Osteoporosis Diagnostics Research Articles

Reproducibility of CT-based opportunistic vertebral volumetric bone mineral density measurements from an automated segmentation framework

BackgroundTo investigate the reproducibility of automated volumetric bone mineral density (vBMD) measurements from routine thoracoabdominal computed tomography (CT) assessed with segmentations by a convolutional neural network and automated correction of contrast phases, on diverse scanners, with scanner-specific asynchronous or scanner-agnostic calibrations.MethodsWe obtained 679 observations from 278 CT scans in 121 patients (77 males, 63.6%) studied from 04/2019 to 06/2020. Observations consisted of two vBMD measurements from Δdifferent reconstruction kernels (n = 169), Δcontrast phases (n = 133), scan Δsessions (n = 123), Δscanners (n = 63), or Δall of the aforementioned (n = 20), and observations lacking scanner-specific calibration (n = 171). Precision was assessed using root-mean-square error (RMSE) and root-mean-square coefficient of variation (RMSCV). Cross-measurement agreement was assessed using Bland-Altman plots; outliers within 95% confidence interval of the limits of agreement were reviewed.ResultsRepeated measurements from Δdifferent reconstruction kernels were highly precise (RMSE 3.0 mg/cm3; RMSCV 1.3%), even for consecutive scans with different Δcontrast phases (RMSCV 2.9%). Measurements from different Δscan sessions or Δscanners showed decreased precision (RMSCV 4.7% and 4.9%, respectively). Plot-review identified 12 outliers from different scan Δsessions, with signs of hydropic decompensation. Observations with Δall differences showed decreased precision compared to those lacking scanner-specific calibration (RMSCV 5.9 and 3.7, respectively).ConclusionAutomatic vBMD assessment from routine CT is precise across varying setups, when calibrated appropriately. Low precision was found in patients with signs of new or worsening hydropic decompensation, what should be considered an exclusion criterion for both opportunistic and dedicated quantitative CT.Relevance statementAutomated CT-based vBMD measurements are precise in various scenarios, including cross-session and cross-scanner settings, and may therefore facilitate opportunistic screening for osteoporosis and surveillance of BMD in patients undergoing routine clinical CT scans.Key PointsArtificial intelligence-based tools facilitate BMD measurements in routine clinical CT datasets.Automated BMD measurements are highly reproducible in various settings.Reliable, automated opportunistic osteoporosis diagnostics allow for large-scale application.Graphical

Osteoporosis - implications of the new guidelines in practice

In September 2023, the guideline on the prophylaxis, diagnosis, and treatment of osteoporosis in postmenopausal women and men was published as a completely revised guideline. The implications for practice include a change in the justifying indication for performing a bone density measurement, the time interval over which the fracture risk is determined, the level and number of therapy thresholds, and the recommendations for the therapeutic approach that are adapted to the individual fracture risk present. Risk assessment for the prediction of spine and hip fractures is essential in the context of osteoporosis diagnostics. In addition to age and gender, there are a total of 33 risk factors to determine the individual risk of fracture. Much more attention is paid to the assessment of the risk of falls and, depending on the result, combined with recommendations for muscle training and protein intake from the age of 65. Risk indicators must also be taken into account when determining the indication for osteoporosis diagnosis, as well as the risk factors of the imminent risk of fracture. The indication for baseline diagnostics has changed from the >20% 10-year fracture risk to diagnostics in postmenopausal women and in men aged 50 years and older, depending on the fracture risk factor profile. This eliminates a specific fracture risk threshold for basic diagnostics. Thus, in the young patient group (50-60 years), the risk factors considered medically relevant for the indication for osteoporosis diagnosis must be taken into account. New thresholds as an indication for initiating therapy is the determination of fracture risk using a risk calculator over 3 years instead of 10 years. The indication for drug therapy should be based on the threshold values of the DVO risk model. The data clearly suggests a significantly faster and more effective fracture risk-reducing effect of anabolic therapy. This is recommended in the first sequence in cases of a very high risk of fracture from 10%/3 years with osteoanabolic active substances (teriparatide or romosozumab). Such a therapy sequence should be initiated directly and not delayed due to upcoming dental procedures. Follow-up therapy to consolidate the reduction of fracture risk should be chosen individually.

