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Al Refaie A, Baldassini L, Mondillo C, Ceccarelli E, Tarquini R, Gennari L, Gonnelli S, Caffarelli C. Glucagon-like Peptide-1 Receptor Agonists and Diabetic Osteopathy: Another Positive Effect of Incretines? A 12 Months Longitudinal Study. Calcif Tissue Int 2024; 115:160-168. [PMID: 38864922 PMCID: PMC11246279 DOI: 10.1007/s00223-024-01240-1] [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: 03/23/2024] [Accepted: 05/22/2024] [Indexed: 06/13/2024]
Abstract
Diabetic osteopathy is a frequent complication in patients with type 2 diabetes mellitus (T2DM). The association between T2DM and increased fracture risk has led to study the impact of new antidiabetic drugs on bone metabolism. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin mimetic drugs which have many pleiotropic properties. The relationship between GLP-1RAs and bone is very complex: while in vitro and animal studies have demonstrated a protective effect on bone, human studies are scarce. We led a 12 months longitudinal study evaluating bone changes in 65 patients withT2DM for whom a therapy with GLP-1RAs had been planned. Fifty-four T2DM patients completed the 12-month study period; of them, 30 had been treated with weekly dulaglutide and 24 with weekly semaglutide. One-year therapy with GLP-1RAs resulted in a significant reduction in weight and BMI. Bone mineral density (BMD), bone metabolism, trabecular bone score (TBS), adiponectin, and myostatin were evaluated before and after 12 months of GLP-1RAs therapy. After 12 months of therapy bone turnover markers and adiponectin showed a significant increase, while myostatin values showed a modest but significant reduction. BMD-LS by DXA presented a significant reduction while the reduction in BMD-LS by REMS was not significant and TBS values showed a marginal increase. Both DXA and REMS techniques showed a modest but significant reduction in femoral BMD. In conclusion, the use of GLP-1RAs for 12 months preserves bone quality and reactivates bone turnover. Further studies are needed to confirm whether GLP-1RAs could represent a useful therapeutic option for patients with T2DM and osteoporosis.
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Affiliation(s)
- Antonella Al Refaie
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
- Division of Internal Medicine I, San Giuseppe Hospital, 50053, Empoli, Italy
| | - Leonardo Baldassini
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Caterina Mondillo
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Elena Ceccarelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Roberto Tarquini
- Division of Internal Medicine I, San Giuseppe Hospital, 50053, Empoli, Italy
| | - Luigi Gennari
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Stefano Gonnelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Carla Caffarelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
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Wearing SC, Hooper SL, Langton CM, Keiner M, Horstmann T, Crevier-Denoix N, Pourcelot P. The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques. Healthcare (Basel) 2024; 12:1254. [PMID: 38998789 PMCID: PMC11241410 DOI: 10.3390/healthcare12131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.
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Affiliation(s)
- Scott C. Wearing
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | - Sue L. Hooper
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Christian M. Langton
- Griffith Centre of Rehabilitation Engineering, Griffith University, Southport, QLD 4222, Australia
| | - Michael Keiner
- Department of Exercise and Training Science, German University of Health and Sport, 85737 Ismaning, Bavaria, Germany
| | - Thomas Horstmann
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | | | - Philippe Pourcelot
- INRAE, BPLC Unit, Ecole Nationale Vétérinaire d’Alfort, 94700 Maisons-Alfort, France
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Fuggle NR, Reginster JY, Al-Daghri N, Bruyere O, Burlet N, Campusano C, Cooper C, Perez AD, Halbout P, Ghi T, Kaufman JM, Kurt A, Matijevic R, Radermecker RP, Tuzun S, Veronese N, Rizzoli R, Harvey NC, Brandi ML, Brandi ML. Radiofrequency echographic multi spectrometry (REMS) in the diagnosis and management of osteoporosis: state of the art. Aging Clin Exp Res 2024; 36:135. [PMID: 38904870 PMCID: PMC11192661 DOI: 10.1007/s40520-024-02784-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).There is a growing literature demonstrating a strong correlation between DXA and REMS measures of BMD and further work supporting 5-year prediction of fracture using the REMS Fragility Score, which provides a measure of bone quality (in addition to the quantitative measure of BMD).The non-ionising radiation emitted by REMS allows it to be used in previously underserved populations including pregnant women and children and may facilitate more frequent measurement of BMD.The portability of the device means that it can be deployed to measure BMD for frail patients at the bedside (avoiding the complications in transfer and positioning which can occur with DXA), in primary care, the emergency department, low-resource settings and even at home.The current evidence base supports the technology as a useful tool in the management of osteoporosis as an alternative to DXA.
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Affiliation(s)
- Nicholas R Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Jean-Yves Reginster
- The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), Liege, Belgium
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyere
- Faculty of Medicine, Department of Public Health Sciences, Research Unit in Public Health, Epidemiology and Health Economics (URSAPES), University of Liège, Liege, Belgium
| | - Nansa Burlet
- The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), Liege, Belgium
| | - Claudia Campusano
- Faculty of Medicine, Clinica Universidad de los Andes, Universidad de los Andes, Santiago, Chile
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Adolfo Diez Perez
- Department of Internal Medicine, Hospital del Mar-IMIM-UAB, CIBERFES, Institute Carlos III, Barcelona, Barcelona, Spain
| | - Philippe Halbout
- The International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - Tullio Ghi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Andreas Kurt
- Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany
| | - Radmila Matijevic
- Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, University of Novi Sad, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Regis P Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium
| | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University- Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy.
| | - Rene Rizzoli
- Division of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Maria Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria-Luisa Brandi
- Metabolic Bone Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Kuliczkowska-Płaksej J, Zdrojowy-Wełna A, Jawiarczyk-Przybyłowska A, Gojny Ł, Bolanowski M. Diagnosis and therapeutic approach to bone health in patients with hypopituitarism. Rev Endocr Metab Disord 2024; 25:513-539. [PMID: 38565758 DOI: 10.1007/s11154-024-09878-w] [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] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
The results of many studies in recent years indicate a significant impact of pituitary function on bone health. The proper function of the pituitary gland has a significant impact on the growth of the skeleton and the appearance of sexual dimorphism. It is also responsible for achieving peak bone mass, which protects against the development of osteoporosis and fractures later in life. It is also liable for the proper remodeling of the skeleton, which is a physiological mechanism managing the proper mechanical resistance of bones and the possibility of its regeneration after injuries. Pituitary diseases causing hypofunction and deficiency of tropic hormones, and thus deficiency of key hormones of effector organs, have a negative impact on the skeleton, resulting in reduced bone mass and susceptibility to pathological fractures. The early appearance of pituitary dysfunction, i.e. in the pre-pubertal period, is responsible for failure to achieve peak bone mass, and thus the risk of developing osteoporosis in later years. This argues for the need for a thorough assessment of patients with hypopituitarism, not only in terms of metabolic disorders, but also in terms of bone disorders. Early and properly performed treatment may prevent patients from developing the bone complications that are so common in this pathology. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary disease.
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Affiliation(s)
- Justyna Kuliczkowska-Płaksej
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Zdrojowy-Wełna
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Aleksandra Jawiarczyk-Przybyłowska
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland.
| | - Łukasz Gojny
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
| | - Marek Bolanowski
- Department and Clinic of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeże Pasteura 4, Wrocław, 50-367, Poland
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Yokota S, Ishizu H, Miyazaki T, Takahashi D, Iwasaki N, Shimizu T. Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights. Biomedicines 2024; 12:843. [PMID: 38672197 PMCID: PMC11048726 DOI: 10.3390/biomedicines12040843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The increased incidence of osteoarthritis (OA), particularly knee and hip OA, and osteoporosis (OP), owing to population aging, have escalated the medical expense burden. Osteoarthritis is more prevalent in older women, and the involvement of subchondral bone fragility spotlights its association with OP. Notably, subchondral insufficiency fracture (SIF) may represent a more pronounced condition of OA pathophysiology. This review summarizes the relationship between OA and OP, incorporating recent insights into SIF. Progressive SIF leads to joint collapse and secondary OA and is associated with OP. Furthermore, the thinning and fragility of subchondral bone in early-stage OA suggest that SIF may be a subtype of OA (osteoporosis-related OA, OPOA) characterized by significant subchondral bone damage. The high bone mineral density observed in OA may be overestimated due to osteophytes and sclerosis and can potentially contribute to OPOA. The incidence of OPOA is expected to increase along with population aging. Therefore, prioritizing OP screening, early interventions for patients with early-stage OA, and fracture prevention measures such as rehabilitation, fracture liaison services, nutritional management, and medication guidance are essential.
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Affiliation(s)
| | | | | | | | | | - Tomohiro Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (S.Y.); (H.I.); (T.M.); (D.T.); (N.I.)
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Giovanni A, Luisa BM, Carla C, Ernesto C, Francesco C, Marco DP, Angelo F, Davide G, Francesca G, Stefano G, Anna LF, Maurizio M, Paola P, Maurizio R. Bone health status evaluation in men by means of REMS technology. Aging Clin Exp Res 2024; 36:74. [PMID: 38494464 PMCID: PMC10944810 DOI: 10.1007/s40520-024-02728-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Osteoporosis in males is largely under-diagnosed and under-treated, with most of the diagnosis confirmed only after an osteoporotic fracture. Therefore, there is an urgent need for highly accurate and precise technologies capable of identifying osteoporosis earlier, thereby avoiding complications from fragility fractures. AIMS This study aimed to evaluate the diagnostic accuracy and precision of the non-ionizing technology Radiofrequency Echographic Multi Spectrometry (REMS) for the diagnosis of osteoporosis in a male population in comparison with conventional Dual-energy X-ray Absorptiometry (DXA). METHODS A cohort of 603 Caucasian males aged between 30 and 90 years were involved in the study. All the enrolled patients underwent lumbar and femoral scans with both DXA and REMS. The diagnostic agreement between REMS and DXA-measured BMD was expressed by Pearson correlation coefficient and Bland-Altman method. The accuracy of the diagnostic classification was evaluated by the assessment of sensitivity and specificity considering DXA as reference. RESULTS A significant correlation between REMS- and DXA-measured T-score values (r = 0.91, p < 0.0001) for lumbar spine and for femoral neck (r = 0.90, p < 0.0001) documented the substantial equivalence of the two measurement techniques. Bland-Altman outcomes showed that the average difference in T-score measurement is very close to zero (-0.06 ± 0.60 g/cm2 for lumbar spine and - 0.07 ± 0.44 g/cm2 for femoral neck) confirming the agreement between the two techniques. Furthermore, REMS resulted an effective technique to discriminate osteoporotic patients from the non-osteoporotic ones on both lumbar spine (sensitivity = 90.1%, specificity = 93.6%) and femoral neck (sensitivity = 90.9%, specificity = 94.6%). Precision yielded RMS-CV = 0.40% for spine and RMS-CV = 0.34% for femur. CONCLUSION REMS, is a reliable technology for the diagnosis of osteoporosis also in men. This evidence corroborates its high diagnostic performance already observed in previous studies involving female populations.
