Bone Mineral Density Values Research Articles

The difficulties of diagnosing and determining the tactics of treating osteoporosis in severe spinal scoliosis case

A female patient with early surgical menopause and severe S-shaped scoliosis was diagnosed with osteoporosis at the place of residence and treated with a bisphosphonate (zoledronic acid). Despite the deformity of the spine and chest, the patient had no complaints until recently and led an active lifestyle. During X-ray densitometry at the National Medical Research Center for Therapy and Preventive Medicine, in particular when examining the lumbar spine, there were difficulties with positioning the patient for correct scanning of the area of interest and, as a result, obtaining information about the true state of trabecular bone tissue. Bone mineral density (BMD) in the proximal femur was consistent with osteopenia. Additional laboratory and instrumental parameters, such as biochemical markers of bone remodelling (osteocalcin and C-terminal type 1 collagen telopeptide) and trabecular bone score (TBS), also did not allow to precise the risk of fractures and make an unambiguous conclusion about the necessity of continuing antiresorptive therapy. Given the low BMD values in lumbar spine (T-score -4.8 SD) and the possibility of developing vertebral compression fractures as a result of minimal trauma with further chest deformity progression and vital organs failure, it was decided to continue treatment with zoledronic acid. Further therapeutic tactics will be determined after the next scheduled examination in 1 year.

Fragility spinal fractures among cirrhotic liver transplant candidates in Croatia

IntroductionExisting data on fragility spinal fractures prevalence in liver transplant candidates are scarce and inconsistent. This may be due to other comorbidities, besides hepatic osteodystrophy (HO), that contribute to bone loss and fragility fracture prevalence in chronic liver disease (CLD). ObjectivesThe aim of this study was to investigate the prevalence of spinal thoracic and lumbar fragility fractures among cirrhotic, non-chronic kidney disease (CKD), non-diabetic liver transplant candidates and to explore their relationship with clinical characteristics, laboratory markers and dual-energy x-ray absorptiometry (DXA) results. Material and methodsThis cross-sectional observational study was conducted at Merkur University Hospital, Croatia, between February 2019 and May 2023. Adult patients with liver cirrhosis referred for liver transplantation were included. Patients with acute infection, CKD, diabetes mellitus, malignancies, inflammatory bone diseases and those on corticosteroid or antiresorptive therapy were excluded. Clinical, laboratory and radiological assessment was carried out and patients were accordingly allocated into non-fractured and fractured group for the purpose of statistical analysis. ResultsA total of 90 patients were included in the study. There was 123 fractures, 87 (70.7 %) in the thoracic and 36 (29.3 %) in the lumbar region. Eighty-nine (72.4 %) fractures were grade 1, 31 (25.2 %) were grade 2 and 3 (2.4 %) were grade 3. Patients in the fractured group were significantly older (p < 0.001). No significant differences between fractured and non-fractured group according to laboratory and DXA parameters were noted. Subgroup with lumbar fractures had significantly lower bone mineral density values at L1-L4 region. Statistically significant negative correlation between bone specific alkaline phosphatase (BALP) and hip total BMD (rho = -0.414, p < 0.001) and spine total BMD (rho = -0.258, p = 0.014) values was found. ConclusionPresent study confirmed detrimental impact of CLD and HO on bone strength. DXA measurement correlated with the presence of lumbar fragility fractures. A combination of standard X-ray imaging and DXA is needed for adequate bone evaluation in pretransplant period and BALP could be useful for detecting HO in CLD. Searching for other risk factors and implementing bone turnover markers and additional imaging techniques for bone loss evaluation in liver transplant candidates is needed.

Relationships between Bone Mineral Density and Antidepressant Use and Physical Activity in U.S. Adults

Introduction: Osteoporosis is a major public health concern that affects millions of people worldwide. It is a progressive disease characterized by low bone mass and deterioration of bone tissue, leading to an increased risk of fractures. Antidepressant use and physical activity have been suggested as potential modifiable factors that may affect bone mineral density (BMD). However, the relationship between these factors and BMD is not fully understood, and it is uncertain whether these relationships differ for males and females.&#x0D; Methods: Using data from the 2011-2018 National Health and Nutrition Examination Surveys, we examined BMD differences in groups among 7,254 adults. Analyses were first conducted by using the Anderson-Darling normality test, T-test, and the Wilcoxon rank-sum test, and then used multivariate linear regressions to investigate its potential associations between antidepressant use and physical activity along with other factors.&#x0D; Results: Excluding the underweight adults, there is significant difference in BMD between those with and without depression in the female group (p=0.03), but not in the male group (p=0.54). No significant difference was found between those who used and those who did not use antidepressants, in either group, female (p=0.96) and male (p=0.77). Antidepressant use and low-level physical activity intensity were associated with decreased BMD values (Mean [SD] = -0.0073 [0.0049]).&#x0D; Discussion: This study suggests that physical activity may be a potential modifiable factor that could help prevent osteoporosis, particularly in females. On the other hand, antidepressant use, and low-level physical activity may increase the risk of low BMD. These findings highlight the importance of lifestyle modifications in the prevention of negative impact of low BMD. Further studies are needed to explore the impact of different types of antidepressant use in BMD.

