Bone Mineral Density Screening Research Articles

Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis.

Osteoporosis is an extrahepatic complication of primary biliary cholangitis (PBC) that increases the risk of fractures and mortality. However, Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack. To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC. This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021. We defined subjects with T-scores ≤ -2.5 in any sites (L1 to L4, femoral neck, or total hip) as having osteoporosis. Demographic, serological, clinical, and histological data were collected. Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis. A total of 268 patients with PBC [236 women (88.1%); mean age, 56.7 ± 10.6 years; 163 liver biopsies (60.8%)] were included. The overall prevalence of osteoporosis in patients with PBC was 45.5% (122/268), with the prevalence of osteoporosis in women and men being 47.0% and 34.4%, respectively. The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women (56.3% vs 21.0%, P < 0.001). Osteoporosis in patients with PBC is associated with age, fatigue, menopausal status, previous steroid therapy, body mass index (BMI), splenomegaly, gastroesophageal varices, ascites, Mayo risk score, histological stage, alanine aminotransferase, albumin, bilirubin, platelet and prothrombin activity. Multivariate regression analysis identified that older age, lower BMI, previous steroid therapy, higher Mayo risk score, and advanced histological stage as the main independent risk factors for osteoporosis in PBC. Osteoporosis is very common in Chinese patients with PBC, allowing for prior screening of BMD in those PBC patients with older age, lower BMI, previous steroid therapy and advanced liver disease.

Endocrinology for the hepatologist.

Endocrinology for the hepatologist.

Risk factors for osteoporosis among postmenopausal women in a Nigerian teaching hospital.

Osteoporosis is a progressive bone disease characterized by a reduction in bone mass and density, leading to bone fragility and an increased risk of sustaining fractures. Several studies have shown that the risk for osteoporosis increases with age and after menopause. A cross-sectional study was undertaken of 422 postmenopausal women at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH). Variables such as socio-demographic characteristics, anthropometric indices, and lifestyle habits of participants were assessed. In addition, bone mineral density was measured using a validated portable dual-energy X-ray absorptiometry scanner. The results of the bone mineral density were analyzed based on T-scores. The mean age of the study subjects was 59.8± ±6.4 years, while the mean age at menopause was 50.15 ± 4.1 years. The majority of the subjects were obese (41.5%), while the prevalence of osteoporosis and osteopenia was 15.1% and 30.6%, respectively. The use of oral steroids was associated with osteoporosis (P < 0.05). We recommend regular bone mineral density screening of postmenopausal women at the primary care level for early diagnosis and treatment of osteoporosis to prevent fragility fractures.

The clinical necessity of a distal forearm DEXA scan for predicting distal radius fracture in elderly females: a retrospective case-control study

BackgroundRecent studies have demonstrated that the distal forearm dual-energy X-ray absorptiometry (DEXA) scan might be a better method for screening bone mineral density (BMD) and the risk of a distal forearm fracture, compared with a central DEXA scan. Therefore, the purpose of this study was to determine the effectiveness of a distal forearm DEXA scan for predicting the occurrence of a distal radius fracture (DRF) in elderly females who were not initially diagnosed with osteoporosis after a central DEXA scan.MethodsAmong the female patients who visited our institutes and who were over 50 years old and underwent DEXA scans at 3 sites (lumbar spine, proximal femur, and distal forearm), 228 patients with DRF (group 1) and 228 propensity score-matched patients without fractures (group 2) were included in this study. The patients’ general characteristics, BMD, and T-scores were compared. The odds ratios (OR) of each measurement and correlation ratio among BMD values of the different sites were evaluated.ResultsThe distal forearm T-score of the elderly females with DRF (group 1) was significantly lower than that of the control group (group 2) (p < 0.001 for the one-third radius and ultradistal radius measurements). BMD measured during the distal forearm DEXA scan was a better predictor of DRF risk than BMD measured during the central DEXA (OR = 2.33; p = 0.031 for the one-third radius, and OR = 3.98; p < 0.001 for the ultradistal radius). The distal one-third radius BMD was correlated with hip BMD, rather than lumbar BMD (p < 0.05 in each group).ConclusionPerforming a distal forearm DEXA scan in addition to a central DEXA scan appears to be clinically significant for detecting the low BMD in the distal radius, which is associated with osteoporotic DRF in elderly females.Level of evidenceIII; case-control study.

