Dual X-ray Absorptiometry Scans Research Articles

A roadmap to artificial intelligence (AI): Methods for designing and building AI ready data to promote fairness

ObjectivesWe evaluated methods for preparing electronic health record data to reduce bias before applying artificial intelligence (AI). MethodsWe created methods for transforming raw data into a data framework for applying machine learning and natural language processing techniques for predicting falls and fractures. Strategies such as inclusion and reporting for multiple races, mixed data sources such as outpatient, inpatient, structured codes, and unstructured notes, and addressing missingness were applied to raw data to promote a reduction in bias. The raw data was carefully curated using validated definitions to create data variables such as age, race, gender, and healthcare utilization. For the formation of these variables, clinical, statistical, and data expertise were used. The research team included a variety of experts with diverse professional and demographic backgrounds to include diverse perspectives. ResultsFor the prediction of falls, information extracted from radiology reports was converted to a matrix for applying machine learning. The processing of the data resulted in an input of 5,377,673 reports to the machine learning algorithm, out of which 45,304 were flagged as positive and 5,332,369 as negative for falls. Processed data resulted in lower missingness and a better representation of race and diagnosis codes. For fractures, specialized algorithms extracted snippets of text around keywork “femoral” from dual x-ray absorptiometry (DXA) scans to identify femoral neck T-scores that are important for predicting fracture risk. The natural language processing algorithms yielded 98% accuracy and 2% error rate The methods to prepare data for input to artificial intelligence processes are reproducible and can be applied to other studies. ConclusionThe life cycle of data from raw to analytic form includes data governance, cleaning, management, and analysis. When applying artificial intelligence methods, input data must be prepared optimally to reduce algorithmic bias, as biased output is harmful. Building AI-ready data frameworks that improve efficiency can contribute to transparency and reproducibility. The roadmap for the application of AI involves applying specialized techniques to input data, some of which are suggested here. This study highlights data curation aspects to be considered when preparing data for the application of artificial intelligence to reduce bias.

The Effect of Fixation Type on Periprosthetic Fractures in High-Risk Patients Who have Osteoporosis Undergoing Total Joint Arthroplasty

IntroductionMinimizing the burden of periprosthetic fractures (PFF) following total joint arthroplasty (TJA) with regard to morbidity and mortality remains an outcome of interest. Patient and surgical risk factors, including osteoporosis and fixation type, have not truly been optimized in patients undergoing TJA as a means to reduce the risk of PFF. As such, we examined: (1) What percentage of patients who underwent THA and total knee arthroplasty (TKA) met the criteria for osteoporosis screening? (2) How did the 5-year rate of PFF and fragility fracture differ in the high-risk and low-risk groups for osteoporosis between the cemented and cementless cohorts? (3) What percentage of the aforementioned patients received a dual x-ray absorptiometry (DEXA) scan before THA or TKA? MethodsWe queried an all-payer, national database from April 1, 2016 to December 31, 2021, to identify high-risk and low-risk patients who underwent TJA with a cementless or cemented fixation. High-risk patients met at least one of the following criteria: men at least 70 years old, women at least 65 years old, or patients at least 60 years old who have the following: tobacco use, alcohol abuse, body mass index < 18.5, prior fragility fracture, chronic systemic corticosteroids, or genetic condition affecting sex hormones or bone mineral density. Exclusion criteria were a diagnosis of malignancy, high-energy events (motor vehicle collision), those who underwent TJA indicated for fracture, patients less than 50 years old, those who had a prior diagnosis of or treatment for osteoporosis, and a minimum follow-up of less than 2 years. ResultsThere were 384,783 patients (67.1%) who underwent cementless TKA and 67,774 patients (11.8%) who underwent cementless TKA who were considered high risk. Additionally, there were 62,505 patients (10.9%) who underwent cemented THA and 58,667 patients (10.2%) who underwent cementless THA and were considered high risk. The cementless cohort had a 5-year periprosthetic fracture risk following TKA of 7.8% (95% CI, 5.56 to 10.98) in comparison to 4.30% in the cemented cohort (85% CI, 3.98 to 4.65), P <0.0001. The high-risk cementless cohort had a 5-year periprosthetic fracture risk following THA of 7.9% (95% confidence interval (CI), 6.87 to 9.19) in comparison to 7.78% in the cemented cohort (85% CI, 6.77 to 8.94), P <0.0001. ConclusionThere is an increased risk of PFF at 5 years following TKA in patients at high risk for osteoporosis undergoing cementless fixation in comparison to cemented fixation. There is an increased risk of PFF at 5 years following THA in patients at high risk for osteoporosis for both cementless fixation and cemented fixation, but no clinically meaningful difference between the two groups. Addressing the shortcomings of the underutilization of bone density scans and better selecting appropriate patients for TJA based on bone quality and fracture risk can help expedite the process of improving the current state of practice.

Effects of Abaloparatide on Bone Mineral Density in Proximal Femoral Regions Corresponding to Arthroplasty Gruen Zones: A Study of Postmenopausal Women with Osteoporosis.

