Bone Mineral Density Screening Research Articles

Screening For Osteoporosis And Osteopenia In Rural Population Using Calcaneum QUS – A Camp Based Study

BACKGROUND: Increasing prevalence of osteoporosis and osteopenia in the Indian population is a major community health concern in future. Camp based screening of low bone mineral density (BMD) by using calcaneum quantitative ultrasound scan (QUS) is widely used low cost procedure in India. Hence Calcaneum QUS was used to determine the prevalence of osteoporosis and osteopenia in rural population of Gurukunj Ashram, Dist Amravati (Maharashtra) in present camp based study. METHODS: In present study total 99 participants aged 25-65 years were included. Each participant was enquired for their demographic details, dietary habit, lifestyle pattern, exercise and menstrual history related information in prescribed format and assessed for BMD (as T score) by using calcaneum QUS. The data were express in percentages and proportions and results were expressed as descriptive statistics. Chi square test was used to compare the risk factors for categorical variables. RESULTS: Out of total participants (n=99), 66.66% (n = 66) were female subjects and 33.3% (n = 33) were male. As per the WHO criteria of BMD, 34.34 % participants were osteoporotic, 56.56% were osteopenic, whereas approximately 9.09% had normal bone density. A significant association (χ2 = 38.50, P < 0.00001) was reported between the T‑score and different age groups. Study shows apparent increasing trend in the frequency of osteopenic and osteoporotic participants with age of 35 and 56 years onward respectively. CONCLUSIONS: Present camp based reports the high prevalence of low bone mass density in increasing age in rural population.

Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: A prospective study of 239 women.

Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3months, 1year, and 2years after RT. Imaging studies were assessed for pelvic fractures for up to 5years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. The median age at diagnosis was 51years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3years, respectively. Fractures were associated with baseline osteoporosis (P<.001), higher baseline bone-specific alkaline phosphatase (P<.001), and older age (P=.007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3months, 1year, and 2years, respectively. A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.

P214 Low bone mineral density in inflammatory bowel disease patients

Abstract Background Low bone mineral density (BMD) is an extra-intestinal manifestation and common complication of inflammatory bowel disease (IBD). There are many risk factors thought to contribute to this reduction in BMD but there is no clear consensus on screening for low BMD in IBD. This study was performed to determine the prevalence, screening strategy and risk factors for low BMD in the IBD population at a single tertiary centre. Methods Patients with IBD attending a single tertiary centre were included. Electronic medical records were reviewed and data on demographics, BMD assessments with dual-energy X-ray absorptiometry (DXA) scans as well as risk factors for low BMD were collected. BMD classification was in line with the World Health Organisation definitions. Multivariate analysis with logistic regression was used to compare variables. Results There were a total of 553 IBD patients; 281 (50.8%) were females and 364 (65.8%) had Crohn’s disease. Of the total cohort, 245 (44.3%) had a DXA scan performed. Of the 245 patients that had a DXA scan, 101 (41.2%) were defined as osteopenic, 16 (6.5%) were defined as osteoporotic and 128 (52.2%) had normal BMD. The average age of the DXA cohort at the time of scanning was 39 years old. There were 124 (50.6%) females and Crohn’s disease was present in 70.2% (n = 172) of the DXA cohort. The average BMI of the DXA cohort was 26.5 with a range of 16.5 to 59.1. The majority (n = 173; 70.6%) of the DXA cohort had reportedly never smoked with the rest being either current smokers (n = 35; 14.3%) or ex-smokers (n = 37; 15.1%) at the time of their scan. Follow up DXAs occurred in 34.6% of those 245 patients with an average time between scans of 4.6 years. In terms of the risk factors, gender was not found to be a significant risk factor (p = 0.085) along with the type of IBD (p = 0.174), steroid usage 20 mg/day in the 2 years prior to DXA scan (p = 0.886) and smoking history (p = 0.195). However, patients aged ≥50 years were more likely to have low BMD than patients aged &amp;lt;50 years (65.6% vs. 41.8%, p &amp;lt; 0.001). Similarly patients with a BMI &amp;lt;25.5 were more likely to have low BMD than patients with a BMI ≥25.5 25.5 (59.7% vs. 36.5%; p = 0.001). Conclusion We found a high prevalence of osteopenia (41%) but osteoporosis (6.5%) was uncommon in this IBD population from a single tertiary centre. Only age ≥50 years and BMI &amp;lt;25.5 were found to be significant risk factors for low BMD. Screening of this population was inconsistent with only 44% of the total cohort having an initial DXA scan and 35% of those who have an initial scan having a follow-up DXA scan. Local guidelines on screening for low bone mineral density are warranted.

