Total Skeletal Mass Research Articles

Associations of Serum Mineral levels of Copper, Magnesium and Calcium with Skeletal Muscle mass and Strength in Chinese children, aged 6-11: A Cross-Sectional Study

Background: Skeletal Muscle Mass (SMM) and strength are crucial for children's health, and low SMM can lead to adverse health outcomes. A deficiency of essential minerals can cause poor growth, fractures or osteoporosis. The study aimed to explore the relationship between serum Calcium (Ca), Copper (Cu), and Magnesium (Mg) levels and SMM in Chinese children. Methods: 466 primary school children were recruited for a cross-section study aged 6-11 in Guangzhou City, South of China, from December 2015 to February 2017. The study conducted whole-body dual-energy x-ray absorptiometry (DXA) scans using the Hologic discovery W to obtain the Total skeletal mass (TSM) and appendicular skeletal mass (ASM) were calculated, which were used as parameters to calculate variables of Skeletal muscle mass (SMM). Results: Of the 466 primary school children, 266 were boys and 200 girls with mean ages of 8.00±1.00 years for boys and 8.08±0.97 years for girls. An increase in mean Cu serum concentration between the T1 and T3 in girls resulted in 3.19% (P- trend =0.034, P-diff =0.083), 3.57% (P- trend =0.037, P-diff=0.083), 2.44% (P- trend =0.018, P=diff=0.060) and 2.25% (P- trend =0.024, P-diff= 0.072) for ASM/Height, ASH/ Weight, TSM/ Height and TSM/ Weight respectively, No significant mean difference was observed between serum Cu and ASM, TSM, ASM/ AFM and TSM/TFM (P- trend >0.05). A significant mean difference in serum Mg levels and ASM/ AFM for the total and boys' group was observed, with 6.68% and 9.44% (P- trend =0.042 and 0.041) respectively. No significant mean differences were seen between all the variables of serum Ca levels and all the variables of skeletal muscle mass and strength. Conclusions: Serum copper levels influence the development of SMM in girls, but not in boys. Serum Ca and Mg level in girls and boys do not influence SMM development among children aged 6-11.

High Prevalence of Hypovitaminosis D among Schoolchildren of Shimla in Himachal Pradesh

Title of the article: High prevalence of hypovitaminosis D among schoolchildren of Shimla in Himachal Pradesh. Context: Acquisition of optimal bone mineral health in childhood and adolescence is essential for adequate bone mass during adulthood and old age, as 40-50% of total skeletal mass is accumulated so early in life. Aims: To estimate the prevalence of vitamin D deficiency among the school children of Shimla Settings and Design: A total of 300 children and adolescents of class V1 to X11 of various schools in Shimla were enrolled during July 1, 2015 to September 30, 2015. Methods and Material: After written informed consent, blood samples for 25(OH) D were collected and measured by radioimmunoassay. Statistical analysis: Data analyzed the data using EpiInfo 7.0.9.7 for windows. Results: Among all enrolled cases, 151(50.33%) were girls and 149 (49.76%) boys. Serum 25(OH) D level was significantly lower in girls 11.70± 4.03ng/ml as compared to boys 13.57 ±7.06ng/dl (p=0.0000001). Hypovitaminosis D was present in 98.66% cases, out of which 93.33% had deficient and 5.33% had insufficient 25 (OH) D levels. A total of 34.33% children had severe deficiency, however 4 (1.33%) had sufficient levels and were boys. Conclusions: Prevalence of hypovitaminosis D in apparently healthy schoolchildren in India is high. Awareness needs to be generated about benefits accrued by direct sunlight exposure.

