Bone Mineral Density Scans Research Articles

The Impact of Freezing on Bone Mineral Density: Implications for Forensic Research.

It is common for researchers using animal or human remains for scientific study to freeze samples prior to use. However, effects of freezing on bone macro- or microstructure are relatively unknown. The research objective of this study was to determine whether freezing could potentially bias experimental results by analyzing changes in bone mineral density (BMD) with the freezing of remains over time. Eight fetal pigs were scanned to determine their initial BMD before freezing. Three piglets underwent a freeze-thaw cycle to assess the effects of the freezing process. Four piglets were frozen and scanned weekly for 20 weeks to assess freezing over time. The overall average between the fresh initial scan and final frozen scan was significantly different (p < 0.001). Per contra, the final thawed BMD scans did not differ from the initial fresh scan (p = 0.418). Thus, completely thawed remains are recommended for experimental studies.

The impact of Vitamin D Deficiency on Bone Mineral Density at Different Age Groups: A Middle Eastern and Asian Cohort

Objectives:This is a pilot study to evaluate the skeletal consequences of the vitamin D deficiency in a big cohort of patients who are Vitamin D naive. Primarily we aimed to assess the effect of vitamin D deficiency on the BMD. Secondarily, we wanted to correlate the low vitamin D and the risk of osteopenia and osteoporosis in different age and gender groups. Methods: This is a retrospective study that analyzed patients who checked their vitamin D between 2007-2015. Age, gender, vitamin D level, serum calcium, creatinine, whether patient is receiving renal replacement therapy or not and bone mineral density scan (DEXA). Results: Total number of patients included was 2587 patients. Overall osteopenia was 47.5% of female’s n=907, while 24.0% of men n=459 had it. But, osteoporosis was in 24.1% n=459 of females, versus 32.2% n=218 of males with a p= of 0.00. 28% of males had normal BMD n=544, and 28.55% of females n=544. Osteoporosis was in >50-years age (78% of those who had osteoporosis). 26% of those who underwent DEXA scan had osteoporosis n=677, 47% had osteopenia n=1216, and 28% had normal BMD n=694 to have normal BMD. At the age of 20-50 years; 36% had normal BMD, 16.8% and 24.2% had osteoporosis and osteopenia, respectively, with a p- value of 0.000. Conclusion: Our studies have shown female predominance of osteopenia plus osteoporosis together, but male’s predominance in the osteoporosis alone. Elder lies had higher rates of osteoporosis. After clearance of the confounding factors, female gender, age >50 years, serum calcium <8 and vitamin D level <10ng/ml are all considered as independent risk factors of osteoporosis.

More-than-minimal-trauma fractures are associated with low bone density: an 8-year prospective study.

The aim of this study was to assess the prevalence and predictors of low bone density in men and women with more-than-minimal-trauma fractures. In an Australian hospital, 630 community-dwelling men and women, 20years of age or older, sustained a fracture due to more-than-minimal-trauma (force greater than a fall from standing height but less than high trauma). We studied 349 individuals who agreed to have a bone mineral density (BMD) scan. These participants were compared with 472 men and women with minimal trauma fractures. Men and women with more-than-minimal-trauma fractures had significantly lower bone density than expected for their age, gender and weight (Z-scorespine = -0.4 SD, 95% confidence interval (CI), -0.5 to -0.3; Z-scorehip = -0.5 SD, 95% CI, -0.6 to -0.4). Almost 1 in 4 of those over 50years of age had osteoporosis by BMD criteria. The independent predictors of low bone density (T-score <-2.0 SD) were age equal to or over 50years (odds ratio (OR) = 5.97, 95% CI, 3.34 to 10.65), low body weight <20kg/m2 (OR = 3.44, 95% CI, 1.32 to 8.94), a prior minimal trauma fracture (OR = 2.76, 95% CI, 1.17-6.52) and in those over 50years of age, an osteoporosis-associated condition (OR = 4.51, 95% CI, 1.69 to 12.06). Men and women with more-than-minimal-trauma fractures had similar bone density (Z-score) compared to those with minimal trauma fractures. Men and women over 50years with a more-than-minimal-trauma fracture, especially those with low body weight, prior minimal trauma fracture or an osteoporosis-associated condition, should be investigated to exclude low bone density and its associated risk of subsequent fractures.

