Low Bone Density Research Articles

Conventional Versus Osseodensification Drilling in the Narrow Alveolar Ridge: A Prospective Randomized Controlled Trial.

Background Conventionally, undersized osteotomies were used to increase initial bone-to-implant contact to achieve primary stability in implantology. This is particularly evident in regions with low bone density. The potential for severe bone compression and ischemia poses a challenge to secondary stability. Instead, lateral bone compaction is caused by the idea of osseodensification. Research on the potential benefits of this method for narrow ridges is lacking. This study aimed to determine if the osseodensification drilling technique affects primary stability and how much the alveolar ridge expands following implant site preparation. Methodology A total of 30 participants aged 20 to 80 years were included in this randomized controlled clinical investigation. Each participant was randomly assigned to one of the following two groups: one that received standard drill preparation, and another that received osseodensification drill preparation. Implant stability using implant stability quotient values, crest width, apical width (5 mm from crest), and bone density were assessed both before and after six months using cone-beam computed tomography. Results Osseodensification impacted the width at the apex (5 mm from the crest) and radiographic bone density, adding to the quality, but did not affect implant stability and crestal width after osseointegration. The mean difference in conventional and osseodensification groups was 0.46 and 0.68 mm, respectively, concerning the crestal width. Moreover, the mean difference was 0.74 and 0.58 mm for conventional and osseodensification groups, respectively, concerning the width at the apex (5 mm from the crest). Conclusions This study demonstratesthat the osseodensification process increased both the radiographic bone density and the width at the apex, demonstrating that osseodensification drilling techniques allow for the placement of implants with larger diameters innarrow alveolar ridges.

Trabecular bone mineral density as measured by thoracic vertebrae predicts incident hip and vertebral fractures: the multi-ethnic study of atherosclerosis.

Osteoporosis affects an enormous number of patients, of all races and both sexes, and its prevalence increases as the population ages. Few studies have evaluated the association between the vertebral trabecular bone mineral density(vBMD) and osteoporosis-related hip fracture in a multiethnic population, and no studies have demonstrated the predictive value of vBMD for fractures. We sought to determine the predictive value of QCT-based trabecular vBMD of thoracic vertebrae derived from coronary artery calcium scan for hip fractures in the Multi-Ethnic Study of Atherosclerosis(MESA), a nationwide multicenter cohort included 6814 people from six medical centers across the USA and assess if low bone density by QCT can predict future fractures. Measures were done using trabecular bone measures, adjusted for individual patients, from three consecutive thoracic vertebrae (BDI Inc, Manhattan Beach CA, USA) from non-contrast cardiac CT scans. Six thousand eight hundred fourteen MESA baseline participants were included with a mean age of 62.2 ± 10.2years, and 52.8% were women. The mean thoracic BMD is 162.6 ± 46.8mg/cm3 (95% CI 161.5, 163.7), and 27.6% of participants (n = 1883) had osteoporosis (T-score 2.5 or lower). Over a median follow-up of 17.4years, Caucasians have a higher rate of vertebral fractures (6.9%), followed by Blacks (4.4%), Hispanics (3.7%), and Chinese (3.0%). Hip fracture patients had a lower baseline vBMD as measured by QCT than the non-hip fracture group by 13.6mg/cm3 [P < 0.001]. The same pattern was seen in the vertebral fracture population, where the mean BMD was substantially lower 18.3mg/cm3 [P < 0.001] than in the non-vertebral fracture population. Notably, the above substantial relationship was unaffected by age, gender, race, BMI, hypertension, current smoking, medication use, or activity. Patients with low trabecular BMD of thoracic vertebrae showed a 1.57-fold greater risk of first hip fracture (HR 1.57, 95% CI 1.38-1.95) and a nearly threefold increased risk of first vertebral fracture (HR 2.93, 95% CI 1.87-4.59) compared to normal BMD patients. There is significant correlation between thoracic trabecular BMD and the incidence of future hip and vertebral fracture. This study demonstrates that thoracic vertebrae BMD, as measured on cardiac CT (QCT), can predict both hip and vertebral fractures without additional radiation, scanning, or patient burden. Osteopenia and osteoporosis are markedly underdiagnosed. Finding occult disease affords the opportunity to treat the millions of people undergoing CT scans every year for other indications.

