The diagnosis of osteoporosis

Automatic phantom-less calibration of routine CT scans for the evaluation of osteoporosis and hip fracture risk

BACKGROUND/PURPOSE

The diagnosis of osteoporosis remains a paramount concern for orthopedic surgeons worldwide. We aim to (1) evaluate the efficacy of automatic phantom-less quantitative computed tomography (PL-QCT) in diagnosing osteoporosis and (2) investigate its clinical value in predicting hip fracture risk.

METHODS

A cohort of 705 patients was included in the study. Hip CT scans from 310 patients and spinal CT scans from 315 patients were analyzed using automatic PL-QCT. The consistency of bone mineral density (BMD) measurement obtained by dual-energy X-ray absorptiometry (DXA), phantom-based QCT (PB-QCT), and automatic PL-QCT was examined through linear regression analysis and Bland-Altman plots. The ability of automatic PL-QCT to predict osteoporosis and hip fracture risk was assessed using ROC analysis.

RESULTS

Linear regression and Bland-Altman plots demonstrated a high level of agreement between BMD measurements from PL-QCT and those from hip DXA and lumbar PB-QCT. The AUC values for PL-QCT and PB-QCT in diagnosing osteoporosis were 0.903 (95 % CI 0.852-0.955) and 0.900 (95 % CI 0.847-0.953). The AUC values for predicting hip fracture risk, based on femoral neck BMD measured by PL-QCT and DXA, were 0.869 (95 % CI 0.823-0.915) and 0.831(95 % CI 0.778-0.885), respectively. When the femoral neck BMD was combined with the percentage of inter-muscular adipose tissue area, the AUC increased to 0.929 (95 % CI 0.897-0.961).

CONCLUSION

Automatic PL-QCT has shown superior performance in predicting hip fracture risk compared to DXA. Furthermore, the novel PL-QCT demonstrates comparable predictive efficacy to that of PB-QCT, suggesting its potential as a valuable tool in clinical practice.

Weight-adjusted waist index as a new predictor of osteoporosis in postmenopausal patients with T2DM

This study aimed to investigate the predictive value of the weight-adjusted waist index (WWI) for osteoporosis in postmenopausal patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 229 postmenopausal patients with T2DM (mean age 64.53 ± 7.4 years). Collect anthropometric data. Bone mineral density (BMD) of the lumbar spine and femoral necks was measured using dual-energy X-ray absorptiometry. Calculate WWI and Osteoporosis Self-Assessment Tool for Asians (OSTA). Use SPSS 25.0 to analyze data employing binary logistic regression and the receiver operating characteristic (ROC) curve. WWI in osteoporosis group was significantly higher than that in non-osteoporosis group (11.54 ± 0.82 vs. 11.07 ± 0.73, P = 0.000), while the OSTA was significantly lower in osteoporosis group compared to non-osteoporosis group (- 1.40 (- 2.8, 0.40) vs. 0.10 (- 1.45,1.80), P = 0.000). Binary logistic regression analysis indicated that the risk of osteoporosis in WWI ≥ 11.55 group was 3.158 times higher than that in WWI < 11.55 group (95% CI 1.714-5.820, P = 0.000). The risk in OSTA ≤ - 1 group was 3.935 times higher than that in OSTA > - 1 group (95% CI 2.168-7.141, P = 0.000). The area under the ROC curve for OSTA and WWI in predicting the risk of osteoporosis in postmenopausal patients with T2DM aged over 70 was 0.761 and 0.808, respectively, with sensitivities of 0.429 and 0.714. In postmenopausal patients with T2DM, WWI is closely associated with osteoporosis and negatively correlates with BMD. Among postmenopausal T2DM patients aged over 70, WWI may be superior to OSTA in predicting osteoporosis.

Investigation of Osteoporosis in Persons Living with Human Immunodeficiency Virus: The HOST Study

Bone health is an emerging concern in the aging human immunodeficiency virus (HIV)-infected population. We aimed to investigate bone mineral density (BMD) and bone microarchitecture in persons living with HIV (PLHIV). The study was a cross-sectional study. BMD and bone microarchitecture were investigated by Dual-Energy X-ray Absorptiometry (DXA) at the hip and lumbar spine and High-Resolution peripheral Quantitative Computed Tomography (HRpQCT) at the radius and tibia. Information about risk factors for fracture was obtained from a questionnaire. 183 PLHIV were included, 160 (131 males, 29 females) completed the visit. Age range was 30-78 years and the mean time since first HIV-positive serology was 16.5 years. 47% had low bone density and 6% had osteoporosis. The mean T-score by DXA was - 1.2 (standard deviation (SD) ± 1.0), - 0.7 (SD ± 0.9), and - 0.7 (SD ± 1.3) at the femoral neck, total hip and lumbar spine, respectively. We observed no significant difference in BMD by DXA between participants below or above age 50. BMI was significantly lower in PLHIV with lower BMD (p = 0.001, ANOVA). HRpQCT measurements showed significant differences in cortical area, volumetric BMD, and most microarchitecture parameters between PLHIV with BMD in the normal, low, and osteoporotic ranges measured at the tibia and radius. Our results indicate that bone microarchitecture and BMI vary considerably between PLHIV with normal, low, and osteoporotic BMD. These differences may partly explain the increased fracture risk seen in PLHIV.Trial numbers: Ethics Committee of the Central Denmark Region (case no. 1-10-72-238-17), Danish Data Protection Agency (case no. 1-16-02-708-17).

Race, Ethnicity, and Mortality Following Major Osteoporotic Fracture: Results from the Women's Health Initiative Study

BACKGROUND

Major osteoporotic fracture (MOF) is associated with increased mortality; however, few studies in postmenopausal women have examined racial and ethnic differences in 1-year and 5-year mortality following MOF.

OBJECTIVE

To assess 1-year and 5-year mortality following MOF by race and ethnicity.

DESIGN

This prospective cohort study included postmenopausal women enrolled in the Women's Health Initiative (WHI), a population-based, multisite US study. Participants were followed from September 1994 to February 2023. Data were analyzed between August 2023 and November 2023.

PARTICIPANTS

Postmenopausal women aged 50 to 79 years old who experienced a MOF (N = 32,675 in 1 year and 29,506 in 5 years following MOF).

MAIN MEASURES

Self-reported race and ethnicity. All-cause mortality was determined by death certificates, reports of surrogates, and the National Death Index Search.

KEY RESULTS

The baseline mean age of participants was 77.0 [SD = 8.5] years with 31,223 [95.6%] White participants in the 1-year mortality analysis, and 76.3 [SD = 8.5] years with 28,212 [95.6%] White participants in the 5-year mortality analysis. In fully adjusted models, compared to White women, Black women had a higher risk of mortality (adjusted odds ratio (aOR) = 1.42, 95% CI [1.06, 1.90], while Asian women had a lower risk of mortality (aOR = 0.48 95% CI [0.27, 0.88]), within 1 year following MOF. Compared to White women, the mortality risk within 5 years after MOF was significantly higher among American Indian/Alaska Native (aOR = 3.30, 95% CI [1.65, 6.60]) and lower among Asian (aOR = 0.58, 95% CI [0.42,0.80]) women. While there were no mortality differences by ethnicity 1 year following MOF, Hispanic/Latina women were less likely to die 5 years following MOF (aOR = 0.74, [95% CI 0.57-0.96]) compared to Non-Hispanic/Latina women.

CONCLUSIONS

In this large prospective study, mortality following MOF differed by race. Future research is needed to delineate the mechanism behind these associations.

Engineered Metal-Organic Frameworks for Targeted CRISPR/Cas9 Gene Editing

The development of precise and efficient delivery systems is pivotal for advancing CRISPR/Cas9 gene-editing technologies, particularly for therapeutic applications. Engineered metal-organic frameworks (MOFs) have emerged as a promising class of inorganic nonviral vectors, offering unique advantages such as tunable porosity, high cargo-loading capacity, and biocompatibility. This review explores the design and application of MOF-based nanoplatforms tailored for the targeted delivery of CRISPR/Cas9 components, aiming to enhance gene-editing precision and efficiency. By incorporating stimuli-responsive linkers and bioactive ligands, these MOFs enable controlled release of CRISPR/Cas9 payloads at the target site. Comparative discussions demonstrate superior performance of MOFs over conventional nonviral systems in terms of stability, transfection efficiency, and reduced off-target effects. Additionally, the intracellular trafficking mechanisms and the therapeutic potential of these platforms in preclinical models are discussed. These findings highlight the transformative potential of MOF-based delivery systems in overcoming the challenges associated with gene-editing technologies, such as immunogenicity and cytotoxicity, paving the way for their application in precision medicine. This review provides a blueprint for the integration of nanotechnology and genome editing, advancing the frontier of nonviral therapeutic delivery systems.

Feasibility and effectiveness of a digital voice assistant for improving anti-osteoporosis medication adherence, and osteoporosis knowledge and attitudes, in postmenopausal women with osteoporosis: A 12-month randomised controlled trial

Digital voice assistants (DVAs) are feasible for delivering a digital health intervention designed to improve osteoporosis self-management in postmenopausal women with osteoporosis. However, the DVA intervention did not improve anti-osteoporosis drug adherence, nor did it enhance osteoporosis knowledge or attitudes in this population.

PURPOSE

To determine feasibility and effectiveness of a digital voice assistant (DVA) intervention for improving anti-osteoporosis medication adherence, and osteoporosis knowledge and attitudes, in postmenopausal women with osteoporosis.