Reference values of Orthopantomographic indices for early detection of low bone mineral density in Indian population.

Orthopantomographic (OPG) indices are considered tools for early screening for low Bone Mineral Density and Osteoporosis. This tool is being used in the western population, and they have developed their reference values for all the OPG indices. The current study aimed to check the validity of the reference values for OPG indices in the Indian population. A cross-sectional study was conducted on 325 participants, and they were recruited in two sets. Dataset one of 130 aged 20-30 years and dataset two of 195 participants aged 40-60 years. OPG was performed, and indices such as Mental Index (MI), Panoramic Mandibular Index (PMI), Gonial Index (GI) and Antegonial Index (AI) were measured. Values obtained in our study were compared with the established OPG indices for the Indian and Western populations. The mean age of participants in dataset one to develop references was 23.5±2.5 years. Females had a significantly lower MI, PMI, and AI than males (p<0.05). MI was significantly higher in validation dataset one males than females (p<0.05). A good agreement was found in MI and PMI of the two references (p<0.05). The reference values derived from this study for MI, PMI, GI and AI are 3.50,0.27,1.10, 2.50, respectively. Compared with previous studies in Indian and western populations, these references were significantly lower.

Barriers to guideline-concordant use of bone modifying agents for prostate cancer.

68 Background: NCCN Guidelines recommend the use of bone-modifying agents (BMAs) to prevent skeletal-related events (SRE) for patients with castrate-resistant prostate cancer (CRPC) and bone metastasis, but not for castrate-sensitive prostate cancer (CSPC). Prior studies have identified both underuse of BMAs for CRPC and overuse for CSPC, but the clinical circumstances underlying these apparent gaps in care are unknown. Methods: Qualitative interview study, with physicians who treat prostate cancer within an academic cancer center and an affiliated network of community-based practices. Using a semi-structured interview guide, an experienced moderator probed participants’ experiences and perceptions around NCCN Guidelines recommendations, guideline adherence and non-adherence, and barriers to adherence. Interviews also probed participants’ views of potential interventions to promote guideline-concordant BMA use. Participants used Likert-scale items to rate the likely effectiveness of each intervention in influencing BMA practice patterns. They also identified the 3 most helpful interventions for reducing BMA underuse and overuse separately. Results: 19 physicians were invited, of whom 15 agreed to participate; 1 physician did not respond to some questions as outside scope of practice. All were aware of the recommendation for use of BMAs in CRPC. 14% (2/14) were unaware of the recommendation against BMA use for CSPC; an additional 29% (4/14) believed that BMA use could be appropriate for CSPC depending on the burden of bony metastatic disease. 36% (5/14) were unaware of recommendations for baseline DEXA scan and BMA for patients with low bone mineral density. The most commonly reported barriers (occurring “often” or “sometimes”) to BMA use for CRPC were obtaining dental clearance (11/15) and insufficient time in clinic (6/15). The interventions perceived as most helpful to reduce underuse for CRPC were dental navigation (11/15) and EMR-based guidance (9/15). The interventions identified as most helpful to reduce overuse for CSPC were peer-to-peer education (14/15) and EMR-based guidance (13/15). Conclusions: Among physicians treating prostate cancer in our study, there was incomplete awareness of guideline recommendations for screening and treatment of low bone mineral density, and against BMA use for SRE prevention in CSPC. Dental navigation, peer-to-peer education, and EMR-based guidance were preferred implementation strategies to reduce underuse and overuse of BMAs.