Low hip bone mineral density (BMD) in patients who undergo total hip arthroplasty (THA) increases the risk of periprosthetic fractures, implant instability, and other complications. Recently, emphasis has been placed on bone health optimization: treating low BMD prior to a planned orthopaedic implant procedure in an effort to normalize BMD and reduce the potential risk of future complications. Abaloparatide is a U.S. Food and Drug Administration-approved osteoanabolic agent for men and postmenopausal women with osteoporosis and a candidate drug for bone health optimization that, in addition to benefits at the spine, increases hip BMD and reduces nonvertebral fracture risk. We hypothesized that abaloparatide would improve BMD in proximal femoral regions surrounding a virtual THA stem. This post hoc analysis obtained dual x-ray absorptiometry (DXA) hip scans from 500 randomly selected postmenopausal women with osteoporosis from the Phase-3 Abaloparatide Comparator Trial in Vertebral Endpoints (ACTIVE, NCT01343004) study after 0, 6, and 18 months of abaloparatide (250 patients) or placebo (250 patients). Hip DXA scans underwent 3-dimensional (3D) modeling via 3D-Shaper, followed by virtual resection of the proximal femur and simulated placement of a tapered, flat-wedge hip stem that guided delineation of the Gruen zones that were fully (zones 1 and 7) or largely (zones 2 and 6) captured in the scanning region. Integral, cortical, and trabecular volumetric BMD, cortical thickness, and cortical surface BMD (the product of cortical volumetric BMD and cortical thickness) were determined for each zone. Compared with placebo, the abaloparatide group showed greater increases in integral volumetric BMD in all zones at months 6 and 18; cortical surface BMD in zones 1, 6, and 7 at month 6; cortical thickness, cortical volumetric BMD, and cortical surface BMD in all zones at month 18; and trabecular volumetric BMD in zones 1 and 7 at months 6 and 18. Abaloparatide increases BMD in proximal femoral regions that interact with and support femoral stems, suggesting that abaloparatide may have value for preoperative or potentially perioperative bone health optimization in patients with osteoporosis undergoing THA. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

EXPLORING THE ROLE OF SKELETAL MUSCLE MICROVASCULAR BLOOD FLOW IN EXERCISE CAPACITY AMONG INDIVIDUALS WITH CONTROLLED TYPE 2 DIABETES

INTRODUCTION &amp; AIMS The cardiac and macrovascular system is vital for human exercise capacity, yet the microvascular network is primarily responsible for delivering nutrients and oxygen to metabolically active tissues like skeletal muscle. Due to methodological limitations, few studies have investigated the role of muscle microvascular blood flow in determining exercise capacity or intolerance in individuals with chronic conditions such as type 2 diabetes. Our aim was to use modern contrast-enhanced ultrasound to directly measure microvascular blood flow in skeletal muscle at rest and after a maximal treadmill exercise test in individuals with controlled type 2 diabetes. METHODS Fifteen adults with controlled type 2 diabetes (age: 62.5 ± 8.0 years [M ± SD]; BMI: 31.6 ± 6.9 kg/m2; HbA1c: 6.7 ± 0.9%; 13 females and 2 male) attended the laboratory after a 2-hour fast and completed a Modified Bruce treadmill exercise test until exhaustion. Microvascular blood velocity, volume, and flow in the vastus lateralis muscle was assessed at rest, immediately post-exercise, and 30 minutes post-exercise via contrast-enhanced ultrasound during a constant-rate intravenous contrast agent infusion (DEFINITY®). Participants also completed a whole-body dual x-ray absorptiometry scan and a six-minute walk test (6MWT). RESULTS Microvascular blood velocity, volume, and flow increased immediately after exercise (∼230%, ∼79%, and ∼529%, respectively; all p&amp;lt;0.001), and remained elevated above baseline levels 30 minutes post-exercise (∼79%, ∼25%, and ∼139%, respectively; all p≤0.003). Resting and post-exercise skeletal muscle microvascular blood flow measures were not associated with VO2peak (ml/min/kg), time to exhaustion, or six-minute walk distance (all p&amp;gt;0.05). CONCLUSION Muscle microvascular blood flow remains elevated for up to 30 minutes following maximal aerobic exercise in individuals with controlled type 2 diabetes. The lack of association between muscle microvascular blood flow and exercise capacity is not clear but may indicate considerable blood flow redundancy or reserve within the vascular network.

Associations between hypertension with reproductive and menopausal factors: An integrated women's health programme (IWHP) study.

