Dual-energy X-ray Absorptiometry Scans Research Articles

A narrative review of the pharmaceutical management of osteoporosis.

Osteoporosis is a skeletal disorder classified by the loss of bone density in older adults leading to compromised bone strength and an increased risk of fracture. It can be divided into categories based on its etiology: senile, post-menopausal, and secondary osteoporosis. Specific prevention measures and treatments exist for targeting bone loss. Here we review and summarize the literature regarding the presentation of osteoporosis and discuss pharmaceutical therapies. PubMed and Google Scholar were searched for articles published in English between 1980 and 2021. Search terms combined "senile osteoporosis", "osteoporosis treatment", "osteoporosis", "bisphosphonates", "denosumab", types of hormone therapy, and other relevant keywords used in various combinations. Osteoporosis affects millions but often goes undiagnosed until a pathologic fracture. Dual-energy X-ray absorptiometry (DEXA) scans evaluate bone mineral density (BMD) and are a diagnostic tool for osteoporosis. Adults over the age of 65, post-menopausal women, and those with risk factors such as previous fractures are recommended to receive DEXA scans every one to two years. Bisphosphonates, denosumab, and hormonal therapies are among the most common pharmacologic treatments for osteoporosis. Daily, orally administered bisphosphonates are the first-line therapy for osteoporosis given their efficacy in decreasing fracture risk and favorable safety profile. Denosumab is an alternative that is administered subcutaneously every six months and may be given as initial therapy to select patients. Hormonal therapies are used if patients cannot tolerate bisphosphonates or denosumab or are refractory to these medications. Preventative measures for osteoporosis include tailored exercise and sufficient intake of calcium and vitamin D via diet or supplementation.

Physical fitness, hormonal profile, nutritional and psychological aspects assessment of transgender women volleyball players submitted to physical tests: protocol paper of a prospective cohort

To evaluate aerobic capacity, strength and other physiological, nutritional, and psychological variables which may influence the performance of transgender women (TW) athletes and compare them to cisgender women (CW) and...

Dual-Energy X-ray Absorptiometry Scan: A Neglected but Essential Investigation in Men

Introduction: Osteoporosis is a condition which affects both men and women but occurs a decade later in men as compared to women. Males constitute a very small percentage of patients who report for dual-energy X-ray absorptiometry (DEXA) scan. This difference may be largely because of lack of information about risk factors for secondary osteoporosis in men. In the present study, we have tried to explore the attributes of males undergoing DEXA scan at a tertiary care center. Materials and Methods: It was a cross-sectional study conducted in males visiting the general physician outpatient department in a tertiary care institute. All study participants who were males, based on inclusion and exclusion were included in the study. DEXA scan for hip and vertebra was performed for all the participants. Results: A total of 486 males fitting the inclusion criteria were included in the study. The mean age of the study participants was 66.98 (standard deviation: 8.55) years. Fifty-six (11.52%) of these participants had hypertension and 41 (8.43%) subjects had diabetes. Patient attributes and DEXA scan parameters of hip and vertebra showed a significant negative correlation with age and positive correlation with body mass index (BMI). Stratified analysis revealed that only 39% of individuals with a BMI of more than 25 kg/m2 had a high risk of osteoporosis (T ≤ −2) as compared to 58.4% of individuals with a BMI of <25 kg/m2. Conclusion: Osteoporosis among men remains a neglected aspect among physicians and surgeons. The DEXA scan is available in urban centers even in the developing countries; however, the lack of knowledge about indications seems to be the major factor for not evaluating the condition at the right time.

Long-Term Mortality Risk in Older Adults with Sarcopenia: An 11-Year Prospective Cohort Study Comparing AWGS 2014 and AWGS 2019 Guidelines for Enhanced Clinical Utility and Accurate Risk Prediction.

To discern the diagnostic accuracy between the updated diagnostic consensus of the Asian Working Group for Sarcopenia (AWGS) in 2019 (AWGS 2019) and the previous AWGS 2014 guidelines. A prospective population-based cohort study. The study included 731 older community-dwelling adults aged ≥ 65 years who participated in face-to-face interviews and were followed up for 11-year mortality until 31 Mar 2022. We utilized a handgrip strength dynamometer to measure participants' muscle strength, while their walking speed was determined by a timed 6-meter walk test at their usual pace. Additionally, muscle mass was measured using dual-energy X-ray absorptiometry scanning. Sarcopenia was defined as the presence of low muscle mass in combination with weakness and/or slowness both by AWGS 2014 and 2019 criteria. The present study followed 731 participants (mean age 73.4 ± 5.4 years, men predominant 52.8%) over a period of 11 years, yielding 5927 person-years and 159 deaths. Prevalence of sarcopenia defined by AWGS 2019 and 2014 criteria were 8.5% and 6.8%, respectively. Sarcopenia defined by AWGS 2019 (HR 1.62, 95% CI 1.04-2.54, p=0.034) but not AWGS 2014 was significantly associated with mortality in community-living older adults after adjusting for potential confounders such as age, sex, education, drinking, disease burden and serum level of testosterone. The study also found that the AWGS 2019 criteria had a better model fitness than AWGS 2014 criteria in predicting mortality. AWGS 2019 criteria outperformed AWGS 2014 in identifying sarcopenia risk and predicting mortality. Screening for sarcopenia in older adults may improve health outcomes by identifying those at increased mortality risk.