Visceral obesity and muscle mass determined by CT scan and surgical outcome in patients with advanced ovarian cancer. A retrospective cohort study

ObjectiveVisceral obesity (VO) is a risk factor for developing postoperative complications in patients undergoing abdominal oncological surgery. However, in ovarian cancer patients this influence of body composition on postoperative morbidity is not well established. The aim of this study is to assess the association between body composition and complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. MethodsPatients with FIGO stage 3 or 4 ovarian cancer between 2006 and 2017 were included. Visceral fat area, total skeletal mass and total fat area were measured on a single slice on the level of L3-L4 of the preoperative CT-scan. VO was defined as visceral fat ≥100cm2. The perioperative data were extracted retrospectively. A multivariate logistic regression analysis was performed to test the predictive value of multiple variables such as body composition, albumin levels and preoperative morbidity. Results298 consecutive patients out of nine referring hospitals were included. VO patients were more likely to be hypertensive (38% vs 17% p < 0.001), and to have an ASA 3 score (21% vs 10% P = 0.012). Complications occurred more often in VO patients (43% vs 21% P < 0.001). Thrombotic events were found in 4.9% of VO patients versus 0.6% of the non-visceral obese patients (p = 0.019). VO(OR: 4.37, p < 0.001), hypertension (OR:1.9, p = 0.046) and duration of surgery (OR: 1.004, p = 0.017) were predictors of post-surgical complications. Muscle mass is not a predictor of complications. ConclusionVisceral obesity is associated with a higher occurrence of complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.

Abstract P2-03-02: Clinical utility of bone scan index (BSI) for breast cancer patients with bone metastasis -Multi-institutional prospective cohort study-

Abstract Background: The bone is the most frequent site of metastasis from breast cancer. However, evaluation for the response to systemic therapy in bone lesion is troublesome. The bone scan index (BSI) is a quantitative tool for improving the interpretability and clinical relevance of bone scans. The utility of the BSI is well studied in prostate cancer. In both hormone-sensitive and castration-resistant prostate cancer, the pre-treatment BSI is significantly correlated with overall survival. Moreover, patients with a lower BSI after endocrine therapy or chemotherapy exhibited better survival than those without a lower BSI. owever its utility for metastatic breast cancer is unknown. The purpose of this study was to investigate whether pretreatment BSI and treatment-related changes in BSI are related with prognosis and adverse events of breast cancer patients with bone metastasis. Patients and Methods: To evaluate the utility of BSI in patients with breast cancer and bone metastasis, we conducted a multi-institutional prospective cohort study. Key inclusion criteria are histologically or cytologically diagnosed breast cancer with bone metastasis, and less than 3 lines of systemic treatments. Primary endpoint is progression free survival (PFS), and the secondary endpoints are overall survaival (OS) and skeletal related events (SREs). Bone scintigraphy was performed at enrollment, 12 and 24 weeks after enrollment. BSI was calculated by determining the percentage of each bone that is involved by the tracer in relationship to the total skeletal mass, as determined from reference man, which is using the BONEVAVI® automated method (FUJIFILM RI Pharma Co., Ltd., Tokyo, Japan). All patients received standard medical treatment according to guidelines and bone modifying agent. A landmarking Cox model was used to predict PFS and OS by baseline and on-treatment BSI changes. Because on-treatment BSI changes could be observed 12 or 24 weeks, the origin of PFS/OS was set to 12 or 24 weeks and analysis set was defined those who are at risk at 12 or 24 weeks, respectively.Results:Between June 2015 and November 2017, a total of 153 patients from 19 centers were enrolled. The median age of was 63 years old [interquartile range,(IQR): 54-70]. All the patients had bone disease, 17 % (n=26) patients had lung and 5 % (n=7) had liver metastasis. The proportion of each intrinsic subtype was follows; luminal type; 84 % (n=125), luminal HER2 type; 6 % (n=9), HER2 type; 4 % (n=6), TN type; 6 % (n=9) and unknown; n=4. 71% (n=109) of the patients received endocrine therapy, 18% (n=27) received chemotherapy and 11% (n=17) received Anti-HER2 therapy. During the follow-up period (median: 22.5 month, IQR:16.8-29.5), 124 events of disease progression and 51 events of death were observed. The baseline BSI was merely associated with PFS [hazard ratio (HR): 1.01, 95% CI: 0.93 to 1.09] and OS (HR: 1.07, 95%CI: 0.95 to 1.21). The change in BSI from baseline to 12 weeks were significantly correlated with PFS (HR, 1.25, 95% CI: 1.13 to 1.40) and OS (HR: 1.26, 95% CI: 1.08 to 1.47). Similarly, the change in BSI from baseline to 24 weeks on treatment prognosticated for PFS (HR: 1.32, 95% CI: 1.06 to 1.65) and OS (HR: 1.47, 95% CI: 1.11 to 1.95). Conclusion: This study is the first to report the clinical significance of evaluating BSI for metastatic breast cancer patients with bone metastasis. Changes in BSI from baseline to 12 weeks and 24 weeks predicts PFS and OS, which could help patients and physicians to guide treatment decision making. Citation Format: Naoto Kondo, Yoichi Naito, Isao Yokota Yokota, Rikiya Nakamura, Yuichiro Kikawa, Hideki Maeda, Hiromitsu Akabane Akabane, Yasuaki Sagara Sagara, Tomohiko Aihara, Mina Takahashi, Yoko Ohtani, Shoichiro Ohtani, Hirofumi Mukai. Clinical utility of bone scan index (BSI) for breast cancer patients with bone metastasis -Multi-institutional prospective cohort study- [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-03-02.

Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial

Sarcopenia is associated with loss of muscle mass as well as an increased risk of physical disability in elderly people. This study was aimed to investigate the effect of elastic band resistance training (ERT) on muscle mass and physical function in older women with sarcopenic obesity. A randomized controlled trial with an intention-to-treat analysis was conducted. A total of 56 women (mean ± SD age 67.3 ± 5.1 years) were randomly assigned to the experimental group receiving 12 weeks of ERT and to the control group receiving no exercise intervention. Lean mass (measured using a dual-energy X-ray absorptiometer), physical capacity (assessed using the global physical capacity score), and a 36-item short form questionnaire were conducted at the baseline examination (T0), as well as the 3-month (T1) and 9-month followups (T2). At T1 and T2, the between-group difference was measured in total skeletal mass relative to T0, with mean differences of 0.70 kg (95% CI 0.12–1.28; P < 0.05) and 0.72 kg (95% CI 0.21–1.23; P < 0.01), respectively. Similar results were found in muscle quality, physical capacity, and physical function outcomes. The ERT exerted a significant beneficial effect on muscle mass, muscle quality, and physical function in older women with sarcopenic obesity.

Relationship between tumor volume and quantitative values calculated using two-dimensional bone scan images

The bone scan index (BSI) is calculated from a whole-body bone scan image; it shows the tumor burden in bone as a percentage of total skeletal mass. It has been used to determine the prognosis and to assess treatment effects; however, little has been reported on whether the BSI calculated using a two-dimensional image can accurately evaluate the three-dimensional spread in tumor volume. We investigated the relationship between tumor volume and BSI using Monte Carlo simulation (MCS). We simulated a gamma camera and constructed a voxel phantom based on an anthropomorphic phantom computed tomography (CT) image and gamma rays emitted from each part according to technetium-99m-labeled methylene diphosphonate (99mTc-MDP) uptake (bone 1, soft tissue 0.2, tumor 2-32). We constructed bone scan images from the obtained counts and analyzed them using the BSI calculation software. The BSI increased with increased tumor uptake (two- to 32-fold). However, there was not always a significant difference between change in BSI and tumor uptake of eight times or greater than that of bone. When BSI was calculated with a tumor having an uptake of four-to-eight times higher than that of bone, the BSI was consistent with tumor volume, but decreased to about half the tumor volume when tumors were in the thoracic spine (Th-spine) segment. The BSI can be a good indicator of tumor volume in most segments, even though it is affected by the tumor's 99mTc-MDP uptake. Nevertheless, values calculated from the Th-spine should be interpreted carefully.