Women are less likely to have classic cardiovascular risk factors than men, and events during their reproductive and menopausal years may increase hypertension risk. The aim of this study is to examine woman-specific factors, including menstrual, reproductive and pregnancy complications, in relation to the prevalence of hypertension in mid-life Asian women. This is a cross-sectional study of 1146 healthy women aged 45-69 years, from a multi-ethnic Asian cohort. The women completed an extensive questionnaire that included their sociodemographic details, medical history, lifestyle and physical activity, and reproductive and menopausal history. They also underwent objectively measured physical performance tests and a dual X-ray absorptiometry scan. Hypertension was defined as a systolic BP ≥140 and/or diastolic BP ≥90mm Hg, past diagnosis by a physician, or use of antihypertensive medications. Multivariable logistic regression was used to assess the independent risk factors for hypertension. The average age of the 1146 women analysed was 56.3 (SD 6.2) years, and 55.2 percent of them were hypertensive. The prevalence of gestational diabetes and gestational hypertension was 12.6% and 9.4%, respectively. Besides age, abnormal menstrual cycle length at 25 years of age (OR:2.35, CI:1.34-4.13), preeclampsia (OR:2.46, CI:1.06-5.74), increased visceral adiposity (OR:4.21, CI:2.28-7.79) and reduced physical performance (OR:2.83, CI:1.46-5.47) were independently associated with hypertension in Asian women. Our findings highlight the necessity of including features of menstrual and reproductive history as possible indicators of hypertension risk in cardiovascular disease risk assessment and prevention among Asian women. Reducing visceral adiposity and exercise to improve physical performance may help women avoid developing hypertension.

Abstract P342: Gut Microbiota and Microbial Metabolites Are Associated With DXA Measured Overall Fat and Trunk Fat in 5-year-old Children

Introduction: Gut microbiota (GMB) has been associated with obesity in children, but no studies have examined GMB with direct measures of fat mass and trunk fat in children. In our study we examine GMB and GMB metabolites with overall body fat and trunk fat mass (TFM) measured by dual x-ray absorptiometry (DXA) in 5-year-old children. Hypothesis: GMB composition and GMB metabolites are associated with DXA-measured overall fat and TFM. Methods: We conducted our study in children from the Gen3G cohort, a community-based cohort enrolled prenatally in 2010-2013 in Quebec, Canada. A total of 153 children had data on GMB and 140 had data on plasma metabolites in addition to DXA scan at 5-6.5 years of age. We assessed GMB by 16s rRNA sequencing of stool samples, and measured plasma metabolites using the untargeted approach by Metabolon. We used multivariable-adjusted (see figure for covariates) linear regression to examine associations of DXA measured fat with 67 pre-defined GMB-derived metabolites from the Metabolon database. We used ANCOM-BC to examine 542 GMB amplicon sequence variants (ASVs) with body composition measurements. We used a false discovery rate (FDR) correction for multiple testing and considered an FDR value of &lt; 0.2 as significant. Results: Of the 153 children, 43.1% female, 96.1% self-identified as white. Average BMI z-score was 0.18 ± 0.90, with average TFM 2125 ± 637 g. A total of 7 ASVs were associated with total body fat, 3 ASVs with TFM, and 1 ASV with BMI ( Fig. panel A ). Of 67 metabolites tested, 1 was associated with total body fat, 2 with TFM, and 3 with BMI. The two metabolites associated with TFM in a linear fashion ( Fig. panel B ) were deoxycholic acid and glycoursodeoxycholate, which are know to be involved in secondary bile acid metabolism and the etiology of diabetes. Conclusion: In children, associations of GMB composition and metabolites with DXA-measured overall fat mass, TFM, and BMI were in a similar direction. In particular, GMB metabolites related to bile acid metabolism were related to adipose tissue accumulation.

A243 BONE MINERAL DENSITY AND DIETARY BONE NUTRIENTS DIFFER IN PATIENTS WITH CROHN'S DISEASE STRICTURES

Abstract Background Crohn’s disease (CD) phenotypes include inflammatory (non-stricture) and stricture behaviours. Strictures are bowel narrowing’s that may lead to obstructions and subsequent dietary restrictions to prevent blockages. Bone mineral density (BMD) in CD is affected by many factors including corticosteroid use, CD itself, but also dietary changes. Clinical gold standard for measuring BMD is by dual x-ray absorptiometry (DXA) scans. High-resolution peripheral quantitative computed tomography (HR-pQCT), a more precise imaging modality assesses volumetric BMD, bone geometry and bone microarchitecture. We aim to compare dietary intake, and bone quality in both stricture and non-stricture CD. Aims To identify nutritional patterns, bone quality differences and deficiencies between two subtypes of CD; including energy intake, dietary components and/or micronutrients Methods Individuals (≥55 years old) with ileal CD strictures (fixed, angulated bowel or thickened bowel with pre-stenotic dilation on diagnostic imaging), or inflammatory CD were prospectively recruited. Patients with short gut, celiac disease, dysphagia history were excluded. All patients completed DXA hip and spine scans and HR-pQCT radius and tibia scans. Dietary assessment questionnaires (Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24), and Diet History Questionnaire III for food frequency over the past year were completed. Results 56 (27 inflammatory (48% female, mean age 64.2, BMI 28.7, 16 years CD duration) and 29 strictures (45% female, mean age 65.9, BMI 27.3, 25 years CD duration, 15 (51.7%) prior bowel resection) were included. 31/56 (55.4%) patients were on biologics and 11 (19.5%) had past corticosteroid exposure. DXA-based BMD for stricture versus non-stricture CD patients was not significantly different at the hip or spine. However, HR-pQCT-based radial total BMD (p=0.03), cortical thickness (p=0.01) and cortical area (p=0.04) were lower in stricture than non-stricture patients.11 (7 stricture, 4 inflammatory) patients with past steroids consumed more dairy (p=0.01), vitamin D (p = 0.04), and calcium (p=0.03) than other CD patients. Stricture patients had significantly less consumption of vitamin K (p=0.001), vegetables (p=0.02), calcium (p=0.03), and dairy (p=0.03). Conclusions Patients with CD strictures have lower BMD and cortical bone quality at the radius than those without strictures. Patients with CD strictures also consume significantly less vitamin K, calcium, and dairy, all vital dietary components to prevent OP, compared to non-stricture patients. Overall, the skeletal fracture risk is likely much greater in CD patients with strictures than without, due to greater inherent bone fragility, and less consumption of key nutrition building blocks of bones. Funding Agencies Koopmans Memorial Research Fund

