Probabilistic Fracture Research Articles

P-451. Adherence to Bone Mineral Density Screening Recommendations in Older Adults with HIV

Abstract Background HIV guidelines recommend bone mineral density (BMD) screening by dual-energy x-ray absorptiometry (DXA) for all postmenopausal women and all men ≥50 years. Uptake of these recommendations has been low. This study describes DXA screening practices among people with HIV (PWH) at highest risk for low BMD. Methods We conducted a retrospective chart review among PWH aged ≥65 or older who were seen for HIV care at the University of Colorado within the last year. First available and most recent DXA scans were collected; FRAX score was calculated to estimate 10-year risk of major osteoporotic and hip fractures. Demographics and clinical factors were also collected. Results We reviewed records of 300 PWH age 65 and older, including 243 (81%) men and 57 (19%) women. The mean age was 69.8 (SD 4.4) years, 62% were non-Hispanic white, 45% had a normal body mass index (18.5-24.9 kg/m2), and 60% reported current/prior tobacco use. 48% had a DXA scan ordered, including 53% of those with previous falls and 54% with prior fracture. Mean age at first DXA scan was 64.9 (SD 6.0) for males and 64.5 (SD 6.4) for women. Of those screened, 13% of women and 27% of men had normal BMD (T-score > -1.0); 45% of women and 53% of men had osteopenia (T-score < -1 to -2.5) and 42% of women and 20% of men had osteoporosis (T-score < -2.5). By FRAX, 10-year probability of major osteoporotic fracture was 9.8% [IQR: 5.7, 13.6] for women and 6.8% [4.7, 11.0] for men. The 10-year probability of hip fracture was 2.2% [0.8, 4.1] for women and 1.4% [0.6, 2.8] for men. Conclusion Older PWH are markedly under-screened for low BMD. There was low adherence to screening per current HIV guidelines, even among those with the highest risk. Osteopenia and osteoporosis were common, though FRAX scores suggested only moderate risk. Improved screening for reduced BMD and fracture risk in PWH is urgently needed. Disclosures Kristine M. Erlandson, MD MS, Gilead: Advisor/Consultant|Gilead: Grant/Research Support|ViiV: Advisor/Consultant

Treatment Strategies for Intermediate Spinal Instability Neoplastic Score Patients: A Systematic Review.

The Spinal Instability Neoplastic Score (SINS) is used in determining instability in patients with spinal metastases. Intermediate scores of 7 to 12 suggest possible instability, but there are no clear guidelines to address patients with these scores. We searched in PubMed, EMBASE, and Cochrane databases for studies that included patient demographics, tumor histology, surgical or radiotherapy management, and outcomes of patients with intermediate SINS. We reported mean differences and odds ratios (ORs) to assess differences between patients managed surgically versus with radiotherapy alone. Thirteen articles, totaling 1822 patients with intermediate SINS were analyzed. In 5 studies (38.4%), the management decision was based on a tumor board review. There was no significant difference between surgical management versus radiotherapy (P= 0.24). When dichotomized into SINS 7-9 and 10-12, the OR for surgical management in the 10-12 group compared to the 7-9 group was 6.88 (95% confidence interval [CI] 2.31-20.5, P= 0.0005). More renal cell carcinomas were managed surgically instead of with radiotherapy alone than other tumor types (OR= 1.87, 95% CI= 1.14-3.05, P= 0.01). There was no statistical difference in overall complications between the 2 treatment groups (OR= 1.12, 95% CI= 0.49-2.54, P= 0.79). Vertebral fracture rates after any radiotherapy type ranged between 20% and 66%. The need for a surgical procedure, including stabilization, vertebroplasty, or kyphoplasty after radiotherapy ranged from 5% to 34.2%. Complication rates after surgery versus radiotherapy in the intermediate SINS category are similar, but the complication types differ. Patients in the 10-12 SINS subgroup, due to larger lytic area and higher probability of vertebral body fracture, could benefit from stabilization before radiotherapy.

Associations between bone material strength index and FRAX scores.

Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, its ability to predict fractures is still uncertain. This study aimed to determine the association between BMSi and 10year fracture probability, as calculated by the FRAX algorithm. BMSi was measured using the OsteoProbe in 388 men (ages 40-90yr) from the Geelong Osteoporosis Study. The probabilities for a major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Australian FRAX tool. Hip (HF) and major osteoporotic (MOF) fracture probabilities were computed with and without the inclusion of femoral neck bone mineral density (BMD). For each participant, four 10year probability scores were therefore generated: (i) HF-FRAXnoBMD; (ii) HF-FRAXBMD; (iii) MOF-FRAXnoBMD; (iv) MOF-FRAXBMD. BMSi was negatively correlated with age (r = -0.114, p = 0.025), no associations were detected between BMSi and femoral neck BMD (r = + 0.035, p = 0.507). BMSi was negatively correlated with HF-FRAXnoBMD (r = -0.135, p = 0.008) and MOF-FRAXnoBMD (r = -0.153, p = 0.003). These trends held true for HF-FRAXBMD (r = -0.087, p = 0.094) and MOF-FRAXBMD (r = -0.111, p = 0.034), but only the latter reached significance. BMSi captures the cumulative effect of clinical risk factors in the FRAX algorithm, suggesting that it could provide additional information that may be useful in predicting risk of fractures. Further studies are warranted to establish its efficacy in predicting fracture risk.

Influence of Microstructure on Music Properties of SWP-B Music Steel Wire Under Different Annealing Treatments.

The mechanical properties of music wire are contingent upon its microstructure, which in turn influences its applications in music. Chinese stringed instruments necessitate exacting standards for comprehensive performance indexes, particularly with regard to the strength, resilience, and rigidity of the musical steel wires, which differ from the Western approach to musical wire. In this study, SWP-B music wire was selected for investigation through metal heat treatment, which was employed to regulate its microstructure characteristics. Furthermore, a spectral analysis was conducted to evaluate the musical expression, encompassing attributes such as pitch and timbre. In conclusion, the governing law of the impact of the microstructure of music wire on its musical expression was established. The results demonstrate that steel wire subjected to a 200 °C annealing treatment for cementite spheroidization can effectively reduce stress concentration, thereby reducing the probability of fracture and consequently improving tonal uniformity and richness while increasing tensile strength from 2578 MPa to 2702 MPa. Conversely, the high-temperature annealing treatment alters the crystalline structure of the material and refines the grain structure, thereby improving the material's performance and sound quality. The fine microstructure of the music steel wire displays enhanced uniformity. As the annealing temperature increases, the strength of the ferrite phase <110>//ND (<010>//ND, indicating that the <010> direction of the crystal is parallel to the normal direction of the material) and the cementite phase <010>//ND demonstrates a gradual decline. However, this also results in a more pronounced harmonic performance, which, in turn, affects the overall music expression.

Evaluation of using grip strength and hand muscle cross-sectional area to predict secondary fractures post distal radius fracture

SummaryGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.PurposeTo evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.MethodsA retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan–Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.ResultsPatients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17–24 kg), or low–risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55–3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.ConclusionsGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

Assessment of fracture risk with FRAX and FRAXplus.

FRAX®, a risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used for fracture risk assessment since its launch in 2008. It is now incorporated into very many guidelines worldwide to inform osteoporosis management. In this review, we explore the development of FRAX and how it enhances fracture risk prediction as compared to use of bone mineral density alone, as well as approaches to utilizing FRAX in determining intervention and assessment thresholds. We also discuss the limitations of FRAX and the arithmetic adjustments that have been proposed to address these. The introduction of FRAXplus® includes these adjustments on a web-based platform for ease of application to enhance treatment decisions in osteoporosis.