Is there a relation between pre-sarcopenia, sarcopenia, cachexia and osteoporosis in patients with ankylosing spondylitis?

BackgroundOsteoporosis is a well-known complication of ankylosing spondylitis (AS). However, data about body composition modifications and muscle performance showed conflicting results. The aim of the study was to determine the prevalence and risk factors of pre-sarcopenia, sarcopenia and cachexia in patients with AS and analyze its relationship with bone loss and symptomatic and severity parameters of the disease.MethodsSixty-seven consecutive male patients with AS (mean age of 40.9 ± 11.0 years) and 67 healthy controls were studied. Body composition and bone mineral density (BMD) scans were obtained using DXA. The fat-free mass index (FFMI; fat-free mass divided by height squared) and the percent of fat mass (%FM) were calculated. Pre-sarcopenia was defined by low skeletal muscle mass (SMI <7.25 kg/m2), sarcopenia by the combined presence of the two following criteria: SMI <7.25 kg/m2 and a low muscle strength (handgrip strength <30 kg) or a low muscle performance (timed get-up-and-go test >10 s) and cachexia by a BMI <20 kg/m2 plus 3 from the 5 following parameters: anorexia, fatigue, handgrip strength <30 kg, CRP >5 mg/l, SMI <7.25 kg/m2.ResultsPre-sarcopenia, sarcopenia, cachexia, and osteoporosis prevalences were (50.4, 34.3, 11.9, and 16.0) respectively. Patients had a mean 3 kg significant decrease in FFM and a 1 kg/m2 decrease in appendicular mass vs. healthy controls. Pre-sarcopenia, sarcopenia and cachexia were significantly associated to higher BASDAI levels and low BMD.ConclusionOur study showed that men with AS had a statistically significant reduction in total and appendicular lean mass that is related to higher disease activity and significantly associated to bone loss.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1155-z) contains supplementary material, which is available to authorized users.

Pelvic Floor Symptoms and Spinal Curvature in Women.

To characterize the association between thoracic (T) and lumbar (L) spinal curvature and pelvic floor (PF) symptoms (pelvic organ prolapse, urinary incontinence [UI], fecal incontinence [FI]). Of women undergoing a bone mineral density scan from January 2007 to October 2010, patients who completed PF symptom questionnaires and had T and/or L spine radiographs or computed tomography examinations within 3 years of questionnaire completion were included in this study. The spine angles were measured using the Cobb angle method. The T and L curvatures were categorized as hypokyphosis (<20°), normal T kyphosis (20-40°), hyperkyphosis (>40°), hypolordosis (<40°), normal L lordosis (40-70°), and hyperlordosis (>70°). The presence and type of UI were identified with the 3 Incontinence Questionnaire and FI with the Modified Manchester Questionnaire. Pelvic organ prolapse was defined as a positive response to the presence of a bulge question from the PF Distress Inventory-20. Of 1665 eligible women, 824 and 302 (mean age 64 ± 10 for both) had T and L spine images, respectively. No differences in PF symptoms were observed in the T or L spine groups categorized by hypo-, normal, and hyperkyphosis/lordosis except for urgency UI being more prevalent in the hypolordosis group (P = 0.01). However, upon further characterization using logistic regression, no association was noted between PF symptoms and T or L spine angles; no differences in the mean angles were found between women with versus without PF symptoms (P ≥ 0.05). The current study shows that the T and L spinal curvatures are not associated with the presence of PF symptoms.

BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearson’s correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

Correlation of Bone Mineral Density Scores and Proton Pump Inhibitors Use in the Elderly.