Body composition and body mass index measures from 8 to 18 years old in children with cystic fibrosis

BackgroundHistorically, body mass index (BMI) >50th percentile has represented optimal nutritional status in children with cystic fibrosis (CF) due to its positive association with lung function. Body composition parameters including fat-free mass index (FFMI) have been suggested as a more physiological nutrition benchmark. Aims: (1) describe changes in body composition with age and gender; (2) assess the correlation between measures of nutritional status (FFMI-z, FMI-z, BMI-z) and lung function (forced expiratory volume in one second predicted; FEV1pp). MethodsThis retrospective, mixed cross-sectional and serial measures study consisted of children with CF (8 to 18 years) attending Sydney Children's Hospital (2007–2020). FFMI and fat mass index (FMI) were taken from biennial dual energy x-ray absorptiometry (DXA) scans. Z-scores were derived using Well's reference population [1]. Repeated measures correlation analyses assessed correlations between FFMI-z, FMI-z, and BMI-z with FEV1pp. Results339 DXA reports were analysed from 137 patients. There were slight downwards trends in BMI-z and FMI-z, and an upwards trend in FFMI-z with increasing age and across both genders. Females had higher FMI-z and FFMI-z than males from 12.5 years. There was a weak, positive correlation between FEV1pp and BMI-z (r = 0.14, p = 0.04), and FFMI-z (r = 0.25, p<0.001). FMI-z had no correlation with FEV1pp (r=-0.06, p = 0.41). ConclusionDeficits in FFMI exist despite increasing trends with age. FFMI-z and BMI-z had a weak, positive correlation with FEV1pp. In contemporary cohorts, nutritional status (reflected by surrogate markers such as FFMI and BMI) may be less influential upon lung function than in previous decades.[1]: Wells, J.C., et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am. J. Clin. Nutr.96, 1316–1326 (2012).

EVALUATION OF PROXIMAL FEMORAL BONE MINERAL DENSITY IN CEMENTLESS TOTAL HIP ARTHROPLASTY: A THREE-ARM PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Femoral stem design affects periprosthetic bone mineral density (BMD), which may impact long term survival of cementless implants in total hip arthroplasty (THA). The aim of this study was to examine proximal femoral BMD in three morphologically different uncemented femoral stems designs to investigate whether one particular design resulted in improved preservation of BMD.119 patients were randomized to receive either a proximally coated dual taper wedge stem, a proximally coated anatomic stem or a fully coated collarless triple tapered stem. Dual energy x-ray absorptiometry scans (Lunar iDXA, GE Healthcare, Madison, WI) assessed BMD across the seven Gruen zones pre-operatively, and post-operatively at 6-weeks, 1-year, and 2-years comparing the unoperated contralateral femur as a control.BMD increased in zones one (2.5%), two (17.1%), three (13.0%), five (10%) and six (17.9%) for all stems. Greater preservation of BMD was measured on the lateral cortex (zone 2) for both the dual taper wedge and anatomic stems (p = 0.019). The dual taper wedge stem also demonstrated preservation of BMD in the medial calcar (zone 7) whilst the anatomic and triple taper stem declined in this region, however this was not statistically significant (p = 0.059). BMD decreased on average by 2.1% in the mid-diaphysis region, distal to the stem tip (zone 4) for all implants. All stems performed equivalently at final follow-up in all patient reported outcome measures.Implant design was shown to impact BMD changes. All stems preserved bone at the metaphyseal level in early follow-up, which theoretically indicates favorable implant fixation. There was no significant stress shielding observed, however longer follow-up is required to elucidate the impact of this finding on implant survivorship.