Consensus on managing open ankle fractures in the frail patient.

Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest. A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS). In the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the open fracture guidelines. Overall, 75% would attempt primary wound closure and 25% would utilize a local flap. There was no orthopaedic agreement on fixation, and 75% would permit weightbearing immediately. In the second stage, performed at the BLRS meeting, experts discussed the survey results and agreed upon a consensus for the management of open elderly ankle fractures. A mutually agreed consensus from the expert panel was reached to enable the best practice for the management of patients with frailty with an open ankle fracture: 1) all units managing lower limb fragility fractures should do so through a cohorted multidisciplinary pathway. This pathway should follow the standards laid down in the "care of the older or frail orthopaedic trauma patient" British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guideline. These patients have low bone density, and we should recommend full falls and bone health assessment; 2) all open lower limb fragility fractures should be treated in a single stage within 24 hours of injury if possible; 3) all patients with fragility fractures of the lower limb should be considered for mobilisation on the day following surgery; 4) all patients with lower limb open fragility fractures should be considered for tissue sparing, with judicious debridement as a default; 5) all patients with open lower limb fragility fractures should be managed by a consultant plastic surgeon with primary closure wherever possible; and 6) the method of fixation must allow for immediate unrestricted weightbearing.

Scaphoid Fractures in Adults Aged 50 Years or Older: Epidemiology and Association With Osteopenia and Nonunion.

Scaphoid fractures are less commonly reported in adults older than 50 years. The association between bone density and outcomes following scaphoid fractures has not been explored in this patient population. The second metacarpal cortical percentage (2MCP) has been shown to predict low bone density. The purpose of this study is to describe the epidemiology and radiographic characteristics associated with scaphoid fractures in adults older than 50 years, determine the prevalence of osteopenia defined by 2MCP, and evaluate the characteristics associated with scaphoid nonunion in this population. We hypothesized that osteopenia defined by 2MCP would be common in this patient population and associated with scaphoid nonunion. Patients older than 50 years with an acute, closed scaphoid fracture were identified. Demographic data, radiographic characteristics, and outcome data were collected. The 2MCP was measured using standard hand radiographs. A total of 111 patients were identified. Most fractures were nondisplaced and occurred in women via low-energy mechanism. Fifty-six patients (50.5%) had osteopenia defined by a 2MCP less than 60%. Nondisplaced fractures achieved union faster than displaced fractures (P < .05). Displaced, unstable fractures were statistically associated with nonunion (P < .001). 2MCP did not correlate with nonunion. In adults older than 50 years, scaphoid fractures may represent a fragility fracture cohort given they occur more frequently in female patients via low-energy mechanisms and over half of the cohort had osteopenia defined by a 2MCP less than 60%. Displaced and unstable fractures were statistically more likely to go on to nonunion. Nonunion was not found to be associated with osteopenia.

Bone Density in Children with Hypermobility Spectrum Disorder Compared to Children with Benign Hypermobility

Background: Hypermobility spectrum disorder (HSD), likely a multifactorial condition characterized by musculoskeletal pain, joint instability, and reduced bone mineral density (BMD), is the focus of this study. Objectives: The aim of this study was to assess and compare bone density in children diagnosed with HSD and those with benign hypermobility. Methods: This case-control study involved 73 pediatric patients diagnosed with hypermobility spectrum disorder and benign hypermobility, who were referred to the Rheumatology clinic of Mofid Hospital in Tehran between February and November 2022. Bone mineral density was measured using Z-scores from L1-L4 and the whole body less head via dual-energy X-ray absorptiometry (DEXA). Results: Significant differences were observed in the frequency distribution of spine BMD Z-scores between the two groups (P = 0.002). There was no significant correlation between spine and whole body BMD Z-scores with age and gender (P &gt; 0.05). A notable correlation was found between spine and whole body BMD Z-scores (P &lt; 0.001 and r = 0.64). Among the HSD group, 18 patients (81.8%) had normal BMD, while 4 patients (18.2%) exhibited low bone density, with no cases of osteoporosis. In contrast, osteoporosis was observed in 7.3% of patients in the benign hypermobility group. Conclusions: Given the high prevalence of osteoporosis in patients with benign hypermobility, clinicians should be vigilant for tendencies toward osteopenia when treating such patients.

