Bone Mineral Research Articles

Efficacy of reactive soft tissue for alveolar ridge preservation: a prospective cohort study.

This study aimed to investigate the effect of alveolar ridge preservation (ARP) sealing using reactive soft tissue (RST) or collagen sponge (CS), in combination with deproteinized bovine bone mineral (DBBM), for teeth with bone deficiency. In this study, 44 patients were recruited. During ARP therapy, RST or CS was applied for socket sealing. Horizontal and vertical bone dimensions were assessed before extraction (T0) and 6 months after ARP (T2). Modified Masse healing index (HI) was recorded to evaluate the soft tissue healing at 14 days after ARP (T1) and T2. Keratinized mucosa width (KMW) was measured at T0 and T2. Biopsies were collected during implant placement for histological analysis. This study was finished by 40 patients. Horizontal ridge gains at 1, 3, and 5mm below the crest were comparable in RST (4.37/5.57/4.16mm) and CS (3.57/4.66/2.97mm) groups. Similar vertical bone gains at both buccal and lingual sides were observed in RST and CS groups. Notably, the sockets in the RST group exhibited a significantly better early healing score (6) at T1 relative to the CS group (7) (p = 0.003). There was no significant difference in KMW changes as well as new bone proportion between the groups. RST and CS, when combined with DBBM, both effectively reduced ridge resorption in sockets with bone deficiency. RST demonstrated a more favorable effect on the early healing of sockets. RST is a promising socket sealing material in ARP, which reduces bone resorption, and promotes soft tissue healing. Clinical trial registration Number: ChiCTR2200061459.

Skull Ossification in the Andean Toad Rhinella spinulosa (Bufonidae) and the Genetic Model Organism Xenopus tropicalis (Pipidae) Reveals Heterochrony Phenomena and Frontoparietal Suture Modifications.

Anurans are famous for having evolved a highly simplified skull through bone loss and fusion events. Nevertheless, their skeleton displays a rich morphological diversity associated with adaptations to diverse lifestyles and ecological niches. Here, we report larval skull ossification in the Andean toad Rhinella spinulosa (Bufonidae), and compare it to the phylogenetically distant genetic model organism Xenopus tropicalis (Pipidae). We find that the ossification timing of most skull bones is conserved between both species, except for the prootic and the angulosplenial that ossify at much later stages in R. spinulosa than X. tropicalis. We propose that a delayed lower jaw ossification in R. spinulosa is tightly related to the more extensive metamorphosis process observed in this species where the ventrally oriented mouth opening shifts anteriorly. We also report two conspicuous notches in the R. spinulosa frontoparietal bone mineralization front which are absent in X. tropicalis, and presumably represent evolutionary remnants of the coronal suture that separates the frontal and parietal bones in most vertebrates. As such notches have not been overtly reported in the literature, we examined the X. tropicalis sibling species Xenopus laevis, and were able to identify similar, albeit transient, indentations in the forming frontoparietal bone, suggesting that vestigial coronal sutures might exist in more frog species than anticipated. Taken together, we show that R. spinulosa represents an ideal organism to study heterochronic shifts and the mechanisms underlying cranial suture loss which drove anuran skull simplification.

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES—a population-based study

BackgroundThe modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.MethodsData from 2007 to 2008, 2009–2010, 2013–2014 and 2017–2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1–L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.ResultsA total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = − 0.0103 (95% CI − 0.0160 to − 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = − 0.0120 (95% CI − 0.0172 to − 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371–0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.ConclusionsThe results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Untreated Osteoporosis in Lumbar Fusion Surgery Patients: Prevalence, Risk-factors and Effect on Bone Metabolism.

