Noninvasive assessment of bone mineral and structure: state of the art

Skeletal muscle estimation: A review of techniques and their applications

Quantifying skeletal muscle size is necessary to identify those at risk for conditions that increase frailty, morbidity, and mortality, as well as decrease quality of life. Although muscle strength, muscle quality, and physical performance have been suggested as important assessments in the screening, prevention, and management of sarcopenic and cachexic individuals, skeletal muscle size is still a critical objective marker. Several techniques exist for estimating skeletal muscle size; however, each technique presents with unique characteristics regarding simplicity/complexity, cost, radiation dose, accessibility, and portability that are important factors for assessors to consider before applying these modalities in practice. This narrative review presents a discussion centred on the theory and applications of current non-invasive techniques for estimating skeletal muscle size in diverse populations. Common instruments for skeletal muscle assessment include imaging techniques such as computed tomography, magnetic resonance imaging, peripheral quantitative computed tomography, dual-energy X-ray absorptiometry, and Brightness-mode ultrasound, and non-imaging techniques like bioelectrical impedance analysis and anthropometry. Skeletal muscle size can be acquired from these methods using whole-body and/or regional assessments, as well as prediction equations. Notable concerns when conducting assessments include the absence of standardised image acquisition/processing protocols and the variation in cut-off thresholds used to define low skeletal muscle size by clinicians and researchers, which could affect the accuracy and prevalence of diagnoses. Given the importance of evaluating skeletal muscle size, it is imperative practitioners are informed of each technique and their respective strengths and weaknesses.

Association of the fat mass index with hepatic steatosis and fibrosis: evidence from NHANES 2017-2018

Limited population-based studies discuss the association between fat mass index (FMI) and the risk of liver diseases. This investigation utilized data from the National Health and Nutrition Examination Survey (NHANES) to examine the linkage between the FMI and liver conditions, specifically steatosis and fibrosis. The study leveraged data from NHANES's 2017-2018 cross-sectional study, employing an oversampling technique to deal with sample imbalance. Hepatic steatosis and fibrosis were identified by vibration-controlled transient elastography. Receiver operating curve was used to assess the relationship of anthropometric indicators, e.g., the FMI, body mass index (BMI), weight-adjusted-waist index (WWI), percentage of body fat (BF%), waist-to-hip ratio (WHR), and appendicular skeletal muscle index (ASMI), with hepatic steatosis and fibrosis. In this study, which included 2260 participants, multivariate logistic regression models, stratified analyses, restricted cubic spline (RCS), and sharp regression discontinuity analyses were utilized. The results indicated that the WHR and the FMI achieved the highest area under the curve for identifying hepatic steatosis and fibrosis, respectively (0.720 and 0.726). Notably, the FMI presented the highest adjusted odds ratio for both hepatic steatosis (6.40 [4.91-8.38], p = 2.34e-42) and fibrosis (6.06 [5.00, 7.37], p = 5.88e-74). Additionally, potential interaction effects were observed between the FMI and variables such as the family income-to-poverty ratio, smoking status, and hypertension, all of which correlated with the presence of liver fibrosis (p for interaction < 0.05). The RCS models further confirmed a significant positive correlation of the FMI with the controlled attenuation parameter and liver stiffness measurements. Overall, the findings underscore the strong link between the FMI and liver conditions, proposing the FMI as a potential straightforward marker for identifying liver diseases.

Effects of kinect-based virtual reality training on bone mineral density and fracture risk in postmenopausal women with osteopenia: a randomized controlled trial

Osteopenia is a condition characterized by low bone mineral density (BMD) that increases fracture risk, particularly among postmenopausal women (PMW). This study aimed to determine the effects of Kinect-based VRT on BMD and fracture risk in PMW with osteopenia. The study was a prospective, two-arm, parallel-design, randomized controlled trial. The study enrolled 52 participants, 26 randomly assigned to each group. In the experimental group, Kinect-based VRT was provided thrice weekly for 24 weeks for 45 min/session. Both groups were instructed to engage in a daily 30-min walk outdoors. The fracture risk assessment tool (FRAX) was used to calculate fracture risk, and dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. Both variables were assessed at baseline and 24 weeks afterwards. After 24 weeks of Kinect-based VRT, the experimental group showed significant BMD increases in the right and left femoral necks and lumbar spine (p value < 0.001). In the control group, the BMD at the right and left femoral necks showed fewer significant changes (p value < 0.022 and 0.004, respectively). In the control group, lumbar spine BMD did not change (p = 0.57). The experimental group showed significantly lower FRAX scores for hip fracture prediction (HFP) and hip prediction of major osteoporotic (HPMO) at both femoral necks (p value < 0.001) than the control group (p = 0.05 and p = 0.01, respectively), but no significant change at the left femoral neck for HFP (p = 0.66) or HPMO (p = 0.26). These findings indicate that a Kinect-based VRT intervention resulted in significantly increased BMD and a reduced fracture risk, as predicted by HFP and HPMO measurements. These improvements were more pronounced in the experimental group than in the control group. Thus, Kinect-based VRT may be utilized as an effective intervention to improve BMD and reduce fracture risk in postmenopausal women with osteopenia.

Protocol for a randomized placebo-controlled clinical trial using pure palmitoleic acid to ameliorate insulin resistance and lipogenesis in overweight and obese subjects with prediabetes

Palmitoleic acid (POA), a nonessential, monounsaturated omega-7 fatty acid (C16:1n7), is a lipid hormone secreted from adipose tissue and has beneficial effects on distant organs, such as the liver and muscle. Interestingly, POA decreases lipogenesis in toxic storage sites such as the liver and muscle, and paradoxically increases lipogenesis in safe storage sites, such as adipose tissue. Furthermore, higher POA levels in humans are correlated with better insulin sensitivity, an improved lipid profile, and a lower incidence of type-2 diabetes and cardiovascular pathologies, such as myocardial infarction. In preclinical animal models, POA improves glucose intolerance, dyslipidemia, and steatosis of the muscle and liver, while improving insulin sensitivity and secretion. This double-blind placebo-controlled clinical trial tests the hypothesis that POA increases insulin sensitivity and decreases hepatic lipogenesis in overweight and obese adult subjects with pre-diabetes. Important to note, that this is the first study ever to use pure (>90%) POA with < 0.3% palmitic acid (PA), which masks the beneficial effects of POA. The possible positive findings may offer a therapeutic and/or preventative pathway against diabetes and related immunometabolic diseases.

Association Between Urinary Bisphenols and Body Composition Among American Adults: Cross-Sectional National Health and Nutrition Examination Survey Study

BACKGROUND

Bisphenol A (BPA), bisphenol S (BPS), and bisphenol F (BPF) are widely used in various consumer products. They are environmental contaminants with estrogenic properties that have been linked to various health outcomes. Understanding their impact on body composition is crucial for identifying potential health risks and developing preventive strategies. However, most current studies have only focused on their relationship with BMI.

OBJECTIVE

This study aimed to investigate the association between urinary levels of BPA, BPS, and BPF and body composition, including BMI, lean mass, and fat mass, in a large population-based sample.

METHODS

We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey 2003-2016. Body composition data were assessed using dual-energy X-ray absorptiometry, which provided precise measurements of lean mass, fat mass, and other indicators. We used multivariate linear regression models to estimate the associations, adjusting for potential confounders such as age, gender, race, socioeconomic factors, and lifestyle variables.

RESULTS

The results revealed significant associations between bisphenol exposure and body composition. After adjusting for covariates, BPS showed a positive association with BMI, with quartiles 3 and 4 having 0.91 (95% CI 0.34-1.48) and 1.15 (95% CI 0.55-1.74) higher BMI, respectively, compared with quartile 1 (P<.001). BPA was negatively associated with total lean mass (TLM) and appendicular lean mass, with quartiles 2, 3, and 4 having -7.85 (95% CI -11.44 to -4.25), -12.33 (95% CI -16.12 to -8.54), and -11.08 (95% CI -15.16 to -7.01) lower TLM, respectively, compared with quartile 1 (P<.001). BPS was negatively associated with TLM, with quartiles 3 (β=-10.53, 95% CI -16.98 to -4.08) and 4 (β=-11.14, 95% CI -17.83 to -4.45) having significantly lower TLM (P=.005). Both BPA and BPS showed a positive dose-response relationship with trunk fat (BPA: P=.002; BPS: P<.001) and total fat (BPA: P<.001; BPS: P=.01). No significant association was found between BPF and any body composition parameter.

CONCLUSIONS

This large-sample study highlights the associations between urinary levels of BPA and BPS and alterations in body composition, including changes in lean mass, fat mass, and regional fat distribution. These findings underscore the importance of understanding the potential health risks associated with bisphenol exposure and emphasize the need for targeted interventions to mitigate adverse effects on body composition.

