Detection Of Osteoporosis Research Articles

Role of lumbar spine signal intensity measurement by MRI in the diagnosis of osteoporosis in post-menopausal women

BackgroundOsteoporosis is a worldwide health problem and a common cause of bone fractures; the most common type of osteoporosis is post-menopausal type. MRI has a role in the diagnosis of osteoporosis and can be used as a screening tool, so the purpose of our study was to define a quantitative MRI-based score (M-score) for the detection of lumbar spine osteoporosis and to evaluate the correlation between lumbar spine signal intensity measured by MRI and BMD (bone mineral density) in post-menopausal women. Our case-control study involved 100 cases (50 old post-menopausal females as a case group and 50 healthy females as a control group of matched age). Both groups were subjected to history taking, dual-energy X-ray absorptiometry (DEXA), and conventional lumbar MRI. DEXA was performed for the lumbar spine and all scores (T-score, Z-score, BMD) were calculated. Lumbar MRI was performed (sagittal T1WI and T2WI) from L1–L4 levels. SNRL1–L4 and M-score were calculated from T1W images.ResultsAll DEXA scores were significantly lower in post-menopausal females compared to the control group (P < 0.0001). Meanwhile, SNRL1–L4 and M-score were significantly higher among cases than controls (P < 0.0001). The diagnostic threshold of SNRL1–L4 and M-score for distinguishing osteoporotic from non-osteoporotic females was 104.5 for SNRL1–L4 with a sensitivity of 94%, specificity 60%, positive predictive values (PPV) 31%, and negative predictive values (NPV) 98%, and 3.5 for M-score with a sensitivity of 93.3%, specificity 83.5%, PPV 50%, and NPV 98.6%. SNRL1–L4 was negatively correlated with M-score (r = − 0.74, P < 0.0001), T-score (r = − 0.42, P < 0.0001), Z-score (r = − 0.32, P < 0.0001), and BMD (r = − 0.31, P < 0.0001). M-score was negatively correlated with T-score (r = − 0.48, P < 0.0001), Z-score (r = − 0.36, P < 0.0001), and BMD (r = − 0.37, P < 0.0001). M-score moderately agreed with T-score (κ = 0.5, P < 0.0001).ConclusionThe MRI-based score (M-score) of the lumbar spine is an accurate quantitative method for distinguishing osteoporotic from non-osteoporotic females. M-score and SNRL1–L4 are significantly correlated with osteoporotic indices (T-score and BMD).

Bayesian inference of a human bone and biomaterials using ultrasonic transmitted signals.

Ultrasonic techniques could be good candidates to aid the assessment of osteoporosis detection, due to their non-intrusiveness and low cost. While earlier studies made use of the measured ultrasonic phase velocity and attenuation inside the bone, very few have considered an inverse identification of both the intrinsic pore microstructure and the mechanical properties of the bone, based on Biot's model. The main purpose of this work is to present an in vitro methodology for bone identification, adopting a statistical Bayesian inference technique using ultrasonic transmitted signals, which allows the retrieval of the identified parameters and their uncertainty. In addition to the bone density, Young's modulus and Poisson's ratio, the bone pore microstructure parameters (porosity, tortuosity, and viscous length) are identified. These additional microstructural terms could improve the knowledge on the correlations between bone microstructure and bone diseases, since they provide more information on the trabecular structure. In general, the exact properties of the saturating fluid are unknown (bone marrow and blood in the case of bone study) so in this work, the fluid properties (water) are identified during the inference as a proof of concept.

Unknown osteoporosis in older patients admitted to post-acute rehabilitation.