Adrenomedullin has no effect on segmental bone defect healing but increases bone mineral density in rat model.

This study aimed to investigate the effect of adrenomedullin on the healing of the segmental bone defect in a rat model. Thirty-six Wistar rats were randomly divided into 6 groups based on follow-up periods and administered a dose of adrenomedullin hormone. In each group, bilaterally, a 2-mm bone defect was created at the diaphysis of the radius. Sodium chloride solution was administered to sham groups 3 times a week for 4 and 8 weeks intraperitoneally. Adrenomedullin was administered to the study groups 3 times a week: 15 μg-4 weeks, 15 μg-8 weeks, 30 μg-4 weeks, and 30 μg-8 weeks, respectively. After euthanasia, the segmental defects were evaluated by histomorphometric [new bone area (NBA)] and microtomographic [bone volume (BV), bone surface (BS), and bone mineral density (BMD)] analyses. Although the 4- and 8-week 15 μg administered study groups had higher NBA values than the other study and control groups, the histomorphometric analysis did not reveal any statistical difference between the control and study groups regarding NBA (P > .05). In microtomographic analysis, BV was higher in the 15 μg 4-week group than 30 μg 4-week group (296.9 vs. 208.5, P=.003), and BS was lower in the 30 μg 4-week group than in the 4-week control group (695.5 vs. 1334.7, P=.005), but overall, no significant difference was found between the control and study groups (P > .05). Despite these minor differences in histomorphometric and microtomographic criteria indicating new bone formation, the BMD values of the 15 μg 8-week study group showed a significant increase compared with the control group (P=.001, respectively). Adrenomedullin positively affected BMD at 15 μg, but this study could not show healing in the segmental defect site at different dose regimens. Further studies are needed to assess its effects on bone tissue trauma.

Performance of iCare quantitative computed tomography in bone mineral density assessment of the hip and vertebral bodies in European spine phantom

BackgroundOsteoporosis is a systemic bone disease which can increase the risk of osteoporotic fractures. Dual-energy X-ray absorptiometry (DXA) is considered as the clinical standard for diagnosing osteoporosis by detecting the bone mineral density (BMD) in patients, but it has flaws in distinguishing between calcification and other degenerative diseases, thus leading to inaccurate BMD levels in subjects. Mindways quantitative computed tomography (Mindways QCT) is a classical QCT system. Similar to DXA, Mindways QCT can directly present the density of trabecular bone, vascular or tissue calcification; therefore, it is more accurate and sensitive than DXA and has been widely applied in clinic to evaluate osteoporosis. iCare QCT osteodensitometry was a new phantom-based QCT system, recently developed by iCare Inc. (China). It has been gradually applied in clinic by its superiority of taking 3-dimensional BMD of bone and converting BMD values to T value automatically. This study aimed at evaluating the osteoporosis detection rate of iCare QCT, compared with synchronous Mindways QCT (USA).MethodsIn this study, 131 patients who underwent hip phantom-based CT scan were included. Bone mineral density (BMD) of the unified region of interests (ROI) defined at the European spine phantom (ESP, German QRM) including L1 (low), L2 (medium), and L3 (high) vertebral bodies was detected for QCT quality control and horizontal calibration. Every ESP scan were taken for 10 times, and the mean BMD values measured by iCare QCT and Mindways QCT were compared. Hip CT scan was conducted with ESP as calibration individually. T-scores gained from iCare QCT and Mindways QCT were analyzed with Pearson correlation test. The detection rates of osteoporosis were compared between iCare QCT and Mindways QCT. The unified region of interests (ROI) was delineated in the QCT software.ResultsThe results showed that there was no significant difference between iCare QCT and Mindways QCT in the evaluation of L1, L2, and L3 vertebrae bodies in ESP. A strong correlation between iCare QCT and Mindways QCT in the assessment of hip T-score was found. It was illustrated that iCare QCT had a higher detection rate of osteoporosis with the assessment of hip T-score than Mindways QCT did. In patients < 50 years subgroup, the detection rate of osteoporosis with iCare QCT and Mindways QCT was equal. In patients ≥ 50 years subgroup, the detection rate of osteoporosis with iCare QCT (35/92, 38.0%) was higher than that with Mindways QCT. In female subgroup, the detection rate of osteoporosis with iCare QCT was significantly higher than Mindways QCT. In male subgroup, the detection rate of osteoporosis with iCare QCT was also markedly higher than Mindways QCT. The detection rate of osteoporosis by iCare QCT was higher than Mindways QCT with hip bone assessment. Of course, the results of the present study remain to be further verified by multicenter studies in the future.