Measurement of implant insertion torque in intentionally undersized osteotomy site preparation in the posterior maxilla, a prospective clinical study.

Achieving adequate primary stability for dental implants in the posterior maxilla is challenging due to the low bone density and the presence of fine trabecular bone in the area. Low primary implant stability can compromise the long-term success of the implant. the study aims to evaluate the effect of intentionally undersized osteotomy sites on the insertion torque of implants placed in type 4 bone density in the posterior maxilla, regardless of the surgeon's tactile sense of the bone density. Conventional implant placement technique was performed in the posterior maxilla by intentionally omitting the last drill of the recommended drilling sequence protocol. The insertion torque was measured using an integrated surgical motor software. The study included 72 implants in both genders and different age groups. The retrieved samples were divided into four groups with insertion torque ranging from 11 Ncm to 48 Ncm. The mean insertion torque was 26.51±0.18 Ncm for all cases (P=0.001). No significant difference was found in the mean insertion torque between different age groups (26.51±2.845, P=0.84). However, a significant difference was observed between male and female cases (P=0.84). Most implant insertion torque measurements vary significantly between cases in the intentionally under-prepared posterior maxillary osteotomy site. Omitting the last drill should be applied for all the preparations of the posterior maxillary implant sites. Minimizing the osteotomy site intentionally is recommended for all posterior maxillary implant cases.

Identification of the Risk Factors Associated with Low Bone Density in Peri- and Early Postmenopausal Women

Evidence has shown that one of the most prevalent chronic conditions in postmenopausal women is osteoporosis. Despite the development of some medications, there are still safety and adherence concerns, and, thus, attention has been placed on understanding modifiable risk factors for bone loss. This study aimed to examine the differences in various sociodemographic and body composition factors, physical activity components, and nutrient and food group intake levels among peri- and early postmenopausal women with whole-body bone mineral density (BMD) Z-scores greater than and less than zero. This cross-sectional study utilized baseline data obtained from 45 peri- and early postmenopausal women aged 45–60 years old who participated in a 6-month three-arm, randomized, double-blind, placebo-controlled clinical trial that evaluated the effects of blackcurrant supplementation on bone metabolism. Anthropometric data, BMD values obtained via DXA scans, and self-reported demographic, health, dietary, and physical activity data were collected at baseline. Overall, participants with whole-body BMD Z-scores greater than zero had higher body mass indexes (BMIs), lean mass, fat mass, android fat percentages, ratios of trunk fat mass to limb fat mass, resting metabolic rates, relative skeletal muscle indexes, total and occupational physical activity, alcohol intakes, trans fatty acid intakes, and adequacy of potassium intake, but lower adequacy of vitamin E (p &lt; 0.05). In addition, total calorie intake was positively correlated with added sugar, vitamin E, potassium, alcohol, trans fatty acids, calcium, and vitamin D intakes (p &lt; 0.05); whole-body BMD was positively correlated with added sugars (p &lt; 0.05); vitamin D intake was positively correlated with vitamin E, potassium, trans fatty acid, and calcium intakes (p &lt; 0.05); and calcium intake was positively correlated with added sugar, vitamin E, potassium, and trans fatty acid intakes (p &lt; 0.05). These findings suggest that numerous body composition factors, components of physical activity, and dietary factors are related to bone health in adult women in the menopause transition.

How to Suppress Mineral Loss and Stimulate Anabolism in Postmenopausal Bones with Appropriate Timing of Exercise and Nutrients.

