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Zhang H, Xu R, Guo X, Zhou D, Xu T, Zhong X, Kong M, Zhang Z, Wang Y, Ma X. Deep learning-based automated high-accuracy location and identification of fresh vertebral compression fractures from spinal radiographs: a multicenter cohort study. Front Bioeng Biotechnol 2024; 12:1397003. [PMID: 38812917 PMCID: PMC11135169 DOI: 10.3389/fbioe.2024.1397003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Background Digital radiography (DR) is a common and widely available examination. However, spinal DR cannot detect bone marrow edema, therefore, determining vertebral compression fractures (VCFs), especially fresh VCFs, remains challenging for clinicians. Methods We trained, validated, and externally tested the deep residual network (DRN) model that automated the detection and identification of fresh VCFs from spinal DR images. A total of 1,747 participants from five institutions were enrolled in this study and divided into the training cohort, validation cohort and external test cohorts (YHDH and BMUH cohorts). We evaluated the performance of DRN model based on the area under the receiver operating characteristic curve (AUC), feature attention maps, sensitivity, specificity, and accuracy. We compared it with five other deep learning models and validated and tested the model internally and externally and explored whether it remains highly accurate for an external test cohort. In addition, the influence of old VCFs on the performance of the DRN model was assessed. Results The AUC was 0.99, 0.89, and 0.88 in the validation, YHDH, and BMUH cohorts, respectively, for the DRN model for detecting and discriminating fresh VCFs. The accuracies were 81.45% and 72.90%, sensitivities were 84.75% and 91.43%, and specificities were 80.25% and 63.89% in the YHDH and BMUH cohorts, respectively. The DRN model generated correct activation on the fresh VCFs and accurate peak responses on the area of the target vertebral body parts and demonstrated better feature representation learning and classification performance. The AUC was 0.90 (95% confidence interval [CI] 0.84-0.95) and 0.84 (95% CI 0.72-0.93) in the non-old VCFs and old VCFs groups, respectively, in the YHDH cohort (p = 0.067). The AUC was 0.89 (95% CI 0.84-0.94) and 0.85 (95% CI 0.72-0.95) in the non-old VCFs and old VCFs groups, respectively, in the BMUH cohort (p = 0.051). Conclusion In present study, we developed the DRN model for automated diagnosis and identification of fresh VCFs from spinal DR images. The DRN model can provide interpretable attention maps to support the excellent prediction results, which is the key that most clinicians care about when using the model to assist decision-making.
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Affiliation(s)
- Hao Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ruixiang Xu
- Department of Pain, YanTai YuHuangDing Hospital, Yantai, Shandong, China
| | - Xiang Guo
- Department of Spinal Surgery, The Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Dan Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tongshuai Xu
- Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Xin Zhong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Meng Kong
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Zhimin Zhang
- Department of Stomatology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Loscalzo E, See J, Bharill S, Yousefzadeh N, Gough E, Wu M, Crane JL. Growth hormone and testosterone delay vertebral fractures in boys with muscular dystrophy on chronic glucocorticoids. Osteoporos Int 2024; 35:327-338. [PMID: 37872346 PMCID: PMC10837224 DOI: 10.1007/s00198-023-06951-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
Glucocorticoid use in Duchenne and Becker muscular dystrophy prolongs ambulation but cause significant skeletal toxicity. Our analysis has immediate clinical implications, suggesting that growth hormone and testosterone have a stronger effect prior to first and subsequent vertebral fracture, respectively, relative to bisphosphonates alone in children with dystrophinopathies on chronic glucocorticoids. PURPOSE Glucocorticoids prolong ambulation in boys with Duchenne muscular dystrophy; however, they have significant endocrine side effects. We assessed the impact of growth hormone (GH), testosterone, and/or zoledronic acid (ZA) on vertebral fracture (VF) incidence in patients with dystrophinopathies on chronic glucocorticoids. METHODS We conducted a longitudinal retrospective review of 27 males with muscular dystrophy. Accelerated failure time (AFT) models were used to estimate the relative time to VF while on GH, testosterone, and/or ZA compared to ZA alone. Results are reported as failure time ratio, where >1 indicates prolonged time versus <1 indicates shorter time to next VF. RESULTS The prevalence of growth impairment was 96% (52% utilized GH), pubertal delay was 86% (72% utilized testosterone), and low trauma fractures were 87% (72% utilized ZA). Multivariable analysis of the AFT models showed that participants on either GH or testosterone treatment relative to ZA alone experienced prolonged time to next VF (1.253, P<0.001), with GH being the significant contributor when analyzed independently from testosterone (1.229, P<0.001). Use of ZA with GH or testosterone relative to ZA alone resulted in prolonged time to next VF (1.171, P<0.001), with testosterone being a significant contributor (1.130, P=0.033). CONCLUSION GH and testosterone each decreased VF risk in patients independent of or in combination with ZA, respectively.
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Affiliation(s)
- Emely Loscalzo
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Julia See
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Sonum Bharill
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Nazanin Yousefzadeh
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Ethan Gough
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Malinda Wu
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Janet L Crane
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Sangondimath G, Sen RK, T. FR. DEXA and Imaging in Osteoporosis. Indian J Orthop 2023; 57:82-93. [PMID: 38107793 PMCID: PMC10721776 DOI: 10.1007/s43465-023-01059-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/11/2023] [Indexed: 12/19/2023]
Abstract
Background Reduced bone density and increased fragility are hallmarks of osteoporosis, making the disease a major public health concern. The disease necessitates early diagnosis and appropriate therapy depend on an accurate evaluation of bone health. Essential tools for assessing osteoporosis include dual-energy X-ray absorptiometry (DEXA) and other imaging modalities. Methods This chapter focuses on dual-energy X-ray absorptiometry (DEXA) and other imaging methods as essential tools for assessment of osteoporosis. The chapter also explores complementary imaging modalities that help overcome limitation of DEXA by providing insights into the microarchitecture and bone quality. Results T-scores, used to categorise bone health, are determined by DEXA by comparing bone mineral density to age-matched standards. Bone mineral density (BMD) is the most common indicator of bone health; nevertheless, DEXA may misclassify bone health owing to reasons other than BMD. These constraints may be overcome with the use of complementary imaging methods, which provide information on the microarchitecture and quality of bone. The evaluation of bone structure is aided by high-resolution peripheral quantitative computed tomography (HR-pQCT), which produces precise 3D images of the trabecular and cortical bone compartments. Independent of traditional methods of gauging fracture risk, quantitative ultrasonography (QUS) uses an analysis of the characteristics of sound waves to determine bone health. Diagnostic precision is improved by magnetic resonance imaging (MRI) due to its ability to view bone marrow and trabecular structure without the use of ionising radiation. Discussion New methods, such as the trabecular bone score (TBS), examine bone texture and provide more data on the likelihood of fracture than conventional DEXA. By modelling bone strength using imaging data, finite element analysis (FEA) provides a biomechanical viewpoint on breakage probability. These combined methods boost diagnostic accuracy and pave the way for individualised treatment plans. Imaging helps with therapy monitoring as well as diagnosis. By monitoring bone density and structure over time, therapy effectiveness or course corrections may be quickly identified. The availability of sophisticated imaging techniques and the standardisation of procedures provide obstacles not withstanding their advantages. Ongoing work is being done to solve these issues and standardise and disseminate these methods in a variety of contexts. Conclusion The evaluation of osteoporosis is significantly aided by DEXA and other imaging methods. While DEXA is still the gold standard for diagnosing osteoporosis, other imaging techniques may shed light on bone health in greater detail. These methods improve fracture risk prediction and treatment assessment by providing information on bone architecture, quality, and strength. Integration of several imaging modalities shows potential for bettering osteoporosis therapy and patient outcomes as the field develops.
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Affiliation(s)
- Gururaj Sangondimath
- Department of Spine Services, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, 110070 India
| | - Ramesh Kumar Sen
- Department of Orthopedics, Max Super Speciality Hospital, Mohali, 160055 India
| | - Fazal Rehman T.
- Department of Spine Services, Indian Spinal Injuries Center, Vasant Kunj, New Delhi, 110070 India
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Xiao BH, Zhu MSY, Du EZ, Liu WH, Ma JB, Huang H, Gong JS, Diacinti D, Zhang K, Gao B, Liu H, Jiang RF, Ji ZY, Xiong XB, He LC, Wu L, Xu CJ, Du MM, Wang XR, Chen LM, Wu KY, Yang L, Xu MS, Diacinti D, Dou Q, Kwok TYC, Wáng YXJ. A software program for automated compressive vertebral fracture detection on elderly women's lateral chest radiograph: Ofeye 1.0. Quant Imaging Med Surg 2022; 12:4259-4271. [PMID: 35919046 PMCID: PMC9338385 DOI: 10.21037/qims-22-433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/25/2022] [Indexed: 11/17/2022]
Abstract
Background Because osteoporotic vertebral fracture (OVF) on chest radiographs is commonly missed in radiological reports, we aimed to develop a software program which offers automated detection of compressive vertebral fracture (CVF) on lateral chest radiographs, and which emphasizes CVF detection specificity with a low false positivity rate. Methods For model training, we retrieved 3,991 spine radiograph cases and 1,979 chest radiograph cases from 16 sources, with among them in total 1,404 cases had OVF. For model testing, we retrieved 542 chest radiograph cases and 162 spine radiograph cases from four independent clinics, with among them 215 cases had OVF. All cases were female subjects, and except for 31 training data cases which were spine trauma cases, all the remaining cases were post-menopausal women. Image data included DICOM (Digital Imaging and Communications in Medicine) format, hard film scanned PNG (Portable Network Graphics) format, DICOM exported PNG format, and PACS (Picture Archiving and Communication System) downloaded resolution reduced DICOM format. OVF classification included: minimal and mild grades with <20% or ≥20–25% vertebral height loss respectively, moderate grade with ≥25–40% vertebral height loss, severe grade with ≥40%–2/3 vertebral height loss, and collapsed grade with ≥2/3 vertebral height loss. The CVF detection base model was mainly composed of convolution layers that include convolution kernels of different sizes, pooling layers, up-sampling layers, feature merging layers, and residual modules. When the model loss function could not be further decreased with additional training, the model was considered to be optimal and termed ‘base-model 1.0’. A user-friendly interface was also developed, with the synthesized software termed ‘Ofeye 1.0’. Results Counting cases and with minimal and mild OVFs included, base-model 1.0 demonstrated a specificity of 97.1%, a sensitivity of 86%, and an accuracy of 93.9% for the 704 testing cases. In total, 33 OVFs in 30 cases had a false negative reading, which constituted a false negative rate of 14.0% (30/215) by counting all OVF cases. Eighteen OVFs in 15 cases had OVFs of ≥ moderate grades missed, which constituted a false negative rate of 7.0% (15/215, i.e., sensitivity 93%) if only counting cases with ≥ moderate grade OVFs missed. False positive reading was recorded in 13 vertebrae in 13 cases (one vertebra in each case), which constituted a false positivity rate of 2.7% (13/489). These vertebrae with false positivity labeling could be readily differentiated from a true OVF by a human reader. The software Ofeye 1.0 allows ‘batch processing’, for example, 100 radiographs can be processed in a single operation. This software can be integrated into hospital PACS, or installed in a standalone personal computer. Conclusions A user-friendly software program was developed for CVF detection on elderly women’s lateral chest radiographs. It has an overall low false positivity rate, and for moderate and severe CVFs an acceptably low false negativity rate. The integration of this software into radiological practice is expected to improve osteoporosis management for elderly women.