Regular sling core stabilization training improves bone density based on calcium and vitamin D supplementation

BackgroundPrimary osteoporosis refers to a disease of aging characterized by reduced bone mass, damage to bone tissue microarchitecture, and predisposition to fracture.Sling core stabilization training emphasizes activating the deep local muscles of the spine under unstable conditions, and enhancing the body’s balance and control during exercise.Case presentationA 70-year-old female went to the Acupuncture and Rehabilitation Department due to low back pain caused by osteoporosis.The patient received sling core stabilization training three times a week based on Calcium and Vitamin D Supplementation. After training, the patient’s back pain was significantly relieved and insisted one year. In the physical examination of bone mineral density, the results showed that the value of bone mineral density was better than last year.The patients adhered to sling core stabilization training and observed the changes of bone mineral density every year basis on calcium and vitamin D supplementation.DiscussionHowever, cases of calcium and vitamin D supplementation-based regular sling core stabilization training that improves bone density in osteoporosis patients have been rarely reported. Our group shared cases and analyzed possible mechanisms, hoping to provide reference for the prevention and treatment of primary osteoporosis.

Genetic variants of MTHFR gene in relation to folic acid levels and bone mineral density in Polish patients with inflammatory bowel disease

Lower bone mineral density (BMD) constitutes a common issue in inflammatory bowel disease (IBD). Studies often explore the association between BMD and folic acid level. The presented study aimed to evaluate the impact of MTHFR gene polymorphism and folic acid levels on BMD in patients with IBDs: Crohn’s disease (CD) and ulcerative colitis (UC). The study group comprised IBD patients and a healthy control group. BMD, T-score, and Z-score of the lumbar spine (L1-L4) and femoral neck (FN) were assessed using dual-energy X-ray absorptiometry. Folic acid level was determined using direct chemiluminescence, and the MTHFR 677C > T (rs1801133) and 1298A > C (rs1801131) genotyping were performed by HRMA. Our study found no significant differences in the folic acid levels between the groups. Patients with CD and UC presented a lower BMD, T-score, and Z-score of the FN and L1-L4 than the CG. UC patients who were homozygotes AA in loci c.1298A>C presented lower than controls lumbar spine L1-L4 BMD and T-score values. Regarding MTHFR 677 polymorphism, we found that IBD patients carrying CC genotype demonstrated lower than controls femoral neck Z-score, lumbar spine L1-L4 BMD, T-score and Z-score. MTHFR polymorphisms were found to have no impact on folic acid concentrations. IBD patients presented a higher risk of low BMD than the healthy controls, regardless of MTHFR 677 and 1298 genotypes. However, MTHFR polymorphism may influence on bone in IBD patients. Nevertheless, it appears essential to conduct further studies.

The relationship of body mass index and T score in healthy and knee osteoarthritis women

Background: Osteoarthritis (OA) is a chronic, degenerative, slowly progressive disease common in women with multiple aetiology. Osteoarthritis occurs simultaneously with the reduction in bone mineral density (BMD)while a high bone mass index (BMI) value is one of the risk factors for OA. Objective: The purpose of this study was to determine the effect of BMI and BMD in healthy and knee OA women. Method: The study was conducted in an orthopaedic outpatient clinic in 2021. This is a quantitative descriptive study with accidental cross-sectional samplings. The Mann-Whitney test was used to analyse the data. Result: Subjects included in the inclusion criteria obtained 74 OA and 49 control groups. The largest subjects in the OA group were aged 56-65 years old (32, 43.24%), obese (51, 68.92%), and post-menopause (49, 66.22%). At the same time, the T score category was normal (14, 18.91%), osteopenia (22, 29.73%), and osteoporosis (38, 51.35%). Statistical analysis found a significant relationship between BMI and BMD (p = 0.002, p = 0.001) in controls and OA groups. Conclusion: Disorders of BMI and BMD are indicators of risk for OA. High BMI and low BMD values occur in women with knee OA. There is a relationship between BMI and BMD in healthy and knee OA women.

