Differences In Bone Mineral Density Research Articles

Comparative effectiveness of four techniques for identifying vertebral fragility fractures among elderly patients.

The incidence of vertebral fragile fractures peaked among the elderly population, and identifying individuals at high risk of vertebral fractures and promptly instituting preventions are of critical importance. This study aims to determine the efficacy and values of Hounsfield unit (HU) values, vertebral bone quality (VBQ) scores, bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA), and quantitative computed tomography (QCT) to discriminate between patients with and without vertebral fractures. A thorough search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, and Wan Fang Database to identify potential studies that met the eligibility criteria. Studies that evaluated the utility of HU values, VBQ scores, QCT-measured BMD, and DXA-measured BMD in discriminating vertebral fractures were qualified. The combined results showed that there were significant differences in HU values, VBQ scores, QCT-measured BMD, and DXA-measured BMD between the fracture and non-fracture groups. Moreover, the pooled sensitivity, specificity, and AUC of HU values were 0.82, 0.67, and 0.76, respectively; the pooled sensitivity, specificity, and AUC of VBQ scores were 0.70, 0.75, and 0.78; the pooled sensitivity, specificity, and AUC of QCT-measured BMD were 0.85, 0.76 and 0.88. All four methods, namely HU values, VBQ scores, QCT-measured BMD, and DXA-measured BMD can effectively distinguish between patients with and without vertebral fragile fractures. Among these, QCT-measured BMD exhibited a relatively high efficacy in discriminating vertebral fractures. VBQ scores and HU values demonstrated comparable efficacy for discriminating vertebral fractures among elderly patients. Question Can four different imaging modalities effectively discriminate vertebral fragility fracture status among elderly patients? Findings These methods can effectively distinguish vertebral fractures status among elderly patients, and quantitative computed tomography (QCT)-measured bone mineral density (BMD) exhibited a relatively high efficacy. Clinical relevance The clinical applications of Hounsfield unit values, vertebral bone quality scores, and BMD measured by dual-energy X-ray absorptiometry and QCT show promising outcomes in identifying individuals at high risk of vertebral fractures.

Cumulative incidence and treatment effectiveness of low bone mineral density among people living with HIV in Iran (2021–2023)

BackgroundThe introduction of antiretroviral therapy (ART) has significantly improved the life expectancy of people living with HIV (PLHIV), leading to an increased prevalence of age-related comorbidities such as osteoporosis. This study investigates the incidence and characteristics of low bone mineral density (BMD) and the treatment effectiveness of low BMD participants among PLHIV in Kerman, Iran.MethodsA longitudinal study utilized dual-energy X-ray absorptiometry (DEXA) to screen 94 PLHIV in Kerman, Iran, for low BMD. Participants were aged 30 or older and had received antiretroviral therapy (ART) for at least 12 months. Those with low BMD were entered into a single-arm clinical trial and received the appropriate treatment. These people were checked to assess the treatment effectiveness 11 months after completion of the treatment. Those with normal BMD entered a cohort study and were checked to determine the cumulative incidence of low BMD. Data on demographics, medical history, and laboratory tests were collected. A chi-square test was used to assess the association between the categorical variables. A t-test (for normally distributed variables), or Mann-Whitney U (for non-normally distributed variables) was used to assess the differences of BMD between the two groups. Statistical significance was set at p ≤ 0.05, with analyses conducted in Stata 17.ResultsAmong 94 PLHIV at baseline, 48 participants (51%) had low BMD. During the follow-up, 11 participants (11.7%) missed the follow-up visits. In the follow-up, 83 PLHIV (40 with low BMD and 43 with normal BMD at baseline) were available. Among 40 participants who received treatment, 5 had normal BMD (treatment effectiveness: 12.5%). However, among 43 PLHIV with normal BMD at baseline, 7 PLHIV had low BMD at the follow-up visit (cumulative Incidence 16.3%). Those with lower body mass index (BMI) had a higher prevalence of low BMD than those with normal BMI during the follow-up (p-value: 0.003). Lumbar spine BMD increased modestly (0.005 g/cm2), while femoral neck and total hip BMD declined in total participants (0.011, 0.007 g/cm2, respectively). Osteocalcin and β-isomerized C-terminal telopeptides (β-CTx) levels were higher in the low BMD group in the follow-up, indicating increased bone turnover.ConclusionsThe study highlights the high cumulative incidence of 16.3% and treatment effectiveness of 12.5% of low BMD among PLHIV in Kerman, Iran, with implications for fracture risk. Despite a steady state in spine BMD decline, the risk of fracture remains elevated due to continued femoral neck and total hip BMD reduction. Gender-specific factors and BMI may influence susceptibility to low BMD.