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Affiliation(s)
- Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Er-Zhu Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Jian-Bing Ma
- Department of Radiology, the First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hua Huang
- Department of Radiology, The Third People's Hospital of Shenzhen, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy.,Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Kun Zhang
- Department of Radiology, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Bo Gao
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Heng Liu
- Department of Radiology, the Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ri-Feng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhong-You Ji
- PET-CT Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiao-Bao Xiong
- Department of Radiology, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Lai-Chang He
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Wu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Chuan-Jun Xu
- Department of Radiology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mei-Mei Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Li-Mei Chen
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kong-Yang Wu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,College of Electrical and Information Engineering, Jinan University, Guangzhou, China
| | - Liu Yang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mao-Sheng Xu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Sapienza University of Rome, Rome, Italy
| | - Qi Dou
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Y C Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wáng YXJ. An update of our understanding of radiographic diagnostics for prevalent osteoporotic vertebral fracture in elderly women. Quant Imaging Med Surg 2022; 12:3495-3514. [PMID: 35782246 PMCID: PMC9246755 DOI: 10.21037/qims-22-360] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/22/2022] [Indexed: 08/30/2023]
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Du EZ, Wáng YXJ. CT detects more osteoporotic endplate depressions than radiograph: a descriptive comparison of 76 vertebrae. Osteoporos Int 2022; 33:1569-1577. [PMID: 35368223 DOI: 10.1007/s00198-022-06391-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study analyzed elderly women who had chest radiograph and chest CT with indications other than spine disorders. Using CT images as reference, the study demonstrates that radiograph can miss a high portion of mild endplate depression. Detection of endplate depression is confounded by the limitation of projectional overlay for radiograph. INTRODUCTION The definition of radiographic OVF (osteoporotic vertebral fracture) remains controversial. Some authors suggest all OVFs should demonstrate endplate fracture/depression on radiograph. Using CT image as the reference, our study tests the hypothesis that a considerable portion of endplate depressions not seen on radiograph can be detected on CT. METHODS We retrospectively analyzed 46 female cases (age: 67-94 years) who had both chest radiography and chest CT with indications other than spine disorders. Sixty-six "vertebrae of interest" were identified on radiograph; then, CT images were read side-by-side with lateral chest radiograph. RESULTS Thirty-eight vertebrae (38/66) had anterior wedging deformity with height loss of < 20% while without radiographic endplate depression. Among them, 28 vertebrae had endplate depression and 8 vertebrae had no endplate depression on CT, while 2 vertebrae with "very" minimal deformity were read as normal on CT. In 9 vertebrae (9/66) with anterior wedging and height loss of ≥ 20%, all had additional endplate depression seen on CT. Five vertebrae (5/66) had ambiguous endplate depression on radiograph, 3 had endplate depression on CT while the other 2 vertebrae in one patient were false positive due to X-ray projection. There were 14 short height vertebrae (14/66) where middle and anterior heights were reduced to the same extent while did not show apparent anterior wedging or bi-concaving. Four cases each had one short height vertebra, and all had endplate depression on CT. Another 4 cases had 2, 2, 3, and 3 adjacent short height vertebrae, respectively, and all did not show endplate depression on CT. In addition, inspection of spine CT showed 10 vertebrae in 9 cases appeared normal on radiograph while demonstrated endplate depression on CT. CONCLUSION With CT images as reference, radiograph can miss a high portion of mild endplate depressions.
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Affiliation(s)
- E-Z Du
- Department of Radiology, Dongguan Traditional Chinese Medicine Hospital, Dongguan, Guangdong province, China
| | - Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
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Jirasirirak S, Disthabanchong S, Ongphiphadhanakul B, Arj-Ong Vallibhakara S, Nimitphong H. Prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease. Heliyon 2022; 8:e09158. [PMID: 35368525 PMCID: PMC8965903 DOI: 10.1016/j.heliyon.2022.e09158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to investigate the prevalence and predictors of asymptomatic vertebral fracture in patients with end-stage renal disease undergoing hemodialysis. Methods This cross-sectional study included 80 patients with end-stage renal disease undergoing hemodialysis. Medical history, Fracture Risk Assessment Tool and anteroposterior and lateral radiographs of the thoracolumbar and lumbosacral spine were obtained. Vertebral fractures were identified using the Genant semiquantitative assessment. Results Radiography demonstrated asymptomatic vertebral fracture in 22 patients (27.5%). FRAX® results for major osteoporotic fracture (area under the curve, 0.64) and hip fracture (area under the curve, 0.62) were able to discriminate patients with prevalent asymptomatic vertebral fracture. A multivariate analysis demonstrated that a 1-year average corrected calcium (odds ratio, 0.38), steroid use (odds ratio, 8.99), and a serum albumin concentration <25 g/dL (odds ratio, 28.82) significantly predicted prevalent asymptomatic vertebral fracture (clinical model; area under the curve, 0.82). Combining the 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® results for major osteoporotic fracture (area under the curve, 0.78) and FRAX® results for hip (area under the curve, 0.75) produced a significantly greater area under the curve value to predict fracture when compared with FRAX® result for major osteoporotic fracture and FRAX® result for hip (P = 0.022). Conclusion Asymptomatic vertebral fracture is prevalent. FRAX® results for major osteoporotic fracture and hip provided lower ability in predicting asymptomatic vertebral facture when compared to the clinical model. Combining a 1-year average corrected calcium and serum albumin concentration <25 g/dL with FRAX® result for major osteoporotic fracture or hip improved the model's performance and provided comparable area under the curve to the clinical model.
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Affiliation(s)
- Sasipim Jirasirirak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Boonsong Ongphiphadhanakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sakda Arj-Ong Vallibhakara
- Faculty of Medicine, Bangkokthonburi University, Bangkok 10170, Thailand.,Child Safety Promotion and Injury Prevention Research Center, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Hataikarn Nimitphong
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Pezzaioli LC, Porcelli T, Delbarba A, Maffezzoni F, Focà E, Castelli F, Cappelli C, Ferlin A, Quiros-Roldan ME. Impact of hypogonadism on bone mineral density and vertebral fractures in HIV-infected men. J Endocrinol Invest 2022; 45:433-443. [PMID: 34460073 PMCID: PMC8783890 DOI: 10.1007/s40618-021-01665-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/20/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Hypogonadism and osteoporosis are frequently reported in HIV-infected men and, besides multifactorial pathogenesis, they might be directly linked because of testicular involvement in bone health. We evaluated the prevalence of osteoporosis and vertebral fractures (VFs) in HIV-infected men, and assessed their relationship with gonadal function. METHODS We enrolled 168 HIV-infected men (median age 53). Osteoporosis and osteopenia were defined with T-score ≤ - 2.5SD and T-score between - 1 and - 2.5SD, respectively. VFs were assessed by quantitative morphometric analysis. Total testosterone (TT), calculated free testosterone (cFT), Sex Hormone Binding Globulin (SHBG), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were obtained; overt hypogonadism was defined on symptoms and low TT or cFT, and classified into primary and secondary according to gonadotropins; compensated hypogonadism was defined as normal TT and cFT with high LH levels. RESULTS Overall, osteoporosis and osteopenia were found in 87.5% of patients, and VFs were detected in 25% of them; hypogonadism was identified in 26.2% of cases. Osteoporotic patients had higher SHBG vs those with normal bone mineral density (BMD). Fractured patients were more frequently hypogonadal and with higher SHBG. SHBG showed negative correlation with both spine and femoral BMD, and positive correlation with VFs. In multivariate models, FSH showed negative impact only on femoral BMD, whereas older age and higher SHBG predicted VFs. CONCLUSION We found a high burden of bone disease and hypogonadism in HIV-infected men, and we showed that the impact of gonadal function on bone health is more evident on VFs than on BMD.
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Affiliation(s)
- L C Pezzaioli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - T Porcelli
- Endocrinology, Montichiari Hospital, ASST Spedali Civili Brescia, Montichiari (Brescia), Italy
| | - A Delbarba
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - F Maffezzoni
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - E Focà
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - F Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - C Cappelli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy
| | - A Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Viale Europa 11, 25123, Brescia, Italy.
| | - M E Quiros-Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
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Boschitsch E, Naegele O, Klinger A, Brix-Samoylenko H. Long-term persistence with denosumab: real-world data from the Austrian Osteoporosis Clinic (AOC). A retrospective data analysis. Osteoporos Int 2022; 33:263-272. [PMID: 34432114 DOI: 10.1007/s00198-021-06102-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
UNLABELLED In short-term studies, persistence with denosumab has been higher than with other osteoporosis drugs. This study shows that persistence can be maintained in the long-term and is associated with efficacy and safety parameters. PURPOSE To assess long-term persistence with denosumab in postmenopausal women with osteoporosis. Secondary purposes were the evaluation of changes in efficacy and tolerance/safety parameters over time. METHODS Persistence was determined by number and rate of patients receiving denosumab on time in 6-month intervals (+ / - 8 weeks). The total population was stratified by internal patients (injections and monitoring at the Austrian Osteoporosis Clinic [AOC], 74%) and external patients (injections at the practitioner's office with occasional monitoring at the AOC, 26%). In internal patients, efficacy parameters including bone mineral density (BMD) and the bone marker CTX were assessed at fixed time points and tolerance/safety parameters including side effects (SEs), adverse events (AEs), and serious AEs (SAEs) evaluated. RESULTS Of 851 patients, 71% (73% internal and 64% external) were persistent at 7.5 years of follow-up. The mean rate of cumulative persistence in internal patients decreased from 94% at the time of the second dose to 73% at the time of the fifteenth dose. BMD increased and CTX decreased, overall and in pairwise comparisons (all p < .001). AEs and SAEs, but not SEs, were lower in persistent than non-persistent patients. CONCLUSIONS This is the first study showing that long-term (> 3 years) real-world persistence with denosumab could be maintained at a high level (> 70%) in most patients. Denosumab was well tolerated and associated with decreased CTX levels and increased BMD.
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Affiliation(s)
- Ewald Boschitsch
- Austrian Osteoporosis Clinic (AOC), Vienna, Austria.
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria.
| | - Oliver Naegele
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
| | - Anita Klinger
- Austrian Osteoporosis Clinic (AOC), Vienna, Austria
- KLIMAX Menopause and Osteoporosis Clinic, Vienna, Austria
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10
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Liu Y, Yu A, Li K, Wang L, Huang P, Geng J, Zhang Y, Duanmu YY, Blake GM, Cheng X. Differences in spine volumetric bone mineral density between grade 1 vertebral fracture and non-fractured participants in the China action on spine and hip status study. Front Endocrinol (Lausanne) 2022; 13:1013597. [PMID: 36387886 PMCID: PMC9647629 DOI: 10.3389/fendo.2022.1013597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE This study evaluated the prevalence of vertebral fractures (VF) in middle-aged and elderly Chinese men and women and explored the differences in lumbar spine volumetric bone mineral density (vBMD) derived from quantitative CT (QCT) between those with a grade 1 vertebral fracture and non-fractured individuals. MATERIALS AND METHODS 3,457 participants were enrolled in the China Action on Spine and Hip Status (CASH) study and had upper abdominal CT examinations. Vertebral fractures were identified by Genant's semi-quantitative method from lateral CT scout views or CT sagittal views. L1-3 vBMD was measured by Mindways QCT Pro v5.0 software. The characteristics of different fracture severity groups were compared using one-way ANOVA, independent-samples t-tests, and Kruskal-Wallis H-tests. RESULTS 1267 males (aged 62.77 ± 9.20 years) and 2170 females (aged 61.41 ± 9.01 years) were included in the analysis. In men, the prevalence of VF increased from 14.7% at age<50 years to 23.2% at age ≥70 years, and in women from 5.1% at age<50 years to 33.0% at age ≥70 years. Differences in mean age and vBMD were found between the different fracture grade groups. After age stratification, vBMD differences in men aged < 50 years old disappeared (p = 0.162) but remained in the older age bands. There was no significant difference in mean vBMD between those with multiple mild fractures and those with a single mild fracture. CONCLUSION In women, the prevalence of VF increased rapidly after age 50, while it grew more slowly in men. In general, with the exception of men <50 years old, participants with a grade 1 VF had lower vBMD than non-fractured individuals. The majority of women younger than 50 with a grade 1 VF had normal bone mass. We recommend that a vertebral height reduction ratio of <25% be diagnosed as a deformity rather than a fracture in people under the age of 50. The presence of multiple mild fractured vertebrae does not imply lower BMD.
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Affiliation(s)
- Yandong Liu
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Aihong Yu
- Radiology Department, Beijing Anding Hospital Capital Medical University, Beijing, China
| | - Kai Li
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ling Wang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Pengju Huang
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Jian Geng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yong Zhang
- Intervention Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yang-yang Duanmu
- South Medical Image Center, The First Affiliated Hospital of University of Science and Technology of China (USTC), Anhui, China
| | - Glen M. Blake
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Xiaoguang Cheng
- Radiology Department, Peking University Fourth School of Clinical Medicine, Beijing, China
- *Correspondence: Xiaoguang Cheng,
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11
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Geusens P, Feldman R, Oates M, Thomas T, Makras P, Jakob F, Langdahl B, Wang Z, Rojeski M, Libanati C. Romosozumab reduces incidence of new vertebral fractures across severity grades among postmenopausal women with osteoporosis. Bone 2022; 154:116209. [PMID: 34547521 DOI: 10.1016/j.bone.2021.116209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Vertebral fractures (VFs) are the most common type of osteoporotic fracture, and their prevalence and severity are key risk factors for future fragility fractures. Here, we assess the treatment effect of romosozumab on the incidence of new on-study VFs according to Genant severity grades (mild, moderate, and severe). Data are reported from two phase 3 clinical studies for patients who received romosozumab versus placebo through 12 months, followed by denosumab through 24 months (FRAME: NCT01575834), and for patients who received romosozumab through 12 months, followed by alendronate through 24 months, versus alendronate only through 24 months (ARCH: NCT01631214). The treatment effect of romosozumab is reported for all included patients, and for patients with prevalent and severe baseline VFs. The incidence of new moderate-or-severe VFs was reduced through 12 months for patients treated with romosozumab versus placebo (FRAME; 0.25% versus 1.42%, respectively; p < 0.001) or alendronate (ARCH; 2.78% versus 4.00%, respectively; p = 0.042). Furthermore, the treatment effect of romosozumab on the incidence of new VFs across moderate and severe severity grades was independent of baseline VF prevalence or severity; through 12 months, consistent reductions in new moderate-or-severe VFs were observed regardless of prevalent (FRAME; p = 0.18) or severe (ARCH; p = 0.52) VFs at baseline. Reductions in the incidence of new moderate and severe VFs were sustained through 24 months, after transition from romosozumab to denosumab or alendronate, independent of baseline VF prevalence or severity; no significant interactions were observed between the incidence of new moderate-or-severe VFs and the presence of prevalent (FRAME; p = 0.81) or severe (ARCH; p = 0.99) VFs at baseline. With increasing recommendations for initial treatment with bone-forming agents for postmenopausal women with osteoporosis, these analyses will help to inform treatment decisions for patients at very high risk of VF.