Vitamin B12 deficiency might be related to sarcopenia in older adults

Sarcopenia and dynapenia are related to repeated falls, mobility restriction, depression, frailty, increased mortality and morbidity. The aim of this study is to evaluate the relationship between vitamin B12 deficiency and sarcopenia in older adults. 403 patients, who attended to outpatient clinic and underwent comprehensive geriatric assessment, were included study. All cases' skeletal muscle mass (SMM), walking speed and hand grip strength were recorded by bioimpedance, 4meter walking test and hand dynamometer respectively. The diagnosis of sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People. Sarcopenia was accepted low SMM with low handgrip strength or low physical performance. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). The prevalence of sarcopenia and dynapenia was 24.8% and 32.0%, respectively. In the patients with sarcopenia, mean age, osteoporosis and frailty were higher, and MMSE, and instrumental ADL scores were lower than the patients without sarcopenia (p<0.05). The frequency of sarcopenia and dynapenia were 31.6% and 35.4%, respectively, in patients with vitamin B12 levels <400pg/mL. In addition lean body mass, total skeletal mass and skeletal muscle mass index were lower in the patients with vitamin B12 levels <400pg/mL compared to higher than 400pg/mL (p<0.05). Sarcopenia, which results in lots of negative clinical outcomes in older adults, might be related to vitamin B12 deficiency. Therefore, these patients should be periodically examined for vitamin B12 deficiency due to the potential negative clinical outcomes such as sarcopenia in older adults.

Mandibular Bone Mineral Density to predict Skeletal Osteoporosis: A Literature Review

AbstractUntil and unless the disease is recognized as a disease entity, a little progress has been made in understanding its etiology and in developing a predictable treatment planning, restoration, and prevention of the tissues. In a process carried out to study a disease entity, whether it be cardiac disease, dental caries, or periodontal disease, it is helpful to study its pathology (the gross and microscopic structural changes of the disease), its pathophysiology (the mechanisms or disordered functions of the disease), its pathogenesis (the life history), and its epidemiology (the worldwide prevalence of the disease and various interrelated factors). The ultimate aim of such researches is the better understanding of the etiology and pathogenesis of the disease, and thereby with such understanding leading to a predictable treatment planning and ultimately the prevention or control of these factors. Osteoporosis is a major health entity affecting the elderly population and thereby resulting in approximately 1.3 million spontaneous fractures in the USA every year. The above clinical condition is a deficiency of bone mass, or skeletal osteopenia, to that level where bone cannot provide adequate mechanical support. Many of the reported studies used inadequate measures of both skeletal and mandibular bone in evaluating their possible relationships. This literature review attempts to determine relationships between the total skeletal bone mass and bone mass of the mandible in the population suffering with osteoporosis.

Bone Scan Index predicts skeletal-related events in patients with metastatic breast cancer.

BackgroundBone Scan Index (BSI) expresses tumor burden in bone as a percentage of total skeletal mass, but its significance for metastatic breast cancer patients is unknown. We investigated whether baseline BSI is associated with skeletal-related events (SREs) or survival and identified the cut-off BSI score for predicting SREs in metastatic breast cancer patients.MethodsWe retrospectively reviewed 144 patients with bone metastatic breast cancer. Bone scan examinations were performed and BSI was calculated using the Bonenavi® automated method. All patients received standard medical treatment for metastatic breast cancer. For bone metastasis prophylaxis, bisphosphonates were infused initially with analgesics as needed. We defined SRE as either bony, requiring intervention (surgery and/or radiotherapy) for pain or prevention of fracture, or spinal cord compression. The rates of SRE and overall survival (OS) were evaluated according to baseline BSI, and the cut-off score of BSI for predicting SRE in metastatic breast cancer patients was identified.ResultsThirty-three patients (25.6 %) had SREs. The median BSI was 1.08 % (inter-quartile range 0.50–3.23 %). To identify the cut-off BSI score for predicting SRE, we performed sensitivity analysis to check P-value at every 0.1 BSI interval (0.4–2.4) by multiple-variable proportional hazard analysis. A BSI cut-off point of 1.4 % showed the lowest P value. Patients with BSI scores ≥1.4 had a significantly higher rate of SRE than those with lower BSI (P = 0.022). However there was no significant difference in OS.ConclusionBSI may predict SRE in patients with metastatic breast cancer. A high BSI value (≥1.4) at diagnosis of bone metastasis may be a predictor of SREs in bone metastatic breast cancer patients.

