Risk Of Osteoporotic Fractures Research Articles

Computer Vision in Osteoporotic Vertebral Fracture Risk Prediction: A Systematic Review.

Osteoporotic vertebral fractures (OVFs) are a significant health concern linked to increased morbidity, mortality, and diminished quality of life. Traditional OVF risk assessment tools like bone mineral density (BMD) only capture a fraction of the risk profile. Artificial intelligence, specifically computer vision, has revolutionized other fields of medicine through analysis of videos, histopathology slides and radiological scans. In this review, we provide an overview of computer vision algorithms and current computer vision models used in predicting OVF risk. We highlight the clinical applications, future directions and limitations of computer vision in OVF risk prediction.

Body mass index, height, and osteoporotic fracture risk in community-dwelling Japanese people aged 40-74 years.

The association between body size and fracture risk is complex and varies by sex and ethnicity. This study aimed to examine associations of body mass index (BMI) and height with osteoporotic fracture risk in middle-aged and older people. This 10-year cohort study included 13,151 community-dwelling Japanese people aged 40-74years. A self-administered questionnaire survey was conducted at baseline to obtain information on demographic characteristics, body size, lifestyle, and disease history. BMI (kg/m2) was categorized as underweight (< 18.5), low-normal (18.5-21.7), high-normal (21.8-24.9), overweight (25.0-29.9), and obese (≥ 30.0). Height was categorized into quartiles. All incident cases of major osteoporotic fractures, including fractures of the distal radius, neck of the humerus, neck or trochanter of the femur, and vertebrae, were obtained from medical records during follow-up. Mean participant age was 58.8years. In men, the underweight group had a significantly higher hazard ratio (HR) for total fracture (adjusted HR = 2.46), and the obese group had significantly higher HRs for total (adjusted HR = 3.01) and vertebral (HR = 3.77) fractures relative to the reference (overweight) group. No significant associations were observed between BMI and risk of any fracture in women. Higher quartiles of height were associated with higher vertebral fracture risk (adjusted P for trend = 0.023) only in women. BMI and osteoporotic fracture risk showed a U-shaped association in men, whereas higher height was associated with higher vertebral fracture risk in women, suggesting sex-dependent differences in these associations.

Bone mass, fracture risk, and associated factors in postmenopausal women living with HIV.

The aim of this study was to assess the prevalence of low bone mass (osteopenia/osteoporosis), the factors associated with low bone mass, and the risk of fractures in Brazilian postmenopausal women living with HIV (WLH) in the Amazon region. This is a cohort study with a cross-sectional assessment at baseline conducted between March 2021 to August 2022 with 100 postmenopausal WLH undergoing antiretroviral therapy (ART) between 45 and 60 years of age and 100 age-matched HIV-negative women. Data on bone mineral density in the lumbar spine (LS) and femoral neck (FN) were collected using dual x-ray absorptiometry and the 10-year risk of hip and major osteoporotic fractures was assessed using the Fracture Risk Assessment tool (FRAX). The age of menopause onset occurred earlier in WLH ( P < 0.001). No differences in prevalence of osteoporosis and osteopenia in LS and FN were observed except for a lower T score in FN in WLH ( P = 0.039). The FRAX for major osteoporotic fracture and hip fracture were low in both groups, despite the mean of both FRAX scores was higher in WLH ( P < 0.001). Multivariate analysis showed that years since menopause onset, higher body mass index and higher FRAX major osteoporotic fracture were associated with the WLH group, while a higher frequency of physical activity was registered in the HIV-negative group. Multivariate analysis also showed that in WLH, a lower T score in FN was associated with years since menopause onset and body mass index and that the number of years since menopause onset was associated with a lower T score in the LS and a higher score in the FRAX hip fracture. Our findings show a high prevalence of low bone mass (osteopenia/osteoporosis) in Brazilian postmenopausal women from the Amazon region. Women living with HIV have higher FRAX scores than HIV-negative women and a lower T score in the FN.

Cross-Disciplinary Approach of Adrenal Tumors: Insights into Primary Aldosteronism-Related Mineral Metabolism Status and Osteoporotic Fracture Risk.