Enhancement of Hip X-ray with Convolutional Autoencoder for Increasing Prediction Accuracy of Bone Mineral Density.

It is very important to keep track of decreases in the bone mineral density (BMD) of elderly people since it can be correlated with the risk of incidence of major osteoporotic fractures leading to fatal injuries. Even though dual-energy X-ray absorptiometry (DXA) is the one of the most precise measuring techniques used to quantify BMD, most patients have restricted access to this machine due to high cost of DXA equipment, which is also rarely distributed to local clinics. Meanwhile, the conventional X-rays, which are commonly used for visualizing conditions and injuries due to their low cost, combine the absorption of both soft and bone tissues, consequently limiting its ability to measure BMD. Therefore, we have proposed a specialized automated smart system to quantitatively predict BMD based on a conventional X-ray image only by reducing the soft tissue effect supported by the implementation of a convolutional autoencoder, which is trained using proposed synthesized data to generate grayscale values of bone tissue alone. From the enhanced image, multiple features are calculated from the hip X-ray to predict the BMD values. The performance of the proposed method has been validated through comparison with the DXA value, which shows high consistency with correlation coefficient of 0.81 and mean absolute error of 0.069 g/cm2.

THU421 Utility Of Forearm DXA As A Tool For Identification Of Osteoporosis: A Cleveland Clinic Experience

Abstract Disclosure: A.F. Ishola: None. K. Alsibai: None. A. Iqbal: None. A. Elsherif: None. P. Rao: None. L.Z. Khan: None. Background: Osteoporosis is a preventable and treatable condition with a significant impact on the quality of life. According to the National Osteoporosis Foundation, 10.2 million Americans have osteoporosis. In addition, more than 2 million osteoporosis-related fractures occur annually in the US and &amp;gt;70% of these occur in women. Unfortunately, most individuals at risk do not undergo appropriate assessment or treatment. Clinically osteoporosis may be diagnosed if there is a fragility fracture, independent of bone mineral density (BMD) T-score value. Diagnosis based on BMD can also be made with a T-score of − 2.5 or below in the lumbar spine, femoral neck, total proximal femur, or distal 1/3 radius. Due to the limitations in interpreting BMD values in patients with degenerative joint disease (DJD), using the forearm (distal 33% radius) as an alternative skeletal site could serve as a more sensitive screening test. Our study primary aims were to assess the frequency at which females age ≥ 65 undergoing BMD testing had DJD of the spine, to determine the frequency at which BMD testing of the forearm was performed in patients with DJD of the spine, and to assess skeletal site-specific rates of osteoporosis. Methods: This is a large, single-center, retrospective, IRB- approved study conducted at Cleveland Clinic Foundation. Postmenopausal female patients above the age of 65 who underwent DXA scans between January 2018 and December 2019 were identified. Manual chart reviews were performed. Patients receiving osteoporosis treatment and those with hyperparathyroidism were excluded. Results: 195 patients were eligible for the study. The mean age was 73.4 ± 8.2 years. DJD of spine and osteoarthritis were present in 74.5% and 58.2% of patients respectively. Forearm BMD testing was only performed in 18.9% of patients with DJD of the spine. Osteoporosis was diagnosed in 39.1 % at the femoral neck, 35.4% of patients at the lumbar spine, 9.3 % at the distal 1/3 radius, and 6.8% at the total hip. Conclusion: DJD of the spine and hip osteoarthritis often lead to falsely elevated T-scores resulting in under-diagnosis and under-treatment of osteoporosis. Although there is a higher sensitivity of using forearm BMD values to diagnose osteoporosis in patients with DJD of spine and/or osteoporosis, our preliminary data show that the forearm DXA scan is an under-utilized clinical tool in cases of DJD of spine, osteoarthritis, and hip replacement. Presentation: Thursday, June 15, 2023