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Affiliation(s)
- Adami Giovanni
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
| | - Brandi Maria Luisa
- Italian Bone Disease Research Foundation (FIRMO), Florence, Italy
- Observatory for Fragility Fractures, Florence, Italy
| | - Caffarelli Carla
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Casciaro Ernesto
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | | | - Di Paola Marco
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Fassio Angelo
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
| | - Gatti Davide
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
| | - Giusti Francesca
- Donatello Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, Florence, Italy
| | - Gonnelli Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | | | | | - Pisani Paola
- Institute of Clinical Physiology, National Research Council, Lecce, Italy.
| | - Rossini Maurizio
- Department of Medicine, Rheumatology Unit, University of Verona, Verona, Italy
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Ishizu H, Shimizu T, Sakamoto Y, Toyama F, Kitahara K, Takayama H, Miyamoto M, Iwasaki N. Radiofrequency Echographic Multispectrometry (REMS) can Overcome the Effects of Structural Internal Artifacts and Evaluate Bone Fragility Accurately. Calcif Tissue Int 2024; 114:246-254. [PMID: 38127125 DOI: 10.1007/s00223-023-01167-z] [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: 09/22/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE This study measured bone mineral density (BMD) in a Japanese population using the novel non-ionizing system using radiofrequency echographic multispectrometry (REMS) and compared the results with those obtained using traditional dual-energy X-ray absorptiometry (DXA). We aimed to identify any discrepancies between measurements obtained using these instruments and identify the influencing factors. METHODS This cross-sectional study examined patients with osteoporosis treated at a single center from April to August 2023. We examined BMD assessment by DXA and REMS in lumbar spine and proximal femur. Patients were categorized into two groups: those with discrepancies between lumbar spine BMD measured by DXA and REMS, and those without. Semiquantitative evaluation of vertebral fractures and abdominal aortic calcification scoring were also performed and compared between the two groups, along with various patient characteristics. RESULTS A total of 70 patients (88.6% female; mean age 78.39 ± 9.50 years) undergoing osteoporosis treatment were included in the study. A significant difference was noted between DXA and REMS measurement of BMD and T-scores, with REMS recording consistently lower values. The discrepancy group exhibited a higher incidence of multiple vertebral fractures and increased vascular calcification than the non-discrepancy group. Multivariate analysis indicated that diabetes mellitus, severe vertebral fractures, and increased abdominal aortic calcification scores were significantly associated with discrepancies in lumbar spine T-scores. CONCLUSION This study suggests that REMS may offer a more accurate measurement of BMD, overcoming the overestimation of BMD by DXA owing to factors such as vertebral deformities, abdominal aortic calcification, and diabetes mellitus.
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Affiliation(s)
- Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Yuki Sakamoto
- Department of Radiological Technology, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Fumi Toyama
- Department of Nursing, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Keita Kitahara
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Orthopaedic Surgery, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Hiroki Takayama
- Department of Orthopaedic Surgery, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Moritaka Miyamoto
- Department of Orthopaedic Surgery, Iwamizawa Hokushokai Hospital, Iwamizawa, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Caffarelli C, Al Refaie A, Mondillo C, Manasse G, Versienti A, Tomai Pitinca MD, Conticini E, Frediani B, Gonnelli S. The Advantages of Radiofrequency Echographic MultiSpectrometry in the Evaluation of Bone Mineral Density in a Population with Osteoarthritis at the Lumbar Spine. Diagnostics (Basel) 2024; 14:523. [PMID: 38472995 DOI: 10.3390/diagnostics14050523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Osteoarthritis (OA) in the lumbar spine can potentially lead to an overestimation of bone mineral density (BMD), and this can be a challenge in accurately diagnosing conditions like osteoporosis, where precise measurement of BMD is crucial. Radiofrequency Echographic Multi Spectrometry (REMS) is being recognized as an innovative diagnostic tool for assessing bone status. The purpose of this study was to evaluate whether the use of REMS may enhance the identification of osteoporosis in patients with osteoarthritis. METHODS A cohort of 500 patients (mean age: 63.9 ± 11.2 years) diagnosed with osteoarthritis and having a medical prescription for dual-energy X-ray absorptiometry (DXA) were recruited for the study. All patients underwent BMD measurements at lumbar spine and femoral sites by both DXA and REMS techniques. RESULTS The T-score values for BMD at the lumbar spine (BMD-LS) by DXA were significantly higher with respect to BMD-LS by REMS across all OA severity scores, and the differences were more pronounced in patients with a higher degree of OA severity (p < 0.001). Furthermore, the percentage of subjects classified as "osteoporotic", on the basis of BMD by REMS was markedly higher than those classified by DXA, both when considering all skeletal sites (39.4% vs. 15.1%, respectively) and the lumbar spine alone (30.5% vs. 6.0%, respectively). A similar pattern was observed when OA patients were grouped according to the Kellgren-Lawrence grading score. CONCLUSIONS The findings from our study indicate that, in a population with varying severity levels of osteoarthritis, REMS demonstrated a higher capability to diagnose osteoporosis compared to DXA, and this could lead to earlier intervention and improved outcomes for patients with bone fragility, reducing the likelihood of fractures and associated complications.
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Affiliation(s)
- Carla Caffarelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Antonella Al Refaie
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Caterina Mondillo
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Giuditta Manasse
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Alessandro Versienti
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Maria Dea Tomai Pitinca
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Stefano Gonnelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
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Ramirez Zegarra R, Degennaro V, Brandi ML, Cagninelli G, Casciaro S, Celora G, Conversano F, Lombardi FA, Pisani P, Ghi T. Longitudinal changes of the femoral bone mineral density from first to third trimester of pregnancy: bone health assessment by means of non-ionizing REMS technology. Aging Clin Exp Res 2024; 36:31. [PMID: 38334854 PMCID: PMC10858072 DOI: 10.1007/s40520-023-02677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Throughout the pregnancy, there is a substantial transfer of calcium from the maternal skeleton to the fetus, which leads to a transient net reduction of the maternal bone mineral density. AIMS To assess longitudinally the changes in the bone mineral density at the femoral neck between the first and third trimester of pregnancy in a cohort of healthy participants using Radiofrequency Echographic Multi Spectrometry (REMS) technology. METHODS Prospective, cohort study conducted at the University hospital of Parma, Italy between July 2022 and February 2023. We recruited healthy participants with an uncomplicated singleton pregnancy before 14 completed weeks of gestation. All included participants were submitted to a sonographic examination of the femoral neck to assess the bone mineral density (and the corresponding Z-score values) using REMS at 11-13 and 36-38 weeks of pregnancy. The primary outcome was the change in the bone mineral density values at the maternal femoral neck between the first and third trimester of pregnancy. RESULTS Over a period of 7 months, a total of 65 participants underwent bone mineral density measurement at the femoral neck at first and third trimester of the pregnancy using REMS. A significant reduction of the bone mineral density at the femoral neck (0.723 ± 0.069 vs 0.709 ± 0.069 g/cm2; p < 0.001) was noted with a mean bone mineral density change of - 1.9 ± 0.6% between the first and third trimester of pregnancy. At multivariable linear regression analysis, none of the demographic or clinical variables of the study population proved to be independently associated with the maternal bone mineral density changes at the femoral neck. CONCLUSIONS Our study conducted on a cohort of healthy participants with uncomplicated pregnancy demonstrates that there is a significant reduction of bone mineral density at femoral neck from early to late gestation.
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Affiliation(s)
- Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Valentina Degennaro
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Maria Luisa Brandi
- Fondazione Italiana per la Ricerca sulle Malattie dell'Osso (F.I.R.M.O.), Florence, Italy
| | - Greta Cagninelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | - Gabriella Celora
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Francesco Conversano
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | | | - Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
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10
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Gross AM, Plotkin SR, Watts NB, Fisher MJ, Klesse LJ, Lessing AJ, McManus ML, Larson AN, Oberlander B, Rios JJ, Sarnoff H, Simpson BN, Ullrich NJ, Stevenson DA. Potential endpoints for assessment of bone health in persons with neurofibromatosis type 1. Clin Trials 2024; 21:29-39. [PMID: 37772407 PMCID: PMC10920397 DOI: 10.1177/17407745231201338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Neurofibromatosis type 1 is a genetic syndrome characterized by a wide variety of tumor and non-tumor manifestations. Bone-related issues, such as scoliosis, tibial dysplasia, and low bone mineral density, are a significant source of morbidity for this population with limited treatment options. Some of the challenges to developing such treatments include the lack of consensus regarding the optimal methods to assess bone health in neurofibromatosis type 1 and limited data regarding the natural history of these manifestations. In this review, the Functional Committee of the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration: (1) presents the available techniques for measuring overall bone health and metabolism in persons with neurofibromatosis type 1, (2) reviews data for use of each of these measures in the neurofibromatosis type 1 population, and (3) describes the strengths and limitations for each method as they might be used in clinical trials targeting neurofibromatosis type 1 bone manifestations. The Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration supports the development of a prospective, longitudinal natural history study focusing on the bone-related manifestations and relevant biomarkers of neurofibromatosis type 1. In addition, we suggest that the neurofibromatosis type 1 research community consider adding the less burdensome measurements of bone health as exploratory endpoints in ongoing or planned clinical trials for other neurofibromatosis type 1 manifestations to expand knowledge in the field.
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Affiliation(s)
- Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura J Klesse
- Division of Hematology/Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jonathan J Rios
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Herb Sarnoff
- Research and Development, Infixion Bioscience, Inc., San Diego, CA, USA
| | - Brittany N Simpson
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
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11
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Kirilov N, Vladeva S, Bischoff F, Batalov Z, Batalov A, Bischoff E. Effect of the body mass index, basal metabolic rate, and body fat on the radiofrequency echographic multi-spectrometry (REMS)-based bone mineral density and fracture risk: a cross-sectional study. Rheumatol Int 2023; 43:2271-2279. [PMID: 37728773 DOI: 10.1007/s00296-023-05460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
Radiofrequency echographic multi-spectrometry (REMS) is a method to assess bone mineral density (BMD) of the axial skeleton, fragility score (FS), body mass index (BMI), basal metabolic rate (BMR), and body fat (BF) in %. The aim of the study was to investigate the influence of the BMI, BMR, and BF on the BMD and fracture risk with REMS. We conducted a cross-sectional study among 313 women, aged 20-90 years who underwent a screening for osteoporosis with REMS. Kruskal-Wallis was used to analyze the differences in BMI, BMR, and BF between the groups according to the BMD: normal BMD, osteopenia and osteoporosis and differences in the FS, fracture risk assessment (FRAX) for major osteoporotic fractures and for hip fractures (HF) according to the BMI groups: underweight, normal weight, overweight, obese, and extreme obese. Linear regression was used to assess the correlations BMI-BMD, BMR-BMD, and BF-BMD. BMI, BMR, and BF differed significantly between the groups according to the BMD (p < 0.001, p = 0.028, and p < 0.001, respectively). BMR showed high positive correlation to BMD (R = 0.765) with 95% confidence interval (CI) [0.715, 0.807] and significance of p < 0.001. BMI correlated significantly to BMD (p < 0.001), the correlation was low positive (R = 0.362) with 95% CI [0.262, 0.455]. In the BMI groups, there was significant difference in FRAX for HF and FS with p value 0.014 and < 0.001, respectively. Subjects with low BMI, BMR, and BF are at high risk for osteoporosis. Underweight women show significantly high fracture risk, assessed with FRAX and FS.