The difference in bone mineral density between femur and tibia is related to tibia deformation in endstage knee osteoarthritis

BackgroundThis study investigated bone mineral density (BMD) around the knee joint to clarify the mechanism by which tibia deformation exceeds that of the femur in patients with end-stage knee osteoarthritis (KOA). MethodsWe retrospectively analyzed 193 patients who underwent total knee arthroplasty for end-stage KOA with varus alignment. Preoperative T-score of the femur neck and femur total using dual-energy X-ray absorptiometry (DXA) and hounsfield units (HU) of the distal femur and proximal tibia using computed tomography (CT) were measured to asess the BMD. HU was measured by dividing the femur and tibia into medial, lateral, and total parts, respectively. Patients with medial proximal tibial angle (MPTA) ≥ 85° were considered ‘group 1′, and MPTA < 85° were ‘group 2′. The HU between femur and tibia were compared in group 1. T-score, HU, and HU difference between group 1 and group 2 were compared. ResultsThe HU of the proximal tibia was lower than that of the distal femur (femur lateral > femur medial > tibia medial > tibia lateral). T-score (femur neck, femur total) and HU (femur lateral, femur total, tibia lateral) were lower in group 2 than in group 1. There was no difference in femur-tibia HU difference between groups. ConclusionThe medial tibia collapse more than the medial femur in varus endstage KOA was associated with the lower BMD of the proximal tibia than that of the distal femur, and the MPTA collapse was affected by the absolute value of BMD rather than by the femur-tibia BMD difference.

Relationships among Physical Activity Bone Mineral Density and Body Composition in Obese and Athletes

Background: Osteoporosis is a significant global public health issue, increasingly affecting younger individuals and placing substantial economic burdens on society. Risk factors vary, with non-modifiable ones like age and ethnicity, as well as modifiable factors including corticosteroid use, caffeine intake, and reduced exercise. This study examines the relationship between bone density, body components, and physical activity (PA) in enhancing bone health, particularly in obese athletes.Methods: The 66 participants aged 18 to 30 were classified into two groups: 34 obese and 32 athletes. Measured parameters included body composition through bioelectrical impedance analysis, and bone mineral density (BMD) via quantitative ultrasound, while PA was assessed using the International PA Questionnaire.Results: Our findings revealed a significant positive correlation between BMD and PA (r=0.284, &lt;i&gt;P&lt;/i&gt;=0.023). Additionally, PA demonstrated strong negative correlations with body mass index (BMI), fat mass, and visceral fat (r=-0.738, r=-0.733, and r=-0.704 respectively, all &lt;i&gt;P&lt;/i&gt;&lt;0.001). In contrast, no significant correlation was observed between PA and lean mass (r=0.065, &lt;i&gt;P&lt;/i&gt;=0.609). BMD was negatively associated with BMI and visceral fat, while a robust correlation between basal metabolic rate and lean mass was evident.Conclusions: A study comparing athletes involved in high-impact sports indicated that these athletes maintained adequate BMD for their chronological age (Z-score≥-2.0). Moreover, a significant difference in BMD was observed when comparing the athletes to the obese group(&lt;i&gt;P&lt;/i&gt;=0.018).

Tenofovir Disoproxil Fumarate/Emtricitabine Prophylaxis Has No Effect on Bone Mineral Density and Bone Mineral Content in African Breastfeeding Women Receiving Pre-Exposure Prophylaxis for HIV.

Tenofovir disoproxil fumarate (TDF) when used as preexposure prophylaxis (PrEP) in pregnancy is considered safe overall however there is insufficient evidence of its effect on maternal bone. We compared bone mineral density (BMD) and content (BMC) at the lumbar spine (LS) and hip of African breastfeeding women exposed and not exposed to TDF-containing PrEP in a randomized control trial (RCT). This is a secondary data analysis of an RCT where pregnant women were randomized to initiating PrEP in pregnancy or delayed initiation of PrEP until breastfeeding cessation. BMD and BMC at the LS and hip were measured using dual-energy x-ray absorptiometry (DXA) at 6, 26, 50, and 74 weeks postpartum. In an exploratory analysis, BMD at the hip and LS were evaluated against varying Tenofovir (TFV) levels during pregnancy. Of 300 women in the RCT who had a DXA at 6 weeks postpartum, 102 (66%) women in the Immediate PrEP arm and 105 (72%) in the Delayed PrEP arm had a 74-week DXA scan. Adjusting for breastfeeding duration and body mass index (BMI), there were no significant differences in BMD or BMC at the hip and LS between treatment arms. There was no consistent dose-effect of TFV-DP detected during pregnancy on BMD at the hip (p=0.231) or the LS (p=0.277). After adjusting for breastfeeding and BMI, TDF when given as oral preexposure prophylaxis during pregnancy had no deleterious effect on BMD and BMC at the hip and LS of African breastfeeding women.