Mandibular radiomorphometric parameters of women with cemento-osseous dysplasia.

To compare the radiomorphometric parameters of mandibular trabecular and cortical bone of females with and without cemento-osseous dysplasia (COD). A retrospective cross-sectional paired study was conducted. Digital panoramic radiographs were obtained from females diagnosed in a public service of Oral Medicine. The participants were divided into two groups of 50 subjects each: females with a diagnosis of COD (COD group) and females without a diagnosis of COD (non-COD group), randomly chosen from the image database and paired for age. The radiomorphometric parameters analyzed were: mandibular cortical width (MCW), fractal dimension (FD) and mandibular cortical index (MCI). The paired t-test and Wilcoxon test were used to compare MCW and FD values and the McNemar-Bowker test compared the MCI. The mean age of both groups was 46.84 ± 11.38 years. The median MCW index was 3.12 mm (2.15-4.55) for the COD group and 3.52 mm (1.90-4.70) for the non-COD group (p = 0.034). The mean FD value of the COD group (1.2039 ± 0.0926) was lower than that of the non-COD group (1.2472 ± 0.0894) in the anatomical region of the interest of mandibular cortical bone (p = 0.031), while no difference was detected in alveolar trabecular bone. The C3 degree of MCI was more frequent in the COD group (p = 0.009). Females with COD had lower values of radiomorphometric parameters in mandibular cortical bone than females of the same age without COD. These results suggest that, in addition to the dental care recommended in the literature, COD females also require more attention and screening for low bone mineral density.

Evaluation of screening accuracy on osteoporosis self-assessment tool for Asians and its cut-off value in healthy physical examination population

To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population. We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined. A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was -1. The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.

Pelvic Fractures and Changes in Bone Mineral Density Following Radiotherapy for Cervical, Endometrial and Vaginal Cancer: A Prospective Study of 239 Women

Background: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers, however, the long-term effects and survivorship implications need further evaluation. The purpose of our study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) following pelvic RT. Methods: We prospectively evaluated 239 women undergoing RT for cervical, endometrial or vaginal cancer between 2008 and 2015. BMD scans and biomarkers of bone turnover were obtained at baseline and three months, one year and two years following RT. Imaging studies were assessed for pelvic fracture for up to 5 years. Patients with osteopenia, osteoporosis or a pelvic fracture at any point were referred to the endocrinology service for evaluation and treatment. Findings: Median age at diagnosis was 51 years; 132 patients (56%) were menopausal. Primary diagnoses were cervical (64%), endometrial (30%) and vaginal (6%) cancer. Sixteen patients (7·8% 95% CI: 4·5–12·4%) developed a pelvic fracture with actuarial rates of 3·6%, 12·7% and 15·7% at one, two, and three years respectively. Fractures were associated with older age (p=0·007), lower BMI (p = 0·035), menopausal status (p = 0·049), higher baseline BAP level (p<0·001) and osteoporosis at baseline (p<0·001). The proportion of patients with osteopenia/osteoporosis increased from 50% at baseline to 58%, 59%, and 70% at three months, one year, and two years, respectively. Vitamin D deficiency was diagnosed and treated at baseline in 43% of patients. Interpretation: A high proportion of women had significant decreases in BMD following pelvic RT, with 7·8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered in these high-risk women. Trial Registration: The study was registered with clinicaltrials.gov (NCT00800644). Funding Statement: National Institutes of Health through MD Anderson's Cancer Center Support Grant CA016672, MD Anderson Cancer Center Institutional Research Grant and Dunaway Family Fund. Declaration of Interests: All the authors declare that they have no conflicts of interest related to this study. Dr. Anil K. Sood has declared consulting relationships (Merck and Kivatec), research funding (M-Trap) and to be a shareholder of BioPath. None of his conflicts are related to this study. Ethics Approval Statement: Institutional Review Board approval was obtained and all patients provided informed consent. This manuscript has been prepared accordingly the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.