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Affiliation(s)
- Nikola Kirilov
- Department of Orthopedics and Traumatology, University Hospital "UMBAL Dr. Georgi Stranski", Medical University-Pleven, Pleven, Bulgaria.
| | - Stoyanka Vladeva
- Department of Health Care, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria
| | | | - Zguro Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital 'Kaspela', Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital 'Kaspela', Plovdiv, Bulgaria
| | - Elena Bischoff
- Department of Internal Diseases, Pharmacology, Paediatrics, Social Medicine, Emergency Medicine, Computer Technology, Infectious Diseases, Physiotherapy and Rehabilitation, Epidemiology and Tropical Diseases, Faculty of Medicine, University "Prof. Dr. Assen Zlatarov"-Burgas, Burgas, Bulgaria
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12
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Chen A, Feng S, Lai L, Yan C. A meta-analysis of the value of MRI-based VBQ scores for evaluating osteoporosis. Bone Rep 2023; 19:101711. [PMID: 37681002 PMCID: PMC10480551 DOI: 10.1016/j.bonr.2023.101711] [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: 04/29/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Osteoporosis is the most common skeletal disease in humans. Early onset of osteoporosis is usually asymptomatic, so early diagnosis is critical. The purpose of this study was to analyze the value of MRI-based VBQ scores for evaluating osteoporosis. Methods We searched PubMed, Embase, the Cochrane Library databases, Web of Science, and some Chinese electronic databases for published articles and the ClinicalTrials.gov site for completed but unpublished studies on evaluating the value of MRI-based VBQ scores for evaluating osteoporosis. We calculated the summarized sensitivity, specificity, the ROC curve (AUC) values and their 95% confidence intervals (CIs) using MetaDiSc 1.4 software and STATA. Results Our study included 8 studies involving 999 patients of which 660 patients were diagnosed with osteopenia/osteoporosis, and 339 patients were identified as having normal BMD. The pooled sensitivity was 0.809 (95% CI, 0.777-0.838, I 2 = 78.8%), the pooled specificity was 0.640 (95% CI, 0.587-0.691, I 2 = 85.9%), and the pooled AUC was 0.8375. Conclusion MRI-based VBQ scores provided high sensitivity and moderate specificity in detecting osteoporosis. Opportunistic use of VBQ scores could be considered, e.g. before lumbar spine surgery. Prospero registration number CRD42022377024.
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Affiliation(s)
- Ang Chen
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Shangyong Feng
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Lijuan Lai
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Caifeng Yan
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
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13
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Vladeva S, Bischoff E, Kirilov N, Bischoff F, Batalov Z, Batalov A. An observational study of the radiofrequency echographic multi-spectrometry (REMS)-based fragility score of the lumbar spine and total fracture risk at 5 years in women. Rheumatol Int 2023; 43:2107-2114. [PMID: 37572173 DOI: 10.1007/s00296-023-05412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
A novel fragility score (FS) parameter, obtained during radiofrequency echographic multi-spectrometry (REMS), was developed to estimate the ultrasound-based skeletal fragility. The aim of our study is to assess the REMS-based FS of the lumbar spine (LS) among the Bulgarian women and to compare their characteristics acquired with REMS between fracture risk classes corresponding to a total fracture risk at 5 years for major osteoporotic fractures (MOF). A total of 100 Bulgarian women, who underwent a screening for osteoporotic fracture risk using the REMS technology, were included in a prospective observational study. The mean age was 60 years (years) ± 13.9 standard deviations. We assessed the FS of the LS and for each subject. The fracture risk class (R1-R7) was identified using a table combining measured REMS T score and FS values. The mean FS was 36.9 ± 17.4 SD (range: 18.5-84.3). Twelve subjects (12%) were classified into the R6 group, twenty-three (23%) into the R5, sixty-one (61%) into R4, and four (4%) into R3. Statistical analysis showed significant difference in age, height, BMD, T score, Z score, age of menopause, FRAX for MOF, and FRAX for hip fractures between the risk class groups. This is the first study which showed the REMS-based FS of the lumbar spine among the Bulgarian women. T score alone is not a good predictor of fractures. Our study showed that its use in combination with the fragility score obtained during REMS offers a robust assessment of the fracture risk at 5 years for MOF.
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Affiliation(s)
- Stoyanka Vladeva
- Department of Health Care, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria.
| | - Elena Bischoff
- Department of Internal Diseases, Pharmacology, Paediatrics, Social Medicine, Emergency Medicine, Computer Technology, Infectious Diseases, Physiotherapy and Rehabilitation, Epidemiology and Tropical Diseases, Faculty of Medicine, University Prof. Dr. Assen Zlatarov, Burgas, Bulgaria
| | - Nikola Kirilov
- Department of Orthopedics and Traumatology, University Hospital UMBAL Dr. Georgi Stranski, Pleven, Bulgaria
| | | | - Zguro Batalov
- Department of Internal Diseases, Clinic of Rheumatology, Medical University of Plovdiv, University Hospital 'Kaspela', Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Internal Diseases, Clinic of Rheumatology, Medical University of Plovdiv, University Hospital 'Kaspela', Plovdiv, Bulgaria
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14
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Kirilov N, Bischoff F, Vladeva S, Bischoff E. A Case Showing a New Diagnostic Aspect of the Application of Radiofrequency Echographic Multi-Spectrometry (REMS). Diagnostics (Basel) 2023; 13:3224. [PMID: 37892045 PMCID: PMC10606550 DOI: 10.3390/diagnostics13203224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Radiofrequency echographic multi-spectrometry (REMS) is an ultrasound technique that has been recently introduced in the medical field to detect osteoporosis and fracture risk at axial sites. The use of sonography to visualize the region of interest (ROI) of the hip neck provides the opportunity to identify occult fractures. A 91-year-old woman with persistent right leg pain was referred to rheumatologist due to a known history of arthritis and osteoporosis. She was able to walk using a crutch, although experiencing an antalgic gait. The patient had recently fallen on her right side from standing height. During the visualization of the ROI of the right femoral neck using REMS, an abrupt break of the femoral cortex suspected to be a fracture was seen; therefore, the measurement of the femoral neck was performed on the left side. The T-score had value of -2.9 SD and the fragility score was 86.7. Due to unclear signs of a fracture after an X-ray of the hip, a computed tomography (CT) exam of the hip was performed, which revealed a femoral neck fracture. Occult fractures of the femoral neck are challenging to diagnose and require numerous radiologic exams. The use of ultrasound as a method to measure bone density allows the simultaneous diagnosis of osteoporosis and detection of fractures.
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Affiliation(s)
- Nikola Kirilov
- Department of Orthopedics and Traumatology, Faculty of Medicine, Medical University—Pleven, 5800 Pleven, Bulgaria
| | | | - Stoyanka Vladeva
- Department of Health Care, Faculty of Medicine, Trakia University, 6015 Stara Zagora, Bulgaria;
| | - Elena Bischoff
- Faculty of Public Health and Healthcare, University “Prof Dr Asen Zlatarov”—Burgas, 8010 Burgas, Bulgaria;
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15
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Caffarelli C, Al Refaie A, Mondillo C, Versienti A, Baldassini L, De Vita M, Tomai Pitinca MD, Gonnelli S. Radiofrequency Echographic Multispectrometry (REMS): A New Option in the Assessment Bone Status in Adults with Osteogenesis Imperfecta. J Imaging 2023; 9:210. [PMID: 37888317 PMCID: PMC10607336 DOI: 10.3390/jimaging9100210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
This study aimed to estimate the utility of the Radiofrequency Echographic Multispectrometry (REMS) approach in the assessment of bone mineral density (BMD) in subjects with osteogenesis imperfecta (OI). In 41 subjects (40.5 ± 18.7 years) with OI and in 36 healthy controls, we measured BMD at the lumbar spine (LS-BMD), femoral neck (FN-BMD) and total hip (TH-BMD), employing a dual-energy X-ray absorptiometry tool. Additionally, REMS scans were also performed at the lumbar and femoral sites. The presence and number of reported fractures were assessed in the study population. Patients characterized by a history of fragility fractures represented 84.5% of the study population. OI subjects showed significantly reduced BMD values both at the level of the lumbar spine and the femoral subregions (p < 0.01) compared to healthy controls when performed using both the DXA and the REMS method. Dividing OI patients on the basis of the Sillence classification, no differences were found between the LS-BMD values carried out using the DXA technique between the OI type I group and OI Type III and IV groups. On the contrary, the OI Type III and IV groups presented significantly lower values of both Trabecular Bone Score (TBS) and LS-BMD through REMS with respect to OI type I patients (p < 0.05). Based on the data of this study, it is possible to conclude that even the new REMS assessment, which does not use ionizing radiation, represents an excellent method for studying the bone status in subjects affected by OI.
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Affiliation(s)
- Carla Caffarelli
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (A.A.R.); (C.M.); (L.B.); (M.D.T.P.); (S.G.)
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16
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Perrone S, Caporilli C, Grassi F, Ferrocino M, Biagi E, Dell’Orto V, Beretta V, Petrolini C, Gambini L, Street ME, Dall’Asta A, Ghi T, Esposito S. Prenatal and Neonatal Bone Health: Updated Review on Early Identification of Newborns at High Risk for Osteopenia. Nutrients 2023; 15:3515. [PMID: 37630705 PMCID: PMC10459154 DOI: 10.3390/nu15163515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
Bone health starts with maternal health and nutrition, which influences bone mass and density already in utero. The mechanisms underlying the effect of the intrauterine environment on bone health are partly unknown but certainly include the 'foetal programming' of oxidative stress and endocrine systems, which influence later skeletal growth and development. With this narrative review, we describe the current evidence for identifying patients with risk factors for developing osteopenia, today's management of these populations, and screening and prevention programs based on gestational age, weight, and morbidity. Challenges for bone health prevention include the need for new technologies that are specific and applicable to pregnant women, the foetus, and, later, the newborn. Radiofrequency ultrasound spectrometry (REMS) has proven to be a useful tool in the assessment of bone mineral density (BMD) in pregnant women. Few studies have reported that transmission ultrasound can also be used to assess BMD in newborns. The advantages of this technology in the foetus and newborn are the absence of ionising radiation, ease of use, and, above all, the possibility of performing longitudinal studies from intrauterine to extrauterine life. The use of these technologies already in the intrauterine period could help prevent associated diseases, such as osteoporosis and osteopenia, which are characterised by a reduction in bone mass and degeneration of bone structure and lead to an increased risk of fractures in adulthood with considerable social repercussions for the related direct and indirect costs.
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Affiliation(s)
- Serafina Perrone
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Caporilli
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Federica Grassi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Mandy Ferrocino
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Eleonora Biagi
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Valentina Dell’Orto
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Virginia Beretta
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Chiara Petrolini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Lucia Gambini
- Neonatology Unit, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (V.D.); (V.B.); (C.P.); (L.G.)
| | - Maria Elisabeth Street
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
| | - Andrea Dall’Asta
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Tullio Ghi
- Obstetric and Gynecology Unit, University Hospital of Parma, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (A.D.); (T.G.)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy; (C.C.); (F.G.); (M.F.); (E.B.); (M.E.S.); (S.E.)
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17
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Al-Hashimi L, Klotsche J, Ohrndorf S, Gaber T, Hoff P. Trabecular Bone Score Significantly Influences Treatment Decisions in Secondary Osteoporosis. J Clin Med 2023; 12:4147. [PMID: 37373840 DOI: 10.3390/jcm12124147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The trabecular bone score (TBS) can be determined in addition to the Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement to diagnose, evaluate, and stratify bone loss and decide on appropriate treatment in patients at risk. Especially in patients with secondary osteoporosis, TBS detects restricted bone quality. To investigate the influence of an additional evaluation of TBS on patients' treatment strategy decisions, we enrolled 292 patients, with a high proportion of patients with secondary osteoporosis, from one outpatient unit over one year. Patients eligible for BMD measurement had the option to opt-in for TBS measurement. We analyzed demographic data, leading diagnoses, bone metabolism parameters, and results of BMD and TBS measurements. More than 90% of patients consented to TBS measurement. TBS measurement influenced the decision in approximately 40% of patients with a treatment indication for anti-osteoporotic drugs. We demonstrate that depending on the underlying disease/risk spectrum, 21-25.5% of patients had an unremarkable BMD measurement with poor bone quality shown in the TBS measurement. In patients with secondary osteoporosis, the use of TBS supplementary to DXA seems useful to better assess fracture risk and, thus, to initiate therapy for osteoporosis in these patients in time.