Osteoporotic fractures are associated with increased morbidity, mortality, and increased health care use. As the number of older adults increases, identifying those at increased risk for osteoporotic fractures has become of utmost importance to providing them with preventive and therapeutic interventions. To determine the prevalence of unknown clinical and densitometric osteoporosis and to investigate the performance of different diagnostic strategies for osteoporosis in elderly patients admitted to rehabilitation. This is an observational study. Eligible participants were older adults admitted to rehabilitation in an academic hospital in Switzerland over an 11-month period. Patients with previously unknown osteoporosis underwent dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA), and history review for past fractures. Complete assessment was available for 252 patients. Previously undiagnosed osteoporosis was identified in 62.3% of these patients, a proportion that was higher among women (71.5%) than men (44.8%). DXA proved most sensitive, followed by VFA and history review. Results differed across gender: DXA remained the most sensitive single test among women, but VFA proved most sensitive in men. The best test to combine with history review was DXA in women (detection increasing from 47.5 to 93.2%) and VFA in men (detection increasing from 35.9 to 84.6%). Prevalence of previously unknown osteoporosis appears very high in elderly patients admitted to post-acute rehabilitation. The combination of history review of previous fractures with DXA in women and with VFA in men appears the best two-step strategy to improving detection of osteoporosis in this population.

UTILITY OF CONE BEAM COMPUTED TOMOGRAPHY OF THE MANDIBLE IN DETECTION OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN

INTRODUCTION: Osteoporosis is a systemic disease characterized by decreased bone mass and increased bone fragility. Dental radiographsare widely used in the adult population especially Cone Beam Computed Tomography (CBCT) that is used in oral and maxillofacial surgeryfor numerous clinical applications. Therefore, dental radiographs may offer an opportunity as a screening tool for the early detection ofosteoporosis and subsequent referral.OBJECTIVES: The aim of this study was to evaluate the diagnostic efficacy of mandibular CBCT images for the detection of osteoporosisin postmenopausal women and to correlate it to Dual energy x-ray absorptiometry (DEXA) scan results.MATERIALS AND METHODS: twenty four postmenopausal female patients were recruited in this study. Based on their DEXA results,they were classified into osteoporotic and control non-osteoporotic groups. CBCT examination was done as part of surgical treatment. Coronalimages were used to measure the computed tomography mandibular index (CTMI) and the computed tomography index (superior) (CTIS).Thecorrelation between these indices and bone mineral density (BMD) measured by DEXA were assessed.RESULTS: There were significant differences between the control and osteoporotic groups in the computed tomography mandibular indexsuperior CTI(S), and computed tomography mental index (CTMI: inferior cortical width).There was significant positive correlation betweenCTMI and T-score measured by DEXA.CONCLUSIONS: CTI(S) and CTMI on the CBCT images can be used to assess the osteoporotic women.

Using texture analysis of head CT images to differentiate osteoporosis from normal bone density

ObjectivesTo investigate the use of texture analysis for the detection of osteoporosis on noncontrast head CTs, and to explore optimal sampling regions within the craniofacial bones. MethodsIn this IRB-approved, retrospective study, the clivus, bilateral sphenoid triangles and mandibular condyles were manually segmented on each noncontrast head CT, and 41 textures features were extracted from 29 patients with normal bone density (NBD); and 29 patients with osteoporosis. Basic descriptive statistics including a false discovery rate correction were performed to evaluate for differences in texture features between the cohorts. ResulsSixteen texture features demonstrated significant differences (P < 0.01) between NBD and osteoporosis in the clivus including 4 histogram features, 2 gray-level co-occurrence matrix features, 8 gray-level run-length features and 2 Law’s features. Nineteen texture features including 9 histogram features, 1 GLCM features, 2 GLRL features, 5 Law’s features and 2 GLGM features demonstrated statistically significant differences in both sides of the sphenoid triangles. A total 24 texture features demonstrated statistically significant differences between normal BMD and osteoporosis in the left sphenoid and a total of 31 texture features in the left condyle. Furthermore, a total of 22 texture features including 6 histogram features, 3 GLCM features, 9 GLRL features, 2 Law’s features and 2 GLGM features demonstrated statistically significant differences in both sides of the mandibular condyles. ConclusionThe results of this investigation suggest that specific texture analysis features derived from regions of interest placed within multiple sites within the skull base and maxillofacial bones can distinguish between patients with normal bone mineral density compared to those with osteoporosis. This study demonstrates the potential utility of a texture analysis for identification of osteoporosis on head CT, which may help identify patients who have not undergone screening with traditional DXA.