Our objective was to overview the novel aspects in the field of adrenal gland neoplasms, namely, the management of bone status with respect to primary aldosteronism (PA). In the current narrative review, a PubMed study was conducted from inception until June 2023. The inclusion criteria were: human (clinically relevant) studies of any study design (at least 10 patients per study); English papers; and the following combination of key words within the title and/or abstract: "aldosterone" AND "bone", "skeleton", "osteoporosis", "fracture", "calcium", "parathyroid", "DXA", "osteocalcin", "P1NP", "alkaline phosphatase", "bone marker", "trabecular bone score", or "FRAX". The exclusion criteria were in vitro or animal studies, reviews, and case reports/series. We screened 1027 articles and finally included 23 studies (13 of case-control type, 3 cross-sectional, 5 prospective, 1 observational cohort, and 1 retrospective study). The assessments provided in these studies were as follows: nine studies addressed Dual-Energy X-ray Absorptiometry (DXA), another study pointed out a bone microarchitecture evaluation underlying trabecular bone score (TBS), and seven studies investigated the bone turnover markers (BTMs) profile. Moreover, 14 studies followed the subjects after adrenalectomy versus medical treatment, and 21 studies addressed secondary hyperparathyroidism in PA patients. According to our study on published data during a period of almost 40 years (n = 23, N = 3965 subjects aged between 38 and 64, with a mean age 56.75, and a female-to-male ratio of 1.05), a higher PTH in PA versus controls (healthy persons or subjects with essential hypertension) is expected, secondary hyperparathyroidism being associated in almost half of the adults diagnosed with PA. Additionally, mineral metabolism anomalies in PA may include lower serum calcium and higher urinary calcium output, all these three parameters being reversible under specific therapy for PA, regardless medical or surgical. The PA subgroup with high PTH seems at higher cardiovascular risk, while unilateral rather than bilateral disease was prone to this PTH anomaly. Moreover, bone mineral density (BMD) according to central DXA might show a higher fracture risk only in certain adults, TBS being a promising alternative (with a still unknown perspective of diabetes' influence on DXA-TBS results in PA). However, an overall increased fracture prevalence in PA is described in most studies, especially with respect to the vertebral site, the fracture risk that seems correctable upon aldosterone excess remission. These data recommend PA as a cause of secondary osteoporosis, a treatable one via PA intervention. There is still an area of debate the way to address BMTs profile in PA, the case's selection toward specific bone evaluation in every day practice, and further on, the understanding of the potential genetic influence at the level of bone and mineral complications in PA patients.

Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on reducing mortality risk remains a topic of controversy. This study aimed to explore the potential protective effects of vertebral augmentation on mortality in patients with osteoporotic vertebral compression fractures (OVCFs) using a large-scale meta-analysis. Cochrane Library, Embase, MEDLINE, PubMed and Web of Science databases were employed for literature exploration until May 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized as a summary statistic via random-effect models. Statistical analysis was executed using Review Manager 5.3 software. After rigorous screening, a total of five studies with substantial sample sizes were included in the quantitative meta-analysis. The total number of participants included in the study was an 2,421,178, comprising of 42,934 cases of vertebral augmentation and 1,991,244 instances of non-operative management. The surgical intervention was found to be significantly associated with an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.78, 0.85). Subgroup analysis revealed a remarkable 71% reduction in mortality risk following surgical intervention during short-term follow-up (HR 0.29; 95% CI 0.26, 0.32). Furthermore, KP exhibited a superior and more credible decrease in the risk of mortality when compared to VP treatment. Based on a comprehensive analysis of large samples, vertebral augmentation has been shown to significantly reduce the mortality risk associated with OVCFs, particularly in the early stages following fractures. Furthermore, it has been demonstrated that KP is more reliable and effective than VP in terms of mitigating mortality risk.

ВЫРАЖЕННЫЕ СОСУДИСТЫЕ КАЛЬЦИНАТЫ МОЛОЧНЫХ ЖЕЛЕЗ КАК ПОТЕНЦИАЛЬНЫЙ МАРКЕР ОСТЕОПОРОЗА

Abstract. Introduction. There are about 16 million people aged 50 or older in the Russian Federation, who are affected by osteoporosis. At the same time, significantly many of these individuals undergo mammography, a diagnostic procedure that effectiently detects vascular calcifications. Aim. To assess the serum biochemistry parameters reflecting the bone turnover, as well as the bone densitometry values and fracture risk in women, depending on the degree of breast vascular calcifications found in mammography. Materials and Methods. We observed 56 women aged 39-81 years (average age: 63.66±1.24) sent to screening mammography in 2018. Results and Discussion. Patients who had newly discovered vascular calcifications showed a significant increase (6.98%) in their total serum calcium levels as compared to women without calcifications. Among women with calcifications, those with grade 3-4 calcifications had the highest median levels of both medium and maximum thyrostimulating hormone (TSH). Additionally, women with grade 1-2 calcifications had the highest median levels of maximum total serum calcium, which were significantly (3.7%) higher than those in women without calcifications and significantly (6.8%) higher than those in women with grade 3-4 calcifications. In women with 3-4 degree calcifications, both the mean and minimum values of the median T-test for L1-L4 vertebral body mineral density were 91% lower than in the group with grade 1-2 grade calcifications. Furthermore, they were 34% lower than in women without calcifications. Patients with grade 1-2 calcifications had the lowest risk of major fractures, as assessed by the FRAX index. At the same time, median of the minimum FRAX value during the follow-up period for patients with grade 1-2 calcifications was significantly (61%) lower than in women without calcifications. Furthermore, it was also significantly (70%) lower than in women with grade 3-4 calcifications.Conclusions. Detecting evident (grades 3-4 according to the classification we have proposed) breast vascular calcifications found in mammography is associated with the lower values of lumbar bone mineral density, indicating osteoporosis. This phenomenon primarily reflects the prospective fracture risk changes rather than retrospective ones, i.e. they precede the increase in the risk of osteoporotic fractures to the critical threshold.