We aimed to identify any correlation between long-term proton pump inhibitor use and low bone mineral density in the elderly. This is a retrospective cohort study looking at PPI usage and bone mineral density scores of patients age 65 and above within a period of two years. Lumbar spine, right hip, and left hip bone mineral density t-scores were reviewed in PPI users and non-users. A total of 1,016 patients who had bone mineral density scans within that period were identified. Non-adjusted data showed no statistically significant association between PPI users and non-users in lumbar spine (p = 0.903), right hip (p = 0.775) and left hip (p = 0.407) bone mineral density scores. After adjusting for age and gender, PPI use was still not associated with low bone mineral density at the lumbar spine (p = 0.957), right hip (p = 0.440), or left hip (p = 0.691). The logistic regression did not show a statistically significant difference in low bone mineral density scores in lumbar spine (p = 0.162), right hip (p = 0.796), and left hip (p = 0.196) when length of use was considered. Among adults 65 years and older proton pump inhibitors users; there appears to be no correlation between PPI use and low bone mineral density and/or the length of PPI use.

A 7-Year Longitudinal Trial of the Safety and Efficacy of a Vitamin/Mineral Enhanced Plant-Sourced Calcium Supplement

Objectives: The objective of this study was to examine the safety and efficacy of a vitamin–mineral enhanced plant-sourced calcium AlgaeCal calcium (AC) in female consumers who had taken the supplement from 1 to 7 years.Methods: Consumers who had completed at least one dual-energy x-ray absorptiometry (DEXA) bone mineral density (BMD) scan (N = 172) and/or blood chemistry test (N = 30) and purchased AC from 1 to 7 years were contacted and offered complimentary repeat tests. Safety and efficacy were examined by annualized changes in a 45-measurement blood chemistry panel and changes in BMD.Results: No adverse effects or safety concerns were found in any of the annualized within-group annualized changes in the 45 blood chemistries or in between-group changes in a similar control group (n = 5070) who completed the same measurements. With regard to BMD, consistent and statistically significant within-group increases were found for the 7-year study period and when compared to expected BMD changes in 3 large databases or the combination (N = 25,885) of the 3 databases. Data from this study suggest that AC supplement was associated with a significant annualized and linear increase in BMD of 1.04% per year, 7.3% over the 7-year study period. These results stand in marked contrast to normative or expected changes of −0.4%/y from 3 different databases or in a combination of all 3 databases (N = 16,289).Conclusions: No evidence was found in cardiovascular risk as measured by adverse changes in blood lipids, nor was any evidence found of a diminished efficacy over the 7-year study period because gains in BMD were consistent and linear over the 7-year study period, averaging 1.04% per year over the 7-year study. The results are also consistent with earlier short-term studies suggesting that this supplement can facilitate significant increases in total body BMD in contrast to studies suggesting that calcium supplements can only slow down age-related declines in BMD.

Relation between phalangeal bone mineral density and radiographic knee osteoarthritis: a cross-sectional study.

BackgroundMajor reports have suggested that bone mineral density (BMD) is higher in patients with osteoarthritis (OA), while other studies do not agree. Our aim was to examine the cross-sectional association between phalangeal BMD and radiographic knee OA.MethodsA total of 2855 participants were included in this study. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) Grade ≥ 2 in at least one leg. BMD scans of the middle phalanges of the second, third and fourth digits of the nondominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). A multivariable logistic analysis model was applied to test the relation between phalangeal BMD with radiographic knee OA, the presence of knee osteophytes (OSTs), and knee joint space narrowing (JSN) after adjusting for a number of potential confounding factors.ResultsThe multivariable-adjusted odds ratios with 95 % confidence intervals [ORs (95 % CI)] of radiographic knee OA across phalangeal BMDs were 1.08 (95 % CI 0.89–1.32) and 0.62 (95 % CI 0.45–0.86), respectively. The P for trend was 0.09. For the female population, the multivariable-adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 1.01 (95 % CI 0.73–1.37) and 0.58 (95 % CI 0.38 − 0.87), respectively. The P for trend was 0.02. This positive finding, however, did not exist in the male subgroup. There was a significantly lower prevalence of OST in the osteoporosis (OP) group than in the normal group (OR = 0.59, 95 % CI 0.40–0.88; P for trend was 0.01). In contrast, the prevalence of JSN was significantly higher in the osteopenia group (OR = 1.22, 95 % CI 1.00–1.48) and the OP group (OR = 1.35, 95 % CI 1.00–1.84) than in the normal group. The P for trend was 0.02.ConclusionsThis study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal subjects. The prevalence of JSN was higher in the osteopenia and OP groups than in normal subjects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0918-x) contains supplementary material, which is available to authorized users.