The Association between Obesity and Reduced Weight-Adjusted Bone Mineral Content in Older Adults: A New Paradigm That Contrasts with the Obesity Paradox.

The relationship between body weight and bone mass in the elderly remains unclear, and whether obesity is a protective factor is still a matter of debate. For this reason, the aim of this study is to assess the association between body mass index (BMI) and bone mineral content adjusted by body weight, expressed as a percentage (w-BMC%), and to test the validity of the obesity paradox in this context. A cohort of 1404 older adults was categorized according to the World Health Organization's BMI cut-off points and completed a total and segmental body composition measurement by means of a dual X-ray absorptiometry scan. Individuals with obesity displayed a lower mean w-BMC% (3.06 ± 0.44%; 2.60 ± 0.37%) compared to those who were normal-weight (3.95 ± 0.54%; 3.38 ± 0.48%) and overweight (3.06 ± 0.44%; 3.04 ± 0.37%) in both genders. Linear regression analysis also showed a negative association between BMI and w-BMC% in males (β = -0.09; p < 0.001) and females (β = -0.06; p < 0.001). Finally, among individuals with obesity, and after adjusting for age, the linear regression models revealed a significant decrease of 0.75% and 0.28% in w-BMC% for every one-unit increase in the trunk fat/appendicular lean mass ratio in both males (β = -0.749; p < 0.0001) and females (β = -0.281; p < 0.001). In conclusion, we suggest a new paradigm regarding the impact of obesity on bone mass, in which the former does not appear to be a protective factor of the latter, especially in individuals with central obesity and low muscle mass.

Bone manifestations in Snyder‐Robinson syndrome

PurposeSnyder-Robinson syndrome (SRS) is a rare, X-linked condition caused by loss of function variants in the SMS gene, which codes for spermine synthase, an enzyme essential for synthesis of the polyamine spermine [1]. It is speculated that polyamines are crucial for osteoblast activity [2]. While published cases of SRS have reported osteopenia or osteoporosis, the natural history of bone health in individuals with SRS has not yet been explored. It is hypothesized that the natural history of bone health in these individuals results in low bone density for age and increased fractures in the absence of intervention. It is important for healthcare providers to recognize bone manifestations in individuals with SRS so that an appropriate standard of care can be administered. MethodsCase histories of 40 males with SRS spanning various ages from birth through adulthood were obtained from the Global Snyder-Robinson Syndrome Natural History Study and previously published cases. The data described and summarized in this study included dual x-ray absorptiometry (DEXA) scan results, fractures, and bisphosphonate treatment histories. ResultsMost individuals experienced at least one fracture, which was most common in their lower extremities. A greater number of fractures was reported when individuals did not receive bisphosphonates. Favorable DEXA results showed improvements in Z-scores and bone mineral density in individuals on bisphosphonates. ConclusionSRS is associated with persistent low bone density for age or osteoporosis. Treatment with bisphosphonates and long-term use requires further evaluation. This review contributes to the knowledge of bone health in the SRS population.