MRI Detection of Osteoporosis Bone Fractures Opposed to DEXA Scan

The study emphasizes the advancement achieved through Magnetic Resonance Imaging (MRI) technology in identifying bone fractures, particularly in cases such as osteoporosis. The paper explores the utilization of MRI in examining bone health to determine fracture risks, particularly those caused by osteoporosis while identifying the limitations of Dual-Energy X-ray absorptiometry (DEXA) scans for comprehensive insights. As evident, the utilization of DEXA scans permits the measurement of Bone Mineral Density (BMD) and the identification of fracture susceptibility. However, the depth of information provided by DEXA scans falls short of that attainable through MRI scans. The researcher's strategy involves a comprehensive evaluation of methods for assessing bone health, encompassing the significance of BMD and the limitations associated with DEXA scans. Moreover, the study delves into the potential utilization of MRI in offering a holistic measurement of bone health and mitigating the risk of osteoporotic fractures. As revealed, MRI meticulously examines bone properties via a process involving magnetic manipulation of protons, creating cross-sectional images that offer unique insights into internal structure. MRI surpasses DEXA in detecting Osteoporotic Bone Fractures, offering a comprehensive understanding essential for treatment planning and patient recovery. Its early detection prevents complications and guides interventions effectively. This technique employs T1-weighted, T2-weighted, and proton-density imaging to analyze complex bone webs. Therefore, the researcher strongly recommends further research to harness MRI's evolving capabilities, enabling more accurate, individualized assessments of fracture risks and treatment strategies, ultimately enhancing fracture care with precise diagnoses and tailored approaches for improved health outcomes.

Sequential management of postmenopausal health and osteoporosis: An update.

Increased life expectancy means that women are now in a hypoestrogenic state for approximately one-third of their lives. Overall health and specifically bone health during this period evolves in accordance with aging and successive exposure to various risk factors. In this review, we provide a summary of the approaches to the sequential management of osteoporosis within an integrative model of care to offer physicians a useful tool to facilitate therapeutic decision-making. Current evidence suggests that pharmacologic agents should be selected based on the risk of fractures, which does not always correlate with age. Due to their effect on bone turnover and on other hormone-regulated phenomena, such as hot flushes or breast cancer risk, we position hormone therapy and selective estrogen receptor modulators as an early postmenopause intervention for the management of postmenopausal osteoporosis. When the use of these agents is not possible, compelling evidence supports antiresorptive agents as first-line treatment of postmenopausal osteoporosis in many clinical scenarios, with digestive conditions, kidney function, readiness for compliance, or patient preferences playing a role in choosing between bisphosphonates or denosumab during this period. For patients at high risk of osteoporotic fracture, the "anabolic first" approach reduces that risk. The effect on bone health with these bone-forming agents or with denosumab should be consolidated with the subsequent use of antiresorptive agents. Regardless of the strategy, follow-up and treatment should be maintained indefinitely to help prevent fractures.

Opportunistic Screening With CT: Comparison of Phantomless BMD Calibration Methods.