Comparative analysis of bone outcomes between quantitative ultrasound and dual-energy x-ray absorptiometry from the UK Biobank cohort

This large cohort study investigated reliability and validity of heel ultrasound to estimate bone mineral density in adults. Reliability calculated between left and right heels was relatively poor and so was criterion validity assessed relative to dual-energy X-ray absorptiometry. Heel ultrasound should be used cautiously when estimating bone mineral density.

INTRODUCTION

Calcaneal quantitative ultrasound (QUS) may be used as a safe, low cost, and portable means to estimate bone mineral density (BMD) in large cohorts. The purpose of this study was to quantify the reliability and validity of QUS in comparison to dual-energy X-ray absorptiometry (DXA), which is the reference method for BMD measurement and diagnoses of osteopenia and osteoporosis.

METHODS

Bone outcomes measured on the large UK Biobank cohort were used. The reliability of QUS estimated BMD was quantified by comparing values obtained from the left and right heel measured in the same session. Criterion validity was assessed through agreement between QUS and DXA, quantifying correlations, and sensitivity and specificity of osteopenia and osteoporosis diagnoses.

RESULTS

Reliability calculations were made using data from over 216,000 participants demonstrating similar QUS BMD values between left and right heels in the absolute scale (Sd of difference for men: 0.12 and 0.07 g·cm-2). However, when expressed in relative scales, including concordance of quartiles, reliability was poor. Agreement between QUS and DXA was quantified using data from 5042 participants. Low to modest correlations (r = 0.29 to 0.44) were obtained between multiple QUS variables and DXA BMD, with sensitivity identified as very poor (0.05 to 0.23) for osteoporosis, and poor (0.37 to 0.62) for osteopenia diagnoses.

CONCLUSIONS

The findings of this large comparative analysis identify that whilst calcaneal QUS has the potential to produce reliable absolute BMD measurements and demonstrate modest associations with DXA BMD measures, use of that information to make relative statements about participants in the context of the larger population or to appropriately diagnose osteopenia or osteoporosis may be severely limited.

Glenoid wear and its impact on clinical results after humeral head replacement using a single prosthesis in cuff tear arthropathy with more than 8 years of follow-up

BACKGROUND

Glenoid wear (GW) is a long-term complication after humeral head replacement (HHR) and is one of the major reasons for revision surgery. This study aimed to evaluate GW at >8 years of follow-up after HHR in patients with cuff tear arthropathy (CTA) by use of a modified classification of GW, to examine the relationship between GW and clinical outcomes, and to identify risk factors for GW progression.

METHODS

This retrospective case-series study included 34 shoulders that were monitored for >8 years after HHR in patients with CTA (13 men and 21 women; mean age at surgery, 70.9 years [range, 55-82 years]). Patients were monitored for a mean of 10.3 years (range, 8.1-13.2 years). GW was classified using plain radiographs as follows: grade 0, no remarkable postoperative changes; grade 1, postoperative glenohumeral joint space narrower than preoperative glenohumeral joint space; grade 2, contact between glenoid and humeral head prosthesis; and grade 3, glenoid erosion. Grade 3 cases were further classified into the following subtypes: grade 3A, partial erosion of anterior glenoid; grade 3B, partial erosion of superior glenoid; and grade 3C, concentric erosion of glenoid. Clinical outcomes including range of motion (active flexion and active external rotation) and postoperative pain (Constant score) were compared between grade 0-2 shoulders and grade 3 shoulders, as well as between the grade 3 subtypes. Age, sex, preoperative range of motion, preoperative pain, and number of ruptured tendons were analyzed as possible risk factors for progression to grade 3.

RESULTS

The final GW grade was grade 0 in 3 shoulders, grade 1 in 10, grade 2 in 6, and grade 3 in 15 (grade 3A in 2, grade 3B in 6, and grade 3C in 7). The grade 3 group had lower pain scores (10.7 ± 6.2 vs. 14.2 ± 1.9, P = .044) and limited active flexion (108.2° ± 42.3° vs. 140.6° ± 26.7°, P = .041) compared with the grade 0-2 group. Subtype comparison showed that the grade 3B group had lower pain scores (7.0 ± 6.7 vs. 15.0 ± 0.0, P = .007) and limited active flexion (80.0° ± 26.2° vs. 140.8° ± 27.5°, P = .010) compared with the grade 3C group. Limited preoperative active external rotation was an individual risk factor for grade 3 GW (odds ratio, 0.93; 95% confidence interval, 0.88-0.99; P = .009).

CONCLUSIONS

In the long term (>8 years) after HHR with tendon transfer in patients with CTA, patients with the development of grade 3C GW ultimately achieve pain relief even without revision surgery whereas grade 3B GW is associated with persistent pain and might require revision surgery.

Evaluation of the performance of osteoporosis/fracture screening models to identify high-risk women for osteoporosis: Bushehr elderly health (BEH) program

Purpose

This study aimed to evaluate the performance of valid risk assessment models developed for osteoporosis/ fracture screening to identify women in need of bone density measurement in a population of Iranian elderly women.

Methods

This study was performed using the data of Bushehr Elderly Health (BEH) program, a population-based cohort study of elderly population aged ≥ 60 years. Seven osteoporosis risk assessment tools, including Osteoporosis Risk Assessment Instrument (ORAI), Malaysian Osteoporosis Screening Tool (MOST), Osteoporosis Prescreening Risk Assessment (OPERA), Osteoporosis Prescreening Model for Iranian Postmenopausal women (OPMIP), Osteoporosis Index of Risk (OSIRIS), and Osteoporosis Self-Assessment Tool for Asians (OSTA), as well as Fracture Risk Assessment Tool (FRAX) were included in the study. By using osteoporosis definition based on BMD results, the performance measurement criteria of diagnostic tests such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Youden index for each model were calculated and the models were compared.

Results

A total of 1237 female participants with the mean age of 69.1 ± 6.3 years were included. Overall, 733 (59%) participants had osteoporosis, and about 80% had no history of fracture. The sensitivity of the seven models ranged from 16.7% (OSIRIS) to 100% (ORAI and MOST) at their recommended cut-off points. Moreover,their specificity ranged from 0.0% (ORAI and MOST) to 78.9% (OSTA). The FRAX and OPERA had the optimal performance with the Youden index of 0.237 and 0.226, respectively. Moreover, after combining these models, the sensitivity of them increased to 85.4%.

Conclusion

We found that the FRAX (model with 11 simple variables) and OPERA (model with 5 simple variables) had the best performance. By combining the models, the performance of each was improved. Further studies are needed to adopt the model and to find the best cut-off point in the Iranian postmenopausal women.

Risk factors for eccentric glenoid wear after humeral head replacement for cuff tear arthropathy

Background

In our previous report, glenoid wear (GW) after humeral head replacement for cuff tear arthropathy was classified with modified Goya’s classification (grade 0-3), and, among 3 subtypes of grade 3 (glenoid bone erosion), grade 3B (superior eccentric erosion) showed significantly more pain and limited active flexion postoperatively compared to grade 3C (concentric erosion). The purpose of this study was to detect individual risk factors for the progression to grade 3B GW.

Methods

Seventy-nine shoulders in 70 patients who were followed up for a mean of 8.2 years (range, 5.0-13.2 years), including 29 men and 41 women, with a mean age at the surgery of 71.1 years (range, 54-87 years), were reviewed. Atrophy and fatty degeneration of torn cuff muscle, preoperative humeral head displacement (superior translation ratio [STR], anterior translation ratio, and other several parameters) on preoperative magnetic resonance imaging, and other individual factors were analyzed as possible risk factors.

Results

GW at the final follow-up was grade 0: 5 shoulders, grade 1: 17, grade 2: 20, and grade 3: 37 (3A: 4, 3B: 22, and 3C: 11). Preoperative higher STR was defined as a risk factor for grade 3 GW (odds ratio, 35.5; 95% confidence interval, 1.8-693.0; P = .018). Comparison among the three subtypes of grade 3 showed that patients with grade 3B GW had larger STR than 3C (41.4 ± 14.2% vs. 23.5 ± 13.3 % P = .006).

Conclusion

Patients with preoperative high STR are considered to have a risk for grade 3B GW, which possibly relates to poor clinical outcome and future revision.

Sex-related association of nonalcoholic fatty liver disease and liver fibrosis with body fat distribution in the general US population

BACKGROUND

Few population-based studies have investigated the association between body fat distribution and the risk of nonalcoholic fatty liver disease (NAFLD) and significant liver fibrosis.

OBJECTIVES

We aimed to evaluate the relations of total body fat and body fat distribution with NAFLD in the general US population.