Intraoperative complications in patients with systemic lupus erythematosus during total hip replacement

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic disease of unknown etiology characterized by systemic immuno-inflammatory damage to vital organs. A serious complication of SLE is aseptic bone necrosis, which is characterized by severe pain syndrome, impaired joint function, decreased quality of life and disability. Despite the fact that hip replacement is a technically proven method of surgical treatment, patients with SLE are still at increased risk of complications at all stages of the perioperative period.AIM: the aim of the work is to describe the effect of SLE on the development of intraoperative complications during hip replacement.MATERIALS AND METHODS: The study included 133 patients diagnosed with SLE who underwent total hip replacement between 1998 and 2021. All surgical interventions were performed in the traumatology and orthopaedic department. The group of patients with SLE was dominated by women, the ratio of women to men was 7.3:1, respectively. The average age of patients at the time of surgery was 36.6±12.6 years.RESULTS: Hip replacement in all patients (n=133) was performed as standard in the patient’s position on the healthy side from the anterolateral Harding access. In 75 cases (56.3%), additional fixation of the acetabulum component with screws was performed. In 10 cases, a cerclage was applied to the proximal femur due to a fracture that occurred during the development of the bone marrow canal. To clarify the factors influencing the development of an intraoperative fracture, patients with SLE were divided into 2 groups: the first group (n=10) — with an intraoperative fracture, the second (n=123) — without a fracture. The comparative characteristics of the first and second groups are carried out. Another complication at the stage of surgical treatment is an increased volume of blood loss, which required transfusion of erythrocyte suspension. There were 54 such patients (40.6%). In relation to patients with increased blood loss, we compared the clinical and laboratory characteristics of patients immediately before surgical treatment, with and without increased blood loss.CONCLUSION: In the study, we analyzed the resulting intraoperative complications. We have not received confirmation of the effect of daily and cumulative doses of HA, as well as the degree of activity and course of SLE on the risk of intraoperative fracture. The probability of fracture was significantly higher in patients with initially reduced bone mineral density. With regard to the increased volume of blood loss in patients with SLE, a significant association was found with baseline anemia (reduced hemoglobin and hematocrit levels) in the preoperative period (p&lt;0.001).

Edge Chipping Resistance and Flexural Strength of CAD-CAM Ceramics Before and After Thermomechanical Aging.

To evaluate the complementary mechanical properties of dental ceramics using edge chipping resistance (Rea) and flexural strength before and after thermomechanical aging. Computer-aided design and computer-aided manufacturing of ceramic materials, including zirconia (ZR), lithium disilicate (LS2), and resin nanoceramics (RNC), were evaluated. Specimens for flexural strength testing were fabricated with dimensions of 3 × 4 × 25 mm, with 30 specimens per group. For the edge chipping test (ECT), specimens were fabricated with dimensions of 3 × 4 × 12 mm, with 48 specimens per group. Half of the specimens for both tests were subjected to thermomechanical aging for 200,000 cycles at 50 N. A Weibull analysis was performed to determine flexural strength. Fractographic analysis was performed before and after thermomechanical aging during the ECT. X-ray diffractometry (XRD) was performed on the ZR specimens before and after thermomechanical aging. Flexural strength was analyzed using a two-way repeated analysis of variance (ANOVA) with a t-test, and Rea was analyzed using Pearson correlation and a two-way repeated ANOVA. The flexural strength and Rea differed according to the material (p = 0.001), whereas they were similar before and after thermomechanical aging (p > 0.05). The Weibull modulus of the flexural strength decreased after thermomechanical aging. In the fractographic analysis of the ECT, more than two fracture origins were identified after thermomechanical aging. The XRD analysis of ZR showed an increased monoclinic phase after thermomechanical aging. All the materials met the ISO 6872 standards for bending test. However, LS2 and RNC show low edge chipping resistance within the range of the occlusal force. The thermomechanical aging did not significantly alter the mechanical properties of the materials. However, the Weibull coefficients of the flexural strength decreased, and an additional origin of fracture appeared after thermomechanical aging. Flexural strength and Rea differed depending on the material used. The probability of the material fracture increased after thermomechanical aging. To understand ceramic fractures, two mechanical tests and thermomechanical aging must be performed together.

Conservative Management of Horizontal Root Fracture: ACase Report.

