Risk Factors For Osteoporosis Research Articles

Predictive Modeling of Osteoporosis Risk Factors using XGBoost and Bagging Ensemble Technique

This study presents a predictive modeling framework for osteoporosis risk assessment using ensemble techniques, specifically XGBoost and Bagging. Leveraging a dataset comprising comprehensive health factors influencing osteoporosis development, including demographic details, lifestyle choices, medical history, and bone health indicators, the aim is to facilitate accurate identification of individuals at risk. The dataset consists of 1958 samples, evenly distributed between osteoporosis-positive and osteoporosis-negative cases. The methodology involves the separation of features and labels, followed by data splitting into training and testing sets. XGBoost, a powerful gradient boosting algorithm, is employed as the base estimator within a Bagging ensemble, enhancing predictive accuracy and generalization. The model is trained on the training set and evaluated using cross-validation techniques to ensure robustness and mitigate overfitting. The results of the classification report demonstrate promising performance metrics, with an overall accuracy of 88% on the test set. Precision and recall scores indicate strong predictive capabilities, particularly in correctly identifying osteoporosis-positive cases. The novel integration of XGBoost within a Bagging ensemble provides an innovative approach to osteoporosis risk prediction, harnessing the strengths of both algorithms to improve model performance. This research contributes to the advancement of osteoporosis management and prevention strategies by providing a reliable tool for early risk assessment. The combination of machine learning techniques with comprehensive health data offers a valuable approach to personalized healthcare, enabling targeted interventions and optimized resource allocation. Ultimately, this study aims to enhance patient outcomes and reduce the burden of osteoporosis-related morbidity and mortality.

Moderate salt restriction in primary aldosteronism improves bone metabolism through attenuation of urinary calcium and phosphate losses.

Accumulating evidence links osteoporosis and dietary salt consumption. Primary aldosteronism (PA) is a model disease with increased dietary salt intake and constitutes an independent risk factor for osteoporosis. We, thus, assessed whether a short-term moderate reduction in salt intake in PA results in detectable osteoanabolic effects. Forty-one patients with PA on stable mineralocorticoid receptor antagonist therapy were subjected to a 12-week salt restriction. Serum and urinary electrolytes, markers of bone turnover, and a 15 steroids plasma profile were registered. After 12 weeks, urinary calcium and phosphate decreased, while plasma testosterone, serum phosphate, and bone alkaline phosphatase (BAP) all increased significantly. Longitudinal changes in BAP were independently correlated with changes in serum phosphate, parathyroid hormone, and urinary calcium in multivariate analysis. Salt restriction in PA limits urinary calcium and phosphate losses and may confer favorable osteoanabolic effects. Our findings suggest that salt restriction should be considered in patients with PA to improve bone health.

Bone mineral density T-scores comparison between obese and non-obese individuals included in a Fracture Liaison Service following a recent fragility fracture.

This study aimed to compare the mean T-scores of obese and non-obese patients after recent fragility fractures. Over a period of 5 and a half years, from January 2016 to May 2021, patients from a fracture liaison service were identified and their demographic characteristics, osteoporosis risk factors, BMD T-scores, and fracture sites were compared between obese (BMI ≥ 30kg/m2) and non-obese (19kg/m2 < BMI < 30kg/m2) patients. A total of 712 patients were included (80.1% women; mean age 73.8 ± 11.3years). Sixteen % had type 2 diabetes mellitus and 80% had a major osteoporotic fracture (MOF). 135 patients were obese and 577 non-obese, with obese patients younger (p < 0.001) and more frequently female (p = 0.03). Obese patients presented with fewer hip fractures (10% vs. 21%, p = 0.003) and more proximal humerus fractures (16% vs. 7%, p < 0.001) than non-obese patients. After adjusting for age, sex, and diabetes mellitus, BMD T-score values were significantly higher at all measurement sites (lumbar spine, total hip, and femoral neck) in obese patients than in non-obese patients for all types of fractures, with a mean difference of 1 standard deviation (p < 0.001 for all comparisons). The same results were observed in the population limited to MOF. Given the crucial role of BMD T-score in determining the need for anti-osteoporotic medication following fragility fractures, it is reasonable to question the existing T-score thresholds in obese patients.