METHODS

This is a cross-sectional, population-based study based on the 2017-2018 cycle of the NHANES. Participants aged 18-59 y without known liver conditions or significant alcohol consumption were studied by DXA and vibration-controlled transient elastography to assess body composition and liver steatosis and fibrosis, respectively. Multivariable logistic regression analysis was performed to evaluate the contribution of BMI and android:gynoid ratio (A:G ratio) to the prevalence of liver steatosis and fibrosis in males and females.

RESULTS

Weighted prevalence of steatosis was 41.5% and 29.9% among the 1115 males and 1113 females included in the study, respectively, whereas 7.0% of males and 4.0% of females had elastographic evidence of significant liver fibrosis. After adjustment for age, race-Hispanic origin, diabetes, cigarette smoke, and BMI, a higher A:G ratio was associated with increased odds of steatosis in both males (OR: 1.79; 95% CI: 1.07, 2.99; P = 0.029) and females (OR: 1.95; 95% CI: 1.11, 3.41; P = 0.023). Conversely, a significant association between A:G ratio and liver fibrosis was identified in females (OR: 2.09; 95% CI: 1.11, 3.97; P = 0.026), but not in males (OR: 0.56; 95% CI: 0.29, 1.08; P = 0.078).

CONCLUSIONS

Independently from BMI, an android fat deposition pattern is associated with increased prevalence of NAFLD in both sexes, whereas the effect on fibrosis was only evident in females.

Evaluation of bone mineral density after instrumented lumbar fusion with computed tomography

BACKGROUND CONTEXT

Computed tomography (CT) measurement of Hounsfield Units (HU) has been described as a tool for assessing BMD. For surgeons considering a revision lumbar fusion, knowledge of the BMD of the UIV is of value for surgical planning. However, the presence of metal artifact from instrumentation presents a potential confounder, and prior studies have not validated measurements of HU in this setting.

PURPOSE

To determine if HU can be measured reliably at the supra-adjacent and upper instrumented levels of a lumbar fusion.

STUDY DESIGN

Retrospective observational cohort PATIENT SAMPLE: Consecutive series of patients who had lumbar CT scans after an instrumented posterior lumbar fusion.

OUTCOME MEASURES

Hounsfield Units at the upper instrumented vertebra and levels proximal.

METHODS

We analysed pre- and postoperative CT scans of 50 patients who underwent L2 and distal instrumented lumbar fusion whose scans were no greater than 1 year apart, obtaining HU measurements of analogous axial cuts at the upper instrumented level (immediately caudal to the halo of the pedicle screw), as well as additional control levels above the construct.

RESULTS

The HU at the pre-and postoperative UIV exhibited a strong correlation (r=0.917, p<.001), as did one (r=0.887, p<.001) and two (r=0.853, p<.001) levels above the UIV. There were significant but predictable reductions in the postoperative HU compared to preoperative at one (-9.0±26.2) and two (-12.2±30.2) levels above the UIV, as well as T12 (-13.9±42.2). There was no significant difference in HU at the UIV (4.6±34.1).

CONCLUSIONS

Postoperative HU at the UIV was strongly correlated with and not significantly different from the preoperative HU. Although the HU in the vertebrae proximal to the UIV were slightly lower postoperatively, this change was predictable using a correction factor.

Photoacoustic characterization of bone physico-chemical information

Osteoporosis usually alters the chemical composition and physical microstructure of bone. Currently, most clinical techniques for bone assessment are focused on the either bone microstructure or bone mineral density (BMD). In this study, a novel multi-wavelength photoacoustic time-frequency spectral analysis (MWPA-TFSA) method was introduced based on the optical absorption spectra and photoacoustic effects of biological macromolecules, which evaluates changes in bone chemical composition and microstructure. The results demonstrated that osteoporotic bones had decreased BMD, more lipids, and wider trabecular separation filled with larger marrow clusters, which were consistent with multiple gold-standard results, suggesting that the MWPA-TFSA method has the potential to provide a thorough bone physico-chemical information evaluation noninvasively and nonradiatively.

Assessment of Osteogenesis Enhancement in Rats Using Bone Densitometry: An In Vivo Study

Background: Human survival depends on the availability of water. Safe drinking water is a fundamental human right as well as a basic need for a good health. At the mineral and organic levels of water composition, exposure to electromagnetic fields can cause considerable changes in the quality of drinking water. As a result, water is more easily absorbed into the cell walls throughout the body, making it better suited for organ growth and development. When drunk on a daily basis, magnetic water causes dramatic changes in bone mineral density and content. Due to the necessity for distinct beam filtering and near-perfect spatial discography of the two attenuations, DXA (DualEnergy X-ray Absorptiometry) was included with general-purpose X-ray systems. In rats that drink magnetized water on a daily basis, the DXA can be used to calculate the weight and area of all head compartments. Objective: By employing a Bone Densitometry scan on the head regions of rats, this study aims to assess the changes in the rat's skull bone measures (area, weight, bone mineral content, and bone mineral density) after feeding the animal with magnetized water. Methods: This study involved thirty adult male rats (6 weeks old). For 30 days, 15 rats were given a magnetized water to drink and used as experimental animals. For comparison purposes, the remaining 15 rats were given regular water for 30 days. After the experimental procedure was done, each rat's head was scanned with a DXA to determine bone weight, area, bone mineral content, and bone mineral density. Before drinking water, each rat in both the experimental and control groups was examined. The head of each rate was scanned using a DXA to get the values of bone: weight, area, mineral density, and mineral content after 30 days of consuming magnetized water. The four bone measures were statistically compared in the experimental and control rats, p-values below 0.05 were considered significant. Results: Comparing to control rats, experimental rats showed a significant increase in the bone’s weight and area of the skull (p<0.05, Wilcoxon test).  Bone marrow content and bone marrow density enhanced significantly as well in experimental rats after drinking the magnetized water for 30 days. Conclusions: Drinking water that has been subjected to electromagnetic fields for 30 days can improve bone marrow content and density in rats. Drinking magnetized water also has a substantial impact on bone mass and area.

Aging Alters Cervical Vertebral Bone Density Distribution: A Cross-Sectional Study

Osteoporosis reduces bone mineral density (BMD) with aging. The incidence of cervical vertebral injuries for the elderly has increased in the last decade. Thus, the objective of the current study was to examine whether dental cone beam computed tomography (CBCT) can identify age and sex effects on volumetric BMD and morphology of human cervical vertebrae. A total of 136 clinical CBCT images were obtained from 63 male and 73 female patients (20 to 69 years of age). Three-dimensional images of cervical vertebral bodies (C2 and C3) were digitally isolated. A gray level, which is proportional to BMD, was obtained and its distribution was analyzed in each image. Morphology, including volume, heights, widths, and concavities, was also measured. Most of the gray level parameters had significantly higher values of C2 and C3 in females than in males for all age groups (p < 0.039). The female 60-age group had significant lower values of Mean and Low5 of C2 and C3 than both female 40- and 50-age groups (p < 0.03). The reduced BMD of the female 60-age group likely resulted from postmenopausal demineralization of bone. Current findings suggest that dental CBCT can detect age-dependent changes of cervical vertebral BMD, providing baseline information to develop an alternative tool to diagnose osteoporosis.

Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?

STUDY DESIGN

Prospective comparative study.

OBJECTIVE

Refinement of the guidelines for screening of osteoporosis and considering quantitative computed tomography (Q-CT) for detecting spinal osteoporosis.

SUMMARY OF BACKGROUND DATA

Spinal osteoporosis is often underestimated and under-evaluated due to either lack of availability of the diagnostic modality or lack of awareness about the possibility of overestimation by dual X-ray absorptiometry (DXA) scan. There is a need for reconsidering osteoporosis evaluation with a site specific and patient specific inclination.

METHODS

Post-menopausal women that underwent bone mineral density (BMD) evaluation from January-2018 to December-2020 with either Q-CT or DXA were evaluated. Comparison studies of the distribution of age and T-scores of the bone densities obtained from the two study groups: age-matched, sex-matched, and common skeletal site of interest (L1-4 vertebrae) were performed. Mann-Whitney U test, correlation and regression analyses were performed and bell curves were plotted.

RESULTS

Of the 718 women evaluated, 447 underwent Q-CT and 271 underwent DXA. There was no significant difference among the age distribution of the two study groups (P-value > 0.05). The mean and mode T-scores obtained by Q-CT and DXA were found to be -2.71, -3.8 and -1.63, -1.7 respectively. A highly significant difference in the T-scores was observed in the Q-CT and DXA groups (P-value < 0.0001). Among those who were screened by Q-CT, 58.16% were osteoporotic, 37.58% were osteopenic, and 4.25% were normal. The respective percentages in the DXA group were 30.63%, 49.82%, and 19.55%.