Association between triglycerides and lumbar bone mineral density in Chinese patients with osteoporotic fractures: a retrospective cross-sectional study

The association between lumbar bone mineral density (BMD) and triglyceride (TG) levels has been extensively studied; however, the results remain controversial. Therefore, this research aimed to elucidate the association of TG levels with lumbar BMD in patients with osteoporotic fractures (OPFs) who have undergone surgery. This cross-sectional study analyzed 3,558 OPF patients (aged 50 years and above) who were admitted to the First People’s Hospital of Kunshan and assessed their TG levels, lumbar BMD, and other variables. The outcome variable of this research was bone density, whereas the baseline glycerol trihydrate levels were considered as the exposure variable. An analysis adjustment was conducted for various covariates, including age, gender, body mass index (BMI), and other baseline laboratory and clinical results. Furthermore, the potential non-linear relationships were assessed via the smooth curve fitting, and threshold effect analyses. The mean age of 3,558 included OPF patients was 68.87 ± 10.55 years. In the fully adjusted multivariate regression analysis, a positive correlation was found between TG levels and lumbar BMD (β = 0.015, 95% CI: 0.001–0.028, p = 0.033). Furthermore, the threshold effect analysis revealed a curvilinear relationship between TG levels and lumbar BMD, with a turning point at 1.26 mmol/L. Moreover, on both sides of the turning point, different patterns were observed. On the left side, TG levels were positively correlated with lumbar BMD. However, despite higher TG levels, the differences in lumbar BMD on the right side of the turning point, were not statistically significant, indicating a lack of significant association (p = 0.712). In summary, this research indicated that in OPF patients, higher TG levels were significantly positively associated with lumbar BMD. Furthermore, there was a threshold value of 1.26 mmol/L, indicating that TG levels in OPF patients with concomitant hypertriglyceridemia should be maintained within the normal range, and reducing TG levels below 1.26 mmol/L requires continuous monitoring. This approach effectively controls TG levels without adversely impacting lumbar BMD.

Subchondral Bone Degeneration and Pathology 3-15 Years Following Ankle Sprain Injury in Adolescent Sport.

Sport-related ankle sprains (SASs) are prevalent in adolescents (ages 10-19), increasing the risk of developing posttraumatic osteoarthritis (PTOA). Although early ankle osteoarthritis (OA) is not well defined, OA eventually includes alterations in bone mineral density (BMD), structural changes, and soft tissue pathology. This study examined the impact of SAS sustained in adolescent sport on bone and soft tissue structural outcomes 3-15 years postinjury. Participants (n = 10) with prior unilateral SAS in adolescent sport (HxAI) were compared to age- and sex-matched controls. To assess injury-related pathologies and BMD, 1.5-tesla (T) extremity magnetic resonance imaging (MRI) and computed tomography scans were used. Semiquantitative scores for injury patterns and OA features from MRI scans were summed and compared between groups. The talus, calcaneus, navicular, and 5% distal tibia were segmented, and BMD was measured for each bone. All HxAI participants exhibited MRI injury pathology (median 2; IQR 1-6), whereas only 1 of 10 controls showed pathology (median 0; IQR 0-0), χ2(1, n = 20) = 16.36, P < .001. Both the injured and uninjured ankles in HxAI displayed injury pattern pathology. Additionally, 3 of 10 injured ankles and 2 of 10 uninjured ankles in the HxAI group (median 0; IQR 0-3), but none of the controls (median 0; IQR 0-0), exhibited OA features. In the HxAI group, talus BMD was lower in the injured ankle (502.4 ± 67.9 g/cm3) compared with the uninjured ankle (515.6 ± 70.1 g/cm3) (F = 13.33, P = .002), with no significant BMD differences at the calcaneus, navicular, or 5% distal tibia. No differences were observed between the ankles of the control group. The presence of injury pattern pathology, structural changes, and reduced talus BMD suggest that degenerative changes may occur in individuals as early as 3-15 years following ankle injury.