In cases where permanent teeth have closed apices and completely erupted roots, the probability of root fractures is increased due to the stable support given by the adjacent bone and periodontal tissues. Fractures have the potential to affect several dental structures, including the pulp, dentin, cementum, bone, and periodontal tissues. In cases of horizontal root fractures (HRF), the apical section typically maintains vitality; however, the present case presented an unusual apex necrosis. Given the patient's age and tooth stability, traditional apical surgery was deemed inappropriate. Instead, a conservative treatment approach was chosen to preserve the tooth. This case report details the management and a 2-year follow-up of a maxillary central incisor exhibiting a HRF and apical necrosis, successfully addressed through the application of Mineral Trioxide Aggregate (MTA) in the both apical and coronal segments. Using MTA prevented apical surgery in cases of apex necrosis accompanied by HRF.

Systemic immune-inflammatory index predicts fragility fracture risk in postmenopausal anemic females with type 2 diabetes mellitus: evidence from a longitudinal cohort study

BackgroundChronic low-grade inflammation is related to bone metabolism in patients with type 2 diabetes mellitus (T2DM). However, credible data indicating the relationship between inflammation and fragility fracture risk in postmenopausal anemic females with T2DM are sparse. The current study sought to investigate the relationships between the systemic immune-inflammatory index (SII) and fragility fracture events, as well as the future 10-year fragility fracture probability evaluated using the fracture risk assessment tool (FRAX) in postmenopausal females with T2DM.MethodsAccording to the tertiles of SII, 423 postmenopausal females with T2DM were divided into three groups: low-level (≤ 381.32, n = 141), moderate-level (381.32–629.46, n = 141), and high-level (≥ 629.46, n = 141). All participants were followed up for 7 years with a median of 46.8 months (1651 person-years). The association between SII and fragility fracture risk was assessed.ResultsOf 423 subjects, 75 experienced a fragility fracture event. Spearman partial correlation analysis revealed that SII was negatively related to bone mineral density (BMD) and was positively associated with the future 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF). Restricted cubic spline (RCS) analysis revealed a positive correlation between SII and fragility fracture risk in an approximately inverted J-shaped dose–response pattern (P for overall < 0.0001). Multivariate Cox regression analysis demonstrated that patients with a high SII presented a greater risk of fragility fractures (P = 0.011). Stratified analysis revealed that fragility fractures in the high-level SII were predominantly associated with anemia with an increase of 4.15 times (P = 0.01). Kaplan‒Meier analysis indicated a greater cumulative incidence of fragility fractures in patients with a high SII (log-rank, all P = 0.0012). Receiver operating characteristic (ROC) analysis indicated an optimal SII cut-off value of 537.34, with an area under the curve (AUC) of 0.646, a sensitivity of 60%, and a specificity of 64.1% (P < 0.001).ConclusionThe SII revealed a significant positive association with a real-world fragility fracture event and a future 10-year fragility fracture probability in postmenopausal females with T2DM, particularly evident in individuals with anemia. Therefore, monitoring the SII and hemoglobin in postmenopausal older women with T2DM is helpful in routine clinical practice to identify individuals at high risk for fragility fractures and to promptly execute appropriate fracture intervention procedures.

Machine learning based finite element analysis (FEA) surrogate for hip fracture risk assessment and visualization

Classical computational biomechanical approaches are costly and require a high level of expertise, often limiting their clinical application. A data-driven Machine Learning (ML) framework can serve as an effective alternative for disease diagnosis and prediction. This study aimed to develop an ML-based modeling approach integrating Quantitative Computed Tomography-based Finite Element Analysis (QCT-based FEA) to assess fall-induced hip fracture probability and probable facture locations in an elderly individual. Specifically, this study focused on predicting patient-specific hip fracture risk using fracture risk index (FRI), calculated on the basis of 1st and 3rd principal strains, and visualizing strain distributions in the proximal femur by generating surrogate FE models via supervised CatBoost model. The training dataset, comprising clinical, anatomical, and mechanical (loading) features, was obtained from QCT image data and QCT-based FEA, which also provided the FRI and strain distributions as targets. The optimized CatBoost model demonstrated 76% accuracy with an AUROC of 0.81 in fracture risk prediction, as well as correlation coefficients of 0.73 for the 1st principal strain and 0.76 for the 3rd principal strain in the surrogate FE models for visualization. Although trained on a limited dataset, this study highlights the efficacy of ML-based surrogate modeling in the QCT-based FEA process for predicting hip fracture risk and visually identifying fracture locations.