CONCLUSION

Q-CT provides more precise estimation of cancellous bone mineral density than DXA. With the reliance on DXA for spinal BMD estimation being questionable, new standards have to be established for spinal osteoporosis evaluation. Q-CT can be a better alternative to replace DXA as the gold standard for the evaluation of spinal osteoporosis.Level of Evidence: 2.

Avaliação da perda óssea utilizando diferentes parâmetros na análise microtomográfica. Estudo em ratos

Resumo Introdução o desafio no uso do Micro-Ct tem sido estabelecer e padronizar padrões adequados para escaneamento e tratamento das imagens, para que se obtenha o máximo desempenho do equipamento, e permitir a comparação dos achados entre diferentes estudos. Objetivo o presente estudo tem como objetivo comparar a porcentagem de volume ósseo em regiões com perda óssea periodontal utilizando diferentes metodologias para definição da área a ser analisada (ROI). Material e método dez ratos foram submetidos à indução de doença periodontal, e, após a eutanásia, as mandíbulas foram escaneadas com cortes de 9 μ e 18 μm de espessura, com passo de rotação de 0.3mm. As imagens foram reconstituídas utilizando o software NRecon, e em seguida, utilizando o software CTAnalyser – CTAn, foram definidas as áreas de interesse (ROI) ao redor dos segundos molares. A primeira área de interesse (ROI1) foi definida em um padrão retangular que se restringiu às regiões interproximais e furca, onde a área total de tecido ósseo foi obtida somando os resultados dos 3 ROIs. A segunda área (ROI2) foi definida no sentido corono/apical ao redor do segundo molar até suas limitações proximais com os dentes vizinhos, onde a porcentagem de tecido ósseo pertencente às raízes foram excluídas das avaliações. As análises foram realizadas com cinco diferentes valores de thresholds (130-50, 130-60, 130-70, 130-80, 130-90 e 130-100). Resultado a análise entre os diferentes ROIs demonstrou que em ambas as análises foi observada a tendência a menor porcentagem de tecido ósseo quanto maior o contraste de tons de cinza utilizado, no entanto, nos resultados obtidos no ROI2 essa diferença não foi estatisticamente significante. Conclusão com os resultados obtidos pode se concluir que a utilização de diferentes thresholds para quantificação óssea, em áreas onde houve doença periodontal, pode trazer resultados divergentes; a definição da área de interesse interfere com os resultados obtidos e que a obtenção de uma área de interesse com a remoção das raízes mostrou-se menos susceptível à variação dos parâmetros de escaneamento.

Periosteal CD68+ F4/80+ Macrophages Are Mechanosensitive for Cortical Bone Formation by Secretion and Activation of TGF-β1

Mechanical force regulates bone density, modeling, and homeostasis. Substantial periosteal bone formation is generated by external mechanical stimuli, yet its mechanism is poorly understood. Here, it is shown that myeloid-lineage cells differentiate into subgroups and regulate periosteal bone formation in response to mechanical loading. Mechanical loading on tibiae significantly increases the number of periosteal myeloid-lineage cells and the levels of active transforming growth factor β (TGF-β), resulting in cortical bone formation. Knockout of Tgfb1 in myeloid-lineage cells attenuates mechanical loading-induced periosteal bone formation in mice. Moreover, CD68⁺ F4/80⁺ macrophages, a subtype of myeloid-lineage cells, express and activate TGF-β1 for recruitment of osteoprogenitors. Particularly, mechanical loading induces the differentiation of periosteal CD68⁺ F4/80^- myeloid-lineage cells to the CD68⁺ F4/80⁺ macrophages via signaling of piezo-type mechanosensitive ion channel component 1 (Piezo1) for TGF-β1 secretion. Importantly, CD68⁺ F4/80⁺ macrophages activate TGF-β1 by expression and secretion of thrombospondin-1 (Thbs1). Administration of Thbs1 inhibitor significantly impairs loading-induced TGF-β activation and recruitment of osteoprogenitors in the periosteum. The results suggest that periosteal myeloid-lineage cells respond to mechanical forces and consequently produce and activate TGF-β1 for periosteal bone formation.

The Proximal Tibia Loses Bone Mineral Density After Anterior Cruciate Ligament Injury: Measurement Technique and Validation of a Quantitative Computed Tomography Method

Purpose

Results

Conclusions

Level of Evidence

Focused ultrasound simulation through cortical bone by finite element method. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021;2021:4362-4365. [PMID: 34892186 DOI: 10.1109/embc46164.2021.9630365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Bone tissue is constantly changed adapting to its mechanical environment and capable of repairing itself. Ultra-sound has recently been used as a diagnostic technique to assess bone conditions. To optimize the experimental model as best as possible computational simulation techniques have been focused on clinical applications in bone. This study aims to analyze by finite element method the propagation of ultrasound waves along the cortical bone. The wave propagation phenomenon is well studied and described by the Helmholtz equation. The first part of the work analytically solves the Helmholtz equation, and later the COMSOL Multiphysics software is used. It was established a cylindrical geometry as the bone sample. The software analyzes with "Pressure Acoustic, Frequency Domain" module. An extremely fine mesh is used for the solution in order not to lose information. According to the analytical solution, the results show the behavior of the acoustic pressure waves throughout the samples. In addition, attenuation coefficients are calculated for biological materials such as bone and muscle. Simulation methods allow to analyze adjustable parameters in the development of new devices. Thus, optimizing resources and allowing the researcher to better understanding the problem to be solved.

Application of a Neural Network Classifier to Radiofrequency-Based Osteopenia/Osteoporosis Screening

This preliminary study reports application of a neural network classifier to the processing of previously collected data on low power radiofrequency propagation through the wrist with the goal to detect osteoporotic/osteopenic conditions. The data set used includes 67 subjects (23-94 years old, 50 females, 17 males, 27 osteoporotic/osteopenic, 40 healthy). We process the entire spectrum of the propagation coefficient through the wrist from 30 kHz to 2 GHz, with 201 sampling points in total. We found that the dichotomic diagnostic test of raw non-normalized radiofrequency data performed with the trained neural network approaches 90% specificity and ~70% sensitivity. These results are obtained without inclusion of any additional clinical risk factors. They justify that the radio transmission data are usable on their own as a predictor of bone density. With the inclusion of additional clinical risk factors, both specificity and sensitivity improve to 95% and 76% respectively. Our approach correlates well with the available DXA measurements and has the potential for screening patients at risk for fragility fractures, given the ease of implementation and low costs associated with both the technique and the equipment.Clinical Relevance- Dichotomic diagnostic test of raw non-normalized radiofrequency data performed with the trained neural network approaches 90% specificity and ~70% sensitivity. With the inclusion of other clinical risk factors, specificity and sensitivity increase to 95% and 76% respectively.

Application of a Neural Network Classifier to Radiofrequency-Based Osteopenia/Osteoporosis Screening

Objective: There is an unmet need for quick, physically small, and cost-effective office-based techniques that can measure bone properties without the use of ionizing radiation. Methods: The present study reports the application of a neural network classifier to the processing of previously collected data on very-low-power radiofrequency propagation through the wrist to detect osteoporotic/osteopenic conditions. Our approach categorizes the data obtained for two dichotomic groups. Group 1 included 27 osteoporotic/osteopenic subjects with low Bone Mineral Density (BMD), characterized by a Dual X-Ray Absorptiometry (DXA) T-score below – 1, measured within one year. Group 2 included 40 healthy and mostly young subjects without major clinical risk factors such as a (family) history of bone fracture. We process the complex radiofrequency spectrum from 30 kHz to 2 GHz. Instead of averaging data for both wrists, we process them independently along with the wrist circumference and then combine the results, which greatly increases the sensitivity. Measurements along with data processing require less than 1 min. Results: For the two dichotomic groups identified above, the neural network classifier of the radiofrequency spectrum reports a sensitivity of 83% and a specificity of 94%. Significance: These results are obtained without including any additional clinical risk factors. They justify that the radio transmission data are usable on their own as a predictor of bone density. This approach has the potential for screening patients at risk for fragility fractures in the office, given the ease of implementation, small device size, and low costs associated with both the technique and the equipment.

NAFLD and Liver Fibrosis Are Not Associated With Reduced Femoral Bone Mineral Density in the General US Population

CONTEXT

It is still debated whether nonalcoholic fatty liver disease (NAFLD) may be a risk factor for reduced bone mineral density (BMD), and it is not known whether liver fibrosis, the major predictor of future development of liver-related events in NAFLD, has an influence on BMD.

OBJECTIVE

To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population.