Type 2 diabetes and bone mineral density: A meta-analysis and systematic review.

Type 2 diabetes (T2D), a widespread chronic metabolic disorder, presents frequently in clinical settings. The relationship between T2D and bone mineral density (BMD) has been subject to ongoing investigation, yielding inconclusive results. A systematic literature search was conducted across several databases, including CNKI, VIP, CBM, Wanfang, PubMed, Cochrane Library, and Embase, targeting observational studies that explored the impact of microangiopathy associated with T2D on BMD or bone metabolism. The search spanned from the inception of each database to July 1, 2023. The Newcastle-Ottawa Scale was employed for quality assessment, and RevMan 5.3 software was utilized for data analysis. Stata 14.0 was used for the quantitative evaluation of publication bias regarding outcome measures. The inclusion criteria were met by 30 observational studies, comprising 6470 participants-3121 with diabetes and 3349 without. The meta-analysis revealed no significant difference in overall BMD between the nondiabetic and T2D groups (mean difference [MD] = -0.07, 95% confidence interval [CI] [-0.17, 0.03], Z = 1.45, P = .15). However, BMD at the lumbar vertebrae was significantly higher in nondiabetic individuals compared with those with T2D (MD = -0.14, 95% CI [-0.22, -0.06], Z = 3.32, P = 0.0009), as was the case with femoral neck BMD (MD = -0.11, 95% CI [-0.18, -0.04], Z = 3.08, P = .002). A difference in femoral neck BMD between nondiabetics and individuals with T2D approached but did not reach statistical significance (MD = -0.14, 95% CI [-0.27, 0.00], Z = 1.94, P = .05). An inverted funnel plot analysis suggested possible publication bias, as evidenced by an asymmetrical distribution of studies around the axis of symmetry, with overlap observed in several cases. The findings indicate a significant association between T2D and reduced BMD at critical sites such as the lumbar vertebrae and femoral neck, highlighting an increased risk of osteoporosis or osteoporotic fractures in these regions.

Bone Mineral Density in the Scaphoid.

Introduction: The scaphoid bone is essential for wrist stability and movement. While fractures commonly occur at the scaphoid's waist, those at the proximal pole, though rarer, tend to result in nonunion, potentially linked to variations in bone mineral density (BMD). Previous studies have shown an increase in BMD at the proximal pole in fractured scaphoids, but BMD distribution in intact scaphoids has not been well studied. This study aims to map the BMD distribution of the intact scaphoid to better understand the etiology of fractures and optimize treatment approaches. Methods: Conducted under ethical approval, this study included 100 individuals, using computed tomography to assess the BMD in distal, middle, and proximal thirds of the scaphoid. Measurements were performed in the defined regions and analyzed using SPSS software, with significance accepted at P < .05. Results: The study comprised 34 females and 66 males, with no significant BMD difference between the right and left wrists. The proximal third exhibited significantly higher BMD (542.2 HU) compared to the middle (293.1 HU) and distal thirds (298.4 HU). A statistically significant higher BMD was observed in males, particularly in the proximal and distal thirds. A weak negative correlation between age and BMD was noted across all sections. Conclusion: The proximal scaphoid shows significantly higher BMD, potentially explaining its lower fracture incidence but higher nonunion rate. This insight into the BMD distribution within an intact scaphoid may guide the clinical management of scaphoid fractures, highlighting the need for targeted treatment strategies based on BMD variations.

The relationship between serum vitamin D, bone mineral density, and injury in collegiate acrobatics and tumbling athletes.

Background: Medical staff for indoor aesthetic sports such as acrobatics and tumbling (A&T) is often concerned with athletes' bone mineral density (BMD), serum vitamin D (SvD), and associated injury risks. Aim: To evaluate the relationship between BMD, SvD, and injury among A&T athletes. Methods: 42 (19 tops, 23 bases) female A&T athletes aged 19.6 (±1.17) years participated. Two samples of SvD were taken. Injury and BMD data were provided by support staff. Bivariate and multivariate analysis assessed relationships between and among variables. Results: Participants experienced a decrease in SvD (6.093 ± 10.973). Spine BMD was significantly higher in bases compared to tops (p = 0.039). BMD and SvD did not differ based on injuries sustained. Conclusion: Relationships between SvD, BMD, and injury were not identified. Positional differences in BMD may be related to the demands of each role. Participants possessed low SvD and high BMDs, which may provide useful information for medical staff.