Secondary analysis of a prospective single-center study. To analyze the prevalence and risk factors for untreated osteoporosis in patients undergoing lumbar spinal fusion surgery (LFS) and its impact on bone mineral density (BMD) and bone turnover markers. Osteoporosis is a risk factor for mechanical complications in LFS, which can be mitigated by antiosteoporotic treatment. However, there's limited research on factors leading to untreated osteoporosis before LFS and its impact on preoperative bone status. A secondary analysis of a prospective study enrolling adults undergoing LFS for degenerative conditions (2014-2024) with preoperative quantitative CT osteoporosis screening was performed. Demographic data and medical history were analyzed for prevalence and risk factors of untreated osteoporosis, while BMD, vitamin D, PTH levels, and bone turnover markers were assessed for the effects of lacking treatment. A total of 445 patients (48% female, median age 64) were included, of which 137 patients (31%) had osteoporosis. Of these, 66 (48%) were untreated and 71 (52%) were treated, with 40 (56%) receiving pharmacological and 31 (44%) non-pharmacologic treatment including vitamin D supplementation and lifestyle modifications. Of the untreated patients, 55 (80%) were identified by preoperative screening. 71% of osteoporotic men versus 35% of osteoporotic women were untreated (P<0.001). Multivariable logistic regression confirmed male sex as an significant contributing factor (OR 4.3, 95% CI 1.9-10.1, P<0.001) for untreated osteoporosis. Treated osteoporotic patients had higher BMD (P<0.001), higher VitD levels P=0.023) and lower levels of bone resorption parameters (P=0.004) than untreated patients. Untreated osteoporosis is common before LFS, especially in men, with the untreated having lower BMD and higher bone resorption marker levels than treated patients. Identification of osteoporotic cases and subsequent osteological optimization could potentially reduce the risks of adjacent fractures or screw loosening.

Prognostic impact of osteosarcopenia on postoperative outcomes in patients with biliary tract cancer.

Frailty, characterized by sarcopenia and osteopenia, is associated with poor survival after the resection of biliary tract cancer (BTC). Osteosarcopenia, the coexistence of sarcopenia and osteopenia, has recently been associated with poor outcomes in various cancers. This study assessed the prognostic value of osteosarcopenia after the resection of BTC. We analyzed 109 patients who underwent BTC resection between 2014 and 2021 for the following conditions: intrahepatic cholangiocarcinoma (n = 21), perihilar cholangiocarcinoma (n = 16), distal cholangiocarcinoma (n = 32), gallbladder carcinoma (n = 17), and ampullary carcinoma (n = 23). Sarcopenia was evaluated using computed tomography of the psoas muscle at the third lumbar vertebra, while osteopenia was measured using bone mineral density at the 11th thoracic vertebra. Osteosarcopenia was defined as the presence of both the conditions. Sarcopenia was present in 54 patients (50%), osteopenia in 50 patients (46%), and osteosarcopenia in 30 patients (28%). Lymph node metastasis is common in patients with osteosarcopenia. A multivariate analysis revealed that lymph node metastasis (p = 0.0278), poor tumor differentiation (p = 0.0027), and osteosarcopenia (p = 0.0436) were independent predictors of poor disease-free survival. Osteosarcopenia was also a significant predictor of poor overall survival (p < 0.0001). Osteosarcopenia serves as a prognostic factor for poor outcomes after BTC resection.

Effect of Physical Activity Interventions on Health Parameters in Children and Adolescents with Intellectual Disabilities: A Systematic Review

Intellectual disability (ID) encompasses diverse challenges that affect daily life and health. Sedentary behaviors, prevalent in this population, contribute to alarming health concerns, notably obesity and musculoskeletal issues. This review examines the role of physical activity (PA) interventions in addressing these health challenges among children and adolescents with ID. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in the Cochrane Library, PubMed, Scopus, and SPORTDiscus databases, using specific keywords aligned with the PICO framework (population, intervention, comparison, and outcome). From January 2013 to October 2024, a total of 5236 studies were identified, of which 17 met the inclusion criteria for this review according to PRISMA procedures. Randomized controlled trials (RCTs) focusing on the impact of PA on body composition, physical fitness, bone health, metabolic indicators, and overall quality of life were included. The study cohort consisted of individuals aged 13–24 diagnosed with ID. The findings consistently highlight the positive relationship between PA interventions and improved health markers in individuals with ID. Diverse PA interventions, ranging from strength training to high-intensity exercises, demonstrated significant improvements in body composition, physical fitness, and bone mineral density. Notably, higher-frequency PA programs (minimum three sessions per week) yielded more substantial benefits. This review underscores the potential of adapted PA interventions to address health concerns and enhance the quality of life for individuals with ID. Further comprehensive research is needed to establish standardized guidelines for effective PA interventions in this population