METHODS

We performed a cross-sectional analysis of the population-based 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES), in which vibration-controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA) of the femoral neck were simultaneously available. Controlled attenuation parameter (CAP) ≥ 274 dB/m was considered indicative of liver steatosis, while a median liver stiffness measurement (LSM) ≥ 8 kPa indicated the presence of significant liver fibrosis. We included all participants older than 50 years with reliable VCTE and femoral neck DXA results (925 men and 859 women). The main outcome measures were femoral neck BMD values indicative of osteopenia or osteoporosis.

RESULTS

Steatosis and significant fibrosis were highly prevalent in the studied population, being present in 53.1% and 9.6% of men and 44.2% and 8.0% of women, respectively. In univariate analysis, liver steatosis was associated with a lower prevalence of osteoporosis in both men and women, while no difference was noted according to the degree of liver fibrosis. After adjustment for potential confounders, including age, BMI, race/ethnicity, cigarette smoking, and diabetes, neither CAP nor LSM were significantly associated with reduced BMD in both sexes.

CONCLUSION

Liver steatosis and fibrosis are not associated with femoral DXA-based diagnosis of osteopenia or osteoporosis in the US population older than 50 years.

Characterization of Ultralow Density Cellular Solids: Lessons from 30 years of Bone Biomechanics Research

Advances in additive manufacturing techniques have enabled the development of micro-architectured materials displaying a combination of low-density and lightweight structures with high specific strength and toughness. The mechanical performance of micro-architectured materials can be assessed using standard techniques; however, when studying low- and ultralow density micro-architectured materials, standard characterization techniques can be subject to experimental artifacts. Additionally, quantitative assessment and comparisons of microarchitectures with distinct lattice patterns is not always straightforward. Cancellous bone is a natural, ultralow density (porosity often exceeding 90%), irregular, cellular solid that has been thoroughly characterized in terms of micro-architecture and mechanical performance over the past 30 years. However, most the literature on cancellous bone mechanical properties and micro-structure-function relationships is in the medical literature and is not immediately accessible to materials designers. Here we provide a brief review of state-of-the-art approaches for characterizing the micro-architecture and mechanical performance of ultralow density cancellous bone, including methods of addressing experimental artifacts during mechanical characterization of ultralow density cellular solids, methods of quantifying microarchitecture, and currently understood structure-function relationships.

Health service use pathways associated with recovery of quality of life at 12-months for individual fracture sites: Analyses of the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS)

PURPOSE

We aimed to identify combinations of health service use specific to each major osteoporotic fracture (MOF) site - hip, distal forearm, vertebrae and humerus - associated with recovery of health-related quality of life (HRQoL) 12-months post-MOF.

METHODS

Patients were 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebral, 434 humerus) from the International Costs and Utilities Related to Osteoporotic fractures Study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain and the UK). HRQoL (pre-fracture and 12-months post-fracture) was measured using the EQ-5D-3L. Health service use data were collected via interviews and medical record reviews and included in-hospital care, outpatient care, supported living, community health services, and medication use. Latent class analyses were undertaken to identify different combinations of health service use ("classes"); and logistic regression to assess associations between classes and HRQoL recovery. Fracture site-specific analyses were performed using pooled data from all 10 countries.

RESULTS

The proportion of patients who recovered to their pre-fracture HRQoL at 12-month follow-up varied across fracture sites: 37.3%, 65.8%, 48.9% and 49.5% for hip, distal forearm, vertebrae, and humerus, respectively. We observed several site-specific classes associated with improved odds of HRQoL recovery. Generally, the combination of hospital presentations without admission; primary care center visits; use of osteoporosis-related medications; vitamin D/calcium supplementation; and non-opioid analgesic use was associated with greater likelihood of HRQoL recovery.

CONCLUSION

The identified fracture site-specific health service use pathways associated with recovery of HRQoL could potentially improve the management and health outcomes of patients treated for a MOF.

Development of a QUS Device to Evaluate Deterioration of Cortical Bone: Verification by HR-pQCT and Measurements in Healthy Individuals and Dialysis Patients

INTRODUCTION

The objectives of this study were to identify what is reflected in cortical speed of sound (cSOS) measured by a cortical quantitative ultrasound (cortical QUS) device we have developed, and to investigate cSOS measurements in healthy individuals and dialysis patients.

METHODS

The cSOS and the SOS were measured by cortical QUS and conventional QUS in 20 volunteers, and the correlations between these measurements and areal bone mineral density measured by dual-energy X-ray absorptiometry and bone microstructural parameters on high-resolution peripheral quantitative computed tomography were analyzed. The cSOS and the SOS were measured in 91 young adults (47 men, 44 women), 64 elderly people (30 men, 33 women), and 64 dialysis patients (33 men, 31 women). The period of hemodialysis and intact parathyroid hormoneevels were also investigated in the dialysis patients.

RESULTS

cSOS was correlated with cortical tissue mineral density (tibia: r = 0.74, radius: r = 0.72) on high-resolution peripheral quantitative computed tomography, reflecting the degree of minaralization and microporosity of cortical bone. There was no correlation with the thickness of cortical bone, suggesting that it measured the bone quality rather than bone mass. Elderly women had lower cSOS than young adults (3865 ± 74 vs 3971 ± 63 m/s, p < 0.01). Many of dialysis patients showed very low cSOS and it was related to higher intact parathyroid hormone levels (male: ß = -0.67, female: ß = -0.60).

CONCLUSIONS

Our cortical QUS device is capable of evaluating the qualitative degradation of cortical bone, which cannot be assessed by conventional QUS, and its use in combination with conventional QUS may provide a better understanding of fracture risk.

A Qualitative Assessment of Bone Mineral Density in Individuals With Hemifacial Microsomia: A Cone-Beam Computed Tomography Study

OBJECTIVE

The purpose of this study is to utilize cone-beam computed tomography (CBCT) to compare the bone mineral density (BMD) on the affected versus nonaffected side, among individuals with hemifacial microsomia (HFM).

METHODS

This retrospective study included 9 patients with HFM. Pretreatment CBCT volumes were imported into Invivo5 software, which was used to measure BMD through Hounsfield units (HU) in 3 regions of the mandible; inferior to the lower lateral incisors, inferior to the first molar and at the ramus inferior to the sigmoid notch. Each region was measured at the buccal cortical bone, lingual cortical bone, and cancellous bone. The densities on the right and left sides were compared by Wilcoxon signed-rank test.

RESULTS

Overall, the BMD on the affected side tended to show slightly lower values when compared with the nonaffected side. Differences ranged from 14 HU at the lingual cortical plate of the first molar region to 234 HU at the buccal cortical plate of the ramus region. Differences were only statistically significant at the ramus region for the buccal (P = .002) and lingual (P < .001) cortical plates and at the lower incisor region at the buccal cortical plate (P = .016) and cancellous bone (P = .044). The differences, however, did not seem to be clinically significant.

CONCLUSIONS

The current study shows that the quality of bone on the affected side may be slightly reduced but did not seem to be clinically significant. This should be accounted for during surgical and orthodontic planning for patients with HFM.

Randomized head-to-head comparison of minodronic acid and raloxifene for fracture incidence in postmenopausal Japanese women: the Japanese Osteoporosis Intervention Trial (JOINT)-04

AIMS

We conducted a head-to-head randomized trial of minodronate, a bisphosphonate, and raloxifene, a selective estrogen receptor modulator, to obtain clinical evidence and information about their efficacy and safety.

METHODS

The Japanese Osteoporosis Intervention Trial protocol number 4 (JOINT-04) trial is a multi-center, open-labeled, blinded endpoints, head-to-head randomized trial of minodronate and raloxifene. Ambulatory elderly women with osteoporosis (age, >60 years) were randomly allocated to the raloxifene or minodronate group by central registration. The co-primary endpoints included any one of osteoporotic fractures (vertebral, humeral, femoral, and radial fractures), vertebral fractures, and major osteoporotic fractures (clinical vertebral, humeral, femoral, and radial fractures). The biological effects of each drug, patients' quality of life, and drug safety were assessed based on the secondary outcomes. This study was registered at the University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) under trial identification number UMIN000005433.

RESULTS

A total of 3896 patients were randomized to the minodronate and raloxifene groups, and drug efficacy assessments were performed for 3247 patients (1623 and 1624 patients, respectively). Among these patients, 1176 and 1187 patients received allocated treatment for 2 years. The incidence rate ratios for osteoporotic, vertebral, and major osteoporotic fractures in the minodronate group were 0.94 (95% CI: 0.78-1.13, p = .494), 0.86 (95% CI: 0.70-1.05, p = .147), and 1.22 (95% CI: 0.86-1.74, p = .274), respectively. Compared to the raloxifene group, the minodronate group showed significantly increased bone mineral density of the lumbar spine for each visit (6 months: p = .007, 12 months: p = .0003, 24 months: p<.0001). Also, serious adverse reactions were observed for four and six patients in the minodronate and raloxifene groups, respectively.