Comparison of laboratory and imaging methods associated with bone metabolism in patients with or without renal failure under the age of 45 years with elevated parathyroid hormone levels

Objectives: Although bone biopsy is considered the gold standard for the definitive diagnosis of renal osteodystrophy; it is not suitable for routine clinical practice due to its invasive nature. The present study was aimed to evaluate and compare the bone mineral status using dual energy X-ray absorptiometry of patients with or without chronic kidney disease in young population with elevated parathyroid hormone levels. Methods: This was a single center, cross-sectional, retrospective study conducted in patients younger than 45 years of age. The study was performed in the outpatient clinic of a university hospital. Patients with elevated parathyroid hormone levels were included. Results: Among them, 29 had renal insufficiency, 158 had normal renal function. Measured bone mineral density with dual energy X-ray absorptiometry and laboratory values were collected from patient files. The primary end point was to assess the efficiacy of dual energy X-ray absorptiometry in patients with or without renal failure. Except Z score at Ward’s triangle, all of the T and Z scores at lomber, femur neck, trochanteric, and intertrochanteric areas were found significantly lower in patients with chronic kidney disease compared to those without (p &amp;lt; 0.001). Conclusion: Dual energy X-ray absorptiometry seemed to be a reliable method for detection of osteoporosis in premenopausal female and male patients younger than 45 years of age with or without renal failure with elevated parathyroid hormone levels.

A computer aided diagnosis system for measurement of mandibular cortical thickness on dental panoramic radiographs in prediction of women with low bone mineral density.

Osteoporosis detection at earlier stages can enhance the life span of an elderly individual. The aim of the study is to perform semi-automated measurement of mandibular cortical thickness (MCT) on a dental panoramic radiograph (DPR) and thereby to predict the risk of low BMD among the studied population. The study involved 76 women (mean age: 57.2 ± 12.6years). The DPR was obtained using KODAK 8000C system. The BMD of right total hip (T-BMD) was obtained using DPX Prodigy Dual-energy X-ray absorptiometry (DXA) Scanner. The DPR obtained were subjected to image processing techniques to perform MCT measurement. The region of interest was manually selected around the mental foramen and enhanced using a median filter. The Ostu segmentation was performed and connected component labelling operation was performed to determine the lower boundary by finding the contour with maximum area. Subsequently, the haar wavelet operation was carried out to find the magnitude and thereby select the upper delineating cortical boundary. The Pearson test results revealed (r = 0.96, p < 0.01) for the standard (manual) MCT measurement against the MCT measured using the proposed semi-automated scheme. ROC analysis revealed that MCT = 2.5mm could be an optimal threshold in spotting individuals at risk of low BMD. The results of the study revealed that the MCT measured on a DPR using the proposed approach could be helpful for identifying individuals at risk of low BMD.

Simulating Dual-Energy X-Ray Absorptiometry in CT Using Deep-Learning Segmentation Cascade

PurposeOsteoporosis is an underdiagnosed condition despite effective screening modalities. Dual-energy x-ray absorptiometry (DEXA) screening, although recommended in clinical guidelines, remains markedly underutilized. In contrast to DEXA, CT utilization is high and presents a valuable data source for opportunistic osteoporosis screening. The purpose of this study was to describe a method to simulate lumbar DEXA scores from routinely acquired CT studies using a machine-learning algorithm. MethodsBetween January 2010 and September 2014, 610 CT studies of the abdomen and pelvis were used to develop spinal column and L1 to L4 multiclass segmentation. DEXA simulation training and validation used 1,843 pairs of CT studies accompanied by DEXA results obtained within a 6-month interval from the same individual. Machine learning–based regression was used to determine correlation between calculated grade (on the basis of vertebrae L1-L4) and DEXA t score. ResultsAnalysis of the t score equivalent, generated by the algorithm, revealed true positives in 1,144 patients, false positives in 92 patients, true negatives in 245 patients, and false negatives in 212 patients, resulting in an accuracy of 82%. Sensitivity for the detection of osteoporosis or osteopenia was 84.4% (95% confidence interval, 82.3%-86.2%), and specificity was 72.7% (95% confidence interval, 67.7%-77.2%). ConclusionsThe presented algorithm can identify osteoporosis and osteopenia with a high degree of accuracy (82%) and a small proportion of false positives. Efforts to cull greater information using machine-learning algorithms from pre-existing data have the potential to have a marked impact on population health efforts such as bone mineral density screening for osteoporosis, in which gaps in screening currently exist.