SAT420 Bone Health In Transgender People

Abstract Disclosure: G. Grande: None. C. Ceolin: None. B. Vescovi: None. M. Dall’Agnol: None. C. Ziliotto: None. S. Pasqualini: None. G. Petre: None. A. Scala: None. S. Giannini: None. V. Camozzi: None. A. Bertocco: None. G. Sergi: None. A. Ferlin: None. A. Garolla: None. In transgender subjects, worse Bone Mineral Density (BMD) values were observed when compared to cisgender controls before initiating Gender-Affirming Hormonal Therapy (GAHT). The reasons have not yet been fully clarified. In this study we analyzed bone metabolism and body composition in a population of transgender people before initiating GAHT, and their possible correlation with endocrine profile, mental health, and lifestyle habits. Medical data, phosphocalcic metabolism and hormonal parameters, lumbar and femoral bone mineral density, body composition, strength and psychological well-being (by Patient Health Questionnaire-9-PHQ-9 and Perceived Stress Scale-PSS questionnaires), were collected in a sample of 32 transgender people before GAHT initiation and 32 cisgender controls. Assigned Female At Birth (AFAB) transgender people presented worse Z-score values at total hip and neck femoral sites (-0.52±0.94 vs 0.15±0.82, and -0.37±0.79 vs 0.19±0.66, p=0.04 respectively), while in Assigned Male At Birth (AMAB) transgender people also lumbar sites were compromised in comparison to cisgender controls. No significant difference in phospho-calcium metabolism (calcium, phosphate, PTH and vitamin D) or hormonal profile (Testosterone, estradiol, LH, FSH) was found between the transgender and the cisgender group. PHQ-9 (a questionnaire to screen for depression) scores were higher in the transgender population than cisgender controls (9.35±7.41 vs 4.08±3.14, p=0.03 in AFAB and 9.54±5.45 vs 4.46±3.59, p=0.02 in AMAB transgender people). Multiple regression analysis identified PSS (a tool to assess stress levels and identify which situations are perceived as stressful) score as an independent predictor of total femur BMD, explaining about 54% of the variance. Transgender people before GAHT have worse bone health than cisgender subjects. In particular, BMD was reduced at the hip and in AMAB even at lumbar site. The reduction in bone mass before GAHT seems independent by hormonal and phospho-calcic profile and associated mostly with psychological status. Further study will clarify the specific pathogenetic mechanisms involved in bone growth in transgender people. However, according to our evidences, the psychological stress might influence negatively lifestyle habits therefore being involved in reduced bone health. Early lifestyle and psychological interventions might so be beneficial also for bone health in the transgender population. Presentation: Saturday, June 17, 2023

FRI673 REMS Technology For The Evaluation Of BMD In Hypothyroidism

Abstract Disclosure: F.A. Lombardi: None. P. Pisani*: None. A.P. Quezada*: None. M. Muratore*: None. M. Di Paola*: None. E. Casciaro*: None. F. Conversano*: None. S. Casciaro: None. *Equal contributors in alphabetical order Thyroid hormones play a crucial role in skeletal development, adult bone turnover, and bone maintenance, but they can also have detrimental effects on bone formation when there is thyroid dysfunction. Thyrotoxicosis (hyperthyroidism), including subclinical illness, can affect bone metabolism, resulting in decreased Bone Mineral Density (BMD) and increased fractures risk, and is a significant contributor to secondary osteoporosis, especially in postmenopausal women. On the other hand, little is known about the impact of overt or subclinical hypothyroidism on bone metabolism. However, hypothyroidism lessens bone turnover, reducing both osteoclastic bone resorption and osteoblastic activity. Such alterations in bone metabolism could potentially result in an increase in bone mineralization, although data on BMD and the risk of fracture in hypothyroidism are lacking and conflicting. Radiofrequency Echographic Multi-spectrometry (REMS) is a novel radiation-free technology for assessing BMD and fracture risk. In this context, the goal of this study was to assess BMD using REMS in patients with and without hypothyroidism, in order to look a possible correlation between the disease, BMD loss and fracture risk. Methods: A sample of 51 Caucasian females with hypothyroidism was compared to a reference group of healthy women who were matched for gender, ethnicity, age, and body mass index (BMI). Using REMS technology, the BMD was measurement at the lumbar spine in all participants at the study. To determine whether the two groups’ lumbar spine BMD value varied, a t-test was run. Results: Patients with and without hypothyroidism were matched in order to get similar anthropometric parameters. In patient with and without hypothyroidism mean ± standard deviation (SD) for age and BMI are (64.8 ± 10.2, 65.2 ± 9.8) and (25.1 ± 3.6, 25.0 ± 3.7), respectively. Patients with hypothyroidism were shown to have a significative lumbar spine BMD difference (0.801 g/cm2 ± 0.063 vs 0.831 g/cm2 ± 0.071, p=0.03) respect to the healthy subjects. Conclusions: Although just a small number of hypothyroidism patients are included in this investigation, without any indication of the drug therapy and its effect, it has been shown that, as compared to controls, women with hypothyroidism have a net decline in REMS-measured BMD values. Based on this thought, REMS technology, thanks to its precision and diagnostic accuracy, might improve the efficient care and follow-up programmes of these patients. Presentation: Friday, June 16, 2023