O-200 Cardiometabolic health in Danish children aged 7-10 years born after assisted reproductive technology with frozen and fresh embryo transfer

Abstract Study question Is cardiometabolic health in children conceived after frozen embryo transfer (FET) different from children conceived after fresh embryo transfer (fresh-ET) and natural conception (NC)? Summary answer FET-children had similar anthropometrics, glucose- and lipid profile in childhood compared to fresh-ET and NC. Blood pressure was higher in FET-girls compared to fresh-ET-girls. What is known already Children conceived after assisted reproductive technology (ART) with FET are more often born large-for-gestational age (LGA) while children born after fresh-ET are at risk of being small-for-gestational age (SGA).In general, children born LGA or SGA are at increased risk of obesity, diabetes and cardiovascular disease later in life. Smaller studies on the whole ART-population have raised concerns about premature vascular aging, increased risk of insulin resistance and higher blood pressure. The long-term cardiometabolic health of children born after ART and especially FET is scarcely explored. Study design, size, duration This study was part of the large cohort study “Health in Childhood following Assisted Reproductive Technology” (HiCART) which included 606 singletons (292 boys) born between December 2009 and December 2013: 200 children were conceived after FET; 203 children were conceived after fresh-ET; and 203 children were conceived naturally and matched for birth year and sex. The study period lastet from January 2019 to September 2021. Participants/materials, setting, methods The children were 7-10 years of age at examination and underwent a clinical examination with anthropometric measurements, pubertal staging and blood pressure measurement. Furthermore a whole-body dual-energy x-ray absorptiometry-scan (DXA) was performed and a fasting blood sample was drawn. Anthropometric measurements and blood pressure were converted to standard deviation scores (SDS) using a Danish reference. The three study groups were compared pairwise using univariate linear regression model. Main results and the role of chance Data is presented as mean (SD). Children conceived after FET had significantly higher birth weight (SDS) (0.20 SDS (1.09)) compared to children conceived after fresh-ET (-0.22 SDS (1.00), mean difference: 0.42 SDS (95% CI: 0.21; 0.62)) and NC-children (-0.16 SDS (1.09), mean difference: 0.35 SDS (95% CI: 0.14; 0.57)). At 7-10 years height (SDS), weight (SDS) and BMI (SDS) were similar between the groups. Fat percentage (DXA) and waist-to-height ratio were also comparable between the groups. Markers of glucose metabolism were similar in the groups including fasting glucose, C-peptide, HbA1c and insulin resistance (HOMA-IR). Lipid profiles including, cholesterol, LDL and HDL were also similar. Blood pressure was comparable between the three groups, but stratified on sex girls conceived after FET had significantly higher systolic blood pressure (SDS) (0.75 SDS (0.84)) compared to girls concieved after fresh-ET (0.49 SDS (0.61), mean difference: 0.25 SDS (95% CI: 0.05; 0.45)) and significantly higher diastolic blood pressure (SDS) (FET: 0.54 SDS (0.57), fresh-ET: 0.38 (0.58), mean difference: 0.16 SDS (0.00; 0.31)). Puberty had started in 17% of the girls, equally distributed in the three groups. Limitations, reasons for caution As the participation rate was between 18-42% in the three groups, selection bias cannot be excluded. We currently do not have information regarding endometrial preparation protocol in the FET-cycles which may bias the results. Due to multiple testing type I errors cannot be excluded. Wider implications of the findings Higher birth weight in children conceived after FET did not translate into differences in anthropometrics, glucose- or lipid profile in children ages 7-10 years. However, the higher systolic- and diastolic blood pressure (SDS) found in girls concieved after FET compared to fresh-ET is of concern and should be further explored. Trial registration number NNF18OC0034092, NFF19OC0054340

Lean tissue mass measurements by dual-energy X-ray absorptiometry and associations with strength and functional outcome measures in facioscapulohumeral muscular dystrophy

Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive disease of skeletal muscle. Dual energy X-ray absorptiometry (DEXA) is a widely available, cost-effective and sensitive technique for measuring whole body and regional lean tissue mass and has been used in prior clinical trials in neuromuscular diseases. The Clinical Trial Readiness to Solve Barriers to Drug Development in FSHD (ReSolve) study is a prospective, longitudinal, observational multisite study. We obtained concurrent DEXA scans and functional outcome measurements in 185 patients with FSHD at the baseline visit. We determined the associations between lean tissue mass in the upper and lower extremities and corresponding clinical outcome measures. There were moderate correlations between upper and lower extremity lean tissue mass and their corresponding strengths and function. Lean tissue mass obtained by DEXA scan may be useful as a biomarker in future clinical trials in FSHD.

Impact of Osteoporosis in Postmenopausal Women With Primary Knee Osteoarthritis.