CONCLUSIONS

Overall, there were no statistical differences in the incidence rates of osteoporotic, vertebral, or major osteoporotic fractures between the two groups. Serious adverse reactions were rare in both groups.

A Call to Action: Now Is the Time to Screen Elderly and Treat Osteosarcopenia, a Position Paper of the Italian College of Academic Nutritionists MED/49 (ICAN-49)

Aging is a risk factor for the development of multiple chronic diseases, including cardiovascular disease, cancer and dementia. Life expectancy has increased in certain countries but this phenomenon is associated with a reduction of years of healthy life. Aging is associated with a number of physical and functional changes, especially sarcopenia. Sarcopenia is a clinical condition associated with a decrease in skeletal muscle and muscle strength, however, sarcopenia is a reversible condition. On the basis of the current scientific literature, sarcopenia could more appropriately capture an individual's vulnerability to negative health-related outcomes since it represents an early form of the chronic diseases. Recognition of this clinical condition can improve the management of older individuals in many different clinical settings. Despite the limitations of the indirect methods used to study body composition, the Italian College of the Academic Nutritionists ME/49 recommends that health authorities and health professionals around the world should make a greater effort to diagnose sarcopenia earlier and to manage it more effectively. In line with the development of cancer screening, the use of two diagnostic tools for sarcopenia (BIA and DXA) should be implemented.

Validity of quantitative ultrasound and bioelectrical impedance analysis for measuring bone density and body composition in children

BACKGROUND/OBJECTIVES

Using dual X-ray absorptiometry (DXA) to assess body composition in children has limitations including expense, lack of portability, and exposure to radiation. The aims of this study were to examine: (1) validity of quantitative ultrasound (QUS) against DXA for measuring bone density and (2) the validity of in-built algorithm of bioelectrical impedance analysis (BIA) for measuring body composition in children (8-13 years) living in New Zealand.

SUBJECTS/METHODS

Total body less head (TBLH), bone mineral content (BMC), bone mineral density (BMD), and body composition were measured with DXA (QDR Discovery A, Hologic, USA); calcaneal BMD and stiffness index (SI) with QUS (Sahara QUS, Hologic, USA), and BIA on the InBody 230 (Biospace Ltd., Seoul, Korea). Relative validity was assessed using Pearson's and Lin's concordance correlation coefficients (CCC), and Bland-Altman plots.

RESULTS

In 124 healthy children, positive correlations between QUS SI and DXA (BMC and BMD) were observed (range = 0.30-0.45, P < 0.01). Results from Lin's CCC test showed almost perfect correlations between BIA and DXA fat free mass (0.96), fat mass (0.92), and substantial correlation for percentage of fat mass (0.75) (P < 0.05).

CONCLUSION

Although BIA results were not as accurate as DXA and DXA remains the gold standard method for clinical assessment, BIA can be an alternative method for investigating body composition among children in large cohort field studies. Calcaneal QUS and DXA are not interchangeable methods for measuring bone density in children similar to our study population.

Computer-aided diagnosis systems for osteoporosis detection: a comprehensive survey

Computer-aided diagnosis (CAD) has revolutionized the field of medical diagnosis. They assist in improving the treatment potentials and intensify the survival frequency by early diagnosing the diseases in an efficient, timely, and cost-effective way. The automatic segmentation has led the radiologist to successfully segment the region of interest to improve the diagnosis of diseases from medical images which is not so efficiently possible by manual segmentation. The aim of this paper is to survey the vision-based CAD systems especially focusing on the segmentation techniques for the pathological bone disease known as osteoporosis. Osteoporosis is the state of the bones where the mineral density of bones decreases and they become porous, making the bones easily susceptible to fractures by small injury or a fall. The article covers the image acquisition techniques for acquiring the medical images for osteoporosis diagnosis. The article also discusses the advanced machine learning paradigms employed in segmentation for osteoporosis disease. Other image processing steps in osteoporosis like feature extraction and classification are also briefly described. Finally, the paper gives the future directions to improve the osteoporosis diagnosis and presents the proposed architecture. Graphical abstract.

The incidence and risk factors for adjacent vertebral fractures in community-dwelling people with prevalent vertebral fracture: the 3rd and 4th survey of the ROAD study

In this 3-year follow-up study of 66 community-dwelling adults with severely deformed vertebral fractures, the annual incidence of adjacent vertebral fracture (AVF) was 6.1%/year. Lower bone mineral density at the femoral neck and spinopelvic malalignment were risk factors for AVF.

PURPOSE

This study aimed to clarify the incidence and risk factors of adjacent vertebral fractures (AVFs)-fractures adjacent to a prevalent vertebral fracture (VF)-using an established population-based cohort from the ROAD study.

METHODS

Among the 1213 participants who underwent whole-spine radiography in ROAD's third (2012-2013, the baseline) and fourth surveys (2015-2016, the follow-up), 66 (12 men, 54 women) had at least one VF at the baseline. VF and AVF were determined radiographically using Genant's semi-quantitative (SQ) method, where VF was SQ ≥ 2 and AVF was a one-level cranial or caudal vertebra with an SQ grade one or more higher at the follow-up. An interviewer-administered questionnaire was applied, and anthropometric measurements and bone mineral density (BMD) measurements at the lumbar spine and femoral neck were performed. Sagittal imbalance of the spine was defined as a mismatch between pelvic incidence and lumbar lordosis (PI-LL) of > 20°. Multivariate logistic regression analyses were performed to identify risk factors for AVF.

RESULTS

AVF occurred in 12 participants (1 man, 11 women). The annual incidence of AVF was estimated at 6.1%/year. Logistic regression analyses revealed that lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF.

CONCLUSIONS

The annual incidence of AVF in a general population with prevalent VF was 6.1%/year. In addition, lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF.

The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research.

COPD as an independent risk factor for osteoporosis and fractures

Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility.

INTRODUCTION

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population.

METHODS

Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history.

RESULTS

The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ - 2.7 in the CG and ≤ - 0.6 in the COPDG.

CONCLUSION

These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.

What is the influence of two strain rates on the relationship between human cortical bone toughness and micro-structure?

Cortical bone fracture mechanisms are well studied under quasi-static loading. The influence of strain rate on crack propagation mechanisms needs to be better understood, however. We have previously shown that several aspects of the bone micro-structure are involved in crack propagation, such as the complete porosity network, including the Haversian system and the lacunar network, as well as biochemical aspects, such as the maturity of collagen cross-links. The aim of this study is to investigate the influence of strain rate on the toughness of human cortical bone with respect to its microstructure and organic non-collagenous composition. Two strain rates will be considered: quasi-static loading (10−4 s−1), a standard condition, and a higher loading rate (10−1 s−1), representative of a fall. Cortical bone samples were extracted from eight female donors (age 50–91 years). Three-point bending tests were performed until failure. Synchrotron radiation micro-computed tomography imaging was performed to assess bone microstructure including the Haversian system and the lacunar system. Collagen enzymatic cross-link maturation was measured using a high performance liquid chromatography column. Results showed that that under quasi-static loading, the elastic contribution of the fracture process is correlated to both the collagen cross-links maturation and the microstructure, while the plastic contribution is correlated only to the porosity network. Under fall-like loading, bone organization appears to be less linked to crack propagation.

Concept of a Radiofrequency Device for Osteopenia/Osteoporosis Screening

Osteoporosis represents a major health problem, resulting in substantial increases in health care costs. There is an unmet need for a cost-effective technique that can measure bone properties without the use of ionizing radiation. The present study reports design, construction, and testing of a safe, and easy to use radiofrequency device to detect osteoporotic bone conditions. The device uses novel on-body antennas contacting the human wrist under an applied, operator-controlled pressure. For the dichotomous diagnostic test, we selected 60 study participants (23-94 years old, 48 female, 12 male) who could be positively differentiated between healthy and osteopenic/osteoporotic states. The band-limited integral of the transmission coefficient averaged for both wrists, multiplied by age, and divided by BMI has been used as an index. For a 100 MHz frequency band centered about 890-920 MHz, the maximum Youden's J index is 81.5%. Both the sensitivity and specificity simultaneously reach 87% given the calibration device threshold tolerance of ±3%. Our approach correlates well with the available DXA measurements and has the potential for screening patients at risk for fragility fractures, given the ease of implementation and low costs associated with both the technique and the equipment. The inclusion of radiofrequency transmission data does add supplementary useful information to the available clinical risk factors.