A new biosensor for osteoporosis detection

Osteoporosis is a disease that is characterized by deterioration of bone tissue and increased risk of fracture as it leads to a decrease in bone mineral density, which is an important public health problem. Today, bone mineral density is measured by radiological techniques. Alternative techniques are needed because of the disadvantages such as excessive radiation intake, the cost of radiological techniques, and the necessity for specialist personnel for the devices. The quantitative determination of biochemical markers that play a role in bone mineralization may be a good alternative for the osteoporosis diagnosis and especially in the follow-up of treatment.In this study, a specific and sensitive immunological biosensor, which quantitatively determines the osteocalcin molecule, has been developed to be used in the early osteoporosis diagnosis and to evaluate the response to the drug treatment. Anti-osteocalcin antibody was immobilized onto gold electrode surface via covalent immobilization method by using 6-mercaptohexanol, 1,4-butanedioldiglycidyl ether, ethanolamine, and glutaraldehyde. Immobilization steps and biosensor characterization were specified by cyclic voltammetry and electrochemical impedance spectroscopy. The detection time and range of Ocn biosensor were determined as 45 min and 10–60 pg µL−1 Ocn concentration, respectively. The Ocn biosensor was successfully applied in artificial serum samples spiked with Ocn.

Computer-aided osteoporosis detection from DXA imaging

Background and objectiveOsteoporosis is a skeletal disease caused by a high rate of bone tissue loss, and it is a major cause of bone fracture. In contemporary society, osteoporosis is more common than cancer and stroke and results in a higher rate of morbidity and mortality in the human population. Osteoporosis can conclusively be diagnosed with dual energy X-ray absorptiometry (DXA). In this study, we propose a computer-aided osteoporosis detection (CAOD) technique that automatically measures bone mineral density (BMD) and generates an osteoporosis report from a DXA scan. MethodsThe CAOD model denoise and segments DXA images using a non-local mean filter, Machine learning pixel label random forest respectively, and locates regions of interest with higher accuracy. Pixel label random forest classifies a pixel either bone or soft tissue; then contours are extracted from binary image to locate regions of interest and calculate BMD from bone and soft tissues pixels. Mean standard deviation and correlation coefficients statistical analysis were used to evaluate the consistency and accuracy of BMD measurements. ResultsDuring a consistency test of BMD measurements using three consecutive scans from Computerized Imaging Reference Systems’ Bona Fide Phantom (CIRS-BFP) for the spine, the CAOD model showed an averaged standard deviation of 0.0029 while the standard deviation from manual measurements on the same data set by three different individuals was recorded as 0.1199. During another correlation study of BMD measurements evaluating real human scan images by the CAOD model versus manual measurement, the model scored a correlation coefficient of R2 = 0.9901 while the CIRS-BFP study scored a correlation coefficient of R2 = 0.9709. ConclusionsThe CAOD model increases the preciseness and accuracy of BMD measurements. This CAOD method will help clinicians, untrained DXA operators, and researchers (medical scientists, doctors, and bone researchers) use the DXA system with reliable accuracy and overcome workload challenges. It will also improve osteoporosis diagnosis from DXA systems and increase system performance and value.