Tobacco toxins induce osteoporosis through ferroptosis

Clinical epidemiological studies have confirmed that tobacco smoking disrupts bone homeostasis and is an independent risk factor for the development of osteoporosis. The low viability and inferior osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) are important etiologies of osteoporosis. However, few basic studies have elucidated the specific mechanisms that tobacco toxins devastated BMSCs and consequently induced or exacerbated osteoporosis. Herein, our clinical data showed the bone mineral density (BMD) values of femoral neck in smokers were significantly lower than non-smokers, meanwhile cigarette smoke extract (CSE) exposure led to a significant decrease of BMD in rats and dysfunction of rat BMSCs (rBMSCs). Transcriptomic analysis and phenotype experiments suggested that the ferroptosis pathway was significantly activated in CSE-treated rBMSCs. Accumulated intracellular reactive oxygen species activated AMPK signaling, furtherly promoted NCOA4-mediated ferritin-selective autophagic processes, increased labial iron pool and lipid peroxidation deposition, and ultimately led to ferroptosis in rBMSCs. Importantly, in vivo utilization of ferroptosis and ferritinophagy inhibitors significantly alleviated BMD loss in CSE-exposed rats. Our study innovatively reveals the key mechanism of smoking-related osteoporosis, and provides a possible route targeting on the perspective of BMSC ferroptosis for future prevention and treatment of smoking-related bone homeostasis imbalance.

Radiofrequency Echographic Multispectrometry (REMS): A New Option in the Assessment Bone Status in Adults with Osteogenesis Imperfecta.

This study aimed to estimate the utility of the Radiofrequency Echographic Multispectrometry (REMS) approach in the assessment of bone mineral density (BMD) in subjects with osteogenesis imperfecta (OI). In 41 subjects (40.5 ± 18.7 years) with OI and in 36 healthy controls, we measured BMD at the lumbar spine (LS-BMD), femoral neck (FN-BMD) and total hip (TH-BMD), employing a dual-energy X-ray absorptiometry tool. Additionally, REMS scans were also performed at the lumbar and femoral sites. The presence and number of reported fractures were assessed in the study population. Patients characterized by a history of fragility fractures represented 84.5% of the study population. OI subjects showed significantly reduced BMD values both at the level of the lumbar spine and the femoral subregions (p < 0.01) compared to healthy controls when performed using both the DXA and the REMS method. Dividing OI patients on the basis of the Sillence classification, no differences were found between the LS-BMD values carried out using the DXA technique between the OI type I group and OI Type III and IV groups. On the contrary, the OI Type III and IV groups presented significantly lower values of both Trabecular Bone Score (TBS) and LS-BMD through REMS with respect to OI type I patients (p < 0.05). Based on the data of this study, it is possible to conclude that even the new REMS assessment, which does not use ionizing radiation, represents an excellent method for studying the bone status in subjects affected by OI.

Virtual unenhanced images derived from dual-energy computed tomography for assessing bone mineral density and detecting osteoporosis.

The early detection and treatment of osteoporosis can help prevent osteoporosis-related fractures, especially in patients who undergo enhanced computed tomography (CT) scans for disease diagnosis or evaluation of treatment outcomes. Although Hounsfield unit (HU) measurement of the vertebral body has been shown to have a strong positive correlation with bone mineral density (BMD), the contrast media will impact the CT value of the vertebral body and decrease the accuracy. This study is aimed to examine the distinctions in vertebral body CT attenuation measurement on true unenhanced (TUE) and virtual unenhanced (VUE) images generated from triphasic enhanced dual-energy CT (DECT) scans and to determine the feasibility of assessing BMD and detecting osteoporosis on VUE images as compared to quantitative CT (QCT). A total of 235 patients underwent abdominal CT examinations that included unenhanced (with 120 kVp and Smart mA) and triphasic enhanced DECT scans. The BMD and CT attenuation values of the L1-L2 vertebrae were measured on TUE and VUE images reconstructed from the triphasic enhanced CT. The differences and associations between TUE and VUE generated from triphasic enhanced CT were analyzed. The diagnostic performances of HU measurements obtained from TUE and VUE images were evaluated using receiver operating characteristic curve. The BMD and HU measurements of the vertebrae showed good interobserver repeatability on both TUE and VUE images (all intercorrelation coefficients >0.92). The CT attenuation values of L1 and L2 and their average value showed no statistically significant difference among the triphasic VUE images (F=0.121, F=0.061, F=0.090; all P values >0.05) but were significantly lower than those obtained from the TUE images. HU measurements in both the TUE and triphasic VUE images, along with the reference BMD derived from QCT, demonstrated a strong positive correlation (rTUE =0.981, rVUEa =0.966, rVUEv =0.962, rVUEd =0.964; all P values <0.05), with excellent diagnostic performance for the diagnoses of osteoporosis and osteopenia (all areas under curve >0.95). The Bland-Altman scatter plot exhibited good agreement, as the deviations between the reference BMD and the calculated BMD were evenly distributed around 0. Although the attenuation values of the vertebrae on the VUE images were underestimated compared to those on the TUE images, the HU measurement on VUE image was effective in assessing BMD and detecting osteoporosis and osteopenia with good diagnostic performance.

