Bone Mineral Density Test Results Research Articles

Prevalence and Factors Associated With Osteoporosis and Bone Mineral Density Testing in Psoriatic Arthritis.

To determine bone mineral density (BMD) in psoriatic arthritis (PsA) patients, factors associated with undergoing BMD testing, and the effect of PsA clinical activity on BMD. Patients attending the University of Toronto PsA Clinic with BMD testing results from cohort inception to January 2019 were included. Descriptive statistics summarized lumbar spine, femoral neck, and total hip T scores. Cox proportional hazards regression identified predictors for BMD testing. Logistic regression analysis determined odds of having normal (T score -1.0 or more) versus osteoporotic-range BMD (T score -2.5 or less). A multistate model determined factors associated with BMD state changes over time. Of the 1,479 patients, 214 had BMD tests performed. The mean ± SD T scores at the lumbar spine, femoral neck, and total hip were -0.30 ± 0.32, -1.10 ± 1.04, and -0.45 ± 0.42, respectively. Osteopenia and osteoporosis occurred in 45.27% and 12.94% of patients. Increasing age, menopause, elevated acute-phase reactants, and biologics, methotrexate, and systemic glucocorticoids use were associated with a higher chance of undergoing BMD testing. Increased body mass index (BMI) and biologics use were associated with a lower chance of having osteoporotic-range BMD test results. In multistate analysis, polyarthritis may portend lower BMD results over time, although this did not achieve statistical significance due to low patient numbers. The prevalence of osteopenia and osteoporosis in the PsA cohort was similar to that of the general population. Clinicians are using osteoporosis risk factors and PsA disease severity markers to select patients for BMD testing. Polyarticular disease may portend worse BMD test results. Biologic use and increased BMI appear to have a protective effect.

Estimating the Proportion of Bone Mineral Density Loss in Patients with Normal Kidney Function among South Indian Population

Background: Bone Mineral density (BMD) is considered as one of the golden tool to measure the bone quality in which two measurements namely T- Score and Z –score are used to report the BMD test results. Whenever there is deterioration of BMD it is associated with low skeletal mass. Creatinine is a chemical waste molecule that is generated from this muscle metabolism. Creatinine is a good marker for muscle mass. However, limited studies have been done which tell us the association between BMD loss and serum creatinine (SCr) levels.Methodology: 200 participants who were referred for CECT abdomen and pelvis were scanned using 128 slice Philips Brilliance CT. Using BMD software, four different vertebral bodies from L1-L4 were taken and ROI was placed at the central portion of the trabecular bone, two reference ROI’s, one in retro spinal muscle and one in fat tissue were also placed. To measure CT attenuation value, a ROI graphic tool was drawn at the trabecular bone. Average HU of BMD, T score and Z score values were taken from L1-L4.Statistical Analysis: The data was analysed using SSPS version 16.0. For assessment of normal BMD values, the results of measurements were averaged for age, creatinine level, T score and Z score and descriptive statistics was calculated. Spearman’s correlation coefficient was used to estimate the correlation between serum creatinine with T score and Z score.Results: T Score and SCr correlated negatively at -0.25. The correlation between Z Score and SCr was also negatively correlated at -0.187.Conclusion: It was evident from the study findings, that there is a non-association between SCr and T Score levels which showed that BMD of a person was not associated with normal kidney function. Thus, SCr levels cannot be used as a biomarker for osteoporosis or osteopenia.

Determination of vitamin D and analysis of risk factors for osteoporosis in patients with chronic pain.

Vitamin D deficiency is common in patients with chronic pain and healthy people, but the difference between the two has not been reported; thus, whether there is a relationship between vitamin D deficiency and chronic pain remains to be confirmed. Osteoporosis is a common disease in chronic pain disorders. Understanding the relationship between vitamin D and osteoporosis will provide a basis for the rational supplementation of vitamin D to prevent osteoporosis, and to understand the risk factors of bone mass change to provide a new treatment plan for early prevention of osteoporosis. To determine 25 hydroxy vitamin D (25OHD) level in patients with chronic pain to clarify its clinical significance. The relationship between vitamin D and bone mineral density (BMD) and the risk factors for bone mass change were also evaluated. In this study, 184 patients with chronic pain were included in the study group, and 104 healthy individuals who underwent routine health checkups during the same period were included in the control group. 25OHD level was detected in both groups by enzyme-linked immunosorbent assay. According to the BMD test results, the patients in the study group were further classified into three subgroups: Normal BMD group, reduced BMD group, and osteoporosis group. Age, sex, ethnicity, living altitude, body mass index, 25OHD level, parathyroid hormone (PTH), calcium (Ca) and phosphorus levels were analyzed statistically in both groups. The vitamin D level in the study group was lower than that in the control group at 53.8% vs 57.7%, with no significant difference between the two groups. The proportion of patients with severe vitamin D deficiency in the study group was higher than that in the control group. The mean age was greater in the osteoporosis subgroup, and the youngest in the normal BMD subgroup. Vitamin D level in the osteoporosis subgroup was lower than that in the other two subgroups, and was not specific for the diagnosis of bone mass reduction and osteoporosis. The above results were analyzed statistically and showed significant differences (P < 0.05). There was a positive correlation between age and BMD in patients with chronic pain (R = 0.567, P < 0.001). Age, PTH and Ca were risk factors for bone mass reduction, while age, ethnicity and altitude were risk factors for osteoporosis. Vitamin D deficiency is a common phenomenon in patients with chronic pain, and severe vitamin D deficiency is not uncommon. Vitamin D level is not a risk factor for bone mass reduction and osteoporosis. Bone mass reduction is correlated with age, PTH and Ca, while osteoporosis is correlated with age, ethnicity and altitude.