METHODS

This 12-month single-blinded, randomised controlled trial included 50 postmenopausal women with osteoporosis randomised to DVA (N = 25) or control (N = 25) for 6 months, followed by a 6-month follow-up period. DVA participants received an Amazon Alexa device that delivered osteoporosis education videos, medication reminders and interactive quizzes. Control participants received emails with links to osteoporosis information. Anti-osteoporosis medication possession ratio (MPR; acceptable adherence defined as ≥ 0.8) was determined using Pharmaceutical Benefits Schedule data. Osteoporosis knowledge was measured using the Osteoporosis Knowledge Assessment Tool (OKAT) and medication attitudes were measured using the Adherence Evaluation of Osteoporosis Treatment (ADEOS-12) questionnaire.

RESULTS

The mean ± SD age of participants was 64.3 ± 6.1 years and 6-month DVA intervention adherence (number of DVA sessions accessed) was 79.5% (95%CI: 73.9, 84.9). The proportion of participants with acceptable 12-month MPRs was similar between groups (control: 86.4% [95%CI: 77.0, 93.6]; DVA: 95.0% [95%CI: 88.4, 100.0], P = 0.34). Mean OKAT scores improved in both groups after both 6- and 12 months, but there were no significance between groups. Changes in mean ADEOS-12 scores did not differ between baseline and 6 months in DVA compared to control (0.61 [95%CI: - 0.80, 2.03]) but worsened post-intervention from 6 to 12 months (net difference: - 1.42 [95%CI: - 2.80, - 0.06]).

CONCLUSIONS

This DVA-delivered intervention achieved good adherence but did not improve medication adherence, osteoporosis knowledge, or attitudes compared with control. Future studies should target populations with poor adherence to anti-osteoporosis medication.

An update on the pharmacotherapy of osteoporosis

INTRODUCTION

Osteoporosis is a chronic metabolic bone disease characterized by progressive bone loss and structural deterioration, increasing fracture risk and morbidity. As the global population ages, its incidence is rising, underscoring the urgent need for more effective prevention and treatment strategies.

AREAS COVERED

This review synthesizes the latest evidence and guidelines from leading international societies, establishing a contemporary framework for osteoporosis pharmacotherapy. It emphasizes best practices and explores future directions in treatment optimization and fracture prevention.

EXPERT OPINION

To optimize outcomes, enhancing early detection, refining treatment strategies, and prioritizing patient-centered care are essential. Improving diagnosis through increased use of bone mineral density (BMD) assessments and identifying secondary causes are critical steps to addressing underdiagnosis, particularly in men. Pharmacotherapies play a vital role in management; while bisphosphonates serve as a cost-effective first-line treatment, denosumab and anabolic agents like Teriparatide and romosozumab are essential alternatives for high-risk patients. Future directions in osteoporosis management emphasize advancing treatment strategies through novel drug targets and innovative delivery systems, alongside personalized medicine approaches considering individual genetic and comorbidity profiles. Enhanced adherence strategies and further research into combination therapies and monitoring tools are crucial for improving prevention and treatment outcomes, ultimately reducing the fragility fracture burden worldwide.

Evaluating the triglyceride glucose index as a predictive biomarker for osteoporosis in patients with type 2 diabetes

Objective

Osteoporosis is a common condition among individuals with type 2 diabetes; however, the relationship between insulin resistance, as measured by the Triglyceride Glucose Index (TyG), and osteoporosis has not been sufficiently explored. This study seeks to address this research gap by investigating the diagnostic value of TyG in identifying osteoporosis in patients with type 2 diabetes.

Methods

A retrospective analysis was performed on clinical data from 207 diabetic subjects (83 in the osteoporosis group, 124 in the non-osteoporosis group), using SPSS version 27.0 and MedCalc 23 for statistical analysis.

Results

Significant statistical differences were noted between the two groups in terms of gender, age, hemoglobin levels, red blood cell count, total cholesterol levels, and the TyG. Binary logistic regression analysis revealed that gender, age, and TyG are independent predictors of osteoporosis in patients with type 2 diabetes. Receiver operating characteristic (ROC) analysis showed that the area under the curve for TyG, gender, age, and their combination in predicting osteoporosis among patients with T2DM was 0.653, 0.698, 0.760, and 0.857, respectively. Additionally, the diagnostic performance of the TyG value was effectively evaluated, determining 8.78 as the optimal cutoff value, with a corresponding sensitivity of 89.1% and specificity of 52.4%. Meanwhile, the predictive model constructed using gender, age, and the TyG index achieved an area under the curve (AUC) of 0.857 (95% confidence interval: 0.801~0.901), with a maximum Youden index of 0.629. The corresponding diagnostic sensitivity was 83.1% and the specificity was 79.8%.

Conclusion

The TyG holds potential to serve as a prominent biomarker for the diagnosis of osteoporosis among type 2 diabetic patients in various clinical settings.

Is there a correlation between distal femur anatomy and bone mineral density measurements?

PURPOSE

This study aimed to investigate the relationship between the Citak classification of distal femoral morphology and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DEXA). We hypothesized that Type C morphology, characterized by a wider femoral canal, would correlate with lower BMD and a higher prevalence of osteoporosis.

MATERIALS AND METHODS

This retrospective study included 150 patients (51 males, 99 females) who underwent DEXA for BMD evaluation and had knee radiographs available for Citak classification. Radiographs were analyzed to classify femoral morphology into Types A, B, and C based on the Citak index. BMD values were categorized as normal, osteopenic, or osteoporotic. Statistical analyses included correlation and group comparisons, with p-values < 0.05 considered significant.

RESULTS

The study revealed a significant association between the Citak classification and BMD (p = 0.013). Type C morphology was strongly linked to osteoporosis, with a higher prevalence of low BMD compared to Types A and B. A weak but significant negative correlation was observed between the Citak index and BMD T-scores in both males (r = - 0.345, p = 0.013) and females (r = - 0.208, p = 0.039). Males exhibited a significantly higher Citak index and Type C morphology prevalence than females (p = 0.001).

CONCLUSIONS

This study is the first to establish a direct correlation between the Citak classification and BMD, demonstrating that Type C morphology serves as a marker for poor bone quality. Integrating the Citak classification with preoperative evaluations can help identify high-risk patients, optimize surgical planning, and improve outcomes in total knee arthroplasty.

LEVEL OF EVIDENCE

Level IV, retrospective study.

Bone and muscle mass characteristics in patients with gastroenteropancreatic neuroendocrine neoplasms

BACKGROUND

Neuroendocrine neoplasms (NEN) are rare tumors arising from neuroendocrine cells most commonly in the gastrointestinal-tract. In recent years, advancements in therapeutics have increased survival rates in patients with NEN leading to a greater clinical burden compared to the general population.

METHODS

The aim of this single-center case-control study was to investigate the incidence of low bone mass and changes in body composition in adult patients diagnosed with gastroenteropancreatic neuroendocrine tumors (GEPNET). Enrolled participants underwent measurements of bone mineral density (BMD) at the lumbar spine (LS), femoral neck (FN), and total hip (TH) and body composition analysis with calculation of total fat-mass (TFM) and relative skeletal mass index (RSMI), by dual X-ray absorptiometry.

RESULTS

Ninety GEPNET patients (28 with Pancreatic-NET, 20 with small-intestine-NET, 42 with gastric-NET), and 50 age and sex-matched controls were enrolled. The mean disease duration was 5±4.4 years, the majority of patients (54/90) was classified as stage-1, and were not receiving systemic-treatment (76/90). The incidence of osteoporosis/osteopenia was threefold higher in the patients' cohort, compared to controls (OR: 3.17 95% CI 1.16-7.8, p < 0.001). Among NEN patients, gastric-NET had the lowest bone mass, especially in LS. In addition, GEPNET patients demonstrated significantly lower TFM and RSMI, compared to controls (TFM: 31.6 ± 9.6 kg vs. 38.6 ± 6.4 kg, respectively, p = 0.03; RSMI: 6.4 ± 1.1 vs. 8.2 ± 0.6, respectively, p < 0.001). Within our patients' cohort, RSMI was significantly associated with LS-BMD (rho = 0.49, p < 0.001) and TH-BMD (rho = 0.58, p < 0.001), and TFM was associated with TH-BMD (rho = 0.31, p = 0.004).

CONCLUSIONS

Patients with GEPNET even at an early stage exhibit significantly lower bone, muscle and fat mass compared to the non-NET population, highlighting the importance of continuous monitoring of the musculoskeletal system in these patients.

A diagnostic model for assessing the risk of osteoporosis in patients with rheumatoid arthritis based on bone turnover markers

BACKGROUND

The risk of developing osteoporosis (OP) is increased in patients with rheumatoid arthritis (RA), which is associated with poorer prognosis and higher mortality. Many patients with RA may experience bone loss early in the disease course. Therefore, timely assessment of the risk of OP in RA patients is essential.

METHODS

This is a retrospective study in which we collected information from 500 RA patients who underwent bone mineral density assessments at Longhua Hospital, Shanghai University of Traditional Chinese Medicine, from January 2018 to December 2022. Based on the data collection timeline, the first 70% of patients were assigned to the training set, while the remaining 30% were included in the validation set. The model was established using the training set and evaluated through plotting of the receiver operating characteristic curves, calibration curves, and clinical decision curves. Internal validation was performed by resampling the training set data 1,000 times using the bootstrap method, while internal hold-out validation was conducted using the validation dataset.