Diagnosis of Osteoporosis by Quantifying Volumetric Bone Mineral Density of Lumbar Vertebrae Using Abdominal CT Images and Two-Compartment Model

With the aging population, osteoporosis has become an important public health issue. The purpose of this study was to establish a two-compartment model (TCM) to quantify the volumetric bone mineral density (vBMD) of the lumbar spine using abdominal computed tomography (CT) images. The TCM approach uses water as the bone marrow equivalent and K2HPO4 solution as the cortical bone equivalent. A phantom study was performed to evaluate the accuracy of vBMD estimation at 100 kVp and 120 kVp. The data of 180 patients who underwent abdominal CT imaging and dual-energy X-ray absorptiometry (DXA) within one month were retrospectively collected. vBMD of L1-L4 vertebrae were calculated, and the receiver-operating characteristic curve analysis was performed to establish the diagnostic thresholds for osteoporosis and osteopenia in terms of vBMD. The average difference between the measured vBMD following TCM and the theoretical vBMD of the self-made phantom was 0.2%, and the maximum difference was 0.5%. vBMD of lumbar vertebrae obtained from TCM and aBMD obtained by DXA had a significant positive correlation (r = 0.655 to 0.723). The average diagnostic threshold for osteoporosis was 0.116 g/cm3. The sensitivity, specificity, and accuracy were 95.7%, 75.6.5%, and 80.0%, respectively. The average diagnostic threshold for osteopenia was 0.126 g/cm3. The sensitivity, specificity, and accuracy were 81.3%, 82.5%, and 82.7%, respectively. The aforementioned threshold values were used to perform the diagnostics on a test cohort, and the performance was equivalent to that in the experimental cohort. From the perspective of preventive medicine, opportunistic screening of bone mineral density using abdominal CT images and the TCM approach can facilitate early detection of osteoporosis and osteopenia and, with in-time treatment, slow down their progression.

Association of Plasma Sex-Related Hormones Levels with Bone Mineral Densities and Risk of Osteoporosis and Osteopenia in Men and Menopausal Women with Type 2 Diabetes Mellitus.

This study aimed to examine associations between plasma sex-related hormones with bone mineral density (BMD) and risks of osteoporosis or osteopenia in men and postmenopausal women patients with type 2 diabetes mellitus (T2DM). Baseline information on an ongoing cohort of 149 men and 102 postmenopausal women with T2DM in Xiamen, China were analyzed. Plasma estradiol (E2), total testosterone (T), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin (PRL) were measured. BMD of lumbar spine (L2-4), femoral neck (FN) and total hip (TH) were determined by dual-energy X-ray absorptiometry (DXA). Osteoporosis or osteopenia was defined as the minimum T-scores of BMD of these three different sites of -1.0 or below. T2DM patients with osteoporosis/osteopenia (66.4% in men and 79.4% in postmenopausal women), compared to those without, showed significantly decreased level of E2 (75.3±28.9 vs. 107.8±25.9pmol/L and 18.4 (18.4-29.5) vs. 22.8 (18.4-40.5) pmol/L for men and postmenopausal women, respectively, both p-values <0.05), but not other sex-related hormones (including T, FSH, LH, or PRL). For all T2DM patients together and men separately, multivariable linear regression and logistic regression analyses showed that higher E2 levels were significantly associated with higher BMD T-scores in L2-4, FN, TH and minimum of these three different sites, lower 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HFs) estimated by Fracture Risk Assessment Tool score, as well as decreased risk of osteoporosis/osteopenia. As for postmenopausal women T2DM patients, E2 level was positively associated with BMD T-scores in L2-4 and minimum of three different sites but was not independently associated with risk of osteoporosis/osteopenia. Higher plasma E2 was significantly associated with increased BMD and lower risk of osteoporosis or osteopenia in T2DM patients, especially for men. Screening of BMD and estradiol levels as well as evaluating risks of osteoporosis/osteopenia are important for T2DM patients.