内蒙古新巴尔虎左旗饮茶型氟铝联合中毒调查

目的：对内蒙古新巴尓虎左旗开展饮茶型氟铝联合中毒病情调查。方法：在无工业污染的内蒙古新巴尔虎左旗乌布尔宝力格苏木锡林贝尔嘎查进行流行病学调查、并对成人进行临床检查、X线摄片、骨密度(BMD)检测；采集砖茶、饮水、奶茶、尿、血液等样品进行检测其含氟量、含铝量，计算人均经砖茶每日摄氟量、摄铝量；血液生化采用日本奥林巴斯AU-400全自动生化分析仪检测，试剂为贝克曼库尔公司提供试剂盒，氟采用离子迭择电极法检测，Al、Ca、采用ICP-AES法检测，CT、ALP、PTH采用ECL法检测。结果：氟斑牙检出率43.20% (35/81)，X线氟骨症检出率24.09% (20/83)，骨密度检测结果为骨量减少和骨质疏松检出率38.82% (33/85)。砖茶、饮水、奶茶、尿、血淸含氟量检测结果分别为(618.2 ± 53.3) mg/kg、(1.03 ± 0.10) mg/L、(3.00 ± 2.59) mg/L、(2.24 ± 0.34) mg/L，(0.074 ± 0.032) mg/L；含铝量分别为(2908.6 ± 225.8) mg/kg、(0.036 ± 2.43) mg/L、(6.34 ± 3.64) mg/L、(2.98 ± 1.47) mg/L，(1.42 ± 1.05) mg/L。其中经砖茶摄入氟9.30 mg/d，摄入铝29.25 mg/d, 血清Ca (2.26 ± 0.21) mmol/L低于正常范围，CT (110.65 ± 26.82)ug/L、ALP (98.47 ± 32.84) u/L位于较高水平。结论：内蒙古新巴尔虎左旗是饮茶型氟铝联合中毒病区。 Objective: This study investigated the condition of tea type aluminum and fluorine joint poisoning in Xin Barag Left county in Inner Mongolia. Methods: Epidemiological investigation was conducted in nonindustrial pollution area of Wborbolog Xilinbuir town which locates in Xin Barag Left county in Inner Mongolia. Clinical examination, X-ray, bone mineral density (BMD) detection were conducted in adults. The fluoride content and aluminum content of brick tea, water, milk tea, urine, blood and other samples were collected. Then we calculated the fluoride content and aluminum content per day of every adult. Blood biochemistry was tested by the Japanese Olympus AU-400 automatic biochemical analyzer; Beckman Kur offered kit; Fluorine is tested by ion selective electrodes; Al, Ca were detected by ICP-AES; CT, ALP, PTH were detected by ECL. Results: The rate of fluorine spot tooth was 43.20% (35/81), X-ray detection rate of skeletal fluorosis was 24.09% (20/83) and Bone mineral density test results were bone loss and osteoporosis rate was 38.82% (33/85). The results of fluorine content detection for brick tea, drinking water, tea with milk, urine, serum were (618.2 ± 53.3) mg/kg, (1.03 ± 0.10) mg/L, (3.00 ± 2.59) mg/L, (2.24 ± 0.34) mg/L, (0.074 ± 0.032) mg/L respectively; Aluminum content for brick tea, drinking water, tea with milk, urine, serum were (2908.6 ± 225.8) mg/kg, (0.036 ± 2.43) mg/L, (6.34 ± 3.64) mg/L, (2.98 ± 1.47) mg/L, (1.42 ± 1.05) mg/L respectively. The fluoride intake through the brick tea was 9.30 mg/d; the aluminum intake through brick tea was 29.25 mg/d; Serum calcium was (2.26 ± 0.21) mmol/L below the normal range. The CT was (110.65 ± 26.82) ug/L and the ALP was (98.47 ± 32.84) u/L, and both of these maintained high level. Conclusion: Xin Barag Left county was the endemic area of tea type aluminum and fluorine joint poisoning in Inner Mongolia.