Association between dietary iron intake and bone mineral density: A cross‐sectional study in Chinese population

AbstractAimThe incidence of osteoporosis is rising continuously along with the ageing process in the Chinese population. Iron is an important trace element for bone growth, development and maintenance. However, the association of dietary iron with bone mineral density has not been widely investigated. The present study examined the cross‐sectional association between dietary iron intake and phalangeal osteoporosis in the Chinese population.MethodsA total of 1870 subjects were included. Dietary intake was assessed using a semi‐quantitative food frequency questionnaire. Bone mineral density scans were performed at the middle phalanges of the second, third and fourth fingers of the non‐dominant hand. Then, a multivariable logistic analysis model was adopted to test the relationship between dietary iron intake and phalangeal osteoporosis after adjusting a number of potential confounding factors.ResultsA modest inverse association between dietary iron intake and phalangeal osteoporosis was observed in the model adjusted by a set of factors, including sex, age, body mass index, smoking status, alcohol drinking status, exercise intensity, waist circumference, total energy intake, calcium intake, fibre intake, nutrient supplementation, history of hypertension and history of diabetes. This association existed both in the total subjects and in the female subgroup, especially in the postmenopausal female subgroup, but not in the male subgroup.ConclusionsThe findings of the present study indicated that proper dietary iron intake may play a positive role in the prevention of osteoporosis in the female subgroup, especially in the postmenopausal female subgroup.

Association between Obesity and Bone Mineral Density by Gender and Menopausal Status.

BackgroundWe investigated whether there were gender differences in the effect of obesity on bone mineral density (BMD) based on menopausal status.MethodsWe assessed 5,892 consecutive patients 20 to 91 years old who were referred for dual-energy X-ray absorptiometry (DXA) scans. All subjects underwent a standard BMD scan of the hip (total hip and femoral neck) and lumbar spine (L1 to L4) using a DXA scan and body size assessment. Body mass index was used to categorize the subjects as normal weight, overweight, and obese.ResultsBMD was higher in obese and overweight versus normal weight men, premenopausal women, and postmenopausal women. Compared to men ≥50 years and postmenopausal women with normal weight, the age-adjusted odds ratio of osteopenia was 0.19 (95% confidence interval [CI], 0.07 to 0.56) and 0.38 (95% CI, 0.29 to 0.51) for obese men ≥50 years and postmenopausal women. Corresponding summaries for osteoporosis were 0.26 (95% CI, 0.11 to 0.64) and 0.15 (95% CI, 0.11 to 0.20), respectively. Compared to men <50 years and premenopausal women with normal weight, the age-adjusted odds ratio of low bone mass was 0.22 (95% CI, 0.11 to 0.45) and 0.16 (95% CI, 0.10 to 0.26) for obese men <50 years and premenopausal women, respectively.ConclusionObesity is associated with BMD of the hip and lumbar spine and overweight and obese individuals have similar degrees of osteoporosis. This result was not significantly different based on gender and menopausal status, which could be an important issue for further investigation.

Bone health after menopause.