Psychological Disorders Linked to Osteoporosis Diagnoses in a Population-Based Cohort Study of Middle and Older Age United States Adults.

Although it is well established that psychological disorders and osteoporosis risk are linked, how the relationship manifests is not. This study examines depressive symptoms and a history of psychological problems as potential risk factors for osteoporosis diagnosis, adjudicating between 4 theoretical models rarely tested together. We analyze these models across multiple domains (i.e., demographic, socioeconomic, and health-related), while accounting for bone mineral density (BMD) scans, which have been shown to improve health equity across sex and racial/ethnic identities. Data from the 2012-2016, nationally representative, population-based, cohort Health and Retirement Study (N = 18,224-18,359) were used to estimate 4 logistic regression models with the outcome of osteoporosis diagnosis. Approximately 50% of the sample identified as female and 50% as male, while about 81% identified as White/European American, 11% as Black/African American, and 8% as another race/ethnicity. The key independent variables were depressive symptoms-measured using two common scales-and a history of psychological problems. A history of psychological problems and one depressive symptoms measure were associated with the odds of osteoporosis diagnosis in the presence of other known risk factors for osteoporosis. Support for the theoretical models was limited. Evidence suggests possible directionality; a history of psychological distress may be a risk factor for osteoporosis, though we cannot rule out the other direction. Public health professionals and healthcare providers should consider a history of psychological problems as a risk factor for osteoporosis when deciding whether to recommend a BMD scan.

Features of bone destruction in rabbits with experimental metabolic syndrome

There is now evidence that abdominal obesity and metabolic syndrome in general are associated with a decrease in bone mineral density, which in turn leads to an increased risk of fractures. A high incidence of osteoporosis and vertebral fractures in patients with MS has been proven. Thus, MS can be considered a new risk factor for osteoporosis. We studied biochemical parameters in rabbits with experimental metabolic syndrome, accompanied by bone destruction, as well as in models of metabolic syndrome (MS) and osteoporosis. The level of glucose and c-peptide indicates the development of insulin resistance in animals with MS and MS, accompanied by bone destruction. It has been shown that with metabolic syndrome associated with bone destruction, rabbits exhibit more profound disorders of lipid metabolism than with MS, the level of which differs slightly from each other. The study of bone remodeling indicators in a model of MS accompanied by bone destruction showed individual and gender differences in the content of bone remodeling markers in blood serum. It has been shown that in most experimental animals there is a decrease in osteocalcin, which is a marker of osteosynthesis, and an increase in the level of type I collagen C-telopeptide, which indicates increased destruction of bone collagen. Moreover, the level of bone destruction was more pronounced in males than in females. A study of biomarkers of cartilage tissue degradation showed that the level of change in COMP and hyaluronic acid was higher in females than in males, and the deviation of aggrecan levels from the reference value was higher in males. From our results we can conclude that in male rabbits with MS, bone tissue damage predominated, while in females the degree of cartilage tissue damage was higher.

H. pylori infection and osteoporosis: a large-scale observational and mendelian randomization study

PurposeThere is controversy concerning the relationship between Helicobacter pylori (H. pylori) infection and osteoporosis. This study is to examine the causal relationship between H. pylori infection and osteoporosis and to analyze the potential mechanism underlying the relationship.MethodsThe clinical data of H. pylori infection and bone mineral density from patients or physical examiner with good general condition in our hospital between September 2019 and September 2020 were retrospectively collected. The relationship between H. pylori infection and osteoporosis was compared and analyzed, using logistic regression to examine the potential mechanism underlying the association. To investigate the causal effects of H. pylori infection and osteoporosis, we conducted a two-sample bidirectional Mendelian randomization (MR) analysis.ResultsA total of 470 patients were positive for H. pylori, with a detection rate of 52.22%. It was found that age, SBP, FPG, DBP, ALB, LDL-C, hs-CRP, and OC were positively correlated with osteoporosis, while negative correlations were observed with BMI, LYM, ALB, TP, TG, HDL-C, SCr, UA, and VitD. After stratified analysis of sex and age, it was found that there was a significant correlation between H. pylori infection and osteoporosis. The levels of SBP, ALP, FPG, LDL-C, hs-CRP, and OC in both H. pylori-positive group and osteoporosis group were higher than those in the H. pylori-negative group while the levels of BMI, ALB, TP, HDL-C, SCr, UA, and VitD in the positive group were significantly lower than those in the negative group. Logistic regression analyses with gender and age showed that ALB, FPG, HDL-C, and VitD were common risk factors for osteoporosis and H. pylori infection. In the MR analysis, the IVW results found a positive effect of H. pylori infection on osteoporosis (OR = 1.0017, 95% CI: 1.0002–1.0033, P = 0.0217). Regarding the reverse direction analysis, there was insufficient evidence to prove the causal effects of osteoporosis on H. pylori infection.ConclusionOur study provides evidence for causal effects of H. pylori infection on osteoporosis. H. pylori may affect osteoporosis through serum albumin, high-density lipoprotein, fasting blood glucose and vitamin D.