Expert consensus on the diagnosis and treatment of pyruvate kinase deficiency

Pyruvate kinase deficiency (PKD) is a rare autosomal recessive disorder caused by mutations in the PKLR gene, encoding erythrocyte pyruvate kinase, which affects erythrocyte energy production, and then in turn affects erythrocyte function and longevity. PKD is characterized by chronic hemolytic anemia, and other features include chronic hemolytic complications, such as iron overload, decreased bone mineral density, and cardiopulmonary complications. The treatment of PKD requires individualized approach based on the patient's condition, including red blood cell transfusions, pyruvate kinase activators, and treatment for complications. This consensus focuses on the pathogenesis, clinical characteristics, diagnosis and treatment of PKD, and aims to provide better medical service for clinicians, such as diagnosis, treatment, monitoring, and prevention of complications for PKD patients.

Enhancing bone regeneration and osseointegration using rhPTH(1-34) and dimeric R25CPTH(1-34) in an osteoporotic beagle model.

This study investigates the effects of two parathyroid hormone (PTH) analogs, rhPTH(1-34) and dimeric R25CPTH(1-34), on bone regeneration and osseointegration in a postmenopausal osteoporosis model using beagle dogs. Twelve osteoporotic female beagles were subjected to implant surgeries and assigned to one of three groups: control, rhPTH(1-34), or dimeric R25CPTH(1-34). Bone regeneration and osseointegration were evaluated after 10 weeks using micro-computed tomographic (micro-CT), histological analyses, and serum biochemical assays. Results showed that the rhPTH(1-34) group demonstrated superior improvements in bone mineral density, trabecular architecture, and osseointegration compared to controls, while the dimeric R25CPTH(1-34) group exhibited similar, though slightly less pronounced, anabolic effects. Histological and TRAP assays indicated both PTH analogs significantly enhanced bone regeneration, especially in artificially created bone defects. The findings suggest that both rhPTH(1-34) and dimeric R25CPTH(1-34) hold potential as therapeutic agents for promoting bone regeneration and improving osseointegration around implants in osteoporotic conditions, with implications for their use in bone-related pathologies and reconstructive surgeries.

Comparative evaluation of trabecular bone density in Hounsfield units in the lumbar native CT cross-section for osteoporosis diagnosis and fracture risk determination by different examiners

An increasing loss of bone mineral density (BMD) in the axial skeleton leads to osteoporosis and fractures, with an increase found in the thoracic and thoracolumbar regions. The extent to which an examiner-independent assessment of the extent of osteoporosis and fracture risk determination is possible by determining the trabecular density in Hounsfield units (HU) in the spine should be examined. The next question was whether quantitative BMD values can be calculated from the HU values. 225 patients (pt.) with an average age of 64.9 ± 13.1 years and abody-mass-index (BMI) of 26.8 ± 6.8 kg/m2, of which 37were men and 188 were women, were examined to determine whether they had osteoporosis. The BMD was determined in mg/cm3 using quantitative computed tomography (QCT) in the lumbar region. After anonymization by three experienced radiologists, an additional measurement of the trabecular bone density in HU, was carried out in the same vertebral bodies (atotal of 675 vertebral bodies), each using aregion of interest (ROI) positioned in the midvertebral cancellous space in the sagittal reformed CT image. In additional lateral X‑rays of the thoracic and lumbar spine, vertebral fractures were detected and graded. Sacral insufficiency fractures that occurred at the same time were also recorded. The median BMD was 73.2 (57.05-104.17) mg/cm3 and the median HU was 89.93 (67.90-126.95). With acorrelation of 0.988 (p < 0.001), quantitative values in mg/cm3 can be calculated using the following formula: Xq = 12.1 + 0.68 × HU. With HU values less than 69.84 and aBMD of the lumbar spine below 59.54 mg/cm3, there was asignificantly increased number of OVF. At least one OVF was found in 137/225 pt. In 17/137 pt., sacral fractures were also found; these patients showed the significantly lowest values with amedian BMD of 41.81 (16.2-53.7) mg/cm3. Comparable HU values were determined independently of the examiners (p > 0.05). The trabecular density measurements in HU values can be converted into quantitative BMD values in mg/cm3, which enables agood assessment of osteoporosis and fracture risk. Taking the results obtained into account, an opportunistic evaluation using HU values in native CT alone seems quite possible. Experienced examiners have arrived at comparable results.