Lifestyle correlates of low bone mineral density in Albanian women

Aim: The aim of this study was to assess the association of lifestyle/behavioral factors with low bone mineral density in Albanian women, a transitional country in the Western Balkans. Methods: A cross-sectional study was conducted in Tirana city in 2010 including a population-based sample of 549 women aged 35 years and above (response rate: 92%). Low bone mineral density (osteopenia and/or osteoporosis defined as a bone mineral density T-score less than -1) was assessed with a bone ultrasound device which is simple and easy to use for screening of bone mineral density in population-based studies. Binary logistic regression was used to determine the relationship of low bone mineral density with behavioral factors in this study population. Results: The prevalence of low bone mineral density in this study population was 28.4% (156/549). In multivariable-adjusted logistic regression models, low bone mineral density was positively associated with smoking (OR=4.1, 95%CI=2.2-7.4) and coffee consumption (OR=2.3, 95%CI=1.3-4.1), but inversely related to overweight and obesity (OR=0.4, 95%CI=0.2-0.7 and OR=0.3, 95%CI=0.2-0.6, respectively). Conclusion: This study offers useful evidence about the lifestyle/behavioral determinants of low bone mineral density among women in this transitional South Eastern European population. Health professionals and policymakers in Albania should be aware of the major behavioral factors which increase the risk of low bone mineral density in order to provide correct treatment and control of this condition in the general population.

Correlation Analysis between Fat Fraction and Bone Mineral Density Using the DIXON Method for Fat Dominant Tissue in Knee Joint MRI: A Preliminary Study

This study aimed to investigate the correlation between the fat signal fraction (FF) of the fat-dominant bone tissue of the knee joint, measured using the MRI Dixon method (DIXON) technique, and bone mineral density (BMD). Among the patients who underwent knee DIXON imaging at our institute, we retrospectively analyzed 93 patients who also underwent dual energy X-ray absorptiometry within 1 year. The FFs of the distal femur metaphyseal (Fm) and proximal tibia metaphyseal (Tm) were calculated from the DIXON images, and the correlation between FF and BMD was analyzed. Patients were grouped based on BMD of lumbar spine (L), femoral neck (FN), and common femur (FT) respectively, and the Kruskal-Wallis H test was performed for FF. We identified a significant negative correlation between TmFF and FN-BMD in the entire patient group (r = -0.26, p < 0.05). In female patients, TmFF showed a negative correlation with FN-BMD, FT-BMD, and L-BMD (r = -0.38, 0.28 and -0.27, p < 0.05). In male patients, FmFF was negatively correlated with only FN-BMD and FT-BMD (r = -0.58 and -0.42, p < 0.05). There was a significant difference in the TmFF between female patients grouped by BMD (p < 0.05). In male patients, there was a significant difference in FmFF (p < 0.05). Overall, we found that FF and BMD around the knee joints showed a negative correlation. This suggests the potential of FF measurement using DIXON for BMD screening.

Comparison of cervical, thoracic, and lumbar vertebral bone quality scores for increased utility of bone mineral density screening.

To evaluate the associations among the validated lumbar vertebral bone quality (VBQ) score, and cervical and thoracic VBQ scores. Radiographic records of 100 patients who underwent synchronous MRI of the cervical, thoracic, and lumbar spine were retrieved. DEXA-validated lumbar VBQ was calculated using median signal intensity (MSI) of the L1-L4 vertebrae and L3 CSF. VBQ was derived as the quotient of MSIL1-L4 divided by MSICSF. Cervical and thoracic VBQ were similarly obtained using C3-C6 and C5 CSF, and T5-T8 and T7 CSF, respectively. Paired sample t-tests were used to evaluate differences among regional VBQ scores. Independent sample t-tests were used to identify sex differences in VBQ. Regression models with one-way analysis of variance (ANOVA) were constructed to identify associations among all permutations of anthropometric and regional VBQ measures. Mean cervical, thoracic, and lumbar VBQ scores were 3.06 ± 0.89, 2.60 ± 0.77, and 2.47 ± 0.61, respectively. Mean differences of .127 (p = 0.045) and - 0.595 (p < 0.001) were observed between thoracic and lumbar, and cervical and lumbar VBQ scores. Correlations of 0.324, 0.356, and 0.600 (p < 0.001) were found between cervical and lumbar, cervical and thoracic, and thoracic and lumbar VBQ scores. Regression with ANOVA predicting lumbar VBQ in relation to cervical and thoracic VBQ demonstrated R Square values of 0.105 and 0.360 (p < 0.001), and β coefficient values of 0.471 and 0.217 (p < 0.001), respectively. Thoracic VBQ provides values representative of the validated lumbar VBQ score. Cervical VBQ scores are distinct from lumbar VBQ scores and do not provide adequate surrogate values of lumbar VBQ.