One for all and all for one: Linear regression from the mass of individual bones to assess human skeletal mass completeness.

Complete and accurate human skeletal inventory is seldom possible in archaeological and forensic cases involving severe fragmentation. In such cases, skeletal mass comparisons with published references may be used as an alternative to assess skeletal completeness but they are too general for a case-by-case routine analysis. The objective is to solve this issue by creating linear regression equations to estimate the total mass of a skeleton based on the mass of individual bones. Total adult skeletal mass and individual mass of the clavicle, humerus, femur, patella, carpal, metacarpal, tarsal, and metatarsal bones were recorded in a sample of 60 skeletons from the 21st century identified skeletal collection (University of Coimbra). The sample included 32 females and 28 males with ages ranging from 31 to 96 years (mean = 76.4; sd = 14.8). Skeletal mass linear regression equations were calculated based on this sample. The mass of individual bones was successfully used to predict the approximate total mass of the adult skeleton. The femur, humerus, and second metacarpal were the best predictors of total skeletal mass with root mean squared errors ranging from 292.9 to 346.1 g. Linear regression was relatively successful at estimating adult skeletal mass. The non-normal distribution of the sample in terms of mass may have reduced the predictive power of the equations. These results have clear impact for bioanthropology, especially forensic anthropology, since this method may provide better estimates of the completeness of the skeleton or the minimum number of individuals. Am J Phys Anthropol 160:427-432, 2016. © 2016 Wiley Periodicals, Inc.

Bone Scan Index as an Imaging Biomarker in Metastatic Castration-resistant Prostate Cancer: A Multicentre Study Based on Patients Treated with Abiraterone Acetate (Zytiga) in Clinical Practice

BackgroundAbiraterone acetate (AA) prolongs survival in metastatic castration-resistant prostate cancer (mCRPC) patients. To measure treatment response accurately in bone, quantitative methods are needed. The Bone Scan Index (BSI), a prognostic imaging biomarker, reflects the tumour burden in bone as a percentage of the total skeletal mass calculated from bone scintigraphy. ObjectiveTo evaluate the value of BSI as a biomarker for outcome evaluation in mCRPC patients on treatment with AA according to clinical routine. Design, setting, and participantsWe retrospectively studied 104 mCRPC patients who received AA following disease progression after chemotherapy. All patients underwent whole-body bone scintigraphy before and during AA treatment. Baseline and follow-up BSI data were obtained using EXINI BoneBSI software (EXINI Diagnostics AB, Lund, Sweden). Outcome measurements and statistical analysisAssociations between change in BSI, clinical parameters at follow-up, and overall survival (OS) were evaluated using the Cox proportional hazards regression models and Kaplan-Meier estimates. Discrimination between variables was assessed using the concordance index (C-index). Results and limitationsPatients with an increase in BSI at follow-up of at most 0.30 (n=54) had a significantly longer median survival time than those with an increase of BSI >0.30 (n=50) (median: 16 vs 10 mo; p=0.001). BSI change was also associated with OS in a multivariate Cox analysis including commonly used clinical parameters for prognosis (C-index=0.7; hazard ratio: 1.1; p=0.03). The retrospective design was a limitation. ConclusionsChange in BSI was significantly associated with OS in mCRPC patients undergoing AA treatment following disease progression in a postchemotherapy setting. BSI may be a useful imaging biomarker for outcome evaluation in this group of patients, and it could be a valuable complementary tool in monitoring patients with mCRPC on second-line therapies. Patient summaryBone Scan Index (BSI) change is related to survival time in metastatic castration-resistant prostate cancer (mCRPC) patients on abiraterone acetate. BSI may be a valuable complementary decision-making tool supporting physicians monitoring patients with mCRPC on second-line therapies.