A view on the skin-bone axis: unraveling similarities and potential of crosstalk.

The phrase "skin as a mirror of internal medicine," which means that the skin reflects many of the diseases of the internal organs, is a well-known notion. Despite the phenotypic differences between the soft skin and hard bone, the skin and bone are highly associated. Skin and bone consist of fibroblasts and osteoblasts, respectively, which secrete collagen and are involved in synthesis, while Langerhans cells and osteoclasts control turnover. Moreover, the quality and quantity of collagen in the skin and bone may be modified by aging, inflammation, estrogen, diabetes, and glucocorticoids. Skin and bone collagen are pathologically modified by aging, drugs, and metabolic diseases, such as diabetes. The structural similarities between the skin and bone and the crosstalk controlling their mutual pathological effects have led to the advocacy of the skin-bone axis. Thus, the skin may mirror the health of the bones and conversely, the condition of the skin may be reflected in the bones. From the perspective of the skin-bone axis, the similarities between skin and bone anatomy, function, and pathology, as well as the crosstalk between the two, are discussed in this review. A thorough elucidation of the pathways governing the skin-bone axis crosstalk would enhance our understanding of disease pathophysiology, facilitating the development of new diagnostics and therapies for skin collagen-induced bone disease and of new osteoporosis diagnostics and therapies that enhance skin collagen to increase bone quality and density.

Diagnostics and treatment of insufficiency fractures of the pelvis

Insufficiency fractures of the pelvis have increased in recent years, primarily due to the demographic change and the incidence will continue to rise. In addition to conventional X‑rays, the diagnostics always require slice imaging. Unlike high-energy trauma magnetic resonance imaging (MRI) plays an important role in insufficiency fractures. Once the fracture has been diagnosed, in addition to the extent of instability in the anterior and posterior pelvic rings, the pain symptoms are crucial for the decision on surgical treatment. The basic principle is to stabilize as little as possible but as much as necessary. There are currently avariety of procedures that can be applied as a minimally invasive procedure, especially for the often slightly or displaced insufficiency fractures. The decisive factor for treatment is that it enables early mobilization of the patients. All of these measures must be accompanied by thorough diagnostics of osteoporosis and the appropriate treatment.

Assessing bone mineral density in non-weight bearing regions of the body: a texture analysis approach using abdomen and pelvis computed tomography Hounsfield units-a cross-sectional study.

Highlighting a gap in comprehending bone microarchitecture's intricacies using dual-energy X-ray absorptiometry (DXA), this study aims to bridge this chasm by analyzing texture in non-weight bearing regions on axial computed tomography (CT) scans. Our goal is to enrich osteoporosis patient management by enhancing bone quality and microarchitecture insights. Conducted at Busan Medical Center from March 1, 2013, to August 30, 2022, 1,320 cases (782 patients) were screened. After applying exclusion criteria, 458 samples (296 patients) underwent bone mineral density (BMD) assessment with both CT and DXA. Regions of interest (ROIs) included spine pedicle's maximum trabecular area, sacrum Zone 1, superior/inferior pubic ramus, and femur's greater/lesser trochanters. Texture features (n=45) were extracted from ROIs using gray-level co-occurrence matrices. A regression model predicted BMD, spotlighting the top five influential texture features. Correlation coefficients ranged from 0.709 (lowest for total femur BMD) to 0.804 (highest for femur intertrochanter BMD). Mean squared error (MSE) values were also provided for lumbar and femur BMD/bone mineral content (BMC) metrics. The most influential texture features included contrast_32, correlation_32_v, and three other metrics. By melding traditional DXA and CT texture analysis, our approach presents a comprehensive bone health perspective, potentially revolutionizing osteoporosis diagnostics.