Sclerostin, periostin and microRNA as potential markers of osteoporosis

In recent years, people have had high hopes for the possibility of using measurements of the so-called modern bone turnover markers in diagnosis, diagnostics of the course and the prediction of the occurrence of complications of bone metabolic diseases, especially osteoporosis. So far, several diagnostic markers of bone turnover have been identified, particular importance attached to PINP and CTx. However, many studies have highlighted that their use in the diagnosis of osteoporosis is rather limited due to their inter-individual and intra-individual variability, tissue non-specificity, the inability to evaluate individual bone tissue compartments, and the ability to assess metabolic activity of only osteoblasts and/or osteoclasts without osteocytes. The data presented in the thesis indicates the potential usefulness of sclerostin measurements, primarily associated with metabolic activity of osteocytes, periostin, as the indicator of metabolic activity of periosteum and microRNAs as the group of specific markers in the early detection of osteoporosis. All of the above-mentioned candidates could possibly become a predictor of osteoporotic fractures: sclerostin in patients with type 2 diabetes; periostin, especially in non-vertebral fractures in postmenopausal women and microRNA in early prediction of these fractures. However, many of the studies underline some of the limitations associated with their use in the diagnosis of osteoporosis. Ambiguous results of the presented studies may be primarily due to population selection, population size, type of fractures and duration of the observation itself. An objective judgement will be made when an adequate number of standardized and independent studies will allow for the exclusion or validation of each of them in clinical practice.

Relationship between abnormal glucose metabolism and osteoporosis in Han Chinese men over the age of 50 years.

AimThe aim of this study was to determine the relationship between abnormal glucose metabolism and osteoporosis (OP) in Han Chinese men over the age of 50 years.Patients and methodsA cross-sectional study of 775 male patients aged over 50 years was performed at our hospital in 2011. The patients were divided into a normal glucose metabolism group, an impaired glucose regulation (IGR) group, and a type 2 diabetes mellitus (T2DM) group. Differences in their bone mineral densities (BMDs), OP detection rates, and indices of bone metabolism were assessed.ResultsAfter adjusting for age and body mass index (BMI), there were no significant differences in lumbar spine, femoral neck, and total hip BMD values in the three groups (P>0.05) nor in OP detection rates (P=0.19). However, there were some significant differences in bone metabolism markers between the groups after adjusting for age, BMI, and serum creatinine (Cr): 25-hydroxyvitamin D (25(OH)D) was positively correlated with the presence of abnormal glycometabolism (r=0.08; P<0.01), while β-carboxy-terminal cross-linking telopeptide of type I collagen (β-CTX), bone gamma-carboxyglutamic acid protein (BGP; osteocalcin [OC]), and procollagen type 1 intact N-terminal propeptide (P1NP) were negatively correlated (r=−0.13, −0.21, −0.14, respectively; P<0.01). Logistic regression analysis of the data indicated that BGP was the only bone metabolism marker significantly influenced by abnormal glucose metabolism (OR =0.96).ConclusionThere were no significant differences in BMD or OP detection rates between the three glycometabolism groups after adjusting for age and BMI. However, the bone metabolism marker, BGP, was significantly negatively correlated with abnormal glucose metabolism.

Screening for Underlying Osteoporosis in Fragility Fracture Patients: The Patients Perspective

Background: Early detection and treatment of osteoporosis are essential in preventing fractures and fracture-related morbidity and mortality. Fractures beget fractures and it is relevant and well-documented beneficial to target osteoporosis screening in patients already suffering a fracture. The associated increased number of patients being confronted with a potential diagnosis of osteoporosis makes it worth considering how this affects patients. Objective: The aim of this study was to explore fracture patients’ experiences when confronted with the option of being screened for osteoporosis as the underlying reason of their fracture. Methods: In a phenomenological hermeneutic framework, semi-structured interviews were performed in 15 fragiligty fracture patients being offered screening for osteoporosis. Analysis inspired by Ricoeur consisting of naive reading, structural analysis, and critical analysis and discussion was applied. Results: Fracture patients were condemned to make a choice when confronted with the possibility of the early detection of osteoporosis. Many questions regarding prevention of new fractures and prospects in the case of a positive test result were raised. The major themes were related to the consequences of knowing what might be hidden in the bones, and the responsibility to prevent illness. Conclusion: The confrontation with the potential risk of osteoporosis provokes fear and worry in patients about lived daily life and anxiety about being treated as a sick person, but in return, it motivates patients to adopt a bone-healthy lifestyle. In general, patients prefer to be given knowledge of their bone health status over not knowing, and being able to seek further information on the condition facing them.