Prevalence and risk factors of sarcopenia: a study in a tertiary care centre

Background: Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. The known causes for sarcopenia are usually age related, changes in tissue secretions or response to hormonal factors, changes in dietary intake, protein metabolism and disuse atrophy. This study was conducted to identify the predictors for sarcopenia among the elderly patients in our area . Methods: 678 patients above the age of 60 years and 50 young patients between the age of 18-40 years (to establish a baseline value) were recruited into the study. Height and weight were measured for all the patients, and BMI was calculated. Lean body mass, appendicular skeletal muscle mass (ASM), and total skeletal mass (TSM) was measured from the controls as well as the patients. Results: Out of the 678 patients, 346 were males and 332 were females. The prevalence of sarcopenia was found to be 15.3% among the elderly males and 20.5% among the females. The lean body mass and the appendicular skeletal mass were significantly more in males than females. Of the risk factors which we studied, there was no significance between the sarcopenic and non sarcopenic individuals. There was a significant difference in the other metabolic factors such as lower protein levels and lower steroid hormones although the numbers were very small in our study. Conclusions: This confirms that the relative muscle mass in significantly lower among the elderly population as compared to the younger generation. Sarcopenia is found to increase the likely hood of disability in these patients independent of the age, weight, BMI, other factors of morbidity and health factors. Therefore, criteria for estimating prevalences of sarcopenia are needed for public health planning purposes.

Exploring the Relationship between Skeletal Mass and Total Body Mass in Birds.

Total body mass (TBM) is known to be related to a number of different osteological features in vertebrates, including limb element measurements and total skeletal mass. The relationship between skeletal mass and TBM in birds has been suggested as a way of estimating the latter in cases where only the skeleton is known (e.g., fossils). This relationship has thus also been applied to other extinct vertebrates, including the non-avian pterosaurs, while other studies have used additional skeletal correlates found in modern birds to estimate TBM. However, most previous studies have used TBM compiled from the literature rather than from direct measurements, producing values from population averages rather than from individuals. Here, we report a new dataset of 487 extant birds encompassing 79 species that have skeletal mass and TBM recorded at the time of collection or preparation. We combine both historical and new data for analyses with phylogenetic control and find a similar and well-correlated relationship between skeletal mass and TBM. Thus, we confirm that TBM and skeletal mass are accurate proxies for estimating one another. We also look at other factors that may have an effect on avian body mass, including sex, ontogenetic stage, and flight mode. While data are well-correlated in all cases, phylogeny is a major control on TBM in birds strongly suggesting that this relationship is not appropriate for estimating the total mass of taxa outside of crown birds, Neornithes (e.g., non-avian dinosaurs, pterosaurs). Data also reveal large variability in both bird skeletal and TBM within single species; caution should thus be applied when using published mass to test direct correlations with skeletal mass and bone lengths.

New Insights Into Androgen and Estrogen Receptor Regulation of the Male Skeleton.

Beginning with the report in 1994 that an adult male with homozygous loss of estrogen receptor α (ERα) had unfused epiphyses and osteopenia,(1) there is now considerable evidence from observational and interventional studies (summarized in Khosla and colleagues(2)) that estrogen is the dominant regulator of bone metabolism in men. Indeed, a legitimate argument can be made that testosterone is largely a prohormone for the skeleton, with its effects on bone mediated principally via aromatization to estrogen, although it remains likely that testosterone contributes to bone size via effects on periosteal apposition and perhaps indirectly to bone mass by increasing muscle mass.

Quantitative imaging by automated bone scan index (BSI) as a response biomarker in standard clinical care of patients with metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide.