The accuracy of panoramic radiography as a screening of bone mineral density in women: a systematic review.

A systematic review and meta-analysis of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes observed in panoramic radiographies could estimate reduced bone mineral density (BMD) similarly to standard technique the bone densitometry (dual energy X-ray absorptiometry) in females older than 30 years. A systematic search in four databases was conducted until January 2019. Two evaluators performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Data were synthesized on a subgroup meta-analysis with a random effect model and the hierarchical summary receiver-operating characteristic curve was used to calculate pooled estimates of studies. Thirty three studies were included and 12 different radiomorphometric indexes identified, including Mandibular Cortical Index (MCI). The final number of cases pooled for the analysis was 5266 females.The MCI for BMD loss (osteopenia) presented values of sensitivity 0.81 [95% confidence interval (CI), 0.78-0.84] and specificity 0.48 (95% CI, 0.45-0.50), while for osteoporosis sensitivity 0.35 (95% CI, 0.30-0.40) and specificity 0.88 (95% CI, 0.86-0.90). The mandibular cortical width presented values of sensitivity 0.58 (95% CI, 0.40-0.73), specificity 0.73 (95% CI, 0.60-0.83) for osteopenia, while for osteoporosis sensitivity 0.57 (95% CI, 0.36-0.76) and specificity 0.83 (95% CI, 0.68-0.92). Due to the high sensitivity, MCI presented a potential value as a screening tool for initial BMD loss (osteopenia), once tests presenting high sensitivity are described as rarely missing subjects with the disease. To the other hand, MCI to osteoporosis and Mandibular Cortical Width for both conditions are not recommended because presented specificity higher than sensitivity. The MCI can be recommended as a feasible tool to screen initial BMD loss (osteopenia) in females above 30 years old using panoramic radiography exams.

114 Opportunistic Screening of Bone Mineral Density With CT Scans in Chronic Pancreatitis

INTRODUCTION: Osteoporosis and fragility fractures have been repeatedly shown to increase morbidity, mortality and socioeconomic costs. Chronic pancreatitis (CP) has multiple shared risk factors and complications that promote an imbalance in bone mineralization and remodeling which ultimately contributes to a high prevalence of metabolic bone disease. However, in the absence of societal guidelines regarding screening, dual-energy x-ray absorptiometry (DEXA) scans are not routinely performed and are not universally covered by insurance. While DEXA scan is the gold standard to assess bone mineral density, a Computed Tomography (CT) L1 vertebral density less than 135 Hounsfield Units (HU) has been validated to diagnose osteoporosis in the general population. The aim of this proof of concept study was to determine if the CT L1 vertebral threshold of 135 HU is also valid as an opportunistic screening cut-point for osteoporosis in chronic pancreatitis patients. METHODS: We selected patients with a definitive diagnosis of CP (according to the American Pancreatic Association guidelines) who were enrolled into The Ohio State Wexner Medical Center Pancreas Disease Biobank. Basic demographic information was abstracted including age, sex, race, BMI, smoking and alcohol history. Pertinent laboratory values and imaging studies, including DEXA scans, were also obtained from these patients. Baseline L1 vertebral HU values on CT scans were determined for BMD assessment (Pickhardt et al, Annals of Internal Medicine 2013). RESULTS: Sixty-four patients with definite CP were identified, including 27 (42%) with a CT and DEXA scan. Of these, 15/27 (56%) had evidence of metabolic bone disease (z-score &lt; −1.5), including 15% with osteoporosis. Mean L1 HU value in those with osteoporosis was 106. There was a statistically significant association between osteoporosis (z score &lt; −2.5) and the CT L1 HU threshold of 135 (P = 0.025, positive likelihood ratio of 8.62, PPV 60%). The L1 HU threshold of 135 had sensitivity of 75% and specificity of 91.3% for osteoporosis and a NPV of 95.45%. CONCLUSION: CT scans performed during routine clinical care of patients with CP may be useful for opportunistic screening for osteoporosis using L1 HU attenuation, especially at a threshold of 135. Larger sample sizes of patients are needed to further develop risk stratification models in CP considering other clinical risk factors.