Opportunistic screening is a new promising technique to identify individuals at high risk for osteoporotic fracture using computed tomography (CT) scans originally acquired for an clinical purpose unrelated to osteoporosis. In these CT scans, a calibration phantom traditionally required to convert measured CT values to bone mineral density (BMD) is missing. As an alternative, phantomless calibration has been developed. This study aimed to review the principles of four existing phantomless calibration methods and to compare their performance against the gold standard of simultaneous calibration (ΔBMD). All methods were applied to a dataset of 350 females scanned with a highly standardized CT protocol (DS1) and to a second dataset of 114 patients (38 female) from clinical routine covering a large range of CT acquisition and reconstruction parameters (DS2). Three of the phantomless calibration methods must be precalibrated with a reference dataset containing a calibration phantom. Sixty scans from DS1 and 57 from DS2 were randomly selected for this precalibration. For each phantomless calibration method first the best combination of internal reference materials (IMs) was selected. These were either air and blood or subcutaneous adipose tissue, blood, and cortical bone. In addition, for phantomless calibration a fifth method based on average calibration parameters derived from the reference dataset was applied. For DS1, ΔBMD results (mean standard deviation) for the phantomless calibration methods requiring a precalibration ranged from 0.1 2.7 mg/cm3 to 2.4 3.5 mg/cm3 with similar means but significantly higher standard deviations for DS2. Performance of the phantomless calibration method, which does not require a precalibration was worse (ΔBMD DS1: 12.6 13.2 mg/cm3 , DS2: 0.5 8.8 mg/cm3 ). In conclusion, phantomless BMD calibration performs well if precalibrated with a reference dataset. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Prevalence and Risk Factors of Osteoporosis in a Chinese Population: A Cross-Sectional Study in Xi'an, Shaanxi Province, China.

BACKGROUND Osteoporosis is a systemic chronic disease characterized by bone mineral density (BMD) reduction. This study aimed to assess the prevalence of osteoporosis and fracture risks in northwestern China and investigate the related anthropometric risk factors. MATERIAL AND METHODS Between July 2022 and August 2022, 1429 participants (1295 females, 134 males) with measured BMD were recruited to participate in this cross-sectional study. Data on height, weight, and T score were collected. Spearman's correlation and multiple linear regression analysis were used to investigate the relationships between various demographic factors and BMD and the 10-year risk of major osteoporotic fracture (MO) and hip fracture (HP). RESULTS The overall prevalence of osteoporosis in northwest China was 42.34%, with 44.56% in females and 20.90% in males. Age negatively affects females' T scores (r=-0.304, P<0.05), and height positively influences both sexes' T scores (r=0.059 P<0.05). Age (r=0.148, P<0.05) and height were positive predictors of MO (r=0.027, P<0.05), while weight was a negative predictor (r=-0.035, P<0.05). The conclusion for HP was consistent with that of MO, except for the T score, which was a positive predictor of HP (r=0.014, P<0.05). CONCLUSIONS The prevalence of osteoporosis in northeast China is high. The association between anthropometric parameters and osteoporosis in adults in northwest China is different between sexes.

Commentary: Risk of Osteoporotic Fracture and Re-Fracture: Dangerous Liaisons

Commentary: Risk of Osteoporotic Fracture and Re-Fracture: Dangerous Liaisons

Clinical features of osteoporosis among indigenous women of Russian and Buryat ethnicity in Trans-Baikal region

Introduction Osteoporosis (OP) is a major social and medical problem for society.The aim of research was to identify risk factors for OP and the incidence of low-energy fractures in women with OP of Russian and Buryat ethnicity in Trans-Baikal region.Materials and methods We examined 98 women with OP (50 of Russian and 48 of Buryat nationality) and 100 women without objective signs of OP, comparable by age and nationality with the main group. All women underwent a questionnaire to identify risk factors for osteoporosis and osteoporotic fractures, determination of bone mineral density (BMD) using dual-energy X-ray absorptiometry, and determination of the absolute 10-year risk of major osteoporotic fractures using the online FRAX® calculator.Results The mean age of women with OP of Russian ethnicity was 65.5 [57.0;71.0] years, of Buryat nationality – 65.3 [56.0;69.0] years. Among risk factors in female members of Russian nationality, age older than 65 years, tendency to fall and decreased creatinine clearance were found more frequently. There was an inverse association between proximal femoral BMD and risk of falls (R = -0.31, p = 0.04) and a direct correlation between family history of ОP and spinal BMD (R = 0.65, p = 0.02).Discussion Age over 65 is a significant risk factor for osteoporosis and is included in the FRAX (Fracture Risk Assessment Tool) model. Reduces creatinine clearance and a tendency to fall have been associated with the development of OP and fractures in some studies. Our findings are consistent with previous studies.Conclusion Russian women were more likely than Buryat women to have risk factors for OP, such as falls and decreased creatinine clearance. Associations were found between proximal femoral BMD and falls, spinal BMD with a family history of OP and smoking among Russian women.