Although knee osteoarthritis (OA) and osteoporosis (OP) are common age-related bone disorders, the association between the two conditions remains indefinable. The aim of the present study is to investigate a possible relationship between the two conditions in post-menopausal women. A cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia, after obtaining IRB approval. The study included all post-menopausal female patients above 50 years of age, who underwent dual-energy X-ray absorptiometry (DXA) scans between January 2019 and July 2021 and have clear radiological data regarding knee OA. For our study, 487 ladies satisfied our inclusion criteria with an age range of 50-94 years (mean 64.67 ±8.4). The severity of knee OA was determined according to theKellgren and Lawrence (KL) grading system. The mean age and weight of all patients showed a significant association withknee OA. There was no significant association between bone quality and all parameters of bone mineral density (BMD) and T-scorewith the presence of knee OA. The mean age, height, weight, and BMI have a significant relationship with OP. Grade 3 of the KL classification system for knee OA is the only grade that showed a significant relationship with the presence of OP. The status of bone quality, BMD, and T-score parameters have no significant relationship with the severity subgrouping of knee OA. The BMD and the T-score of the right femoral neck have a significant correlation with BMI, which is linked to the presence of knee OA. We didn't find a clear relationship between OP or BMD and the presence of knee OA. However, our findings demonstrated that BMD, T-score of the right femoral neck, and BMI can all be utilized as predictors for the development and progression of knee OA. We recommendconsidering the many potential confounding variations when describing a relationship between OP and OA.

Age-related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study.

Longitudinal changes in bone health in children with intestinal failure (IF) are unclear. We aimed to better understand the trajectory of bone mineral status over time in children with IF and identify clinical factors that influence the trajectory. Clinical records of patients attending the Intestinal Rehabilitation Center of Cincinnati Children's Hospital Medical Center between 2012 and 2021 were reviewed. Children diagnosed with IF before age 3 years with at least two lumbar spine dual-energy x-ray absorptiometry scans were included. We abstracted information on medical history, parenteral nutrition, bone density, and growth. We calculated bone density z scores with and without adjustment for height z scores. Thirty-four children with IF met inclusion criteria. Children were shorter than average with a mean height z score of -1.5 ± 1.3. The mean bone density z score was -1.5 ± 1.3 with 25 of the cohort having a z score < -2.0. After height adjustment, the mean bone density z score was -0.42 ± 1.4 with 11% below -2.0. Most dual-energy x-ray absorptiometry scans (60%) had a feeding tube artifact. Bone density z scores increased slightly with age and lower parenteral nutrition dependency and were higher in scans without an artifact. Etiologies of IF, line infections, prematurity, and vitamin D status were not associated with height-adjusted bone density z scores. Children with IF were shorter than expected for age. Deficits in bone mineral status were less common when adjusting for short stature. Etiologies of IF, prematurity, and vitamin D deficiency were not associated with bone density.

Age- and sex-specific changes in visceral fat mass throughout the life-span.

Visceral fat mass (VFM) is a risk factor for cardiovascular diseases, type 2 diabetes mellitus, and malignancy; however, normative data are limited. The aim of this study was to provide reference data for VFM from a large, apparently healthy Caucasian adult population. Volunteers aged 20 to 93 years from the Copenhagen City Heart Study had a standardized whole-body dual-energy x-ray absorptiometry scan performed using the iDXA (GE Lunar). Total and regional fat mass was measured. VFM was quantified using the CoreScan application. A total of 1277 participants were included (708 women, mean [SD],age: 56 [19] years, height: 1.66 [0.07] m, BMI: 24.64 [4.31] kg/m2 ; and 569 men, age: 57 [18] years, height: 1.80 [0.07] m, BMI: 25.99 [3.86] kg/m2 ). Increased VFM was positively correlated with age in both sexes. Men had significantly higher VFM in mass (g) after normalization to body size (m2 ) and total fat mass (p < 0.001). VFM increased more in women with high values of the android/gynoid ratio. Normative data of VFM from a large, healthy Danish cohort aged 20 to 93 years are presented. VFM increased with age in both sexes, but men had significantly higher VFM compared with women with the same BMI, body fat percentage, and fat mass index.

Associations of Type 2 Diabetes, Body Composition, and Insulin Resistance with Bone Parameters: The Dubbo Osteoporosis Epidemiology Study.