115 Bone Health in Chronic Pancreatitis: A Pilot Study

INTRODUCTION: Metabolic bone disease is associated with increased morbidity, mortality, and resultant health care costs. Chronic pancreatitis (CP) has multiple overlapping risk factors and complications (smoking, vitamin D malabsorption, fat maldigestion, alcohol abuse, and chronic inflammation) that promote an imbalance in bone mineralization and remodeling. This, in turn, leads to an increased risk of osteoporosis and fragility fractures. In this pilot study, we sought to assess the distribution of bone mineral density (BMD) and the clinical factors associated with reduced BMD in CP. METHODS: We selected patients with a definitive diagnosis of CP (according to the American Pancreatic Association guidelines) who were enrolled into The Ohio State Wexner Medical Center Pancreas Disease Biobank. Demographic and clinical details were abstracted, including age, sex, race, BMI, smoking, and alcohol history, and compared to BMD assessed by DEXA scans. RESULTS: Sixty-four patients with definite CP were identified. A total of 32 (50%) had bone mineral density screening with DEXA scans completed. Of those with BMD assessment, 59.3% (19/32) had a Z-score &lt; −1.5. The overall mean of the lowest DEXA Z-score for the CP cohort was −1.39. Of the CP patients with metabolic bone disease, the majority were older than 50 years of age (68%), and there was an equal distribution of males (59%) to females (60%). The mean Z-score was lower for females than males, although this did not reach statistical significance (−1.9 versus −1.3 respectively; P = 0.25). There was no association with bone disease and race, smoking and alcohol. CONCLUSION: Despite the increased risk of metabolic bone disease, only 50% of patients with CP had screening DEXA scans. Of these, metabolic bone disease was seen in up to 60% of CP patients. Older patients and female-gender had similar bone mineral density trends in CP as expected in the general population. A larger sample size of CP patients is needed to evaluate the true impact and predictors of metabolic bone disease in CP.

Cervical Spine Computed Tomography Hounsfield Units Accurately Predict Low Bone Mineral Density of the Femoral Neck.

A retrospective cohort. The objective of this study to determine the correlation between Hounsfield unit (HU) measurements from the C4 vertebral body and dual-energy x-ray absorptiometry (DXA) T-score. Recent attention has turned to the utilization of HU measurements from computed tomography (CT) as a potential screening method for low bone mineral density (BMD). We hypothesized that cervical spine CT HU measurements will correlate with BMD measurements conducted with DXA scans of the femoral neck. Patients with cervical CT and femoral neck DXA scans at 1 institution were included in the study. HUs were manually measured from the cancellous bone in the C4 vertebrae by 1 author blinded to DXA scans. HU measurements were compared with femoral neck DXA T-scores for the entire population. A total of 149 patients with 149 cervical CT and femoral neck DXA scans were included in the study. The low BMD group (osteoporotic and osteopenic combined) showed a significant difference in HU compared with the normal groups within the study (P<0.0001). A low BMD screening value of 447 HU captured over 95% of patients with low BMD within our study and provided a sensitivity of 92% and negative predictive value of 82.1%. The male and female intrasex analysis demonstrated a significant difference between the low BMD and normal BMD groups with P=0.001 and P=0.0001, respectively. HU measurements taken from the C4 vertebral body on CT scan correlate with low BMD of the femoral neck as determined by DXA scan T-scores. Screening values of 447 HU captured 95% of patients with low BMD, with a high degree of sensitivity, and negative predictive value of 80%. Utilization of cervical spine HU as a screening method provides a simple, quick, and easily assessable screening tool for assessing low BMD. Level III-diagnostic.