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Affiliation(s)
- Piet Geusens
- Maastricht University Medical Center, Maastricht, the Netherlands; University Hasselt, Belgium.
| | | | | | - Thierry Thomas
- Hopital Nord, CHU Saint-Etienne, Saint-Etienne and INSERM 1059, Universite de Lyon, Saint-Etienne, France
| | - Polyzois Makras
- 251 Hellenic Air Force & VA-General Hospital, Athens, Greece
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12
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Mostert JM, Romeijn SR, Dibbets-Schneider P, Rietbergen DDD, Pereira Arias-Bouda LM, Götz C, DiFranco MD, Dimai HP, Grootjans W. Inter-observer agreement of vertebral fracture assessment with dual-energy x-ray absorptiometry equipment. Arch Osteoporos 2021; 17:4. [PMID: 34893935 DOI: 10.1007/s11657-021-01046-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate the time and effort needed to perform vertebral morphometry, as well as inter-observer agreement for identification of vertebral fractures on vertebral fracture assessment (VFA) images. METHODS Ninety-six images were retrospectively selected, and three radiographers independently performed semi-automatic 6-point morphometry. Fractures were identified and graded using the Genant classification. Time needed to annotate each image was recorded, and reader fatigue was assessed using a modified Simulator Sickness Questionnaire (SSQ). Inter-observer agreement was assessed per-patient and per-vertebra for detecting fractures of all grades (grades 1-3) and for grade 2 and 3 fractures using the kappa statistic. Variability in measured vertebral height was evaluated using the intraclass correlation coefficient (ICC). RESULTS Per-patient agreement was 0.59 for grades 1-3 fracture detection, and 0.65 for grades 2-3 only. Agreement for per-vertebra fracture classification was 0.92. Vertebral height measurements had an ICC of 0.96. Time needed to annotate VFA images ranged between 91 and 540 s, with a mean annotation time of 259 s. Mean SSQ scores were significantly lower at the start of a reading session (1.29; 95% CI: 0.81-1.77) compared to the end of a session (3.25; 95% CI: 2.60-3.90; p < 0.001). CONCLUSION Agreement for detection of patients with vertebral fractures was only moderate, and vertebral morphometry requires substantial time investment. This indicates that there is a potential benefit for automating VFA, both in improving inter-observer agreement and in decreasing reading time and burden on readers.
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Affiliation(s)
- Jacob M Mostert
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Stephan R Romeijn
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Lenka M Pereira Arias-Bouda
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Radiology, Alrijne Hospital, Leiderdorp, Netherlands
| | | | | | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
| | - Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
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13
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Spiegl U, Bork H, Grüninger S, Maus U, Osterhoff G, Scheyerer MJ, Pieroh P, Schnoor J, Heyde CE, Schnake KJ. Osteoporotic Fractures of the Thoracic and Lumbar Vertebrae: Diagnosis and Conservative Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:670-677. [PMID: 34342263 PMCID: PMC8727857 DOI: 10.3238/arztebl.m2021.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/12/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have not been defined clearly or uniformly. In this article, we present the current state of the evidence on the diagnosis and conservative treatment of osteoporotic fractures of the thoracic and lumbar vertebrae. METHODS A systematic review of the literature up to May 2020 was carried out in the PubMed and Web of Science Core Collection databases. 549 articles were identified, of which 36 were suitable for inclusion in the review. Articles were sought in the areas of diagnosis, provision of physical aids, pharmacotherapy, physiotherapy, and treatments from the realm of alternative medicine. RESULTS The primary diagnostic technique was conventional x-ray in two planes (with the patient standing, if possible), which had 51.3% sensitivity and 75% specificity. If a fracture was suspected, magnetic resonance imaging (MRI) of the entire spine and regional computed tomography (CT) were carried out. The overall state of the evidence on treatment is poor; the best available evidence is for exercise therapy and physiotherapy, which are supported by three level I and four level II studies. Improvements were seen mainly in mobility and a reduced fear of falling. The use of an active orthosis can be useful as well. No evidence was found on the use of drugs or alternative medicine exclusively in the conservative treatment of osteoporotic vertebral body fractures. CONCLUSION It is reasonable to evaluate instability with imaging repeatedly, at regular intervals, over a period of six months. There is still a lack of reliable data on the optimal intensity and duration of physiotherapy, and on the use of orthoses.
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Affiliation(s)
- Ulrich Spiegl
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany; Rehabilitation Center, St. Josef-Stift Sendenhorst, Sendenhorst, Germany; Department of Orthopedic and Trauma Surgery, University Hospital of the Paracelsus Medical University (PMU), Nuremberg site, Nürnberg, Germany; Department of Orthopedic and Trauma Surgery, Special Orthopedic Surgery, Osteology (DVO, German Osteology Society), University Hospital of Düsseldorf, Düsseldorf, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany; Department of Anesthesiology and Intensive Care Medicine, Paul Gerhardt Stift Hospital, Lutherstadt Wittenberg, Germany; Interdisciplinary Center for Spine and Scoliosis therapy. Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
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14
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Dussault PM, McCarthy D, Davis SA, Thakore-James M, Lazzari AA. High prevalence of vertebral fractures in seizure patients with normal bone density receiving chronic anti-epileptic drugs. Osteoporos Int 2021; 32:2051-2059. [PMID: 33822290 DOI: 10.1007/s00198-021-05926-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
UNLABELLED People with epilepsy who take certain medications are at risk for developing osteoporosis and fractures of the vertebrae that commonly go undiagnosed. By using technology available in a bone density scan, we observed at least one fracture in many subjects with bone density in the normal and osteopenic range. PURPOSE/INTRODUCTION Chronic use of antiepileptic drugs (AEDs), both enzyme-inducing (phenytoin, phenobarbital, carbamazepine, and primidone) and non-enzyme-inducing (i.e., valproate), is recognized as a cause of secondary osteoporosis. Vertebral compression fractures (VF) are the most common type of osteoporotic fractures and may confer an increased risk of future hip, wrist, and vertebral fractures. Vertebral compression fractures in the general population are frequently asymptomatic, and under-diagnosed. The purpose of this study is to describe the prevalence of VF in a cohort of male veterans with epilepsy on chronic AEDs. METHODS The cohort for this study consisted of 146 male veterans who carried a diagnosis of epilepsy and were chronic users of AEDs known to cause osteoporosis (phenobarbital, phenytoin, carbamazepine, primidone, and valproate). Chronic AED use was defined as receiving an AED for at least 2 years. Subjects were previously seen in the osteoporosis clinic and had been evaluated by a dual-energy X-Ray absormetry (DXA) instrument including morphometric studies following a standard vertebral fracture assessment (VFA) protocol during the same DXA imaging acquisition session. RESULTS The mean age was 63 years. Low bone mineral density defined as osteoporosis or osteopenia was observed in 29% and 43% respectively. We observed at least one VF in 41 % of the subjects who had normal BMD, 54% in the osteopenic range, and 75% in the osteoporotic range. CONCLUSIONS By performing a VFA in addition to standard bone densitometric studies, we disclosed a large prevalence of compression fractures in individuals with epilepsy chronically treated with AEDs who had BMDs in the normal and osteopenic ranges. The addition of VFA or other imaging methods to evaluate VF should be included in the evaluation of bone health in individuals with epilepsy receiving AEDs since it may modify treatment recommendations to prevent future osteoporotic fractures.
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Affiliation(s)
- P M Dussault
- VA Boston Health Care System, Boston, MA, USA.
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA.
| | - D McCarthy
- VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Harvard University Medical School, Boston, MA, USA
- Neurology Services, VA Boston HCS, Epilepsy Center of Excellence, Boston, MA, USA
| | - S A Davis
- VA Boston Health Care System, Boston, MA, USA
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA
| | - M Thakore-James
- VA Boston Health Care System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Neurology Services, VA Boston HCS, Epilepsy Center of Excellence, Boston, MA, USA
| | - A A Lazzari
- VA Boston Health Care System, Boston, MA, USA
- VA Boston Health Care System, Osteoporosis Prevention and Treatment Clinic, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
- Harvard University Medical School, Boston, MA, USA
- Primary Care and Rheumatology Sections, VA Boston Health Care System, Boston, MA, USA
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15
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Chen W, Liu X, Li K, Luo Y, Bai S, Wu J, Chen W, Dong M, Guo D. A deep-learning model for identifying fresh vertebral compression fractures on digital radiography. Eur Radiol 2021; 32:1496-1505. [PMID: 34553256 DOI: 10.1007/s00330-021-08247-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To develop a deep-learning (DL) model for identifying fresh VCFs from digital radiography (DR), with magnetic resonance imaging (MRI) as the reference standard. METHODS Patients with lumbar VCFs were retrospectively enrolled from January 2011 to May 2020. All patients underwent DR and MRI scanning. VCFs were categorized as fresh or old according to MRI results, and the VCF grade and type were assessed. The raw DR data were sent to InferScholar Center for annotation. A DL-based prediction model was built, and its diagnostic performance was evaluated. The DeLong test was applied to assess differences in ROC curves between different models. RESULTS A total of 1877 VCFs in 1099 patients were included in our study and randomly divided into development (n = 824 patients) and test (n = 275 patients) datasets. The ensemble model identified fresh and old VCFs, reaching an AUC of 0.80 (95% confidence interval [CI], 0.77-0.83), an accuracy of 74% (95% CI, 72-77%), a sensitivity of 80% (95% CI, 77-83%), and a specificity of 68% (95% CI, 63-72%). Lateral (AUC, 0.83) views exhibited better performance than anteroposterior views (AUC, 0.77), and the best performance among respective subgroupings was obtained for grade 3 (AUC, 0.89) and crush-type (AUC, 0.87) subgroups. CONCLUSION The proposed DL model achieved adequate performance in identifying fresh VCFs from DR. KEY POINTS • The ensemble deep-learning model identified fresh VCFs from DR, reaching an AUC of 0.80, an accuracy of 74%, a sensitivity of 80%, and a specificity of 68% with the reference standard of MRI. • The lateral views (AUC, 0.83) exhibited better performance than anteroposterior views (AUC, 0.77). • The grade 3 (AUC, 0.89) and crush-type (AUC, 0.87) subgroups showed the best performance among their respective subgroupings.
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Affiliation(s)
- Weijuan Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Xi Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Kunhua Li
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Yin Luo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Shanwei Bai
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Jiangfen Wu
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Weidao Chen
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Mengxing Dong
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China.
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Vincze A, Gaál J, Griger Z. Bone Health in Idiopathic Inflammatory Myopathies: Diagnosis and Management. Curr Rheumatol Rep 2021; 23:55. [PMID: 34196873 PMCID: PMC8249248 DOI: 10.1007/s11926-021-01016-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW This article provides an update on the most recent advances in epidemiology, pathogenesis, diagnostic procedures, and therapeutic approaches for myositis-associated bone diseases, such as osteoporosis and bone fractures. RECENT FINDINGS In the recent years, several studies showed that osteoporosis and consequent fractures are a common and frequently underestimated complication in patients with idiopathic inflammatory myopathies (IIM). In younger patients, asymptomatic fractures might present in the early phase of the disease which could increase the risk of development of further fractures. High-risk patients could be selected with early application of combined diagnostic procedures, such as fracture risk scores with steroid dose adjustments and imaging. Recent advances might help clinicians from different fields of medicine in the early recognition and management of myositis-associated osteoporosis, which will potentially improve the quality of life of patients with IIM.
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Affiliation(s)
- Anett Vincze
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - János Gaál
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
- Department of Medicine, Kenézy Gyula University Hospital, University of Debrecen, Debrecen, Hungary
| | - Zoltán Griger
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Móricz Zsigmond út 22, Debrecen, H-4032, Hungary.
- Gyula Petrányi Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary.