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Affiliation(s)
- Leith Al-Hashimi
- MVZ Endokrinologikum Berlin am Gendarmenmarkt, 10117 Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre (DRFZ) Berlin, a Leibniz Institute, 10117 Berlin, Germany
| | - Sarah Ohrndorf
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Timo Gaber
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Paula Hoff
- MVZ Endokrinologikum Berlin am Gendarmenmarkt, 10117 Berlin, Germany
- Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Universitätsmedizin Berlin, 10117 Berlin, Germany
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18
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Messina C, Gitto S, Colombo R, Fusco S, Guagliardo G, Piazza M, Poli JC, Albano D, Sconfienza LM. Short-Term Precision and Repeatability of Radiofrequency Echographic Multi Spectrometry (REMS) on Lumbar Spine and Proximal Femur: An In Vivo Study. J Imaging 2023; 9:118. [PMID: 37367466 DOI: 10.3390/jimaging9060118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/28/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
To determine the short-term intra-operator precision and inter-operator repeatability of radiofrequency echographic multi-spectrometry (REMS) at the lumbar spine (LS) and proximal femur (FEM). All patients underwent an ultrasound scan of the LS and FEM. Both precision and repeatability, expressed as root-mean-square coefficient of variation (RMS-CV) and least significant change (LSC) were obtained using data from two consecutive REMS acquisitions by the same operator or two different operators, respectively. The precision was also assessed in the cohort stratified according to BMI classification. The mean (±SD) age of our subjects was 48.9 ± 6.8 for LS and 48.3 ± 6.1 for FEM. Precision was assessed on 42 subjects at LS and 37 subjects on FEM. Mean (±SD) BMI was 24.71 ± 4.2 for LS and 25.0 ± 4.84 for FEM. Respectively, the intra-operator precision error (RMS-CV) and LSC resulted in 0.47% and 1.29% at the spine and 0.32% and 0.89% at the proximal femur evaluation. The inter-operator variability investigated at the LS yielded an RMS-CV error of 0.55% and LSC of 1.52%, whereas for the FEM, the RMS-CV was 0.51% and the LSC was 1.40%. Similar values were found when subjects were divided into BMI subgroups. REMS technique provides a precise estimation of the US-BMD independent of subjects' BMI differences.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy
| | - Roberta Colombo
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157 Milan, Italy
| | - Stefano Fusco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Giada Guagliardo
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Mattia Piazza
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Jacopo Carlo Poli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157 Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso, 173, 20157 Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli, 31, 20133 Milan, Italy
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Al Refaie A, Baldassini L, Mondillo C, Giglio E, De Vita M, Tomai Pitinca MD, Gonnelli S, Caffarelli C. Radiofrequency Echographic Multi Spectrometry (R.E.M.S.): New Frontiers for Ultrasound Use in the Assessment of Bone Status-A Current Picture. Diagnostics (Basel) 2023; 13:diagnostics13101666. [PMID: 37238151 DOI: 10.3390/diagnostics13101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Osteoporosis is a frequently occurring skeletal disease, and osteoporosis-related fractures represent a significant burden for healthcare systems. Dual-Energy X-ray Absorptiometry (DXA) is the most commonly used method for assessing bone mineral density (BMD). Today, particular attention is being directed towards new technologies, especially those that do not use radiation, for the early diagnosis of altered bone status. Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology that evaluates the bone status at axial skeletal sites by analyzing raw ultrasound signals. In this review, we evaluated the data on the REMS technique present in the literature. The literature data confirmed diagnostic concordance between BMD values obtained using DXA and REMS. Furthermore, REMS has adequate precision and repeatability characteristics, is able to predict the risk of fragility fractures, and may be able to overcome some of the limitations of DXA. In conclusion, REMS could become the method of choice for the assessment of bone status in children, in women of childbearing age or who are pregnant, and in several secondary osteoporosis conditions due to its good precision and replicability, its transportability, and the absence of ionizing radiation. Finally, REMS may allow qualitative and not just quantitative assessments of bone status.
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Affiliation(s)
- Antonella Al Refaie
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Leonardo Baldassini
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Caterina Mondillo
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Elisa Giglio
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Michela De Vita
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Maria Dea Tomai Pitinca
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Stefano Gonnelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Carla Caffarelli
- Section of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
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20
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Pisani P, Conversano F, Muratore M, Adami G, Brandi ML, Caffarelli C, Casciaro E, Di Paola M, Franchini R, Gatti D, Gonnelli S, Guglielmi G, Lombardi FA, Natale A, Testini V, Casciaro S. Fragility Score: a REMS-based indicator for the prediction of incident fragility fractures at 5 years. Aging Clin Exp Res 2023; 35:763-773. [PMID: 36752950 PMCID: PMC10115670 DOI: 10.1007/s40520-023-02358-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Accurate estimation of the imminent fragility fracture risk currently represents a challenging task. The novel Fragility Score (FS) parameter, obtained during a Radiofrequency Echographic Multi Spectrometry (REMS) scan of lumbar or femoral regions, has been developed for the non-ionizing estimation of skeletal fragility. AIMS The aim of this study was to assess the performance of FS in the early identification of patients at risk for incident fragility fractures with respect to bone mineral density (BMD) measurements. METHODS Data from 1989 Caucasians of both genders were analysed and the incidence of fractures was assessed during a follow-up period up to 5 years. The diagnostic performance of FS to discriminate between patients with and without incident fragility fracture in comparison to that of the BMD T-scores measured by both Dual X-ray Absorptiometry (DXA) and REMS was assessed through ROC analysis. RESULTS Concerning the prediction of generic osteoporotic fractures, FS provided AUC = 0.811 for women and AUC = 0.780 for men, which resulted in AUC = 0.715 and AUC = 0.758, respectively, when adjusted for age and body mass index (BMI). For the prediction of hip fractures, the corresponding values were AUC = 0.780 for women and AUC = 0.809 for men, which became AUC = 0.735 and AUC = 0.758, respectively, after age- and BMI-adjustment. Overall, FS showed the highest prediction ability for any considered fracture type in both genders, resulting always being significantly higher than either T-scores, whose AUC values were in the range 0.472-0.709. CONCLUSION FS displayed a superior performance in fracture prediction, representing a valuable diagnostic tool to accurately detect a short-term fracture risk.
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Affiliation(s)
- Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | | | | | - Giovanni Adami
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | | | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Ernesto Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Marco Di Paola
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Roberto Franchini
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Siena, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | | | | | - Valentina Testini
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy.
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Cianferotti L, Cipriani C, Corbetta S, Corona G, Defeudis G, Lania AG, Messina C, Napoli N, Mazziotti G. Bone quality in endocrine diseases: determinants and clinical relevance. J Endocrinol Invest 2023:10.1007/s40618-023-02056-w. [PMID: 36918505 DOI: 10.1007/s40618-023-02056-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Bone is one of the main targets of hormones and endocrine diseases are frequent causes of secondary osteoporosis and fractures in real-world clinical practice. However, diagnosis of skeletal fragility and prediction of fractures in this setting could be a challenge, since the skeletal alterations induced by endocrine disorders are not generally captured by dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD), that is the gold standard for diagnosis of osteoporosis in the general population. The aim of this paper is to review the existing evidence related to bone quality features in endocrine diseases, proposing assessment with new techniques in the future. METHODS A comprehensive search within electronic databases was performed to collect reports of bone quality in primary hyperparathyroidism, hypoparathyroidism, hyperthyroidism, hypercortisolism, growth hormone deficiency, acromegaly, male hypogonadism and diabetes mellitus. RESULTS Using invasive and non-invasive techniques, such as high-resolution peripheral quantitative computed tomography or DXA measurement of trabecular bone score (TBS), several studies consistently reported altered bone quality as predominant determinant of fragility fractures in subjects affected by chronic endocrine disorders. CONCLUSIONS Assessment of skeletal fragility in endocrine diseases might take advantage from the use of techniques to detect perturbation in bone architecture with the aim of best identifying patients at high risk of fractures.
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Affiliation(s)
- L Cianferotti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale GB Morgagni 50, 50134, Florence, Italy
| | - C Cipriani
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Corbetta
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy
| | - G Defeudis
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128, Rome, Italy
- Department of Movement, Human and Health Sciences, Health Sciences Section, University "Foro Italico", Rome, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via A Manzoni 56, 20089, Rozzano, MI, Italy
| | - C Messina
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- University of Milan, Department of Biomedical Sciences for Health, Milan, Italy
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico di Roma, 00128, Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via R. Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via A Manzoni 56, 20089, Rozzano, MI, Italy.
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22
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Cost-minimization analysis to support the HTA of Radiofrequency Echographic Multi Spectrometry (REMS) in the diagnosis of osteoporosis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2023; 10:1-11. [PMID: 36789180 PMCID: PMC9923405 DOI: 10.33393/grhta.2023.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/15/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction A timely diagnosis of osteoporosis is key to reducing its growing clinical and economic burden. Radiofrequency Echographic Multi Spectrometry (REMS), a new diagnostic technology using an ultrasound approach, has been recognized by scientific associations as a facilitator of patients' care pathway. We aimed at evaluating the costs of REMS vs. the conventional ionizing technology (dual-energy X-ray absorptiometry, DXA) for the diagnosis of osteoporosis from the perspective of the Italian National Health Service (NHS) using a cost-minimization analysis (CMA). Methods We carried out structured qualitative interviews and a structured expert elicitation exercise to estimate healthcare resource consumption with a purposeful sample of clinical experts. For the elicitation exercise, an Excel tool was developed and, for each parameter, experts were asked to provide the lowest, highest and most likely value. Estimates provided by experts were averaged with equal weights. Unit costs were retrieved using different public sources. Results Considering the base-case scenario (most likely value), the cost of professionals amounts to €31.9 for REMS and €48.8 for DXA, the cost of instrumental examinations and laboratory tests to €45.1 for REMS and €68.2 for DXA. Overall, in terms of current costs, REMS is associated with a mean saving for the NHS of €40.0 (range: €27.6-71.5) for each patient. Conclusions REMS is associated with lower direct healthcare costs with respect to DXA. These results may inform policy-makers on the value of the REMS technology in the earlier diagnosis for osteoporosis, and support their decision regarding the reimbursement and diffusion of the technology in the Italian NHS.
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23
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Radiofrequency echographic multi-spectrometry and DXA for the evaluation of bone mineral density in a peritoneal dialysis setting. Aging Clin Exp Res 2023; 35:185-192. [PMID: 36329361 PMCID: PMC9816283 DOI: 10.1007/s40520-022-02286-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this real-life cross-sectional explorative study was to compare radiofrequency echographic multi-spectrometry (REMS) with dual-energy X-rays absorptiometry (DXA) in the BMD assessment of patients receiving peritoneal dialysis (PD). Furthermore, we investigated the relationship between lumbar aortic calcifications (AOCs) and the DXA lumbar measurements. METHODS Consecutive patients referring to the PD clinic of our hospital were included. Lumbar spine and femur scans were acquired with both techniques (including lumbar laterolateral DXA scans). The risk assessment of two fracture risk algorithms (FRAX® and DeFRA®) were compared. Cohen's k coefficients were used to assess the inter-technique agreement in the classification of patients as osteoporotic. Lumbar AOCs were estimated semi-quantitatively on laterolateral DXA scans. RESULTS 41 patients were enrolled. No significant differences were documented between the BMD T-scores measured through DXA or REMS at the femur. At the lumbar spine, the DXA anteroposterior mean T-score (- 0.49 ± 1.98) was significantly higher than both the laterolateral DXA (- 1.66 ± 0.99) and the REMS (- 2.00 ± 1.94) measurements (p < 0.01 vs both). No significant differences were found between the DXA and REMS fracture risk estimates with both algorithms. The inter-technique Cohen's k coefficient (for the worst T-score, any site) was 0.421, p < 0.001. The discrepancy between the DXA laterolateral and anteroposterior lumbar T-score was positively associated with the AOCs extent and severity (r = 0.402, p < 0.01). CONCLUSIONS Our data showed a promising agreement, in a real-life PD setting, between DXA and REMS BMD assessment and in the consequent fracture risk estimation and confirm the AOCs interference on the diagnostic accuracy of lumbar DXA.