Sprint and upper limbs power field tests for the screening of low bone mineral density in children.

Background: The possibility of carrying out screening, with acceptable accuracy, of a child's bone mass status based on a physical fitness test can advance the concept of health-related physical fitness. In addition, the relevance of the applicability of this type of screening in educational environments is mainly due to the difficulty of direct assessments of bone health indicators. This study aimed to propose cut-off points for physical fitness tests based on children's bone health indicators. Methods: This is a two-phase cross-sectional study. Phase-1: 160 children (6-11years-old) performed the 20-m sprint test (20-mST) and the 2kg medicine ball throw test (2kgMBTT). Areal bone mineral density (aBMD) and content was assessed by DXA. The area under the ROC curve greater than 70% was considered valid. Phase-2: It was carried out a secondary analysis in a sample with 8,750 Brazilians (6-11years-old). The percentile values (identified in phase-1) were used to identify the values of the cut-off points in the unit of measurement of the tests. The validation of the cut-off points found was by odds ratio values and p ≤ 0.05. Results: Phase 1: The areas under the ROC curve were 0.710, 0.712 (boys and girls-20-mST), 0.703, and 0.806 (boys and girls-2kgMBTT) with total spine and pelvis aBMD as the outcome. Phase 2: From percentile values, we find valid cut-off points in the Brazilian sample (OR > 3.00; p < 0.001) for boys and girls. Values ranged between 5.22s-4.00s to 20-mST and between 125.0cm-160.0cm to 2kgMBTT. Conclusion. The 20-mST and the 2kgMBTT presented sufficient accuracy for the screening of children aged between 6 and 11years with greater chances of having low aBMD in the total spine and pelvis, with valid cut-off points.

Bone mineral density in children and young adults with idiopathic scoliosis: a systematic review and meta-analysis.

Osteoporosis is a risk factor for idiopathic scoliosis (IS) progression, but it is still unclear whether IS patients have bone mineral density (BMD) loss and a higher risk of osteoporosis than asymptomatic people. This systematic review aims to explore the differences in BMD and prevalence of osteoporosis between the IS group and the control group. We searched 5 health science-related databases. Studies that were published up to February 2022 and written in English and Chinese languages were included. The primary outcome measures consisted of BMD z score, the prevalence of osteoporosis and osteopenia, and areal and volumetric BMD. Bone morphometry, trabecular microarchitecture, and quantitative ultrasound measures were included in the secondary outcome measures. The odds ratio (OR) and the weighted mean difference (WMD) with a 95% confidence interval (CI) were used to pool the data. A total of 32 case-control studies were included. The pooled analysis revealed significant differences between the IS group and the control group in BMD z score (WMD -1.191; 95% CI - 1.651 to -0.732, p < 0.001). Subgroup analysis showed significance in both female (WMD -1.031; 95% CI -1.496 to -0.566, p < 0.001) and male participants (WMD -1.516; 95% CI -2.401 to -0.632, p = 0.001). The prevalence of osteoporosis and osteopenia in the group with IS was significantly higher than in the control group (OR = 6.813, 95% CI 2.815-16.489, p < 0.001; OR 1.879; 95% CI 1.548-2.281, p < 0.000). BMD measures by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography showed a significant decrease in the IS group (all p < 0.05), but no significant difference was found in the speed of sound measured by quantitative ultrasound between the two groups (p > 0.05). Both the male and female IS patients had a generalized lower BMD and an increased prevalence of osteopenia and osteoporosis than the control group. Future research should focus on the validity of quantitative ultrasound in BMD screening. To control the risk of progression in IS patients, regular BMD scans and targeted intervention are necessary for IS patients during clinical practice.