Evaluation of screening practices for low bone mass and prevalence of osteoporosis and fractures in people living with human immunodeficiency virus attending a sexual health clinic.

Adults with human immunodeficiency virus (HIV) infection commonly experience fractures and have a high prevalence of osteoporosis. The reasons for low bone mineral density (BMD) in HIV patients are multifactorial and there are now guidelines for screening. The aims of this study were to determine the screening practices for osteoporosis at this sexual health clinic, the prevalence of osteoporosis and to examine the risk factors for bone disease. We performed a retrospective cohort study of all HIV patients attending the Sunshine Coast Health Service District Sexual Health Clinic. Through chart review we collected the following details: patient demographics, co-morbid conditions, HIV status and anti-retroviral therapy, BMD screening, fractures, screening for secondary causes of bone disease and treatment interventions for osteoporosis. A total of 243 patients with HIV attended the sexual health clinic. Of these, 149 met screening criteria for BMD assessment and 93 (61%) of those eligible underwent BMD examination. In those who had a BMD performed, 13 (19%) had sustained a previous fracture, 28 (30%) had osteoporosis and 42 (45%) had osteopenia. In the osteoporosis group, 21 (78%) were treated with vitamin D and calcium, 7 (26%) had a change in ART, 19 (68%) were treated with anti-resorptive therapy and 9 received testosterone replacement. In this cohort, there was a high prevalence of low bone mass and BMD screening rates of 60%. Our results highlight the importance of this condition and the need to improve screening and availability of BMD assessment.

Improving bone mineral density screening in patients with inflammatory bowel disease: a quality improvement report

The prevalence of osteopenia and osteoporosis in patients with inflammatory bowel disease (IBD) is estimated between 17% and 41%, partly due to repeat courses of glucocorticoids which enhance the risk...

Multiple sclerosis is associated with low bone mineral density and osteoporosis

To compare measures of bone mineral density (BMD) between people with and without MS. Using population-based administrative data from Manitoba, Canada, we identified people with MS who received BMD screening and controls who received BMD screening matched 5:1 on age, sex, region of residence, and date of BMD screening. We determined the BMD T-scores for the femoral neck, total hip, and lumbar spine and frequency of osteoporosis (defined as T-score -2.5 or lower). We compared the groups with respect to the femoral neck T-score using multivariable linear regression, adjusting for age, sex, region, disability, continuity of care, recent previous fracture, falls history, medication use, and comorbidities. We compared the odds of osteoporosis between groups using multivariable logistic regression analysis. We identified 783 MS cases who underwent BMD screening and 3,915 matched controls. The mean (SD) femoral BMD T-score was lower in MS cases (-1.48 [1.08]) than in matched controls (-1.12 [0.98], p < 0.001), and the prevalence of osteoporosis was higher among the MS cases (range across BMD sites: 16%-26%) vs controls (6%-15%). MS was associated with a lower femoral neck BMD T-score after accounting for covariates (β = -0.24; 95% CI: -0.32 to -0.17) and more than 2-fold increased odds of osteoporosis (covariate-adjusted OR 2.41; 95% CI: 1.82-3.19). People with MS have lower BMD and a higher prevalence of osteoporosis compared with people of similar age and sex without MS. These findings indicate the importance of addressing bone health as part of comprehensive MS care.

Unrecognized Osteoporosis Is Common in Patients With a Well-Functioning Total Knee Arthroplasty