Melatonin: Another avenue for treating osteoporosis?

Melatonin is a signal molecule that modulates the biological circadian rhythms of vertebrates. Melatonin deficiency is thought to be associated with several disorders, including insomnia, cancer, and cardiovascular and neurodegenerative diseases. Accumulating evidence has also indicated that melatonin may be involved in the homeostasis of bone metabolism. Age-related reductions in melatonin are considered to be critical factors in bone loss and osteoporosis with aging. Thus, serum melatonin levels might serve as a biomarker for the early detection and prevention of osteoporosis. Compared to conventional antiosteoporosis medicines, which primarily inhibit bone loss, melatonin both suppresses bone loss and promotes new bone formation. Mechanistically, by activating melatonin receptor 2 (MT2), melatonin upregulates the gene expression of alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP2), BMP6, osteocalcin, and osteoprotegerin to promote osteogenesis while inhibiting the receptor activator of NF-kB ligand (RANKL) pathway to suppress osteolysis. In view of the distinct actions of melatonin on bone metabolism, we hypothesize that melatonin may be a novel remedy for the prevention and clinical treatment of osteoporosis.

Simultaneous Estimation of the Fat Fraction and R₂* Via T₂*-Corrected 6-Echo Dixon Volumetric Interpolated Breath-hold Examination Imaging for Osteopenia and Osteoporosis Detection: Correlations with Sex, Age, and Menopause.

ObjectiveTo investigate the relationships of T2*-corrected 6-echo Dixon volumetric interpolated breath-hold examination (VIBE) imaging-based fat fraction (FF) and R2* values with bone mineral density (BMD); determine their associations with sex, age, and menopause; and evaluate the diagnostic performance of the FF and R2* for predicting osteopenia and osteoporosis.Materials and MethodsThis study included 153 subjects who had undergone magnetic resonance (MR) imaging, including MR spectroscopy (MRS) and T2*-corrected 6-echo Dixon VIBE imaging. The FF and R2* were measured at the L4 vertebra. The male and female groups were divided into two subgroups according to age or menopause. Lin's concordance and Pearson's correlation coefficients, Bland-Altman 95% limits of agreement, and the area under the curve (AUC) were calculated.ResultsThe correlation between the spectroscopic and 6-echo Dixon VIBE imaging-based FF values was statistically significant for both readers (pc = 0.940 [reader 1], 0.908 [reader 2]; both p < 0.001). A small measurement bias was observed for the MRS-based FF for both readers (mean difference = −0.3% [reader 1], 0.1% [reader 2]). We found a moderate negative correlation between BMD and the FF (r = −0.411 [reader 1], −0.436 [reader 2]; both p <0.001) with younger men and premenopausal women showing higher correlations. R2* and BMD were more significantly correlated in women than in men, and the highest correlation was observed in postmenopausal women (r = 0.626 [reader 1], 0.644 [reader 2]; both p < 0.001). For predicting osteopenia and osteoporosis, the FF had a higher AUC in men and R2* had a higher AUC in women. The AUC for predicting osteoporosis was highest with a combination of the FF and R2* in postmenopausal women (AUC = 0.872 [reader 1], 0.867 [reader 2]; both p < 0.001).ConclusionThe FF and R2* measured using T2*-corrected 6-echo Dixon VIBE imaging can serve as predictors of osteopenia and osteoporosis. R2* might be useful for predicting osteoporosis, especially in postmenopausal women.

