk. For the lumbar spine, BMD is typically measured from L1-L4 as it provides the largest area for assessment with the best measurement precision. Structural artifact often confounds spine BMD in clinical practice, and the International Society for Clinical Densitometry (ISCD) recommends removing vertebrae with artifact when reporting spine BMD. In its most recent position statements, the ISCD recommended against the use of a single vertebra when reporting spine BMD but stated that further studies should be done. The current analysis was performed to compare the performance of BMD from different numbers and combination of vertebral levels on fracture prediction in a large clinical registry of DXA tests for the Province of Manitoba, Canada. The study population comprised 39,727 individuals aged 40 years and older (mean age 62.7 years, 91.0 % female) with baseline DXA after excluding those with evidence of structural artifact. Mean follow-up for ascertaining fracture outcomes was 8.7 years. Area under the curve (AUC) for incident fracture risk stratification was statistically significant regardless of the BMD measurement site or fracture outcome. AUC differences with the various numbers and combinations of vertebral levels including a single vertebral body were small (less than or equal to 0.01). More substantial AUC differences were seen for femoral neck and total hip BMD versus L1-L4 BMD, approaching 0.1 for hip fracture stratification. In summary, we found that using combinations of fewer than 4 vertebrae including individual lumbar vertebrae predicted incident fractures. Importantly, differences between these different combinations were small when compared with L1-L4. Spine BMD was a better predictor of incident spine fracture compared to the hip, whereas the hip was better for hip fracture and overall fracture prediction.

Machine-learning models for diagnosis of rotator cuff tears in osteoporosis patients based on anteroposterior X-rays of the shoulder joint

ObjectiveThis study aims to diagnose Rotator Cuff Tears (RCT) and classify the severity of RCT in patients with Osteoporosis (OP) through the analysis of shoulder joint anteroposterior (AP) X-ray-based localized proximal humeral bone mineral density (BMD) measurements and clinical information based on machine learning (ML) models. MethodsA retrospective cohort of 89 patients was analyzed, including 63 with both OP and RCT (OPRCT) and 26 with OP only. The study analyzed a series of shoulder radiographs from April 2021 to April 2023. Grayscale values were measured after plotting ROIs based on AP X-rays of shoulder joint. Five kinds of ML models were developed and compared based on their performance in predicting the occurrence and severity of RCT from ROIs' greyscale values and clinical information (age, gender, advantage side, lumbar BMD, and acromion morphology (AM)). Further analysis using SHAP values illustrated the significant impact of selected features on model predictions. ResultsR1-6 had a positive correlation with BMD respectively. The nine variables, including greyscale R1-6, age, BMD, and AM, were used in the prediction models. The RF model was determined to be superior in effectively diagnosing RCT in OP patients, with high AUC scores of 0.998, 0.889, and 0.95 in the training, validation, and testing sets, respectively. SHAP values revealed that the most influential factors on the diagnostic outcomes were the grayscale values of all cancellous bones in ROIs. A column-line graph prediction model based on nine variables was constructed, and DCA curves indicated that RCT prediction in OP patients was favored based on this model. Furthermore, the RF model was also the most superior in predicting the types of RCT within the OPRCT group, with an accuracy of 86.364% and 73.684% in the training and test sets, respectively. SHAP values indicated that the most significant factor affecting the predictive outcomes was the AM, followed by the grayscale values of the greater tubercle, among others. ConclusionsML models, particularly the RF algorithm, show significant promise in diagnosing RCT occurrence and severity in OP patients using conventional shoulder X-rays based on the nine variables. This method presents a cost-effective, accessible, and non-invasive diagnostic strategy that has the potential to substantially enhance the early detection and management of RCT in OP patient population.