BackgroundPeri-prosthetic fractures after total knee arthroplasty (TKA) are associated with poorer outcomes and high costs. We hypothesize that osteoporosis is under-recognized in the TKA population. The purpose of this study is to report osteoporosis prevalence in a healthy cohort of patients with well-functioning TKA and to compare prevalence between males and females. MethodsThis study is a cross-sectional study of 30 adults (15 males/15 females) aged 59-80 years without known bone health issues who volunteered to undergo routine dual-energy X-ray absorptiometry 2-5 years (average 3.2 ± 0.8) after primary unilateral TKA. These data plus clinical risk factors were used to estimate fracture risk via the Fracture Risk Assessment Tool and skeletal status (normal, osteopenic, osteoporotic) was determined based on the World Health Organization definition. The National Osteoporosis Foundation criteria for treatment were applied to all patients. ResultsSix of 30 (20%) patients had T-score ≤ −2.5. Eighteen of 30 (60%) patients had T-score between −1 and −2.5 and 6 (20%) patients had T-score ≥ −1. Five patients with normal or osteopenic bone mineral density (BMD) had occult vertebral fractures. Eleven of 30 (36.7%) patients met National Osteoporosis Foundation criteria for pharmacologic treatment. ConclusionThe prevalence of occult osteoporosis meeting treatment guidelines after TKA is substantial in this sample (36.7%). BMD and osteoporosis prevalence are similar between men and women. This underappreciated prevalence of osteoporosis may contribute to peri-prosthetic fracture risk. Arthroplasty surgeons and bone health specialists must be aware of post-operative changes in bone density. These data support the further study of post-operative osteoporosis and consideration of routine BMD screening after TKA. Level of EvidenceIII.

Screening and Treatment for Osteoporosis After Stroke

Background and Purpose- Stroke is a risk factor for subsequent osteoporosis and fractures. We sought to understand current rates and predictors of screening and treatment for bone loss after stroke. Methods- Using the Ontario Stroke Registry from July 1, 2003 to March 31, 2013, we identified patients ≥65 years who were seen in the emergency department or hospitalized with stroke at 11 regional stroke centers in Ontario, Canada and discharged alive. We calculated the cumulative incidence of (1) screening with bone mineral density testing and (2) treatment with medications for fracture prevention, within 1 year after the index stroke, accounting for the competing risk of death. We then used cause-specific hazard models to estimate the effect of various covariates on the cause-specific hazard of bone mineral density testing and osteoporosis pharmacotherapy. Results- In the sample of 16 581 patients, 5.1% overall and 2.9% of those without prior testing underwent screening bone mineral density testing, and 15.5% overall and 3.2% of those not previously on treatment were prescribed medications for fracture prevention within 1 year after stroke. Results were similar in all subgroups of patients. Female sex, prestroke osteoporosis, and poststroke falls and fractures were associated with increased rates of osteoporosis pharmacotherapy. Conclusions- Patients with recent stroke are infrequently screened and treated for osteoporosis, which may increase the risk of fractures. Future work should focus on identifying and treating patients who are at increased risk of fractures after stroke.

SAT-523 The Use of FRAX in Identifying Women Less Than 65 Years Needing Bone Mineral Density Testing

The United States Preventive Service Task Force (USPSTF) recommends bone mineral density (BMD) screening for osteoporosis in women under the age of 65 by dual-energy x-ray absorptiometry (DXA) if their risk of a major osteoporotic fracture (MOF) is greater or equal to that of an average 65-year-old woman without risk factors for osteoporosis.(1) The absolute risk of a MOF is calculated using the FRAX ®, a tool that incorporates various risk factors to calculate risk with or without the addition of BMD of the femoral neck as a variable. Those, without the BMD variable, having a calculated 10-year risk of a MOF of 9.3% or greater are recommended for BMD testing. A retrospective chart review was completed for patients between 2012 to 2018. We identified 128 charts and analyzed the extracted data for 113 women < 65-years with osteoporosis confirmed by BMD or fractures. MOF fracture risk calculation without BMD by FRAX of 9.3% or greater were found in 51 (45.1%) patients. Osteoporosis by T-score <-2.5 at the spine, total hip, femoral neck or distal radius was evident in 102 (90%) patients. Previous osteoporotic fractures were noted in 29 (25.7%) patients. Demographics were stratified in terms of high-risk (FRAX >= 9.3%) and low-risk (FRAX< 9.3%). The average age of women in the high-risk group was 58 years and 55 years in the low-risk group. In the high-risk group, 88.2% were Caucasian, 11.8% Hispanic, 0% African American, 0% Asian. In the low risk group, 59.7% were Caucasian, 32.3% Hispanic, 3.2% African American, 4.8% Asian. Women with MOF >9.3% were older, had more years post menopause, and had more risk factors (average 2.18 factors vs 0.61) than women with MOF <9.3%. Total hip T-score was lower in the high-risk group. The sensitivity of FRAX for identifying women with a T-score < -2.5 was 40%. The sensitivity of FRAX for identifying women with a history of fracture was 32%. The sensitivity of FRAX for identifying women with a T-score < -2.5 or identifying women with a history of fracture was 32%. These results demonstrate that the FRAX tool alone, according to USPSTF recommendation, fails to identify many women under the age of 65 with osteoporosis in need of BMD testing. Over half of women would not have had a BMD performed based on guidelines for screening BMD in women < 65. Further study is needed to characterize women under the age of 65 with osteoporosis with FRAX MOF less than 9.3%. Reference: 1. U.S. Preventive Services Task Force (2011). Screening for osteoporosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2011;154:356-64. Research Support: Grant to support statistical analysis from the University of Texas Health San Antonio School of Medicine Office of the Dean.