Utilizing machine learning for opportunistic screening for low BMD using CT scans of the cervical spine

BackgroundComputed Tomography (CT) scans of the cervical spine are often performed to evaluate patients for trauma and degenerative changes of the cervical spine. We hypothesized that the CT attenuation of the cervical vertebrae can be used to identify patients who should be screened for osteoporosis. MethodsA retrospective study of 253 patients (177 training/validation and 76 test) with unenhanced CT scans of the cervical spine and Dual-energy x-ray Absorbtiometry (DXA) studies within 12 months of each other was performed. Volumetric segmentation of C1-T1, clivus, and first ribs was performed to obtain the CT attenuation of each bone. The correlations of the CT attenuations between the bones and with DXA measurements were evaluated. Univariate receiver operator characteristic (ROC) analyses, and multivariate classifiers (Random Forest (RF), XGBoost, Naïve Bayes (NB), and Support Vector Machines (SVM)) analyzing the CT attenuation of all bones, were utilized to predict patients with osteopenia/osteoporosis and femoral neck bone mineral density (BMD) T-scores <-1. ResultsThere were positive correlations between the CT attenuation of each bone, and with the DXA measurements. A CT attenuation threshold of 305.2 Hounsfield Units (HU) at C3 had the highest accuracy (0.763, AUC=0.814) to detect femoral neck BMD T-scores ≤-1 and a CT attenuation threshold of 323.6 HU at C3 had the highest accuracy (0.774, AUC=0.843) to detect osteopenia/osteoporosis. The SVM classifier (AUC=0.756) had higher AUC than the RF (AUC=0.692, P=0.224), XGBoost (AUC=0.736; P=0.814), NB (AUC=0.622, P=0.133) and CT threshold of 305.2 HU at C3 (AUC=0.704, P=0.531) classifiers to identify patients with femoral neck BMD T-scores <-1. The SVM classifier (accuracy=0.816) was more accurate than using the CT threshold of 305.2 HU at C3 (accuracy=0.671) (McNemar's χ12=7.55, P=0.006). ConclusionOpportunistic screening for low BMD can be done using cervical spine CT scans. A SVM classifier was more accurate than using the CT threshold of 305.2 HU at C3.

Electronic health record data use in the assessment of quality indicators for glucocorticoid osteoporosis screening in systemic lupus erythematosus.

To determine whether electronic health record (EHR) data components could be identified and used to assess bone health quality indicators in patients with systemic lupus erythematosus as a foundation for population health management. We identified patients in our EHR system who had diagnosis codes for lupus from 2012 to 2017 and characterized them based on the frequency and dosage of prescribed glucocorticoid medications. The medical records of patients who received repeated high-dose glucocorticoid orders were further reviewed for osteoporosis, osteoporotic fractures, receipt of appropriate preventive screening, and orders for protective medications based on established quality indicators. Descriptive statistics were calculated to summarize results. We identified 617 patients with a lupus diagnosis; 414 received glucocorticoid prescriptions, 189 received chronic, high-dose; and 83 received chronic, low-dose prescription orders. Of those with chronic high-dose glucocorticoid prescriptions, 14% had an osteoporosis diagnosis, 3% had an osteoporotic fracture, 51% received a prescription for calcium/vitamin D, 43% had bone mineral density screening orders, 20% received a spine radiograph order, 29% had a documented T-score, 12% received a prescription for osteoporosis medication, and 6% had a documented osteoporosis screening. We were able to identify data elements in the EHR for all nine components of the osteoporosis management quality indicator. It is possible to identify data in the EHR for all attributes of the quality indicator for osteoporosis in lupus patients who receive chronic high-dose glucocorticoids. However, missing data and need to extract data from text-based notes may make development of population management tools challenging.