Bone Mineral Density in Patients Suffering from Ménière's Disease

INTRODUCTION

Previous studies have reported an association between reduced bone mineral density and the occurrence of benign paroxysmal positional vertigo, balance impairment, and saccular dysfunction. Furthermore, the results of recent animal studies have raised the possibility that vestibular dysfunction could affect bone remodeling and bone mass. The goal of the study was to compare bone mineral density of patients suffering from definite Ménière's disease to that of a matched control group.

METHODS

We conducted a case-control cross-sectional study in a tertiary referral center. The study group included 23 patients suffering from definite Ménière's disease, and the control group was comprised of 23 patients matched in their race, gender, and age parameters in whom no vestibular pathology could be found. Dual energy X-ray absorptiometry of the femoral head was used for the assessment of bone mineral density. The T and Z scores of the femoral heads' bone mineral density were compared.

RESULTS

The average T scores were -1.53 ± 1.08 in the study and -0.39 ± 0.72 (p = 0.016) in the control groups, and the Z scores were -0.4 ± 0.63 and 0.33 ± 0.31 (p = 0.018), respectively. Seventeen patients (74%) of the study group and 9 (39%) of the control group had T scores less than -1.0, indicating osteopenia/osteoporosis (p = 0.036).

CONCLUSIONS

The results showed a significant association between Ménière's disease and reduced bone mineral density of the femoral head. Bone mineral density studies of the weight-bearing bones are warranted in Ménière's disease for the early diagnosis and treatment of osteopenia/osteoporosis on the one hand and possible benefit of this treatment for the evolution of Ménière's disease on the other hand.

Differences in bone density on chest CT according to smoking status in males without chronic obstructive lung disease

The goals of this study were to determine whether bone density measured using CT (CTBD) can show significant differences in bone loss according to smoking status and pack-years, and to examine the correlation between CTBD and bone mineral density when measured by dual-energy X-ray absorptiometry (DEXA-BMD) in males without chronic obstructive pulmonary disease (COPD). In this cross-sectional study, 1,011 males without airflow obstruction ≥50 years old were included. CTBD and DEXA-BMD were compared among groups with different smoking statuses. The correlation between CTBD and DEXA-BMD and the association of CTBD with pack-years were also investigated. CTBD of all vertebral bodies (VBs) and DEXA-BMD of all VBs without L1 showed significant differences among never, former, and current smokers. CTBD was significantly lowest in ≥30-pack-year smokers and was significantly lower in ≥30-pack-year smokers than in <15-pack-year smokers (all P < 0.05). There were significant correlations between DEXA-BMD and CTBD at all VB levels (correlation coefficient [r], 0.448~0.640; all P < 0.01). A lower CTBD had a significant association with a 15 ≤ x < 30-pack-year smoking history and ≥30-pack-year smoking history, while there was no association with never-smokers. In conclusion, CTBD demonstrated significant differences in bone quality according to smoking status and pack-years in males without COPD.

Pulsed vibro-acoustic method for assessment of osteoporosis & osteopenia: A feasibility study on human subjects

In this paper we propose a new non-invasive ultrasound method, pulsed vibro-acoustic, for evaluating osteoporotic and osteopenic bone in humans. Vibro-acoustic method uses acoustic radiation force (ARF) to stimulate bone and the resulting acoustic signal can be used to characterize bone. The resulting acoustic signal is collected by a hydrophone at the skin surface. Wave velocity and numbers of intrinsic modes are used for analysis. Wave velocity is estimated using the received signal and maximum power mode of the decomposed signal is estimated using variational mode composition from different push points of ARF based on the cross-correlation method. A total of 27 adult volunteers, including healthy and those diagnosed with osteopenia and osteoporosis, were tested. Results of pulsed vibro-acoustic test on tibia of volunteers showed that healthy group could be differentiated from osteoporosis or osteopenia (p < 2 × 10^-5). The results of our study support the feasibility of pulsed vibro-acoustic method for measuring mechanical properties of bone and the potential clinical utility of the proposed method for assessment of bone health.

Denosumab is effective toward glucocorticoid-induced osteoporosis patients complicated with rheumatic diseases regardless of prior anti-osteoporotic drugs

We examined the efficacy and safety of denosumab as treatment for glucocorticoid-induced osteoporosis (GIOP) patients complicated with rheumatic diseases, by measuring patients' lumber bone mineral density (BMD) and bone turnover markers. A total of 66 consecutive patients for whom denosumab was initiated between July 2013 and August 2016 were enrolled and evaluated for 12 months. All of the patients were treated with glucocorticoids for underlying rheumatic diseases. The clinical assessment included measurements of the BMD of the lumbar spine (L2-L4) by a dual-energy X-ray absorptiometry technique and the bone turnover markers N-terminal telopeptide of type 1 collagen (NTX) in urine, serum intact procollagen type 1 N-terminal propeptide (P1NP), and bone-specific alkaline phosphatase (BAP) at baseline, 6 months and 12 months after the start of denosumab treatment. Adverse events (AEs) until 12 months were also analyzed. The mean percentage changes in BMD from baseline to 6 and 12 months were significant (2.85% increase, p < 0.0001 and 4.40% increase, p < 0.0001, respectively) regardless of the prior anti-osteoporotic drugs treatment (16 no transition from anti-osteoporotic drugs, 27 transition from bisphosphonate, 23 transition from teriparatide). The decreases in NTX, P1NP and BAP at 6 and 12 months were also significant. No serious AEs were noted. A multivariable logistic analysis showed that the prednisolone dose at baseline was associated with the clinical response to denosumab. In a real-world setting, denosumab was effective and safe for treating GIOP patients complicated with rheumatic diseases regardless of prior anti-osteoporotic drug treatment.

Parity and lactation are not associated with incident fragility fractures or radiographic vertebral fractures over 16 years of follow-up: Canadian Multicentre Osteoporosis Study (CaMos)

Parity and lactation showed no associations with incident clinical fragility fractures or radiographic vertebral compression fractures in the 16-year CaMos prospective study. Parity was associated with slightly greater decline in femoral neck but not hip or spine areal bone mineral density (aBMD), while lactation showed no associations with aBMD change.

PURPOSE

Pregnancy and especially lactation cause loss of bone mass and microarchitectural changes, which temporarily increase fracture risk. After weaning, aBMD increases but skeletal microarchitecture may be incompletely restored. Most retrospective clinical studies found neutral or even protective associations of parity and lactation with fragility fractures, but prospective data are sparse. CaMos is a randomly selected observational cohort that includes ~ 6500 women followed prospectively for over 16 years.

METHODS

We determined whether parity or lactation were related to incident clinical fragility fractures over 16 years, radiographic (morphometric and morphologic) vertebral fractures over 10 years, and aBMD change (spine, total hip, and femoral neck) over 10 years. Parity and lactation duration were analyzed as continuous variables in predicting these outcomes using univariate and multivariate regression analyses.

RESULTS

Three thousand four hundred thirty-seven women completed 16 years of follow-up for incident clinical fractures, 3839 completed 10 years of morphometric vertebral fracture assessment, 3788 completed 10 years of morphologic vertebral fracture assessment, and 4464 completed 10 years of follow-up for change in aBMD. In the multivariate analyses, parity and lactation duration showed no associations with clinical fragility fractures, radiographic vertebral fractures, or change in aBMD, except that parity associated with a probable chance finding of a slightly greater decline in femoral neck aBMD.

CONCLUSIONS

Parity and lactation have no adverse associations with clinical fragility or radiographic vertebral fractures, or the rate of BMD decline over 10 years, in this prospective, multicenter study of a randomly selected, population-based cohort of women.

Macrophage-lineage TRAP+ cells recruit periosteum-derived cells for periosteal osteogenesis and regeneration

The periosteum, a thin tissue that covers almost the entire bone surface, accounts for more than 80% of human bone mass and is essential for bone regeneration. Its osteogenic and bone regenerative abilities are well studied, but much is unknown about the periosteum. In this study, we found that macrophage-lineage cells recruit periosteum-derived cells (PDCs) for cortical bone formation. Knockout of colony stimulating factor-1 eliminated macrophage-lineage cells and resulted in loss of PDCs with impaired periosteal bone formation. Moreover, macrophage-lineage TRAP+ cells induced transcriptional expression of periostin and recruitment of PDCs to the periosteal surface through secretion of platelet-derived growth factor-BB (PDGF-BB), where the recruited PDCs underwent osteoblast differentiation coupled with type H vessel formation. We also found that subsets of Nestin+ and LepR+ PDCs possess multipotent and self-renewal abilities and contribute to cortical bone formation. Nestin+ PDCs are found primarily during bone development, whereas LepR+ PDCs are essential for bone homeostasis in adult mice. Importantly, conditional knockout of Pdgfrβ (platelet-derived growth factor receptor beta) in LepR+ cells impaired periosteal bone formation and regeneration. These findings uncover the essential role of periosteal macrophage-lineage cells in regulating periosteum homeostasis and regeneration.