Evaluating alternatives to dual-energy x-ray absorptiometry for assessing bone quality in patients undergoing spine surgery.

The purpose of this study was to compare and contrast lumbar bone quality and osteoporosis/osteopenia screening results via dual-energy x-ray absorptiometry (DEXA), CT, and MRI. A consecutive series of 426 candidates screened for lumbar disc replacement over a 5-year period beginning in 2018 was reviewed. Patients with a preoperative lumbar spine DEXA scan and a CT and/or MRI scan were included. The primary outcome measures included the bone mineral density (BMD) and osteoporosis or osteopenia classification from DEXA scans, Hounsfield units (HUs) for CT, and vertebral bone quality (VBQ) assessment for MRI. Patients were included if they had a DEXA scan within 1 year of an MRI or CT scan. DEXA BMD scores from composite or level-by-level reports were recorded. Asynchronous MRI and CT measurements were conducted using PACS. Interrater and intrarater reliability scores were generated for both CT and MRI measurements and ranged from 1.000 for MRI L1-4 scans to 0.683 for MRI VBQ. All 3 types of scans were statistically significantly correlated with one another; however, CT was more strongly correlated with the lumbar DEXA value (r = 0.439, p < 0.001). The correlation between MRI VBQ and DEXA was -0.103, (p < 0.045). The CT level-by-level measurements correlate with the corresponding level-by-level DEXA BMD values (correlation ranging from 0.531 to 0.289, p < 0.001 to p = 0.007). CT HU values were more strongly related to osteoporosis/osteopenia classification based on DEXA T-scores than were MRI VBQ values. Receiver operating characteristic analyses found that the area under the curve was 0.817 for CT and 0.539 for MRI. These results demonstrate that CT HUs more closely correlate to DEXA scores than MRI VBQ in this population of patients undergoing surgery for symptomatic disc degeneration. Thus, CT may be an alternative to DEXA for assessing VBQ in this population.

Association between lumbar endplate damage and bone mineral density in patients with degenerative disc disease

BackgroundTo explore the independent association between lumbar endplate damage and bone mineral density (BMD) in patients with degenerative disc disease (DDD).MethodsThis retrospective investigation was based out of a prospectively collected database from the Affiliated Kunshan Hospital of Jiangsu University. Data from 192 DDD patients, collected between December 2018 and January 2022, were chosen for the final analysis. The average total endplate score (TEPS) of lumbar(L) 1-L4 was assessed by magnetic resonance imaging (MRI), and represents the extent of endplate damage. Osteoporosis severity was assessed via the L1-L4 BMD evidenced by dual-energy x-ray absorptiometry (DXA). Other analyzed information included gender, age, body mass index (BMI), and osteophyte score (OSTS). Uni- and multivariate linear regression analyses were employed to evaluate the association between average TEPS and BMD of L1-L4. Moreover, the generalized additive model (GAM) was employed for non-linear association analysis.ResultsUpon gender, age, BMI, and OSTS adjustments, a strong independent inverse relationship was observed between average TEPS and BMD (β, -0.021; 95% CI, -0.035 to -0.007, P-value = 0.00449). In addition, the gender stratification analysis revealed a linear relationship in males, and a non-linear relationship in females. Specifically, there was a significantly stronger negative relationship between average TEPS and BMD in females, when the average TEPS was < 3.75 (β, -0.063; 95% CI, -0.114 to -0.013; P-value = 0.0157). However, at an average TEPS > 3.75, the relationship did not reach significance (β, 0.007; 95% CI, -0.012 to 0.027; P-value = 0.4592).ConclusionsThis study demonstrated the independent negative association between average TEPS and BMD values of L1-L4. Upon gender stratification, a linear relationship was observed in males, and a non-linear association in females. The findings reveal that patients with osteoporosis or endplate damage require more detailed examinations and treatment regimen.