Increased prevalence of osteopenia and osteoporosis in systemic sclerosis patients, including in men and young women- a case-control study.

To investigate bone mineral density (BMD), osteoporosis prevalence and systemic sclerosis (SSc) specific associations of BMD in SSc patients compared with background population. In total, 211 SSc patients (182 women, 29 men; mean age 61.3 and 62.2 respectively) and 505 age and sex matched controls from the same geographic area participated. BMD and T-score at total hip and lumbar spine was measured by Dual-energy X-ray absorptiometry. Osteopenia was defined as T-score -1.0 to -2.5; osteoporosis as T-score ≤-2.5. Associates of low BMD were identified by multiple regression analysis. Women with SSc had lower BMD for total hip (p< 0.001) and spine (p= 0.011), equivalent to ΔT-score -0.56 and -0.35 compared with controls. Osteopenia was present in 51.6% and 16.5% had osteoporosis (p= 0.001, compared with controls). Already in women below age 45, differences in hip BMD were apparent (ΔT-score -0.93, p= 0.005). In addition to expected risk factors for osteoporosis (older age, lower BMI and menopause), finger ulcers (p= 0.009) and diffuse skin involvement (p= 0.027) were associated with lower hip BMD in women. In men with SSc, more than half displayed osteopenia or osteoporosis and had numerically lower hip BMD than their age matched counterparts. SSc patients, including men and younger women, have lower BMD than the background population. Finger ulcers and diffuse skin involvement, in addition to older age, lower BMI and being post-menopausal, are associated with lower BMD in women. The data emphasizes the importance of performing bone health assessment of all SSc patients, including men and young subjects.

Bone mineral density determinants in adolescents and young adults with congenital adrenal hyperplasia.

The effects of long-term glucocorticoid (GC) treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) remain controversial. This cross-sectional study aimed to evaluate BMD in relation to genotype, growth, vitamin D status, cumulative GC doses, and other relevant factors in youths with CAH. Thirty-two patients with classical CAH (13 males; mean age 26.0 ± 7.1 years) were compared with 32 healthy controls matched by age and sex. BMD was measured using dual-energy x-ray absorptiometry, and statistical analyses, including the Mann-Whitney U-test and Spearman's correlation coefficient, were performed to evaluate differences and associations. Median whole-body and lumbar BMD Z-scores were similar between CAH patients and controls (p = 0.27 and 0.15, respectively). Low bone density was observed in 12.5% of CAH patients and 18.75% of controls (p = 0.5), and osteoporosis was confirmed in 12.5% of CAH patients and 0% of controls (p = 0.04). BMD did not correlate with cumulative GC doses, estradiol, renin, phosphate, sodium levels, or anthropometric parameters in CAH patients. There was no significant difference in BMD between severe and non-severe genotypes of CAH. However, a positive correlation was found between the whole-body BMD Z-score and growth velocity during infancy (r = 0.776, p = 0.021) in CAH patients. Vitamin D deficiency was noted in 56.25% of CAH patients, although vitamin D levels did not correlate with BMD or genotype. No history of bone fractures was reported among study participants. CAH patients are at risk of developing osteoporosis, but in this study, BMD Z-scores were not associated with cumulative GC doses. The study did not identify an association between genotype and BMD. Poor growth during infancy was linked to decreased BMD in adulthood.