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Improving osteoporotic vertebral deformity detection on chest frontal view radiograph by adjusted X-ray beam positioning. J Orthop Translat 2021; 28:169-178. [PMID: 34036040 PMCID: PMC8121774 DOI: 10.1016/j.jot.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose In clinics, chest frontal view radiograph (CFR) is often taken for patients suspected of respiratory diseases and for assessing the heart and big vessels. CFR can be utilised to opportunistically detect osteoporotic vertebral fracture (OVF). However, for standard CFR, the site of highest OVF prevalence, i.e., the thoracolumbar junction, is usually 'off-centre' to the X-ray beam focus. This study tested the hypothesis that, if a CRF is taken with approximately two vertebrae lower than the standard X-ray beam positioning, the visualization of thoraco-lumbar junction can be much improved. Materials Four hospitals (A, B, C, D) provided 101 elderly women's digital CFRs with standard filming (28, 20, 24, and 21 cases respectively). Eighty four elderly female patients were prospectively recruited from hospitals-A and B, who were consecutive patients referred for chest radiograph with indications other than spine disorders. For theses prospective CFRs, the focus of X-ray beam was adjusted from towards vertebra T6 to towards T8, and standard lateral radiographs were obtained for reference. Visibility of spine and detectability of OVF were assessed on the CFRs. OVF was diagnosed based on chest lateral radiograph (CLR) after excluding other potential causes both radiographically and clinically. Results For standardly filmed CFR, spine readability was similar among those from Hospitals-A, B, and C, while performed less well for those from Hospital-D. With the prospective cases from Hospitals-A and B, spines readable to vertebra L1 level or lower increased from 48.2% for standard filming to 80.7% for adjusted filming. Spines with 'blurry' labelling decreased from 35.7% for standard filming to 15.7% for adjusted filming. For the 84 prospective cases, 42.9% (36/84) of the patients had OVF, and 26 cases of CLR positive cases were detected as having vertebral deformity on CFR. For minimal OVF cases (<20% height loss), 38% (5/13) were detected on CFR. Among 22 cases with apparent OVF (≥20% height loss), two cases were missed on CFR. False positivity was labelled in five cases, among them four cases had 'burry' spines. Conclusion CFR can help opportunistically detect OVF, which can be further improved if X-ray beam is adjusted to towards vertebra T8 instead of towards vertebra T6. The translational potential of this article This study confirms that CFR can help detect OVF opportunistically, and the visibility of the mid/lower thoracic spine and thoracolumbar junction can be much improved after minor adjustment of X-ray beam positioning. This study also suggests high positive rate of OVF in elderly Chinese female patients indicated for chest radiograph. Radiologists should be trained and sensitized in vertebral deformity identification on CFR as the clinical management can be improved by opportunistic detection of OVF.
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Velioglu A, Kaya B, Aykent B, Ozkan B, Karapinar MS, Arikan H, Asicioglu E, Bugdaycı O, Yavuz DG, Tuglular S. Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study. PLoS One 2021; 16:e0251035. [PMID: 33930070 PMCID: PMC8087085 DOI: 10.1371/journal.pone.0251035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.
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Affiliation(s)
- Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Burcu Kaya
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Basar Aykent
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Bige Ozkan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Melis Sevil Karapinar
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Onur Bugdaycı
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Division of Endocrinology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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19
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Kolanu N, Silverstone EJ, Ho BH, Pham H, Hansen A, Pauley E, Quirk AR, Sweeney SC, Center JR, Pocock NA. Clinical Utility of Computer-Aided Diagnosis of Vertebral Fractures From Computed Tomography Images. J Bone Miner Res 2020; 35:2307-2312. [PMID: 32749735 DOI: 10.1002/jbmr.4146] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/09/2022]
Abstract
Osteoporotic vertebral compression fractures (VCFs) are a risk factor for morbidity and mortality, frequently asymptomatic and often present in computed tomography (CT) scans performed for unrelated conditions. Computer-aided diagnosis (CAD) of VCF from such images can potentially improve identification and treatment of osteoporosis. This single-blinded, single tertiary center study compared a CAD (Zebra Medical Vision®) to an adjudicated imaging specialist reevaluation using a retrospective consecutive sample of abdominal and thoracic CT scans (n = 2357) performed as part of routine care. Subjects over 50 years between January 1, 2019 and May 12, 2019 were included. Duplicates and unanalyzable scans were excluded resulting in a total of 1696 CT scans. The sensitivity, specificity, and accuracy were calculated for all VCF and for Genant grades 2 or 3 (ie, height loss of >25%) using imaging specialist as the gold standard. Prestudy VCF reporting by hospital-rostered radiologist was used to calculate the number of scans needed to screen (NNS) to detect one additional VCF using CAD. Prevalence of any VCF was 24% (406/1696) and of Genant 2/3 VCF was 18% (280/1570). The sensitivity and specificity were 54% and 92%, for all fractures, respectively, and 65% and 92% for Genant 2/3 fractures, respectively. Accuracy for any VCF, and for detection of Genant 2/3 VCF, was 83% and 88%, respectively. Of 221 CAD-detected VCFs, 133 (60.2%) were reported prestudy resulting in 88 additional fractures (72 Genant 2/3) being identified by CAD. NNS to detect one additional VCF was 19 scans for all fractures and 23 for Genant 2/3 fractures. Thus, the CAD tested in this study had a high specificity with moderate sensitivity to detect incidental vertebral fractures in CT scans performed for routine care. A low NNS suggests it is an efficient tool to assist radiologists and clinicians to improve detection and reporting of vertebral fractures. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nithin Kolanu
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Elizabeth J Silverstone
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Bao H Ho
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Hiep Pham
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Ash Hansen
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Emma Pauley
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Anna R Quirk
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Sarah C Sweeney
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Jacqueline R Center
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas A Pocock
- Endocrinology/Radiology and Nuclear Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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20
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Wáng YXJ, Lentle BC. Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between the sexes. Quant Imaging Med Surg 2020; 10:1863-1876. [PMID: 32879863 PMCID: PMC7417751 DOI: 10.21037/qims-2020-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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21
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Wáng YXJ, Liu WH, Diacinti D, Yang DW, Iannacone A, Wang XR, Kripa E, Che-Nordin N, Diacinti D. Diagnosis and grading of radiographic osteoporotic vertebral deformity by general radiologists after a brief self-learning period. J Thorac Dis 2020; 12:4702-4710. [PMID: 33145043 PMCID: PMC7578449 DOI: 10.21037/jtd-20-2379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The expanded semi-quantitative (eSQ) osteoporotic vertebral deformity (OVD) classification has minimal, mild, moderate, moderately-severe, severe, and collapsed grades with <20%, 20–25%, >25%–1/3, >1/3–40%, >40%–2/3, >2/3 vertebral height loss respectively. This study evaluates the performance of using this grading criterion by radiology readers who did not have former training in OVD assessment. Methods Spine radiographs of 44 elderly women with 278 normal appearing vertebrae and 65 OVDs were selected, with two senior readers agreed the reference reading. Three readers from Italy and three readers from China were invited to evaluate these radiographs after reading five reference articles including one detailing eSQ criteria with illustrative examples. Before the second round of reading, the readers were asked to read an additional explanatory document. For the readers in Italy an additional on-line demonstration was given on how to measure vertebral height loss in another five cases of OVD. Two Chinese readers had a third round of reading after a 90 minutes’ on-line lecture. Results The final absolute agreement rate with the reference reading (i.e., exactly the same grading as the reference) ranged between 46.2% to 68.2% for the six readers, and the final relative agreement (with one eSQ grade difference allowed) ranged between 78.5% to 92.5%. The >1 grade disagreement rate was all below 11%, and mostly below 7%. The missed OVD were mostly minimal grade. The rate for missing a ≥ mild OVD was <4.5%, and false positive rate was generally <1.4% among the final reading. If the minimal grade was removed and the remaining gradings were converted to Genant’s semi-quantitative (GSQ) grading, the mean kappa values against the reference reading for SQ grades-1,2,3 were 0.813, 0.814, and 0.916 respectively. Conclusions This study demonstrates good performance of the six learner readers for assessing radiographic after a brief self-learning period.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Wei-Hong Liu
- Department of Radiology, General Hospital of China Resources & Wuhan Iron and Steel Corporation, Wuhan, China
| | - Davide Diacinti
- Department of Oral and MaxilloFacial Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy.,Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Da-Wei Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Antonio Iannacone
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Endi Kripa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
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22
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Mazziotti G, Rodari M, Gelardi F, Tosi G, Zucali PA, Pepe G, Chiti A. Morphometric vertebral fractures in patients with castration-resistant prostate cancer undergoing treatment with radium-223: a longitudinal study in the real-life clinical practice. Endocrine 2020; 69:204-211. [PMID: 32239451 DOI: 10.1007/s12020-020-02277-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Radium-223 was associated with high incidence of non-vertebral fractures in patients with castration-resistant prostate cancer (CRPC). However, it is still unclear whether radium-223 may induce skeletal fragility regardless of other therapies for CRPC. We aimed at evaluating the prevalence, incidence, and determinants of vertebral fractures (VFs), i.e., the most frequent complication of skeletal fragility, in CRCP patients undergoing radium-223 therapy in the real-life clinical practice. METHODS We retrospectively reviewed 49 CRPC patients with symptomatic bone metastases treated with radium-223. Patients received median number of four radium-223 doses (range: 2-6) and were followed-up for a median period of 11 months (range: 6-44). VFs were assessed by a quantitative morphometry using lateral images of spine 11C-Choline PET/CT, excluding from the analysis the vertebral bodies affected by bone metastases. RESULTS Before radium-223 administration, 24 patients (49%) had VFs significantly associated with duration of androgen deprivation therapy (ADT; odds ratio 1.29) and previous abiraterone therapy (odds ratio 3.80). During radium-223 therapy, incident VFs occurred in 25% of patients, in relationship with prevalent VFs (hazard ratio 6.89) and change in serum total alkaline phosphatase values (hazard ratio 0.97), whereas the correlations with ADT and abiraterone therapy were lost. Noteworthy, the risk of VFs did not correlate with the therapeutic end points of radium-223. CONCLUSIONS This study provides a first evidence that in real-life clinical practice, radium-223 therapy may induce skeletal fragility with high risk of VFs, likely by inhibition of bone formation and independently of ADT and abiraterone therapy.
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Affiliation(s)
- Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Marcello Rodari
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Fabrizia Gelardi
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanni Tosi
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Paolo A Zucali
- Department of Oncology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanna Pepe
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
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23
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Jales Neto LH, Wicik Z, Torres GHF, Takayama L, Caparbo VF, Lopes NHM, Pereira AC, Pereira RMR. Overexpression of SNTG2, TRAF3IP2, and ITGA6 transcripts is associated with osteoporotic vertebral fracture in elderly women from community. Mol Genet Genomic Med 2020; 8:e1391. [PMID: 32602654 PMCID: PMC7507059 DOI: 10.1002/mgg3.1391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
Background Vertebral fractures (VFs) are the most common clinical manifestation of osteoporosis associated with high morbimortality. A personal/familiar history of fractures increases the risk of fractures. The purpose of this study is to identify possible molecular markers associated with osteoporotic VFs in elderly women from community. Methods Transcriptomic analysis using Affymetrix HTA2 microarray was performed using whole blood samples of 240 subjects from a population‐based survey (Sao Paulo Ageing & Health [SPAH] study). Only elderly women with osteoporosis diagnosis by densitometry were analyzed, and divided in two groups: VF: women with osteoporosis and VFs versus no vertebral fracture (NVF): women with osteoporosis and NVFs. They were matched for age, chronic disease, medication use, and bone mineral density (BMD). The logistic regression model adjusted for age was applied for transcriptome data analysis. SYBR green‐based quantitative polymerase chain reaction (qPCR) was used to validate the most significant expression changes obtained in the microarray experiment. Results Microarray analysis identified 142 differentially expressed genes (DEGs, p < .01), 57 upregulated and 85 downregulated, compared VF versus NVF groups. The DEG with the greatest expression difference was the Gamma2‐Syntrophin (SNTG2) (β = 31.88, p = .005). Validation by qPCR confirmed increased expression in VF group of Syntrophin (SNTG2, fold change = 2.79, p = .009), TRAF3 Interacting Protein2 (TRAF3IP2, fold change = 2.79, p = .020), and Integrin Subunit Alpha 6 (ITGA6, fold change = 2.86, p = .038). Conclusion Our data identified and validated the association of SNTG2 (608715), TRAF3IP2 (607043), and ITGA6 (147556) with osteoporotic VF in elderly women, independently of BMD. These results suggest that these transcripts have potential clinical significance and may help to explain the molecular mechanisms and biological functions of vertebral fracture.