Study of Ultrasonic Guided Wave Propagation in Bone Composite Structures for Revealing Osteoporosis Diagnostic Indicators.

Tubular bones are layered waveguide structures composed of soft tissue, cortical and porous bone tissue, and bone marrow. Ultrasound diagnostics of such biocomposites are based on the guided wave excitation and registration by piezoelectric transducers applied to the waveguide surface. Meanwhile, the upper sublayers shield the diseased interior, creating difficulties in extracting information about its weakening from the surface signals. To overcome these difficulties, we exploit the advantages of the Green's matrix-based approach and adopt the methods and algorithms developed for the guided wave structural health monitoring of industrial composites. Based on the computer models implementing this approach and experimental measurements performed on bone phantoms, we analyze the feasibility of using different wave characteristics to detect hidden diagnostic signs of developing osteoporosis. It is shown that, despite the poor excitability of the most useful modes associated with the diseased inner layers, the use of the improved matrix pencil method combined with objective functions based on the Green's matrix allows for effective monitoring of changes in the elastic moduli of the deeper sublayers. We also note the sensitivity and monotonic dependence of the resonance response frequencies on the degradation of elastic properties, making them a promising indicator for osteoporosis diagnostics.

Early Changes in the Bone Mineral Density on Dual-energy X-ray Absorptiometry Scan of Patients Undergoing Primary Cemented Total Knee Arthroplasty: A Prospective Cohort Study

Background: The known risk factors of osteoarthritis (OA) knee are aging and obesity while the risk factors of osteoporosis are aging and low body weight, so the relationship between all three is complex. Currently, the dual-energy X-ray absorptiometry (DXA) test is the gold standard in osteoporosis diagnostics. Many epidemiologic studies have revealed increased bone mineral density (BMD) in individuals with OA knee. The impact of total knee arthroplasty (TKA) on BMD levels is not fully understood. Concern has been raised regarding the increased risk of femoral and spine fractures early after TKA. Hence, we conducted this study to measure the BMD changes in the hip and spine in patients receiving TKA. Materials and Methods: It was a prospective interventional cohort study conducted from December 2018 to December 2020. The study included 43 patients admitted for elective TKA after applying the relevant inclusion and exclusion criteria. Patients were analyzed with DXA scans both preoperatively and 6 months postoperatively. Results: When we studied all the patients as one single sample, the initial observation was that at the 6-month follow-up, the patients showed a statistically significant improvement in the femur BMD score while the change in spine BMD was statistically insignificant. However, when subsets of the study sample, i.e. preoperatively normal, osteopenic, and osteoporotic patients, underwent further analysis, we found that out of 18 patients having normal BMD preoperatively, one patient developed osteopenia and another developed osteoporosis upon postoperative follow-up DXA scan. Similarly, one out of the eight patients, having osteoporosis preoperatively, improved a grade to osteopenia upon postoperative follow-up DXA scan. However, these changes were not statistically significant. Conclusions: we conclude that there is no statistically significant change in both the femur and the spine BMD at least 6-month follow-up postprimary TKA.

MiR-21-5p regulates the dynamic of mitochondria network and rejuvenates the senile phenotype of bone marrow stromal cells (BMSCs) isolated from osteoporotic SAM/P6 mice