Background. Bone Health and Osteoporosis Foundation (BHOF) reports that as of 2023, approximately 10 million of older Americans have osteoporosis and another 44 million have low bone density. Osteoporosis is a serious handicap for the elderly and, in particular, for estrogen-deficient postmenopausal women, as it increases the risk of debilitating bone weakness and fractures. The BHOF recommendations for prevention of osteopenia, osteoporosis and bone fractures are to perform weight-bearing and muscle-strengthening exercises and to take recommended amounts of daily calcium and vitamin D. Methods. The purpose of this review is to describe and discuss recent evidence-based research on how to effectively utilize timing of exercise and calorie intake for stimulation of postmenopausal bone anabolism, and to provide this new information in the form of specific and actionable recommendations. Results. The five evidence-based recommendations are as follows: 1. Select an appropriate circadian time of day for exercise; 2. Increase walking speed to raise the movement momentum; 3. Eat a weight-maintenance meal one or two hours before the exercise bout; 4. Sustain the duration of walking activity (impulse) for 40 to 45 min; and 5. Repeat effective exercise stimulus 7 to 8 h after the first one to double the anabolic effect. Osteogenesis can also be increased with subthreshold mechanical loading, where needed, under several special circumstances. Conclusions. This review should provide pragmatic actionable pointers on how to utilize the idiosyncratic bone responsiveness to timing of movement and meals to prevent osteoporosis and encourage research toward a better understanding of how bone detects adequacy of a mechanical stimulus and determines duration of necessary rest to recover its sensitivity to mechanical stimulation and nutrients.

Comparative Analysis of Osseodensification and Standard Implant Site Preparation Techniques in Low Density Bone

Introduction. Dental implantation is getting more popular with patients who require total dental rehabilitation. Patients note that possibility of immediate loading based on dental implants is more favorable treatment option due to active social life. Low bone density, often occurred in the maxilla, frequently presents challenges for clinicians to achieve successful implant primary stability for predictable immediate loading.The aim of our study was to increase the efficiency of treatment of patients who require dental implantation in the maxilla.Materials and methods. Twenty-seven patients aged from 27 to 66 years with missing teeth in the alveolar process of maxilla were treated. All patients in this randomized clinical trial were divided into two groups. We used two methods for implant site preparation: the standard technique according to manufacturer’s recommendations in the first group (n = 13) and the Osseodensification technique via Densah drills (n = 14) in the second. All patients were treated by Astra Tech dental implants with the same dimensions (diameter 4 mm, length 9 mm). Immediately after implant placement the data of the frequency-resonance analysis of the implant stability and insertion torque were installed and obtained. Furthermore, a comparison of the operation time was carried out. Clinical evaluation and patient appreciation of pain, edema and hyperemia of the mucosa were evaluated using a questionnaire at 1, 3, 5 and 7 days after surgery. The measurement of the values of the stability quotient of the implants was repeated and carried out after six months.Results. Higher values of implant primary stability (insertion torque and implant stability quotient during surgery) were showed in the osseodensification group (IT — (45,0±5,8), ISQ — (71,8±2,9)) in comparison with standard technique (IT — (27,7±3,8), ISQ — (62,8±3,2)); p &lt; 0,05.Discussion. Osseodensification technique promotes compaction of a low density bone in direct contact with the implant, which leads to higher implant primary stability due to the physical interaction between bone and implant.Conclusion. The obtained results allow us to consider that the osseodensification method is progressive for improving the effectiveness of implantological treatment on maxilla.

Association between bone health and dynapenic obesity in postmenopausal women.

The combination of dynapenia (age-related muscle weakness) and obesity is referred to as dynapenic obesity. We examined the associations between dynapenic obesity and cortical bone thickness and trabecular bone density. The participants were 797 community-dwelling postmenopausal women (with an average age of 62.5 years) who were stratified into normopenia without obesity, dynapenia without obesity (dynapenia), normopenia with obesity (obesity) and dynapenia with obesity (dynapenia obesity) groups based on their grip strength and body fat percentage. Cortical bone thickness and trabecular bone density were measured using ultrasonic bone densitometry. The participants were further divided into those with low cortical bone thickness and low trabecular bone density. Logistic regression analysis was used to identify associated factors. Individuals with dynapenia (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.16-2.68), obesity (OR 2.46, 95% CI 1.62-3.75) and dynapenic obesity (OR 4.07, 95% CI 2.44-6.79) all significantly increased the odds of low cortical bone thickness. Conversely, the odds of low trabecular bone density were significantly lower in the obesity group (OR 0.65, 95% CI 0.43-0.99) and dynapenic obesity group (OR 0.60, 95% CI 0.37-0.97). Dynapenic obesity was found to be associated with cortical bone thinning that might compromise bone health. Postmenopausal women with dynapenic obesity might need to be closely monitored for preserving bone health. Geriatr Gerontol Int 2024; 24: 378-384.