Simulating Dual-Energy X-Ray Absorptiometry in CT Using Deep-Learning Segmentation Cascade

PurposeOsteoporosis is an underdiagnosed condition despite effective screening modalities. Dual-energy x-ray absorptiometry (DEXA) screening, although recommended in clinical guidelines, remains markedly underutilized. In contrast to DEXA, CT utilization is high and presents a valuable data source for opportunistic osteoporosis screening. The purpose of this study was to describe a method to simulate lumbar DEXA scores from routinely acquired CT studies using a machine-learning algorithm. MethodsBetween January 2010 and September 2014, 610 CT studies of the abdomen and pelvis were used to develop spinal column and L1 to L4 multiclass segmentation. DEXA simulation training and validation used 1,843 pairs of CT studies accompanied by DEXA results obtained within a 6-month interval from the same individual. Machine learning–based regression was used to determine correlation between calculated grade (on the basis of vertebrae L1-L4) and DEXA t score. ResultsAnalysis of the t score equivalent, generated by the algorithm, revealed true positives in 1,144 patients, false positives in 92 patients, true negatives in 245 patients, and false negatives in 212 patients, resulting in an accuracy of 82%. Sensitivity for the detection of osteoporosis or osteopenia was 84.4% (95% confidence interval, 82.3%-86.2%), and specificity was 72.7% (95% confidence interval, 67.7%-77.2%). ConclusionsThe presented algorithm can identify osteoporosis and osteopenia with a high degree of accuracy (82%) and a small proportion of false positives. Efforts to cull greater information using machine-learning algorithms from pre-existing data have the potential to have a marked impact on population health efforts such as bone mineral density screening for osteoporosis, in which gaps in screening currently exist.

Racial disparities in survivorship care adherence among Medicare beneficiaries with prostate cancer.

72 Background: African-American men with prostate cancer have higher cancer-related and all-cause mortality than their Caucasian counterparts. Differences in adherence to guideline-based survivorship care may contribute to these disparities. Methods: Using the SEER-Medicare database, we conducted a retrospective cohort study of men ≥66 years old treated for localized prostate cancer between 2008 and 2011 who had at least two visits with a specialist or primary care physician after diagnosis. Patients were followed until 2013. We calculated rates of bone mineral density screening (among men treated with androgen deprivation therapy) and colorectal cancer screening after diagnosis, stratified by race and provider seen. We analyzed the association between continuity of care (CoC) and adherence to colorectal cancer screening after calculating a CoC index. Results: Among 107262 men with localized prostate cancer, adherence to colorectal cancer and bone mineral density screening was higher for Non-Hispanic White and Hispanic men compared to African-American men (Table). Adherence to screening was slightly higher for men who followed with primary care physicians compared to specialists. After adjusting for relevant covariates and number of providers, higher CoC with primary care physicians was associated with improved adherence to colorectal screening among Non-Hispanic Whites (OR = 1.25, 95% CI = 1.11-1.40), African-Americans (OR = 1.39, CI = 1.05-1.84) and Hispanics (OR = 2.74, CI = 1.27-5.90). However, higher CoC with specialists was significantly associated with colon cancer screening only among African Americans (OR 1.59, 95% CI 1.25-2.04). Conclusions: Among a large cohort of men with localized prostate cancer, the association between CoC and guideline-based survivorship care varied by type of provider and by racial and ethnic group. [Table: see text]

Accuracy of FRAX® in People With Multiple Sclerosis.