7522 Effects of Trikafta On Bone Mineral Density And Body Composition In Patients With Cystic Fibrosis

Abstract Disclosure: N. Mon: None. S.S. Krishnasamy: None. G. Bakeerathan: None. L. Healy: None. E. Favier: None. S. Foushee: None. Background: Cystic fibrosis related bone disease (CFBD) is a common complication of adult Cystic fibrosis (CF) patients due to calcium, vitamin D and K malabsorption from exocrine pancreatic insufficiency, increased inflammatory cytokines, glucocorticoid therapy, delayed puberty, physical inactivity, and hypogonadism. Newer CF transmembrane conductance regulator (CFTR) modulator therapy elexacaftor/tezacaftor/ivacaftor (Trikafta) has proven benefit in pulmonary and nutritional outcomes. There is limited data on effects of Trikafta on bone health and body composition. The aim is to examine the effects of Trikafta on bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN), and body composition in terms of fat free mass index (FFMI) and fat mass index (FMI) in our CF patients. Method: We conducted a cross sectional and retrospective review of 38 adults with CF (Ages 20-59, 28 males and 10 females) in our CF clinic. Body Mass Index (BMI), Body composition measured by bioelectric impedance analysis, BMD of LS and FN by Dual-energy X-ray absorptiometry, Vitamin D level, and forced expiratory volume in one second (FEV1 % predicted) in patients taking Trikafta were analyzed and compared with control CF group who were not on Trikafta. Results: 38 subjects on Trikafta, aged 33.29 ± 10.36 years with FEV1 % predicted 65.11± 28.14% were studied. Serum 25-hydroxyvitamin D level was 35.92 ± 18.52 ng/dL. Of the 38 study patients, 23 (60.53%) had a diagnosis of CF related diabetes (CFRD). Among the Trikafta cohort, 18 (50%) had low BMD with Z-scores ≤ -2.0 and 7 (19.44%) of them had Z score ≤ -1.0 and &amp;gt; -2.0. Compared with the control group, LS BMD 0.93 ± 0.16 g/cm2 and FN BMD 0.73± 0.13g/cm2 (p &amp;gt;0.05) were not improved significantly. BMI of study population 23.09 ± 4.21 kg/m2 (p &amp;lt;0.05) and FMI 6.11 ± 4.25 kg/m2 (p &amp;lt;0.05) increased significantly; however, there was a decrease in FFMI 9.60 ± 1.44 kg/m2 (p &amp;lt;0.05). Conclusion: Treatment with Trikafta in CF patients was associated with increases in BMI and fat mass index but decrease in fat free mass index. There was no statistically significant difference in BMD at LS and FN in our study cohort. This study has limitations in terms of gender differences within the study cohort, duration of Trikafta use in relation to bone mass, and also extent of glucocorticoid use among the study subjects. Larger prospective clinical trials are needed to study efficacy of Trikafta on CFBD. Presentation: 6/3/2024

12455 Bone Mineral Density Improvement After Resolution Of Endogenous Cushing Syndrome

Abstract Disclosure: C. Plessias: None. N. Charoenngam: None. T. Rittiphairoj: None. T. Suenghataiphorn: None. T. Srikulmontri: None. P. Wattanachayakul: None. M. Kurt: None. Bone Mineral Density Improvement After Resolution of Endogenous Cushing Syndrome: a Meta-analysis and meta-regression Patients with endogenous Cushing syndrome (eCS) are known to have decreased bone mineral density (BMD) and are prone to fragility fractures. Treatment of eCS have been shown in multiple studies to result in improvement in BMD. However, the degree of BMD improvement after resolution of eCS remains inadequately explored due to limited sample sizes in existing studies. Through systematic review, meta-analysis, and meta-regression techniques, we aimed to identify all available evidence to evaluate BMD improvement after resolution of eCS. Potentially eligible studies were identified from the PubMed and EMBASE databases from inception to February 2024, utilizing a search strategy incorporating terms related to "Bone mineral density" and "Cushing syndrome". Eligible studies must include adult or pediatric patients diagnosed with any form of eCS, encompassing Cushing disease (CD), adrenal adenoma, mild autonomous cortisol secretion or ectopic ACTH-secreting tumors, who received treatment resulting in CS resolution. These studies must either present lumbar spine (LS) or femoral neck (FN) BMD measurements in the form of T-score, Z-score or actual BMD values before and after CS resolution, or report mean differences (MD) of BMD, or provide individual BMD data. Point estimates with corresponding standard errors were extracted from each study and combined using the generic inverse variance method. Meta-regression analysis was utilized to explore the impact of time after resolution of eCS on BMD improvement.A total of 5,085 records were identified from the databases. After systematic review, 14 studies, including a total of 386 patients, were deemed eligible for analysis. The meta-analysis demonstrated that resolution of eCS resulted in statistically significantly improvement of LS BMD (pooled MD: Z-score: +0.76, 95%CI 0.50 – 1.02, I2 76%; T-score: +0.87, 95%CI 0.55 – 1.19, I2 78%; actual BMD: +0.092 g/cm2, 95%CI 0.060 – 0.124, I2 74%) and FN BMD (pooled MD: Z-score: +0.54, 95%CI 0.32 – 0.76, I2 75%; T-score: +0.38, 95%CI 0.25 – 0.51, I2 0%; actual BMD: +0.041 g/cm2, 95%CI 0.021 – 0.062, I2 0%). The meta-regression analysis revealed a statistically significant association between follow-up time and improvements in LS T-score BMD (predicted LS T-score improvement = 0.42 + 0.062 × year, p = 0.027) and FN Z-score BMD (predicted FN Z-score improvement = 0.35 + 0.037 × year, p = 0.003), but not with LS Z-score and FN T-score.In summary, our study presents the extent of improvement in LS and FN BMD following the resolution of eCS based on all available data in the literature. These findings have clinical significance as they offer guidance for management of osteoporosis following the resolution of eCS. Presentation: 6/3/2024

Relationship between Feline Knee Joint Osteoarthritis and Bone Mineral Density Quantified Using Computed Tomography and Computed Digital Absorptiometry.