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Advancement in the Treatment of Osteoporosis and the Effects on Bone Healing. J Clin Med 2022; 11:jcm11247477. [PMID: 36556093 PMCID: PMC9781093 DOI: 10.3390/jcm11247477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Osteoporosis (OP) is a major global health concern, with aging being one of the most important risk factors. Osteoarthritis (OA) is also an age-related disorder. Patients with OP and/or OA may be treated surgically for fractures or when their quality of life is impaired. Poor bone quality due to OP can seriously complicate the stability of a bone fixation construct and/or surgical fracture treatment. This review summarizes the current knowledge on the pathophysiology of normal and osteoporotic bone healing, the effect of a bone fracture on bone turnover markers, the diagnosis of a low bone mineral density (BMD) before surgical intervention, and the effect of available anti-osteoporosis treatment. Interventions that improve bone health may enhance the probability of favorable surgical outcomes. Fracture healing and the treatment of atypical femoral fractures are also discussed.
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25
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Caffarelli C, Al Refaie A, De Vita M, Tomai Pitinca MD, Goracci A, Fagiolini A, Gonnelli S. Radiofrequency echographic multispectrometry (REMS): an innovative technique for the assessment of bone status in young women with anorexia nervosa. Eat Weight Disord 2022; 27:3207-3213. [PMID: 35896857 PMCID: PMC9803747 DOI: 10.1007/s40519-022-01450-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/12/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Reduced bone mineral density (BMD) and increase risk of fragility fracture are common complication of anorexia nervosa (AN). BMD by dual-energy X-ray absorptiometry (DXA) present several limits in subjects with AN. This study aimed to evaluate the usefulness of the new Radiofrequency echographic multispectrometry (REMS) technique in the assessment of bone status in young women with AN. METHODS In a cohort of 50 subjects with restrictive AN and in 30 healthy controls, we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using both DXA and REMS technique. RESULTS BMD evaluated by DXA and REMS technique at all measurement sites were all significantly (p < 0.01) lower in subjects suffering from AN subjects than in controls. Good correlations were detected between BMD by DXA and BMD by REMS measurements at LS (r = 0.64, p < 0.01) at FN (r = 0.86, p < 0.01) and at TH (r = 0.84, p < 0.01) in subjects suffering from AN. Moreover, Bland-Altman analysis confirmed the good agreement between the two techniques. The subjects suffering from AN with previous vertebral fragility fractures presented lower values of both BMD-LS and BMD-TH by DXA and by REMS with respect to those without fractures; however, the difference was significant only for BMD-TH by REMS (p < 0.05). CONCLUSIONS Our data suggest that REMS technique due to its characteristic of precision and reproducibility may represent an important tool for the evaluation of the changes in bone status in AN young women, especially during the fertile age and in case of pregnancy and breastfeeding. LEVEL OF EVIDENCE Level of evidence: level III cohort study.
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Affiliation(s)
- Carla Caffarelli
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
| | - Antonella Al Refaie
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Michela De Vita
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maria Dea Tomai Pitinca
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Arianna Goracci
- Division of Psychiatry, Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Division of Psychiatry, Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Stefano Gonnelli
- Division of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
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26
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Osteoporosis Screening: Applied Methods and Technological Trends. Med Eng Phys 2022; 108:103887. [DOI: 10.1016/j.medengphy.2022.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022]
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27
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Ou X, Chen M, Xu L, Lin W, Huang H, Chen G, Wen J. Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis. Eur J Med Res 2022; 27:144. [PMID: 35934692 PMCID: PMC9358806 DOI: 10.1186/s40001-022-00774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm2, CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm2, CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm2, CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm2, CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm2, CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.
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Affiliation(s)
- Xiaodan Ou
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Mingguang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiac Intensive Care Unit, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Lizhen Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| | - Gang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
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Luo W, Chen Z, Zhang Q, Lei B, Chen Z, Fu Y, Guo P, Li C, Ma T, Liu J, Ding Y. Osteoporosis Diagnostic Model Using a Multichannel Convolutional Neural Network Based on Quantitative Ultrasound Radiofrequency Signal. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1590-1601. [PMID: 35581115 DOI: 10.1016/j.ultrasmedbio.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 06/15/2023]
Abstract
Quantitative ultrasound (QUS) is a promising screening method for osteoporosis. In this study, a new method to improve the diagnostic accuracy of QUS was established in which a multichannel convolutional neural network (MCNN) processes the raw radiofrequency (RF) signal of QUS. The improvement in the diagnostic accuracy of osteoporosis using this new method was evaluated by comparison with the conventional speed of sound (SOS) method. Dual-energy X-ray absorptiometry was used as the diagnostic standard. After being trained, validated and tested in a data set consisting of 274 participants, the MCNN model could significantly raise the accuracy of osteoporosis diagnosis compared with the SOS method. The adjusted MCNN model performed even better when adjusted by age, height and weight data. The sensitivity, specificity and accuracy of the adjusted MCNN method for osteoporosis diagnosis were 80.86%, 84.23% and 83.05%, respectively; the corresponding values for SOS were 50.60%, 73.68% and 66.67%. The area under the receiver operating characteristic curve of the adjusted MCNN method was also higher than that of SOS (0.846 vs. 0.679). In conclusion, our study indicates that the MCNN method may be more accurate than the conventional SOS method. The MCNN tool and ultrasound RF signal analysis are promising future developmental directions for QUS in screening for osteoporosis.
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Affiliation(s)
- Wenqiang Luo
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Bioland Laboratory, Guangzhou, China.
| | - Zhiwei Chen
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Qi Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Baiying Lei
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China
| | - Zhong Chen
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Fu
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peidong Guo
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Changchuan Li
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Teng Ma
- Paul C. Lauterbur Research Center for Biomedical Imaging, Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Jiang Liu
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Industrial Technology, Chinese Academy of Sciences, Ningbo, China; Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China.
| | - Yue Ding
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Bioland Laboratory, Guangzhou, China.
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Reproducibility and Accuracy of the Radiofrequency Echographic Multi-Spectrometry for Femoral Mineral Density Estimation and Discriminative Power of the Femoral Fragility Score in Patients with Primary and Disuse-Related Osteoporosis. J Clin Med 2022; 11:jcm11133761. [PMID: 35807046 PMCID: PMC9267756 DOI: 10.3390/jcm11133761] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to investigate the reproducibility and accuracy of Radiofrequency Echographic Multi-Spectrometry (REMS) for femoral BMD estimation and the reproducibility and discriminative power of the REMS-derived femoral fragility score. 175 patients with primary and disuse-related osteoporosis were recruited: one femoral Dual-energy X-ray Absorptiometry (DXA) scan and two femoral REMS scans were acquired. No significant test—retest differences were observed for all REMS-derived variables. The diagnostic concordance between DXA and REMS was 63% (Cohen’s kappa = 0.31) in patients with primary osteoporosis and 13% (Cohen’s kappa: −0.04) in patients with disuse-related osteoporosis. No significant difference was observed between REMS and DXA for either femoral neck BMD (mean difference between REMS and DXA: −0.015 g/cm2) or total femur BMD (mean difference: −0.004 g/cm2) in patients with primary osteoporosis. Significant differences between the two techniques were observed in patients with disuse-related osteoporosis (femoral neck BMD difference: 0.136 g/cm2; total femur BMD difference: 0.236 g/cm2). Statistically significant differences in the fragility score were obtained between the fractured and non-fractured patients for both populations. In conclusion, REMS showed excellent test-retest reproducibility, but the diagnostic concordance between DXA and REMS was between minimal and poor. Further studies are required to improve the REMS—derived estimation of femoral BMD.
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Estimation of Thickness and Speed of Sound for Transverse Cortical Bone Imaging Using Phase Aberration Correction Methods: An In Silico and Ex Vivo Validation Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Delay-and-sum (DAS) beamforming of backscattered echoes is used for conventional ultrasound imaging. Although DAS beamforming is well suited for imaging in soft tissues, refraction, scattering, and absorption, porous mineralized tissues cause phase aberrations of reflected echoes and subsequent image degradation. The recently developed refraction corrected multi-focus technique uses subsequent focusing of waves at variable depths, the tracking of travel times of waves reflected from outer and inner cortical bone interfaces, the estimation of the shift needed to focus from one interface to another to determine cortical thickness (Ct.Th), and the speed of sound propagating in a radial bone direction (Ct.ν11). The method was validated previously in silico and ex vivo on plate shaped samples. The aim of this study was to correct phase aberration caused by bone geometry (i.e., curvature and tilt with respect to the transducer array) and intracortical pores for the multi-focus approach. The phase aberration correction methods are based on time delay estimation via bone geometry differences to flat bone plates and via the autocorrelation and cross correlation of the reflected ultrasound waves from the endosteal bone interface. We evaluate the multi-focus approach by incorporating the phase aberration correction methods by numerical simulation and one experiment on a human tibia bone, and analyze the precision and accuracy of measuring Ct.Th and Ct.ν11. Site-matched reference values of the cortical thickness of the human tibia bone were obtained from high-resolution peripheral computed tomography. The phase aberration correction methods resulted in a more precise (coefficient of variation of 5.7%) and accurate (root mean square error of 6.3%) estimation of Ct.Th, and a more precise (9.8%) and accurate (3.4%) Ct.ν11 estimation, than without any phase aberration correction. The developed multi-focus method including phase aberration corrections provides local estimations of both cortical thickness and sound velocity and is proposed as a biomarker of cortical bone quality with high clinical potential for the prevention of osteoporotic fractures.
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Caffarelli C, Tomai Pitinca MD, Al Refaie A, De Vita M, Catapano S, Gonnelli S. Could radiofrequency echographic multispectrometry (REMS) overcome the overestimation in BMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine? BMC Musculoskelet Disord 2022; 23:469. [PMID: 35590362 PMCID: PMC9118880 DOI: 10.1186/s12891-022-05430-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) and vertebral fractures at the lumbar spine lead to an overestimation of bone mineral density (BMD). Recently, a new approach for osteoporosis diagnosis, defined as radiofrequency echographic multi-spectrometry (REMS), represents an innovative diagnostic tool that seems to be able to investigate bone quality and provide an estimation of fracture risk independent of BMD. The aim of this paper was to evaluate whether the use of REMS technology can favor the diagnosis of osteoporosis in subjects with an apparent increase in BMD. METHODS In a cohort of 159 postmenopausal (66.2 ± 11.6 yrs) women with overestimated BMD by DXA at the lumbar spine, we performed an echographic scan with the REMS technique. RESULTS The mean values of BMD at different skeletal sites obtained by the DXA and REMS techniques showed that the BMD T-scores by REMS were significantly lower than those obtained by the DXA technique both at the lumbar spine (p < 0.01) and at all femoral subregions (p < 0.05). In OA subjects, the percentage of women classified as "osteoporotic" on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (35.1% vs 9.3%, respectively). Similarly, the REMS allows a greater number of fractured patients to be classified as osteoporotic than DXA (58.7% vs 23.3%, respectively). CONCLUSIONS REMS technology by the analysis of native raw unfiltered ultrasound signals appears to be able to overcome the most common artifacts, such as OA and vertebral fracture of the lumbar spine, which affect the value of BMD by DXA.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maria Dea Tomai Pitinca
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Antonella Al Refaie
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Michela De Vita
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Simone Catapano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
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Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila MI, Saag KG, Rossini M. Osteoporosis in 10 years time: a glimpse into the future of osteoporosis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083541. [PMID: 35342458 PMCID: PMC8941690 DOI: 10.1177/1759720x221083541] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Patients living with osteoporosis are projected to increase dramatically in the
next decade. Alongside the forecasted increased societal and economic burden, we
will live a crisis of fractures. However, we will have novel pharmacological
treatment to face this crisis and, more importantly, new optimized treatment
strategies. Fracture liaison services will be probably implemented on a large
scale worldwide, helping to prevent additional fractures in high-risk patients.