Performance of iCare quantitative computed tomography in bone mineral density assessment of the hip and vertebral bodies in European spine phantom

BackgroundOsteoporosis is a systemic bone disease which can increase the risk of osteoporotic fractures. Dual-energy X-ray absorptiometry (DXA) is considered as the clinical standard for diagnosing osteoporosis by detecting the bone mineral density (BMD) in patients, but it has flaws in distinguishing between calcification and other degenerative diseases, thus leading to inaccurate BMD levels in subjects. Mindways quantitative computed tomography (Mindways QCT) is a classical QCT system. Similar to DXA, Mindways QCT can directly present the density of trabecular bone, vascular or tissue calcification; therefore, it is more accurate and sensitive than DXA and has been widely applied in clinic to evaluate osteoporosis. iCare QCT osteodensitometry was a new phantom-based QCT system, recently developed by iCare Inc. (China). It has been gradually applied in clinic by its superiority of taking 3-dimensional BMD of bone and converting BMD values to T value automatically. This study aimed at evaluating the osteoporosis detection rate of iCare QCT, compared with synchronous Mindways QCT (USA).MethodsIn this study, 131 patients who underwent hip phantom-based CT scan were included. Bone mineral density (BMD) of the unified region of interests (ROI) defined at the European spine phantom (ESP, German QRM) including L1 (low), L2 (medium), and L3 (high) vertebral bodies was detected for QCT quality control and horizontal calibration. Every ESP scan were taken for 10 times, and the mean BMD values measured by iCare QCT and Mindways QCT were compared. Hip CT scan was conducted with ESP as calibration individually. T-scores gained from iCare QCT and Mindways QCT were analyzed with Pearson correlation test. The detection rates of osteoporosis were compared between iCare QCT and Mindways QCT. The unified region of interests (ROI) was delineated in the QCT software.ResultsThe results showed that there was no significant difference between iCare QCT and Mindways QCT in the evaluation of L1, L2, and L3 vertebrae bodies in ESP. A strong correlation between iCare QCT and Mindways QCT in the assessment of hip T-score was found. It was illustrated that iCare QCT had a higher detection rate of osteoporosis with the assessment of hip T-score than Mindways QCT did. In patients < 50 years subgroup, the detection rate of osteoporosis with iCare QCT and Mindways QCT was equal. In patients ≥ 50 years subgroup, the detection rate of osteoporosis with iCare QCT (35/92, 38.0%) was higher than that with Mindways QCT. In female subgroup, the detection rate of osteoporosis with iCare QCT was significantly higher than Mindways QCT. In male subgroup, the detection rate of osteoporosis with iCare QCT was also markedly higher than Mindways QCT. The detection rate of osteoporosis by iCare QCT was higher than Mindways QCT with hip bone assessment. Of course, the results of the present study remain to be further verified by multicenter studies in the future.

FRI679 Risks Of Incident Major Osteoporotic Fractures Following SARS-CoV-2 Infection

Abstract Disclosure: D. Lui: None. X. Xiong: None. M. Chung: None. I. Au: None. F. Lai: None. E. Wan: None. C. Chui: None. X. Li: None. F. Cheng: None. C. Cheng: None. E. Chan: None. C. Lee: None. T. Ip: None. Y. Woo: None. K. Tan: None. C. Wong: None. I. Wong: None. Objectives: Pre-clinical and small cohort studies have suggested the potential deleterious effects of SARS-CoV-2 infection on bone health. We aimed to estimate the risks of incident fractures following SARS-CoV-2 infection in a population-based cohort. Methods: This was a retrospective, propensity-score matched, population-based cohort study of COVID-19 patients and non-COVID individuals identified from the electronic database of the Hong Kong Hospital Authority from January 2020 to March 2022. The primary outcome was a composite of major osteoporotic fractures (hip, clinical vertebral, proximal humerus and wrist fractures), identified by the ICD-9-CM codes 805.x, 812.x, 813.x, 814.x, 820.x. Episodes of falls were identified by the ICD-9-CM codes 781.2, 781.3, 781.99, V15.88, E880-E888. COVID-19 patients were 1:1 matched to controls using propensity-score according to age, sex, comorbidities and medications. The cohort was followed up until the occurrence of outcomes, death, or 31 January 2023, whichever came first. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models. Results: 740,692 COVID-19 patients were included, 1:1 matched to non-COVID individuals. Upon median follow-up of 11 months, COVID-19 patients had higher risks of major osteoporotic fractures (0.35% vs 0.29%; HR 1.21, 95%CI 1.14-1.29, p&amp;lt;0.001), hip fractures (0.16% vs 0.11%; HR 1.34, 95%CI 1.23-1.47, p&amp;lt;0.001), and fall (0.89% vs 0.65%; HR 1.29, 95%CI 1.24-1.34, p&amp;lt;0.001). There was also statistically non-significant increased risk of clinical vertebral (0.03% vs 0.02%; HR 1.22, 95%CI 0.99-1.50, p=0.062) and upper limb (0.14% vs 0.12%; HR 1.08, 95%CI 0.99-1.18, p=0.081) fractures. Subgroup analyses revealed no significant interaction by age (&amp;lt;60 vs ≥60 years), presence of diabetes, fracture history, and the predominant SARS-CoV-2 variant. However, the impact of SARS-CoV-2 infection on fracture and fall risks was greater among men (p-interaction&amp;lt;0.001) and unvaccinated people (p-interaction=0.015). Among COVID-19 patients, hospitalised and dexamethasone-treated ones had higher subsequent fracture and fall risks. When dividing the follow-up period into the acute phase (within 30 days after SARS-CoV-2 infection) and the post-acute phase (beyond 30 days after SARS-CoV-2 infection), the risk of major osteoporotic fractures and falls was consistently increased in the whole cohort, particularly among the older individuals (≥60 years). Conclusions: Our study demonstrated increased risk of major osteoporotic fractures following SARS-CoV-2 infection, contributed by increased fall risk. Clinicians should be aware of musculoskeletal health of COVID-19 survivors, especially older individuals, and provide appropriate preventive actions. Presentation: Friday, June 16, 2023