This article reviews recent publications (January 2014-June 2015) on bone health and menopause. Recent articles suggest that simple instruments, such as the osteoporosis self-assessment tool based on age and weight may identify women age 50-64 for bone mineral density (BMD) testing. Rescreening of women age 50-64 is not recommended because their overall risk of fracture is quite low. A novel risk factor for hip fracture among non-Caucasian women is socioeconomic status. Midlife women with low serum 25-hydroxyvitamin D (<20 ng/ml) have an increased risk of fracture over the menopausal transition and vitamin D supplementation is warranted. Wrist fractures are the most common fracture in women age 50-64. Women who experience a wrist fracture have an increased risk of subsequent fracture and should have a BMD scan. Results of studies using composite measures of femoral neck strength relative to load emphasize the need for osteoporotic research to move beyond BMD. This recent research has provided new and important findings improving our understanding of osteoporosis during the menopausal transition.

The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing's syndrome.

In a cohort study of 182 consecutive patients with active endogenous Cushing's syndrome, the only predictor of fracture occurrence after adjustment for age, gender bone mineral density (BMD) and trabecular bone score (TBS) was 24-h urinary free cortisol (24hUFC) levels with a threshold of 1472 nmol/24 h (odds ratio, 3.00 (95% confidence interval (CI), 1.52-5.92); p = 0.002). The aim was to estimate the risk factors for fracture in subjects with endogenous Cushing's syndrome (CS) and to evaluate the value of the TBS in these patients. All enrolled patients with CS (n = 182) were interviewed in relation to low-traumatic fractures and underwent lateral X-ray imaging from T4 to L5. BMD measurements were performed using a DXA Prodigy device (GEHC Lunar, Madison, Wisconsin, USA). The TBS was derived retrospectively from existing BMD scans, blinded to clinical outcome, using TBS iNsight software v2.1 (Medimaps, Merignac, France). Urinary free cortisol (24hUFC) was measured by immunochemiluminescence assay (reference range, 60-413 nmol/24 h). Among enrolled patients with CS (149 females; 33 males; mean age, 37.8 years (95% confidence interval, 34.2-39.1); 24hUFC, 2370 nmol/24 h (2087-2632), fractures were confirmed in 81 (44.5%) patients, with 70 suffering from vertebral fractures, which were multiple in 53 cases; 24 patients reported non-vertebral fractures. The mean spine TBS was 1.207 (1.187-1.228), and TBS Z-score was -1.86 (-2.07 to -1.65); area under the curve (AUC) was used to predict fracture (mean spine TBS) = 0.548 (95% CI, 0.454-0.641)). In the final regression model, the only predictor of fracture occurrence was 24hUFC levels (p = 0.001), with an increase of 1.041 (95% CI, 1.019-1.063), calculated for every 100 nmol/24-h cortisol elevation (AUC (24hUFC) = 0.705 (95% CI, 0.629-0.782)). Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.

Predictive factors for the progression of spontaneous osteonecrosis of the knee.

To assess potentially predictive factors that were evaluated 1year after the onset of symptoms in patients with spontaneous osteonecrosis of the knee (SONK) and to determine receiver operating characteristic (ROC) curve cut-off values. Within 1year of symptom onset, patients with SONK-selected treatment options, mainly based on severity of pain, chose either conservative treatment (n=27 knees) or operative treatment (n=27 knees). Knee and whole-leg radiographs, knee MRIs and bone mineral density scans of the lumbar spine, femoral neck and femoral condyles were obtained. The parameters measured were: (1) anatomical angle on whole-leg radiograph and (2) lesion size and medial meniscus extrusion on MRI. The anatomical angle and lesion size in the sagittal section (depth) on MRI were markedly larger in the operative treatment group than those in the conservative treatment group. The anatomical angle and depth on MRI of SONK at Stages 1-3 were significantly different between groups, with odds ratios (95% confidence intervals) of 1.16 (1.18-2.34) and 1.11 (1.01-1.23). One year after symptom onset, ROC curve cut-off value for anatomical angle was 180° and depth on MRI was 20mm. An anatomical angle >180° and depth >20mm on MRI were predictive factors for a poorer prognosis 1year after symptom onset in patients with SONK. Our results on radiographs and MRI provided a predictive prognosis for patients with SONK at the initial visit to their orthopaedic surgeons. III.