In the next decade, novel advances in the diagnostic tools will be largely
available. Moreover, new and more precise fracture risk assessment tools will
change our ability to detect patients at high risk of fractures. Finally, big
data and artificial intelligence will help us to move forward into the world of
precision medicine. In the present review, we will discuss the future
epidemiology and costs of osteoporosis, the advances in early and accurate
diagnosis of osteoporosis, with a special focus on biomarkers and imaging tools.
Then we will examine new and refined fracture risk assessment tools, the role of
fracture liaison services, and a future perspective on osteoporosis
treatment.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
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Sergio RO, Nayelli RGE. Evaluation of the bone mineral density in the Mexican female population using the Radiofrequency Echographic Multi Spectrometry (REMS) technology. Arch Osteoporos 2022; 17:43. [PMID: 35257242 DOI: 10.1007/s11657-022-01080-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/15/2022] [Indexed: 02/03/2023]
Abstract
The bone health status of a Mexican female population, including a cohort of 455 women aged over 40 years, was assessed by Radiofrequency Echographic Multi Spectrometry (REMS). PURPOSE Assessment of the bone health status in an average female Mexican population with REMS. The secondary objective investigated age- and body mass index (BMI)-related effects on the diagnostic classification and the influence of risk factors for osteoporosis. METHODS Women aged over 40 years underwent a REMS scan at the lumbar spine and both femoral necks. The degree of correlation of the bone mineral density (BMD) across axial sites was assessed by the Pearson correlation coefficient (r), along with the diagnostic discordance. The association between risk factors, age, and BMI and diagnostic classification was determined by the chi-squared test. RESULTS Four hundred seventy-one women were enrolled. Osteoporosis was diagnosed in 11.0%, 8.1%, and 8.3% of cases at the lumbar spine and right and left femoral neck, respectively. The diagnostic agreement between the lumbar spine and femoral necks was about 73% (85% considering a 0.3 T-score tolerance), whereas the agreement between the femoral necks was 97.4% (99.6% considering a 0.3 T-score tolerance). Most of discordant cases were minor discordances. The correlation between the lumbar spine and femoral neck was r = 0.82 and 0.85, respectively, whereas both femoral necks correlated with r = 0.97. As expected, the prevalence of osteoporosis increased with age and decreased as BMI increased. CONCLUSION The widespread applicability of the non-ionizing REMS technology has been demonstrated in a representative Mexican cohort, covering wide age and BMI ranges. Age and BMI variations correlate with the prevalence of osteoporosis, in line with the recent scientific literature.
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Affiliation(s)
- Rosales-Ortiz Sergio
- Hospital de Gineco Obstetricia, No. 4 "Luis Castelazo Ayala", IMSS, Mexico City, Mexico.
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Wang CY, Chu SY, Lin YC, Tsai YW, Tai CL, Yang KC, Tsui PH. Quantitative imaging of ultrasound backscattered signals with information entropy for bone microstructure characterization. Sci Rep 2022; 12:414. [PMID: 35013540 PMCID: PMC8748747 DOI: 10.1038/s41598-021-04425-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/08/2021] [Indexed: 12/19/2022] Open
Abstract
Osteoporosis is a critical problem during aging. Ultrasound signals backscattered from bone contain information associated with microstructures. This study proposed using entropy imaging to collect the information in bone microstructures as a possible solution for ultrasound bone tissue characterization. Bone phantoms with different pounds per cubic foot (PCF) were used for ultrasound scanning by using single-element transducers of 1 (nonfocused) and 3.5 MHz (nonfocused and focused). Clinical measurements were also performed on lumbar vertebrae (L3 spinal segment) in participants with different ages (n = 34) and postmenopausal women with low or moderate-to-high risk of osteoporosis (n = 50; identified using the Osteoporosis Self-Assessment Tool for Taiwan). The signals backscattered from the bone phantoms and subjects were acquired for ultrasound entropy imaging by using sliding window processing. The independent t-test, one-way analysis of variance, Spearman correlation coefficient rs, and the receiver operating characteristic (ROC) curve were used for statistical analysis. The results indicated that ultrasound entropy imaging revealed changes in bone microstructures. Using the 3.5-MHz focused ultrasound, small-window entropy imaging (side length: one pulse length of the transducer) was found to have high performance and sensitivity in detecting variation among the PCFs (rs = − 0.83; p < 0.05). Small-window entropy imaging also performed well in discriminating young and old participants (p < 0.05) and postmenopausal women with low versus moderate-to-high osteoporosis risk (the area under the ROC curve = 0.80; cut-off value = 2.65; accuracy = 86.00%; sensitivity = 71.43%; specificity = 88.37%). Ultrasound small-window entropy imaging has great potential in bone tissue characterization and osteoporosis assessment.
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Affiliation(s)
- Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyüan, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyüan, Taiwan
| | - Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyüan, Taiwan
| | - Yu-Wei Tsai
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyüan, Taiwan
| | - Ching-Lung Tai
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyüan, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyüan, Taiwan. .,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyüan, Taiwan. .,Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyüan, Taiwan.
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Pulse-Echo Measurements of Bone Tissues. Techniques and Clinical Results at the Spine and Femur. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:145-162. [DOI: 10.1007/978-3-030-91979-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Clinical Devices for Bone Assessment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:35-53. [DOI: 10.1007/978-3-030-91979-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Caffarelli C, Tomai Pitinca MD, Al Refaie A, Ceccarelli E, Gonnelli S. Ability of radiofrequency echographic multispectrometry to identify osteoporosis status in elderly women with type 2 diabetes. Aging Clin Exp Res 2022; 34:121-127. [PMID: 34050917 PMCID: PMC8795029 DOI: 10.1007/s40520-021-01889-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with type 2 diabetes (T2DM) have an increased or normal BMD; however fragility fractures represent one of the most important complications of T2DM. AIMS This study aimed to evaluate whether the use of the Radiofrequency Echographic multi spectrometry (REMS) technique may improve the identification of osteoporosis in T2DM patients. METHODS In a cohort of 90 consecutive postmenopausal elderly (70.5 ± 7.6 years) women with T2DM and in 90 healthy controls we measured BMD at the lumbar spine (LS-BMD), at femoral neck (FN-BMD) and total hip (TH-BMD) using a dual-energy X-ray absorptiometry device; moreover, REMS scans were also carried out at the same axial sites. RESULTS DXA measurements were all higher in T2DM than in non-T2DM women; instead, all REMS measurements were lower in T2DM than in non T2DM women. Moreover, the percentage of T2DM women classified as "osteoporotic", on the basis of BMD by REMS was markedly higher with respect to those classified by DXA (47.0% vs 28.0%, respectively). On the contrary, the percentage of T2DM women classified as osteopenic or normal by DXA was higher with respect to that by REMS (48.8% and 23.2% vs 38.6% and 14.5%, respectively). T2DM women with fragility fractures presented lower values of both BMD-LS by DXA and BMD-LS by REMS with respect to those without fractures; however, the difference was significant only for BMD-LS by REMS (p < 0.05). CONCLUSIONS Our data suggest that REMS technology may represent a useful approach to enhance the diagnosis of osteoporosis in patients with T2DM.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Maria Dea Tomai Pitinca
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Antonella Al Refaie
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Elena Ceccarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
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Ambrosio MR, Aliberti L, Gagliardi I, Franceschetti P, Zatelli MC. Bone health in adolescence. Minerva Obstet Gynecol 2021; 73:662-677. [PMID: 34905874 DOI: 10.23736/s2724-606x.20.04713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.
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Affiliation(s)
- Maria R Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Ludovica Aliberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Operative Unit of Endocrinology and Metabolic Diseases, Department of Oncology and Specialty Medicine, Ferrara University Hospital, Ferrara, Italy
| | - Maria C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Tomai Pitinca MD, Fortini P, Gonnelli S, Caffarelli C. Could Radiofrequency Echographic Multi-Spectrometry (REMS) Overcome the Limitations of BMD by DXA Related to Artifacts? A Series of 3 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2773-2777. [PMID: 33615539 DOI: 10.1002/jum.15665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
Dual-energy X-ray absorptiometry (DXA) is considered the gold standard in the evaluation of bone mineral density (BMD) and in the diagnosis of osteoporosis.The diagnostic sensitivity of BMD at lumbar spine is frequently reduced by the presence of artifacts. This study aimed to show the usefulness of radiofrequency echographic multi-spectrometry (REMS) in determining lumbar BMD in the presence of artifacts with DXA measurements. We present 3 cases in which REMS technology, by the analysis of native raw unfiltered ultrasound signals, appears to be able to recognize and overcome the most common artifacts that affect the value of the BMD by DXA, thus allowing a better assessment of fracture risk.
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Affiliation(s)
| | - Pietro Fortini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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40
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New technology REMS for bone evaluation compared to DXA in adult women for the osteoporosis diagnosis: a real-life experience. Arch Osteoporos 2021; 16:175. [PMID: 34786596 DOI: 10.1007/s11657-021-00990-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis is a prevalent skeletal disorder in postmenopausal women. REMS represents a potential technology for osteoporosis diagnosis in clinical practice. OBJECTIVE To assess the accuracy of Radiofrequency Echographic Multi Spectrometry (REMS) technology in diagnosing osteoporosis in comparison with dual X-ray absorptiometry (DXA) on a population of Brazilian women. METHODS A population of women age ranged between 30 and 80 was recruited at DXA Service of São Paulo School-Hospital, Brazil. They underwent REMS and DXA scans at the axial sites. The REMS accuracy for the osteoporosis diagnosis was evaluated in comparison with DXA on both sites. The intra-operator and inter-operator coefficient of variation (CV) was also calculated. RESULTS A total of 343 patients were enrolled in the study. Erroneous scans due to poor quality acquisitions with both methods or to other technical reasons were excluded; 227 lumbar spine exams and 238 hip exams were acceptable for comparison analysis. The comparison between REMS and DXA outcomes showed that the average difference in BMD (expressed as bias±1.96 SD) was -0.026±0.179g/cm2 for the spine and -0.027±0.156g/cm2 for the femoral neck. When accepted 0.3 tolerance on T-score, there were no cases diagnosed as osteoporosis by DXA that were defined as normal by REMS. The REMS intra-operator CV was 0.51% for the lumbar spine and 1.08% for the femoral neck. The REMS inter-operator CV was 1.43% for the lumbar spine and 1.93% for the femoral neck. CONCLUSION The REMS approach had high accuracy for the diagnosis of osteoporosis in comparison with DXA in adult women. According to our results, this new technology has shown to be a promising alternative for populations without access to DXA densitometry.