RESULTS

Ultimately, six variables were identified as independently associated with RA combined with OP (RA-OP): female sex, age, beta C-terminal cross-linked peptide (β-CTX), anti-cyclic citrullinated peptide antibody (ACPA), triglycerides (TG), and N-terminal propeptide of type I procollagen (PINP). The regression equation for the model is as follows: Logistic (RA-OP) = -8.703 + 0.946*female + 0.053*age + 0.004*β-CTX + 0.001*ACPA + 0.6*TG-0.008*PINP. The model demonstrated good discrimination (AUC = 0.819, 95% CI: 0.775-0.863) and calibration. In both internal and internal hold-out validation, the model also performed well, with AUC values of 0.814 (95% CI: 0.772-0.864) and 0.772 (95% CI: 0.697-0.847), respectively. Clinical decision curves indicated that the model outperformed both extreme curves, suggesting good clinical utility.

CONCLUSIONS

Our model is user-friendly and has shown good predictive performance in both internal and internal hold-out validation, offering new insights for the early screening and treatment of OP risk in RA patients.

Heavy Strength Training in Older Adults: Implications for Health, Disease and Physical Performance

Older adults typically exhibit reductions in skeletal muscle maximal strength and the ability to produce force rapidly. These reductions are often augmented by concomitant acute and chronic diseases, resulting in attenuated physical performance and higher propensity of falls and injuries. With the proportion of older adults in the population increasing, there is an alarming need for cost-effective strategies to improve physical performance and combat a multitude of age-related diseases. Surprisingly, despite convincing evidence emerging over three decades that strength training can substantially improve maximal strength (1RM), rate of force development (RFD) and power, contributing to improved health, physical performance and fall prevention, it appears that it has not fully arrived at the older adults' doorsteps. The aim of the current narrative review is to accentuate the convincing benefits of strength training in healthy and diseased older adults. As intensity appears to play a key role for improvements in 1RM, RFD and power, this review will emphasize training performed with heavy (80%-84% of 1RM) and very heavy loads (≥ 85% of 1RM), where the latter is often referred to as maximal strength training (MST). MST uses loads of ~90% of 1RM, which can only be performed a maximum of 3-5 times, 3-5 sets and maximal intentional concentric velocity. Strength training performed with loads in the heavy to very heavy domain of the spectrum may, because of the large increases in muscle strength, focuses on neural adaptations and relatively low risk, provides additional benefits for older adults and contrasts current guidelines which recommend low-to-moderate intensity (60%-70% of 1RM) and slow-moderate concentric velocity. This review also provides information on practical application of MST aimed at practitioners who are involved with preventive and/or rehabilitative health care for older adults.

Influence of low bone mineral density on risk of falls and gait in post-menopausal women and elderly: A systematic review

BackgroundLow bone mineral density (LBMD) significantly contributes to loss of independence, gait impairment, and increased fall risk. Instrumental gait analysis provides an accurate evaluation of walking ability, that represent the first step for a personalized rehabilitation.ObjectiveTo collect and describe the available literature on the effect of LBMD on walking characteristics and the use of motion analysis systems in patients with LBMD.MethodsWe performed a literature search of the last ten years on PubMed, Web of Science and Scopus of papers on older people and patients with LBMD in terms of gait parameters, balance, and fall risk. The review protocol was registered on PROSPERO (CRD42024590090).ResultsThe database search identified totally 756 records; after duplicates deletion, 13 were considered eligible. The results reported that subjects with LBMD had kinematic alterations of the walk, alterations of posture, speed of walking and the strength generated in the gait. Patients with osteoporosis show a reduction of gait speed and trunk asymmetry; moreover, there is a a decrease in body rotation and lower hip and ankle moments in post-menopausal women.ConclusionsPatients with LBMD showed gait alterations that can higher the risk of falls. In this context, gait analysis can be useful in detecting variations in pattern, symmetry, gait speed and posture in elderly patients, that can represent an essential step for a personalized rehabilitation program.

Developmental Endothelial Locus-1 Promotes Osteoclast Differentiation and Activation

Developmental endothelial locus-1 (DEL-1) has traditionally been characterized within the scientific community as having anti-inflammatory properties with potential inhibitory effects on osteoclast formation. Our investigation challenges this paradigm by examining Del-1 expression in RAW264.7 cells and bone marrow-derived macrophages (BMMs) during osteoclastogenesis, as well as its functional impact on osteoclast development and activity. Our experimental findings revealed that Del-1 mRNA levels were markedly elevated in cells stimulated by the receptor activator of the nuclear factor κB ligand compared to unstimulated precursors. When cultured with varying concentrations of recombinant DEL-1, osteoclast differentiation increased in a dose-dependent manner. Furthermore, BMMs isolated from ovariectomized mice exhibited significantly higher Del-1 mRNA expression than those from control animals. To confirm DEL-1's role, we employed RNA interference techniques, demonstrating that DEL-1 silencing in RAW264.7 cells substantially reduced osteoclast formation. These results suggest that DEL-1 plays a previously unrecognized role in promoting osteoclastogenesis and may contribute to bone metabolism imbalances in conditions like osteoporosis, highlighting its complex role in skeletal homeostasis and its potential as a therapeutic target.

Predictive modelling of knee osteoporosis

OBJECTIVE

The objective of this research was to develop a machine learning-based predictive model for osteoporosis screening using demographic and clinical data, including T-scores derived from calcaneus Quantitative Ultrasound (QUS). The study aimed to offer a cost-effective and accessible alternative to Dual-Energy X-ray Absorptiometry (DXA) scans, especially in resource-constrained settings.

RESULTS

The model achieved a classification accuracy of 88%, outperforming traditional decision trees by 10%. This improvement in accuracy demonstrates the potential of the random forest algorithm in identifying patients at risk of osteoporosis. Misclassification rates were minimal, with most errors occurring in distinguishing osteopenia from normal cases. The findings indicate that machine learning models trained on QUS data can aid in early identification of osteoporosis, reducing reliance on costly DXA scans.

Association between particulate air pollution, physical activity, and the risk of osteoporosis in the UK Biobank

As a major threat to global health, particulate air pollution has a great possibility of affecting bone metabolism. However, the results of limited studies examining the association between particulate air pollution and bone mineral density (BMD) as well as incident osteoporosis (OP) are conflicting, and the role of physical activity in the association above remains to be further studied. We evaluated the relationship between long-term exposure to Black Carbon (BC) and Particulate Matter (PM) (including PM1 (particles with aerodynamic diameter < 1 μm), PM2.5 (particles with aerodynamic diameter < 2.5 μm) and PM10 (particles with aerodynamic diameter < 10 μm)) and BMD together with OP risks, based on a total of 233,184 subjects from the UK Biobank. General linear regression, logistic regression and restricted cubic spline (RCS) methods were adopted to measure both linear and nonlinear relationship between particulate air pollution and BMD and OP prevalence. Stratified analyses were further utilized to evaluate the potential protective effect of physical activity on bone health under particulate air pollution exposure. BC, PM1 and PM2.5 exposure were negatively associated with BMD (BC: β = -2.35E-03, P = 1.78E-02; PM1: β = -1.57E-03, P = 9.04E-04; PM2.5: β = -9.38E-04; P = 2.98E-13) and positively associated with OP risk (BC: OR (95 %CI) = 1.300 (1.150,1.480), P < 0.001; PM1: OR (95 %CI) = 1.100 (1.040,1.170), P < 0.001; PM2.5: OR (95 %CI) = 1.020 (1.000,1.040), P = 0.019). The RCS analysis presented non-linear relationships between all included particulate air pollutants and incident OP. Higher intensity physical activity could alleviate the risks of BMD decline and OP prevalence caused by particulate air pollution. Our study concluded that particulate air pollution is a crucial threat to bone health, the effect of which can be receded by physical activity. Strengthening air pollution control measures and promoting public engagement in physical activity will contribute to reducing the disease burden associated with OP.

Proposed practice parameters for the performance of radiofrequency echographic multispectrometry (REMS) evaluations

Aims

Assessment of bone health is a multifaceted clinical process, incorporating biochemical and diagnostic tests that should be accurate and reproducible. Dual-energy X-ray absorptiometry (DXA) is the reference standard for evaluation of bone mineral density, but has known limitations. Alternatives include quantitative CT (q-CT), MRI, and peripheral quantitative ultrasound (QUS). Radiofrequency echographic multispectrometry (REMS) is a new generation of ultrasound technology used for the assessment of bone mineral density (BMD) at axial sites that is as accurate as quality-assured DXA scans. It also provides an assessment of the quality of bone architecture. This will be of direct value and significance to orthopaedic surgeons when planning surgical procedures, including fracture fixation and surgery of the hip and spine, since BMD alone is a poor predictor of fracture risk.

Methods

The various other fixed-site technologies such as high-resolution peripheral q-CT (HR-pQCT) and MRI offer no further significant prognostic advantages in terms of assessing bone structure and BMD to predict fracture risk. QUS was the only widely adopted non-fixed imaging option for bone health assessment, but it is not considered adequately accurate to provide a quantitative assessment of BMD or provide a prediction of fracture risk. In contrast, REMS has a robust evidence base that demonstrates its equivalence to DXA in determining BMD at axial sites. Fracture prediction using REMS, combining the output of fragility information and BMD, has been established as more accurate than when using BMD alone.

Conclusion

The practice parameters described in this protocol provide a framework for clinicians who provide REMS services that will, to the greatest possible extent, ensure the most accurate assessment possible from this diagnostic technology.