Osteoporosis epidemiology using international cohorts.

To provide an update on the most important new cohort studies within osteoporosis and their bearing on clinical management and directions for future research. We identified a collection of new observational cohort studies - including new reports from already established large cohorts - and intervention studies providing new insights into osteoporosis pathophysiology, risk finding, intervention, and treatment barriers. Recent cohort studies in osteoporosis highlight the importance of timely identification and treatment of people who are at high risk of suffering osteoporotic fractures. Physical performance is a strong indicator of fracture risk and one that is tightly linked to a number of chronic conditions, not least inflammatory conditions like rheumatoid arthritis. Advances in case finding may involve opportunistic screening for low bone mineral density and vertebral fractures of radiology images obtained for other purposes, polygenic risk scores, and routinely collected medication and comorbidity information.

The impact of bone mineral density screening on incident fractures and healthcare resource utilization among postmenopausal breast cancer survivors treated with aromatase inhibitors

Postmenopausal women with hormone receptor-positive breast cancer (BC) often receive aromatase inhibitor (AI) therapy. However, AIs induce bone loss and BC survivors are at an increased risk of bone fractures. This study determined whether receipt of baseline dual-energy x-ray absorptiometry (DXA) screening is associated with decreased incident fractures and lower healthcare resource utilization. We retrospectively analyzed 22,713 stage 0-III primary BC survivors who received AI therapy ≤ 1year prior to BC diagnosis from the Medicare-Linked Surveillance, Epidemiology, and End-Results database. We categorized DXA screening for those who had a procedural claim within 12months prior through 6months after first AI claim. We used propensity score methods to assess the association of DXA screening with bone fractures and health resource utilization. Of the study cohort, 62% received a DXA screening. Women with comorbid dementia, renal disease, and congestive heart failure were less likely to receive a DXA. After adjusting for confounders, BC survivors who received a DXA had a 32% decreased risk of any bone fracture compared to those who did not (hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.60-0.76, p < 0.001). Similarly, those who received a DXA were less likely to be hospitalized (HR 0.73 (0.62-0.86)) or use outpatient services (HR 0.85 (0.74-0.97)). Bone density screening is associated with decreased incident bone fractures and a lower likelihood of utilizing healthcare resource for fracture-related events. Postmenopausal BC survivors treated with AIs should undergo appropriate bone density screening to reduce morbidity, mortality, and health care expenses.

Bone Mineral Density Screening Interval and Transition to Osteoporosis in Asian Women.

Background Bone mineral density (BMD) testing is indicated for women aged 65 years, but screening strategies for osteoporosis are controversial. Currently, there is no study focusing on the BMD testing interval in Asian populations. The current study aimed to evaluate the estimated time interval for screening osteoporosis.Methods We conducted a study of 6,385 subjects aged 50 years and older who underwent dual-energy X-ray absorptiometry screening more than twice at Samsung Medical Center as participants in a routine health checkup. Subjects were divided based on baseline T-score into mild osteopenia (T-score, <–1.0 to >–1.5), moderate osteopenia (T-score, ≤–1.5 to >–2.0), and severe osteopenia (T-score, ≤–2.0 to >–2.5). Information about personal medical and social history was collected by a structured questionnaire.Results The adjusted estimated BMD testing interval for 10% of the subjects to develop osteoporosis was 13.2 years in mild osteopenia, 5.0 years in moderate osteopenia, and 1.5 years in severe osteopenia.Conclusion Our study provides extended information about BMD screening intervals in Asian female population. Baseline T-score was important for predicting BMD screening interval, and repeat BMD testing within 5 years might not be necessary in mild osteopenia subjects.