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Affiliation(s)
- Levi H Jales Neto
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Zofia Wicik
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Georgea H F Torres
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valéria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Neuza H M Lopes
- Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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24
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Wáng YXJ, Du MM, Che-Nordin N, Ye PP, Qiu SW, Griffith JF, Yan ZH. Recognizing osteoporotic vertebral deformity on frontal view radiograph: a cohort analysis and a pictorial review. Arch Osteoporos 2020; 15:41. [PMID: 32144508 DOI: 10.1007/s11657-020-00716-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/10/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE Opportunities exist to detect osteoporotic vertebral deformities (VDs) on frontal radiograph (FR) indicated for lung or abdominal diseases, while literature have been mostly based on lateral radiograph (LR). This study analyzed the detectability of moderate and severe grades VD on FR. METHODS There were 105 female cases (mean 72 years, range 55~93 year), who were referred for digital spine FR and LR with back and/or leg pain. The LR and FR were read, osteoporotic VDs with < 20%, 20-25%, 25-40%, and > 40% vertebral body height loss were recorded as minimal, mild, moderate, and severe grades, respectively. After a 10-month interval, only FRs were read again, and each vertebra was classified as (1) no notable VD, (2) with notable VD, and (3) ambiguous. The first reading was the reference, while the second reading was allowed to miss minimal/mild VCD and endplate/cortex fracture. RESULTS Counting by subjects, for 98 cases, the two reading sessions had agreement, including 43 "true negative" cases and 55 true positive cases. There were two false positive cases, and five ambiguous cases. In total, 1286 vertebra were assessed, FR reading had 1126 vertebrae "true negative," 130 vertebrae true positive, one vertebra false negative, 3 vertebrae false positive, and 26 ambiguous vertebrae (65.4% being true negative and 34.6% being true positive). Most of the disagreements were associated with kyphosis or poor X-ray projection. Nineteen illustrative cases are presented graphically. CONCLUSION Moderate and severe grades of VD are identifiable on FR as long as the involved vertebrae are clearly filmed.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | - Mei-Mei Du
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Pei-Pei Ye
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Shi-Wen Qiu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Zhi-Han Yan
- Department of Radiology, Wenzhou Medical University, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou, Zhejiang Province, China.
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25
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Bouvard B, Pascaretti-Grizon F, Legrand E, Lavigne C, Audran M, Chappard D. Bone lesions in systemic mastocytosis: Bone histomorphometry and histopathological mechanisms. Morphologie 2020; 104:97-108. [PMID: 32127247 DOI: 10.1016/j.morpho.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/06/2023]
Abstract
Osteoporosis is considered the most frequent skeletal manifestation of systemic mastocytosis (SM). We performed a retrospective analysis of sixty patients (37 males and 23 females) who underwent a bone biopsy in the assessment of SM or in the assessment of unexplained bone fragility. Thirty-three had simultaneously a bone marrow biopsy with a Jamshidi's needle; this sample was used for immunohistochemical analysis (tryptase, c-KIT. CD20, VCAM-1). Bone biopsy was realized in 42 cases in the assessment of SM to provide histologic proof of the disease and in 18 cases in the assessment of unexplained bone fragility and surprisingly revealed a SM. An increased bone turnover was observed in patients with SM with elevated eroded surfaces, osteoclast number and bone formation rate. In addition to nodules of mast cells (MC), a high number of MC was directly apposed on the trabeculae, affixed on the osteoblasts or the lining cells. The VCAM-1 adhesion protein recognizing α4β7 and α4β1 integrins may be a candidate to explain this particular adherence. One third of the bone marrow biopsies did not exhibit MC nodules or MC infiltration and led to a false negative diagnosis for SM. SM can be discovered in the assessment of fracture or osteoporosis. Transiliac bone biopsy allows for the diagnosis of the disease more accurately than bone marrow biopsy; it also provides a histomorphometric analysis of bone remodeling.
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Affiliation(s)
- B Bouvard
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - F Pascaretti-Grizon
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France
| | - E Legrand
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - C Lavigne
- Department of internal medicine, CHU d'Angers, 49933 Angers cedex, France
| | - M Audran
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France; Department of rheumatology, CHU d'Angers, 49933 Angers cedex, France
| | - D Chappard
- Groupe études remodelage osseux et biomatériaux (GEROM), EA-4658, SFR-4208, IRIS-Institut de Biologie en Santé (IBS), université d'Angers, CHU d'Angers, 49933 Angers, France.
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26
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Wáng YXJ, Diacinti D, Yu W, Cheng XG, Nogueira-Barbosa MH, Che-Nordin N, Guglielmi G, Ruiz Santiago F. Semi-quantitative grading and extended semi-quantitative grading for osteoporotic vertebral deformity: a radiographic image database for education and calibration. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:398. [PMID: 32355842 PMCID: PMC7186643 DOI: 10.21037/atm.2020.02.23] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Genant’s semi-quantitative (GSQ) criteria is currently the most used approach in epidemiology studies and clinical trials for osteoporotic vertebral deformity (OVD) evaluation with radiograph. The qualitative diagnosis with radiological knowledge helps to minimize false positive readings. However, unless there is a face-to-face training with experienced readers, it can be difficult to apply GSQ criteria by only reading the text description of Genant et al. (in 1993), even for a musculoskeletal radiologist. We propose an expanded semi-quantitative (eSQ) OVD classification with the following features: (I) GSQ grade-0.5 is noted as minimal grade (eSQ grade-1) for OVDs with height loss <20%; (II) GSQ mild grade (grade-1) is the same as eSQ mild grade (grade-2); (III) GSQ moderate grade (grade-2) is subdivided into eSQ grade-3 (moderate, >25%–1/3 height loss) and eSQ grade-4 (moderately-severe, >1/3–40% height loss); (IV) GSQ severe grade is subdivided into eSQ grade-5 (severe, >40%–2/3 height loss) and eSQ grade-6 (collapsed, with >2/3 height loss). We advocate to estimate vertebral height loss with adjacent vertebral heights as the reference (rather than using individual vertebra’s posterior height as the reference). This article presents radiographs of 36 cases with OVD, together with gradings using GSQ criteria and eSQ criteria. The examples in this article can serve as teaching material or calibration database for readers who will use GSQ criteria or eSQ criteria. Our approach for quantitative measurement is explained graphically.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100005, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | | | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Corrigendum to how to define an osteoporotic vertebral fracture. Quant Imaging Med Surg 2019; 9:1922-1931. [PMID: 31867245 DOI: 10.21037/qims.2019.11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
[This corrects the article DOI: 10.21037/qims.2019.09.10.].
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Wáng YXJ, Wang XR, Che-Nordin N, Xu FR, Huang QL. On the possibility of over-diagnosis of osteoporotic vertebral fracture at mid-thoracic level. J Thorac Dis 2019; 11:5708-5711. [PMID: 32030308 DOI: 10.21037/jtd.2019.11.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiao-Rong Wang
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Fei-Rong Xu
- Department of Radiology, Ningbo Women and Children's Hospital, Ningbo 315000, China
| | - Qiu-Li Huang
- Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
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Wáng YXJ, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY. Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 2019; 30:2505-2514. [PMID: 31478068 DOI: 10.1007/s00198-019-05136-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED MrOS (Hong Kong)'s year-4 follow-up shows, for subjects at baseline without vertebral deformity (VD) and endplate or/and cortex fracture (ECF), the VD progression/new VD rate during follow-up in males was half of our paired MsOS (Hong Kong) study's results. For those with VD or ECF, the VD progression/new VD was less than one sixth of females' rate. INTRODUCTION This study documents MrOS (Hong Kong)'s year-4 follow-up, and the results are compared with the MsOS (Hong Kong) study. Of elderly females with Genant's grade-0, -1, -2, and -3 VD, at year-4 follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or incident VD, respectively. METHODS Spine radiographs of 1500 Chinese males with baseline (mean age 71.7 years, range 65-91 years) and year-4 follow-up were evaluated according to Genant's VD criteria and ECF (non-existent, ECF0; or existent, ECF1). Grade-2 VDs were divided into mild (VD2m, 25-34% height loss) and severe (VD2s, 34-40% height loss) subgroups. Study subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new VD incident was a change from grade-0 to grade-2/3, or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grade-0, 2.05% (25/1219) developed at least one VD progression or/and new VD, while of subjects with Genant's grade-1, -2, and -3 VD, only 2% (3/149), 3.1% (3/96), and 2.8% (1/36) developed at least one VD progression/new VD, respectively. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. CONCLUSION VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
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Underreporting characteristics of osteoporotic vertebral fracture in back pain clinic patients of a tertiary hospital in China. J Orthop Translat 2019; 23:152-158. [PMID: 32913707 PMCID: PMC7452293 DOI: 10.1016/j.jot.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/28/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
Aim Osteoporotic vertebral compressive fractures (VCFs) are known to be commonly missed in X-rays indicated for pulmonary or heart diseases. In this study, we investigated the underreporting status of VCF in back pain clinic patients when the spine was the focus of interest. Materials and methods This is a retrospective analysis of 105 female cases (mean: 72 years, range: 55–93 years) from a tertiary hospital in China (facility A, FA). The patients with back and/or leg pain were referred for a spine X-ray. The images were retrieved and transferred to a central reading facility (facility B, FB), where images were double-read by two readers experienced in evaluating osteoporotic vertebral compressive deformity (VCD)/VCF. A qualitative VCD with <20%, 20–25%, 25–40%, and >40% vertebral body height loss was recorded as minimal, mild, moderate, and severe grades, respectively. A VCD coexisted with endplate/cortex fracture (ECF) was VCF. FB readings were considered as the reference. Results There were 34 true negative cases where FA and FB had a consensus. In 7 cases with minimal VCD, 3 cases with ECF, and 7 cases with minimal or mild VCFs, the FA readings were false negative. No standalone singular moderate or severe VCD/VCF in a patient was missed in FA's reports. In 25 FA reading positive cases with multiple VCFs, one VCF was missed in 8 cases, more than one VCF was missed in 15 cases, and one additional ECF was missed in 2 cases. In 14 cases, FA and FB had VCF number agreement, with the term ‘vertebral fracture’ was used appropriately in FA reports. In 15 cases, FA and FB had agreement in VCF number; however, the appropriate term ‘vertebral fracture’ was not used in FA reports; instead the terms of ‘compressive change’ or ‘wedging change’ were used. In most VCFs, severity grading was not given in FA. In 13 VCFs where grading was reported, all were marked as ‘mild’, including seven mild VCFs, five moderate VCFs, and even one severe VCF. Conclusion Among the patients with VCD/VCF, the false negative rate among was 23.9% (17/71), but the missed cases were all minimal or mild grades. One or more VCFs were missed in 32.4% (23/71) of the cases with multiple VCFs. Appropriate severity grading was not reported for most cases. The translational potential of this article The underreporting rate of osteoporotic vertebral compressive fracture in back pain clinic patients in a typical tertiary hospital setting in China compared favorably with literature reports. However, there is a general lack of awareness of vertebral endplate/cortex fracture sign and vertebral fracture severity grading, while minimal and mild VCD with endplate/cortex fracture may have clinical significance. Moreover, after one VCF is spotted in a patient, it is highly advisable to carefully check the whole spine so that multiple VCFs will not be missed.
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Abstract
A vertebral deformity (VD) is not always a vertebral fracture (VF). Because of lack of a completely satisfactory "gold standard", there is no consensus on the exact definition of a VF. Therefore, it may sometimes be difficult, especially in mild cases, to discriminate the prevalent VF from a non-fracture deformity or short vertebral height (SVH). A combined standardized approach based on qualitative and semiquantitative (SQ) vertebral assessment may be the most option to correctly identify a VD as a VF. However this visual approach for VF identification is subjective, therefore it is mandatory an adequate training and experience of radiologist to reach a good sensitivity and specificity. Vertebral morphometry, objective and reproducible method, could be used only to evaluate the severity of VFs but requires the availability of reference values of vertebral height ratios. There is actually an evidentiary basis for suggesting that a qualitative approach by expert radiologists to morphological vertebral assessment, combined SQ and morphometric methods seem to be the preferred option for the correct diagnosis of VF as endplate or/and cortex fracture (ECF) or severe vertebral height loss.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, University Sapienza, Rome, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Deng M, Zeng XJ, He LC, Leung JCS, Kwok AWL, Griffith JF, Kwok T, Leung PC, Wáng YXJ. Osteoporotic Vertebral Fracture Prevalence in Elderly Chinese Men and Women: A Comparison of Endplate/Cortex Fracture-Based and Morphometrical Deformity-Based Methods. J Clin Densitom 2019; 22:409-419. [PMID: 29307693 DOI: 10.1016/j.jocd.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate endplate/cortex fracture (ECF)-based method for detecting osteoporotic vertebral fracture (VF) in elderly Chinese population (age ≥ 65 years). The radiographs of 1954 elderly Chinese men (mean: 72.3 years) and 1953 elderly Chinese women (mean: 72.5 years) were evaluated according to Genant's morphometrical vertebral deformity (VD) severity criteria, as well as identified VF according to ECF without necessary requirement of VD. According to ECF, grade-1, -2, and -3 VF prevalence was 1.89%, 1.74%, and 2.25% in men, and 3.33%, 3.07%, and 5.89% in women, respectively. In men and women, 15.7% (35 of 223) and 34.5% (48 of 139) of vertebrae with VD grade-1 deformity were ECF(+, with fracture), respectively. In men and women, 89.7% (35 of 39) and 66.7% (48 of 72) of vertebrae with ECF grade-1 fracture had VD grade-1 deformity. For grade-1 change, ECF(+) subjects tended to have a lower BMD than the VD(+) subjects. In subjects with VD grade-2 deformity, those who were also EC (+) tended to have a lower BMD than those were ECF(-). In all grades, VD(-) and ECF(-) subjects tended to have highest BMD, whereas VD(+) and ECF(+) subjects tended to have lowest BMD. ECF may be more specific for assessing mild VF than the criteria based on vertebral deformity.