Osteoporosis and Osteopenia in patients with psoriatic arthritis: a single-center retrospective study.

It is known that fracture risk is increased in patients with psoriatic arthritis (PsA), however, there is no consensus on the association with osteoporosis. The purpose of this study was to elicit the rate of osteoporosis and the risk factors of osteoporosis in patients with PsA at our institution. The data in this study were extracted from 163 patients with PsA. Osteoporosis and osteopenia were defined based on the WHO definition. Osteoporosis was also diagnosed when a fragility vertebral compression fracture was observed. The osteoporosis and osteopenia rates for PsA patients were 11.7% and 33.1%, respectively. The rates of osteoporosis and osteopenia in males were particularly high compared to previous reports, at 9.3% and 34.3%, respectively. Trabecular bone score (TBS) was considered age-appropriate for both males and females. Body mass index (BMI) and TBS were significantly lower in patients with osteoporosis. In patients with PsA, males are at elevated risk of osteoporosis and associated fragility fractures even if they are under 50 years old. BMI was significantly lower in osteoporotic cases, suggesting the importance of bone mineral density testing and treatment in such cases.

Bone loss over time and risk of osteoporosis in advanced pancreatic cancer.

Pancreatic cancer has a high risk of developing osteoporosis. However, the impact of osteoporosis has not been well-studied. This study aimed to evaluate bone loss over time and risk of osteoporosis in patients with advanced pancreatic cancer. We retrospectively examined consecutive patients with unresectable pancreatic cancer who had evaluable computed tomography before treatment and at 1-year follow-up. Bone mineral density at the first lumbar vertebra was measured on computed tomography, and osteoporosis was defined as bone mineral density <135 Hounsfield units. The prevalence and risk factors for osteoporosis, changes in bone mineral density over time and incidence of bone fractures were analyzed. Three hundred eighty patients were included. Osteoporosis was associated with older age, female sex, low body mass index and poor performance status at baseline. A consistent decrease in bone mineral density was observed over time regardless of age, sex or disease status, resulting in an increase in the prevalence of osteoporosis over time (47% at baseline, 79% at 1year, 88% at 2years, 89% at 3years, 95% at 4years and 100% at 5years). Changes in bone mineral density from baseline were greater in patients with locally-advanced pancreatic cancer, in those who received modified FOLFIRINOX or S-IROX for more than 3 months, and in those who received radiation therapy. Incident fractures developed in 45 patients (12%) during follow-up. Osteoporosis and osteoporotic fractures were highly prevalent in patients with advanced pancreatic cancer. This study highlights the importance of screening for osteoporosis in such patients.

Osteoporosis and low bone mass among schizophrenia and bipolar disorder: A cross-sectional study with newly diagnosed, drug-naïve subjects

