Spine Bone Density Research Articles

A study on the efficacy and safety of long-term adjusted low-dose gonadotropin-releasing hormone agonist therapy for uterine fibroids and adenomyosis.

To investigate the efficacy and safety of long-term adjusted low-dose gonadotropin-releasing hormone agonist therapy (GnRH agonist drawback therapy) with nafarelin acetate in patients with uterine fibroids and/or adenomyosis with menstrual symptoms. This single-center, retrospective, observational study initially included 118 patients with uterine fibroids and/or adenomyosis with menstrual symptoms who had received GnRH agonist (nafarelin acetate) drawback therapy for at least 7 months between 2010 and 2020. Blood hemoglobin level, maximum fibroid diameter, area of the corpus uteri, blood estradiol level, daily dosage of nafarelin acetate, and bone density in the lumbar spine and femoral neck were assessed before and after the treatment initiation. The median treatment period was 28 months. Menstruation had ceased in all patients. The median hemoglobin level significantly increased from 8.6 to 13.2 g/dL before treatment and at 12 months after the treatment initiation in patients with fibroids and from 8.8 to 13.3 g/dL in patients with adenomyosis, respectively. Although the treatment did not exert a significant shrinking effect on the fibroids and adenomyosis, an increase in their size was not observed in any patient. The initial dose of nafarelin acetate was 400 μg/day and was lowered to 130 μg/day at 12 months. Only 29 patients (25%) had an estradiol level <30 pg/mL. The average rate of bone density change over 6 months was -1.23% in the lumbar spine and -1.12% in the femoral neck in patients with fibroids and -1.06% in the lumbar spine and -0.14% in the femoral neck in patients with adenomyosis, which were lower than the previously reported rates. GnRH agonist drawback therapy was found to be useful for the long-term conservative treatment of uterine fibroids and adenomyosis. The treatment was safely and inexpensively performed with few adverse events.

Efficacy and safety of traditional Chinese medicine in managing bone loss post-endocrine therapy in hormone receptor-positive breast cancer patients.

This study aims to evaluate the efficacy and safety of traditional Chinese medicine (TCM) kidney-tonifying methods in treating bone loss and osteoporosis following endocrine therapy in patients with hormone receptor-positive breast cancer. This research systematically searched 6 major medical electronic databases, initially identifying 986 articles, ultimately including 22 randomized controlled trials. These studies encompassed a total of 1579 patients and investigated the impact of TCM kidney-tonifying methods on lumbar spine bone density, lumbar spine bone density T-values, femoral neck bone density, clinical efficacy, and drug safety. The Cochrane quality scoring system was utilized to assess the quality of the literature, and data were synthesized using meta-analysis techniques. TCM kidney-tonifying methods significantly improved lumbar spine bone density (standardized mean difference [SMD] = 0.70, 95% confidence interval [CI]: 0.43-0.97) and lumbar spine bone density T-values (SMD = 1.012, 95% CI: 0.506-1.517). There was also a positive trend in enhancing femoral neck bone density (SMD = 0.645, 95% CI: 0.321-0.970). Although improvements in clinical efficacy did not reach statistical significance (relative risk [RR] = 1.122, 95% CI: 0.933-1.348), the studies indicated good safety of the treatment, with most studies reporting no significant adverse reactions. TCM kidney-tonifying methods may have a positive therapeutic effect on bone loss and osteoporosis following endocrine therapy in patients with hormone receptor-positive breast cancer, demonstrating good tolerability and safety. Given the current evidence, it is recommended to include TCM kidney-tonifying methods as a complementary therapeutic approach in treatment protocols. Future research should further validate these findings and explore their application in different patient subgroups.