Exposure to perfluoroalkyl substances and longitudinal changes in bone mineral density in adolescents and young adults: A multi-cohort study

BackgroundPer- and polyfluoroalkyl substances (PFAS) may impair bone development in adolescence, which impacts life-long bone health. No previous studies have examined prospective associations of individual PFAS and their mixture with bone mineral density (BMD) changes in Hispanic young persons, a population at high risk of osteoporosis in adulthood. ObjectivesTo examine associations of individual PFAS and PFAS mixtures with longitudinal changes in BMD in an adolescent Hispanic cohort and examine generalizability of findings in a mixed-ethnicity young adult cohort (58.4% Hispanic). MethodsOverweight/obese adolescents from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR; n = 304; mean follow-up = 1.4 years) and young adults from the Southern California Children's Health Study (CHS; n = 137; mean follow-up = 4.1 years) were included in this study. Plasma PFAS were measured at baseline and dual x-ray absorptiometry scans were performed at baseline and follow-up to measure BMD. We estimated longitudinal associations between BMD and five PFAS via separate covariate-adjusted linear mixed effects models, and between BMD and the PFAS mixture via quantile g-computation. ResultsIn SOLAR adolescents, baseline plasma perfluorooctanesulfonic acid (PFOS) was associated with longitudinal changes in BMD. Each doubling of PFOS was associated with an average −0.003 g/cm2 difference in change in trunk BMD per year over follow-up (95% CI: −0.005, −0.0002). Associations with PFOS persisted in CHS young adults, where each doubling of plasma PFOS was associated with an average −0.032 g/cm2 difference in total BMD at baseline (95% CI -0.062, −0.003), though longitudinal associations were non-significant. We did not find associations of other PFAS with BMD; associations of the PFAS mixture with BMD outcomes were primarily negative though non-significant. DiscussionPFOS exposure was associated with lower BMD in adolescence and young adulthood, important periods for bone development, which may have implications on future bone health and risk of osteoporosis in adulthood.

FRI079 Long-term Bone Consequences Of Roux-En-Y Gastric Bypass: A Cross-sectional And Case-Control Study Of Post-menopausal Women

Abstract Disclosure: G. Papadakis: None. E. Gonzalez Rodriguez: None. S. Mantziari: None. J. Pasquier: None. E. Shevroja: None. N. Vionnet: None. L. Favre: None. Bariatric surgery decreases bone mineral density (BMD) due to mechanical unloading (weight loss) and secondary hyperparathyroidism linked to nutrient deficiencies (calcium, vitamin D). Most studies on the bone impact of bariatric surgery have investigated premenopausal women after a follow up of less than 3 years. In the current study, we sought to determine the long-term bone impact of Roux-en-Y gastric bypass (RYGB) on post-menopausal women. A cross-sectional and a case-control study were performed in women for whom a Dual X-ray absorptiometry (DXA) at least 3 years after surgery was available. BMD was measured at lumbar spine (LS), total hip (TH) and femoral neck (FN). Trabecular bone score (TBS) at LS was analyzed after correction for soft tissue thickness. History of fractures was inquired and DXA images were reviewed for vertebral fractures. For patients on anti-osteoporotic drugs, the DXA scan before the onset of therapy was taken into account. One-hundred nineteen women were eligible at a mean 9.0 ± 5.6 years after RYGB. The fracture rate was 12% and 6% for major osteoporotic and vertebral fractures, respectively. As calcium/vitamin D supplements were administered to all patients, serum 25-hydroxyvitamin D levels exceeded the threshold of 75 nmol/l in 77% of participants with insufficient levels (less than 50 nmol/l) only in 3 patients. Serum PTH levels were within the normal range in 87% of participants. A multivariate regression model including BMI, age, time since RYGB, one-year weight loss and serum PTH highlighted higher BMI as the sole significant predictor for better BMD at LS and TH (p=0.001 and p=0.008, respectively). Time since RYGB was the only variable inversely associated with TBS. Plasma levels of bone turnover markers (β-crosslaps, P1NP) exhibited a strong inverse correlation with BMD at all sites. For the case-control substudy, 76 post-RYGB women were age- and BMI-matched to female participants of the OsteoLaus study, a population-based cohort in Lausanne. The patient group had significantly lower BMD at all sites: LS (p=0.03), TH (p=0.01), FN (p=0.007), as well as lower TBS (p=0.003) compared to controls. No statistical difference was observed for fractures, although more major osteoporotic fractures occurred in the post-RYGB group (8 vs 4 in the controls). Possibly contributing to the bone impairment, the post-bariatric cohort had more active smokers (21 vs 7 in the controls, p=0.006) and less hormonal replacement therapy users (2 vs 12 in the controls, p=0.009). In conclusion, post-bariatric BMI is the strongest determinant of long-term BMD levels. Despite satisfactory vitamin D/PTH levels, a history of RYGB several years ago was associated with lower BMD and altered bone structure in this postmenopausal cohort. Long-term bone health monitoring is warranted after RYGB especially in women who are smoking and achieved substantial weight loss. Presentation: Friday, June 16, 2023