BackgroundA growing body of data shows that schizophrenia (SCZ) and bipolar disorder (BD) have substantial metabolic risks; however, few studies have focused on bone metabolism. This study aimed to assess the prevalence and associated influencing factors of low bone mass and osteoporosis in SCZ and BD before pharmacological effects occur. Methods108 healthy controls (HCs) and drug-naïve individuals with SCZ (n = 56) and BD (n = 130) had their lumbar spine (L1–L4) and left femur (Neck/Trochanter/Ward's triangle) bone mineral density (BMD) determined using dual-energy X-ray absorptiometry. Besides, we measured bone turnover markers (BTMs) levels, including procollagen I N-terminal propeptide, osteocalcin, and C-terminal cross-linking telopeptide of type I collagen in different groups. ResultsIndividuals with SCZ and BD had significantly lower BMD and significantly higher prevalence of low bone mass and osteoporosis compared with HCs. In the main observation regions of the total lumbar (F = 18.368, p < 0.001) and left femur (F = 14.790, p < 0.001), BMD was lower in individuals with SCZ and BD than HCs, with SCZ showing lower BMD than BD. The osteocalcin (H = 11.421, p = 0.003) levels were significantly higher in SCZ and BD than HCs.Binary regression analysis showed that SCZ or BD was an independent risk factor for low bone mass and osteoporosis. In addition, sex, age, and BTMs also influenced the occurrence of low bone mass and osteoporosis. LimitationsCross-sectional study. ConclusionThe results findings of the study might contribute to our understanding of the increased risk of bone metabolism in SCZ and BD. Clinical trial registrationwww.chictr.org.cn, identifier ChiCTR1900021379.

Association between Osteoporosis and Skeletal Muscle Mass in Men.

Cross-sectional study. This cross-sectional study aimed to investigate the risk factors for osteoporosis in men by assessing bone mineral density (BMD), skeletal muscle mass, body fat mass, grip strength, and advanced glycation end products (AGEs). Fewer studies have reported the correlation between BMD and skeletal muscle mass in women. Moreover, a few studies have examined the relationship between osteoporosis and skeletal muscle mass. This study included 99 men (mean age, 74.9 years; range, 28-93 years) who visited Qiball Clinic for BMD and body composition examinations. The osteoporosis group consisted of 24 patients (mean age, 72.5 years; range, 44-92 years), and the control group consisted of 75 individuals (mean age, 74.9 years; range, 28-93 years). Whole-body skeletal muscle mass was measured using a bioelectrical impedance analyzer. BMD was measured by dual X-ray absorptiometry. Skin autofluorescence (SAF), a marker of dermal AGE accumulation, was measured using a spectroscope. Osteoporosis was defined as a bone density T score of -2.5 or less. Physical findings, skeletal muscle mass, BMD, grip strength, and SAF were compared between the osteoporosis and control groups. The osteoporosis group had significantly lower trunk muscle mass (23.1 kg vs. 24.9 kg), lower leg muscle mass (14.4 kg vs. 13.0 kg), and skeletal mass index (7.1 kg/m2 vs. 6.7 kg/m2) than the control group (all p<0.05). Lower limb muscle mass was identified as a risk factor for osteoporosis in men (odds ratio, 0.64; p=0.03). Conservative treatment of osteoporosis in men will require an effective approach that facilitates the maintenance or strengthening of skeletal muscle mass, including exercise therapy with a focus on lower extremities and nutritional supplementation.

Risk factors of primary Sjögren's syndrome combined with osteoporosis.

Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease that is prevalent in middle-aged and elderly women, characterized by dry mouth, dry eyes, fatigue, and joint pain. Nearly one-third pSS patients have been suffering with osteoporosis (OP), displaying symptoms of lumbago, back pain, and even fracture, all of which severely affect their life quality. Common risk factors for pSS and OP include gender and age, persistent state of inflammation, immune disorders, intestinal flora imbalance, vitamin D deficiency, dyslipidemia and sarcopenia. Meanwhile, the comorbidities of pSS, such as renal tubular acidosis, primary biliary cholangitis, autoimmune thyroid diseases, and drugs (glucocorticoids, methotrexate, and cyclophosphamide) are unique risk factors for pSS complicated with OP. Education, guidance of healthy lifestyle, and OP screening are recommended for bone management of pSS patients. Early detection and intervention are crucial for keeping bone health and life quality in pSS patients.