Type 2 diabetes (T2D) may be associated with increased risk of fractures, despite preserved bone mineral density (BMD). Obesity and insulin resistance (IR) may have separate effects on bone turnover and bone strength, which contribute to skeletal fragility. We characterized and assessed the relative associations of obesity, body composition, IR, and T2D on bone turnover markers (BTMs), BMD, and advanced hip analysis (AHA). In this cross-sectional analysis of Dubbo Osteoporosis Epidemiology Study, 525 (61.3% women) participants were grouped according to T2D, IR (homeostasis model assessment insulin resistance [HOMA-IR] </≥2.5), and BMI (</≥25 kg/m2): insulin-sensitive lean (IS-L), insulin-sensitive overweight/obese (IS-O), insulin-resistant (IR), and T2D. BMD, AHA, and body composition, including visceral adipose tissue (VAT) (on dual-energy x-ray absorptiometry scan) and fasting BTMs, were assessed. Analyses performed using Bayesian model averaging and principal component analysis. T2D was associated with low BTMs (by 26%-30% [95% confidence interval [CI] 11%-46%] in women, 35% [95% CI 18%-48%] in men compared to IS-L), which persisted after adjustment for VAT. BTMs were similar among IR/IS-O/IS-L. BMD was similar among T2D/IR/IS-O; BMD was low only in IS-L. All groups were similar after adjustment for BMI. Similarly, AHA components were lowest in IS-L (attenuated following adjustment). On multivariate analysis, T2D was independently associated with BTMs. IR was also associated with C-terminal telopeptide of type 1 collagen in men. Age and body size were the strongest independent contributors to BMD and AHA. VAT was inversely associated with section modulus, cross-sectional area, cross-sectional moment of inertia in women, and hip axis length in men. Low bone turnover is associated with T2D and IR (in men), while BMD and hip strength/geometry are predominantly associated with body size. VAT, indicative of dysglycemia, is also associated with impaired bone geometry. Establishing the role of BTMs and AHA fracture risk may improve skeletal assessment in T2D people. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Changes in Bone Density in Carriers of BRCA1 and BRCA2 Pathogenic Variants After Salpingo-Oophorectomy.

To evaluate the effect of risk-reducing salpingo-oophorectomy (RRSO) on change in bone mineral density (BMD) in women aged 34-50 years with pathogenic variants in BRCA1 or BRCA2 ( BRCA1 /2). The PROSper (Prospective Research of Outcomes after Salpingo-oophorectomy) study is a prospective cohort of women aged 34-50 years with BRCA1 or two germline pathogenic variants that compares health outcomes after RRSO to a non-RRSO control group with ovarian conservation. Women aged 34-50 years, who were planning either RRSO or ovarian conservation, were enrolled for 3 years of follow-up. Spine and total hip BMD were measured by dual-energy X-ray absorptiometry (DXA) scans obtained at baseline before RRSO or at the time of enrollment for the non-RRSO group, and then at 1 and 3 years of study follow-up. Differences in BMD between the RRSO and non-RRSO groups, as well as the association between hormone use and BMD, were determined by using mixed effects multivariable linear regression models. Of 100 PROSper participants, 91 obtained DXA scans (RRSO group: 40; non-RRSO group: 51). Overall, total spine, and hip BMD decreased significantly from baseline to 12 months after RRSO (estimated percent change -3.78%, 95% CI -6.13% to -1.43% for total spine; -2.96%, 95% CI -4.79% to -1.14% for total hip) and at 36 months (estimated percent change -5.71%, 95% CI -8.64% to -2.77% for total spine; -5.19%, 95% CI -7.50% to -2.87% for total hip. In contrast, total spine and hip BMD were not significantly different from baseline for the non-RRSO group. The differences in mean percent change in BMD from baseline between the RRSO and non-RRSO groups were statistically significant at both 12 and 36 months for spine BMD (12-month difference -4.49%, 95% CI -7.67% to -1.31%; 36-month difference -7.06%, 95% CI -11.01% to -3.11%) and at 36 months for total hip BMD (12-month difference -1.83%, 95% CI -4.23% to 0.56%; 36-month difference -5.14%, 95% CI -8.11% to -2.16%). Across the study periods, hormone use was associated with significantly less bone loss at both the spine and hip within the RRSO group compared with no hormone use ( P <.001 at both 12 months and 36 months) but did not completely prevent bone loss (estimated percent change from baseline at 36 months -2.79%, 95% CI -5.08% to -0.51% for total spine BMD; -3.93%, 95% CI -7.27% to -0.59% for total hip BMD). Women with pathogenic variants in BRCA1 /2 who undergo RRSO before the age of 50 years have greater bone loss after surgery that is clinically significant when compared with those who retain their ovaries. Hormone use mitigates, but does not eliminate, bone loss after RRSO. These results suggest that women who undergo RRSO may benefit from routine screening for BMD changes to identify opportunities for prevention and treatment of bone loss. ClinicalTrials.gov , NCT01948609.