SAT519 Association of Free Thyroxine Level With Survival Outcome In Patients With Intermediate And High-Risk Differentiated Thyroid Cancer

Abstract Disclosure: R. Ghosh: None. S. Auh: None. S. Gubbi: None. P. Veeraraghavan: None. C. Cochran: None. L. Shobab: None. K.D. Burman: None. L. Wartofsky: None. J. Klubo-Gwiezdzinska: None. Background Total thyroidectomy followed by radioiodine (RAI) is a standard treatment for patients with intermediate and high-risk differentiated thyroid cancer (DTC). Long-term management consists of therapy with supraphysiologic doses of levothyroxine to suppress thyrotropin (TSH), as in vitro models have shown that TSH can act as a differentiation signal at physiologic concentrations, but as cancer proliferating stimulus in higher concentrations. On the other hand, preclinical studies have shown that thyroid hormones (T4/T3) can act as a growth stimulus in thyroid cancer cell lines. Moreover, supraphysiologic doses of T4/T3 are associated with an increased risk of atrial fibrillation and osteoporotic fractures. There are limited data on the role of elevated free T4 (FT4) on survival outcomes in patients with DTC. The goal of this study was to assess the association between FT4 levels and progression-free survival (PFS) in patients with intermediate-to-high-risk DTC. Material and Methods This cohort study was approved by the multi-institutional review board. Patients with DTC treated uniformly with total thyroidectomy and RAI between January 1, 1979, and March 1, 2015, and subjected to TSH suppression therapy, with at least 3 TSH and FT4 values available over time were included. The association between average FT4 level above the upper reference range (&amp;gt;1.8 ng/dl) at landmarks 6, 12, and 18 months was assessed by Kaplan-Meier survival curves. A Cox proportional hazards model was used to assess the contribution of competing risks such as age, sex, tumor size, lymph node, and distant metastases on PFS. Results The study included 382 patients, aged 46.6 ± 16.5 years, 245/382 (64.1%) women, treated with a median RAI dosage of 159 (110-410) mCi and followed for 8.5±6.2 years during which 132/382 (34.5%) experienced disease progression. During follow-up, 108/382 (28.3%) patients presented with an average FT4 of &amp;gt;1.8 ng/dl, while the remaining patients had FT4 within the normal range. Overall, elevated FT4 level was not associated with decreased PFS (HR 0.9, CI 0.54 -1.5, p=0.69), while age at diagnosis (HR 1.02, CI 1.004-1.04, p=0.01), tumor size (HR 1.15, CI 1.04 -1.28, p=0.01), lateral neck lymph node metastases (HR 2.9, CI 1.78 - 4.74, p&amp;lt;0.001), bone metastases (HR 4.87, CI 1.79 - 13.3, p=0.002) and brain metastases (HR 5.56, CI 2.54 - 12.2, p&amp;lt;0.001) were associated with shorter PFS. The landmark analysis performed to reduce the bias due to time-varying covariates at 6, 12, and 18 months confirmed these results. Conclusions Although high FT4 may stimulate thyroid cancer growth in vitro, elevated FT4 levels do not appear to worsen PFS. However, in managing patients with persistent DTC, clinicians must balance the benefits of TSH suppression with the potential detrimental effects of high FT4 on cardiovascular and bone health. Presentation Date: Saturday, June 17, 2023