Abdominal obesity: A lethal factor in elderly male osteoporosis patients - insights from NHANES

BACKGROUND AND AIM

This study aims to investigate the relationship between A Body Shape Index (ABSI) Z-score and all-cause mortality among osteoporotic patients using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS AND RESULTS

We analyzed NHANES data from 2005 to 2010, 2013 to 2014, and 2017 to 2018, focusing on individuals aged 50 and above with complete bone mineral density (BMD) data. The ABSI Z-score, calculated by adjusting waist circumference (WC) for height and weight, was used to independently assess abdominal fat beyond Body Mass Index (BMI). Mortality status was confirmed by linking NHANES data with the National Death Index (NDI), with follow-up until December 31, 2019. Weighted Cox proportional hazards models were employed for analysis, adjusting for age, gender, race, fracture history, anti-osteoporosis treatment history, diabetes, and cardiovascular disease (CVD). The study included 1596 participants. Higher ABSI Z-scores were significantly associated with increased all-cause mortality risk, especially among elderly male osteoporotic patients. This association remained robust after adjusting for multiple potential confounders.

CONCLUSION

The ABSI Z-score serves as a valuable non-invasive screening tool that effectively identifies osteoporotic patients at higher risk of mortality. These findings emphasize the importance of body management in health, supporting further research to explore the practical utility of ABSI Z-score in osteoporotic patients and how body management can enhance long-term survival rates.

Optimized surveillance frequency for low bone mineral density (BMD) screening using dual-energy X-ray absorptiometry (DXA) in patients after lung transplant

BACKGROUND

Approximately 2,700 lung transplants are performed annually in the United States. These patients are at increased risk of developing low bone mineral density (BMD) (osteopenia/osteoporosis) and subsequent fractures. Dual-energy X-ray absorptiometry (DXA) is the most common method used for screening for low BMD; however, the optimal surveillance frequency for low BMD using DXA is unknown.

METHODS

We evaluated the change in femoral neck, total femur, L1, L2, L3, and L4 BMD after lung transplant in a retrospective cohort of 259 patients (69.9% male) who were followed with serial DXA scans for a median of 725 (interquartile range [361-1,116]) days after transplant. Generalized linear mixed-effects models adjusting for sex, time, time-squared, baseline osteopenia/osteoporosis, active rejection, and their interaction terms were used to model the rate of change of BMD at each site. The final multivariable models for the femoral neck, L1, and L4 BMD measurements had random slopes and intercepts, and the models for the total hip, L2, and L3 measurements had random slopes.

RESULTS

Sixty-five percent of the patients undergoing lung transplants had osteopenia or osteoporosis before transplant. Men exhibited higher baseline BMD levels compared to women at all sites (p < 0.001 for all). After the transplant, the greatest rate of BMD decrease was at the femoral neck. Although patients with low BMD had significantly lower baseline BMDs (p < 0.001 for all), they experienced a slower rate of BMD decrease at all sites compared to patients with normal BMD at baseline (p < 0.001 for all). All patients received corticosteroids. Patients with low BMD at baseline had significantly higher odds of receiving bisphosphonate therapy (odds ratio = 3.95, 95% confidence interval [CI] [1.44, 13.51], p = 0.003). We estimated that a significant change in the femoral neck BMD would be expected to occur within 409 days (95% CI [131, 708]) and again at 867 days (95% CI [551, 1,216]) after lung transplant.

CONCLUSIONS

Patients undergoing lung transplant should be screened annually with DXA for the first 2 years after transplant, consistent with the current International Society for Heart and Lung Transplantation guidelines.

Ultra-processed food intake and prevalence of osteoporosis in US adults aged 50 years and older: a cross-sectional analysis

Dietary quality may be a factor in the progression of non-communicable, chronic diseases. This analysis of NHANES data demonstrates association between consumption of UPF and prevalence of osteoporosis and osteopenia in adults 50 years and older. UPF intake is an important consideration when recommending dietary patterns for optimum bone health PURPOSE: Declining bone mineral density in older adults can result in osteoporosis, leading to decreased physical function, quality of life, and increased risk of mortality. Poor dietary quality may contribute to the progression of this disease. This study explores the association between the consumption of ultra-processed foods (UPF) and the prevalence of osteoporosis and osteopenia in adults aged 50 years and older.

METHOD

Using regression analysis and adjusting for covariates, 24-h recall data from adults 50 years and over in four cycles of NHANES were examined for associations between prevalence of osteoporosis and intakes of UPF as a proportion of daily energy intake.

RESULTS

Mean (SE) intake of UPF as a proportion of total daily energy ranged from 29.5% (0.3) in the lowest quintile to 76.3% (0.3) in the highest. 50.5% of women and 28.0% of men had osteopenia, 8.2% and 1.8%, respectively, had osteoporosis. Increased risk of osteopenia or osteoporosis was observed in the highest quintile of UPF intake compared to that of the lowest: OR 1.52 (95% CI 1.28, 1.79). The odds of self-reported prior fractures at hip, wrist, or spine in women increased by 1.9% for every percentage increase in proportion of UPF intake (95% CI 1.003, 1.035). Increased risk of fracture was not observed among men.

CONCLUSIONS

These findings indicate an association between osteoporosis and osteopenia and the intake of UPF as a proportion of total daily energy. Further investigation into the impact of dietary quality on osteoporosis and fracture risk is warranted, particularly in post-menopausal women.

High prevalence of osteoporosis among virally suppressed older people (≥60 years) living with HIV

OBJECTIVES

Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya.

METHODS

The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre-enrolment regimen. At enrolment, dual-energy x-ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T-scores calculated for BMD. Osteoporosis was defined as T-score -2.5 or lower and osteopenia as T-score between -1 and -2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®-HIV and BMD assessed.

RESULTS

Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60-77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm2 (interquartile range [IQR] 0.78-0.99), 0.89 g/cm2 (IQR 0.79-1.01), and 0.75 g/cm2 (IQR 0.67-0.84), respectively, with median T-scores of -1.9 (IQR -2.8 to -0.7), -1.0 (IQR -1.9 to -0.3), and -1.5 (IQR -2.2 to -0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10-year median probabilities using FRAX®-HIV were 3.4% (IQR 2.8-4.6) and 1.0% (IQR 0.7-1.3). Correlation coefficients between these FRAX®-HIV probabilities and femoral neck BMD were -0.204 for major osteoporotic fracture and -0.338 for hip fracture.

CONCLUSIONS

The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population-specific risk calculators.

Physical health effects of sedentary behaviour on adults with an intellectual disability: A scoping review

This literature review was designed to establish the effects of sedentary behaviour on the physical health of adults with an intellectual disability. Sedentary behaviour is defined as any waking behaviour characterized by an energy expenditure of ≤1.5 METs while in a sitting, lying or reclining posture. An extensive search was executed in six databases: EMBASE, Medline, CINAHL, PsycINFO, ASSIA and Web of Science. Following screening, 18 articles remained for inclusion in the review. A thematic analysis using the Braun and Clarke six step process resulted in the identification of seven broad health areas. Studies showed a prevalence of obesity, multimorbidity and metabolic syndrome as well as elevated levels of sedentary behaviour in adults with an intellectual disability. This literature review demonstrated that sedentary behaviour could be a contributor to the poor health which is common in adults with an intellectual disability. However to date the body of evidence does not confirm a cause-and-effect relationship.

Advances in research of metabolic bone disease secondary to chronic pancreatitis

Chronic pancreatitis (CP) is a progressive chronic inflammatory disease that can cause irreversible damage to pancreatic tissue, ultimately leading to pancreatic endocrine and exocrine insufficiency. Metabolic bone disease (MBD) is one of the systemic complications of CP, which includes osteopenia and osteoporosis, characterized by degradation of bone microstructure and an increased risk of fragility fracture. Nearly half of the patients with CP suffer from MBD, which is affected by a number of factors. Pancreatic exocrine insufficiency and pancreatic diabetes mellitus, which are also systemic complications of CP, can affect bone mineral density by lowering serum calcium, and increased levels of inflammatory factors in chronic inflammatory states, as well as the use of opioids to alleviate the pain of CP, can disrupt the balance between bone formation and resorption and promote the development of MBD. In addition, known risk factors for osteoporosis, such as smoking, alcohol abuse, aging, and low body mass index, account for a higher proportion of CP cases than in the general population and contribute to the high prevalence of MBD in CP patients. Foreign guidelines recommend that CP patients be regularly screened for fat-soluble vitamin deficiency, tested for bone mineral density, and evaluated for fracture risk, and encourage all CP patients to actively take preventive measures. In this article, we present a review on the research progress of CP-related metabolic bone disease, discussing the prevalence, related risk factors, and prevention and management of MBD, which will provide a reference for clinical workers.

Adherence to a healthy dietary pattern mitigates the detrimental associations between osteosarcopenic adiposity and both all-cause mortality and life expectancy: a cohort study

Background and aims: To determine the associations between osteosarcopenic adiposity (OSA) and both all-cause mortality and life expectancy, and to investigate whether adherence to a healthy diet can modify these associations. Methods: Utilizing data obtained from 201 223 UK Biobank participants, we assessed body composition for OSA and a healthy diet score was used to assess dietary quality. Results: Compared to participants with no body composition abnormality, the adjusted HRs (95% CIs) of all-cause mortality for those with 1, 2, and 3 (OSA) abnormalities were 1.13 (1.08, 1.18), 1.28 (1.21, 1.35), and 2.01 (1.58, 2.56) after adjustments, respectively. Compared with participants with no body composition abnormality, OSA patients with poor dietary patterns had a higher risk of all-cause mortality (HR = 2.92, 95% CI: 1.96, 4.36) than those with medium (HR = 1.73, 95% CI: 1.27, 2.37) and healthy dietary patterns (HR = 1.39, 95% CI: 0.34, 5.60). Specifically, a lower intake of fish and a higher intake of processed meat contributed to such different associations. Compared with participants without body composition abnormality, those with 1, 2, and 3 (OSA) body composition abnormalities had 0.31 (95% CI: -0.07, 0.69), 0.62 (95% CI: 0.16, 1.09) and 3.03 (95% CI: 1.05, 5.00) years of reduced life expectancy at age 45 years. Conclusions: Body composition abnormality, particularly OSA, is associated with both increased risk of all-cause mortality and reduced life expectancy. Nevertheless, it is noteworthy that adopting a healthy dietary pattern appears to mitigate these associations.