تصميم وتنفيذ جهاز محمول لقياس كثافة العظام بالموجات فوق الصوتية

هشاشة العظام مرض يتميز بانخفاض كتلة العظام مما يزيد من خطر الإصابة بالكسور. يعتبر مقياس كثافة امتصاص الأشعة السينية ثنائي الطاقة (DXA) بمثابة المعيار الذهبي لقياس كثافة المعادن في العظام (BMD). في سورية، يعد DXA مكلفاً وغير متوفر على نطاق واسع ويقترن بتردد قوي بين المرضى فيما يتعلق بالتعرض للإشعاع المؤين. من ناحية أخرى، وجدت العديد من الدراسات الحديثة أن الموجات فوق الصوتية الكمية (QUS) مفيدة في تحديد تشخيص هشاشة العظام وإعطاء معلومات دقيقة حول صفات العظام. كان الهدف من هذه الدراسة هو تصميم وبناء جهاز قياس كثافة العظام بالموجات فوق الصوتية لقياس كثافة المعادن بالعظام. الجهاز محمول (0.4 كيلو غرام) وهو اقل تكلفة بكثير وليس له اي اثر ضار من الاشعاعات المؤينة. تم تصميم الجهاز باستخدام زوج من أجهزة توليد واستشعار بالموجات فوق الصوتية HC-SR04 لإرسال واستقبال الموجات فوق الصوتية عبر العظم ثم تضخيمها وقراءتها رقمياً باستخدام منصة Arduino. تم تنفيذ الجهاز باستخدام نموذج مُصمم مسبقاً باستخدام برنامج CAD، مع رأس قياس متحرك بحيث يمكن أن يكون مناسباً للعديد من المرضى من مختلف الأعمار. تم اختبار الجهاز على العديد من الأفراد الأصحاء والمرضى من مختلف الجنسين، الذين تتراوح أعمارهم بين 18 و 85 عاماً، كما تمت معايرته والتحقق من صحته باستخدام قيمة كثافة المعادن بالعظام التي يوفرها مقياس كثافة العظام DXA. أظهرت النتائج أن أجهزتنا حساسة بدرجة كافية للتمييز بين الأفراد الأصحاء والمرضى باستخدام أدوات منخفضة التكلفة. وفقًا لذلك، قد يكون للجهاز المقترح فرصة جيدة في المستقبل ليتم اعتباره مقياس كثافة عظام محمول فعال ومنخفض التكلفة.

Risk factors for decreased bone mineral density in patients with metabolic dysfunction-associated steatotic liver disease: A cross-sectional study at a health examination center

Background & AimsSteatotic liver disease (SLD) is often detected in health examinations. However, although individuals with metabolic dysfunction-associated SLD (MASLD) may have decreased bone mineral density (BMD), the specific risk factors remain unclarified. The objective of this study was to identify the factors associated with decreased BMD in patients with MASLD. MethodsIndividuals who underwent abdominal ultrasonography and BMD measurements at our healthcare center were included. The BMD of the calcaneus was assessed using an AOS-10SA bone densitometer. Decreased BMD was defined as a T-score below -1.0 SD or the administration of osteoporosis treatment. SLD was diagnosed based on specific ultrasonographic criteria. ResultsA total of 1,410 patients were diagnosed with MASLD. The median age was 52 years. Multivariate analysis using a logistic regression model revealed that the independent predictors of decreased BMD were a low body mass index (BMI) or a small waist circumference (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.34–0.67), hypertriglyceridemia (OR: 1.29, 95% CI: 1.00–1.65), and a weak grip strength (OR: 0.98, 95% CI: 0.97–1.00). Subgroup analyses of individuals aged 50 years or older, men, and individuals with a FIB-4 index of 1.3 or greater revealed that the absence of a high BMI or a large waist circumference was associated with decreased BMD. The subgroup analysis of men revealed that a weaker grip strength was associated with decreased BMD. ConclusionThe present study suggested several potential risk factors for decreased BMD in patients with MASLD. Individuals with the abovementioned risk factors should be encouraged to undergo BMD measurement from the perspective of preventive medicine.