BackgroundProgression of senile osteoporosis is associated with deteriorated regenerative potential of bone marrow-derived mesenchymal stem/stromal cells (BMSCs). According to the recent results, the senescent phenotype of osteoporotic cells strongly correlates with impaired regulation of mitochondria dynamics. Moreover, due to the ageing of population and growing osteoporosis incidence, more efficient methods concerning BMSCs rejuvenation are intensely investigated. Recently, miR-21-5p was reported to play a vital role in bone turnover, but its therapeutic mechanisms in progenitor cells delivered from senile osteoporotic patients remain unclear. Therefore, the goal of this paper was to investigate for the first time the regenerative potential of miR-21-5p in the process of mitochondrial network regulation and stemness restoration using the unique model of BMSCs isolated from senile osteoporotic SAM/P6 mice model.MethodsBMSCs were isolated from healthy BALB/c and osteoporotic SAM/P6 mice. We analysed the impact of miR-21-5p on the expression of crucial markers related to cells’ viability, mitochondria reconstruction and autophagy progression. Further, we established the expression of markers vital for bone homeostasis, as well as defined the composition of extracellular matrix in osteogenic cultures. The regenerative potential of miR-21 in vivo was also investigated using a critical-size cranial defect model by computed microtomography and SEM–EDX imaging.ResultsMiR-21 upregulation improved cells’ viability and drove mitochondria dynamics in osteoporotic BMSCs evidenced by the intensification of fission processes. Simultaneously, miR-21 enhanced the osteogenic differentiation of BMSCs evidenced by increased expression of Runx-2 but downregulated Trap, as well as improved calcification of extracellular matrix. Importantly, the analyses using the critical-size cranial defect model indicated on a greater ratio of newly formed tissue after miR-21 application, as well as upregulated content of calcium and phosphorus within the defect site.ConclusionsOur results demonstrate that miR-21-5p regulates the fission and fusion processes of mitochondria and facilitates the stemness restoration of senile osteoporotic BMSCs. At the same time, it enhances the expression of RUNX-2, while reduces TRAP accumulation in the cells with deteriorated phenotype. Therefore, miR-21-5p may bring a novel molecular strategy for senile osteoporosis diagnostics and treatment.

ПРИМЕНЕНИЕ МЕТОДА УЛЬТРАЗВУКОВОЙ ОСТЕОМЕТРИИ ДЛЯ СКРИНИНГ-ДИАГНОСТИКИ И МОНИТОРИНГА ЭФФЕКТИВНОСТИ ТЕРАПИИ ОСТЕОПОРОЗА

Purpose: Development of an algorithm screening diagnostics of osteoporosis with use of ultrasonic osteometers based on complex data analysis of external instrumental investigations and the anamnesis data. Material and methods: The material including data of complex researches of 53 women aged from 20 up to 75 years, such as results of external inspection and anamnesis and data of instrumental researches was used: ultrasonic osteometry of a calcaneal bone and two energy x-ray densitometry inspection of lumbar area. Results: The developed complex processing procedure of data based on data of external inspection, the anamnesis and an ultrasonic osteometry leads to the acceptable level of false-negative and false positive errors of diagnostics when comparing with data of x-ray two-energy densitometry. Conclusions: The comparative analysis of accuracy of assessment of patient’s distribution on risk groups based on data of external inspection and the anamnesis with data densitometry is carried out. The comparative analysis of accuracy on risk groups based on data of an ultrasonic osteometry with data densitometry is carried out. It was shown that the level of errors when using these two tool techniques is rather high. The complex rule of creation of risk groups based on data of external inspection, the anamnesis and an ultrasonic osteometry which showed good correlation with data of measurements with use two-energy x-ray densitometry is developed. The conversion function given the received complex decisive rule in the T scale – parameter, compatible to the estimates received at two-energy x-ray densitometry is constructed.

Using prior information to enhance microwave tomography images in bone health assessment