OR13-02 Ethnic Variation In Non-vertebral Major Osteoporotic Fractures Among US Asian/Pacific Islander Men

Abstract Disclosure: C.E. Chu: None. M. Chandra: None. N.P. Gordon: None. D.W. Zeltser: None. C. Lee: None. J.A. Darbinian: None. J.C. Lo: None. Background: Our recent characterization of hip fracture incidence among Asian/Pacific Islander (PI) adults compared Chinese, Japanese, Filipino, and South Asian adults and found that South Asian men had a higher incidence of hip fracture compared to Chinese men, but Japanese and Filipino men did not. However, published data pertaining to major osteoporotic fracture (MOF) risk remain limited. We now further examine the incidence of non-vertebral MOF among Asian/PI men, including findings by Asian subgroup. METHODS: We used data from a previously reported retrospective cohort of 188,328 Asian/PI men in an integrated healthcare delivery system who were age ≥50y during 2000-2019. Asian/PI subgroups examined included 41,862 Chinese, 45,779 Filipino, 13,322 South Asian, and 7,838 Japanese men (the four largest Asian/PI subgroups among men and women), with the remaining 79,527 Asian/PI men comprising 8,293 Vietnamese, 3,500 other Southeast Asian, 6,629 Native Hawaiian/PI (NHPI), 3,132 Korean, 451 Central Asian, and 57,522 of multiple or unspecified Asian/PI ethnicity. Incident non-vertebral MOF was defined as the first hip, humerus, or wrist fracture identified by ICD diagnosis codes during follow up to 2021. Age adjusted fracture incidence [with 95% CI] was calculated using weights from the 2010 US Census. Log-Poisson regression was used to determine fracture incidence rate ratios (IRR) with Chinese adults as reference, adjusting for age and calendar year. RESULTS: Among 188,328 Asian/PI men (aged 55.3 ± 7.8 years at entry), 1501 experienced hip (43.3%), humerus (16.3%), or wrist (37.4%) fracture, or &amp;gt;1 of these non-vertebral MOFs (3.0%) during follow-up, with mean age 71.0 ± 13.0 years at the time of incident fracture. The age-adjusted incidence of non-vertebral MOF for Asian/PI men was 1.18 [1.12-1.25] per 1000 person-years overall but varied among the major Asian/PI subgroups: 1.19 [1.08-1.29] for Chinese, 1.00 [0.88-1.12] for Filipino, 1.51 [1.28-1.77] for Japanese, and 2.01 [1.67-2.41] for South Asian men per 1000 person-years. Compared to Chinese men, the IRR for non-vertebral MOF were 0.83 [0.72-0.95] for Filipino, 1.21 [1.01-1.44] for Japanese, and 1.84 [1.54-2.20] for South Asian, and 0.89 [0.77-1.03] for all other Asian/PI men, including those with unspecified ethnicity. Conclusions: The majority of non-vertebral MOF occurred at the hip and wrist among men. When comparing fracture incidence across major Asian/PI subgroups, the largest difference in non-vertebral MOF incidence was seen among South Asian men compared to their Chinese counterparts, consistent with previous hip fracture findings. Japanese men also had somewhat higher incidence of MOF, while Filipino men had lower incidence. Future studies are needed to examine whether differences are evident in other Asian/PI subgroups and whether there are differences in clinical outcome after non-vertebral MOF fracture. Presentation: Friday, June 16, 2023

Association of Alternative Dietary Patterns with Osteoporosis and Fracture Risk in Older People: A Scoping Review.

Although the Mediterranean diet has been associated with a lower risk of hip fracture, the effect of other dietary patterns on bone density and risk of fracture is unknown. This scoping review aims to investigate the association between adherence to alternative dietary patterns (other than the traditional Mediterranean diet) and osteoporosis or osteoporotic fracture risk in older people. A systematic search was carried out on three electronic databases (Medline, EMBASE, and Scopus) to identify original papers studying the association between alternative dietary patterns (e.g., Baltic Sea Diet (BSD), modified/alternative Mediterranean diet in non-Mediterranean populations, Dietary Approaches to Stop Hypertension (DASH)) assessed using 'prior' methods (validated scores) and the risk of osteoporotic fracture or Bone Mineral Density (BMD) in people aged ≥50 (or reported average age of participants ≥ 60). Results from the included studies were presented in a narrative way. Six observational (four prospective cohort and two cross-sectional) studies were included. There was no significant association between BMD and BSD or DASH scores. Higher adherence to DASH was associated with a lower risk of lumbar spine osteoporosis in women in one study, although it was not associated with the risk of hip fracture in another study with men and women. Higher adherence to aMED (alternative Mediterranean diet) was associated with a lower risk of hip fracture in one study, whereas higher adherence to mMED (modified Mediterranean diet) was associated with a lower risk of hip fracture in one study and had no significant result in another study. However, diet scores were heterogeneous across cohort studies. There is some evidence that a modified and alternative Mediterranean diet may reduce the risk of hip fracture, and DASH may improve lumbar spine BMD. Larger cohort studies are needed to validate these findings.