288 Background: Enzalutamide (ENZ), an androgen receptor antagonist therapy, was approved for patients (pts) with mCRPC. However, in standard of care for mCRPC pts, change in prostate specific antigen (PSA) is not accepted as an efficacy response measurement and the radiological change is inadequately measured in an interpreter-dependent subjective analysis of bone scan. Therefore, an objective efficacy response biomarker is warranted. In this registry study, we evaluated BSI as a quantitative analysis of bone scintigraphy, to access response in mCRPC pts being treated with ENZ. Methods: Pts with mCRPC, at Skåne University Hospital (SUH), Sweden, who initiated treatment with ENZ after failing chemotherapy were eligible for the study. Primary objective was to associate the change in BSI and PSA, after 12 weeks (wks) of treatment with EZN, with overall survival (OS). Automated BSI generated by EXINI boneBSI platform is quantitative representation of tumor burden as a percent of total skeletal mass. Bivariate cox regression analysis was used to evaluate the association of BSI and PSA with OS. Results: Thirty-five pts, who initiated ENZ treatment at (SUH), were eligible for the BSI analysis. Follow-up scans for the BSI analysis were available from 24 pts. Median baseline BSI value was 2.92 (range: 0.0 - 11.72) and at follow-up the median BSI value was 2.83 (range: 0.0 - 12.65). OS was associated with BSI at both baseline and at follow-up as opposed to that of PSA (table 1). The change in BSI between baseline and follow-up was also significantly associated with OS, whereas the change in PSA was not. Conclusions: Automated BSI and its relative change were observed to be associated with OS in mCRPC pts receiving ENZ as standard of care treatment. The result deserves further validation, in controlled investigational studies, of BSI as a quantitative imaging biomarker indicative of efficacy response to second-line treatment in mCRPC pts. [Table: see text]

Analysis of regional bone scan index measurements for the survival of patients with prostate cancer.

BackgroundA bone scan is a common method for monitoring bone metastases in patients with advanced prostate cancer. The Bone Scan Index (BSI) measures the tumor burden on the skeleton, expressed as a percentage of the total skeletal mass. Previous studies have shown that BSI is associated with survival of prostate cancer patients. The objective in this study was to investigate to what extent regional BSI measurements, as obtained by an automated method, can improve the survival analysis for advanced prostate cancer.MethodsThe automated method for analyzing bone scan images computed BSI values for twelve skeletal regions, in a study population consisting of 1013 patients diagnosed with prostate cancer. In the survival analysis we used the standard Cox proportional hazards model and a more advanced non-linear method based on artificial neural networks. The concordance index (C-index) was used to measure the performance of the models.ResultsA Cox model with age and total BSI obtained a C-index of 70.4%. The best Cox model with regional measurements from Costae, Pelvis, Scapula and the Spine, together with age, got a similar C-index (70.5%). The overall best single skeletal localisation, as measured by the C-index, was Costae. The non-linear model performed equally well as the Cox model, ruling out any significant non-linear interactions among the regional BSI measurements.ConclusionThe present study showed that the localisation of bone metastases obtained from the bone scans in prostate cancer patients does not improve the performance of the survival models compared to models using the total BSI. However a ranking procedure indicated that some regions are more important than others.

Increase in bone scan index during abiraterone treatment in relation to reduced survival in mCRPC patients.

244 Background: Abiraterone acetate (AA) is one of several new treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC). It has showed to prolong survival in patients who had disease progression after chemotherapy. An objective biomarker that is associated with improvement in survival would be of value in the management of patients under AA treatment, for example in decisions to continue or change treatment. Bone Scan Index (BSI) is a measurement that reflects the tumor burden in bone as a percent of the total skeletal mass. The purpose of this study was to evaluate BSI as a response biomarker in mCRPC patients on treatment with AA. Methods: We retrospectively studied a consecutive series of 28 mCRPC patients who received AA following disease progression after chemotherapy. All patients had undergone whole-body bone scan before and during AA treatment. Baseline and follow-up BSI data was obtained using the automated quantification software EXINI Bonebsi(EXINI Diagnostics AB, Sweden). Data on prostate-specific antigen (PSA) and survival were collected from the medical records. Cox proportional-hazards regression models and Kaplan-Meier estimates of the survival function were used to investigate the association between changes in BSI and PSA from baseline to follow-up and survival. Discrimination between prognostic variables was assessed using the concordance index (C-index). Results: Patients with an increase in BSI of at least 0.2 (n=15) had a worse one-year survival (36%) than those with improvement or stable disease (BSI change &lt;0.2) (96%) (p&lt; 0.006). Both follow-up BSI and the BSI change from baseline to follow-up showed higher C-index (0.80) than the corresponding PSA values (0.73 and 0.75). Conclusions: Increase in BSI is significantly associated with reduced survival in mCRPC patients under AA treatment following disease progression after chemotherapy. Calculation of BSI could be a valuable tool for treatment response evaluation as a complement to the traditional methods. [Table: see text]