The Prevalence Of Osteoporosis Is Low in Adult Cutaneous Mastocytosis Patients

BackgroundSystemic mastocytosis (SM) is a clonal disorder of mast cells frequently associated with vertebral osteoporosis (OP) and subsequent vertebral fractures. The natural history of this OP remains unclear. Importantly, we do not know whether OP represents an early event triggered alongside mast cell abnormalities, and whether mast cell clonality is sufficient to trigger osteoporosis. ObjectiveTo describe OP in patients with medullar clonality in cutaneous mastocytosis (CM) and monoclonal mast cell activation syndrome (MMAS) and to compare their osteoporosis characteristics to those of non-advanced SM patients (bone marrow mastocytosis (BMM) and indolent systemic mastocytosis (ISM)). MethodsWe retrospectively analyzed clinical, biological and densitometric data of 27 CM, 13 MMAS and 135 SM patients from the mastocytosis expert center (CEREMAST) in Toulouse. ResultsOP (respectively 3.7, 30.8 and 34.1%) and vertebral fractures (0.0, 15.4 and 20%) were less frequent in CM compared to MMAS and SM, despite the presence of clonal mast cells in the bone marrow. Most patients with OP and vertebral fractures in the non-SM groups had the usual risk factors for OP. Interestingly, the only non-SM patient with a typical SM-like OP had high bone marrow tryptase, developed bone marrow KIT mutation during follow-up, and had a family history of SM. Our data show that OP is not a common clinical finding in CM but is frequent in MMAS. When OP and fractures occur in CM and MMAS patients, they differ from the usual phenotype of SM bone fragility. ConclusionOur findings suggest that in most CM patients, the meaning and management of OP differs from that of OP in MMAS and non-advanced SM. Prospective longitudinal studies and the validation of predictors are needed to identify CM and MMAS patients developing SM-related OP.

Bone health in women with premature ovarian insufficiency/early menopause: a 23-year longitudinal analysis.

Bone health in women with premature ovarian insufficiency/early menopause: a 23-year longitudinal analysis.

Expert opinions on the prevalence, diagnosis and treatment choice for osteoarthritis management in Indian settings

Studies have reported the capability of bisphosphonates to delay the progression of structural deterioration associated with osteoarthritis (OA). Limited studies exist regarding OA management in India and the determinants influencing patients' decisions regarding surgical interventions. So, this study aimed to assess the prevalence, diagnostic practices, and treatment options available for OA management in Indian clinical practice with a special focus on alendronate, a bisphosphonate medication for OA pain management. The cross-sectional, multiple-response questionnaire-based study collected a survey response using a 25-item questionnaire from 276 clinicians across India. Additionally, the survey focused on determining the diagnostic practices helpful in determining osteoporosis and the preference of treatment options for OA management. Based on the responses of 276 participants, 43% indicated that the diagnosis of OA was predominant in both genders. Moreover, about 51% of the respondents suggested that mass screening for osteoporosis in Indian patients should be conducted using the one-minute risk test developed by the International Osteoporosis Foundation. Additionally, 47% of the respondents highlighted hip fractures as the most common type of bone fracture observed in these patients. Furthermore, around 51% of the study participants emphasized that adequate calcium consumption during childhood can potentially reduce the incidence of osteoporosis. For the effective management of OA, alendronate was preferred by 49% of respondents over the other bisphosphonates.As per the expert consensus,patients who have osteoporosis risk factors and osteopenia without fragility fractures were recommended to adhere to dietary and lifestyle modifications, coupled with calcium and vitamin D supplementation, and bisphosphonate therapy. Alendronate was preferred over other bisphosphonates for the effective management of OA.

The impact of chronic obstructive pulmonary disease on bone strength.

Chronic obstructive pulmonary disease (COPD) is a lifestyle-related disease that develops in middle-aged and older adults, often due to smoking habits, and has been noted to cause bone fragility. COPD is a risk factor for osteoporosis and fragility fracture, and a high prevalence of osteoporosis and incidence of vertebral fractures have been shown in patients with COPD. Findings of lung tissue analysis in patients with COPD are primarily emphysema with a loss of alveolar septal walls, and the severity of pulmonary emphysema is negatively correlated with thoracic spine bone mineral density (BMD). On the other hand, epidemiological studies on COPD and fracture risk have reported a BMD-independent increase in fracture risk; however, verification in animal models and human bone biopsy samples has been slow, and the essential pathogenesis has not been elucidated. The detailed pathological/molecular mechanisms of musculoskeletal complications in patients with COPD are unknown, and basic research is needed to elucidate the mechanisms. This paper discusses the impacts of COPD on bone strength, focusing on findings in animal models in terms of bone microstructure, bone metabolic dynamics, and material properties.

Pre-existing osteoporosis and serum vitamin D levels in patients with distal radius fractures: are we missing something?