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Affiliation(s)
- Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Xian Jun Zeng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lai-Chang He
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Anthony W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Timothy Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Lajlev SE, Rejnmark L, Harsløf T. T-score differences and nonprogression in lumbar vertebrae as predictors of vertebral fractures. Clin Endocrinol (Oxf) 2019; 91:58-62. [PMID: 30973641 DOI: 10.1111/cen.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/07/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE In case of a vertebral fracture, the area of the vertebrae decreases with a concomitant increase in BMD, as assessed by a DXA scanning. Furthermore, a vertebral fracture may disrupt the normal increase in vertebral body area from L1 to L4 (nonprogression). We aimed to examine associations between T-score difference and nonprogression of vertebral area and vertebral fractures. METHODS We identified 100 patients with 1 or more fractures in L1-L4 and 106 patients without fractures. All patients had undergone a DXA scan and a lumbar spine X-ray. In fracture patients, we recorded T-score difference between the fractured vertebra and the adjacent vertebra, and whether the fractured vertebra was smaller than the one above (nonprogression). In nonfracture patients, the greatest positive T-score difference was recorded, and nonprogression was present if vertebral area did not increase successively from L1 to L4. RESULTS With a T-score difference ≥1 SD odds ratio for fracture was 1.30 (0.74-2.29). Sensitivity and specificity were 0.40 and 0.66, respectively. With T-score difference ≥1.5 SD, odds ratio for fracture was 2.26 (1.08-4.73). Sensitivity and specificity were 0.24 and 0.88, respectively. Nonprogression was very common in the no-fracture group (38%), while only 23% of X-ray verified fractures had nonprogression. CONCLUSION A randomly found T-score difference ≥1.5 SD between adjacent vertebrae on a DXA scan is associated with a small increased risk of compression fracture. Nonprogression is very common in patients without fractures.
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Affiliation(s)
- Siv E Lajlev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Torben Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
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Amin N, Kinsey S, Feltbower R, Kraft J, Whitehead E, Velangi M, James B. British OsteoNEcrosis Study (BONES) protocol: a prospective cohort study to examine the natural history of osteonecrosis in older children, teenagers and young adults with acute lymphoblastic leukaemia and lymphoblastic lymphoma. BMJ Open 2019; 9:e027204. [PMID: 31122988 PMCID: PMC6538027 DOI: 10.1136/bmjopen-2018-027204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Osteonecrosis is a well-recognised treatment-related morbidity risk in patients diagnosed with acute lymphoblastic leukaemia (ALL) and lymphoblastic lymphoma (LBL), with a high rate of affected patients requiring surgical intervention. Patients may have asymptomatic changes on imaging studies that spontaneously regress, and little is known about the natural history of osteonecrotic changes seen. The main aim of the British OsteoNEcrosis Study (BONES) is to determine the incidence of symptomatic and asymptomatic osteonecrosis in the lower extremities of survivors of ALL or LBL diagnosed aged 10-24 years in the UK at different time points in their treatment. This study also aims to identify risk factors for progression and the development of symptomatic osteonecrosis in this population, as well as specific radiological features that predict for progression or regression in those with asymptomatic osteonecrosis METHODS AND ANALYSIS: BONES is a prospective, longitudinal cohort study based at principal treatment centres around the UK. Participants are patients aged 10-24 years diagnosed with ALL or LBL under standard criteria. Assessment for osteonecrosis will be within 4 weeks of diagnosis, at the end of delayed intensification and 1, 2 and 3 years after the start of maintenance therapy. Assessment will consist of MRI scans of the lower limbs and physiotherapy assessment. Clinical and biochemical data will be collected at each of the time points. Bone mineral density data and vertebral fracture assessment using dual-energy X-ray absorptiometry will be collected at diagnosis and annually for 3 years after diagnosis of malignancy. ETHICS AND DISSEMINATION Ethical approval has been obtained through the Yorkshire and Humber Sheffield Research Ethics Committee (reference number: 16/YH/0206). Study results will be published on the study website, in peer-reviewed journals and presented at relevant conferences and via social media. TRIAL REGISTRATION NUMBER NCT02598401; Pre-results.
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Affiliation(s)
- Nadia Amin
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sally Kinsey
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
| | | | - Jeannette Kraft
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | - Mark Velangi
- Department of Paediatric Haematology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Beki James
- Department of Paediatric Haematology, Leeds Children’s Hospital, Leeds, UK
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Quantitative analysis of modified functional muscle-bone unit and back muscle density in patients with lumbar vertebral fracture in Chinese elderly men: a case-control study. Aging Clin Exp Res 2019; 31:637-644. [PMID: 30128661 DOI: 10.1007/s40520-018-1024-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/10/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Bone mineral density (BMD) is associated with muscle mass and quality, but little research has been done on functional muscle-bone unit and back muscle density in patients with lumbar vertebral fracture. This study used the "modified functional muscle-bone unit" concept and measured back muscle density to investigate muscle-bone interaction difference between the fracture and control group. METHODS This was a case-control study. A total of 52 elderly male patients (mean age 75 years) with lumbar vertebral fracture (cases) and 52 control healthy subjects were enrolled. Cross-sectional area (CSA) and density of paravertebral muscle were measured in quantitative computed tomography (QCT) images to represent the muscle mass, while the bone mineral density measured by QCT was used to represent the bone mass. The modified functional muscle-bone unit was calculated as the value of volumetric BMD divided by muscle area. RESULTS People with vertebral fractures reported significantly lower values in the cross-sectional area and density of paravertebral muscle compared to control group. In the multivariate analysis, BMD (odds ratio, OR = 0.929; 95% confidence intervals, CIs 0.888-0.971), erector muscle density (OR = 0.698; 95% CI 0.547-0.892), and summated muscle CSA (OR = 0.963; 95% CI 0.93-0.991) were independent protective factors for the presence of a fracture. BMD resulted significantly and moderately associated with cross-sectional area and density of paravertebral muscle (r = 0.329-0.396). CONCLUSIONS There were significant differences between the modified functional muscle-bone unit and back muscle density between the fracture group and control group in elderly men. Lower BMD, loss of muscle mass and density are associated with increased presence of the lumbar vertebral fracture.
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Wáng YXJ, Che-Nordin N, Deng M, Leung JCS, Kwok AWL, He LC, Griffith JF, Kwok TCY, Leung PC. Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS (Hong Kong) study results. Osteoporos Int 2019; 30:897-905. [PMID: 30666373 DOI: 10.1007/s00198-019-04856-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Compared with vertebrae without deformity, vertebrae with mild/moderate deformity have a higher risk of endplate or/and cortex fracture (ecf). Compared with subjects without ecf, subjects with ecf are at a higher risk of short-term (4-year period) deformity progression and new incident deformity. INTRODUCTION The progression and incidence of osteoporotic vertebral deformity/fracture (VD/VF) in elderly Chinese females remain not well documented. METHODS Spine radiographs of 1533 Chinese females with baseline and year-4 follow-up (mean age 75.7 years) were evaluated according to Genant's VD criteria and endplate/cortex fracture (non-existent: ecf0 or existent: ecf1). Grade-2 VDs were divided into mild (vd2m, 25-34% height loss) and severe (vd2s, 34-40% height loss) subgroups. According to their VD/VF, subjects were graded into seven categories: vd0/ecf0, vd1/ecf0, vd2m/ecf0, vd1/ecf1, vd2m/ecf1, vd2s/ecf1, and vd3/ecf1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade-0 to grade-2/3 or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grades 0, - 1, - 2, and - 3 VD, at follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or new incident VD respectively. Among the three ecf0 groups, there was no difference in VD progression or new VD; while there was a significant difference in new ecf incidence, with vd0/ecf0 being lowest and vd2m/ecf0 being highest. Vd1/ecf0 and vd2m/ecf0 vertebrae had a higher risk of turning to ecf1 than vd0/ecf0 vertebrae. If vd1/ecf0 and vd2m/ecf0 subjects were combined together (range 20-34% height loss) to compare with vd1/ecf1 and vd2m/ecf1 subjects, the latter had significantly higher VD progression and new VD rates. CONCLUSION Vertebrae with grade-1/2 VDs had a higher risk of developing ECF. Subjects with pre-existing ECFs had a higher risk of worsening or new vertebral deformities.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Wáng YXJ. A modified semi-quantitative (mSQ) grading scheme for osteoporotic vertebral fracture in elderly women. Quant Imaging Med Surg 2019; 9:146-150. [PMID: 30976538 DOI: 10.21037/qims.2019.02.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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Nuti R, Brandi ML, Checchia G, Di Munno O, Dominguez L, Falaschi P, Fiore CE, Iolascon G, Maggi S, Michieli R, Migliaccio S, Minisola S, Rossini M, Sessa G, Tarantino U, Toselli A, Isaia GC. Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med 2019; 14:85-102. [PMID: 29948835 PMCID: PMC6329834 DOI: 10.1007/s11739-018-1874-2] [Citation(s) in RCA: 167] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/06/2018] [Indexed: 12/16/2022]
Abstract
The purpose of this document, a result of the harmonisation and revision of Guidelines published separately by the SIMFER, SIOMMMS/SIR, and SIOT associations, is to provide practical indications based on specific levels of evidence and various grades of recommendations, drawn from available literature, for the management of osteoporosis and for the diagnosis, prevention, and treatment of fragility fractures. These indications were discussed and formally approved by the delegates of the Italian Scientific Associations involved in the project (SIE, SIGG, SIMFER, SIMG, SIMI, SIOMMMS, SIR, and SIOT).
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Affiliation(s)
- Ranuccio Nuti
- SIMI, (Italian Society of Internal Medicine), Rome, Italy
| | | | - Giovanni Checchia
- SIMFER (Italian Society of Physical and Rehabilitation Medicine), Rome, Italy
| | | | - Ligia Dominguez
- SIOMMMS (Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases), Rome, Italy
| | - Paolo Falaschi
- SIGG (Italian Society of Gerontology and Geriatrics), Firenze, Italy
| | | | - Giovanni Iolascon
- SIMFER (Italian Society of Physical and Rehabilitation Medicine), Rome, Italy
| | - Stefania Maggi
- SIGG (Italian Society of Gerontology and Geriatrics), Firenze, Italy
| | - Raffaella Michieli
- SIMG (Italian Society of General Medicine and of Primary Care), Firenze, Italy
| | | | | | | | | | | | - Antonella Toselli
- SIMG (Italian Society of General Medicine and of Primary Care), Firenze, Italy
| | - Giovanni Carlo Isaia
- SIOMMMS (Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases), Rome, Italy
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Sahuguet J, Fechtenbaum J, Molto A, Etcheto A, López-Medina C, Richette P, Dougados M, Roux C, Briot K. Low incidence of vertebral fractures in early spondyloarthritis: 5-year prospective data of the DESIR cohort. Ann Rheum Dis 2018; 78:60-65. [PMID: 30389692 DOI: 10.1136/annrheumdis-2018-213922] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/26/2018] [Accepted: 10/16/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES An increased risk of vertebral fractures (VFs) has been reported in spondyloarthritis (SpA). Our hypothesis is that the prevalence of VFs is lower than reported in previous studies, especially in early SpA. This study aimed at assessing the incidence of radiographical VFs over 5 years in early axial SpA. METHODS The DESIR (DEvenir des Spondylarthropathies Indifférenciées Récentes) cohort, which included patients with inflammatory back pain highly suggestive of axial SpA, is the basis of this study. All radiographs of the DESIR cohort had been assessed at a central facility, by one investigator specialised in the field of the diagnosis of VFs according to Genant's method. We assessed the prevalence and incidence of VFs and vertebral deformities at baseline and over 5 years. RESULTS Five-year X-rays were available for 432 patients (mean age 34.3±8.7 years, 53% women). Diagnosis of VF was doubtful and needed adjudication for 19 patients (4.4%). 13 patients had prevalent VFs (3.0%) which were located at the thoracic spine (12 were grade 1). At 5 years, five patients had an incident VF (1.15%); seven vertebrae were fractured, mostly located at the thoracic spine (n=6/7), and of grade 1 (n=6/7). CONCLUSION In the DESIR cohort, a population of early SpA, we found a low prevalence and incidence of VFs (3.0% and 1.15 %), respectively. This confirms our hypothesis that the actual prevalence and incidence of VFvertebral fracture in SpA is lower than that reported in the previous studies.