6722 Increase in Femoral Neck BMD After Parathyroidectomy in Patients with Mild Primary Hyperparathyroidism

Abstract Disclosure: F. Abdul Kather: None. G.A. Clines: None. C. Janney: None. D.T. Hughes: None. N.H. Esfandiari: None. S. Saberi: None. Objective: This study aimed to assess changes in bone mineral density (BMD) following parathyroidectomy in patients with mild primary hyperparathyroidism, defined as serum calcium 10.4 mg/dl to 11.2 mg/dl, by comparing distinct patient variables. Hypothesis: Pre-op demographic factors, laboratory values, and BMD significantly influence post-parathyroidectomy BMD. Methods: This retrospective chart review included 93 subjects with primary hyperparathyroidism who underwent parathyroidectomy between 2000-2022 with BMD measurements performed at the same site pre- and post-parathyroidectomy. Exclusion criteria were age &amp;lt;50 years, GFR &amp;lt;30, recurrent primary hyperparathyroidism, chronic oral glucocorticoid use (&amp;gt;1 month), rheumatoid arthritis, suppressed serum TSH, hormone-deprivation therapy, cinacalcet use, and prescription osteoporosis medication therapy. Statistical analyses were performed using ANOVA and a p-value of &amp;lt;0.05 was considered statistically significant. Results: The mean age of the subjects was 63.65 ± 6.58 years, who were mostly female (84.9%) and white (88.2%). Pre-op laboratory values revealed mean uncorrected calcium 10.52 ±0.26 mg/dL, corrected calcium 10.25 ± 0.32 mg/dL, 25-OH vitamin D 35.82 ±15.31 ng/mL, and parathyroid hormone (PTH) 99.12 ±37.06 pg/mL. Pre-op mean bone densities for the lumbar spine, femoral neck, and total hip were 1.04 ± 0.16, 0.81 ± 0.11, and 0.87 ± 0.11 g/cm2, respectively, with corresponding T-scores of -1.13 ± 1.23, -1.60 ± 0.74, and -1.13 ± 0.89. Changes in BMD post-parathyroidectomy were determined by comparing pre-op and post-op DXA scans. No statistically significant differences in DXA were found between ages of 50-55 vs. &amp;gt;55, post-op timing of DXA 1-2 years post parathyroidectomy vs. &amp;gt;2 years post parathyroidectomy, number of parathyroid glands removed, the total weight of resected parathyroid glands, pre-op vitamin D level &amp;lt;30 ng/mL vs. ≥30 ng/mL, or pre-op urinary calcium levels &amp;lt;200 mg/day vs. ≥200 mg/day. Grouping subjects by pre-operative DXA T-scores revealed a statistically significant improvement in femoral neck bone density between osteoporotic and osteopenic subjects (p=0.018) and between osteoporotic and normal bone density subjects (p=0.019). No significant differences were identified in the spine and total hip bone density changes among these groups. Conclusion: In subjects with osteoporosis undergoing parathyroidectomy, a significant improvement in femoral neck bone density was observed, unaffected by pre-op variables of age, timing of DXA post parathyroidectomy, parathyroid gland characteristics, and pre-op vitamin D and urinary calcium levels. These findings underscore the potential for tailored interventions in managing bone health post-parathyroid surgery, emphasizing the need for personalized approaches to optimize outcomes in individuals with mild hyperparathyroidism. Presentation: 6/2/2024

The influence of adult urine lead exposure on bone mineral densit: NHANES 2015-2018.

Previous studies have indicated that exposure to heavy metals related to bone health is primarily limited to some common harmful metals, and the impact of lead has not been fully understood. This study aims to explore the relationship between urine lead exposure and bone density. 1,310 adults were included from the NHANES database (2015-2018), and through generalized linear regression analysis and constrained cubic spline models, the association between lead levels and total bone density as well as lumbar spine bone density was explored. The study also examined the impact of combined exposure to lead and cadmium on bone density. Urinary lead levels were significantly negatively correlated with total bone mineral density (β: -0.015; 95%CI: -0.024, -0.007) and lumbar spine bone mineral density (β: -0.019; 95%CI: -0.031, -0.006). Compared to the lowest three quartiles of lead levels, the adjusted odds ratios for T3 changes in total bone mineral density and lumbar spine bone mineral density were 0.974 (95%CI: 0.959, 0.990) and 0.967 (95%CI: 0.943, 0.991), indicating a significant negative trend. Further analysis with constrained cubic spline models revealed a non-linear decreasing relationship between urinary lead and total bone mineral density as well as lumbar spine bone mineral density. Stratified analyses suggested that the relationship between urinary lead levels and bone mineral density might be significantly influenced by age, while gender showed no significant impact on the relationship. Moreover, combined exposure to lead and cadmium was found to be associated with decreased bone mineral density, emphasizing the potential synergistic effects between lead and cadmium on bone health. However, the specific mechanisms of lead and its effects on different populations require further comprehensive research. This study provides valuable insights for further exploration and development of relevant public health policies.

Nonquantitative CT scan Hounsfield unit as a determinant of cervical spine bone density.