Nanocrystal residual strains and density layers enhance failure resistance in the cleithrum bone of evolutionary advanced pike fish

Failure-resistant designs are particularly crucial for bones subjected to rapid loading, as is the case for the ambush-hunting northern pike (Esox lucius). These fish have slim and low-density osteocyte-lacking bones. As part of the swallowing mechanism, the cleithrum bone opens and closes the jaw. The cleithrum needs sufficient strength and damage tolerance, to withstand years of repetitive rapid gape-and-suck cycles of feeding. The thin wing-shaped bone comprises anisotropic layers of mineralized collagen fibers that exhibit periodic variations in mineral density on the mm and micrometer length scales. Wavy collagen fibrils interconnect these layers yielding a highly anisotropic structure. Hydrated cleithra exhibit Young's moduli spanning 3-9 GPa where the yield stress of ∼40 MPa increases markedly to exceed ∼180 MPa upon drying. This 5x observation of increased strength corresponds to a change to brittle fracture patterns. It matches the emergence of compressive residual strains of ∼0.15% within the mineral crystals due to forces from shrinking collagen layers. Compressive stresses on the nanoscale, combined with the layered anisotropic microstructure on the mm length scale, jointly confer structural stability in the slender and lightweight bones. By employing a range of X-ray, electron and optical imaging and mechanical characterization techniques, we reveal the structure and properties that make the cleithra impressively damage resistant composites. Statement of significanceBy combining structural and mechanical characterization techniques spanning the mm to the sub-nanometer length scales, this work provides insights into the structural organization and properties of a resilient bone found in pike fish. Our observations show how the anosteocytic bone within the pectoral gridle of these fish, lacking any biological (remodeling) repair mechanisms, is adapted to sustain natural repeated loading cycles of abrupt jaw-gaping and swallowing. We find residual strains within the mineral apatite nanocrystals that contribute to forming a remarkably resilient composite material. Such information gleaned from bony structures that are different from the usual bones of mammals showcases how nature incorporates smart features that induce damage tolerance in bone material, an adaptation acquired through natural evolutionary processes.

Pediatric and adult osteoporosis: a contrasting mirror.

Pediatric osteoporosis (PO) is a condition that is currently gaining recognition. Due to the lack of official definitions over the past few decades, the exact incidence of PO is unknown. The research does not provide a specific prevalence of PO in different world regions. However, this is expected to change with the latest 2019 guidelines proposed by the International Society of Clinical Densitometry. Although adult osteoporosis (AO) has been postulated a pediatric disease because its manifestation in adulthood is a result of the bone mass acquired during childhood, differences between PO and AO should be acknowledged. AO is defined as low bone density; however, PO is diagnosed based on existing evidence of bone fragility (vertebral fractures, pathological fractures). This is particularly relevant because unlike in adults, evidence is lacking regarding the association between low bone density and fracture risk in children. The enhanced capacity of pediatric bone for reshaping and remodeling after fracture is another difference between the two entities. This contrast has therapeutic implications because medication-free bone reconstitution is possible under certain conditions; thus, background therapy is not always recommended. In this narrative review, differences between PO and AO in definition, assessment, and medical approach were investigated.

Effectiveness and safety of pamidronate treatment in nonambulatory children with low bone mineral density.