Osteoarthritis (OA), including knee joint OA, is a common chronic condition in cats. In both cats and humans, knee joint OA is characterized radiographically by the presence of osteophytes, enthesiophytes, subchondral sclerosis, and joint space narrowing. However, only in humans have these radiographic signs been reported to increase bone mineral density (BMD). Therefore, this study aims to quantify the volumetric (vBMD) and relative (rBMD) BMD measures of the feline knee joint and compare BMD measures between various severities of OA to test the hypothesized OA-BMD relationship in the knee joint in cats. The 46 feline knee joints were imaged using computed tomography (CT) and conventional radiography supported by the computed digital absorptiometry (CDA) method to obtain vBMD and rBMD, respectively. Both BMD measures were assessed in three regions of interest (ROIs): the distal femur (ROI 1), patella (ROI 2), and proximal tibia (ROI 3). In all locations, vBMD and rBMD showed moderate (ROI 2: r = 0.67, p < 0.0001) to strong (ROI 1: ρ = 0.96, p < 0.0001; ROI 3: r = 0.89, p < 0.0001) positive correlations. Due to differences (p < 0.0001) in the width of the distal femur (17.9 ± 1.21 mm), patella (8.2 ± 0.82 mm), and proximal tibia (19.3 ± 1.16 mm), the rBMD was corrected (corr rBMD) using the thickness coefficient of 0.46 ± 0.04 for ROI 2 and 1.08 ± 0.03 for ROI 3. Regardless of the quantification method used, BMD measures increased linearly from a normal knee joint to severe OA, with differences in BMD between normal and mild to severe knee joint OA. The OA-BMD relationship in the feline knee joint can be preliminarily confirmed.

Dietary Intakes of Copper and Selenium in Association with Bone Mineral Density.

The important trace elements, copper and selenium, have diverse effects on human health. As well as other important roles in living tissues, these trace elements are toxic at high levels but are key constituents of various enzymes and proteins essential for maintaining physiological health. However, links between dietary intakes of these elements, particularly copper, and bone mineral density (BMD) in humans remain uncertain. This study aimed to investigate whether dietary intakes of copper and selenium are associated with BMD in women. Dietary intakes of copper and selenium were assessed for 575 women in the Geelong Osteoporosis Study, using a detailed semi-quantitative food frequency questionnaire in conjunction with nutrition composition databases. Participants taking oral multivitamin preparations were excluded from analyses; 522 participants (ages 20-88 y) met the eligibility criteria. BMD at multiple skeletal sites was measured by dual energy X-ray absorptiometry (Lunar DPX-L). Separate multivariable regression models were developed to identify associations between copper and selenium intakes and BMD, after adjustments for age, anthropometry, other dietary factors, medication use, and lifestyle factors. Median (interquartile range) daily intake for copper was 1.5 mg (1.2-1.9) and for selenium, 72 μg (57-90). Low intakes (lowest tertile versus pooled upper tertiles) of copper and selenium were consistently associated with lower BMD at multiple skeletal sites. Fully adjusted models identified small but statistically significant differences in BMD, ranging from 1.8% to 4.0% for low copper intakes and 1.4% to 4.0% for low selenium intakes. Low dietary intakes of copper and selenium were both independently associated with lower BMD, at least in this sample of women. The results contribute to the evidence base for informing dietary recommendations for these trace elements with respect to their contributions to optimal bone health.

Developing Cut-off Values for Low and Very Low Bone Mineral Density at the Thoracic Spine Using Quantitative Computed Tomography

Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm3), low (80–120 mg/cm3), and normal BMD (> 120 mg/cm3) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31–74] years, 51% women) had a lumbar BMD of 121.6 mg/cm3 (95% CI 115.9–127.3) and a thoracic BMD of 137.0 mg/cm3 (95% CI: 131.5–142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm3. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis.

The Association of Systemic and Mandibular Bone Mineral Density in Postmenopausal Females with Osteoporosis.