Hounsfield unit (HU) values measured using CT have been increasingly recognized to stand as a reliable corollary to dual-energy x-ray absorptiometry (DEXA) scores in evaluating bone mineral density. The authors examined the correlation between cervical HU values and DEXA T- and Z-scores and determined novel cervical HU thresholds for determining bone quality classification. One hundred patients who underwent both cervical spine CT and DEXA, 85 patients who underwent both lumbar CT and DEXA, and 128 patients who underwent cervical and lumbar CT within 24 months at a single institution were included in this retrospective review. Two independent reviewers collected HU values from 3 cervical vertebral levels (C4-6) and 4 lumbar vertebral levels (L1-4), and the averaged values were used. Pearson's correlation coefficient analysis was performed to compare the association of cervical HU values with lumbar HU values and T- and Z-scores. The mean cervical HU values for each DEXA classification were calculated and compared. Receiver operating characteristic (ROC) curves were created to determine the threshold and its sensitivity and specificity for diagnosis. Cervical (C4-6) HU values and average, lumbar, and femoral T- and Z-scores had significant correlations (0.436 > r > 0.274, all p < 0.01). A strong positive correlation between cervical and lumbar HU values was found (r = 0.79, p < 0.01). The average cervical HU value of healthy patients was 361.2 (95% CI 337.1-385.3); of osteopenic patients, 312.1 (95% CI 290.3-333.8); and of osteoporotic patients, 288.4 (95% CI 262.6-314.3). There was a significant difference between the cervical HU values of healthy and osteopenic patients (p = 0.0134) and between those of healthy and osteoporotic patients (p = 0.0304). The cervical HU value of 340.98 was 73.5% specific and 57.9% sensitive for diagnosing osteopenia with an area under the ROC (AUROC) curve of 0.655. The cervical HU value of 326.5 was 88.9% specific and 63.2% sensitive for diagnosing osteoporosis with an AUROC curve of 0.749. This is the second large-scale study and first with a patient population from the United States to show that HU values obtained using cervical CT were significantly correlated with bone quality based on DEXA T- and Z-scores and to establish a cervical HU threshold for determining bone quality classification. These results show that cervical HU values can and should be used to predict poor bone quality in surgical cervical spine patients.

Relationship between non-alcoholic fatty liver and progressive fibrosis and serum 25-hydroxy vitamin D in patients with type 2 diabetes mellitus

ObjectiveWe aimed to analyze the relationship between non-alcoholic fatty liver and progressive fibrosis and serum 25-hydroxy vitamin D (25(OH)D) in patients with type 2 diabetes mellitus.MethodsA total of 184 patients with T2DM who were hospitalized in the Department of Endocrinology of the ShiDong Clinical Hospital between January 2023 and June 2023 were selected. We compared review of anthropometric, biochemical, and inflammatory parameters and non-invasive scores between groups defined by ultrasound NAFLD severity grades.We determine the correlation between 25(OH)D and FLI and FIB-4 scores, respectively.ResultsStatistically significant differences were seen between BMI, WC, C-peptide levels, FPG, ALT, serum 25(OH)D, TC, HDL, lumbar spine bone density, FLI, and FIB-4 in different degrees of NAFLD. Multivariate logistic regression analysis showed that 25(OH)D (OR = 1.26, p = 0.001), age (OR = 0.93, P < 0.001) and BMI (OR = 1.04, p = 0.007) were independent predictors of NAFLD in patients with T2DM.ConclusionsThis study revealed the correlation between serum 25(OH)D levels and NAFLD in patients with T2DM. We also demonstrated that serum 25(OH)D levels were negatively correlated with FLI/FIB-4 levels in patients with T2DM with NAFLD, suggesting that vitamin D deficiency may promote hepatic fibrosis progression in T2DM with NAFLD.

A Comparative Study of Bone-Health and Associated Factors in Healthy Indian Adolescents and Young Women.

Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health. This cross-sectional case-control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography-DXA and pQCT-respectively) were evaluated using standard protocols. A P value of < 0.05 was considered statistically significant. Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls (P < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm2), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm3) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm2) were significantly lower in slum dwelling participants as compared to their NS counterparts (P < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD. The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.

Association between serum insulin-like growth factor 1 and osteoporosis risk in Parkinson's disease: a cross-sectional study.