Nonambulatory pediatric patients may have low bone mineral density (BMD) and increased risk of pathologic fractures. Though bisphosphonate therapy is the mainstream medical intervention in these children, clinical data regarding this treatment are limited. Therefore, this study aimed to evaluate the effectiveness and safety of bisphosphonate therapy in such children. We conducted a retrospective study of 21 nonambulatory children (Gross Motor Function Classification System level V) with BMD z-score ≤ -2.0 who were treated with intravenous pamidronate for at least 1 year. These patients received pamidronate every 4 months at a dose of 1.0 to 3.0 mg/kg for each cycle and had regular follow-ups for at least 1 year. The main outcome measures were changes in BMD, risk rate of fracture, biochemical data, and adverse events. The average duration of pamidronate treatment was 2.0±0.9 years, and the mean cumulative dose of pamidronate according to body weight was 7.7±2.5 mg/kg/yr. After treatment, the mean lumbar spine bone mineral content, BMD, and height-for-age-z-score-adjusted BMD z-score (BMDhazZ) significantly improved. The relative risk of fracture after treatment was 0.21 (p=0.0032), suggesting that pamidronate treatment reduced fracture incidence significantly. The increase in the average dose per body weight in each cycle significantly increased the changes in BMDhazZ. Pamidronate treatment improved the bone health of nonambulatory children with low bone density without any significant adverse events. Independent of cumulative dosage and duration of treatment, the effectiveness of pamidronate increased significantly with an increase in the average dose per body weight in subsequent cycles.

Osseo-densification for preservation and compaction of alveolar bone in enhancing stability of dental implants: A systematic review

A higher implant failure rate may be associated with a lack of primary stability. Primary stability is a stationary, entirely mechanical parameter that determines when an implant is placed. Several methods have been developed to improve the primary implant's level of stability. However, Osseo-densification (OD) is a revolutionary implant preparation approach that addresses these issues and enhances the main stability of implants inserted into low-density bones. In light of this, the present systematic review was conducted to understand the Osseo-densification for preservation and compaction of alveolar bone in enhancing the stability of the dental implant. Research papers from PubMed, CINAHL, Web of Science, and Web of Science, Medline searched. The most recent literature suggests that using the Osseo-densification drilling protocol increases the overall value of implant insertion torque and, consequently, increases the primary stability of implants. To evaluate the caliber of the contained research, CARE, ARRIVE, and modified CONSORT checklists were employed. 133 full texts were chosen for further investigation after duplicates were removed and titles and abstracts were reviewed of these, 27 entire texts met the inclusion criteria. The thorough literature search identified 6 Case Studies &amp; Case Series, 11 in vivo animal studies, and ten /experimental animal studies that noted the use of the Osseo-densification technique. The data from most recent animal in vivo/in vitro studies and case reports / case series suggest that Osseo-densification drilling protocol increases the overall value of implant insertion torque and, as a result, increases implant primary stability.

Are Sandwich Vertebrae Prone to Refracture After Percutaneous Vertebroplasty or Kyphoplasty? A Meta-Analysis.

The formation of sandwiched vertebrae (SDVs) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) has become a common phenomenon. Whether SDVs are more likely to fracture is still controversial. Therefore, we conducted a meta-analysis to provide medical evidence for whether SDVs are more prone to refracture than non-SDVs (NSDVs) after PVP or PKP. This study was conducted in accordance with the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Several databases, including PubMed, Embase, Medline databases, China National Knowledge Infrastructure, Wanfang, and Weipu, were thoroughly searched for relevant studies included from any point up until June 2022. Statistical analyses were performed using Revman 5.4. A total of 4052 individuals from 9 studies were enrolled. Overall, patients with SDV presented more risk to have refracture than patients with NSDV (OR = 1.57, P = 0.04). The incidences of refracture were comparable between the 2 cohorts in studies with a follow-up time less than 3 years (OR = 1.28, P = 0.49). However, patients with SDV were more prone to have refracture than patients with NSDV in studies with a follow-up time longer than 3 years (OR = 1.92, P = 0.009). Moreover, patients with SDV were more likely to have refracture than patients with NSDV in studies that involved both PVP and PKP (OR = 1.62, P = 0.002). In addition, age, low bone density, and postoperative kyphosis angle of sandwich fracture segments >10° were independent factors to predict refracture. Patients with SDV were more likely to have refracture after PVP or PKP, especially when the follow-up time was longer than 3 years.