Acquisition of Quasi-Monochromatic Dual-Energy in a Microfocus X-ray Generator and Development of Applied Technology

In regenerative medicine, evaluation of bone mineral density using a microfocus X-ray generator could eventually be used to determine the degree of bone tissue regeneration. To evaluate bone mineral density against regenerated bone material, two low-energy X-rays are necessary. Herein, the acquisition of quasi-monochromatic, dual-energy soft X-ray and the subsequent medical application were examined using the K-absorption edges of two types of metal filters (i.e., zirconium and tin) in a microfocus X-ray generator. Investigation of the optimal tube voltage and filter thickness to form a quasi-monochromatic energy spectrum with a single filter revealed that a filter thickness of 0.3 mm results in an optimal monochromatization state. When a dual filter was used, the required filter thickness was 0.3 mm for tin and 0.2 mm for zirconium at a tube voltage of 35 kV. For the medical application, we measured quasi-monochromatic, dual-energy X-rays to evaluate the measurement accuracy of bone mineral density. Using aluminum as a simulated bone sample, a relative error of ≤5% was consistent within the aluminum thickness range of 1–3 mm. These data suggest that a bone mineral density indicator of recycled bone material can be easily obtained with the quasi-monochromatic X-ray technique using a microfocus X-ray generator.

Analysis of bone mass and its relationship with body composition in school-aged children and adolescents based on stage of puberty and site specificity: A retrospective case-control study

The aim of this study was to better understand the relationship of bone mass with body composition based on different stages of puberty and to illuminate the contribution of site-specific fat mass and lean mass (FM and LM) compared with bone mass in school-aged children and adolescents in Chongqing, China.A total of 1179 healthy subjects of both sexes were recruited. Bone mineral content (BMC), bone mineral density (BMD), bone area, and both FM and LM were measured by dual-energy X-ray absorptiometry (DXA). The fat mass and lean mass indexes (FMI and LMI, respectively) were calculated as the FM (kg) and LM (kg) divided by the height in meters squared, respectively.Most of the bone mass indicators were significantly higher for postpubertal boys than for girls at the same stage (P < .001). The proportion of subjects with normal bone mass increased, while the proportion of subjects with osteopenia and osteoporosis decreased with increased body weight regardless of gender and puberty stage (P < .01). FM and LM were significantly positively related to bone mass regardless of gender and puberty stage (P < .0001). FMI and LMI were significantly positively related to bone mass in most conditions (P < .05 and P < .0001, respectively). Four components of the FM and LM were linearly and significantly associated with BMD and BMC for TB and TBHL. Among them, the head fat mass and head lean mass showed the greatest statistical contribution.In the process of assessing bone status, we recommend measuring fat and lean masses, including the fat and lean masses of the head.

Large Bone not Necessarily High Bone Mineral Density: Evidence from a National Survey

There is scarcity of population-level data on the bone areal size (BA) that produces the highest bone mineral density (BMD), and how BA relates to BMD among racial groups. We use population-level data to estimate the BA that coincide with the highest BMD among racial groups in the United States. A total of 7425 participants, age 18-75 years, whose BA and BMD were measured in the United States National Health and Nutrition Examination Survey (NHANES) 2009-2014, were assessed in this study. Multiple regression models were used to estimate race-specific relationships between BA and BMD. The critical BA that associates with the highest (peak) BMD among racial groups adjusted for confounders was estimated. Results showed a curvilinear relationship between BA and BMD at the population level such that BMD increases with BA at lower values and then decreases after a peak value. Races combined, BA of about 45 cm² seems to correspond to a peak femur BMD in this sample. The peak BMD was different among racial groups. The BA at which BMD peaks was lower among blacks and Mexicans compared to whites. We conclude that femur BMD increases up to a critical femur BA and then decreases thereafter. Persons with femur BA at or close to the critical value may tend to have higher than average BMD.

Frequency of Osteoporosis and Vertebral Fractures in Chronic Obstructive Pulmonary Disease (COPD) Patients

BACKGROUND

Osteoporosis is a systemic skeletal disease characterized by low bone mass and/or microarchitectural deterioration of bone. Osteoporosis is a risk factor for fractures specially in patients with advanced COPD. The aim of this cross-sectional study was to determine the frequency of osteoporosis and vertebral fracture in COPD patients.

METHODS

We evaluated 91 COPD patients and compared to 82 healthy subjects (control group) matched for gender and age. We measured the bone mineral density by means of dual energy X-ray absorptiometry (DXA), evaluating the lumbar vertebra (L1-L4), proximal femur and total femur and evaluated vertebral fractures in thoracic and lumbar spine using X-ray. We questioned patients whether they had had any fall that resulted in any fracture in the past five years.

RESULTS

Males comprised 60.4% of COPD group and 57.3% of the control group. Mean age was 66.2±9.2 years for COPD group and 64.2±8.8 for the control group. The frequency of osteoporosis in the COPD group was 29.7% and 18.3% in control group (p=0.007). The frequency of vertebral fractures was 18.6% in the COPD group and 9.0% in control group (p=0.06). The frequency of reported falls at resulting in any fracture was 36.3% in the COPD group and 7.3% in control group (p=0.001).

CONCLUSIONS

Our data indicate that COPD patients present a high frequency of osteoporosis and falls seem to be an important factor for vertebral fracture.

Relative radiographic bone density measurement in revision hip arthroplasty and its correlation with qualitative subjective assessment by experienced surgeons

BACKGROUND

Conventional radiography (CR) is the imaging method of choice in monitoring bone remodelling and other stability parameters after total hip arthroplasty (THA). Quantitative roentgen- or computed-tomography-based methods to determine bone density are prone to metal artifacts and often very costly, which is why they are not used as standard in a clinical setting. Since subjective assessment of bone remodelling in CR also has a certain susceptibility to errors, semi-quantitative methods have been developed to help approximate periprosthetic bone density development via CR to open up an additional tool for documentation of radiographic THA follow-up.

OBJECTIVE

Proof-of-principle of a newly designed imaging-software-aided method to measure relative bone density around the femoral stem in a series of conventional radiographs following THA.

METHODS

Eighty-six patients with hip modular tapered, fluted titanium stems were selected from the clinical database and series of baseline and postoperative follow-up radiographs were obtained after 24 and 48 weeks. Relative bone densities were measured per Gruen zones G1-7 with the use of an open-source image analysis package (ImageJ) by means of greyscale histograms. In addition, subjective evaluation of selected cases was performed by three independent, blinded orthopedic surgeons. Besides descriptive and nonparametric analyses, intra-class correlation (ICC) was performed and objective and subjective results were compared by linear regression analysis.

RESULTS

Two individual cases are presented as a proof-of-principle. Increase or decrease of bone density could be measured correctly over time in each case. In a collective analysis there were no significant differences in mean relative bone densities between groups after 24 and 48 weeks, although a positive tendency was visible towards increased bone formation over time. Individual analyses by Gruen zones revealed that some zones, namely the proximal ones (e.g. G6), exhibit a broader scattering than others over time. This could be explained by the design of the evaluated tapered revision stem that achieves distal fixation and allows for proximal micromotion. Correlation analysis with subjective ratings (inter-rater reliability ICC = 0.71) showed a positive correlation with objective results, suggesting a feasibility of the method for clinical use.

CONCLUSIONS

In conclusion the presented method is an easy and accessible tool to quantify relative bone density changes during THA follow-up. It shows a positive correlation to established subjective assessment of bone remodelling and may therefore serve as a quantitative supplement in clinical documentation.

Segmentation of the Proximal Femur from MR Images using Deep Convolutional Neural Networks

Magnetic resonance imaging (MRI) has been proposed as a complimentary method to measure bone quality and assess fracture risk. However, manual segmentation of MR images of bone is time-consuming, limiting the use of MRI measurements in the clinical practice. The purpose of this paper is to present an automatic proximal femur segmentation method that is based on deep convolutional neural networks (CNNs). This study had institutional review board approval and written informed consent was obtained from all subjects. A dataset of volumetric structural MR images of the proximal femur from 86 subjects were manually-segmented by an expert. We performed experiments by training two different CNN architectures with multiple number of initial feature maps, layers and dilation rates, and tested their segmentation performance against the gold standard of manual segmentations using four-fold cross-validation. Automatic segmentation of the proximal femur using CNNs achieved a high dice similarity score of 0.95 ± 0.02 with precision = 0.95 ± 0.02, and recall = 0.95 ± 0.03. The high segmentation accuracy provided by CNNs has the potential to help bring the use of structural MRI measurements of bone quality into clinical practice for management of osteoporosis.