Association of serum sclerostin levels with marrow adiposity in postmenopausal women with glucocorticoid-induced osteoporosis

BackgroundGlucocorticoids and sclerostin act as inhibitors of the Wnt signaling pathway, thereby hindering bone formation. Given the pathway's intricate association with mesenchymal stem cells, the hypothesis suggests that heightened sclerostin levels may be intricately linked to an augmentation in marrow adiposity induced by glucocorticoids. This study endeavored to delve into the nuanced relationship between circulating sclerostin and bone marrow adipose tissue in postmenopausal women grappling with glucocorticoid-induced osteoporosis (GIO).MethodsIn this cross-sectional study, 103 patients with autoimmune-associated diseases underwent glucocorticoid treatment, boasting an average age of 61.3 years (standard deviation 7.1 years). The investigation encompassed a thorough assessment, incorporating medical history, anthropometric data, biochemical analysis, and dual-energy X-ray absorptiometry measurements of lumbar and femoral bone mineral density (BMD). Osteoporosis criteria were established at a T-score of -2.5 or lower. Additionally, MR spectroscopy quantified the vertebral marrow fat fraction.ResultsBMD at the femoral neck, total hip, and lumbar spine showcased an inverse correlation with marrow fat fraction (r = –0.511 to – 0.647, P < 0.001). Serum sclerostin levels exhibited a positive correlation with BMD at various skeletal sites (r = 0.476 to 0.589, P < 0.001). A noteworthy correlation emerged between circulating sclerostin and marrow fat fraction at the lumbar spine (r = –0.731, 95% CI, –0.810 to –0.627, P < 0.001). Multivariate analysis brought to light that vertebral marrow fat fraction significantly contributed to sclerostin serum concentrations (standardized regression coefficient ß = 0.462, P < 0.001). Even after adjusting for age, body mass index, physical activity, renal function, BMD, and the duration and doses of glucocorticoid treatment, serum sclerostin levels maintained a significant correlation with marrow fat fraction.ConclusionsCirculating sclerostin levels exhibited a noteworthy association with marrow adiposity in postmenopausal women grappling with GIO.

“The least significant change on bone mineral density scan increased in patients with higher degrees of obesity”

Background: The least significant change (LSC) threshold of 0.03 g/cm² is used to interpret bone mineral density (BMD) scans in the general population. Our working hypothesis was that the current LSC threshold would not be applicable in obese populations. Aims: The aim of this study was to calculate the LSC in an obese population. Methods: We performed an interventional study among 120 obesity patients, in whom two measurements of BMD were performed at 3 sites. Pairs of measures were used to calculate the LSC, using the Bland and Altman method. Results: We calculated that the LSC was 0.046 g/cm² at the lumbar spine, 0.069 g/cm² at the femoral neck, and 0.06 g/cm² at the total hip. We also calculated the LSC for each class of obesity and observed an increase in LSC with increasing body mass index (BMI). We calculated a LSC of 0.05 g/cm² in patients with class 2 or class 3 obesity, whereas the LSC in patients with class 1 obesity is similar to the threshold used in the general population. Discussion: In obese population, like BMD, LSC is higher than the threshold value of the general population, and increases with increasing BMI.Conclusion: LSC of 0.05 g/cm² could be used in clinical practice in patients with class 2 or 3 obesity. These findings should help to improve the interpretation of BMD scans in these patients and optimize their management. Trial registration number: Comité de Protection des Personnes Ile-de France VII, France.

The characteristics of the body mass frequency index in dysmobility syndrome: A pilot study

BackgroundWith the advancement of global aging, there has been an increase in patients with dysmobility syndrome (DS), often accompanied by osteoporosis, sarcopenia, and sarcopenic obesity. The objective of this study was to evaluate the application value of the body mass frequency index (BMFI) in older patients with DS by comprehensively analyzing the differences in BMFI between community-dwelling older subjects using medical and engineering methods. MethodsA cross-sectional study was conducted to recruit community-dwelling older subjects aged 60–90 years. Various assessments and measurements were performed, including basic information collection, gait analysis, bone mineral density (BMD) and body composition measurement, fall and fracture risk et al. Gait analysis and body mass index (BMI) are in the established model to calculate BMFI. Analysis of BMFI was performed in community-dwelling older subjects, and the specificity and threshold of BMFI in predicting dysmobility syndrome (DS) were further analyzed. ResultsSignificant differences in BMFI were observed between older adults with DS and those without DS. BMFI in older people was associated with bone quality, fracture risk, body fat percentage, appendicular skeletal muscle mass index (ASMI), grip strength, and speed. The odds ratio (OR) and 95 % confidence interval (CI) for BMFI in the non-DS and DS groups were 0.823 (0.743–0.901), respectively. Receiver operating characteristic (ROC) analysis demonstrated that BMFI had predictive value in distinguishing non-DS from DS (AUC = 0.669) (P < 0.05). The optimal threshold for predicting non-DS and DS was found to be 16.04 (sensitivities = 0.483, specificities = 0.774). ConclusionThe measurement of BMFI has demonstrated disparities in musculoskeletal status among older adults with and without DS. Notably, BMFI exhibits a unique predictive capacity for DS among the elderly population.