Trabecular bone scores in children with osteogenesis imperfecta respond differently to bisphosphonate treatment depending on disease severity

IntroductionOsteogenesis imperfecta (OI) is a congenital skeletal disorder characterized by bone fragility. Bisphosphonates (BISs) have become the mainstream treatment in children with OI. However, an optimal treatment protocol has not yet been established, while BIS treatment tends to be administered to normalize bone mineral density (BMD). Bone quality is an important component of bone strength. The trabecular bone score (TBS) is a quantitative measure of the microstructure that affects bone quality. This study investigated the TBS during BIS treatment in children with OI.Materials and methodsTwenty-nine children with OI were enrolled and classified into two groups: mild (type 1) and moderate to severe (types 3 and 4). Dual-energy x-ray absorptiometry images were retrospectively analyzed for TBS calculation. The relationship between the areal BMD (aBMD), its Z-score, height-adjusted BMD (BMDHAZ) Z-score, TBS, and TBS Z-score with the treatment duration was assessed for each group.ResultsIn the mild group, the aBMD, its Z-score, and BMDHAZ Z-score showed a significant positive correlation with treatment duration (r = 0.68, 0.68, 0.72, respectively, p &amp;lt; 0.01). The TBS Z-score tended to increase with treatment duration, albeit without reaching significance. In the moderate to severe group, the TBS Z-score showed a significant positive correlation with treatment duration (r = 0.48, p &amp;lt; 0.01), in contrast to the aBMD Z-score, which did not increase. Finally, the BMDHAZ Z-score only showed a weak positive correlation with treatment duration (r = 0.37, p &amp;lt; 0.01).ConclusionBecause BIS affect the BMD and TBS differently based on the severity of OI, treatment goals may need to be stratified by disease severity.

Improved Osteoporosis Prediction in Breast Cancer Patients Using a Novel Semi-Foundational Model.

Small cohorts of certain disease states are common especially in medical imaging. Despite the growing culture of data sharing, information safety often precludes open sharing of these datasets for creating generalizable machine learning models. To overcome this barrier and maintain proper health information protection, foundational models are rapidly evolving to provide deep learning solutions that have been pretrained on the native feature spaces of the data. Although this has been optimized in Large Language Models (LLMs), there is still a sparsity of foundational models for computer vision tasks. It is in this space that we provide an investigation into pretraining Visual Geometry Group (VGG)-16, Residual Network (ResNet)-50, and Dense Network (DenseNet)-121 on an unrelated dataset of 8500 chest CTs which was subsequently fine-tuned to classify bone mineral density (BMD) in 199 breast cancer patients using the L1 vertebra on CT. These semi-foundational models showed significant improved ternary classification into mild, moderate, and severe demineralization in comparison to ground truth Hounsfield Unit (HU) measurements in trabecular bone with the semi-foundational ResNet50 architecture demonstrating the best relative performance. Specifically, the holdout testing AUC was 0.99 (p-value < 0.05, ANOVA versus no pretraining versus ImageNet transfer learning) and F1-score 0.99 (p-value < 0.05) for the holdout testing set. In this study, the use of a semi-foundational model trained on the native feature space of CT provided improved classification in a completely disparate disease state with different window levels. Future implementation with these models may provide better generalization despite smaller numbers of a disease state to be classified.