BackgroundOsteoporosis is the major cause of bone weakness and fragility in more than 10 million people in the United States. This disease causes bone fractures in the hip or spine, which result in increasing the risk of disabilities or even death. The current gold standard in osteoporosis diagnostics, X-ray, although reliable, it uses ionizing radiations that makes it unfeasible for early and continuous monitoring applications. Recently, microwave tomography (MWT) has been emerging as a biomedical imaging modality that utilizes non-ionizing electromagnetic signals to screen bones’ electrical properties. These properties are highly correlated to bones’ density, which makes MWT to be an effective and safe alternative for frequent testing in osteoporosis diagnostics.ResultsBoth the conventional and wearable simulated systems were successful in localizing the tibia and fibula bones in the enhanced MWT images. Furthermore, structure extraction of the leg’s model from the blind MWT images had a minimal error compared to the original one (L2-norm: 15.60%). Under five sequentially incremental bone volume fraction (BVF) scenarios simulating bones’ treatment procedure, bones were detected successfully and their densities were found to be inversely proportional to the real part of the relative permittivity values.ConclusionsThis study paves the way towards implementing a safe and user-friendly MWT system that can be wearable to monitor bone degradation or treatment for osteoporosis cases.MethodsAn anatomically realistic finite-element (FE) model representing the human leg was initially generated and filled with corresponding tissues’ (skin, fat, muscles, and bones) dielectric properties. Then, numerically, the forward and inverse MWT problems were solved within the framework of the finite-element method-contrast source inversion algorithm (FEM-CSI). Furthermore, image reconstruction enhancements were investigated by utilizing prior information about different tissues as an inhomogeneous background as well as by adjusting the imaging domain and antennas locations based on the prior structural information. In addition, the utilization of a medically approved matching medium that can be used in wearable applications, namely an ultrasound gel, was suggested. Additionally, an approach based on k-means clustering was developed to extract the prior structural information from blind reconstructions. Finally, the enhanced images were used to monitor variations in BVF.Graphical

Gender-, Age- and Region-Specific Characterization of Vertebral Bone Microstructure Through Automated Segmentation and 3D Texture Analysis of Routine Abdominal CT.

PurposeTo identify long-term reproducible texture features (TFs) of spinal computed tomography (CT), and characterize variations with regard to gender, age and vertebral level using our automated quantification framework.MethodsWe performed texture analysis (TA) on baseline and follow-up CT (follow-up duration: 30–90 days) of 21 subjects (8 females, 13 males, age at baseline 61.2 ± 9.2 years) to determine long-term reproducibility. TFs with a long-term reproducibility error Δrel<5% were further analyzed for an association with age and vertebral level in a cohort of 376 patients (129 females, 247 males, age 62.5 ± 9.2 years). Automated analysis comprised labeling and segmentation of vertebrae into subregions using a convolutional neural network, calculation of volumetric bone mineral density (vBMD) with asynchronous calibration and TF extraction. Varianceglobal measures the spread of the gray-level distribution in an image while Entropy reflects the uniformity of gray-levels. Short-run emphasis (SRE), Long-run emphasis (LRE), Run-length non-uniformity (RLN) and Run percentage (RP) contain information on consecutive voxels of a particular grey-level, or grey-level range, in a particular direction. Long runs (LRE) represent coarse texture while short runs (SRE) represent fine texture. RLN reflects similarities in the length of runs while RP reflects distribution and homogeneity of runs with a specific direction.ResultsSix of the 24 extracted TFs had Δrel<5% (Varianceglobal, Entropy, SRE, LRE, RLN, RP), and were analyzed further in 4716 thoracolumbar vertebrae. Five TFs (Varianceglobal,SRE,LRE, RLN,RP) showed a significant difference between genders (p<0.001), potentially being caused by a finer and more directional vertebral trabecular microstructure in females compared to males. Varianceglobal and Entropy showed a significant increase from the thoracic to the lumbar spine (p<0.001), indicating a higher degree and earlier initiation of trabecular microstructure deterioration at lower spinal levels. The four higher-order TFs showed significant variations between spine regions without a clear directional gradient (p ≤ 0.001-0.012). No TF showed a clear age dependence. vBMD differed significantly between genders, age groups and spine regions (p ≤ 0.001–0.002).ConclusionLong-term reproducible CT-based TFs of the thoracolumbar spine were established and characterized in a predominantly older adult study population. The gender-, age- and vertebral-level-specific values may serve as foundation for osteoporosis diagnostics and facilitate future studies investigating vertebral microstructure.