A surrogate FRAX model for Nepal

SummaryA surrogate FRAX® model for Nepal has been constructed using age- and sex-specific hip fracture rates for Indians living in Singapore and age- and sex-specific mortality rates from Nepal.IntroductionFRAX models are frequently requested for countries with little or no data on the incidence of hip fractures. In such circumstances, the development of a surrogate FRAX model is recommended based on country-specific mortality data but using fracture data from a country, usually within the region, where fracture rates are considered to be representative of the index country.ObjectiveThis report describes the development and characteristics of a surrogate FRAX model for Nepal.MethodsThe FRAX model used the ethnic-specific incidence of hip fracture in the Indian community of Singapore, combined with the death risk for Nepal in 2015–2019. The number of hip fractures in 2015 and 2050 was estimated based on the United Nations’ predicted changes in population demography.ResultsThe surrogate model gave similar hip fracture probabilities to estimates from Sri Lanka, India and Pakistan but lower 10-year fracture probabilities for men and women at older ages compared to the model for Singapore, reflecting a higher mortality risk in Nepal compared with Singapore. There were very close correlations in fracture probabilities between the Nepalese and the Singapore models (r> 0.995) so that the use of the Nepalese model had little impact on the rank order of risk, i.e. a person at the xth percentile of risk with one model will be at the xth percentile of risk with the other. It was estimated that 6897 hip fractures arose in 2015 in individuals aged 50 years and older in Nepal, with a predicted 3-fold increase expected by 2050, when 23,409 hip fractures are expected nationally.ConclusionThe surrogate FRAX model for Nepal provides an opportunity to determine fracture probability within the Nepalese population and help guide decisions about treatment.

Genetics and bone mineral density predict the fractures in adults with osteogenesis imperfecta: a prospective study.

Osteogenesis imperfecta (OI) is a rare genetic bone disorder characterized by recurrent fractures. In adults, the value of bone mineral density (BMD) in fracture risk is unknown. We prospectively investigated changes in BMD over time and analysed the determinants of fracture in OI. Among 106 individuals with grade 1 and 4 OI in the Reference Centre of Rare Bone Diseases in Paris, we included those with BMD measurements at one or more skeletal sites (hip, lumbar spine, radius) from 2000 to 2022. For 71 individuals with reliable measurements (44 women, 8 postmenopausal; mean age 41.4 ± 13.7 years), baseline BMD was low at the lumbar spine only (mean Z-score -2.3±1.5), affecting mainly men (mean Z-score -3±1.6). Longitudinal changes were assessed for a median follow-up of 5.1 years (interquartile range 3.2-8.8). On adjustment for age, sex and body mass index, BMD did not significantly change at any site. Logistic regression analysis revealed a high probability of fracture with baseline BMD Z-score <-2 SD versus ≥-2 SD (odds ratio 4.38, 95% CI 1.10-21.75, p=0.048) and harbouring splicing, stop codon and frameshift variants of COL1 gene (odds ratio 29.8, 95% CI 2.56-1503, p=0.024). our OI cohort showed low BMD at the lumbar spine but no significant change at any site after a median of 5.0 years of follow-up. The probability of fracture was associated with baseline BMD Z-score <-2 SD versus ≥-2 SD and harbouring COL1 splicing, stop codon and frameshift variants.

Plastic strain effect on cleavage microcracks propagation in probabalistic statement. Part 2. Research results

The second part of the paper presents the results of uniaxial tension testing of smooth round bars of 2Cr–Ni–Mo–V steel in the thermally-embrittled state and St3 steel in the initial state. SEM examination of the fracture surfaces is carried out. The brittle fracture probability is calculated using the Prometey model presented in the first part of this article. It has been found that the plastic strain effect on the microcrack propagation probability is caused by two reasons: (1) the critical brittle fracture stress increase due to formation of new barriers for microcrack under plastic deformation, and (2) the working volume decrease due to the neck formation in tensile round bar. A unified set of parameters has been proposed to take into account the plastic strain effect on cleavage microcracks propagation probability for WWER-1000 RPV steel and low-alloyed low-strength steel.