To examine the correlation between serum insulin-like growth factor 1 (IGF-1) and osteoporosis (OP) in Parkinson's disease (PD). We retrospectively analyzed clinical data from 105 PD patients (PD group) and 78 individuals in the health examination group (HC group). We compared general clinical data and serum IGF-1 levels between the two groups. PD patients were further categorized into PD with OP (50 cases) and PD without OP (55 cases) based on dual-energy X-ray absorptiometry (DXA) results for bone density. We compared general clinical data and serum IGF-1 levels between these two subgroups. Pearson correlation coefficient analysis was conducted to assess the relationship between serum IGF-1 levels and bone density at the lumbar spine and left femoral neck. Multifactorial logistic regression analysis was performed to identify risk factors for PD with OP. Serum IGF-1 levels were significantly lower in the PD group compared to the HC group (P < 0.05). Pearson correlation analysis revealed a positive association between serum IGF-1 levels and both lumbar spine and left femoral neck bone densities (r = 0.653, P < 0.001; r = 0.625, P < 0.001). Multivariate logistic regression analysis identified decreased serum IGF-1 levels, lower uric acid levels, and higher H-Y stage as risk factors for PD with OP (P < 0.05). Reduced levels of serum IGF-1, uric acid, and an increased H-Y stage are closely linked to osteoporosis in PD. Elevating serum levels of IGF-1 and uric acid may potentially offer therapeutic avenues for PD with osteoporosis.

The Effects of Tai Chi Rouli Ball Exercise on Bone Mineral Content and Bone Metabolism Indicators in Perimenopausal Women

Background Perimenopause is associated with a decline in estrogen levels, leading to decreased bone mineral density (BMD) and altered bone metabolism, increasing the risk of osteoporosis. Tai Chi Rouli Ball, a traditional Chinese sport, is thought to have beneficial effects on physical health, but its impact on bone health in perimenopausal women is not well understood.Methods This study involved a randomized controlled trial with 52 perimenopausal women aged 45–55 years from community senior centers. Participants were divided into two groups: the Tai Chi Rouli Ball group and the control group. Baseline assessments of bone density, bone mineral content (BMC), and bone metabolism markers, including estrogen levels, were conducted. The Tai Chi Rouli Ball group underwent regular training for a specific period, while the control group did not receive any intervention. Post-experiment assessments were then compared to the baseline.Results Post-intervention, the Tai Chi Rouli Ball group showed a significant increase in spine bone density and BMC in various body parts, including the whole body, trunk/torso, and spine, compared to the control group. Bone metabolism indicators also improved, with increased levels of estrogen and a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Calcium levels showed a significant increase, while other markers like alkaline phosphatase (ALP), phosphorus (P), and magnesium (Mg) had non-significant changes.Conclusions Tai Chi Rouli Ball exercise may positively influence bone health by improving bone density, BMC, and altering bone metabolism markers in perimenopausal women. These findings suggest that Tai Chi Rouli Ball could be a viable non-pharmacological approach to prevent osteoporosis in this demographic.

Simultaneous automated ascertainment of prevalent vertebral fracture and abdominal aortic calcification in clinical practice: role in fracture risk assessment.

Whether simultaneous automated ascertainments of prevalent vertebral fracture (auto-PVFx) and abdominal aortic calcification (auto-AAC) on vertebral fracture assessment (VFA) lateral spine bone density (BMD) images jointly predict incident fractures in routine clinical practice is unclear. We estimated the independent associations of auto-PVFx and auto-AAC primarily with incident major osteoporotic and secondarily with incident hip and any clinical fractures in 11 013 individuals (mean [SD] age 75.8 [6.8] years, 93.3% female) who had a BMD test combined with VFA between March 2010 and December 2017. Auto-PVFx and auto-AAC were ascertained using convolutional neural networks (CNNs). Proportional hazards models were used to estimate the associations of auto-PVFx and auto-AAC with incident fractures over a mean (SD) follow-up of 3.7 (2.2) years, adjusted for each other and other risk factors. At baseline, 17% (n = 1881) had auto-PVFx and 27% (n = 2974) had a high level of auto-AAC (≥ 6 on scale of 0 to 24). Multivariable-adjusted hazard ratios (HR) for incident major osteoporotic fracture (95% CI) were 1.85 (1.59, 2.15) for those with compared with those without auto-PVFx, and 1.36 (1.14, 1.62) for those with high compared with low auto-AAC. The multivariable-adjusted HRs for incident hip fracture were 1.62 (95% CI, 1.26 to 2.07) for those with compared to those without auto-PVFx, and 1.55 (95% CI, 1.15 to 2.09) for those high auto-AAC compared with low auto-AAC. The 5-year cumulative incidence of major osteoporotic fracture was 7.1% in those with no auto-PVFx and low auto-AAC, 10.1% in those with no auto-PVFx and high auto-AAC, 13.4% in those with auto-PVFx and low auto-AAC, and 18.0% in those with auto-PVFx and high auto-AAC. While physician manual review of images in clinical practice will still be needed to confirm image quality and provide clinical context for interpretation, simultaneous automated ascertainment of auto-PVFx and auto-AAC can aid fracture risk assessment.