Sarcopenic obesity is closely associated with metabolic syndrome

Obesity is a risk factor for metabolic syndrome (MetS). We aimed to investigate whether sarcopenic obesity (SO) was associated with MetS. A total of 600 community-dwelling males and females aged 63.6 ± 10.1 years in Northern Taiwan were enrolled in this study. Sarcopenia was defined by the percentage of total skeletal mass (total skeletal muscle mass (kg)/weight (kg) x 100). Cut-offs were established at <37% in men and <27.6% in women using the bioelectrical impedance analysis (BIA) method. Obesity was defined as body mass index (BMI) ≥25 kg/m(2). MetS was defined by the consensus of National Cholesterol Education Program-Adult Treatment Panel III modified for Asians. The association between MetS and SO was examined using multivariate logistic regression analyses after controlling potential confounders. The SO group demonstrated a higher risk for MetS (odds ratio [OR] 11.59 [95% confidence interval [CI] 6.72-19.98]) than the obese group (7.53 [4.01-14.14]) and sarcopenic group (1.98 [1.25-3.16]). The individual components including waist circumference, serum triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting serum glucose were independently associated with SO. SO is a major risk factor for MetS. The BIA method and BMI can easily identify subjects at high risk for MetS. The underlying mechanism for the relationship between SO and MetS warrants further research.

An image-based skeletal tissue model for the ICRP reference newborn

Hybrid phantoms represent a third generation of computational models of human anatomy needed for dose assessment in both external and internal radiation exposures. Recently, we presented the first whole-body hybrid phantom of the ICRP reference newborn with a skeleton constructed from both non-uniform rational B-spline and polygon-mesh surfaces (Lee et al 2007 Phys. Med. Biol. 52 3309–33). The skeleton in that model included regions of cartilage and fibrous connective tissue, with the remainder given as a homogenous mixture of cortical and trabecular bone, active marrow and miscellaneous skeletal tissues. In the present study, we present a comprehensive skeletal tissue model of the ICRP reference newborn to permit a heterogeneous representation of the skeleton in that hybrid phantom set—both male and female—that explicitly includes a delineation of cortical bone so that marrow shielding effects are correctly modeled for low-energy photons incident upon the newborn skeleton. Data sources for the tissue model were threefold. First, skeletal site-dependent volumes of homogeneous bone were obtained from whole-cadaver CT image analyses. Second, selected newborn bone specimens were acquired at autopsy and subjected to micro-CT image analysis to derive model parameters of the marrow cavity and bone trabecular 3D microarchitecture. Third, data given in ICRP Publications 70 and 89 were selected to match reference values on total skeletal tissue mass. Active marrow distributions were found to be in reasonable agreement with those given previously by the ICRP. However, significant differences were seen in total skeletal and site-specific masses of trabecular and cortical bone between the current and ICRP newborn skeletal tissue models. The latter utilizes an age-independent ratio of 80%/20% cortical and trabecular bone for the reference newborn. In the current study, a ratio closer to 40%/60% is used based upon newborn CT and micro-CT skeletal image analyses. These changes in mineral bone composition may have significant dosimetric implications when considering localized marrow dosimetry for radionuclides that target mineral bone in the newborn child.

Parathyroid hormone and bone quality

Bone quality has been seen as an important concept which refers to microarchitecture, bone turnover, micro-damage accumulation, and mineralization because there is no strong correlation between the increase of bone mineral density and the fracture risk reduction. Intermittent administration of parathyroid hormone (PTH) stimulates bone formation, and continuous infusion of PTH stimulates bone resorption. In the preclinical studies, intermittent administration of PTH increased bone strength in association with the increase in total body skeletal mass and the improvement of bone structure. Furthermore, the clinical studies showed that PTH improved bone structure such as trabecular connectivity and cortical thickness, as well as increased bone mass. These changes were considered to contribute to reduction of fracture risk.