Low geriatric nutritional risk index is associated with osteoporosis and fracture risk in patients with chronic liver disease: a cross-sectional study

BackgroundPatients with chronic liver disease (CLD) frequently suffer from malnutrition and bone diseases, both of which heighten the risk of poor clinical outcomes. This study investigated the relationship between geriatric nutritional risk index (GNRI) and osteoporosis or fracture risk using the fracture risk assessment tool (FRAX) in patients with CLD.MethodsThis cross-sectional study included 209 consecutive patients with CLD. The participants were divided into two groups: the all-risk group (GNRI ≤ 98.0) with nutrition-related risk and the no-risk group (GNRI > 98.0) without nutrition-related risk. Osteoporosis was diagnosed according to the World Health Organization criteria. The FRAX was used to estimate the 10-year probabilities of hip fracture (FRAX-HF) and major osteoporotic fracture (FRAX-MOF).ResultsOf the 209 patients, 72 (34.4%) had osteoporosis. The all-risk group had a significantly higher prevalence of osteoporosis than the no-risk group (p < 0.001). Conversely, patients with osteoporosis had significantly lower GNRI than those without osteoporosis (p < 0.001). Multivariate analysis found lower GNRI to be a significant and independent risk factor for osteoporosis (odds ratio [OR], 0.927; p < 0.001) and high fracture risk derived from FRAX (without BMD) (OR, 0.904; p = 0.009). GNRI had a positive correlation with bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, but a negative correlation with FRAX-HF and FRAX-MOF in the FRAX with and without BMD (p < 0.001 for all). The cutoff value of GNRI for predicting osteoporosis was 104.9, with sensitivity of 0.667 and specificity of 0.657.ConclusionsThe GNRI was significantly associated with osteoporosis and FRAX-derived fracture risk in patients with CLD, suggesting that it could be a simple and useful indicator for the management of bone diseases.

Cost-effectiveness intervention thresholds for romosozumab and teriparatide in the treatment of osteoporosis in the UK.

To estimate the 10-year probability of a major osteoporotic fracture (MOF) at which sequential treatment with romosozumab or teriparatide followed by alendronate, compared with alendronate alone, becomes cost-effective in a UK setting. A microsimulation model with a Markov structure was used to simulate fractures, costs, and quality-adjusted life years (QALYs), in women receiving sequential treatment with either romosozumab or teriparatide followed by alendronate, compared with alendronate alone. Patients aged 50 to 90years with a recent MOF, hip or spine fracture were followed from the start of a 5-year treatment until the age of 100years or death. The analysis had a healthcare perspective. Efficacy of romosozumab, teriparatide and alendronate was derived from phase III randomised controlled trials. Resource use and unit costs were derived from the literature. Cost-effectiveness intervention threshold (CEIT), defined as the 10-year probability of a major osteoporotic fracture at which treatment becomes cost-effective, was compared with clinically appropriate intervention thresholds for bone-forming treatment in women with very high fracture risk as recommended by the UK National Osteoporosis Guideline Group (NOGG). The base case analysis showed that sequential romosozumab-to-alendronate treatment was cost-effective from a 10-year MOF probability of 18-35% and above depending on age and site of sentinel fracture at a willingness to pay (WTP) of £30,000. For teriparatide-to-alendronate, treatment was cost-effective at a 10-year MOF probability of 27-57%. The results were sensitive to pricing of the drugs but relatively insensitive to treatment duration, romosozumab persistence assumptions, and site of sentinel fracture. The CEITs for romosozumab-to-alendronate treatment were lower than the clinical thresholds from the age of 70years meaning that treatment could be considered both cost-effective and aligned with the NOGG treatment guidelines. By contrast, for teriparatide-to-alendronate the CEITs were higher than the clinical thresholds irrespective of age. However, cost-effective scenarios were found in the presence of strong clinical risk factors in addition to a recent sentinel fracture. The results of this study indicate that sequential romosozumab-to-alendronate or teriparatide-to-alendronate treatment can be a cost-effective treatment option for postmenopausal women at very high risk of fracture.