IntroductionGiven the significant therapeutic gap for osteoporosis, this study aims to investigate the most common osteoporosis-related fracture. The analysis will also consider patients’ serum vitamin D levels and the indications for basic osteoporosis diagnostic tests and osteoporosis therapy prior to fracture.Materials and methodsThis prospective clinical trial included patients with distal radius fractures who underwent surgery at our hospital between 1 April 2021 and 7 April 2022. Blood samples were taken from all participants and existing risk factors for osteoporosis were recorded. In addition, the indication for a guideline-based osteoporosis diagnosis was assessed and the risk of another future fracture with FRAX® was calculated. This information was used to decide whether there was an indication for specific osteoporosis therapy.ResultsA diagnosis gap of 53% and a treatment gap of 84% were identified among the 102 patients investigated. The patients’ ages ranged from 46 to 91 years, with an average vitamin D level of 57 nmol/l, which was below the recommended level of 75 nmol/l. It was noted on a monthly basis that the vitamin D level (without substitution) never exceeded the recommended value of 75 nmol/l in any month. Three-quarters of patients had indications for a baseline osteoporosis diagnosis, yet less than 50% received one. According to FRAX® data, 57% of patients had indications for specific osteoporosis treatment before experiencing the fracture.ConclusionEven without a previous distal radius fracture, many patients are in need of osteoporosis diagnosis or treatment. Our research suggests that patients with distal radius fractures should have their vitamin D levels checked via a blood test and be evaluated for osteoporosis. As endogenous vitamin D levels are often inadequate, year-round vitamin D supplementation should be considered for the prevention of osteomalacia and as a basis for the treatment of osteoporosis.German clinical trial register IDDRKS00028085.

The evaluation of the effect of long-term antihypertensive drug usage on bone density with dental volumetric tomography.

HT is a systemic disease that presents with persistent high blood pressure, which has become an important health problem due to its cause of serious complications and high prevalence in the community. Aim: This study aims to examine the bone mineral density (BMD) of male patients using different groups of antihypertensive drugs for long terms with dental volumetric tomography. The study was carried out using the data of patients who applied to the Dicle University Faculty of Dentistry and underwent the Dental Volumetric Tomography (DVT) scan for any reason. The patients included in the study were divided into 4 groups according to their antihypertensive use; Group 1: 60 patients who never used hypertensive medication before, Group 2: 60 patients who received Calcium Channel Blocker treatment for over 5 years, Group 3: 60 patients who received Beta Blocker treatment for over 5 years, Group 4: 60 patients who received ACE inhibitor treatment for over 5 years. Radiomorphometric measurements were made on the DVT data and the DVT-Mandibular Index Inferior, DVT-Cortical Index, Hounsfield Unit-Cortical and Hounsfield Unit-Spongios values were calculated. The Kruskal-Wallis test, the Mann Whitney test with Bonferroni correction, the One-Way ANOVA and Post-Hoc Tukey test were used in the study. A significant increase in DVT-CI and a significant decrease in HU-CORTIKAL, HU-SPONGIOS and DVT-MII values were observed in the patients using Calcium Channel Blocker medication. These findings pointed to osteoporosis. In addition, no statistically significant difference in the use of antihypertensive drugs in the Beta Blocker and ACE Inhibitor groups compared to the Control Group were found. The long term use of Calcium Channel Blocker group antihypertensive drugs should be considered as a risk factor for osteoporosis in men. Key words:Antihypertensive drug, Osteoporosis, Radiomorphometric index, Mandible, Dental volumetric tomography, Bone mineral density.

Comparison of bone mineral density between female amateur triathletes and nonathletes: A cross-sectional study.

Physical inactivity is considered an important risk factor for osteoporosis, however, some athletes performing extremely high training volumes can also develop bone mass loss. Moreover, the effect of total body mass or body surface area on bone mineral density remains controversial. Therefore, the aim of this study was to compare the absolute bone mineral density and bone mineral density adjusted to body surface area between amateur triathletes and nonactive women. Forty-two healthy women (23 amateur triathletes and 19 nonactive individuals) were evaluated for body composition using a dual-energy X-ray absorptiometry system. Compared to nonactive women, amateur triathletes exhibited lower body mass index (p < 0.001), lower bone mineral density (p < 0.001), and body surface area (p < 0.001). However, bone mineral density adjusted by body surface area in the triathletes was higher than in the nonactive women (p = 0.03). These findings showed that amateur triathles presented lower absolute bone mineral density, but higher bone mineral density adjusted to body surface area. Future studies are recommended to identify if the higher bone mineral density adjusted to body surface area are associated with a lower bone fragility.