Preoperative proximal tibial bone density, bone microarchitecture, and bone turnover are not associated with postoperative tibial component migration in cemented and cementless medial unicompartmental knee replacements: secondary analyses from a randomized controlled trial.

Cementless arthroplasty fixation relies on early bone ingrowth and may be poor in patients with low proximal tibial bone density or abnormal bone turnover. We aimed first to describe the baseline bone properties in patients undergoing medial unicompartmental knee replacement (UKR), and second to investigate its association with cemented and cementless tibial component migration until 2 years. A subset investigation of 2 patient groups from a 3-armed randomized controlled trial was conducted. There were 26 cemented and 25 cementless medial UKRs with twin-pegged femoral components. Volumetric bone mineral density (vBMD) and microstructure of the excised medial tibial plateau were ascertained with µCT. Bone turnover was estimated using dynamic histomorphometry (eroded surface/bone surface = ES/BS, osteoid surface/bone surface = OS/BS, mineralizing surface/bone surface = MS/BS). Tibial component migration in 4 feature points was followed for 2 years with radiostereometry. At the 2-year follow-up, the cementless tibial components migrated 0.38 mm (95% confidence interval [CI] 0.14-0.62) total translation more than the cemented components at the posterior feature point. The greatest migration in the cementless group was subsidence at the posterior feature point of 0.66 mm (CI 0.48-0.84) until 6 weeks, and from 3 months the components were stable. Cemented tibial components subsided very little. Between 1- and 2-year follow-ups, no cementless but 4 cemented tibial components revealed continuous migration. OS/BS was half of the ES/BS. No µCT or histomorphometric parameters showed any clinically relevant correlation with tibial component migration at the posterior feature point for either cemented or cementless UKR at 6 weeks' or 2 years' follow-up after adjustment for age, BMI, and sex. Preoperative vBMD, bone turnover, and microstructure were not associated with postoperative tibial component migration of cemented and cementless medial UKR.

Osteoporosis and its associated factors among patients attending Manakamana Hospital, Chitwan, Nepal.

Osteoporosis is the most common skeletal disorder that weakens bones and increases their susceptibility to fractures. It is becoming an urgent and serious global epidemic. Early diagnosis and treatment are essential to reduce morbidity and mortality associated with it. This study aimed to find out the prevalence of osteoporosis among patients attending at Manakamana Hospital, Bharatpur, Chitwan, Nepal. A cross-sectional study was adopted and 623 patients attending at orthopaedic outpatients department (OPD) of Manakamana Hospital were selected using non-probability consecutive sampling technique. Data were collected from 15th October 2021 to 15th April, 2022, by using interview schedule, chart review and Bone Mineral Density (BMD) measurement through calcaneal ultrasonography. Ethical approval was obtained from Nepal Health Research Council Ethical Review Board prior to study procedures. Obtained data were analysed using descriptive statistics. Association between the variables were measured using chi-square test. The mean age of the patients was 43.5 (±14.26) years. Nearly half (44%, n = 274) were middle aged adults, 59.7% were female and 56.0% were involved in agriculture and household chores. Nearly half of the patients (45.7%) were overweight/ obese, 7.9% were smokers and 13.5% had habit of alcohol use. Osteopenia or low bone density was detected in 58.9% patients and 19.4% had osteoporosis. The prevalence of osteoporosis was significantly associated with age group (p = <0.001) and educational status (p = 0.013) of the patients. Osteoporosis and osteopenia are prevalent in patients attending in the hospital. Hence, awareness, early screening, and treatment are necessary for the hospital attended patients to enhance their health and, minimize the risk of osteoporosis and the consequences associated with it.

Abdominal Body Composition Reference Ranges and Association With Chronic Conditions in an Age- and Sex-Stratified Representative Sample of a Geographically Defined American Population.