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Gómez O, Talero AP, Zanchetta MB, Madeira M, Moreira CA, Campusano C, Orjuela AM, Cerdas P S, de la Peña-Rodríguez MP, Reza AA, Velazco C, Mendoza B, Uzcátegui LR, Rueda PN. Diagnostic, treatment, and follow-up of osteoporosis-position statement of the Latin American Federation of Endocrinology. Arch Osteoporos 2021; 16:114. [PMID: 34302550 DOI: 10.1007/s11657-021-00974-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED The Latin American Federation of Endocrinology position statement on osteoporosis was developed by endocrinologists from 9 countries. It encompasses the definition, diagnosis, treatment, and follow-up of the disease, the identification of barriers to healthcare, and proposals to improve the disease care in the region. INTRODUCTION There is a gap in the understanding of osteoporosis in Latin America. The objective of this work is to state the position of the Latin American Federation of Endocrinology on osteoporosis care in postmenopausal women to better bridge this gap. METHODS An experts' panel was formed comprising of 11 endocrinologists from 9 countries. A data search was conducted with a conceptual approach and data selection was based on the hierarchy of the EBHC pyramid. Unpublished data was considered for local epidemiological data and expert opinion for the identification of barriers to healthcare. An expert consensus based on the Delphi methodology was carried out. Experts were asked to respond on a 5-point Likert Scale to two provided answers to guiding questions. RESULTS Consensus was agreed on the answer for the questions with the higher median on the Likert scale and synthetized on 16 statements covering the definition of osteoporosis, diagnostic approach, treatment options, and follow-up. Besides clinical topics, unmet needs in osteoporosis were identified in relation to local epidemiological data, barriers to treatment, and misclassification of programs within health systems. CONCLUSIONS Through a process based on recognized methodological tools, FELAEN's position on osteoporosis was developed. This made it possible to state an optimum scenario for the care of the disease and helped to identify knowledge gaps. There is great variability in the approach to osteoporosis in Latin America and barriers in all the stages of healthcare persist.
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Affiliation(s)
- O Gómez
- Departamento de Ciencias Fisiológicas, Facultad de Medicina de la Pontificia, Universidad Javeriana, Bogotá, Colombia.
| | - A P Talero
- Asociación Colombiana de Endocrinología, Diabetes y Metabolismo (ACE), Bogotá, Colombia
| | - M B Zanchetta
- Cátedra de Osteología y Metabolismo Mineral, Facultad de Medicina, Universidad del Salvador, Instituto de Investigaciones Metabólicas (IDIM), Asociación Argentina de Osteología y Metabolismo Mineral (AAOMM), Sociedad Argentina de Endocrinología (SAEM), Buenos Aires, Argentina
| | - M Madeira
- Departamento de Metabolismo Óseo y Mineral de La Sociedad Brasilera de Endocrinología y Metabolismo (SBEM), Universidade Federal Do Rio de Janeiro (UFRJ), Río de Janeiro, Brazil
| | - C A Moreira
- Servicio de Endocrinología del Hospital de Clínicas da UFPR (SEMPR), Departamento de Metabolismo Óseo y Mineral de la Sociedad Brasilera de Endocrinología y Metabolismo (SBEM), Universidade Federal Do Paraná (UFPR), Curitiba, Brazil
| | - C Campusano
- Facultad de Medicina de la Universidad de los Andes, Unidad de Endocrinología de la Clínica Universidad de los Andes, Sociedad Chilena de Endocrinología y Diabetes (SOCHED), Santiago, Chile
| | - A M Orjuela
- Facultad de Medicina de la Fundación Universitaria de Ciencias de la Salud (FUCS), Servicio de Endocrinología del Hospital San José, Asociación Colombiana de Osteoporosis y Metabolismo Mineral (ACOMM), Asociación Colombiana de Endocrinología (ACE), Bogotá, Colombia
| | - S Cerdas P
- Facultad de Medicina de la Universidad de Costa Rica, Servicio de Endocrinología del Hospital Cima, Asociación Pro Estudio de la Diabetes, Endocrinología y Metabolismo (ANPEDEM), San José, Costa Rica
- Departamento de Endocrinología de la Facultad de Medicina de la Universidad Autónoma de Guadalajara (UAG), Servicios Médicos De la Peña, SC, Sociedad Mexicana de Nutrición y Endocrinología, Asociación Mexicana de Metabolismo Óseo y Mineral. Colegio Jalisciense de Endocrinología y Nutrición. Presidenta electa para la Asociación Mexicana de Metabolismo Óseo y Mineral, AC (AMMOM), Guadalajara, México
| | - M P de la Peña-Rodríguez
- Universidad Nacional Autónoma de México, sede Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Departamento de Endocrinología y Metabolismo del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Sociedad Mexicana de Nutrición y Endocrinología y Consejo Mexicano de Endocrinología, Ciudad de México, México
| | - A A Reza
- Instituto de Endocrinología, Nutrición y Osteoporosis, Fundación Dominicana de Enfermedades Metabólicas, Menopausia y Osteoporosis (FUNDEMOS), Santo Domingo, República Dominicana
| | - C Velazco
- Clínica de Endocrinología y Metabolismo de la Facultad de Medicina de la República Oriental del Uruguay, Clínica de Endocrinología y Metabolismo del Hospital Manuel Quintela, Sociedad Uruguaya de Endocrinología y Metabolismo (SUEM), Montevideo, Uruguay
| | - B Mendoza
- Universidad de Los Andes, Sociedad Venezolana de Endocrinología y Metabolismo, Mérida, Venezuela
| | - L R Uzcátegui
- Universidad Nacional de Colombia, Asociación Colombiana de Endocrinología, diabetes y metabolismo (ACE), Presidente de la Federación Latinoamericana de Endocrinología (FELAEN), Bogotá, Colombia
| | - P N Rueda
- Presidente de la Federación Latinoamericana de Endocrinología (FELAEN), Universidad Nacional de Colombia, Asociación Colombiana de Endocrinología, Diabetes y Metabolismo (ACE), Bogotá, Colombia
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Tan YJ, Lim SY, Yong VW, Choo XY, Ng YD, Sugumaran K, Md Shah MN, Raja Aman RRA, Paramasivam SS, Mohd Ramli N, Grossmann M, Tan AH. Osteoporosis in Parkinson's Disease: Relevance of Distal Radius Dual-Energy X-Ray Absorptiometry (DXA) and Sarcopenia. J Clin Densitom 2021; 24:351-361. [PMID: 32888777 DOI: 10.1016/j.jocd.2020.07.001] [Citation(s) in RCA: 3] [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: 04/25/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022]
Abstract
Osteoporotic fractures are common in Parkinson's disease (PD). Standard dual-energy X-ray absorptiometry (DXA) measuring bone mineral density (BMD) at the femoral neck and lumbar spine (central sites) has suboptimal sensitivity in predicting fracture risk in the general population. An association between sarcopenia and osteoporosis in PD has not been studied. We compared BMD and osteoporosis prevalence in PD patients vs controls; determined the osteoporosis detection rates using central alone vs central plus distal radius DXA; and analyzed factors (in particular, sarcopenia) associated with osteoporosis. One hundred and fifty-six subjects (102 patients with PD, 54 spousal/sibling controls) underwent femoral neck-lumbar spine-distal radius DXA. Seventy-three patients and 46 controls were assessed for sarcopenia using whole-body DXA and handgrip strength. Patients underwent clinical and serum biochemical evaluations. PD patients had significantly lower body mass index compared to controls. After adjustment for possible confounders, distal radius BMD and T-scores were significantly lower in PD patients compared to controls, but not at the femoral neck/lumbar spine. With distal radius DXA, an additional 11.0% of patients were diagnosed with osteoporosis (32.0% to 43.0%), vs 3.7% in controls (33.3% to 37.0%) additionally diagnosed; this increase was largely driven by the markedly higher detection rate in female PD patients. Female gender (adjusted odds ratio [ORadjusted] = 11.3, 95% confidence interval [CI]: 2.6-48.6) and sarcopenia (ORadjusted = 8.4, 95% CI: 1.1-64.9) were independent predictors for osteoporosis in PD. Distal radius DXA increased osteoporosis detection, especially in female PD patients, suggesting that diagnostic protocols for osteoporosis in PD could be optimized. A close association between osteoporosis and sarcopenia was documented for the first time in PD, which has important implications for clinical management and future research.
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Affiliation(s)
- Yan Jing Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shen-Yang Lim
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Voon Wei Yong
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xing Yan Choo
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yi-De Ng
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kavita Sugumaran
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohammad Nazri Md Shah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Sharmila Sunita Paramasivam
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlisah Mohd Ramli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mathis Grossmann
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Ai Huey Tan
- Division of Neurology, Department of Medicine; and the Mah Pooi Soo & Tan Chin Nam Centre for Parkinson's & Related Disorders, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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Degennaro VA, Brandi ML, Cagninelli G, Casciaro S, Ciardo D, Conversano F, Di Pasquo E, Gonnelli S, Lombardi FA, Pisani P, Ghi T. First assessment of bone mineral density in healthy pregnant women by means of Radiofrequency Echographic Multi Spectrometry (REMS) technology. Eur J Obstet Gynecol Reprod Biol 2021; 263:44-49. [PMID: 34167032 DOI: 10.1016/j.ejogrb.2021.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The maternal bone structure is the largest calcium reserve for the fetus during pregnancy, and this is claimed to lead to a bone mineral density (BMD) reduction in pregnant women. The primary outcome of the present work was to assess the BMD in a group of healthy pregnant women. STUDY DESIGN In this prospective case - control observational study, a non-consecutive group of pregnant women with uncomplicated pregnancy at or >37 weeks were enrolled at the unit of Obstetrics and Gynecology, University of Parma, from February to December 2020. The study subjects were submitted to a sonographic examination of the proximal femur with Radiofrequency Echographic Multi Spectrometry (REMS) technology to quantify the BMD of the femur. The BMD values obtained in the study group were compared with those of a control group of non-pregnant women matched for age, ethnicity and pre-pregnant body mass index (BMI). RESULTS Overall, 78 pregnant women at 39.1 ± 1.5 weeks were assessed. Compared with non-pregnant women, the femoral BMD values measured in pregnancy using REMS were significant lower (0.769 ± 0.094 g/cm2 vs 0.831 ± 0.101 g/cm2, p = 0.0001) with a mean BMD reduction of 8.1%. The femoral neck BMD presented a positive correlation with the pre-pregnant BMI (p = 0.0004) and a negative correlation with the maternal age (p < 0.0001). In addition, a lower femoral neck BMD in Caucasian ethnicity compared with non-Caucasian was noted (p < 0.0001). CONCLUSION In this exploratory and proof of concept study, for the first time, a decreased BMD has been objectively demonstrated in pregnant compared with non-pregnant women by means of REMS technology. New studies are required to assess the longitudinal changes of maternal bone density throughout the pregnancy.
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Affiliation(s)
- Valentina Anna Degennaro
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Maria Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Greta Cagninelli
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Council Research, Lecce, Italy
| | - Delia Ciardo
- Institute of Clinical Physiology, National Council Research, Lecce, Italy
| | | | - Elvira Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | | | - Paola Pisani
- Institute of Clinical Physiology, National Council Research, Lecce, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy.