Grain Microstructure in Friction-Stir-Welded Dissimilar Al/Mg Joints of Thin Sheets with/without Ultrasonic Vibration.

Electron backscattered diffraction (EBSD) characterization was conducted on the typical regions in friction-stir-welded dissimilar Al/Mg joints of 2 mm thick sheets with/without ultrasonic assistance. The effects of ultrasonic vibration (UV) on the grain size, recrystallization mechanisms, and degree of recrystallization on both sides of the Al-Mg bonding interface and the intermetallic compounds (IMCs) were investigated. It was found that on the Mg side of the weld nugget zone (WNZ), the primary dynamic recrystallization (DRX) mechanisms were discontinuous dynamic recrystallization (DDRX) and continuous dynamic recrystallization (CDRX), with geometric dynamic recrystallization (GDRX) playing a secondary role. On the Al side of the WNZ, CDRX was identified as the primary mechanism, with GDRX as a secondary contributor. While UV did not significantly alter the DRX mechanisms in either alloy within the WNZ, it promoted the aggregation and rearrangement of dislocations. This led to an increase in high-angle grain boundaries (HAGBs) and an enhanced degree of recrystallization in the welds. The average grain size in both the Al and Mg alloys of the WNZ followed a pattern of initially increasing and then decreasing along the thickness direction, reaching a maximum in the upper-middle part and a minimum at the bottom. The influence of UV on the average grain size in the WNZ was minimal, with only slight grain refinement observed, and the minimum refinement degree was only 0.9%. The Schmid factor (SF) on the WNZ and thermo-mechanically affected zone (TMAZ) boundary regions of the advancing side (AS) indicates that the application of UV increased the likelihood of basal slip and extension twinning in the crystal structure. In addition, UV reduced the thickness of IMCs and improved the strength of the Al-Mg bonding interface. These results suggest a higher probability of fracture along the TMAZ and WNZ boundary on the AS when UV was applied.

Fracture Risk Prediction Using the Fracture Risk Assessment Tool in Individuals With Cancer

The Fracture Risk Assessment Tool (FRAX) is a fracture risk prediction tool for 10-year probability of major osteoporotic fracture (MOF) and hip fracture in the general population. Whether FRAX is useful in individuals with cancer is uncertain. To determine the performance of FRAX for predicting incident fractures in individuals with cancer. This retrospective population-based cohort study included residents of Manitoba, Canada, with and without cancer diagnoses from 1987 to 2014. Diagnoses were identified through the Manitoba Cancer Registry. Incident fractures to March 31, 2021, were identified in population-based health care data. Data analysis occurred between January and March 2023. FRAX scores were computed for those with bone mineral density (BMD) results that were recorded in the Manitoba BMD Registry. This study included 9877 individuals with cancer (mean [SD] age, 67.1 [11.2] years; 8693 [88.0%] female) and 45 877 individuals in the noncancer cohort (mean [SD] age, 66.2 [10.2] years; 41 656 [90.8%] female). Compared to individuals without cancer, those with cancer had higher rates of incident MOF (14.5 vs 12.9 per 1000 person-years; P < .001) and hip fracture (4.2 vs 3.5 per 1000 person-years; P = .002). In the cancer cohort, FRAX with BMD results were associated with incident MOF (HR per SD increase, 1.84 [95% CI, 1.74-1.95]) and hip fracture (HR per SD increase, 3.61 [95% CI, 3.13-4.15]). In the cancer cohort, calibration slopes for FRAX with BMD were 1.03 for MOFs and 0.97 for hip fractures. In this retrospective cohort study, FRAX with BMD showed good stratification and calibration for predicting incident fractures in patients with cancer. These results suggest that FRAX with BMD can be a reliable tool for predicting incident fractures in individuals with cancer.