Is panoramic mandibular index a reliable marker in the evaluation of bone mineral density and sexual dimorphism??

Introduction:Osteoporosis is a silent, progressive, and chronic disease affecting bones of the adults, especially postmenopausal women. Its effect on mandibular bone quality has also been described by some authors in men inferring that gender and age are factors that may influence bone mineral density (BMD) and prognosis. The panoramic radiograph is used widely for the early detection of osteoporosis. The present study was undertaken to evaluate whether the panoramic mandibular index (PMI) is useful for BMD and sexual dimorphism.Materials and Methods:A total of 60 patients (30 males and 30 females) in the age group of 25–40 years were selected for the study. Orthopantomograph was taken and PMI determined with the help of Sidexis next-generation software. All the measurements were performed by four observers and data subjected to the statistical analysis.Results:The mean superior PMI was 0.22–0.27, and the inferior PMI was 0.28–0.34. The mean superior and inferior linear measurements from the mental foramen were higher in males than females and statistically significant. The mean mandibular cortical width was 3.8–4.7 mm but did not show much gender difference.Conclusion:PMI is a reliable indicator for determining BMD but is not much influenced by gender variation.

Osteoporosis in children: Possible risk factors and role of antioxidants

Osteoporosis is well recognized in children as a consequence of several factors. Therefore, the present review sheds light on the role of diabetes mellitus (DM), malabsorption, glucocorticoids, nutrition, free radicals, and oxidative stress in the induction of osteoporosis. It may also provide valuable information regarding the early detection of osteoporosis to improve not only the bone health of schoolchildren but also their general quality of life. Measurement of bone mineral density (BMD) does not capture all the risk factors of bone fractures and/or osteoporosis. Therefore, bone resorption and formation markers such as osteoprotegerin; prolidase; osteocalcin; bone alkaline phosphatase and Vitamin D; parathyroid hormones; and macroelements such as calcium, phosphorus, and magnesium should be measured beside BMD in the plasma of school-aged children. Moreover, endocrine abnormalities, high levels of free radicals, and induction of oxidative stress showed an adverse effect on the skeleton and cause osteoporosis. It has been found that there is a strong correlation between osteoporosis and DM, malnutrition, and glucocorticoids in both pediatric and adult patients. Inhibition of antioxidant enzyme activities, such as superoxide dismutase, catalase, and glutathione peroxidase, was found to increase the production of reactive oxygen species by osteoclasts. Therefore, oxidative stress and other factors are important mediators of bone loss and also osteoporosis. Furthermore, antioxidants should be provided to maintain bone integrity because a deficiency of antioxidant vitamins has been found in the osteoporotic children.

Prevalence of Osteoporosis among Adults in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Osteoporosis is a common metabolic bone disease characterized by increased bone fragility, yet underdiagnosed and undertreated. With the increase in longevity of the populace, it is becoming an urgent and serious global epidemic. This being a preventable disease, has no clinical manifestations until there is a fracture. Early diagnosis and treatment are of dire necessity. Hence the aim of our study is to find the prevalence of osteoporosis among adults attending a tertiary care hospital-based on calcaneal quantitative ultrasound. This descriptive cross-sectional study was done in a tertiary care hospital, from 15th July 2019 to 15th October 2019 after receiving ethical approval from the Institutional Review Committee (Registration number: 2075 / 76 / 119). Convenient sampling was done. Data collection and entry was done in Microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 464 participants the overall prevalence of osteoporosis was 38 (8.2%) at a 95% confidence interval (5.7-10.7). Among the participants, 141 (30.4%) were male and 323 (69.6%) were female. The mean age of the participant was 41.02±14.96 years. Osteoporosis was more common in the older age group 11.66 (30.7%) in 60 years above Women were found to be more osteoporotic than men, 3.42 (9.0%) and 2.43 (6.4%) respectively. Bone mineral density and osteoporosis had a bimodal distribution, underweight 5.01 (13.2%) and obese group 5.32 (14.0%) were the two peaks. The prevalence of osteoporosis in our study is high and is consistent with other South Asian studies. Early detection of osteoporosis using calcaneal quantitative ultrasound can be a good screening tool.