Body composition can be accurately quantified from abdominal computed tomography (CT) exams and is a predictor for the development of aging-related conditions and for mortality. However, reference ranges for CT-derived body composition measures of obesity, sarcopenia, and bone loss have yet to be defined in the general population. We identified a population-representative sample of 4900 persons aged 20 to 89 years who underwent an abdominal CT exam from 2010 to 2020. The sample was constructed using propensity score matching an age and sex stratified sample of persons residing in the 27-county region of Southern Minnesota and Western Wisconsin. The matching included race, ethnicity, education level, region of residence, and the presence of 20 chronic conditions. We used a validated deep learning based algorithm to calculate subcutaneous adipose tissue area, visceral adipose tissue area, skeletal muscle area, skeletal muscle density, vertebral bone area, and vertebral bone density from a CT abdominal section. We report CT-based body composition reference ranges on 4649 persons representative of our geographic region. Older age was associated with a decrease in skeletal muscle area and density, and an increase in visceral adiposity. All chronic conditions were associated with a statistically significant difference in at least one body composition biomarker. The presence of a chronic condition was generally associated with greater subcutaneous and visceral adiposity, and lower muscle density and vertebrae bone density. We report reference ranges for CT-based body composition biomarkers in a population-representative cohort of 4649 persons by age, sex, body mass index, and chronic conditions.

New Perspectives of Therapies in Osteogenesis Imperfecta-A Literature Review.

(1) Background: Osteogenesis imperfecta (OI) is a rare skeletal dysplasia characterized as a heterogeneous disorder group with well-defined phenotypic and genetic features that share uncommon bone fragility. The current treatment options, medical and orthopedic, are limited and not efficient enough to improve the low bone density, bone fragility, growth, and mobility of the affected individuals, creating the need for alternative therapeutic agents. (2) Methods: We searched the medical database to find papers regarding treatments for OI other than conventional ones. We included 45 publications. (3) Results: In reviewing the literature, eight new potential therapies for OI were identified, proving promising results in cells and animal models or in human practice, but further research is still needed. Bone marrow transplantation is a promising therapy in mice, adults, and children, decreasing the fracture rate with a beneficial effect on structural bone proprieties. Anti-RANKL antibodies generated controversial results related to the therapy schedule, from no change in the fracture rate to improvement in the bone mineral density resorption markers and bone formation, but with adverse effects related to hypercalcemia. Sclerostin inhibitors in murine models demonstrated an increase in the bone formation rate and trabecular cortical bone mass, and a few human studies showed an increase in biomarkers and BMD and the downregulation of resorption markers. Recombinant human parathormone and TGF-β generated good results in human studies by increasing BMD, depending on the type of OI. Gene therapy, 4-phenylbutiric acid, and inhibition of eIF2α phosphatase enzymes have only been studied in cell cultures and animal models, with promising results. (4) Conclusions: This paper focuses on eight potential therapies for OI, but there is not yet enough data for a new, generally accepted treatment. Most of them showed promising results, but further research is needed, especially in the pediatric field.

Older Tissue Age Derived From Abdominal Computed Tomography Biomarkers of Muscle, Fat, and Bone Is Associated With Chronic Conditions and Higher Mortality

ObjectiveTo determine whether body composition derived from medical imaging may be useful for assessing biologic age at the tissue level because people of the same chronologic age may vary with respect to their biologic age. MethodsWe identified an age- and sex-stratified cohort of 4900 persons with an abdominal computed tomography scan from January 1, 2010, to December 31, 2020, who were 20 to 89 years old and representative of the general population in Southeast Minnesota and West Central Wisconsin. We constructed a model for estimating tissue age that included 6 body composition biomarkers calculated from abdominal computed tomography using a previously validated deep learning model. ResultsOlder tissue age associated with intermediate subcutaneous fat area, higher visceral fat area, lower muscle area, lower muscle density, higher bone area, and lower bone density. A tissue age older than chronologic age was associated with chronic conditions that result in reduced physical fitness (including chronic obstructive pulmonary disease, arthritis, cardiovascular disease, and behavioral disorders). Furthermore, a tissue age older than chronologic age was associated with an increased risk of death (hazard ratio, 1.56; 95% CI, 1.33 to 1.84) that was independent of demographic characteristics, county of residency, education, body mass index, and baseline chronic conditions. ConclusionImaging-based body composition measures may be useful in understanding the biologic processes underlying accelerated aging.