Patterns of Misdiagnosis and Discordance in Detecting Osteoporosis: A Comparison of Dual-energy X-ray Absorptiometry and Lumbar Computed Tomography Hounsfield Units.

This was a retrospective chart review. This study aims to identify the prevalence of osteoporosis (OP) by lumbar computed tomography (CT) Hounsfield units (HUs) in patients who have normal or osteopenic bone determined by dual-energy x-ray absorptiometry (DEXA). OP is a critical issue in the postmenopausal and aging population. Bone mineral density assessment by DEXA has been described as insensitive for diagnosing OP in the lumbar spine. Improving the detection of OP can bring more patients to treatment and reduce the risks associated with low bone mineral density. We retrospectively reviewed all patients with DEXA scans and noncontrast CTs of the lumbar spine over a 15-year period. Patients were diagnosed as non-OP if they had a normal DEXA T -score (≥ -1) or osteopenic DEXA T -score (between -1.1 and -2.4). Patients in this cohort were considered osteoporotic by CT if L1-HU ≤110. Demographics and lumbar HUs were compared between these stratified groups. A total of 74 patients were included for analysis. All patients were demographically, similar, and the average patient age was 70 years. The prevalence of OP determined by CT L1-HU ≤110 was 46% (normal DEXA: 9%, osteopenic DEXA: 63%). A significant number of males in our study were considered osteoporotic by L1-HU ≤110 (74%, P = 0.03). All individual axial and sagittal lumbar HU measurements including L1-L5 average lumbar HUs were statistically significant among non-OP and OP groups except for the lower lumbar levels ( P > 0.05 for L4 axial HUs, and L4-L5 sagittal HUs). The prevalence of OP in patients with normal or osteopenic T -scores is high. Among those with osteopenia by DEXA, more than 50% may lack appropriate medical treatment. The DEXA scan may be particularly insensitive to male bone quality making the CT HU the diagnostic method of choice for detecting OP. Level III.

What is the role of CT-based Hounsfield unit assessment in the evaluation of bone mineral density in patients undergoing 1- or 2-level lumbar spinal fusion for degenerative spinal pathologies? A prospective study

Computed tomography-based vertebral attenuation values (CT-based HU) have been shown to correlate with T-scores on DEXA scan; and have been acknowledged as an independent factor for predicting fragility fractures. Most patients undergoing lumbar surgeries require CT as part of their preoperative evaluation. The current study was thus planned to evaluate the role of lumbar CT as an opportunistic investigation in determining BMD preoperatively in patients undergoing lumbar fusion. Prospective cohort study. Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions. Comparison of the quantitative assessment of osteoporosis using Hounsfield Units (HU) on CT (L1-L5) and mean lumbar T-scores on DEXA (Dual Energy X-ray Absorptiometry). HU on CT is comparable to T-score on DEXA as a suitable modality for the assessment of osteoporosis in patients undergoing one- to two-level lumbar fusion. A prospective cohort study was conducted between January and December 2021. Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions and had complete clinico-radiological records, were prospectively enrolled. A comparison was drawn between the HU (measured by placing an oval region of interest [ROI] over axial, sagittal and coronal images of lumbar vertebrae) on CT and T-scores on DEXA, and analyzed statistically. The HU values correlating best with normal (group A), osteopenia (B) and osteoporosis (C) categories (classified based on T-scores of lumbar spines) were determined statistically. Overall, 87 patients (mean age of 60.56±11.63 years; 63 [72.4%] female patients) were prospectively studied. There was a statistically significant difference in the mean age (p=.01) and sex distribution (predominantly female patients; p=.03) of patients belonging to groups B (osteopenic) and C (osteoporotic patients), as compared with group A. The greatest correlation between T-score (on DEXA) and HU (on CT) for differentiating osteopenia (group B) from group A was observed at levels L1 (p<.001), L2 (p<.001) and L3 (p<.001). Based on receiver-operating characteristic (ROC) curve analysis, the cut-off values for HU for identifying osteopenia were 159 (at L1; sensitivity 81.6 and specificity 80) and 162 (at L2; sensitivity 80 and specificity 71.1). In addition, there was statistically significant correlation between T-score (on DEXA) and HU at all the lumbar levels for distinguishing osteoporosis (group C), although the difference was most evident at the upper lumbar (L1 and L2) levels (p<.001). Based on ROC analysis, cut-off HU values for defining osteoporosis were 127 (at L1; sensitivity 71.3 and specificity 70) and 117 (at L2; sensitivity 65.5 and specificity 90). Based on our study, the measurement of HU on CT at upper lumbar levels can be considered as "surrogate marker" for BMD in the diagnosis of osteopenia (cut-off: 159 at L1, 162 at L2) and osteoporosis (cut-off: 127 at L1, 117 at L2) in patients undergoing lumbar fusion surgeries. The HU measurements on CT at the lower lumbar levels (L4 and L5) are less reliable in this preoperative scenario.