The association between different insulin resistance indexes and bone health in the elderly

The triglyceride-glucose (TyG) index and its related indexes (TyG-BMI, TyG-WC, TyG-WHtR) are effective markers for screening metabolic diseases like insulin resistance (IR). However, few studies have explored the relationship between the TyG and its related indexes with bone density (BMD), osteopenia, and osteoporosis. This is a cross-sectional study that involved 1,303 adults aged 50 years and above from the National Health and Nutrition Examination Survey 2007-2010, and 2013-2014. In the multivariable-adjusted model, linear regression analysis and logistic regression analysis demonstrated that TyG and its related indexes have a significant positive correlation with BMD and a negative correlation with osteopenia/osteoporosis in the femoral neck, lumbar spine, and total hip region. Trend analysis further confirms these associations (p < 0.05). Restricted cubic spline analysis showed a nonlinear relationship between these indexes with BMD and osteopenia/osteoporosis. Sensitivity analyses further confirmed the robustness of these associations. This study reveals the significant and complex correlation between the TyG and its related indexes with BMD and osteoporosis, indicating the potential link between IR and bone health. The TyG and related indexes offer a new perspective for the diagnosis, prevention, and treatment of osteoporosis.

Construction and validation of a predictive model for the risk of osteoporosis in patients with chronic kidney disease based on NHANES data

BACKGROUND

Chronic kidney disease (CKD) patients tend to exhibit a heightened susceptibility to osteoporosis owing to abnormalities in mineral and bone metabolism. The objective of this study was to develop and validate a nomogram for the prediction of osteoporosis risk in patients with CKD.

METHODS

1498 patients diagnosed with CKD were enrolled from the National Health and Nutrition Examination Survey (NHANES) data spanning 2005-2010, 2013-2014, and 2017-2018. The dataset was randomly divided into a training set and a validation set in a ratio of 7:3. Utilizing the least absolute shrinkage and selection operator (LASSO) regression technique for predictor identification, followed by employing multivariate logistic regression based on the selected predictors to construct a nomogram. The performance of the prediction model was assessed using various metrics, including the area under the receiver operating characteristic curve (AUC), calibration curve, the Hosmer-Lemeshow test, and decision curve analysis (DCA).

RESULTS

The construction of the nomogram was based on five predictors, namely age, height, weight, alkaline phosphatase (ALP), and history of fracture. The AUC of 0.8511 in the training set and 0.8184 in the validation set demonstrates robust discriminability. Furthermore, the excellent calibration and clinical applicability of the model have been thoroughly validated.

CONCLUSIONS

Our study suggests a nomogram, providing nephrologists with a convenient and effective tool for identifying individuals at high risk of osteoporosis and avoiding adverse outcomes related to CKD.

In Vivo Bone Mineral Density Assessment With Spectral Localizer Radiographs From Photon-Counting Detector CT: Prospective Comparison With DXA

PURPOSE

The aim of this study was to determine in a prospective patient study the accuracy of areal bone mineral density (aBMD) measurements with spectral localizer radiographs obtained with a clinical photon-counting detector computed tomography (PCD-CT) scanner in comparison with dual-energy x-ray absorptiometry (DXA).

METHODS

In this institutional review board-approved, prospective study, 41 patients (15 females, 26 males; mean age 61.3 years, age range 35-78 years) underwent PCD-CT of the abdomen with a spectral localizer radiograph (tube voltage 140 kVp, tube current 30 mA) and DXA within a median of 45 days. aBMD values were derived for lumbar vertebrae L1-L4 from both methods and were compared with linear regression, Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman plots. T-scores were calculated on a patient level and were compared between methods.

RESULTS

DXA and spectral localizer radiographs showed strong correlation in aBMD measurements (R = 0.97, P < 0.001) and patient level T-scores (R = 0.99, P < 0.001). There was a strong agreement between aBMD from both methods (ICC, 0.96; 95% CI, 0.94-0.97). Bland-Altman analysis revealed a very small mean difference in aBMD between methods (mean absolute error 0.019 g/cm2) with narrow limits of agreement (-0.083 g/cm2 to 0.121 g/cm2). Similarly, there were small differences in regard to the T-score (mean absolute error 0.156) with narrow limits of agreement (-0.422 to 0.734) between methods. ICCs indicated an excellent agreement between T-scores from DXA and spectral localizer radiographs (ICC, 0.98; 95% confidence interval, 0.95-0.99).

CONCLUSIONS

Our prospective patient study indicates that spectral localizer radiographs obtained with a clinical PCD-CT system enable accurate quantification of the lumbar bone areal mineral density. This opens up the opportunity for opportunistic screening of osteoporosis in patients who undergo CT for other indications.

Modification of bone architecture following sleeve gastrectomy: a five-year follow-up

Bariatric surgery induces a decrease in areal BMD (aBMD), but the long-term effect on trabecular and cortical volumetric BMD (vBMD) has not been well assessed. The main aim of this 5-yr longitudinal study was to investigate the changes following sleeve gastrectomy (SG) in aBMD, bone turnover markers, and trabecular and cortical vBMD. Forty-five patients with obesity were assessed before and 1, 2, and 5 yr after SG. Trabecular and cortical vBMD, cortical thickness, and structural parameters were assessed by 3D-Shaper software at the hip. Values of bone turnover markers peaked after 1 yr and decreased after 2 and 5 yr, but without returning to baseline values. aBMD decreased mostly at the femoral neck (-9.7%) and total hip (-10.7%) over the 5 yr, with the greatest loss occurring at 1 yr (-5.9% and -6.3%, respectively). A similar profile of decrease was observed for integral hip vBMD with significant decreases of 6.6%, 7.7%, and 10.7% after 1, 2, and 5 yr, mainly due to a reduction in the trabecular (10.5%, 12.0%, and 17.2%, respectively) rather than cortical (1.4%, 1.9%, and 2.9%, respectively) component. A modest decrease in mean cortical thickness (2.5%, 2.8%, and 3.9%, respectively) and an alteration in the structural parameters were concomitantly observed. Older age and greater body weight loss were the factors most associated with an increased loss of aBMD and vBMD. In conclusion, the study demonstrates that SG induces not only an alteration in bone turnover and aBMD, but also a reduction in vBMD at the hip, predominantly due to trabecular component deterioration as determined by 3D-Shaper software. The maintenance of bone deterioration for at least 5 yr-ie, after 4 yr of relative body weight stabilization or minimal weight regain-suggests the need for a therapeutic approach to preserve bone health in patients who undergo SG.

Bone mineral density and the risk of kidney disease in patients with type 1 diabetes

AIM

To explore the association between bone disorder and the risk for progression of diabetic kidney disease (DKD) in persons with type 1 diabetes mellitus (T1DM).

METHODS

In this prospective cohort study the association between bone mineral density (BMD), bone-derived factors (sclerostin, Dickkopf-1, and osteoprotegerin (OPG)), and four outcomes were investigated: 1) progression of albuminuria; 2) decline in estimated glomerular filtration rate (eGFR) ≥30 %; 3) kidney failure (KF); and 4) a composite kidney outcome consisting of at least one of the outcomes.

RESULTS

In 318 participants (median follow-up time 5.5 years) patients with osteoporosis (BMD with T-score < -2.5) had increased risk of eGFR decline: hazard ratio (HR) 2.56 (95 % CI 1.06-6.19, p = 0.04), KF: HR 9.92 (95 % CI 1.16-84.95, p = 0.04), and the composite kidney outcome: HR 2.42 (95 % CI 1.18-4.96, p = 0.02). Patients with high OPG had increased risk of eGFR decline, KF, and the composite outcome, compared to patients with low OPG in unadjusted analysis. No bone-derived factor was associated with any outcome in adjusted analyses.

CONCLUSIONS

In patients with T1DM low BMD was associated with progression of DKD, suggesting an interaction between bone and kidney.

Assessing osteoporosis and bone mineral density through 18F-NaF uptake at lumbar spine

OBJECTIVES

The use of 18F-Sodium fluoride (NaF) PET/CT is established in the detection of metastatic bone disease, yet its utility in osteoporosis remains underexplored. This research aims to assess the variations in 18F-NaF uptake among individuals with differing bone mineral density (BMD) and to examine the relationship between 18F-NaF uptake and BMD.

METHODS

In this retrospective study, 199 patients (average age 56 ± 6, comprising 52 males and 147 females) with a history of cancer were analyzed. Each participant underwent both 18F-NaF PET/CT and lumbar dual-energy X-ray absorptiometry (DXA) scans within a span of 7 days. Based on DXA outcomes, patients and their lumbar vertebrae were categorized into normal BMD, osteopenia, and osteoporosis groups. The lumbar 18F-NaF uptake across these groups were compared, and to explore the association between lumbar standardized uptake values (SUV) values and BMD. The efficacy of 18F-NaF uptake in diagnosing osteoporosis or osteopenia was also evaluated. Analysis was conducted using Mann-Whitney U tests, Spearman regression, and receiver operating characteristic (ROC) curve analysis through GraphPad Prism 10.0.