Assessing Change in Spine Bone Density from Different Numbers and Combinations of Lumbar Vertebrae: The Manitoba BMD Registry

Introduction: Change in bone mineral density (BMD) is considered significant when it exceeds the 95 % least significant change (LSC) derived from that facility's precision study. The lumbar spine is often affected by structural artifact such that not all four lumbar vertebrae are evaluable. Guidelines suggest using a site-matched LSC when omitting vertebrae from the BMD measurement. The current study describes significant BMD change related to intervening anti-osteoporosis treatment for different numbers and combinations of lumbar vertebrae using site-matched LSC values.Methodology: We identified 10,526 untreated adult women mean age 59.6 years with baseline and repeat spine BMD testing (mean interval 4.7 years) where all 4 lumbar vertebrae were evaluable. Change in spine BMD for different combinations of lumbar vertebrae was assessed in relation to intervening anti-resorptive treatment, contrasting women with high treatment exposure (medication possession ratio, MPR ≥ 0.8) versus women who remained untreated. Site-matched LSC values were derived from 879 test-retest precision measurements.Results: There was consistent linear trend between increasing MPR and BMD change exceeding the LSC for all lumbar vertebral combinations, positive with BMD increase and negative with BMD decrease (all p-trend <0.001). In the high treatment exposure group, mean percent increases in spine BMD were similar for all vertebral combinations, from L1-4 to a single vertebra. In untreated women, mean percent decreases in spine BMD were also similar for all vertebral combinations. The net treatment response (proportion of women with treatment-concordant changes minus proportion with treatment-discordant changes exceeding the LSC) was 29.7 % for 4 vertebrae, 27.5-30.0 % for 3 vertebrae, 22.4-28.5 % for 2 vertebrae, and 18.1-21.9 % for a single vertebra.Conclusions: All numbers and combinations of lumbar vertebrae, when used in conjunction with site-matched LSC values, can provide clinically meaningful follow-up in treated and untreated patients, even when spine BMD is based on a single vertebral body.

Bone density of the cervical, thoracic and lumbar spine measured using Hounsfield units of computed tomography – results of 4350 vertebras

IntroductionThe assessment of bone density has gained significance in recent years due to the aging population. Accurate assessment of bone density is crucial when deciding on the appropriate treatment plan for spinal stabilization surgery. The objective of this work was to determine the trabecular bone density values of the subaxial cervical, thoracic and lumbar spine using Hounsfield units.Material and methodsData from 200 patients who underwent contrast-enhanced polytrauma computed tomography at a maximum care hospital over a two-year period were retrospectively analyzed. HUs were measured with an elliptical measurement field in three different locations within the vertebral body: below the upper plate, in the middle of the vertebral body, and above the base plate. The measured Hounsfield units were converted into bone density values using a validated formula.ResultsThe mean age of the patient collective was 47.05 years. Mean spinal bone density values decreased from cranial to caudal (C3: 231.79 mg/cm3; L5: 155.13 mg/cm3; p < 0.001), with the highest values in the upper cervical spine. Bone density values generally decreased with age in all spinal segments. There was a clear decrease in values after age 50 years (p < 0.001).ConclusionsIn our study, bone density decreased from cranial to caudal with higher values in the cervical spine. These data from the individual spinal segments may be helpful to comprehensively evaluate the status of the spine and to design a better preoperative plan before instrumentation.

The effect of the whole-process care model of the medical union on the improvement of kinesiophobia and bone mineral density in patients with osteoporosis.

To observe the effect of the whole-process care model of the medical union on the improvement of kinesiophobia and bone mineral density in patients with osteoporosis. In this descriptive study, a convenient sampling method was used to select 148 patients with osteoporosis who visited the hospital from January 2020 to December 2021. Patients aged ≥ 18years and diagnosed with osteoporosis through quantitative computed tomography (QCT) were included in the study. They were able to cooperate during follow-up and had normal cognitive function. Patients with combined spinal curvature, thoracic deformity, and pulmonary dysfunction, accompanied by severe cardiovascular or limb dysfunction, and those who withdrew midway or participated in other clinical studies were excluded. According to whether to use the whole-process care model of the medical union, they were divided into intervention group and control group, with 74 cases each. The control group used conventional care, and the intervention group used the whole-process care model of the medical association. The occurrence of kinesiophobia between the two groups were compared. The dual-energy X-ray absorption detector is used to measure differences in bone density changes. There was no significant difference between the two groups in the TSK scale score and the incidence of kinesiophobia before intervention (P > 0.05). The TSK scale scores of patients in the intervention group were higher than those in the control group at 3months and 6months after operation (P < 0.05). The incidence of kinesiophobia in the intervention group for 3months and 6months was significantly lower than that in the control group (P < 0.05). There was no significant difference in bone mineral density between the two groups before and 3months after intervention (P > 0.05). The bone mineral density of lumbar spine, femoral neck and total hip in the intervention group was significantly higher than that in the control group after 6months of intervention (P < 0.05). The whole-process care model of the medical association is used for osteoporosis patients, which might reduce the risk of kinesiophobia and improve the bone density of the lumbar spine and total hip in patients. But further promotion and improvement of relevant support systems are needed to achieve comprehensive promotion and maximize clinical benefits in this field.