Prevalence of vertebral fractures and associated factors in thai diabetic postmenopausal women

T2DM (Type 2 Diabetes Mellitus) patients with vertebral fractures have a higher mortality rate than non-DM (nondiabetic patients). However, the prevalence of vertebral fractures in the Asian diabetic population is not well established. Moreover, despite an apparent increase in fracture risk in patients with diabetes, Asian countries have provided contradictory data demonstrating that bone mineral density (BMD) varies significantly in T2DM patients. The aim of this study was to examine and compare the prevalence of vertebral fractures and osteoporosis, as well as BMD and the FRAX score, between individuals with and without T2DM and assess the association of these factors with vertebral fractures. Postmenopausal Thai women attending diabetic and health check-up clinics were recruited. BMD at the lumbar spine, total hip, and femoral neck was measured via dual-energy X-ray absorptiometry. A morphometric vertebral fracture (VF) was defined by a lateral thoracolumbar (T-L) X-ray radiograph. The Fracture Risk Assessment Tool (FRAX) was used to calculate the 10-year probabilities of hip and major osteoporotic fracture (MOF), which were calculated on the basis of the Thai FRAX model. A total of 435 participants were recruited, including 145 postmenopausal women with T2DM and 290 non-DM individuals. T2DM patients had a significantly greater BMI (p = 0.006) and BMD at the femoral neck (p = 0.024) and total hip (p = 0.017), but there was no significant difference in the FRAX score, including the 10-year probability of hip fracture or MOF, either with or without BMD, between individuals with and without T2DM. The prevalence of osteoporosis in non-DM women was significantly higher at the femoral neck (OR = 0.56, 95% CI: 0.34 to 0.93, p = 0.029) but comparable at the lumbar spine. Individuals with T2DM had a significantly higher rate of vertebral fractures, particularly those involving two or more levels, than those without T2DM. Diabetes was significantly associated with \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document}2 VF (OR = 3.83, 95% CI: 1.77 to 8.28, p = 0.001), and the association remained unchanged after controlling for other clinical factors (adjusted OR = 3.72, 95% CI 1.70–8.15; p = 0.001). Our study demonstrated a greater prevalence of multiple (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\ge\\:$$\\end{document} two levels) VFs in women with T2DM than in non-DM controls.

Fracture strength analysis of large-size and thin photovoltaic monocrystalline silicon wafers

Diamond wire slicing technology is the main method to manufacture the substrate of the monocrystalline silicon-based solar cells. With the development of technology, the size and thickness of monocrystalline silicon wafer are respectively getting larger and thinner, which cause an increase in silicon wafer fracture probability during wafer processing and post-processing. And the change of the sawing speed, saw wire diameter and abrasive size also affect the wafer’s surface characteristics, thereby affect its fracture strength. In this paper, monocrystalline silicon wafer with large size of 210 mm × 210 mm was taken as the research object, 4-point bending test was carried out on each series of silicon wafers. The load–displacement curves during bending test were collected, and the fracture stress values were calculated by finite element method. The characteristic fracture strength and Weibull modulus of each series of silicon wafers were obtained through the statistical analysis of the data using Weibull distribution function. The effect of the silicon wafer thickness, the position of the silicon wafer in the silicon brick (usage time of the saw wire varies), and the bending test direction on the fracture characteristics was analyzed. The results showed that the increase of thickness increase the characteristic fracture strength of silicon wafer. The characteristic fracture strength of the front wafers (sawn by the fresh wire) is the smallest, while the characteristic fracture strength of the middle wafers and the rear wafers (sawn by the worn wire) are similar. The characteristic fracture strength of bending in the direction of perpendicular to the saw marks is 2–3 times that of bending in the direction of parallel to the saw marks. The reason of the difference of characteristic fracture strength was analyzed based on the surface morphology, roughness, and the saw marks of silicon wafer. In this paper, the fracture characteristics of large size monocrystalline silicon wafer are studied to provide fracture data support for industry production. The mechanism and main effect factors of silicon wafer fracture are revealed, which provides directions for improving the sawing quality and reducing the fracture probability during wafer production process and post-processing.