RESULTS

A total of 796 lumbar vertebrae from 199 patients were measured. It was observed that osteoporotic patients had significantly lower 18F-NaF uptake than those with osteopenia and normal BMD across the L1-L4 lumbar vertebrae (P < 0.0001). In a vertebra-based analysis, normal BMD vertebrae exhibited the highest maximum SUV(SUVmax) compared to osteopenic (8.13 ± 1.28 vs. 6.61 ± 1.01, P < 0.0001) and osteoporotic vertebrae (8.13 ± 1.28 vs. 4.82 ± 1.01, P < 0.0001). There was a positive correlation between lumbar 18F-NaF uptake and BMD across all vertebrae, with correlation coefficients exceeding 0.5 (range: 0.57-0.8). The area under the ROC curve values were notably high, at 0.96 for osteoporosis and 0.83 for osteopenia diagnosis.

CONCLUSION

This study demonstrates distinct 18F-NaF uptake patterns among individuals with varying BMD levels, with a positive correlation between 18F-NaF uptake and BMD. These findings highlight the potential of 18F-NaF PET/CT as a supportive diagnostic method in the management of osteoporosis.

Denosumab for osteoporosis in older adults in long-term care: A randomized trial

BACKGROUND

In long-term care (LTC), the incidence of hip or vertebral fractures are eight times that in the community. Despite the wide availability of osteoporosis therapy, LTC residents are omitted from pivotal trials and not treated. Denosumab is a relatively new, monoclonal antibody therapy for osteoporosis treatment. Via a randomized trial, we sought to determine the safety and efficacy of denosumab in LTC residents.

METHODS

We conducted a 2-year, double-blind, placebo-controlled, randomized clinical trial in 201 osteoporotic men and women aged ≥ 65 years, living in LTC communities. Participants with multimorbidity, dysmobility, and cognitive impairment were not excluded. The intervention was denosumab 60 mg subcutaneous every 6 months or placebo. Our primary outcome measures were hip and spine bone mineral density (BMD) improvement at 24 months. Secondary outcomes included BMD at other skeletal sites, function, and safety.

RESULTS

We included 123 women and 78 men with a mean ± standard error age of 81.5 ± 0.6. Overall, 83% and 71% completed 12 and 24 months, respectively. Compared with placebo, the women receiving denosumab had a greater 24-month percent increase in spine (7.41 ± 0.93 vs. 2.15 + 0.56; p = 0.014), and total hip BMD (4.62 ± 0.62 vs. -0.19 ± 0.79; p = 0.007); and men in spine (7.91 ± 0.96 vs. 1.12 ± 1.13; p = 0.002) and total hip (3.74 ± 0.55 vs. 0.48 ± 0.74; p = 0.018). There were no significant differences in safety metrics.

CONCLUSIONS

Denosumab was a safe and effective therapy for improving BMD in osteoporotic older men and women with multiple comorbidities in LTC.

Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older Chinese men can be the same as that of older Chinese women, both much lower than the value for Caucasians

For older Caucasian women and men, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) threshold for classifying osteoporosis is 80 mg/ml. It was recently proposed that, for older East Asian women, the QCT LS BMD value equivalent to the Caucasian women's threshold of 80 mg/mL is about 45∼50 mg/ml. For a data of 328 cases of Chinese men (age: 73.6 ± 4.4 years) who had QCT LS BMD and DXA LS BMD at the same time and with the DXA BMD value of ≤ 0.613 g/cm2 to classify osteoporosis, the corresponding QCT LS BMD threshold is 53 mg/ml. Osteoporotic-like vertebral fracture sum score (OLVFss) ≤ -2.5 has been proposed to diagnose osteoporosis. For 316 cases of Chinese men (age:73.7±4.5 years), OLVFss ≤ -2.5 defines an osteoporosis prevalence of 4.4%; to achieve this osteoporosis prevalence, the corresponding QCT LS BMD value is < 47.5 mg/ml. In the China Action on Spine and Hip Status study, a Genant grades 2/3 radiographic 'osteoporotic vertebral fracture' prevalence was 2.84% for Chinese men (total n = 1267, age: 62.77 ± 9.20 years); to achieve this osteoporosis prevalence, the corresponding BMD value was < 42.5 mg/ml. In a study of 357 Beijing older men, according to the clinical fragility fracture prevalence and femoral neck DXA T-score, the QCT LS BMD value to classify osteoporosis was between 39.45 mg/ml and 51.38 mg/ml. For older Chinese men (≥ 50 years), we recommend the cutpoint for the QCT LS BMD definition of osteoporosis to be 45∼50 mg/ml which is the same as the value for Chinese women.

The L-shaped association between body roundness index and all-cause mortality in osteoporotic patients: a cohort study based on NHANES data

Purpose

This study aims to investigate the relationship between the body roundness index (BRI) and overall mortality rates in individuals with osteoporosis (OP), utilizing information sourced from the NHANES database, in order to assess BRI's capability as an indicator for predicting mortality risk.

Methods

Data from NHANES (2005 to 2010, 2013-2014, and 2017-2018) were analyzed, including 1,596 osteoporotic individuals aged 50 and above. BRI was calculated based on waist circumference (WC) and height, categorizing participants into high (>4.07) and low (≤4.07) BRI groups. To analyze the relationship between BRI and mortality while accounting for important covariates, we employed weighted Cox proportional hazards models, conducted Kaplan-Meier survival analyses, and utilized restricted cubic splines (RCS).

Results

Higher BRI was significantly associated with better long-term survival, showing an "L"-shaped nonlinear inverse relationship with mortality, with a threshold at BRI = 5. In subgroup analyses, this association remained relatively stable.

Conclusion

The "L"-shaped association between BRI and mortality indicates that BRI may serve as a useful indicator for evaluating mortality risk in patients with OP, thereby informing clinical interventions and public health approaches.

High Prevalence of Symptomatic Knee Osteoarthritis Among Patients Who Have Fragility Hip Fractures

BACKGROUND

Knee osteoarthritis (OA) is a common degenerative musculoskeletal condition that impairs mobility and balance, increasing fall risk. When combined with osteoporosis, it further increases the risk of fragility fractures. Despite its prevalence, the frequency of knee OA in patients who have fragility hip fractures (FHFs) is not well established. This study aimed to determine the prevalence of knee OA among FHF patients.

METHODS

We conducted a cross-sectional analysis of patients who underwent surgical treatment for FHF. The knee OA diagnoses followed the American College of Rheumatology criteria, and severity was assessed via the Kellgren-Lawrence classification system. Bone mineral density (BMD) was evaluated at the lumbar spine and contralateral hip, and fall risk was assessed using a self-report questionnaire.

RESULTS

Among the 162 patients who had FHF (mean age 79 ± 8.1 years; 80.2% women), 66% had symptomatic knee osteoarthritis (SKOA). Of these, 21.0% were classified as end-stage knee osteoarthritis. Notably, 47.1% of these end-stage knee osteoarthritides were recommended for knee OA surgery before their hip fracture. The presence of SKOA was significantly associated with a history of multiple falls (P = 0.013) and a high fall risk (P = 0.020). Among the 120 patients who had BMD data, 68% had low BMD (T-score ≤ -2.5) at the contralateral hip or lumbar spine. Almost half (45%) of the FHF patients had concurrent SKOA and low BMD, whereas approximately 20% had SKOA, low BMD, and a high fall risk.

CONCLUSIONS

There is a high prevalence of SKOA among FHF patients. Comprehensive evaluation and management of knee OA and osteoporosis are essential to reduce the risk of subsequent fractures in this vulnerable population.

Crispant analysis in zebrafish as a tool for rapid functional screening of disease-causing genes for bone fragility

Heritable fragile bone disorders (FBDs), ranging from multifactorial to rare monogenic conditions, are characterized by an elevated fracture risk. Validating causative genes and understanding their mechanisms remain challenging. We assessed a semi-high throughput zebrafish screening platform for rapid in vivo functional testing of candidate FBD genes. Six genes linked to severe recessive osteogenesis imperfecta (OI) and four associated with bone mineral density (BMD) from genome-wide association studies were analyzed. Using CRISPR/Cas9-based crispant screening in F0 mosaic founder zebrafish, Next-generation sequencing confirmed high indel efficiency (mean 88%), mimicking stable knock-out models. Skeletal phenotyping at 7, 14, and 90 days post-fertilization (dpf) using microscopy, Alizarin Red S staining, and microCT was performed. Larval crispants showed variable osteoblast and mineralization phenotypes, while adult crispants displayed consistent skeletal defects, including malformed neural and haemal arches, vertebral fractures and fusions, and altered bone volume and density. In addition, aldh7a1 and mbtps2 crispants experienced increased mortality due to severe skeletal deformities. RT-qPCR revealed differential expression of osteogenic markers bglap and col1a1a, highlighting their biomarker potential. Our results establish zebrafish crispant screening as a robust tool for FBD gene validation, combining skeletal and molecular analyses across developmental stages to uncover novel insights into gene functions in bone biology.