SAT207 Parathyroid Carcinoma: A Case Report

Abstract Disclosure: K.T. Sy: None. Background: Parathyroid carcinoma is a rare malignancy, accounting for less than 1% of causes of primary hyperparathyroidism. Case reports have mentioned of parathyroid carcinoma arising in patients with prior neck irradiation, in secondary and tertiary hyperparathyroidism and in patients with history of thyroid cancer and parathyroid adenoma. However, none of these reported associations have been completely established. Clinical Case: The is a case of a 59-year old male presenting with hypercalcemia. He was diagnosed with primary hyperparathyroidism secondary to a parathyroid adenoma, underwent parathyroidectomy with resolution of the hypercalcemia. Six years later, patient had recurrence of hypercalcemia with elevated PTH levels. Parathyroid imaging revealed a mild sestamibi-avid focus in the left retrosternal region, suggestive of an ectopic parathyroid gland and radio-guided neck exploration was done with excision of lesion. Histopathological report revealed parathyroid carcinoma. Two years later, there was recurrence of parathyroid carcinoma but mediastinal exploration revealed no lesions consistent with parathyroid carcinoma. Hypercalcemia with hyperparathyroidism persisted, and cinacalet was started but the patient could not tolerate the nausea associated with the medication. Repeat parathyroid imaging revealed sestamibi-avid lesions in the right retroclavicular, left prevascular/retrosternal, and a left paratracheal areas. Surgical exploration was offered but the patient refused. The patient also developed hypertension and low bone density was noted on dual X-ray absorptiometry (DXA) scan. He was started on denosumab 60 mg subcutaneously every 6 months, which was increased to 60mg every month and then 120mg every month to maintain normal calcium levels. The patient also developed chronic kidney disease, eventually requiring hemodialysis for elevated creatinine levels and hypercalcemic crisis. Soon after hemodialysis was started, the patient had a myocardial infarction and eventually expired. Conclusion: Complete surgical resection is the primary mode of therapy in parathyroid carcinoma, although hypercalcemia is the main cause of morbidity and mortality, rather than the tumor burden. The adjuvant use of radiotherapy and chemotherapy are still controversial. Some studies have shown that long term survival is favorable, but recurrences are frequent and patients tend to live a life filled with long-term follow up, multiple laboratory exams and imaging, hospitalizations and frequent reoperations. Mortality is usually due to uncontrollable hypercalcemia, leading to renal failure and cardiac arrhythmias. Presentation: Saturday, June 17, 2023

THU471 Resolution Of Elevated Alkaline Phosphatase After Joint Replacement In Severe Osteoarthritis

Abstract Disclosure: J. Rakholiya: None. S. Nagaraj: None. P. Sharma: None. Introduction: Alkaline phosphatase (ALP) elevation is commonly seen in hepatobiliary disorders. Conditions of high turnover such as healing fractures, hyperparathyroidism, Pagets’ disease of the bone, also lead to ALP elevation (1). Osteoarthritis (OA), characterised by degeneration of articular cartilage, joint space narrowing, and osteophyte formation, rarely causes ALP elevation. We present a case of ALP elevation that resolved after the arthritic joint was replaced. Case Presentation: A 60-year-old female with history of bilateral knee OA presented to the endocrinology clinic due to elevated ALP for over a year. She reported chronic fatigue, sleep disturbance, dry skin, hair loss, inability to lose weight and anxiety. ALP level at presentation was 165 U/L. An extensive work-up showed unremarkable serum and ionized calcium, serum phosphorus, parathyroid hormone, vitamin D 25-OH, calcitriol, 24-hour urine calcium, serum protein electrophoresis, and 24-hour urine protein electrophoresis. Dual x-ray absorptiometry (DXA) scan was normal with Fracture risk assessment tool (FRAX) score 5.9% for major osteoporotic fracture and 0.2% for hip fracture. Patient underwent total left knee arthroplasty following which ALP improved from 165 U/L to 135 U/L within 9 weeks of the procedure. Five months later, ALP was elevated (164 U/L) again. She then underwent right knee arthroplasty and ALP dropped to normal level (114 U/L) within 1 week post-surgery. Discussion: We report the rare phenomenon of ALP elevation in severe OA, that resolved after joint replacement. OA is characterised by inflammation mediated cartilage destruction, subchondral bone change, osteophyte formation, and alterations of ligaments and meniscuses. Bone change in severe OA is associated with increased synovial fluid ALP level. However, there is a paucity of literature studying the association of ALP with OA. A cross-sectional study of 3060 patients demonstrated higher serum ALP with symptomatic knee OA. Another study showed higher ALP levels with increased joint stiffness. The ALP elevation was attributed to low grade inflammation causing an inflammatory response in chondrocytes, and osteoarthritic pain. There is a need for more studies to evaluate the utility of serum ALP as a biomarker for severe OA. Presentation: Thursday, June 15, 2023