Deficiency of β-arrestin 2 in mice-induced bone remodeling was associated with down-regulation of GPER1 expression

Objective To determine the role of β-arrestin 2 on bone mineral density and microarchitecture, and its underlying mechanisms. Methods Ex vivo dual-energy-X-ray-absorptiometry(DXA) was used to measure the total body bone mineral density (BMD) and micro-CT scan was performed on mouse femora from female mice of wild type(WT) and β-arrestin 2 knockout(KO) at 16, 26, 30 weeks of age. RT-PCR was applied for the mRNA expression. Results Started from 16 weeks of age, total body BMD and the bone volume/total volume(BV/TV), trabecular number(Tb.N) in the femoral metaphysis of β-arrestin 2 KO female mice decreased dramatically. BMD decreased by 8.10%, 7.53%, 8.56%, BV/TV by 53.3%, 49.4%, 55.7% and Tb.N by 53.2%, 52.1%, 49.3% at 16, 26, 30 weeks of age, respectively, compared with those in WT mice(all P<0.05). In contrast, the trabecular pattern factor(Tb.Pf), trabecular separation(Tb.Sp), and structure model index(SMI) of the mice increased gradually with age, and reached statistically significant at age of 30 weeks(increased by 32.0%, 54.3%, and 23.7%, respectively, all P<0.05). RT-PCR showed that mRNA expression levels of osteoprotegrin, RANKL, and G protein-coupled estrogen receptor 1 in tibia from β-arrestin 2 KO mice were significantly lower than those in WT mice. Conclusion The effects of β-arrestin 2 on bone remodeling might be associated with G protein-coupled estrogen receptor1 signaling pathway. (Chin J Endocrinol Metab, 2015, 31: 897-901) Key words: β-Arrestin 2; Bone mineral density; Microarchitecture; Osteoprotegrin; G protein-coupled estrogen receptor 1

Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur.

Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns. This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling. After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively). Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores compared to neck of femur fractures, suggesting that the fracture traversed through the areas with the lowest bone density in the proximal femur. In the absence of reduced T.Troc and T.Inter, neck of femur fractures occurred more commonly. T-Total scores may underestimate the severity of osteoporosis/osteopenia and measuring T-score at the neck of femur may better reflect the severity of osteoporosis and likelihood of a fragility fracture.

Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework.

BackgroundBehavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change.There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication.MethodsA behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted.ResultsNine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included “memory, attention and decision processes”, “knowledge”, “environmental context and resources”, “social influences” and “beliefs about consequences”. Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size.ConclusionsWhen explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0280-7) contains supplementary material, which is available to authorized users.

Self-assessment Tool to Identify Primary Osteoporosis in Chinese Elderly Males

Validation of the effectiveness of the Osteoporosis Self-Assessment Tool for Asians (OSTA) in identifying elderly males at increased risk of primary osteoporosis has been seldom reported in China. A cross-sectional study was conducted to assess the performance of the OSTA in 245 healthy males aged ≥50 years for routine bone mineral density (BMD) scanning by dual-energy X-ray absorptiometry. The ability of OSTA to discriminate low BMD as defined by a T score ≤ −2.5 at different sites (femoral neck, total hip, and lumbar spine) was evaluated using receiver operating characteristic (ROC) curve analysis. ROC curves were generated to determine the optimal cutoff points, sensitivity, specificity, and areas under the ROC curves. Of the study participants, 14% had osteoporosis, and the prevalence of osteoporosis increased progressively with age. The area under the ROC curves of the OSTA index to identify osteoporosis in the femoral neck site was 0.712 ( p < 0.0001). The sensitivity and specificity of the optimal OSTA index (cutoff = 1) to identify osteoporosis based on femoral neck BMD in all males were 84% and 49%, respectively. The sensitivity of OSTA increased with age, whereas its specificity decreased with age. Sensitivity and specificity values of 70% and 68%, respectively, were obtained in 50-year-old to 69-year-old males. The OSTA index may be a useful tool for identifying primary osteoporosis as defined by dual-energy X-ray absorptiometry at the femoral neck site in males aged ≥50 years, especially in males aged <70 years.