Effects of recreational artistic gymnastics on bone mineral density and content of school-age girls

Aims :This study aimed to evaluate whether Artistic Gymnastics (AG) practice has beneficial effects on Bone Mineral Density (BMD) and Bone Mineral Content (BMC) of young gymnasts.Methods : All girls involved in AG training from the city of Pelotas, aged 6 to 12 years were recruited. Control group participants could not be involved in any extracurricular sports activity. Predictive equations based on anthropometric and physical tests were used to assess bone mass (BMD and BMC).Results : When compared to control group, AG group showed higher Femoral neck (0.672 ± 0.147 vs 0.561 ± 0.172) and Upper limbs (1.482 ± 0.159 vs 1.289 ± 0.178) BMD. In addition, Lumbar spine BMD was higher in AG group regardless of the predictive equation used. When compared with girls not involved in extracurricular activities, AG practitioners presented higher upper limbs, femoral neck and lumbar spine BMD.Conclusion : However, caution is required when using predictive equations to assess BMD and BMC.

Influence of LED light spectra and photoperiods on performance, bone characteristics and related genes expression in broiler breeders

ABSTRACT 1. Lighting is a crucial environmental factor in poultry production. This study evaluated the effects of light-emitting diodes (LED) on performance and several bone characteristics, including bone mineralisation, morphometry, histology and selected gene expression in broiler breeders. 2. A total of 800 one-d-old female broiler breeder chickens (Ross 308) were randomly allocated to one of 20 light-proof pens and reared under green (GL) or white (WL) LED light for two photophases (8 or 12 h) in a 2 × 2 factorial experiment and compared to a control group (incandescent lamp at 8 L:16D duration; CON). Weight gain, feed consumption and feed conversion ratio (FCR) were calculated. Femoral and tibial characteristics were measured. 3. The LED colour affected feed intake during the rearing period, being higher for birds under white compared to green light. Tibial calcium (Ca) concentration in WL birds was lower than for green LED lighting regimens but not different from the CON group (p ≤ 0.05). Birds under 12 h lighting had greater tibia bone dry matter and trabecular separation (mm) than those in the 8 h groups. However, bone volume fraction and trabecular number per mm in 8 h birds were higher than in 12 h groups (p ≤ 0.01). There was greater expression of the osteocalcin gene under WL compared with CON. Osteopontin expression in WL8 was 4.63 times greater than in the CON group (p ≤ 0.05). The alkaline phosphatase gene expression in WL12 was higher than in the CON group (p ≤ 0.05). 4. Exposure to white and green LED spectra enhanced bone gene expression and mineralisation, respectively, without adverse effects on bird performance. Thus, LED light may be beneficial to broiler breeder bone traits.

Bone Erosions and Systemic Bone Loss on HR-pQCT in Men With Tophaceous Gout.

Gout, a prevalent inflammatory arthropathy, predominantly affects males and arises from persistent hyperuricemia, resulting in monosodium urate crystal deposition. Hyperuricemia is associated with comorbidities, exacerbating patient morbidity. Conflicting literature exists regarding uric acid's impact on bone mineral density (BMD), with potential proinflammatory effects in gout patients. Localized bone destruction (erosions) is a hallmark of gout, necessitating early detection due to its predictive role in musculoskeletal disability. This cross-sectional study included 26 tophaceous gout patients. Clinical and densitometric parameters were assessed, and high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for bone microarchitecture evaluation, as well as bone erosions in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. A healthy control group of 52 age and BMI-matched individuals was included. Despite normal areal bone mineral density (BMD), tophaceous gout patients exhibited impaired HR-pQCT parameters, including lower cortical volumetric BMD (Ct.vBMD) and higher cortical porosity at the distal radius. Similar trends were observed at the tibia. Bone erosions were prevalent (96%), with distribution across MCP and PIP joints. Patients with ≥ 4 erosions displayed increased tophi prevalence and longer uricosuric use. Erosions correlated with compromised microarchitecture, emphasizing their association with disease activity. Despite normal BMD, tophaceous gout patients manifest systemic bone loss, with bone microarchitectural deterioration and localized bone erosions, underscoring the need for detailed clinical approaches to prevent musculoskeletal disabilities, including fragility fractures, in this population.