Low skeletal muscle mass and liver fibrosis in children with cerebral palsy

The purpose of the study was to conduct a nutritional and metabolic assessment of children with cerebral palsy, including an investigation of liver status, body composition, and bone mineral density. In this cross-sectional study we included 22 children with cerebral palsy. By using ultrasound, transient elastography, dual x-ray absorptiometry (DXA) scan, blood samples, anthropometric measurements, and a three-day diet registration, the nutritional and metabolic status was evaluated. Liver fibrosis and steatosis were found in four patients (18.2%), all with severe motor impairments, low skeletal muscle mass, and epilepsy. All patients with liver involvement had normal liver-related blood samples. Decreased bone mineral density was found in 26.3%, and 91.0% had low skeletal muscle mass. Fat mass and muscle mass were significantly lower in the patients with severe motor impairments compared to the patients with less severe motor impairments. Within the children classified as ‘underweight’ or ‘normal’ according to body mass index, body fat determined by DXA scan was normal or high in 50% of these patients.Conclusions: This study is the first to report liver fibrosis and steatosis in children with cerebral palsy. Possible causes of liver fibrosis and/or steatosis are altered body composition with low skeletal muscle mass, decreased mobility and medical drug intake. Further investigations of liver involvement and risk factors are needed.What is Known:• Children and adolescents with cerebral palsy are at risk of malnutrition and altered body composition, both of which can lead to fatty liver disease.• It is unknown whether children with cerebral palsy are at increased risk of metabolic disturbances such as fatty liver disease.What is New:• Altered body composition and low skeletal muscle mass, regardless of ambulation is present in 91% of the children with cerebral palsy.• Liver fibrosis and/or steatosis were found in 18.2% of the patients. Possible causes are altered body composition, decreased mobility and medical drug intake.

Influence of bone mineral density on femoral stem subsidence after cementless THA.

Femoral stem subsidence can lead to aseptic loosening after total hip arthroplasty (THA). Low bone mineral density (BMD) is a risk factor for stem subsidence as it can affect the initial stability and osteointegration. We evaluated whether reduced bone mineral density is related to higher subsidence of the femoral stem after primary cementless THA with enhanced recovery rehabilitation. 79 patients who had undergone primary cementless THA with enhanced recovery rehabilitation were analyzed retrospectively. Subsidence of the femoral stem was measured on standing pelvic anterior-posterior radiographs after 4-6weeks and one year. Patient individual risk factors for stem subsidence (stem size, canal flare index, canal fill ratio, body mass index (BMI), demographic data) were correlated. Dual X-ray absorptiometry (DXA) scans were performed of the formal neck and the lumbar spine including the calculation of T-score and Z-score. Patient-reported outcome measures were evaluated 12months postoperatively. Stem subsidence appeared regardless of BMD (overall collective 2.3 ± 1.64mm). Measure of subsidence was even higher in patients with normal BMD (2.8 ± 1.7mm vs. 2.0 ± 1.5mm, p = 0.05). High BMI was correlated with increased stem subsidence (p = 0.015). Subsidence had no impact on improvement of patient-related outcome measures (WOMAC, EQ-5D-5L and EQ-VAS) after THA. Patients with low BMD reported lower quality of life 12month postoperatively compared to patients with normal BMD (EQ-5D-5L 0.82 vs. 0.91, p = 0.03). Stable fixation of a cementless stem succeeds also in patients with reduced BMD. Regarding stem subsidence, enhanced recovery rehabilitation can be safely applied in patients with low BMD.

Evaluating Male Patients’ Understanding of Osteoporosis Evaluation and Treatment Following a Distal Radius Fracture

Current estimates suggest that 1-2 million men in the United States have osteoporosis, yet the majority of osteoporosis literature focuses on postmenopausal women. Our aim was to understand men's awareness and knowledge of osteoporosis and its treatment. Semistructured interviews were conducted with 20 male patients >50 years old who sustained a low-energy distal radius fracture. The goal was to ascertain patients' knowledge of osteoporosis, its management, and experience discussing osteoporosis with their primary care physicians (PCP). Participants had little knowledge of osteoporosis or its treatment. Many participants regarded osteoporosis as a women's disease. Most participants expressed concern regarding receiving a diagnosis of osteoporosis. Several patients stated that they believe osteoporosis may have contributed to their fracture. Families, friends, or mass media served as the primary information source for participants, but few had good self-reported understanding of the disease itself. The majority of participants reported never having discussed osteoporosis with their PCPs although almost half had received a dual x-ray absorptiometry scan. Participants expressed general interest in being tested/screened and generally were willing to undergo treatment despite the perception that medication has serious side effects. One patient expressed concern that treatment side effects could be worse than having osteoporosis. Critical knowledge gaps exist regarding osteoporosis diagnosis and treatment in at-risk male patients. Specifically, most patients were unaware they could be osteoporotic because of the perception of osteoporosis as a women's disease. Most patients had never discussed osteoporosis with their PCP. Male patients remain relatively unaware of osteoporosis as a disease entity. Opportunity exists for prevention of future fragility fractures by improving communication between patients and physicians regarding osteoporosis screening in men following low-energy distal radius fractures.