The association between bone density of lumbar spines and different daily protein intake in different renal function

Background Low protein intake (LPI) has been suggested as a treatment for chronic kidney disease (CKD). However, protein intake is essential for bone health. Methods We studied the database of the National Health and Nutrition Examination Survey, 2005–2010. Basic variables, metabolic diseases, and bone density of different femoral areas were stratified into four subgroups according to different protein intake (DPI) (that is, <0.8, 0.8–1.0, 1.0–1.2, and >1.2 g/kg/day). Results Significant differences were found among all lumbar area bone mineral density (BMD) and T-scores (p < 0.0001). There was an apparent trend between a decreasing BMD in the CKD groups with increasing DPI in all single lumbar spines (L1, L2, L3, and L4) and all L spines (L1-L4). Compared with DPI (0.8–1.0 g/day/kg), higher risks of osteoporosis were noticed in the subgroup of >1.2 g/day/kg over L2 (relative risk (RR)=1.326, 95% confidence interval (CI)=1.062–1.656), subgroup >1.2 g/day/kg over L3 (RR = 1.31, 95%CI = 1.057–1.622), subgroup <0.8 g/day/kg over L4 (RR = 1.276, 95%CI = 1.015–1.605), subgroup <0.8 g/day/kg over all L spines (RR = 11.275, 95%CI = 1.051–1.548), and subgroup >1.2 g/day/kg over all L spines (RR = 0.333, 95%CI = 1.098–1.618). However, a higher risk of osteoporosis was observed only in the non-CKD group. There was an apparent trend of higher DPI coexisting with lower BMD and T scores in patients with CKD. For osteoporosis (reference:0.8–1.0 g/day/kg), lower (<0.8 g/day/kg) or higher DPI (>1.2 g/day/kg) was associated with higher risks in the non-CKD group, but not in the CKD group. Conclusions In the CKD group, LPI for renal protection was safe without threatening L spine bone density and without causing a higher risk of osteoporosis.

A Study on Intelligent Optical Bone Densitometry.

Osteoporosis is a prevalent chronic disease worldwide, particularly affecting the aging population. The gold standard diagnostic tool for osteoporosis is Dual-energy X-ray Absorptiometry (DXA). However, the expensive cost of the DXA machine and the need for skilled professionals to operate it restrict its accessibility to the general public. This paper builds upon previous research and proposes a novel approach for rapidly screening bone density. The method involves utilizing near-infrared light to capture local body information within the human body. Deep learning techniques are employed to analyze the obtained data and extract meaningful insights related to bone density. Our initial prediction, utilizing multi-linear regression, demonstrated a strong correlation (r = 0.98, p-value = 0.003**) with the measured Bone Mineral Density (BMD) obtained from Dual-energy X-ray Absorptiometry (DXA). This indicates a highly significant relationship between the predicted values and the actual BMD measurements. A deep learning-based algorithm is applied to analyze the underlying information further to predict bone density at the wrist, hip, and spine. The prediction of bone densities in the hip and spine holds significant importance due to their status as gold-standard sites for assessing an individual's bone density. Our prediction rate had an error margin below 10% for the wrist and below 20% for the hip and spine bone density.

Association of per- and polyfluoroalkylated substances/heavy metals and bone health in children and adolescents.