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Affiliation(s)
- Julie Sahuguet
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Jacques Fechtenbaum
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Anna Molto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France
| | - Adrien Etcheto
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | | | - Pascal Richette
- Department of Rheumatology, Lariboisière Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France.,Paris Descartes University, Paris, France
| | - Christian Roux
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France.,INSERM U1153, Paris, France.,Paris Descartes University, Paris, France
| | - Karine Briot
- Department of Rheumatology, Cochin Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France .,INSERM U1153, Paris, France
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40
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Wáng YXJ, Che-Nordin N. Informed communication with study subjects of radiographically detected osteoporotic vertebral deformity. Quant Imaging Med Surg 2018; 8:876-880. [PMID: 30306065 PMCID: PMC6177369 DOI: 10.21037/qims.2018.09.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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41
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Ávila-Rubio V, García-Fontana B, Novo-Rodríguez C, Cantero-Hinojosa J, Reyes-García R, Muñoz-Torres M. Higher Levels of Serum 25-Hydroxyvitamin D Are Related to Improved Glucose Homeostasis in Women with Postmenopausal Osteoporosis. J Womens Health (Larchmt) 2018; 27:1007-1015. [PMID: 29874115 DOI: 10.1089/jwh.2017.6806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Postmenopausal osteoporosis (PMO) is associated with other comorbidities such as impaired glucose homeostasis and cardiovascular disease. Vitamin D insufficiency is highly prevalent and may be a common link between these disorders. However, the relationship between circulating 25-hydroxyvitamin D [25(OH)D] and insulin resistance in women with PMO has not been well evaluated. The aim of this study was to assess the relationship between circulating levels of 25(OH)D and parameters of glucose homeostasis in a cohort of women with PMO to establish a serum concentration threshold of 25(OH)D for improved glycemic parameters. MATERIALS AND METHODS This cross-sectional study included 40 women with PMO. We measured 25(OH)D serum levels and glucose homeostasis parameters (glucose and insulin levels, insulin sensitivity, and β-secretion index HOMA2-%S and HOMA2-%B, respectively). Anthropometric, biochemical, and clinical parameters and bone markers were also evaluated. RESULTS Circulating levels of 25(OH)D were related to glucose parameters (negatively with HOMA2-%B and insulin levels and positively with HOMA2-%S) in women with PMO, resulting in an indicator of insulin sensitivity independent of age, body mass index, percent body fat, and undercarboxylated osteocalcin. Patients with serum 25(OH)D ≥45 ng/mL showed lower HOMA2-%B values and insulinemia and greater HOMA2-%S. CONCLUSIONS Our results support the hypothesis that circulating 25(OH)D levels are related to improved glucose homeostasis in women with PMO. However, this relationship was apparent only in the presence of high circulating levels of 25(OH)D.
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Affiliation(s)
- Verónica Ávila-Rubio
- 1 Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs. GRANADA) , Granada, Spain .,2 Department of Medicine, University of Granada , Granada, Spain
| | - Beatriz García-Fontana
- 1 Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs. GRANADA) , Granada, Spain .,3 CIBERFES, Instituto de Salud Carlos III , Madrid, Spain
| | - Cristina Novo-Rodríguez
- 1 Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs. GRANADA) , Granada, Spain
| | - Jesús Cantero-Hinojosa
- 2 Department of Medicine, University of Granada , Granada, Spain .,4 Unit of Internal Medicine, Hospital Universitario San Cecilio , Granada, Spain
| | - Rebeca Reyes-García
- 5 Endocrinology and Nutrition Unit, Complejo Hospitalario Torrecardenas , Almería, Spain
| | - Manuel Muñoz-Torres
- 1 Bone Metabolic Unit, Endocrinology and Nutrition Division, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria de Granada (Ibs. GRANADA) , Granada, Spain .,2 Department of Medicine, University of Granada , Granada, Spain .,3 CIBERFES, Instituto de Salud Carlos III , Madrid, Spain
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42
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Ning L, Song LJ, Fan SW, Zhao X, Chen YL, Li ZZ, Hu ZA. Vertebral heights and ratios are not only race-specific, but also gender- and region-specific: establishment of reference values for mainland Chinese. Arch Osteoporos 2017; 12:88. [PMID: 29022168 DOI: 10.1007/s11657-017-0383-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 09/29/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study established gender-specific reference values in mainland Chinese (MC) and is important for quantitative morphometry for diagnosis and epidemiological study of osteoporotic vertebral compressive fracture. Comparisons of reference values among different racial populations are then performed to demonstrate the MC-specific characteristic. PURPOSE Osteoporotic vertebral compressive fracture (OVCF) is a common complication of osteoporosis in the elder population. Clinical diagnosis and epidemiological study of OVCF often employ quantitative morphometry, which relies heavily on the comparison of patients' vertebral parameters to existing reference values derived from the normal population. Thus, reference values are crucial in clinical diagnosis. To our knowledge, this is the first study to establish reference values of the mainland Chinese (MC) for quantitative morphometry. METHODS Vertebral heights including anterior (Ha), middle (Hm), posterior (Hp) heights, and predicted posterior height (pp) from T4 to L5 were obtained; and ratios of Ha/Hp, Hm/Hp and Hp/pp. were calculated from 585 MC (both female and male) for establishing reference values and subsequent comparisons with other studies. RESULTS Vertebral heights increased progressively from T4 to L3 but then decreased in L4 and L5. Both genders showed similar ratios of vertebral dimensions, but male vertebrae were statistically larger than those of female (P < 0.01). Vertebral size of MC population was smaller than that of US and UK population, but was surprisingly larger than that of Hong Kong Chinese, although these two are commonly considered as one race. Data from different racial populations showed similar dimensional ratios in all vertebrae. CONCLUSIONS We established gender-specific reference values for MC. Our results also indicated the necessity of establishing reference values that are not only race- and gender-specific, but also population- or region-specific for accurate quantitative morphometric assessment of OVCF.
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Affiliation(s)
- Lei Ning
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Li-Jiang Song
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Shun-Wu Fan
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Xing Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yi-Lei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhao-Zhi Li
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zi-Ang Hu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China. .,Sir Run Run Shaw Institute of Clinical Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
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Hanusch BC, Tuck SP, McNally RJQ, Wu JJ, Prediger M, Walker J, Tang J, Piec I, Fraser WD, Datta HK, Francis RM. Does regional loss of bone density explain low trauma distal forearm fractures in men (the Mr F study)? Osteoporos Int 2017; 28:2877-2886. [PMID: 28685278 DOI: 10.1007/s00198-017-4122-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/08/2017] [Indexed: 01/02/2023]
Abstract
UNLABELLED The pathogenesis of low trauma wrist fractures in men is not fully understood. This study found that these men have lower bone mineral density at the forearm itself, as well as the hip and spine, and has shown that forearm bone mineral density is the best predictor of wrist fracture. INTRODUCTION Men with distal forearm fractures have reduced bone density at the lumbar spine and hip sites, an increased risk of osteoporosis and a higher incidence of further fractures. The aim of this case-control study was to investigate whether or not there is a regional loss of bone mineral density (BMD) at the forearm between men with and without distal forearm fractures. METHODS Sixty-one men with low trauma distal forearm fracture and 59 age-matched bone healthy control subjects were recruited. All subjects underwent a DXA scan of forearm, hip and spine, biochemical investigations, health questionnaires, SF-36v2 and Fracture Risk Assessment Tool (FRAX). The non-fractured arm was investigated in subjects with fracture and both forearms in control subjects. RESULTS BMD was significantly lower at the ultradistal forearm in men with fracture compared to control subjects, in both the dominant (mean (SD) 0.386 g/cm2 (0.049) versus 0.436 g/cm2 (0.054), p < 0.001) and non-dominant arm (mean (SD) 0.387 g/cm2 (0.060) versus 0.432 g/cm2 (0.061), p = 0.001). Fracture subjects also had a significantly lower BMD at hip and spine sites compared with control subjects. Logistic regression analysis showed that the best predictor of forearm fracture was ultradistal forearm BMD (OR = 0.871 (0.805-0.943), p = 0.001), with the likelihood of fracture decreasing by 12.9% for every 0.01 g/cm2 increase in ultradistal forearm BMD. CONCLUSIONS Men with low trauma distal forearm fracture have significantly lower regional BMD at the ultradistal forearm, which contributes to an increased forearm fracture risk. They also have generalised reduction in BMD, so that low trauma forearm fractures in men should be considered as indicator fractures for osteoporosis.
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Affiliation(s)
- B C Hanusch
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - S P Tuck
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - R J Q McNally
- Institute of Health and Society, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - J J Wu
- Biophysical Sciences Institute and School of Engineering and Computing Sciences, Durham University, Lower Mountjoy, South Road, Durham, DH1 3LE, UK
| | - M Prediger
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - J Walker
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
| | - J Tang
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - I Piec
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - W D Fraser
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - H K Datta
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - R M Francis
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
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García-Carrasco M, Mendoza-Pinto C, León-Vázquez MDLL, Méndez-Martínez S, Etchegaray-Morales I, Montiel-Jarquín Á, Enriquez-Guerra MA, Muñóz-Guarneros M, Gálvez-Romero JL, Soto-Santillán P, Cervera R. Incidence of Vertebral Fractures in Women with Systemic Lupus Erythematosus After 8 Years of Follow-Up. Calcif Tissue Int 2017; 101:291-299. [PMID: 28508265 DOI: 10.1007/s00223-017-0286-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/22/2017] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate possible associations between potential risk factors and the occurrence of established vertebral fractures (VF) in Mexican patients with systemic lupus erythematosus (SLE). Consecutive patients with SLE were enrolled in a prospective, observational study from 2006 to 2015. Information on potential risk factors, including demographics, clinical data, and bone mineral density (BMD) at the lumbar spine and hip on dual-energy X-ray absorptiometry was collected at baseline and follow-up. Semiquantitative analysis was used to determine incident VF on lateral thoracic and lumbar radiographs, defined as any vertebral body graded normal at baseline and at least mildly deformed (20-25% reduction or more in any vertebral height) during follow-up. Differences in baseline characteristics were assessed in patients with and without new radiographic VF. Of 110 SLE patients included, with a median follow-up of 8 (IQR 8-9) years, 22 (20%) had radiographic VF at baseline; 35 (32%) patients had a new VF. The annual incidence rate of new morphometric VF was 3.5 (95% CI 2.4-4.91) per 100 patient/years. Most fractures were mild or moderate and biconcave shaped. Incident VF were significantly associated with baseline BMD at the total hip and longer disease duration. Cumulative glucocorticoid dose, postmenopausal status, and previous prevalent VF were not associated with VF. In this SLE cohort in daily clinical practice, new VF were frequently present in SLE patients, especially those with longer disease duration and low-hip BMD.
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Affiliation(s)
- Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico
- Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico.
- Department of Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico.
| | - María de la Luz León-Vázquez
- Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico
| | | | - Ivet Etchegaray-Morales
- Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico
| | - Álvaro Montiel-Jarquín
- Jefatura de División de Investigación en Salud, UMAE, Hospital de Traumatología, Instituto Mexicano del Seguro Social, Puebla, Puebla, Mexico
| | | | - Margarita Muñóz-Guarneros
- Secretary of Research and Postgraduate Studies, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - José Luis Gálvez-Romero
- Immunology Department, Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, Mexico
| | - Pamela Soto-Santillán
- Systemic Autoimmune Diseases Research Unit, Hospital General Regional 36-CIBIOR, Instituto Mexicano del Seguro Social, Av. 10 Poniente 2721, Amor, 72090, Puebla, Puebla, Mexico
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Catalonia, Spain
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Chang AJ, Ying Q, Chen XN, Wang WM, Chen N. Evaluation of three risk assessment tools in discriminating fracture status among Chinese patients undergoing hemodialysis. Osteoporos Int 2016; 27:3599-3606. [PMID: 27392466 DOI: 10.1007/s00198-016-3690-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED We evaluated three risk assessment tools, including bone mineral density (BMD) measurement by dual energy X-ray absorptiometry (DXA), osteoporosis self-assessment tool for Asians (OSTA), and fracture risk assessment tool (FRAX), for the prediction of fracture status among Chinese patients undergoing hemodialysis. All of the three assessment tools have a reasonable capability in discriminating fractures. INTRODUCTION Fractures are common in hemodialysis patients however insufficiently assessed. Our study aimed to assess the ability of three widely used tools [BMD, OSTA, and FRAX] to discriminate fracture status in patients with renal failure undergoing hemodialysis. METHODS We enrolled 136 hemodialysis patients in a tertiary teaching hospital setting. BMD was measured using DXA at the lumbar spine and the hip region. OSTA was calculated from weight and age. FRAX score was calculated based upon online availability. Discriminative abilities of BMD, OSTA, and FRAX in fracture status were analyzed by receiver operator characteristic (ROC) curves. RESULTS There were total 16 fractures (11.76 %) identified in 136 hemodialysis patients. BMD at any site (lumbar spine L1-L4, femoral neck, and total hip) was independently associated with fracture. Areas under the curves (AUC) of BMD (lumbar spine L1-L4, femoral neck, total hip), OSTA, FRAX1 (non-BMD model), and FRAX2 (BMD model) were 0.669 (95 % CI 0.583, 0.747), 0.708 ( 95 % CI 0.624, 0.783), 0.736 (95 % CI 0.654, 0.808), 0.686 (95 % CI 0.601, 0.763), 0.715 (95 % CI 0.631, 0.789), and 0.697 (95 % CI 0.613, 0.773), respectively. The differences of their performance were not significant. CONCLUSIONS All of the three risk assessment tools had the ability to discriminate fracture status among hemodialysis patients; FRAX BMD model did not improve the discriminative ability of BMD or FRAX non-BMD model alone.