Changes in Testing and Treatment Methods in Osteoporosis Care.

Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment.

Bidirectional mediation of bone mineral density and brain atrophy on their associations with gait variability

This mediation analysis aimed to investigate the associations among areal bone mineral density, mobility-related brain atrophy, and specific gait patterns. A total of 595 participants from the Taizhou Imaging Study, who underwent both gait and bone mineral density measurements, were included in this cross-sectional analysis. We used a wearable gait tracking device to collect quantitative gait parameters and then summarized them into independent gait domains with factor analysis. Bone mineral density was measured in the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. Magnetic resonance images were obtained on a 3.0-Tesla scanner, and the volumes of brain regions related to mobility were computed using FreeSurfer. Lower bone mineral density was found to be associated with higher gait variability, especially at the site of the lumbar spine (β = 0.174, FDR = 0.001). Besides, higher gait variability was correlated with mobility-related brain atrophy, like the primary motor cortex (β = 0.147, FDR = 0.006), sensorimotor cortex (β = 0.153, FDR = 0.006), and entorhinal cortex (β = 0.106, FDR = 0.043). Bidirectional mediation analysis revealed that regional brain atrophy contributed to higher gait variability through the low lumbar spine bone mineral density (for the primary motor cortex, P = 0.018; for the sensorimotor cortex, P = 0.010) and the low lumbar spine bone mineral density contributed to higher gait variability through the primary motor and sensorimotor cortices (P = 0.026 and 0.010, respectively).

Assessing Change in Spine Bone Density from Different Numbers and Combinations of Lumbar Vertebrae: The Manitoba BMD Registry

Introduction: Change in bone mineral density (BMD) is considered significant when it exceeds the 95 % least significant change (LSC) derived from that facility's precision study. The lumbar spine is often affected by structural artifact such that not all four lumbar vertebrae are evaluable. Guidelines suggest using a site-matched LSC when omitting vertebrae from the BMD measurement. The current study describes significant BMD change related to intervening anti-osteoporosis treatment for different numbers and combinations of lumbar vertebrae using site-matched LSC values.Methodology: We identified 10,526 untreated adult women mean age 59.6 years with baseline and repeat spine BMD testing (mean interval 4.7 years) where all 4 lumbar vertebrae were evaluable. Change in spine BMD for different combinations of lumbar vertebrae was assessed in relation to intervening anti-resorptive treatment, contrasting women with high treatment exposure (medication possession ratio, MPR ≥ 0.8) versus women who remained untreated. Site-matched LSC values were derived from 879 test-retest precision measurements.Results: There was consistent linear trend between increasing MPR and BMD change exceeding the LSC for all lumbar vertebral combinations, positive with BMD increase and negative with BMD decrease (all p-trend <0.001). In the high treatment exposure group, mean percent increases in spine BMD were similar for all vertebral combinations, from L1-4 to a single vertebra. In untreated women, mean percent decreases in spine BMD were also similar for all vertebral combinations. The net treatment response (proportion of women with treatment-concordant changes minus proportion with treatment-discordant changes exceeding the LSC) was 29.7 % for 4 vertebrae, 27.5-30.0 % for 3 vertebrae, 22.4-28.5 % for 2 vertebrae, and 18.1-21.9 % for a single vertebra.Conclusions: All numbers and combinations of lumbar vertebrae, when used in conjunction with site-matched LSC values, can provide clinically meaningful follow-up in treated and untreated patients, even when spine BMD is based on a single vertebral body.

The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report.

Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.