An enhanced version of FREM (Fracture Risk Evaluation Model) using national administrative health data: analysis protocol for development and validation of a multivariable prediction model

BackgroundOsteoporosis poses a growing healthcare challenge owing to its rising prevalence and a significant treatment gap, as patients are widely underdiagnosed and consequently undertreated, leaving them at high risk of osteoporotic fracture. Several tools aim to improve case-finding in osteoporosis. One such tool is the Fracture Risk Evaluation Model (FREM), which in contrast to other tools focuses on imminent fracture risk and holds potential for automation as it relies solely on data that is routinely collected via the Danish healthcare registers. The present article is an analysis protocol for a prediction model that is to be used as a modified version of FREM, with the intention of improving the identification of subjects at high imminent risk of fracture by including pharmacological exposures and using more advanced statistical methods compared to the original FREM. Its main purposes are to document and motivate various aspects and choices of data management and statistical analyses.MethodsThe model will be developed by employing logistic regression with grouped LASSO regularization as the primary statistical approach and gradient-boosted classification trees as a secondary statistical modality. Hyperparameter choices as well as computational considerations on these two approaches are investigated by an unsupervised data review (i.e., blinded to the outcome), which also investigates and handles multicollinarity among the included exposures. Further, we present an unsupervised review of the data and testing of analysis code with respect to speed and robustness on a remote analysis environment. The data review and code tests are used to adjust the analysis plans in a blinded manner, so as not to increase the risk of overfitting in the proposed methods.DiscussionThis protocol specifies the planned tool development to ensure transparency in the modeling approach, hence improving the validity of the enhanced tool to be developed. Through an unsupervised data review, it is further documented that the planned statistical approaches are feasible and compatible with the data employed.

Guideline for diagnostic, prevention and treatment of postmenopausal osteoporosis

Background. Postmenopausal osteoporosis (PMO), which is developed due the estrogen defi ciency in women after menopause, is the most common type of systemic osteoporosis. The latest Ukrainian recommendation for its management requires revision due to new data from high-quality research performed in recent years. The purpose was to develop a guideline on the diagnosis, prevention, and treatment of PMO based on an analytical analysis of modern literary sources in order to improve the awareness of the medical community of Ukraine. Methodology. To develop the guideline, an expert group of 13 leading Ukrainian scientists of various specialties was created who conducted a tho rough review of modern literature on this topic, assessed the level of existing evidence using the GRADE system, proposed and voted on 15 recommendations of the guideline. Results. The guideline contains chapters on diagnosis and diff erential diagnosis of PMO, assessment of the osteoporotic fracture risk, the role of bone turnover markers in the management of PMO, and modern strategies of antiosteoporotic treatment. Conclusions. The Ukrainian guideline on the diagnosis, prevention, and treatment of PMO, which contains 15 main recommendations, created on the basis of a tho rough analysis and synthesis of modern literature data, is an important tool for the management of PMO and is recommended by Ukrainian Association of Osteoporosis for use in Ukrainian me dical community.

Clinical Studies On Romosozumab: An Alternative For Individuals With A High Risk Of Osteoporotic Fractures: A Current Concepts Review (Part II)

Romosumab (ROMO) should be used to treat postmenopausal women with osteoporosis at high fracture risk after carefully considering the cardiovascular status and the risk/benefit balance. Clinicians should avoid ROMO for patients with a history of myocardial infarction or stroke in the past 12 months. Although ROMO offers an alternative for patients with a high risk of osteoporotic fractures, it is affected by previous osteoporosis treatment: using denosumab (DENO) and oral bisphosphonates for over one year attenuates its effect. An additional 12 months of DENO appears to be more effective than ibandronate for the enhancement of bone mineral density (BMD) as a sequential agent after 12 months of ROMO, with few severe adverse events. However, it is important to emphasize that ROMO is not a first-choice medication. It is only indicated when bisphosphonates cannot help, and its clinical use has demonstrated cardiovascular risks. The cost and availability could also make its use problematic in clinical practice. Therefore, although ROMO represents an important advance in the treatment of osteoporosis, it is by no means a solution for osteoporosis.