MicroRNAs in fluorosis pathogenesis: impact on dental, skeletal, and soft tissues.

Fluoride-induced toxicity (fluorosis) poses a significant health concern globally, affecting millions of individuals. Understanding the molecular mechanisms underlying fluorosis, particularly the role of microRNAs (miRNAs), is crucial for developing effective preventive and therapeutic strategies. This review explores the pivotal role of miRNAs in the pathogenesis of fluorosis, particularly examining its impact on both hard (skeletal and dental) and soft (brain, liver, kidney, heart, and reproductive organs) tissues. Skeletal fluorosis manifests as abnormal bone mineralization and structure, while dental fluorosis affects enamel formation. In vitro and in vivo studies suggest a significant involvement of miRNAs in the progression of these conditions. For skeletal fluorosis, miR-124, miR-155, and miR-200c-3phave been identified askeyregulators, while miR-296-5p and miR-214-3pare implicatedin dental fluorosis.Moreover, soft tissue fluorosis encompasses a spectrum of adverse effects on various organs, including the brain, liver, kidneys, heart, and reproductive system. In soft tissues, miRNAs, such as miR-124, miR-200c-3p, miR-132, and miR-34b-5p, havebeen linkedto cellular damage and dysfunction. Notably, miRNAs exert their effectsthrough the modulation ofcritical pathways involved in fluorosis pathology, including Wnt signaling, apoptosis, cell cycle, and autophagy. Understanding the regulatory roles of miRNAs in fluorosis pathogenesis holds promise for identifying biomarkers and therapeutic targets. However, further research is needed to elucidate the molecular mechanisms underlying miRNA-mediated responses to fluoride exposure.Integration ofmiRNA research into fluorosis studies could facilitate the development of diagnostic tools and therapeutic interventions, thus mitigating the detrimental effects of fluorosis on both hard and soft tissues.

Image-based finite element model stiffness and vBMD by single and dual energy CT reconstruction kernel

Single-energy quantitative computed tomography (SEQCT) provides volumetric bone mineral density (vBMD) measures for bone analysis and input to image-based finite element models (FEMs). Dual-energy CT (DECT) improves vBMD by accounting for voxel-specific material variations utilizing scans at multiple x-ray energies. vBMD is also altered by reconstruction kernel that cannot be accounted for using calibration phantoms. This study compared vBMD and FEM stiffness derived from SEQCT and DECT images reconstructed with two common kernels. SEQCT and DECT images of cadaveric shoulders (n = 10) were collected using standard (STD) and boneplus (BONE) kernels. Hounsfield Units were converted to vBMD using specimen-specific calibrations. DECT STD and BONE images were generated using an established material decomposition method with 40 and 90 keV simulated monochromatic images. A proximal humerus bone section below the anatomic neck was used for vBMD analysis and FEM generation. FEMs were loaded to 1 % apparent strain for stiffness measurements.Between STD and BONE kernel images, average vBMD differed 0.9 mgK2HPO4/cc and 4.1 mg K2HPO4/cc, in SEQCT and DECT images, respectively. Significant differences occurred in DECT images (p = 0.001). BONE reconstructed images produced higher vBMD measures across both SEQCT and DECT images. The difference between STD and BONE in both SEQCT- and DECT-based FEMs persisted, with larger estimated stiffness in BONE models. For six of the models DECT-based had higher stiffness than SEQCT-based models using the same kernel, although these models differed between STD and BONE kernels. Differences in stiffness between STD and BONE derived models were similar across image types (DECT: 17.5 kN/mm; SEQCT: 19.0 kN/mm). Stiffness values were significantly different within SECT kernels and between SEQCT BONE and DECT STD models. This study shows important differences in vBMD and FEM stiffness that occur due to CT-based imaging parameters alone. These results indicate that consistent imaging parameters should be used for vBMD analysis and FEM input to avoid systematic measurement errors.