Bone mineral density and its influential factors in Chinese patients with newly diagnosed Crohn's disease.

Bone loss is a common morbidity sign in patients with inflammatory bowel disease. Bone mineral density measurement is currently recommended for those with high risk of osteoporosis in patients with inflammatory bowel disease. However, there is lack of evidence in the need of bone mineral density measurement in patients who are young at the age of first onset. In this study, we aimed to investigate the prevalence of bone mineral density disorders in newly diagnosed Crohn's disease with young age and to determine potential risk factors. A retrospective cross-sectional study from a single center was conducted. Dual energy X-ray absorptiometry scan was collected to evaluate the prevalence of bone mineral density disorders (including osteopenia and osteoporosis) in newly diagnosed Crohn's disease with young age. Logistic regression analysis was applied to investigate risk factors for bone mineral density disorders. A total of 221 patients with Crohn's disease were included in this study. 23.1% or 39.4% of patients with osteopenia and 8.6% or 7.2% of patients with osteoporosis were diagnosed (Z-score and T-score respectively). Male and body mass index at diagnosis were identified as independent factors for bone mineral density disorders. Bone mineral density disorders are common in newly diagnosed Crohn's disease with young age. Male and malnourished patients are at high risk of bone loss. Therefore, bone mineral density measurement and early intervention are recommended in these patients. This article is protected by copyright. All rights reserved.

Whole-food plant-based diet (WFPBD) to control weight and metabo-inflammation in overweight/obese men with prostate cancer (PC) receiving androgen deprivation therapy (ADT): A multi-center randomized control trial.

TPS5098 Background: Obesity promotes a chronic inflammatory state that is associated with PC progression. ADT can cause significant side effects including weight gain, accumulation of body fat, insulin resistance, and an increased risk of diabetes and cardiovascular disease. A WFPBD has been shown to promote weight loss, decrease chronic inflammation, and shift gut microbial profiles to a microbiome that promotes insulin sensitivity. We hypothesize that a WFPBD and behavior intervention will promote weight loss and a reduction in adiposity in overweight/obese patients with PC on ADT and will decrease biomarkers of metabo-inflammation; and that a WFPBD, which is enriched in fiber, will modulate the fecal microbiota and metabolites, and alter study participants’ serum metabolome. Correlative studies will offer insight into the impact of nutrition on metabolic pathways that are known to be affected by PC, ADT and/or excess body fat, including steroid metabolism, ketogenesis, and fatty acid metabolism. Methods: Key eligibility criteria include pts with PC with a BMI ≥ 27 receiving ADT with an LHRH/GnRH analogue for &gt;24 weeks pre-study (+ androgen receptor pathway inhibitor for &gt;3 mos) with anticipation of &gt;26 more weeks of ADT. 60 patients randomized 1:1 between two cohorts. Cohort 1: pts receive 12 prepared meals (provided by Plantable) per weeks 1-4 and 6 meals weeks 5-8 plus Plantable coaching, nutritional counseling and education to assist in self-prepping plant-based meals (weeks 9-26); Cohort 2 (control): pts receive general nutritional counseling from a Registered Dietician weekly for 8 weeks, then monthly x 4. Collection of baseline and serial measurements (pre-intervention, weeks 4, 8 and 26) including weight, serum carotenoid levels (to monitor dietary compliance), dual energy x-ray absorptiometry (DXA) scans, MnSOD polymorphisms, and biomarkers of inflammation and metabolism. The primary comparison is weight loss at 4 weeks (with an 80% power to detect an effect size 0.74 standard deviations with a 2-sided significance level of 0.05 using a two-sample t-test). Secondary objectives will assess and compare changes in: a) biomarkers of metabolic disorders (Hemoglobin A1c, fasting insulin/glucose) and cardiovascular risk (LDL cholesterol, HDL cholesterol, triglycerides); b) pro-inflammatory markers (IL-6, hsCRP) and adipokines (leptin, adiponectin); c) fecal microbiota; and d) quality of life measurements. Exploratory objectives will assess the effects of a WFPBD on serum and fecal metabolomics and on clonal hematopoiesis. Trial is open at Weill Cornell Medicine (WCM), John Hopkins University and Columbia University. First pt enrolled at WCM September 2022. Funding support from the Prostate Cancer Foundation; PC Clinical Trials Consortium c22-301. Clinical trial information: NCT05471414 .