The Value of Trabecular Bone Score in Patients with Rheumatic Diseases

Background.Trabecular bone score obtained by lumbar spine Dual-energy X-ray Absorptiometry is a novel and insufficiently explored instrument of accessing trabecular bone quality. One of its promising applications is early diagnostics of osteoporosis (OP) before fragility fractures appear. Meanwhile most of systemic inflammatory rheumatic diseases affect bone tissue either directly and indirectly by glucocorticoids consumption. Both factors potentiate OP development and can influence the trabecular bone score. Aimsto evaluate the possibilities of trabecular bone score using in rheumatology. Materials and Methods.Data analysis of domestic and foreign scientific publications. Results and Discussion.Authors of analyzed publications note stable association of low trabecular bone score with vertebral fractures, its correlation with local inflammatory markers in lumbar spine and ankylosing spondylitis structural progression. In most studies trabecular bone score do not have association with systemic inflammatory activity and treatment. Conclusion. Trabecular bone score is effective in OP diagnostics in rheumatic patients, evaluation of local inflammatory activity in the lumbar spine and structural progression of ankylosing spondylitis.

Senile osteoporosis: Modern view of the problem

The article summarizes the data on senile osteoporosis and presents a clinical case of this disease. The reference sources on peculiarities of bone remodeling in senile osteoporosis are summarized; low bone formation takes place against the background of a pronounced bone resorption. The article also presents pathomorphological features of bone tissue remodeling resulting in pronounced impairments of the compact bone, which increase the risk of fracture. Vitamin D plays a significant role in the complex mechanism of senile osteoporosis. The data on the combined effect of vitamin D and parathormone on bone remodeling are summarized. The paper presents data on other cumulative effects of senile osteoporosis development. Against the background of ageing-associated systemic changes, calcium and vitamin D deficiency, increased pro-inflammatory cytokine expression, localized bone disorders develop. An important link to the development of senile osteoporosis is an increased marrow adipose tissue with an intensified adipogenesis, resulting in a decrease of osteoblasts due to the toxic effects of adipokines, reduced differentiation and proliferation of osteoblasts. Age-associated immune-related mechanisms of inflammation, indirectly affecting the bone, are considered. Peculiarities of the senile osteoporosis diagnostics by means of bone mineral density assessment tools are described. Despite the successes achieved in the study of senile osteoporosis development mechanisms, further research is required to explore local and systemic factors affecting bone tissue which are involved in the development of this disease.

The Role of microRNAs in Osteoporosis Diagnostics

AbstractMicroRNAs (miRNAs) are short (18–24 nucleotides) non-coding RNA sequences that regulate gene expression via binding of messenger RNA. It is estimated that miRNAs co-regulate the expression of more than 70% of all human genes, many of which fulfil important roles in bone metabolism and muscle function. In-vitro and in-vivo experiments have shown that the targeted loss of miRNAs in distinct bone cell types (osteoblasts and osteoclasts) results in altered bone mass and bone architecture. These results emphasize the biological relevance of miRNAs for bone health.MiRNAs are not only considered as novel bone biomarkers because of their biological importance to bone metabolism, but also on the basis of other favorable properties: 1) Secretion of miRNAs from cells enables “minimally invasive” detection in biological fluids such as serum. 2) High stability of miRNAs in serum enables the retrospective analysis of frozen blood specimens. 3) Quantification of miRNAs in the serum is based on the RT-PCR - a robust method that is considered as the gold standard for the analysis of nucleic acids in clinical diagnostics.With regard to osteoporosis, it has been shown that many of the known risk factors are characterized by distinct miRNA profiles in the affected tissues: i) age-related loss of bone mass, ii) sarcopenia, iii) changes in estrogen metabolism and related changes Loss of bone mass, and iv) diabetes. Therefore, numerous studies in recent years have dealt with the characterization of miRNAs in the serum of osteoporosis patients and healthy controls, and were able to identify recurring miRNA patterns that are characteristic of osteoporosis. These novel biomarkers have great potential for the diagnosis and prognosis of osteoporosis and its clinical outcomes.The aim of this article is to give a summary of the current state of knowledge on the research and application of miRNA biomarkers in osteoporosis.