Associations among computed tomographic measures of bone and muscle quality and biomechanical measures of tibiotarsal bone quality in laying hens.

The objectives of the current study were to quantify laying hen sternal carina (keel) and tibiotarsal bone and muscle quality using clinical CT, tissue level, and biomechanical measures; test associations among muscle transverse sectional area, bone mineral density, and biomechanical measures of bone quality; and determine whether CT measures of bone and muscle quality would be predictive of biomechanical measures of tibiotarsal bone quality. 60 40-week-old Hy-Line brown laying hens were used. Associations among CT imaging, tissue level, and biomechanical measures of tibiotarsal and keel bone and muscle quality were tested using multivariate correlational analyses. Bivariate and generalized regressions were performed to determine whether CT measures were predictive of biomechanical measures of tibiotarsal bone quality. Low positive correlations were identified between tibiotarsal muscle transverse-sectional area (cross-sectional area [CSA]) and bone mineral density (BMD) in the proximal location of the bone (r = -0.11 to 0.31). Tibiotarsal muscle CSA was also low to moderately correlated with biomechanical measures of bone quality (r = 0.20 to 0.41). Keel muscle CSA values were not correlated with keel BMD values, but they were correlated with biomechanical measures of tibiotarsal bone quality (r = 0.18 to 0.40). Keel CT measures of bone quality were not correlated with tibiotarsal CT measures of bone quality. At the proximal location, muscle CSA and tibiotarsal BMD were predictive of biomechanical failure load (F = 9.68, P = .0003muscle CSA; F = 9.13, P = .004tibiotarsal BMD). Findings supported using noninvasive CT measures of muscle and bone quality in longitudinal research studies evaluating the effects of interventions on laying hen welfare.

Bone Mineral Density Evaluation Among Type 2 Diabetic Patients in Rural Haryana, India: An Analytical Cross-Sectional Study.

Background and objective Diabetes is one of the most prevalent diseases globally, affecting almost all organ systems. The relationship between type 2 diabetes mellitus (T2DM) and bone mineral density (BMD) has been a matter of controversy, and data from developing countries in this regard is highly scarce. Early detection of low BMD indiabetic patients will help prevent further bone loss and risk of fragility fracture. In this study, we aimed to assess the effect of T2DM on BMD among the rural population of Haryana, India. Materials and methods This was a cross-sectional study involving 850 patients between 25 and 60 years of age, including 425 diabetic and 425 non-diabetic subjects (as controls). Calcaneus BMD was measured by using quantitative ultrasound (QUS), and the data were compared against matched parameters in both groups. Results The mean age of diabetics was 42.21 ± 10.5 years and that of non-diabetics was 42.18 ± 10.4 years. The mean BMI was 27.8 ± 4.17 kg/m2 in diabetics and 21.6 ± 3.32kg/m2 in the non-diabetic control group. BMD values significantly differed between the groups: -4.3 ± 1.23 vs. -2.6 ± 0.34 in diabetics and non-diabetics, respectively (p=0.002). Conclusion A significant difference in BMD was observed between the diabetic andnon-diabetic groups. Based on our findings, We recommend that all type 2 diabetics be screened for osteoporosis so that this silent bone loss can be detected in the early phase itself and appropriate preventive measures can be promptly initiated.

Associations between birth season and lumbar spine bone mineral density in perimenopausal Polish women

In European populations, the birth season significantly correlates with many biological features. It is thus possible that the observed clinical effects of bone metabolism disorders are a partial consequence of bone mineral density (BMD), modified by the season of prenatal development (the birth season). The aim of this study was to evaluate the relationship between the birth season and BMD among Polish women in perimenopausal age. A total of 653 Polish women aged 50.0–59.9 years were included in the study. BMDs of lumbar vertebrae were measured by dual-energy x-ray absorptiometry. Statistical analyses were based on measured lumbar BMD values, age, and body mass index (BMI). The analysis of variance (ANOVA) was applied to evaluate the season-related differentiation of mineral density of lumbar vertebrae. BMDs of lumbar vertebrae negatively correlated with age and positively with BMI. We regressed BMD on age and BMI and used the residuals as a measure of age- and BMI-independent lumbar BMD values. The ANOVA results showed that women born in summer had significantly lower BMD of the L1 vertebra compared to those born in autumn, regardless of age and BMI. The results of our study indicate the need to extend the group of risk factors for osteoporosis in Central Europeans with the season of woman’s birth.