Denosumab for smoldering multiple myeloma: Rates of osteoporosis and change in lowest T-score after 12 months of treatment.

e20057 Background: Smoldering multiple myeloma (SMM) is a plasma cell precursor disease with variable risk of progression to multiple myeloma (MM). The standard of care for the treatment of SMM remains observation. Numerous clinical trials have sought to determine optimal treatment for SMM but have either failed to demonstrate efficacy, or resulted in unacceptable toxicity for the treatment of a disease that may not lead to progression in some patients. Denosumab is a human monoclonal IgG2 antibody directed against RANKL, that has demonstrated non-inferiority to zoledronic acid for the prevention of lytic bone lesions in MM patients. We are investigating the use of denosumab in patients with SMM and hypothesize that it will lead to decreased rates of progression to MM and increased bone mineral density. In this report, we describe the rates of osteoporosis and change in T scores for patients that received all 12 planned treatment doses. Methods: This is a single-center, open-label, phase II single-arm trial of denosumab in patients with SMM, with at least 1 high-risk feature for progression. All patients received denosumab 120 mg administered by subcutaneous injection every 4 weeks for a total of 12 cycles. Patients underwent bone mineral density analysis by dual-energy X-ray absorptiometry (DEXA) scan at enrollment and after completing study treatment at 13 months. Results: Target enrollment of 20 patients has been reached with a median age of 73 (38-82), 55% of participants being male and 90% identifying as Caucasian/white. At enrollment, 15% of patients were classified as osteoporotic and 40% were classified as osteopenic. Of the 15/20 (75%) of patients that completed all 12 doses of denosumab, 12 had an increase or no change in their lowest t-score [80%, 95% CI = (51.9, 95.7%)]. Only 1 of 15 patients that completed all doses changed classification from osteoporotic to osteopenic. Of the 5 patients that did not complete all 12 doses of denosumab, 3 stopped treatment due to biochemical progression of disease, and 2 patients withdrew from study. One patient withdrew due to COVID-19 concerns and another withdrew due to extensive dental work required during the treatment period. None of the patients have responded to treatment and 6/20 (30%) have progressed. Three of those patients progressed while on treatment and 3 progressed after completing study treatment. All progression of disease has been biochemical and there have been no skeletal-related events recorded at the time of this report. Conclusions: While there appears to be minimal disease response of SMM to denosumab, there does appear to be either stable or increased bone mineral density in the majority of patients that have completed therapy. All patients that have progressed since initiation of the study experienced biochemical progression and no patients have had skeletal-related events at the time of this report. Clinical trial information: NCT03839459 .

P337 Bone health status and audit of DEXA scan frequency of adults with cystic fibrosis at a UK centre

Adults with CF are at increased risk of low bone mineral density (BMD), with single-centre studies reporting up to 70% may have lower than expected BMD due to factors such as lung disease, cortico-steroid treatment, low body mass index (BMI), nutrient malabsorption, and insufficient weight bearing exercise. CF guidelines recommend screening patients using dual energy x-ray absorptiometry (DEXA) at specific intervals to enable identification and timely management of low BMD. This audit was conducted to assess bone health status of adults with CF at a UK centre.

Analysis of Age Distribution of Bone Mineral Density by Dual-Energy X-Ray Absorptiometry

Objective: to conduct the study of age distribution of bone mineral density (BMD) by the database of dualenergy X-ray absorptiometry (DXA) and to compare it with datа of population NHANES study. Material and methods. We used data from the densitometry of three-zone (total hip (TH), femoral neck (FN), and lumbar spine) measured by DXA from two outpatient clinics. The obtained data were compared with NHANES III for TH and FN and with NHANES 2005-08 for lumbar spine. The BMD value was corrected with the calibration coefficient for each DXA scanner. Adjustments were also made for the population distribution by sex and age. Results. Compared with NHANES for FN and TH, the obtained BMD values were significantly decreased for patients aged less than 50 years (men and women). The BMD values for FN and TH were unsignificantly decreased in men older 50 years. In women older 50 years unsignificantly decreased BMD values for FN and a significantly increased BMD values for TH were observed. The BMD values were decreased for lumbar spine in men and women throughout this age interval (more than 50 years old). Conclusion. The population BMD distribution in men and women was assessed by DXA method. The obtained dependence of the BMD for FN in women older 50 years was in good agreement with the results given by Russian and foreign authors.