The impact of body mass index on the relationship between psoriasis and Osteopenia: a mediating analysis based on NHANES (2003-2006)

The relationship between psoriasis and osteopenia remains undetermined. Patients with psoriasis tend to have a higher Body Mass Index (BMI) compared to those without the condition. While it appears plausible that BMI could mediate this association, further study is required to confirm this hypothesis. The objective of this study is to ascertain whether BMI plays a role in influencing the impact of psoriasis on osteopenia. This study encompassed 2,624 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2006. The condition of psoriasis was self-reported, while osteopenia was assessed based on bone mineral density (BMD) range and self-reported osteoporosis. BMI was derived from NHANES body measurement data. Weighted logistic regression analyses and mediation analysis were utilized to elucidate the relationship. Subgroup differences were further explored in the absence of a clear relationship. A positive correlation was observed between psoriasis and osteopenia. Furthermore, BMI was positively related to psoriasis and negatively related to osteopenia. Additionally, BMI served as a mediator in the relationship between psoriasis and osteopenia, accounting for 20.8% of the variance. Specifically, the mediating influence of BMI exhibited variations based on diabetes status and gender. In conclusion, Controlling BMI could potentially mitigate the impact of psoriasis on osteopenia. Therefore, we advocate for a rigorous focus on bone health in individuals with psoriasis, particularly among males and non-diabetic populations.

A Pilot Study on the Age-Dependent, Biomechanical Properties of Longitudinal Ligaments in the Human Cervical Spine

The cervical spine ligaments, including the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL), play a key role in maintaining spinal stability by limiting excessive movements. This study investigates how ageing affects the mechanical properties of these ligaments. We analysed 33 samples from 12 human cervical spines (15 ALL, 18 PLL), averaging data from the same donors for independent analysis, resulting in 18 final samples (8 ALL, 10 PLL). To explore age-related changes, we classified the samples into two groups-below and above 50 years old-aligning with the peak incidence of major musculoskeletal disorders. The investigation concentrated on the effects of age on four mechanical parameters of the uniaxial stress-stretch curve: initial tangent stiffness (E0), maximum tangent stiffness (Em), ultimate stress (Pu) and ultimate stretch (λu). When the age effect is neglected, then the behaviours of both the ALL and PLL appeared similar. However, when introducing age as a variable into the context of the ALL and PLL, statistically significant differences became evident. The findings underscored a reduction in maximum tangent stiffness (p-value = 0.0147), ultimate stress (p-value = 0.0009), and ultimate stretch (p-value = 0.0024) when the ALL and PLL were grouped under and above 50 years as a consequence of ageing.

Fracture Risk Assessment in the 2023 Osteoporosis Canada Guideline

Radiologists and other diagnostic imaging specialists play a pivotal role in the management of osteoporosis, a highly prevalent condition of reduced bone strength and increased fracture risk. Bone mineral density (BMD) measurement with dual-energy X-ray absorptiometry (DXA) is a critical component of identifying individuals at high risk for fracture. Strategies to prevent fractures are consolidated in the Osteoporosis Canada clinical practice guideline which was updated in 2023. In this guideline, treatment recommendations are based upon a consideration of fracture history, 10-year major osteoporotic fracture (MOF) risk, and BMD T-score in conjunction with age. The current review aims to familiarize radiologists and other diagnostic imaging specialists with the reporting requirements needed to support implementation of this guideline using the FRAX™ risk calculation tool. Fortunately, for specialists already familiar with the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool, the transition to FRAX-based reporting is readily accommodated in a radiology workflow.

Trends in osteoporosis assessment, diagnosis after fragility fractures, and treatment for hospitalized patients with osteoporosis or fragility fractures between 2012 and 2021

Our study investigated trends in osteoporosis management in Xiamen from 2012 to 2021, revealing improvements in screening and treatment, although medication use remained low. Additionally, we identified factors that may influence medication use and emphasized the importance of effective osteoporosis management strategies.

PURPOSE

The goal of the current study is to explore trends in assessment, diagnosis after fragility fractures, and osteoporosis treatment among hospitalized patients in Xiamen, China, between 2012 and 2021.

METHODS

We conducted a retrospective cross-sectional study, using the Cochran-Armitage trend test to describe trends. Logistic regression was performed to identify the influencing factors of anti-osteoporosis medication (AOM) treatment. We performed a sensitivity analysis to verify the robustness of our findings.

RESULTS

From 2012 to 2021, the rates of dual-energy X-ray absorptiometry (DXA) scans and bone turnover marker (BTM) examinations increased from 0 to 37% and 36.5%, respectively. 29.3% of patients with fragility fractures were diagnosed with osteoporosis. The use rate of AOM was only 22.7%. There was an upward trend in the prescription of bisphosphonates, increasing from 1% in 2012 to 16.8% in 2021. The use of calcitonin ranged from 4.1% (2014) to 32.7% (2021). Calcium and vitamin D supplementation prescribing increased significantly from 5.6% in 2012 to 78.7% in 2021. Logistic regression analysis showed that old age, female sex, history of fractures, DXA scans, and osteoporosis diagnosis were significantly associated with increased AOM use. Tobacco use, hypertension, diabetes, congestive heart failure, cerebral vascular accidents, and severe liver diseases were associated with a reduced likelihood of AOM treatment.

CONCLUSIONS

Although assessment, diagnosis after fragility fractures, and osteoporosis treatment have increased over the past decade, there are still deficiencies in the management of osteoporosis. In the future, it will be necessary to further strengthen management of osteoporosis.

Dietary glycemic and insulin indices with the risk of osteoporosis: results from the Iranian teachers cohort study

Background

Osteoporosis is a chronic condition characterized by reduced bone strength and an elevated risk of fractures. The influence of diet and glucose metabolism on bone health and the development of osteoporosis has been an area of interest. This study aimed to investigate the potential association between dietary glycemic index (DGI), dietary glycemic load (DGL), dietary insulin index (DII), dietary insulin load (DIL), and the odds of osteoporosis among Iranian adults.

Methods

Data from 12,696 Iranian teachers (35-50 years) in a cross-sectional study on diet, nutrition, physical activity, and diseases were analyzed. The participants had no history of diabetes, cardiovascular diseases, stroke, thrombosis, or cancer and consumed between 800 and 4,200 kcal/day. We estimated DGI, DGL, DII, and DIL from a validated semi-quantitative food-frequency questionnaire (FFQ). We also diagnosed osteoporosis using dual-energy X-ray absorptiometry.

Results

In the fully adjusted model, higher DGI and DGL were significantly associated with increased odds of osteoporosis (OR = 1.78 and 1.46 for the highest vs. the lowest tertile; P trend < 0.05). Nonetheless, no significant association was found between DII or DIL and osteoporosis prevalence. Moreover, higher DIL and DGL were associated with a higher intake of calorie-dense/nutrient-poor foods and a lower intake of antioxidant-rich foods.

Conclusion

Although our study showed that high DGI/DGL increased osteoporosis risk in Iranian teachers, no association was found between DII/DIL and osteoporosis prevalence. More research is needed to confirm these results and understand the mechanisms involved.

Associations of Serum Homocysteine with Bone Mineral Density and Osteoporosis Incidence in Chinese Middle-Aged and Older Adults: A Retrospective Cohort Study

OBJECTIVE

This research investigated the prospective association of serum homocysteine with lumbar bone mineral density (BMD) and the risk of osteoporosis in the Chinese population.

METHODS

In this cohort, 2551 Chinese individuals aged ≥50 years underwent annual health examinations. Among them, 2551, 1549, and 926 completed two, three, and more than three examinations, respectively. We used generalized estimating equations to analyze the connection between serum homocysteine and lumbar BMD. Additionally, we assessed the connection between serum homocysteine and the incidence of osteoporosis using Cox proportional hazard models. Subgroup analyses based on covariates were performed to identify important at-risk populations.

RESULTS

Participants with higher homocysteine levels showed decreased lumbar BMD compared to those with lower homocysteine levels (p-trend < 0.05). Specifically, lumbar BMD decreased by -0.002 (-0.003, -0.001) g/cm2 for every standard deviation increase in log-transformed serum homocysteine. Compared to the lowest quartile of homocysteine levels, lumbar BMD decreased by -0.006 (-0.010, -0.002) g/cm2 in the highest quartile in men. In smokers, lumbar BMD decreased by -0.007 (-0.012, -0.003) g/cm2 in the highest quartile. During the follow-up period, 175 incidences of osteoporosis were recorded. Serum homocysteine was linked to an increased risk of osteoporosis (p-trend < 0.05). Furthermore, for every standard deviation rise in log-transformed homocysteine, the HR for osteoporosis was 1.33 (95% CI, 1.12-1.58).

CONCLUSIONS

Elevated homocysteine levels may be responsible for reduced lumbar BMD in middle-aged and older Chinese people, especially men and smokers. In addition, elevated homocysteine levels may be a risk factor for the development of osteoporosis.

Choose your mother wisely: the familial resemblance of bone adaptation

This study demonstrates how complex bone microarchitectural features can be summarized to describe bone adaptations seen with aging in women, which are consistent with the stages of osteoporosis. Additionally, we showed familial resemblance in these bone microarchitectural traits between mothers and daughters that can be used to predict bone adaptations.

INTRODUCTION

Patient-specific characterization of bone quality can reduce complex microarchitectural features to common combinations of bone characteristics, known as bone phenotypes. This study investigated whether there is a general trend in bone phenotype change over time seen with aging in females and whether there is a familial resemblance to phenotype membership between mothers and daughters.

METHODS

Bone phenotype membership was calculated on biological mother and daughter pairs (Participants = 101), scanned using high resolution peripheral quantitative computed tomography, to the three pre-defined phenotypes (healthy, low volume, and low density). The trajectory of bone phenotype with age was explored using all participant's data. Linear regression models were used to assess the familial resemblance of phenotyping in the mother-daughter pairs.