Influence of Insurance Benefit Criteria on the Administration Rate of Osteoporosis Drugs in Postmenopausal Females

BackgroundPreventive measures need to be implemented to lower the incidence of osteoporotic fractures. Osteoporotic fractures increase morbidity and mortality as well as impose a socioeconomic burden; however, current research is limited to the administration rates of osteoporosis drugs for Korean postmenopausal females.MethodsThis study represents a nationwide, observational, and cross-sectional survey that investigates the administration rates of osteoporosis drugs based upon a bone mineral density (BMD) test performed on Korean postmenopausal patients who visited outpatient orthopedic clinics. BMD test results were examined in postmenopausal female patients (50 to 80 years of age); subsequently, the patients were classified into an osteoporosis group, osteopenia group, and normal group. The administration rates of osteoporosis drugs and bisphosphonates were then analyzed. The osteoporosis group was subdivided into a T-score less than -3.0 group and a T-score between -3.0 and -2.5 group that were separately analyzed.ResultsBased on the lumbar spine BMD, the rate of administration of osteoporosis drugs in the osteoporosis group was 42.1%, which was significantly higher compared to the osteopenia group or normal group. A significantly low bone mineral density was observed in patients who were administered bisphosphonates. Based on the lumbar spine BMD, the administration rate of osteoporosis drugs in the group with a T-score between -3.0 and -2.5 (34.2%) was significantly lower than the group with a T-score less that -3.0 (46.2%). The bisphosphonate administration rate was also significantly low; however, the administration rate for osteoporosis drugs was significantly lower than that of the osteopenia group.ConclusionsOnly about 40% of Korean postmenopausal female patients with osteoporosis were administered osteoporosis drugs. The administration rate in patients with a T-score between -3.0 and -2.5 was particularly low and active treatment to prevent osteoporotic fractures is required in this group.

Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy’s fracture clinic screening program

Potential mediating factors in the pathway to initiation of osteoporosis treatment following a fragility fracture were evaluated. Patients' perceived need for treatment, mediated by their perception of bone density test results, was central to treatment initiation. Interventions focusing on patients' perceptions of need and test results may improve treatment rates. We tested a hypothesized pathway to osteoporosis (OP) pharmacotherapy initiation in fragility fracture patients. We hypothesized that bone mineral density (BMD) testing is strongly associated with treatment initiation and perception of BMD test results would inform patients' perceived need for treatment, which would mediate the effect between BMD testing and treatment initiation. A longitudinal cohort study followed patients, ≥50 years of age, screened for fragility fracture in 31 fracture clinics in Ontario, Canada who had no prior diagnosis of or treatment for OP. At screening, OP risk factors, baseline-patient perception of OP risk, OP knowledge, and perceived benefits of medication were reported by patients. Patients were followed up within 6 months of fracture to determine BMD testing and prescription of and adherence to first-line OP pharmacotherapy. Structural equation modeling tested the hypothesized pathway. Significance and magnitude of the coefficients and indicators of overall model fit were used to test our model. The direct path from BMD testing to OP treatment initiation was non-significant. The pathway to treatment initiation was mediated by patients' perception of their need, which was influenced by their self-reported BMD results. Baseline fracture risk factors, knowledge of OP, and perceived benefits of treatment-predicted patient-perceived need for treatment at follow-up and initiation of OP treatment. Patient perceptions were central factors in the path to initiation of OP pharmacotherapy. Interventions to facilitate accurate patient perceptions of BMD test results and OP risk status could prove helpful in improving OP treatment initiation.

The BMD Muddle: The Disconnect Between Bone Densitometry Results and Perception of Bone Health

We conducted a phenomenological qualitative study to examine fracture patients’ interpretations of their most recent bone densitometry results and perceptions of their current bone health. English-speaking outpatients who had sustained a fragility fracture in the previous 18–24 mo and reported having at least 1 previous bone mineral density (BMD) test were eligible. Data were collected through semistructured interviews in patients’ homes. Patients were asked to describe their most recent BMD test results and perception of their bone health status based on these results. Eighteen patients (14 women and 4 men) aged 49–82 yr were recruited. BMD results showed bone density in patients to be normal (n = 4), osteopenic (n = 9), and osteoporotic (n = 5). A correct diagnosis was recalled by 6 patients. Two common interpretations of BMD test results emerged: (1) no news was considered to be good news (n = 9) and (2) evidence of compromised bone health was not considered to be serious or accurate (n = 6). Medication adherence did not appear to be associated with perception of bone health or actual BMD results. Patients’ perceptions of their current bone health did not correspond to the results of their most recent BMD test. Standardized bone densitometry reporting may improve patients’ understanding of their bone health.

Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups

BackgroundOsteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care.MethodsThe conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology.ResultsOf the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in the patient education component of the osteoporosis tool. Suggestions for modifying the tool included the addition of a percentile graph showing patients' 10-year risk for osteoporosis or fractures, and ensuring that the tool takes no more than 5 minutes to complete.ConclusionsFocus group data revealed the facilitators and barriers to using the osteoporosis tool at the point of care so that it can be optimized to aid physicians in their clinical decision making.

Improving osteoporosis management in patients with fractures

A history of fracture is an independent risk factor for future fractures, but patients who have sustained a fracture are rarely evaluated for osteoporosis (OP). The objective of this study was to determine if a simple intervention in a general orthopedic clinic would lead to more fracture patients receiving evaluation and treatment for OP. Patients with a history of fracture visiting a weekly orthopedic clinic during a 6-month intervention period were educated about OP, and a bone mineral density (BMD) test was offered. The number of BMD tests performed and other OP-specific actions taken as a result of the intervention were compared with a 6-month pre-intervention period. The prevalence of OP in those who underwent BMD testing was examined. In the pre-intervention period, only 12.7% (16 of 126) had a BMD test as compared with 62.5% of the 136 intervention-period subjects (odds ratio [OR] 11.5, 95% confidence interval [CI] 6.1, 21.4). Based on BMD test results, 11.9% of the pre-intervention patients, and 41.9% of the intervention patients received OP-specific recommendations (OR 5.3, 95% CI 2.8, 10.1). The intervention led to more patients being treated for low bone mass (9.5% vs 23.5%); OR 2.9, 95% CI 1.4, 5.9. Low bone mass was common among all types of fracture patients: 20% had osteoporosis and 41%, osteopenia. BMD testing in patients with fractures should identify those at risk for future fractures, leading to appropriate treatment.

Initiation of osteoporosis treatment after bone mineral density testing.

The aim of the study was to describe initiation of osteoporosis drug therapy after bone mineral density (BMD) testing and to determine any association with BMD test results obtained, physician factors, or both. The setting was the Kaiser Foundation Health Plan (KFHP), a large health maintenance organization (HMO) in Northern California. Data were collected from bone densitometry centers at four KFHP medical centers sites in Sacramento, San Rafael, Fresno, and Oakland. We identified 17,290 women aged > or = 45 years who had BMD testing between January 1, 1997 and June 30, 1999. After excluding those for whom any osteoporosis drugs were prescribed in the year before testing, 8020 women were available for analysis. Using logistic regression, we examined the association between BMD diagnosis (i.e., osteoporosis or osteopenia versus normal) and initiation of drug therapy, for osteoporosis (including hormone replacement therapy (HRT), alendronate, etidronate, raloxifene and calcitonin) within 6 months after the test. Among the 8020 women, 1934 (24%) filled a prescription for an osteoporosis drug within 6 months after BMD testing. Compared with women who had a normal BMD test result, women diagnosed with osteopenia were nearly 4 times more likely (OR = 3.7; CI = 3.0-4.4), and women diagnosed with osteoporosis were 15 times more likely (OR = 15.0; CI = 12.5-18.1), to fill a prescription for an osteoporosis drug within 6 months after BMD testing. Women with high exposure to corticosteroid agents were twice as likely (OR = 2.1; CI = 1.7-2.7) to start osteoporosis drug therapy compared with women who were not similarly exposed; women diagnosed with recent osteoporotic fractures were 50% more likely (OR = 1.5; CI = 1.2-1.9) to begin therapy than women without such fractures. Despite the strong association between BMD and initiating treatment, nearly half the osteoporotic women did not initiate treatment. In addition, we found that age strongly influenced choice of osteoporotic drug. Compared with osteoporotic women aged 45-54 years, women aged 55-64 years who started drug therapy were 40% more likely (OR = 1.4; CI = 1.0-2.2) and women aged > or = 65 years were twice as likely (OR = 2.0; CI = 1.4-2.8) to start non-HRT drugs. BMD test results indicating osteoporosis were thus strongly associated with increased likelihood of beginning drug therapy, and half of such women initiated therapy. Drug initiation was also associated with other factors, including age, use of corticosteroid agents, recent fracture, and physician characteristics. However, these factors showed much weaker associations than those found for BMD. Health care providers must consider whether test results will influence treatment decisions, and our data indicate that results of BMD testing do influence management decisions regarding osteoporosis drug use for women.