Probability of the 10-year Risk of Hip and Major Osteoporotic Fracture in Non-radiographic Axial Spondyloarthritis.

Fracture risk in non-radiographic spondyloarthritis is underestimated. A reliable tool such as the Fracture Risk Assessment tool (FRAX) may assess this risk probability. This study aimed to assess the fracture risk by the FRAX score in patients with nr-axSpA and to determine factors associated with high fracture risk. We conducted a retrospective study of nr-axSpA patients meeting the Assessment of SpondyloArthritis International Society (ASAS) classification criteria for spondyloarthritis. All patients had Bone Mineral Density (BMD) by dual-energy X-ray absorptiometry (DEXA). The 10- year probability of major osteoporotic fracture (MOF) and hip fracture (HF) was calculated using the Fracture Risk Assessment Tool (FRAX). Among 40 patients with nr-axSpA, 27 were women (67.5%). Their mean age was 43.7 ± 12.1 years. The mean disease duration was 3.15 ± 2.7 years. Eighteen patients (45%) had osteopenia, and 12 patients (30%) had osteoporosis. The median HF FRAX was 0% [0-1.2]. The median MOF FRAX was 0.5% [0.3-1.8]. MOF FRAX was positively correlated with age (p = 0.002), disease onset age (p = 0.006), disease duration (p = 0.024), and the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (p < 0.0001), and negatively correlated with daily calcium intake (p < 0.0001). HF FRAX was positively correlated with mSASSS (p < 0.0001) and negatively correlated with daily calcium intake (p = 0.005). Our study confirmed the frequency of bone loss during nr-axSpA and showed that osteoporotic risk fracture was related not only to traditional risk factors for osteoporosis but also to disease-related factors.

Comparison of the prevalence of osteoporosis in people with spinal cord injury according to bone mineral density reference values for the diagnosis of osteoporosis: a retrospective, cross-sectional study

BackgroundSpinal cord injury (SCI) is a complex cause of rapid low bone mass that easily predisposes the affected individuals to osteoporosis-induced fractures. Several studies have investigated osteoporosis pathophysiology in SCI; however, those associated with its diagnosis in SCI are limited. Additionally, errors in osteoporosis diagnosis and its prevalence vary based on the bone mineral density (BMD) reference values (BMDRV), and no studies have reported BMDRV application for osteoporosis diagnosis in individuals with SCI. Therefore, this study aimed to compare the prevalence of osteoporosis among Korean adults aged ≥ 50 years with SCI according to BMDRV for diagnosing osteoporosis.MethodsOverall, 855 patients with SCI who underwent BMD tests of the lumbar spine, femoral neck, and total hip at the National Rehabilitation Center (NRC) in Korea between 2010 and 2020 were included in this retrospective cross-sectional study. Osteoporosis was diagnosed in patients with SCI by comparing the differences in prevalence, diagnostic consistency, and risk factors according to the region-based BMDRV of the dual-energy x-ray absorptiometry (DXA) manufacturer and international BMDRV based on the Third National Health and Nutrition Examination Survey (NHANES III) data of females aged 20–29 years.ResultsThe prevalence of osteoporosis according to the T-score provided by a single reference population of the NHANES III (TNHA) (PONHA) (males: 26.69%; females: 69.35%) was significantly higher in females and males than that according to the T-scores provided by the DXA manufacturer (TDXA) (PODXA) (males: 15.32%; females: 43.15%). The lumbar spine and femoral neck were major osteoporosis diagnosis sites for the PODXA and PONHA, respectively. Risk factors for osteoporosis differed based on the probability of osteoporosis (also known as the OZ ratio) according to the BMD criteria; however, the risk factors were similar according to old age, female sex, low body mass index (BMI), and long SCI period. No significant relationship was noted between the different SCI-related clinical factors (p > 0.05).ConclusionsThe osteoporosis diagnostic site and prevalence in SCI differed according to the regional-based TDXA and international standards of the TNHA. Therefore, further studies on BMDRV are warranted to establish accurate diagnostic criteria for osteoporosis prevention in patients with SCI.