Research on the correlation between exposure to per- and polyfluoroalkylated substances (PFASs)/heavy metals and bone health during childhood and adolescence is limited. Considering their role as endocrine disruptors, we examined relationships of six PFASs and three heavy metals with bone mineral density (BMD) in children and adolescents using representative samples from the National Health and Nutrition Examination Survey (NHANES). The study included 622 participants aged 12-19. The relationship between single pollutant and lumbar spine and total BMD was studied using linear regression analyses. Additionally, Bayesian Kernel Machine Regression (BKMR) models were applied to assess the joint effects of multiple PFASs and heavy metals exposure on the lumbar spine and total BMD. Statistically significant differences were noted in the serum concentrations of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), blood lead (Pb), and blood manganese (Mn) between male and female participants (all p < 0.05). Single-exposure studies have shown that Mn was negatively correlated with lumbar spine BMD and total BMD. Multivariate linear regression models revealed that, in the male group, total bone density decreased as the blood PFOA levels [95% CI = (-0.031, -0.001), p = 0.040] and blood manganese levels [95% CI = (-0.009, -0.002), p = 0.004] increased. Similarly, lumbar spine bone density decreased as the blood manganese levels [95% CI = (-0.011, -0.002), p = 0.009] increased. In the female group, total bone density decreased as the serum PFNA levels [95% CI = (-0.039, 0.000), p = 0.048] increased. As shown in the BKMR model, the joint effects of pollutant mixtures, including Mn, were negatively associated with both the lumbar spine and total BMD. Among the pollutants analyzed, Mn appeared to be the primary contributor to this negative association. This study suggests that exposure to certain PFASs and heavy metals may be associated with poor bone health. Childhood and adolescence are crucial stages for bone development, and improper exposure to PFASs and heavy metals during these stages could potentially jeopardize future bone health, consequently raising the risk of osteoporosis in adulthood.

The Relationship Between Scoliosis, Spinal Bone Density, and Truncal Muscle Strength in Familial Dysautonomia Patients.

This combined retrospective and prospective study aimed to investigate the relationship between scoliosis, spinal bone mineral density (BMD), and truncal muscle strength in patients with familial dysautonomia (FD). A total of 79 FD patients (40 male, 39 female) aged 5-44years were included. The severity of scoliosis, lumbar spine BMD (Z-score), and truncal muscle strength were assessed. Correlations were analyzed using Pearson's correlation coefficient. Inverse correlations were observed between scoliosis severity and BMD (r = -0.328, p = 0.001), as indicated by increasingly negative Z-score values with worsening osteoporosis. There were also inverse correlations between scoliosis and truncal muscle strength (r = -0.595, p < 0.001). The correlation between scoliosis and age was notable up to 22years (r = 0.421, p = 0.01), but not in the older age group (22-44years). Our study identified inverse correlations between osteoporosis and scoliosis, as well as between scoliosis and truncal muscle strength, in FD patients. These findings suggest that there may be a relationship between bone density, muscle strength, and the severity of spinal curvature in this population. While our results highlight the potential importance of early diagnosis and management of osteoporosis, and possibly the benefits of physical therapy to strengthen truncal muscles, further research is needed to determine the direct impact of these interventions on preventing the progression of scoliosis and its associated complications in FD patients. A long-term longitudinal study could provide more insights into these relationships and inform treatment strategies for FD patients.

Causal association of epigenetic aging and osteoporosis: a bidirectional Mendelian randomization study

BackgroundThe relationship between aging and osteoporosis is well established. However, the relationship between the body's physiological age, i.e. epigenetic age, and osteoporosis is not known. Our goal is to analyze the bidirectional causal relationship between epigenetic clocks and osteoporosis using a bidirectional Mendelian randomization study.MethodsWe used SNPs closely associated with GrimAge, Hannum, PhenoAge, and HorvathAge in epigenetic age and SNPs closely associated with femoral neck bone mineral density, lumbar spine bone mineral density, and forearm bone mineral density as instrumental variables, respectively, using the inverse variance weighting method and several other MR methods to assess the bidirectional causal relationship between epigenetic age and osteoporosis.ResultThere was no evidence of a clear causal relationship of epigenetic age (GrimAge, Hannum, PhenoAge, and HorvathAge) on femoral neck bone mineral density, lumbar spine bone mineral density, and forearm bone mineral density. In reverse Mendelian randomization analysis showed a significant causal effect of lumbar spine bone mineral density on GrimAge: odds ratio (OR) = 0.692, 95% confidence interval (CI) = (0.538–0.890), p = 0.004. The results suggest that a decrease in lumbar spine bone mineral density promotes an acceleration of GrimAge.ConclusionThere was no significant bidirectional causal relationship between epigenetic age and osteoporosis A decrease in lumbar spine bone density may lead to an acceleration of the epigenetic clock "GrimAge". Our study provides partial evidence for a bidirectional causal effect between epigenetic age and Osteoporosis.