Discordance in diagnosis of osteoporosis by quantitative computed tomography and dual-energy X-ray absorptiometry in Chinese elderly men

ObjectiveThe objective of this study was to investigate the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. MethodsA total of 313 males older than 60 years, who underwent both spinal QCT and lumbar spine and hip DXA in our department, were included. The diagnostic criteria established by the World Health Organisation in 1994 were used for DXA to diagnose osteoporosis, and the criteria recommended by the International Society of Clinical Densitometry were used for QCT. The osteoporosis detection rate by the two techniques was calculated, and the difference was compared. The minor discordance was considered present when the different diagnostic classes between the two techniques were adjacent. Major discordance was present when the diagnosis by one technique was osteoporosis and the other was normal. The computed tomography images were reviewed by radiologists to assess whether vertebral fracture, aorta calcification or degeneration was present. ResultsIn the 313 participants (mean age, 79.6 ± 7.2 years), the osteoporosis detection rate was 10.9% for DXA (lumbar spine and hip) and 45.1% for QCT, a significant difference (p < 0.001). The major discordance, minor discordance and concordance of diagnosis between the two techniques were seen in 8.3%, 50.8% and 40.9%, respectively. QCT detected osteoporosis better than DXA. The causes of this discordance were degeneration of spine, abdominal aorta calcification and vertebral fractures. ConclusionOur study demonstrated that discordance was common when using QCT and DXA to diagnose osteoporosis and that spinal degeneration, aorta calcification and fracture obscure the bone mineral density measurement of spine by DXA. QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. The translational potential of this articleThis study investigated the diagnostic discordance of osteoporosis by quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in Chinese elderly men. The results demonstrated that QCT is a more sensitive method of choice to identify osteoporosis in elderly Chinese men. This work may help clinicians make an appropriate choice of technique for the accurate diagnosis of osteoporosis and identify the patients at high risk of osteoporosis who should be treated early to prevent fractures. This may influence the therapeutic plan and the overall prognosis of patients.

Does Simultaneous Computed Tomography and Quantitative Computed Tomography Show Better Prescription Rate than Dual-energy X-ray Absorptiometry for Osteoporotic Hip Fracture?

PurposeThis study aimed to evaluate the efficacy of simultaneous computed tomography (CT) and quantitative CT (QCT) in patients with osteoporotic hip fracture (OHF) by analyzing the osteoporosis detection rate and physician prescription rate in comparison with those of conventional dual-energy X-ray absorptiometry (DXA).Materials and MethodsThis study included consecutive patients older than 65 years who underwent internal fixation or hip arthroplasty for OHF between February and May 2015. The patients were assigned to either the QCT (47 patients) or DXA group (51 patients). The patients in the QCT group underwent QCT with hip CT, whereas those in the DXA group underwent DXA after surgery, before discharge, or in the outpatient clinic. In both groups, the patients received osteoporosis medication according to their QCT or DXA results. The osteoporosis evaluation rate and prescription rate were determined at discharge, postoperative (PO) day 2, PO day 6, and PO week 12 during an outpatient clinic visit.ResultsThe osteoporosis evaluation rate at PO week 12 was 70.6% (36 of 51 patients) in the DXA group and 100% in the QCT group (P<0.01). The prescription rates of osteoporosis medication at discharge were 70.2% and 29.4% (P<0.001) and the cumulative prescription rates at PO week 12 were 87.2% and 60.8% (P=0.003) in the QCT and DXA groups, respectively.ConclusionSimultaneous CT and QCT significantly increased the evaluation and prescription rates in patients with OHF and may enable appropriate and consistent prescription of osteoporosis medication, which may eventually lead to patients' medication compliance.