Automated body composition estimation from device-agnostic 3D optical scans in pediatric populations

Excess adiposity in children is strongly correlated with obesity-related metabolic disease in adulthood, including diabetes, cardiovascular disease, and 13 types of cancer. Despite the many long-term health risks of childhood obesity, body mass index (BMI) Z-score is typically the only adiposity marker used in pediatric studies and clinical applications. The effects of regional adiposity are not captured in a single scalar measurement, and their effects on short- and long-term metabolic health are largely unknown. However, clinicians and researchers rarely deploy gold-standard methods for measuring compartmental fat such as magnetic resonance imaging (MRI) and dual X-ray absorptiometry (DXA) on children and adolescents due to cost or radiation concerns. Three-dimensional optical (3DO) scans are relatively inexpensive to obtain and use non-invasive and radiation-free imaging techniques to capture the external surface geometry of a patient's body. This 3D shape contains cues about the body composition that can be learned from a structured correlation between 3D body shape parameters and reference DXA scans obtained on a sample population. This study seeks to introduce a radiation-free, automated 3D optical imaging solution for monitoring body shape and composition in children aged 5-17. We introduce an automated, linear learning method to predict total and regional body composition of children aged 5-17 from 3DO scans. We collected 145 male and 206 female 3DO scans on children between the ages of 5 and 17 with three scanners from independent manufacturers. We used an automated shape templating method first introduced on an adult population to fit a topologically consistent 60,000 vertex (60k) mesh to 3DO scans of arbitrary scanning source and mesh topology. We constructed a parameterized body shape space using principal component analysis (PCA) and estimated a regression matrix between the shape parameters and their associated DXA measurements. We automatically fit scans of 30 male and 38 female participants from a held-out test set and predicted 12 body composition measurements. The coefficient of determination (R2) between 3DO predicted body composition and DXA measurements was at least 0.85 for all measurements with the exception of visceral fat on 3D scan predictions. Precision error was 1-4 times larger than that of DXA. No predicted variable was significantly different from DXA measurement except for male trunk lean mass. Optical imaging can quickly, safely, and inexpensively estimate regional body composition in children aged 5-17. Frequent repeat measurements can be taken to chart changes in body adiposity over time without risk of radiation overexposure.

Less early subsidence of cemented Exeter short stems compared with cemented Exeter standard stems in Dorr type A femurs.

The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness.

The Effects of a Western Diet vs. a High-Fiber Unprocessed Diet on Health Outcomes in Mice Offspring.

Diet influences critical periods of growth, including gestation and early development. We hypothesized that a maternal/early life diet reflecting unprocessed dietary components would positively affect offspring metabolic and anthropometric parameters. Using 9 C57BL-6 dams, we simulated exposure to a Western diet, a high-fiber unprocessed diet (HFUD), or a control diet. The dams consumed their respective diets (Western [n = 3], HFUD [n = 3], and control [n = 3]) through 3 weeks of pregnancy and 3 weeks of weaning; their offspring consumed the diet of their mother for 4.5 weeks post weaning. Measurements included dual X-ray absorptiometry (DEXA) scans, feed consumption, body weight, blood glucose, and insulin and glycated hemoglobin (HbA1c) in the offspring. Statistical analyses included one-way ANOVA with Tukey's post hoc analysis. The offspring DEXA measures at 5 and 7.5 weeks post parturition revealed higher lean body mass development in the HFUD and control diet offspring compared to the Western diet offspring. An analysis indicated that blood glucose (p = 0.001) and HbA1c concentrations (p = 0.002) were lower among the HFUD offspring compared to the Western and control offspring. The results demonstrate that diet during gestation and early life consistent with traditional diet patterns may influence hyperglycemia and adiposity in offspring.

The paradox of obesity with normal weight; a cross-sectional study.

To evaluate the prevalence of excessive adiposity among normal-weight individuals, and their cardiometabolic risk. This cross-sectional study included 3,001 participants (ages 20-95, 52% men, BMI 28.0 ± 5.5 kg/m2) who completed an anthropometric evaluation, dual x-ray absorptiometry (DXA) scan to measure body composition, and cardiometabolic blood markers. Excess adiposity was defined as ≥25% for men and ≥ 35% for women. Of the entire study participants, 967 were in normal BMI (18.5-24.9 kg/m2) with a wide body fat distribution (4-49%). Of them, 26% of men and 38% of women were classified with excess adiposity. As compared to normal-weight lean participants, normal-weight obese men and women had higher triglycerides (76.5 ± 37.3 vs. 101.2 ± 50.3 mg/dL, p = 0.004 and 84 ± 44.2 vs. 101.4 ± 91.1 mg/dL, p = 0.030; respectively) and elevated low-density lipoprotein cholesterol (103.3 ± 31.7 vs. 119.6 ± 45.5 mg/dL, p = 0.011) and total cholesterol (171.5 ± 40.3 vs. 190.2 ± 39 mg/dL, p = 0.007) for men only. Among NWO, abdominal circumference was prevalent in 60% of the females with NWO (≥88 cm), but only in 4% of males (≥102 cm). Higher adiposity, even within normal weight, increases cardiometabolic risk, and abdominal waist circumference misclassified obesity in normal-weight individuals. This study highlights the need for a body composition evaluation to determine cardiometabolic risk for adults with normal body weight.