Increased spine bone density in patients with chronic hepatitis B switched to tenofovir alafenamide: A prospective, multinational study.

Data on patients switched to tenofovir alafenamide (TAF) from nucleos(t)ide analogues (NUCs) other than tenofovir disoproxil fumarate are limited. To assess the treatment and renal/bone safety outcomes following the switch to TAF. We prospectively enrolled adult patients with chronic hepatitis B (CHB) who switched from any NUC to TAF at 14 centres in Japan, Korea, Taiwan and the U.S. Study outcomes were viral suppression (VR; HBV DNA < 20 IU/mL), biochemical response (BR; alanine aminotransferase normalisation), and changes in estimated glomerular filtration rate (eGFR) and T-scores (L-spine) by bone absorptiometry by 24 months after switch to TAF. We enrolled 270 eligible patients. Mean age was 58.1; 58.2% were male; 12.2% had cirrhosis and 73.3% previously received entecavir monotherapy. VR rate increased significantly from 95.2% to 98.8% by 24 months after the switch to TAF (p = 0.014). Between the switch and 24 months later, the mean spine T-score improved significantly from -1.43 ± 1.36 to -1.17 ± 1.38 (p < 0.0001), while there was no significant change in mean eGFR (88.4 ± 16.9-89.5 ± 16.3 mL/min/1.73 m2 , p = 0.13). On multivariable analysis adjusted for age, sex, baseline spine T-score and prior TDF or adefovir dipivoxil use, male sex was significantly associated with lower risk of worsening spine T-score (odds ratio: 0.29, p = 0.020), while age was significantly associated with a higher risk of worsening chronic kidney disease stage (OR: 1.07, p = 0.019). At 24 months after the switch to TAF, VR rates and spine bone density improved significantly while renal function remained stable.

THU437 Oral Ulcers As A Clue To Bone Fragility

Abstract Disclosure: S. Sridhar: None. E.I. Krug: None. Introduction: Metabolic bone disease is common in celiac disease (CD) and can occur in patients without gastrointestinal symptoms. Successful treatment of malabsorption is associated with amelioration of bone loss. Recurrent aphthous stomatitis (RAS) may be the sole manifestation of CD (1). According to American College of Gastroenterology Guidelines, tissue transglutaminase (tTG)-IgA antibody and total IgA level is the single preferred test for detection of CD in adults due to reported sensitivity of 90-98% and specificity of 95-97%. No additional testing is typically recommended for patients without IgA deficiency (2). Case: The patient is a 58 year old woman with past medical history of RAS treated with prednisone, 5 mg daily for 10 years, facial and ocular rosacea, menopause at age 49, asthma, chronic back and neck pain, history of spontaneous rib fracture and L4 compression fractures during chiropractic manipulation, who had progressive bone loss despite ongoing treatment with oral bisphosphonates, calcium and vitamin D supplementation for 4 years with good adherence, and was referred for endocrine evaluation. Laboratory studies revealed TSH 1.94 mIU/L (0.4-4.5), 25(OH)vit D 41 ng/mL (30-100 ng/mL), PTH 31 pg/mL (14-64), Ca 9. mg/dL (8.6-10.4), albumin 4.1 mg/dL (3.6-5.1), Mg 2.1 mg/dL (1.5-2.5), tTG-IgA 1 U/mL (&amp;lt;4), total IgA 190 mg/dL (47-310), Gliadin deamidated peptide IgA Ab 11 Units (&amp;lt;20), Gliadin deamidated peptide IgG Ab (DGP-IgG) 44 Units (&amp;lt;20). Duodenal biopsy revealed diffuse increase in intraepithelial lymphocytes, acute and chronic inflammation of lamina propria, focally marked villous blunting consistent with CD. The patient reported complete resolution of RAS and rosacea symptoms within one month of starting a strict gluten free diet. She also noted marked improvement in neck and back pain. After 6 months repeat DGP-IgG was 13 Units. Treatment with teriparatide of 12 months duration resulted in 12.1% and 5.4% gain in bone density of lumbar spine and total hip respectively. Conclusion: CD should be suspected in patients with osteoporosis and extraintestinal conditions including RAS and, possibly, rosacea. CD has been reported in 2.83% of 247 patients with RAS screened for (tTG)-IgA and anti-endomysial IgA Abs (2). Rosacea has also been linked to CD in one study (3). Our case suggests that patients presenting with RAS may need to be tested for DGP-IgG reported to have a sensitivity of 92% and specificity of 100%, regardless of total IgA level.