Osteoporosis in nontuberculous mycobacterial pulmonary disease: a cross-sectional study

BackgroundSince nontuberculous mycobacterial pulmonary disease (NTM-PD) is common in middle-aged/elderly slender women at risk of osteoporosis, we hypothesized that NTM-PD could be associated with osteoporosis. The study aimed to evaluate the prevalence of osteoporosis in patients with NTM-PD compared with that in the general population and determine the factors associated with osteoporosis in the subjects, including the serum estradiol (E2) and 25-hydroxyvitamin D (25OHD) levels.MethodsWe have recruited 228 consecutive adult patients with NTM-PD from a prospective cohort study at the Keio University Hospital, who had no history of osteoporosis or osteoporosis-associated bone fracture but underwent dual-energy X-ray absorptiometry-based bone mineral density (BMD) evaluation from August 2017–September 2019. The E2 and 25OHD levels were measured in 165 patients with available stored serum samples. We performed multivariable logistic regression analyses for osteopenia and osteoporosis.ResultsOsteoporosis (T-score ≤ − 2.5) and osteopenia (T-score − 1 to − 2.5) were diagnosed in 35.1% and 36.8% of patients with NTM-PD, respectively. Compared with the general population, the proportion of osteoporosis was significantly higher in 50–59-, 60–69-, and 70–79-year-old women with NTM-PD. Multivariable analysis revealed that older age (adjusted odds ratio [aOR] for 1-year increase = 1.12; 95% confidence interval [CI] = 1.07–1.18), female sex (aOR = 36.3; 95% CI = 7.57–174), lower BMI (aOR for 1 kg/m2 decrease = 1.37; 95% CI = 1.14–1.65), and chronic Pseudomonas aeruginosa (PA) infection (aOR = 6.70; 95% CI = 1.07–41.8) were independently associated with osteoporosis. Additionally, multivariable analysis in 165 patients whose serum E2 and 25OHD levels were measured showed that both low E2 levels (< 10 pg/mL) and lower 25OHD levels were independently associated with osteoporosis.ConclusionsMiddle-aged/elderly women with NTM-PD have a higher prevalence of osteoporosis than the general population. BMD screening should be considered in NTM-PD, especially in older females with severe diseases such as chronic PA infection and lower BMI, and low serum E2 and 25OHD levels.

Repeat Bone Mineral Density Screening Measurement and Fracture Prediction in Older Men: A Prospective Cohort Study.

Whether repeated bone mineral density (BMD) screening improves fracture prediction in men is uncertain. We evaluated whether a second BMD 7 years after the initial BMD improves fracture prediction in older men. Among 3651 community-dwelling men (mean age 79.1 years) with total hip BMD at baseline and Year 7 (Y7), self-reported fractures after Y7 were confirmed by radiographic reports. Fracture prediction assessed using Cox proportional hazards regression and logistic regression with receiver operating characteristic curves for models based on initial BMD, BMD change, and the combination of initial BMD and BMD change (combination model). During an average follow-up of 8.2 years after Y7, 793 men experienced ≥ 1 clinical fractures, including 426 men with major osteoporotic fractures (MOF) and 193 men with hip fractures. Both initial BMD and BMD change were associated with risk of fracture outcomes independent of each other, but the association was stronger for initial BMD. For example, the multivariable hazard ratio of MOF in the combination model per 1 SD decrement in BMD was 1.76 (95% CI 1.57-1.98) for initial BMD and 1.19 (95% CI 1.08-1.32) for BMD change. Discrimination of fracture outcomes with initial BMD models was somewhat better than with BMD change models and similar to combination models (AUC value for MOF 0.68 [95% CI 0.66-0.71] for initial BMD model, 0.63 [95% CI 0.61-0.66] for BMD change model, and 0.69 [95% CI 0.66-0.71] for combination model). Repeating BMD after 7 years did not meaningfully improve fracture prediction at the population level in community-dwelling older men.