People with multiple sclerosis (MS) have a higher risk of low bone mineral density (BMD), osteoporosis, and osteoporotic fractures than healthy adults. The Fracture Risk Assessment tool (FRAX® ) has been reported to underestimate fracture risk in people with MS when BMD is unknown. We tested FRAX performance for people with MS when BMD is known, and determined if MS is a risk factor for fracture independent of FRAX score. Using population-based databases in Manitoba, Canada, we identified people with MS who underwent BMD screening after MS diagnosis (n = 744) and controls matched on age, sex, and first BMD screening date (n = 3721). We calculated FRAX 10-year probabilities at the BMD screening date, and ascertained incident major osteoporotic fractures (MOF). Using Cox proportional hazards modeling we assessed the effect of MS on the hazard of MOF, adjusting for FRAX 10-year probabilities. MS cases had a higher mean FRAX 10-year probability of MOF calculated with BMD (8.32 ± 7.53) than controls (6.98 ± 5.18; p < 0.01). MS increased the risk for MOF after controlling for FRAX 10-year probability without BMD (HR 1.67; 95% confidence interval [CI], 1.29 to 2.16), and after controlling for FRAX individual risk factors (HR 1.45; 95% CI, 1.12 to 1.89). MS remained a risk factor for MOF even when controlling for FRAX 10-year probability of MOF with BMD (HR 1.48; 95% CI, 1.14 to 1.92). The FRAX 10-year probability with and without BMD underestimated the observed 10-year MOF risk in MS cases by 3% to 5%. Calibration improved when secondary osteoporosis was used to calculate FRAX without BMD. Calibration was best when the rheumatoid arthritis input was used to calculate FRAX probability along with BMD. Using secondary osteoporosis or rheumatoid arthritis as proxies for MS improves performance of FRAX and accurately predicts MOF outcomes in those with MS. This provides clinicians with a readily available approach to improve the accuracy of fracture prediction in MS. © 2019 American Society for Bone and Mineral Research.

Factors associated with receiving bone mineral density screening among people with multiple sclerosis

BackgroundAccidental falls and fall-related injuries are common among people with multiple sclerosis (MS). Fractures are the most common injury, pointing to the need to understand current practices related to bone health management in this population. We sought to identify factors associated with bone mineral density (BMD) screening, using dual-energy X-ray absorptiometry, among people with MS. MethodsUsing population-based databases from Manitoba, Canada, we identified all people with MS. Through linkage to the Manitoba Bone Mineral Density Database we subsequently determined which of these individuals underwent BMD screening following their MS diagnosis. We used Cox proportional hazards regression analysis to identify factors associated with time to BMD screening after MS diagnosis. ResultsOf the 5729 eligible persons with MS, most were females (n = 4032, 70.4%) and were living in an urban centre (n = 3601, 62.9%). Ten percent (n = 584) had suffered a recent fracture and nearly one-third used anticonvulsants. BMD screening occurred in 783 (13.7%). Factors associated with BMD screening were female sex (hazard ratio [HR] 5.34; 95%CI: 4.10–6.95), prolonged glucocorticoid therapy (HR 3.73; 95%CI: 2.64–5.25), breast cancer (HR 3.54; 95%CI: 2.37–5.30), recent fracture (HR 3.44; 95%CI: 2.39–4.90), continuity of care (HR 1.69; 95%CI: 1.17–2.44), greater disability (HR 1.49; 95%CI: 1.19–1.86), older age (HR/decade 1.34; 95%CI: 1.22–1.34), anticonvulsant use (HR 1.32; 95%CI: 1.06–1.63) and urban (versus rural) residence (HR 1.17; 95%CI: 1.00–1.36). ConclusionFactors known to be associated with low BMD were associated with BMD screening in people with MS, but overall BMD screening rates are relatively low, suggesting that a clinically meaningful proportion of individuals with MS who have low bone mass may be missed.