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Marchenkova LA, Fesyun AD, Gerasimenko MY. [The relevance of the diagnosis, treatment and prevention of osteoporosis for the clinical practice of doctors working in the field of rehabilitation and spa medicine]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2021; 98:55-64. [PMID: 33899453 DOI: 10.17116/kurort20219802155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a high prevalence of osteoporosis (OP) among patients of the older age undergoing rehabilitation. Therefore, it is obvious that physicians working in the field of physical and rehabilitative medicine should be well oriented in this medical problem. OBJECTIVE To study the relevance of the OP problem for physicians working in the field of physical and rehabilitation medicine, their awareness of the main methods of diagnosis, treatment and prevention of OP, as well as the frequency of using these methods in daily clinical practice. MATERIAL AND METHODS A cross-type study was carried out using a questionnaire survey. The study included 157 doctors (male 34, female 123) of 8 medical specialties working in 27 specialized medical institutions on the profile of «medical rehabilitation» or «spa treatment». The questionnaire for doctors consisted of 21 items of special questions. RESULTS 90.45% of doctors considered the problem of OP is relevant for their clinical activities, 100% of respondents indicated that the presence of OP significantly affects the rehabilitation prognosis, 95.54% - the effectiveness of medical rehabilitation. According to the respondents the patients with OP cover 30.0% of total patients flow on average. 145 (92.36%) doctors noted that they know the OP risk factors, 155 (98.73%) - methods for OP diagnosing, 108 (68.79%) - methods for OP treatment, 126 (80, 25%) - methods for OP prevention, 74 (47.13%) - FRAX. 55 (35.01%) respondents identified their level of awareness on the OP problem as sufficient for managing patients with this pathology. Diagnostic procedures for OP were recommended by all interviewed endocrinologists (100%), most of traumatologists-orthopedists (72.73%), obstetricians-gynecologists (66.67%) and cardiologists (64.28%), as well as on average 1/2 (50%) neurologists and therapists. OP treatment was mainly performed by endocrinologists (100%), obstetricians-gynecologists (66.67%) and therapists (60%). 32.48% of physicians in the study sample have ever referred their patients to a densitometry and the diagnosis of OP was established in 80.25% of cases on the basis of bone densitometry data. CONCLUSION The problem of OP is relevant for the clinical practice of doctors working in the field of rehabilitation and balneology medicine; the presence of OP significantly affects the prognosis and effectiveness of medical rehabilitation. The results of the study demonstrated the need to expand the availability of OP diagnostics methods in rehabilitation and balneology organizations, as well as the need to raise awareness of the OP problem among specialists working in this area.
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Affiliation(s)
- L A Marchenkova
- National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia
| | - A D Fesyun
- National Medical Research Center of Rehabilitation and Balneology, Moscow, Russia
| | - M Yu Gerasimenko
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Cortet B, Dennison E, Diez-Perez A, Locquet M, Muratore M, Nogués X, Ovejero Crespo D, Quarta E, Brandi ML. Radiofrequency Echographic Multi Spectrometry (REMS) for the diagnosis of osteoporosis in a European multicenter clinical context. Bone 2021; 143:115786. [PMID: 33278653 DOI: 10.1016/j.bone.2020.115786] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Radiofrequency Echographic Multi Spectrometry (REMS) is a non-ionizing technology for the densitometric assessment of osteoporosis. It has already been validated in Italian women with respect to the current clinical reference technology, Dual-energy X-ray Absorptiometry (DXA). PURPOSE Aim of the current study was to assess the diagnostic accuracy of REMS technology with respect to DXA in a wider European clinical context. METHODS A total of 4307 female Caucasian patients aged between 30 and 90 years underwent DXA and REMS scans at femoral neck and/or lumbar spine (the site depending on the medical prescription). The acquired data underwent a rigorous quality check in order to exclude the erroneous DXA and REMS reports. The diagnostic agreement between the two technologies was assessed, also stratifying for patients' age groups. The ability to recognise previously fractured patients was also investigated. RESULTS Overall, 4245 lumbar spine scans and 4271 femoral neck scans were performed. The ability to discriminate patients with and without osteoporosis by femoral neck investigation resulted in sensitivity and specificity of 90.4% and 95.5%, respectively. For lumbar spine scans, a sensitivity of 90.9% and a specificity of 95.1% were obtained. The areas under the curve (AUCs) of the Receiver Operating Characteristic (ROC) curve evaluating the ability to discriminate groups of patients with previous osteoporotic fracture using DXA and REMS T-score values were 0.631 and 0.683 (p < 0.0001), respectively, for femoral neck scans, whereas 0.603 and 0.640 (p = 0.0002), respectively, for lumbar spine scans. CONCLUSION The diagnostic effectiveness of REMS technology at reference anatomical sites for the assessment of osteoporosis has been confirmed in a large series of female patients, spanning from younger and pre-menopausal to elderly women up to 90 years, in a multicenter European clinical context.
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Affiliation(s)
- Bernard Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Adolfo Diez-Perez
- Musculoskeletal Research Group, IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Barcelona, Catalonia, Spain
| | - Médéa Locquet
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | | - Xavier Nogués
- Musculoskeletal Research Group, IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Barcelona, Catalonia, Spain
| | - Diana Ovejero Crespo
- Musculoskeletal Research Group, IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES), ISCIII, Barcelona, Catalonia, Spain
| | | | - Maria Luisa Brandi
- FirmoLab Fondazione F.I.R.M.O., Florence, Italy; Department of Biological, Experimental and Clinical Science, University of Florence, Florence, Italy.
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Ulivieri FM, Rinaudo L. Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index. Front Med (Lausanne) 2021; 7:590139. [PMID: 33521014 PMCID: PMC7843921 DOI: 10.3389/fmed.2020.590139] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
For a proper assessment of osteoporotic fragility fracture prediction, all aspects regarding bone mineral density, bone texture, geometry and information about strength are necessary, particularly in endocrinological and rheumatological diseases, where bone quality impairment is relevant. Data regarding bone quantity (density) and, partially, bone quality (structure and geometry) are obtained by the gold standard method of dual X-ray absorptiometry (DXA). Data about bone strength are not yet readily available. To evaluate bone resistance to strain, a new DXA-derived index based on the Finite Element Analysis (FEA) of a greyscale of density distribution measured on spine and femoral scan, namely Bone Strain Index (BSI), has recently been developed. Bone Strain Index includes local information on density distribution, bone geometry and loadings and it differs from bone mineral density (BMD) and other variables of bone quality like trabecular bone score (TBS), which are all based on the quantification of bone mass and distribution averaged over the scanned region. This state of the art review illustrates the methodology of BSI calculation, the findings of its in reproducibility and the preliminary data about its capability to predict fragility fracture and to monitor the follow up of the pharmacological treatment for osteoporosis.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Unità Operativa (UO) Medicina Nucleare, Milan, Italy
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Olszynski WP, Davison KS, Adachi JD, Brown JP, Hanley DA. Change in Quantitative Ultrasound-assessed Speed of Sound as a Function of Age in Women and Men and Association With the Use of Antiresorptive Agents: The Canadian Multicentre Osteoporosis Study. J Clin Densitom 2020; 23:549-560. [PMID: 31735596 DOI: 10.1016/j.jocd.2019.10.001] [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: 08/06/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Five-year changes in multisite quantitative ultrasound-assessed speed of sound (SOS in m/s) were studied in a cohort of women and men. The impacts of antiresorptive therapies and menopausal status on SOS were also assessed. METHODOLOGY Two SOS assessments, clinical assessments, and comprehensive questionnaires were completed 5 years apart on 509 women and 211 men. Age at first assessment was grouped into: <40 yr, 40-49 yr, 50-59 yr, 60-69 yr, 70-79 yr and 80+ yr. Mean rate of change in SOS at the distal radius and tibia were calculated for each age grouping by sex. SOS changes were stratified by antiresorptive use (yes, no) or menopausal status (premenopausal, postmenopausal, or bilateral oophorectomy). RESULTS Mean losses in SOS occurred over the 5 years in almost all age groupings. In women, mean losses in SOS for the <40 yr, 40-49 yr, 50-59 yr, 60-69 yr, 70-79 yr, and 80+ yr age groupings were -59, -83, -107, -92, -80 and -66 (p = 0.30; differences among age groupings) at the radius and -18, -16, -54, -1, -9 and 31 at the tibia (p < 0.05), respectively. In men, mean SOS losses were -101, -56, -69, -67, -83 and -127 at the radius (p = 0.61) and -46, -61, 0, -35, -29, and -26 at the tibia (p = 0.23). At the tibia, women prescribed antiresorptives had a mean increase in SOS (8.6 m/s) whereas untreated participants had a mean loss (-23.0; p < 0.001); there was no significant impact at the distal radius. There were no significant differences in change in SOS among menopausal groups (p > 0.26). CONCLUSIONS Mean SOS generally declined over 5 years in all age groupings of both sexes. The consistent mean losses in SOS over the age spans investigated are coincident with increasing fracture risk. Women on antiresorptive therapy had increased mean SOS over the 5-year assessment period at the tibia, whereas untreated women had mean losses in SOS.
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Affiliation(s)
- Wojciech P Olszynski
- Saskatoon Osteoporosis Centre and Camos Centre (Saskatchewan), Saskatoon, SK, Canada.
| | | | | | - Jacques P Brown
- CHU de Québec Research Centre, Laval University, Quebec City, Canada
| | - David A Hanley
- Departments of Medicine, Community Health Sciences, and Oncology, Cumming School of Medicine, The University of Calgary, Calgary, AB, Canada
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Gitto S, Messina C, Vitale N, Albano D, Sconfienza LM. Quantitative Musculoskeletal Ultrasound. Semin Musculoskelet Radiol 2020; 24:367-374. [PMID: 32992365 DOI: 10.1055/s-0040-1709720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ultrasound (US) imaging plays a crucial role in the assessment of musculoskeletal (MSK) disorders. Several quantitative tools are offered by US systems and add information to conventional US imaging. This article reviews the quantitative US imaging tools currently available in MSK radiology, specifically focusing on the evaluation of elasticity with shear-wave elastography, perfusion with contrast-enhanced US and noncontrast superb microvascular imaging, and bone and muscle mass with quantitative US methods. Some of them are well established and already of clinical value, such as elasticity and contrast-enhanced perfusion assessment in muscles and tendons. MSK radiologists should be aware of the potential of quantitative US tools and take advantage of their use in everyday practice, both for clinical and research purposes.
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Affiliation(s)
- Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Carmelo Messina
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Nicoló Vitale
- Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Dipartimento di Scienze Biomediche e Biotecnologiche, Università Degli Studi di Catania, Catania, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Automatic extraction of vertebral landmarks from ultrasound images: A pilot study. Comput Biol Med 2020; 122:103838. [DOI: 10.1016/j.compbiomed.2020.103838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022]
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Adami G, Arioli G, Bianchi G, Brandi ML, Caffarelli C, Cianferotti L, Gatti D, Girasole G, Gonnelli S, Manfredini M, Muratore M, Quarta E, Quarta L. Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study. Bone 2020; 134:115297. [PMID: 32092480 DOI: 10.1016/j.bone.2020.115297] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures. METHODS A population of Caucasian women (30-90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA. RESULTS 1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9-5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77-3.76, p < 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20-2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p < 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p < 0.001). CONCLUSIONS REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Arioli
- Department of Neurosciences and Rehabilitation, "Carlo Poma" Hospital, ASST-Mantova, Mantova, Italy
| | | | - Maria Luisa Brandi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Metabolic Bone Diseases Unit, University Hospital of Florence, Florence, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luisella Cianferotti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Metabolic Bone Diseases Unit, University Hospital of Florence, Florence, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | - Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Monica Manfredini
- Department of Neurosciences and Rehabilitation, "Carlo Poma" Hospital, ASST-Mantova, Mantova, Italy
| | - Maurizio Muratore
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy.
| | - Eugenio Quarta
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy
| | - Laura Quarta
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy
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