Impact of interactive voice response technology on primary adherence to bisphosphonate therapy: a randomized controlled trial.

Osteoporosis (weak bones) is a disorder that has high morbidity, mortality, and healthcare utilization. Effective treatment is available for this disorder, but many patients choose not to start therapy. This is the first study showing an intervention that increases the initiation rates to medications for osteoporosis. One out of six patients prescribed an oral bisphosphonate does not initiate therapy, a phenomenon known as primary non-adherence. Reasons for bisphosphonate primary non-adherence have been identified, but not interventions that positively impact primary adherence rates. The purpose of this study is to determine the effectiveness of interactive voice response technology to improve oral bisphosphonate primary adherence. This was a prospective, randomized controlled trial conducted in January-December 2014 at Kaiser Permanente Colorado, an integrated healthcare system. Adults with a new oral bisphosphonate prescription for osteoporosis or osteopenia which was not purchased within 14-20 days of being ordered were included. There were 127 and 118 patients in the intervention group and control groups, respectively. The intervention group received an interactive voice response phone call followed by a letter 1 week later if primary non-adherence continued, whereas the control group did not receive any outreach. The primary outcome was the proportion of patients who purchased their oral bisphosphonate within 25 days of randomization. There were 62/127 (48.8%) intervention patients and 36/118 (30.5%) control patients who purchased their bisphosphonate prescription within 25 days of randomization (OR = 2.17, 95% CI 1.29-3.67). When adjusted for age, sex, history of bone mineral density scan and fracture, the odds ratio for intervention versus control group was 2.3 (95% CI 1.34-3.94). An interactive voice response phone call and follow-up letter significantly improved primary adherence to oral bisphosphonate therapy. Such an intervention could be considered for improving primary adherence rates to other medication classes.

The effects of bazedoxifene on bone structural strength evaluated by hip structure analysis

Bazedoxifene (BZA) is a selective estrogen receptor modulator that has been shown to prevent and treat postmenopausal osteoporosis. Hip structure analysis (HSA) can be used to extract bone structural properties related to strength from hip bone mineral density (BMD) scans. This exploratory analysis used HSA to evaluate changes in hip structural geometry in postmenopausal women enrolled in a phase 3 osteoporosis treatment study who were treated with BZA 20mg or placebo for 2years. This analysis cohort included women at increased fracture risk based on known skeletal risk factors (n=521); 1 or more moderate or severe fractures or 2 or more mild vertebral fractures and/or femoral neck BMD T-score≤−3.0 at baseline combined with additional women from the overall study population (n=475); a subgroup analysis included just those women at increased fracture risk. HSA was applied to duplicate hip dual-energy X-ray absorptiometry (DXA) scans acquired at screening and 24months. Percent change from baseline was evaluated using an analysis of covariance for BMD and geometric parameters including section modulus (SM), cross-sectional area (CSA), outer diameter (OD), and buckling ratio (BR). In all regions, BZA was associated with increased BMD and improvements in hip structural geometry. In the narrow neck, BZA 20mg significantly increased SM, CSA, OD, and BMD compared with placebo (P <0.05 for all). In the intertrochanter region, BZA 20mg significantly increased CSA and BMD and decreased BR compared with placebo (P <0.05 for all). Other than BMD (P <0.05), effects of BZA 20mg at the shaft did not reach statistical significance. Similar trends toward improvement in structural geometry with BZA 20mg were observed in all three regions of the hip for the subgroup of women at increased fracture risk. Overall, BZA was associated with geometry-related improvements in bone strength with regard to resistance to bending and compressive forces and to local buckling. These improvements were evident at common fracture locations such as the femoral neck and intertrochanter regions, and are consistent with the significant treatment effect reported for BZA on nonvertebral fractures in higher-risk postmenopausal women with osteoporosis.