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Affiliation(s)
- A-J Chang
- Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Q Ying
- Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Department of Nephrology, Shanghai Ruijin Hospital, No.197 Ruijin 2nd Road, Luwan District, Shanghai, China.
| | - X-N Chen
- Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - W-M Wang
- Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - N Chen
- Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Deleskog L, Laursen NØ, Nielsen BR, Schwarz P. Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis. Osteoporos Int 2016; 27:2317-2326. [PMID: 26892040 DOI: 10.1007/s00198-016-3532-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporotic patient. METHODS A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporotic patients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.
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Affiliation(s)
- L Deleskog
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - N Ø Laursen
- Department of Radiology, Frederiksberg University Hospital, Copenhagen, Denmark
| | - B R Nielsen
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark
| | - P Schwarz
- Research Centre of Ageing and Osteoporosis, Department of Endocrinology PE, Rigshospitalet, Copenhagen, Denmark.
- Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.
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Torres A, Torregrosa V, Marcen R, Campistol JM, Arias M, Hernández D, Fernández C, Esforzado N, Paschoalin R, Pérez N, García AI, Del Amo M, Pomés J, González Rinne A, Marrero D, Pérez E, Henríquez F, Díaz JM, Silva I, López V, Perello M, Ramos D, Beneyto I, Cruzado JM, Martínez Castelao A, Bravo J, Rodríguez M, Díaz C, Crespo J, Anaya F, Rodríguez ML, Cubero JJ, Pascual P, Romero R, Andrés Belmonte A, Checa MD, Jiménez C, Escuin F, Crespo M, Mir M, Gómez G, Bayes B, González MJ, Gutiérrez A, Cuberes M, Rodríguez Benoit A, García T, Llamas F, Ortega A, Conde JL, Gómez Alamillo C. Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study). Nefrologia 2016; 36:255-67. [PMID: 27133898 DOI: 10.1016/j.nefro.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/06/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established. METHOD We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally. RESULTS Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters. CONCLUSIONS Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients.
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Affiliation(s)
- Armando Torres
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain.
| | - Vicens Torregrosa
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Roberto Marcen
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal (RedInRen, RD12/0021/0020-Instituto de Salud Carlos III), Madrid, Spain
| | - Josep María Campistol
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Manuel Arias
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain
| | - Domingo Hernández
- Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain
| | - Constantino Fernández
- Servicio de Nefrología, Complexo Hospitalario Universitario Juan Canalejo, A Coruña , Spain
| | - Nuria Esforzado
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Raphael Paschoalin
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nuria Pérez
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ana Isabel García
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Montserrat Del Amo
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Jaume Pomés
- Unidad de Nefrología y Trasplante Renal, Hospital Clinic, RedInRen, RD12/0021/0028, Instituto de Salud Carlos III, Barcelona, Spain
| | - Ana González Rinne
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Domingo Marrero
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Estefanía Pérez
- Servicio de Nefrología, HospitalUniversitario de Canarias, CIBICAN, Universidad de La Laguna, RedInRen RD12/0021/0008-Instituto de Salud Carlos III, Tenerife, Spain
| | - Fernando Henríquez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Juan Manuel Díaz
- Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain
| | - Irene Silva
- Servicio de Nefrología, Fundació Puigvert I.U.N.A, Barcelona, Spain
| | - Verónica López
- Servicio de Nefrología, Hospital Regional Carlos Haya, Universidad de Málaga (IBIMA), RedInRen RD12/0021/0015-Instituto de Salud Carlos III, Málaga, Spain
| | - Manuel Perello
- Servicio de Nefrología, Hospital Vall D́Hebrón, Barcelona, Spain
| | - David Ramos
- Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Beneyto
- Servicio de Nefrología, Hospital Universitario La Fe, Valencia, Spain
| | - José María Cruzado
- Servicio de Nefrología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Juan Bravo
- Servicio de Nefrología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Minerva Rodríguez
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carmen Díaz
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Josep Crespo
- Servicio de Nefrología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Fernando Anaya
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Rodríguez
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan José Cubero
- Servicio de Nefrología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain
| | - Pilar Pascual
- Servicio de Nefrología, Hospital Clínico Universitario de Valladolid, Spain
| | - Rafael Romero
- Servicio de Nefrología, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - María Dolores Checa
- Servicio de Nefrología, Centro Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carlos Jiménez
- Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain
| | - Fernando Escuin
- Servicio de Nefrología, Hospital Universitario La Paz, Madrid, Spain
| | - Marta Crespo
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Marisa Mir
- Servicio de Nefrología, Hospital del Mar, Barcelona, Spain
| | - Gonzalo Gómez
- Servicio de Nefrología, Hospital Universitario Son Dureta, Palma de Mallorca, Spain
| | - Beatriz Bayes
- Servicio de Nefrología, Hospital Universitario Germans Trias I Pujol, Barcelona, Spain
| | - María José González
- Servicio de Nefrología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alex Gutiérrez
- Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marta Cuberes
- Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Teresa García
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Francisco Llamas
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain
| | - Agustín Ortega
- Servicio de Nefrología, Complejo Hospitalario y Universitario de Albacete, Spain
| | - José Luis Conde
- Servicio de Nefrología, Hospital Complejo Hospitario de Toledo, Spain
| | - Carlos Gómez Alamillo
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, RedInRen RD12/0021/0007-Instituto de Salud Carlos III, Santander, Spain
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Jackman TM, Hussein AI, Curtiss C, Fein PM, Camp A, De Barros L, Morgan EF. Quantitative, 3D Visualization of the Initiation and Progression of Vertebral Fractures Under Compression and Anterior Flexion. J Bone Miner Res 2016; 31:777-88. [PMID: 26590372 PMCID: PMC4964591 DOI: 10.1002/jbmr.2749] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/31/2015] [Accepted: 11/14/2015] [Indexed: 01/15/2023]
Abstract
The biomechanical mechanisms leading to vertebral fractures are not well understood. Clinical and laboratory evidence suggests that the vertebral endplate plays a key role in failure of the vertebra as a whole, but how this role differs for different types of vertebral loading is not known. Mechanical testing of human thoracic spine segments, in conjunction with time-lapsed micro-computed tomography, enabled quantitative assessment of deformations occurring throughout the entire vertebral body under axial compression combined with anterior flexion ("combined loading") and under axial compression only ("compression loading"). The resulting deformation maps indicated that endplate deflection was a principal feature of vertebral failure for both loading modes. Specifically, the onset of endplate deflection was temporally coincident with a pronounced drop in the vertebra's ability to support loads. The location of endplate deflection, and also vertebral strength, were associated with the porosity of the endplate and the microstructure of the underlying trabecular bone. However, the location of endplate deflection and the involvement of the cortex differed between the two types of loading. Under the combined loading, deflection initiated, and remained the largest, at the anterior central endplate or the anterior ring apophysis, depending in part on health of the adjacent intervertebral disc. This deflection was accompanied by outward bulging of the anterior cortex. In contrast, the location of endplate deflection was more varied in compression loading. For both loading types, the earliest progression to a mild fracture according to a quantitative morphometric criterion occurred only after much of the failure process had occurred. The outcomes of this work indicate that for two physiological loading modes, the vertebral endplate and underlying trabecular bone are critically involved in vertebral fracture. These outcomes provide a strong biomechanical rationale for clinical methods, such as algorithm-based qualitative (ABQ) assessment, that diagnose vertebral fracture on the basis of endplate depression. © 2015 American Society for Bone and Mineral Research.
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Affiliation(s)
- Timothy M Jackman
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Amira I Hussein
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Cameron Curtiss
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Paul M Fein
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Anderson Camp
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Lidia De Barros
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Elise F Morgan
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.,Department of Mechanical Engineering, Boston University, Boston, MA, USA
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Karlsson MK, Kherad M, Hasserius R, Nilsson JÅ, Redlund-Johnell I, Ohlsson C, Lorentzon M, Mellström D, Rosengren BE. Characteristics of Prevalent Vertebral Fractures Predict New Fractures in Elderly Men. J Bone Joint Surg Am 2016; 98:379-85. [PMID: 26935460 DOI: 10.2106/jbjs.15.00328] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies have shown that specific characteristics of prevalent vertebral fractures are associated with a markedly low bone mineral density. This study evaluates if these characteristics also predict subsequent fractures. METHODS MrOS (Mister Osteoporosis) Sweden is a population-based, prospective observational study that includes 3014 community-living men who are sixty-nine to eighty-one years of age. At baseline, 1453 men underwent lateral thoracic and lumbar spine radiography; radiographs of 1427 men were readable. A radiologist identified and characterized prevalent vertebral fractures. Incident fractures during the next five and ten years were objectively registered with use of radiographs. The annual fracture incidence and relative risk of sustaining new fractures were assessed for men with and without baseline prevalent vertebral fracture. Data are presented as the mean and the 95% confidence interval. RESULTS There were 215 men (15.1%) with at least one prevalent vertebral fracture. During the five-year follow-up, these men had a relative risk of 3.3 (95% confidence interval, 2.6 to 4.3) of sustaining new fractures. The relative risk of sustaining any fracture was especially high in men with two or more prevalent vertebral fractures at 5.5 (95% confidence interval, 3.7 to 7.8), in men with different types of prevalent vertebral fractures at 5.7 (95% confidence interval, 3.6 to 8.5), in men with prevalent fractures in both the thoracic and lumbar regions at 6.4 (95% confidence interval, 4.5 to 8.8), and in men with prevalent fractures with a degree of vertebral body compression in the three worst quartiles, with the relative risk for the worst quartile at 4.0 (95% confidence interval, 2.6 to 5.9). CONCLUSIONS Older men with a prevalent vertebral fracture have three times increased risk of sustaining new fractures compared with men without a vertebral fracture. Older men with two or more prevalent vertebral fractures, different types of fractures (wedge, biconcave, and/or crush), fractures in both the thoracic and lumbar regions, and a degree of vertebral body compression in the three worst quartiles are at an especially high risk of sustaining new fractures. Older men with prevalent vertebral fractures should be considered for fracture-prevention efforts.
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Affiliation(s)
- Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mehrsa Kherad
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ralph Hasserius
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan-Åke Nilsson
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Inga Redlund-Johnell
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Claes Ohlsson
- Center for Bone and Arthritis Research, Institute of Medicine, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Institute of Medicine, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Dan Mellström
- Geriatric Medicine, Institute of Medicine, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Björn E Rosengren
- Departments of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Lund University, Skåne University Hospital, Malmö, Sweden
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50
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Abstract
INTRODUCTION Severe osteoporosis represents a disease of high mortality and morbidity. Recognition of what constitutes and causes severe osteoporosis and aggressive intervention with pharmacological agents with evidence to reduce fracture risk are outlined in this review. AREAS COVERED This review is a blend of evidence obtained from literature searches from PubMed and The National Library of Medicine (USA), clinical experience and the author's opinions. The review covers the recognition of what constitutes severe osteoporosis, and provides up-to-date references on this sub-set of high risk patients. EXPERT OPINION Severe osteoporosis can be classified by using measurements of bone densitometry, identification of prevalent fractures, and, knowledge of what additional risk factors contribute to high fracture risk. Once recognized, the potential consequences of severe osteoporosis can be mitigated by appropriate selection of pharmacological therapies and modalities to reduce the risk for falling.
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Affiliation(s)
- Paul D Miller
- a University of Colorado Health Sciences Center , Colorado Center for Bone Research , Lakewood , CO , USA
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