Romosozumab versus denosumab in long-term users of glucocorticoids: A pilot randomized controlled trial.

To compare the efficacy of romosozumab (ROMO) and denosumab (DEN) in prevalent long-term glucocorticoid (GC) users. Adult patients receiving oral prednisolone (≥5mg/day) with high risk of fracture were randomized to receive subcutaneous ROMO (210mg monthly) or DEN (60mg 6-monthly) for 12 months, followed by DEN for two more doses. The primary end point was the change in spine bone mineral density (BMD) from Months 0 to 12. Secondary end points included changes in BMD of the spine/hip/femoral neck and bone turnover markers at various time points and adverse events. Seventy patients (age 62.6±9.1 years; 96% women; median prednisolone dose 5.0mg/day; duration of therapy 10.7±7.4 years) were enrolled, and 63 completed the study. At Month 12, the spine BMD increased significantly in both ROMO (+7.3%±4.5%; p<0.001) and DEN (+2.3%±3.1%; p<0.001) groups. The absolute spine BMD gain from Months 0 to 12 was significantly greater in ROMO-treated patients (p<0.001). Although the total hip BMD at Month 12 also increased significantly in the ROMO (+1.6%±3.3%; p=0.01) and DEN groups (+1.6%±2.6%; p=0.003), the absolute BMD gain was not significantly different between the groups. At Month 24, the spine BMD continued to increase in both the ROMO (+9.7%±4.8%; p<0.001) and DEN group (+3.0%±3.0%; p<0.001) compared to baseline, and the absolute BMD gain remained significantly greater in ROMO-treated patients. The total hip BMD continued to increase in both groups (ROMO +2.9%±3.7%; p<0.001; DEN +2.2%±3.4%; p=0.001), but the changes from baseline were similar. Injection site reaction was more frequently reported in ROMO-treated patients. ROMO was superior to DEN in raising the spine BMD at Month 12 in chronic GC users. After switching to DEN, ROMO-treated patients continued to gain spine BMD to a greater extent than DEN until Month 24.

Hypoparathyroidism: Musculoskeletal Manifestations Related to Parathormone Deficiency.

Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Musculoskeletal manifestations included myopathy, shoulder disorder, immune-negative non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation, seen in patients with hypoparathyroidism, may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density. However, the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism, including muscular, axial, peripheral articular, and entheseal manifestations.

Total Hip Arthroplasty in Patients with Hip Osteoporosis: A Narrative Review.

Osteoporosis and osteopenia can affect patients undergoing arthroplasty of the hip, which is typically recommended for patients with severe osteoarthritis or elderly patients with a femoral neck fracture. Preoperative screening for this type of bone loss could be helpful to patients and prevent poor outcomes due to the rate of underdiagnosis of osteoporosis, which can reach 73% in patients undergoing hip arthroplasty. Complications associated with low bone mineral density include periprosthetic fractures as well as an increased revision rate. Although the benefit of antiresorptive medications postoperatively has been demonstrated, when administered preoperatively, worse outcomes were reported compared to its non-usage. Surgical management is as important as pre-medication. According to general recommendations, cemented implants provide greater benefit in osteoporotic patients. However, when using cementless implants, ribbed stems, straight tapered stems, stems with medial calcar contact, and titanium-composed stems can be used to prevent periprosthetic loss of bone mineral density; however, they should not be placed in a varus position. These stems can also be coated with zoledronate and other products.

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

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