Diagnosis of osteoporosis in COPD patients: Estimation of the 10-year probability of a major osteoporotic fracture (FRAX), and Dual-energy X-Ray Absorptiometry

The aim of the study was to evaluate various methods of osteoporosis diagnostics (FRAX® and Dual-energy Х-Ray absorptiometry – DXA) and the sequence of their application in the diagnostic algorithm in COPD patients without a history of large bone fractures. Methods. Cross-sectional study of 115 COPD patients without exacerbation (93 men and 22 women, mean age 67.2 ± 7.1 years). The study included clinical examination, FRAX® estimation and comparison of the 10-year probability of a major osteoporotic fracture (MOF) with the Russian intervention threshold, spirometry, DXA of lumbar spine and proximal femur, semi-quantitative radiographic morphometry by Genant. All patients were examined using several methods that are possible in clinical practice: 1) FRAX® without DXA; 2) FRAX® + DXA in patients with intermediate 10-year probability of MOF and recalculation of FRAX® probability including femoral neck bone mineral density (BMD); 3) FRAX® + DXA in patients with intermediate 10-year probability of MOF. Take into account DXA results; 4) DXA without FRAX® ; 5) DXA + recalculation of FRAX ® for individuals with normal BMD or osteopenia. Results. In the whole sample of patients 1 – 5 diagnostic methods revealed 5.1, 7.0, 15.7, 44.3, 45.2% of individuals with osteoporosis, respectively. In men, the methods using FRAX ® (1 – 3) gave unsatisfactory results – the number of patients requiring treatment did not exceed 4.3%, while DXA revealed osteoporosis in 43%. FRAX® + DXA analysis in patients with intermediate 10-year probability of MOF (3 th method) was the best for women. The main independent predictors of low bone mineral density were post-bronchodilator FEV 1 ≤ 30% predicted and/or long-term oral glucocorticoid use. Asymptomatic vertebral fractures were detected in 11 patients. Before the radiographic morphometry, treatment would have been prescribed only 1 patient for the 1th or 2th methods; 5 patients – 3th method and 9 patients using 4th or 5th methods. Conclusion. The use of the Russian FRAX® model in men with COPD revealed a very low percentage of people who need osteoporosis treatment; DXA was the optimal diagnostic method. If it`s not possible to perform DXA in the most COPD patients, it should be prescribed to people with very severe bronchial obstruction and/or taking long-term oral glucocorticoid therapy. Regardless of the BMD parameters, semi-quantitative X-ray morphometry should be performed to diagnose asymptomatic vertebral fractures.

Detecting pathological features and predicting fracture risk from dual-energy X-ray absorptiometry images using deep learning

Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning to identify lumbar scoliosis and structural abnormalities that potentially affect BMD but are often neglected in lumbar spine DXA analysis. In addition, we tested the approach's ability to predict fractures using only DXA images. A dataset of 2949 images gathered by Kuopio Osteoporosis Risk Factor and Prevention Study was used to train a convolutional neural network (CNN) for classification. The model was able to classify scoliosis with an AUC of 0.96 and structural abnormalities causing unreliable BMD measurement with an AUC of 0.91. It predicted fractures occurring within 5 years from the lumbar spine DXA scan with an AUC of 0.63, meeting the predictive performance of combined BMD measurements from the lumbar spine and hip. In an independent test set of 574 clinical patients, AUC for lumbar scoliosis was 0.93 and AUC for unreliable BMD measurements was 0.94. In each classification task, neural network visualizations indicated the model's predictive strategy. We conclude that deep learning could complement the well established DXA method for osteoporosis diagnostics by analyzing incidental findings and image reliability, and improve its predictive ability in the future.