RESULTS

When stratified for age, the trajectory of the phenotype membership transitioned from healthy (20-40 years), to low volume (40-60 years), to low density (60-80 years), which similarly aligns with the stages of osteoporosis observed in females. Familial resemblance (½h2) was observed in the healthy phenotype (β = 0.432, p < 0.01). Predictive modelling showed a significant association in phenotype membership between mothers and daughters in the healthy (R2 = 0.347, p = 0.04) and low volume (R2 = 0.416, p < 0.01) phenotypes, adjusted for age, height, and weight.

CONCLUSION

Our results suggest that phenotype membership in females changes with age in a pattern that is consistent with the stages of osteoporosis. Additionally, we showed familial resemblance in bone phenotype, which can be used to predict bone adaptations between mothers and daughters that are associated with bone loss with aging.

Efficacy of Recombinant Human Parathyroid Hormone 1-34 and Vitamin K2 Combination Therapy in Postmenopausal Osteoporosis

This study aimed to assess the efficacy and safety of a combined recombinant human parathyroid hormone 1-34 [rhPTH (1-34)] and vitamin K2 therapy versus vitamin K2 alone in the treatment of postmenopausal osteoporosis. A total of 77 postmenopausal osteoporosis patients were randomly divided into two groups. Patients in one group received vitamin K2 alone, while patients in the other group received a combination of rhPTH (1-34) and vitamin K2. Bone mineral density (BMD), electrolyte levels, pain scores, bone metabolism levels, and adverse drug reactions were compared pre- and post-treatment. Both two treatments improved BMD, blood calcium concentrations, pain scores, and increased osteocalcin and osteoprotegerin levels. Notably, the combined rhPTH (1-34) and vitamin K2 treatment demonstrated superior efficacy in improving BMD and bone metabolism markers. Furthermore, there was no significant difference in the incidence of adverse reactions between the two groups, indicating the safety of the combined treatment. In summary, the combined therapy of rhPTH (1-34) and vitamin K2 exhibited more potent efficacy in the treatment of postmenopausal osteoporosis, more effectively enhancing BMD and bone metabolism markers than vitamin K2 alone, without a significant increase in adverse reactions.

Systematic evaluation of abdominal aortic calcification in patients with a recent clinical fracture visiting the Fracture Liaison Service

The prevalence of AAC in patients attending a Fracture Liaison Service is 27.6%. Prevalent vertebral fractures were associated with AAC, but not with severe AAC in patients without CVD. Fracture location and BMD were not related to AAC or severe AAC.

PURPOSE

Abdominal aortic calcification (AAC) is associated with an increased risk of cardiovascular disease (CVD), osteoporosis and fractures. We aimed to analyze the prevalence and severity of AAC and to assess whether index fracture location, bone mineral density (BMD) and prevalent VFs are associated with AAC in patients with a recent fracture.

METHODS

Cross-sectional cohort study of patients with a recent clinical fracture (aged 50-90 years) attending the FLS. Patients received a BMD measurement and lateral spine imaging using Dual-energy X-ray absorptiometry. AAC prevalence was assessed using the AAC-24 score and categorized as none, moderate (AAC-24 1-4) and severe (AAC-24 ≥ 5). Multivariate logistic regression analyses were performed to study the association between risk factors and AAC presence/ severity.

RESULTS

AAC was present in 478 (27.6%) of 1731 patients of whom 207 (43.3%) had moderate and 271 (56.7%) severe AAC. The presence of AAC was associated with age, BMI, smoking, history of CVD and prevalent grade 2 or 3 VFs, but index fracture location and BMD were not associated with AAC or severe AAC. In patients with AAC (n =  318) without a history of CVD, there was no association between index fracture location and BMD. In that subgroup, severe AAC was not associated with prevalent VFs.

CONCLUSIONS

In FLS patients, the prevalence of AAC and severe AAC was 27.6% and 15.7%. Index fracture location and BMD were not associated with AAC or severe AAC. Prevalent VFs were associated with AAC, but not with severe AAC in the subgroup of patients without CVD.

Unexpected Increase in Bone Mineral Density With Rapamycin and Low-Dose Naltrexone: A Case Report of a 52-Year-Old Woman With Osteopenia

Osteopenia and osteoporosis are prevalent bone disorders characterized by reduced bone mineral density (BMD), leading to an increased risk of fractures. This case report presents a 52-year-old Caucasian female patient with osteopenia who experienced an unexpected 15.9% increase in lumbar spine BMD within two years after enrolling in a clinical trial involving low-dose rapamycin and subsequently starting low-dose naltrexone. This case potentially opens novel treatment strategies for bone density improvement in aging populations.

Associations of Body Mass Index and Percent Body Fat with Osteoporosis, Sarcopenia, and Osteosarcopenia: A Retrospective Study Based on Postmenopausal Women in China

Background/Objectives: Alterations in the body mass index (BMI) and percent body fat (PBF) have been considered to be related to aging-induced changes in bone and muscle. This study aimed to evaluate the associations of the BMI and PBF with osteoporosis, sarcopenia, and osteosarcopenia in postmenopausal women. Methods: A total of 342 participants who underwent musculoskeletal function assessments at the First Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2022 were retrospectively screened. The diagnosis of osteoporosis was based on the WHO criteria, and sarcopenia was diagnosed according to the 2019 consensus of the Asian Working Group for Sarcopenia. Results: The BMI was positively correlated with the musculoskeletal function assessment parameters (bone mineral density, relative skeletal muscle index, and grip strength) and identified as an independent protective factor for sarcopenia alone (OR = 0.592, 95% CI: 0.455-0.769) or osteosarcopenia (OR = 0.411, 95% CI: 0.319-0.529), with a moderate diagnostic accuracy (area under the curve [AUC] = 0.682) for the former and a high diagnostic accuracy (AUC = 0.823) for the latter. However, the PBF was negatively correlated with the relative skeletal muscle index and identified as a risk factor for osteosarcopenia (OR = 1.404, 95% CI: 1.007-1.959), with a moderate diagnostic accuracy (AUC = 0.613). Conclusions: A higher BMI and lower PBF were associated with a lower prevalence of osteosarcopenia in postmenopausal women. Further research is required to elucidate the independent effects of the BMI and PBF on bone health.

Hand grip strength and all-cause mortality risk in individuals with decreased bone mass: a study from NHANES database

Objective

Previous studies have demonstrated that grip strength is associated with various health outcomes, including osteoporosis. However, the impact of grip strength on long-term mortality risk among individuals with low bone mass remains unclear. This study aims to investigate the association between grip strength and the risk of all-cause mortality in the population with low bone mass.

Methods

We included 1,343 cases of decreased bone mass from the NHANES database spanning 2013 to 2014. All-cause mortality data were ascertained through linkage with national death index records up to December 31, 2015. Analysis was conducted using the Cox proportional hazards regression model, and we assessed result reliability through various model adjustments and hierarchical analyses, Schoenfeld's global and individual tests are utilized to estimate the time-varying covariance in the Cox proportional hazards regression model's hypothesis.

Results

Throughout an average follow-up period of 69.5 months, 148 deaths were documented. After adjusting for covariates, a significant association between grip strength and the risk of all-cause mortality was observed in individuals with decreased bone mass (HR = 0.9, 95% CI: 0.87-0.93, p < 0.001). Individuals with normal grip strength, compared to those with low grip strength, exhibited a 56% lower risk of all-cause mortality (HR = 0.44, 95% CI: 0.29-0.67, p < 0.001). Various models consistently demonstrated similar significant trends post-adjustment. Subgroup analysis revealed an interaction between grip strength and coronary heart disease (p < 0.05). Schoenfeld's global and individual tests confirmed the reliability of the model (p > 0.05).

Conclusion

Our findings indicate that low grip strength is associated with increased all-cause mortality risk in individuals with decreased bone mass. The inclusion of routine monitoring of grip strength in patients with osteopenia and the encouragement of maintaining or improving grip strength in this population may offer a novel approach to health management for these individuals.

Discordance Between Spine-Hip and Paretic-Nonparetic Hip Bone Mineral Density in Hemiplegic Stroke Patients: A Multicenter Retrospective Study

OBJECTIVE

To identify the prevalence and factors associated with T-score discordance between the spine and hip, as well as between the paretic and non-paretic hips in hemiplegic stroke patients, this study investigated bone mineral density (BMD) patterns. Bone loss predominantly affects the paretic hip after a stroke, and typical clinical assessments using dual-energy X-ray absorptiometry (DXA) that scan the lumbar spine (LS) and a single hip may overlook an osteoporosis diagnosis. This oversight could potentially lead to suboptimal treatment for stroke patients.

METHODS

This study was a multicenter retrospective analysis of 540 patients admitted for stroke rehabilitation between October 2014 and February 2022, who underwent DXA of LS and bilateral hips.

RESULTS

The prevalence rates of concordance, low LS discordance, and low hip discordance between the LS and hips were 48.2%, 12.2%, and 39.6%, respectively. The discordance rate between bilateral hips was 17.0%. The paretic side had significantly lower total hip T-scores than the non-paretic side (p<0.001). Notably low paretic hip discordance was more prevalent during the chronic phase. DXA scans of the LS and both hips revealed a 0.7%-0.9% higher major discordance compared to LS and single hip DXA scans. The multivariate analysis revealed a significant correlation between a low paretic hip discordance and cognitive impairment (adjusted odds ratio 0.071, 95% confidence interval 0.931-1.003, p<0.05).

CONCLUSION

Since stroke survivors are at high risk for hip fractures, comprehensive BMD assessments, which include LS and bilateral hips, should be considered for post-stroke osteoporosis care to enhance diagnostic accuracy and timely treatment.