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1-L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1-L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis.

Variability in performance of genetic-enhanced DXA-BMD prediction models across diverse ethnic and geographic populations: A risk prediction study.

Osteoporosis is a major global health issue, weakening bones and increasing fracture risk. Dual-energy X-ray absorptiometry (DXA) is the standard for measuring bone mineral density (BMD) and diagnosing osteoporosis, but its costliness and complexity impede widespread screening adoption. Predictive modeling using genetic and clinical data offers a cost-effective alternative for assessing osteoporosis and fracture risk. This study aims to develop BMD prediction models using data from the UK Biobank (UKBB) and test their performance across different ethnic and geographical populations. We developed BMD prediction models for the femoral neck (FNK) and lumbar spine (SPN) using both genetic variants and clinical factors (such as sex, age, height, and weight), within 17,964 British white individuals from UKBB. Models based on regression with least absolute shrinkage and selection operator (LASSO), selected based on the coefficient of determination (R2) from a model selection subset of 5,973 individuals from British white population. These models were tested on 5 UKBB test sets and 12 independent cohorts of diverse ancestries, totaling over 15,000 individuals. Furthermore, we assessed the correlation of predicted BMDs with fragility fractures risk in 10 years in a case-control set of 287,183 European white participants without DXA-BMDs in the UKBB. With single-nucleotide polymorphism (SNP) inclusion thresholds at 5×10-6 and 5×10-7, the prediction models for FNK-BMD and SPN-BMD achieved the highest R2 of 27.70% with a 95% confidence interval (CI) of [27.56%, 27.84%] and 48.28% (95% CI [48.23%, 48.34%]), respectively. Adding genetic factors improved predictions slightly, explaining an additional 2.3% variation for FNK-BMD and 3% for SPN-BMD over clinical factors alone. Survival analysis revealed that the predicted FNK-BMD and SPN-BMD were significantly associated with fragility fracture risk in the European white population (P < 0.001). The hazard ratios (HRs) of the predicted FNK-BMD and SPN-BMD were 0.83 (95% CI [0.79, 0.88], corresponding to a 1.44% difference in 10-year absolute risk) and 0.72 (95% CI [0.68, 0.76], corresponding to a 1.64% difference in 10-year absolute risk), respectively, indicating that for every increase of one standard deviation in BMD, the fracture risk will decrease by 17% and 28%, respectively. However, the model's performance declined in other ethnic groups and independent cohorts. The limitations of this study include differences in clinical factors distribution and the use of only SNPs as genetic factors. In this study, we observed that combining genetic and clinical factors improves BMD prediction compared to clinical factors alone. Adjusting inclusion thresholds for genetic variants (e.g., 5×10-6 or 5×10-7) rather than solely considering genome-wide association study (GWAS)-significant variants can enhance the model's explanatory power. The study highlights the need for training models on diverse populations to improve predictive performance across various ethnic and geographical groups.

Adjacent Vertebral Refracture Prediction Model Based on Imaging Data After Vertebroplasty for Osteoporotic Vertebral Compression Fracture

To establish a predictive model to evaluate the risk of adjacent vertebral refracture (VRF) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF) based on perioperative imaging data. This study was a retrospective cohort study which established a predictive model of VRF after PKP for OVCF. Patients who underwent PKP for OVCF in our hospital between January 2018 and December 2020 were enrolled and divided into a refracture group and normal group. Perioperative imaging data including preoperative bone mineral density (BMD), fatty infiltration (FI%) of paravertebral muscle, sagittal parameters of the spine and pelvis, and recovery rate of vertebral height were collected. The prediction model is obtained by multifactor logistic regression analysis. A total of 242 patients were included, including 23 cases in the VRF group and 219 cases in the normal group. There were statistical differences in BMD, FI%, recovery rate of vertebral height, and sagittal imbalance between the 2 groups. Receiver operating characteristic curve analysis of continuous variables showed that BMD≤-2.80, FI% ≥40%, and recovery rate of vertebral height≥10% were the cutoff values. Logistic regression analysis showed that BMD≤-2.80, FI% ≥40%, and sagittal imbalance were independent risk factors for VRF. The area under the curve according to the predicted probability was 0.85 (P < 0.05). After simplifying the model, the total point of the model was 7 points, with a cutoff value of 5 points. The prediction model obtained in this study can predict refracture after PKP for OVCF early and effectively. It has an excellent predictive effect which is suitable for clinicians.