Current Trends in Osteoporosis Diagnostics: An Opportunity for Quantitative Ultrasound and Biomarkers

Osteoporosis is a pathological decrease in bone mineral density (BMD) that increases risk of fragility fracture...

ON THE ROLE OF HISTOMORPHOMETRIC (STEREOLOGICAL) MICROSTRUCTURE PARAMETERS IN THE PREDICTION OF VERTEBRAE COMPRESSION STRENGTH

The well-documented relation between bone mineral density (BMD) and bone compression strength constitutes the basis for osteoporosis diagnostics and the assessment of fracture risk. Simultaneously, this relation demonstrates a considerable scatter of results as bones of identical mineral density may have significantly different properties. The experimentally confirmed theorem that two materials or tissues of identical microstructure have identical properties leads to the evaluation of various quantitative stereological parameters (also referred to in biomedicine as histomorphology). These parameters, obtained from analysis of 2D or 3D images, have been used in numerous attempts to explain changes in bone strength. Although numerous correlation dependencies, often with high correlation coefficients, were evaluated, we do not know which parameters are worth evaluating, and there is no physical interpretation of these relations. An extended statistical analysis was accomplished on the basis of analysis of 3D images from 23 lumbar (L3) vertebrae scanned with micro-CT and the results of subsequent compression tests. A new parameter called SDF (structure destruction factor) was proposed in order to characterise the quality of 3D trabecular structures, and its significance was demonstrated. The final correlation function, which uses only three stereological parameters, made it possible to predict compression strength with considerable precision. The estimated values correlated very well with the apparent values (correlation coefficient r=0.96). Finally, the stereological parameters most suitable for characterisation of bone compression strength were chosen and a mechanism responsible for the changes in mechanical properties was proposed. The results obtained defined the necessary improvements in diagnostic techniques that would allow for more efficient quantitative microstructure evaluation and guidelines on how to improve treatment of patients with weakened bones.

The use of an electronic register in monitoring the incidence of osteoporosis among residents of the north

The article deals with operating the systems for preventing low-energy fractures in patients older than 50 years with signs of osteoporosis, complemented by trauma and therapeutic services. The current paradigm of osteoporosis diagnostics is to identify and follow up on patients with high risk of osteoporotic fractures – on the basis of clinical factors for 10-year absolute risk according to FRAX international scale. Further, the article presents the results of work to develop the electronic register to record information about patients with signs of osteoporosis, hosted by the endocrinological center at E.E. Volosevich First Municipal Clinical hospital in Arkhangelsk. The developed register includes six sections allowing to enter data on patients; results of laboratory research; x-ray osteodensitometry; and the osteoporosis therapy prescribed. The rationale is presented for the need in the development of such a monitoring system for more effective collection of epidemiological data on osteoporosis in Arkhangelsk and Arkhangelsk Region, as well as in more objective assessment of health services quality.

Osteoporosis Is a &amp;quot;Silent&amp;quot; Problem in Children’s Sport Medicine

The article is devoted to one of the relevant problems of modern medicine - osteoporosis. Osteoporosis epidemiology, risk factors, diagnostic approaches, which are confirmed in domestic and foreign researches, are discussed. Particular attention is paid to the ambiguity and inconsistency of information on osteoporosis in childhood and adolescence, as well as the lack of convincing studies of this issue in children's sports medicine. The authors analyze the generally accepted approaches to the identification of risk groups for the osteoporosis development in children, the predisposing factors and the complex issues of osteoporosis diagnostics. Paper includes data on own observations of the most complex group of children and adolescents involved in sport, including professional sport. A separate section is devoted to the analysis of prescribed medications for the prevention and treatment of osteoporosis in children and young athletes. The data are presented in accordance with the official information provided by World Anti-Doping Agency (WADA, 2017).