Diagnostic criteria for primary osteoporosis: year 2012 revision

Side-to-side differences in hip bone mineral density in patients with unilateral hip osteoarthritis

BACKGROUND

Accurately evaluating bone mineral density (BMD) in patients with unilateral hip osteoarthritis (OA) is crucial for diagnosing osteoporosis and selecting implants for hip arthroplasty. Our goal was to measure the BMD differences between sides, examine contributing factors, and identify the optimal side for BMD assessment in these patients.

METHODS

We analyzed 108 women with unilateral hip OA. Bilateral hip BMD was assessed automatically through quantitative CT (QCT) utilizing a validated, deep-learning-based approach. We evaluated BMD variations between the OA and healthy hips across total, neck, and distal regions. To determine their contributions, we analyzed factors, including patient demographics, Crowe classification, Bombelli classification, knee OA status, hip functional score, and gluteal muscle volume and density. Furthermore, we examined how side-to-side BMD differences influenced osteoporosis diagnosis using T-scores based on QCT.

RESULTS

The average BMD on the OA side was 6.9 % lower in the total region, 14.5 % higher in the neck region, and 9.4 % lower in the distal region than on the healthy side. Contributing factors to the reduced BMD in the OA hip included younger age, Bombelli classification (atrophic type), and significant gluteal muscle atrophy. Diagnoses from the OA side revealed lower sensitivity (61 %) than those from the healthy side (88 %).

CONCLUSIONS

Analysis on one side alone yields a more precise osteoporosis diagnosis from the healthy side. Nonetheless, bilateral BMD assessment remains crucial, particularly in younger individuals and those with atrophic OA types. Although based on QCT, our findings support bilateral analysis by dual-energy X-ray absorptiometry for these patients.

Randomized crossover comparison of two teriparatide self-injection regimens for primary osteoporosis: Interim report (end of 52-week treatment) of the Japanese Osteoporosis Intervention Trial 06 (JOINT-06)

INTRODUCTION

Patient satisfaction with two teriparatide (TPTD) self-injection regimens [once-daily (1/D)-TPTD and twice-weekly (2/W)-TPTD] was compared in a randomized crossover study involving patients with osteoporosis at high fracture risk.

MATERIALS AND METHODS

Questionnaires evaluated overall satisfaction, satisfaction with treatment effectiveness, satisfaction with utility of the self-injection device, and preference for a particular injection regimen after crossover. Quality of life (QOL), visual analogue scale pain scores, and bone mineral density (BMD) were also analyzed. Safety was evaluated based on the incidence and severity of adverse events (AEs).

RESULTS

The 1/D-TPTD and 2/W-TPTD groups comprised 180 (mean age: 75.9 ± 7.3 years) and 178 (75.4 ± 6.9 years) patients, respectively. After 26 weeks of treatment, the injection regimens were switched and treatment continued for another 26 weeks. Significantly higher persistence was observed in the 1/D-TPTD to 2/W-TPTD group (p = 0.032). No significant between-group differences in overall satisfaction scores or satisfaction with treatment were observed. Satisfaction with the utility of the injection device was significantly higher with the 2/W-TPTD regimen (p < 0.05); this regimen was preferred by 69.4% of patients after crossover (p < 0.001). A significant increase in BMD from baseline was observed at the lumbar vertebrae in both groups and at the hip area in the 1/D-TPTD to 2/W-TPTD group at 52 weeks (p < 0.05). Significant improvement in the QOL score was observed in both groups (p < 0.05). No serious AEs were reported.

CONCLUSION

Continuation of this study will further clarify patient satisfaction, treatment effects, and tolerability.

Impact of Cage Placement on Vertebral Endplate Cyst Formation and Bone Union in Transforaminal Lumbar Interbody Fusion

Study DesignRetrospective cohort study.ObjectivesTo determine the ideal cage placement position in transforaminal lumbar interbody fusion (TLIF) surgery to prevent vertebral endplate cyst (VEC) formation and improve bone union rates.MethodsThis study retrospectively analyzed 69 patients who underwent TLIF, and 88 intervertebral levels were observed. Patients were categorized into peripheral, central, and mixed types based on the cage placement. The incidence of VEC formation and endplate injuries (EIs) were assessed using computed tomography 1 year postoperatively. Factors associated with VEC formation and non-union, including patient demographics, clinical data, cage placement, Hounsfield unit values, and intraoperative EIs, were analyzed.ResultsVECs occurred in 55.7% of surgical levels and were significantly associated with non-union (P < .001). Center-type cage placement was a strong predictor of VEC formation (P = .028, OR = 16.3, 95% confidence interval [CI]: 1.36-195.0), along with EIs (P = .003, OR = 5.86, 95% CI: 1.80-19.0). In contrast, pre-existing VECs appeared to have a protective effect (P = .046, OR = 0.272, 95% CI: 0.076-0.979).ConclusionsCage placement in the central region significantly increases the risk of VEC formation and non-union. Periphery-type placement may be preferable to reduce endplate damage and improve fusion outcomes. Preventing EIs and optimizing cage positioning are critical to minimize VEC formation. Further prospective studies are needed to refine surgical strategies and improve long-term outcomes following TLIF.

Dual-energy computed tomography may reduce delayed diagnosis of occult hip fractures: Experiences at a single center

Objectives

Early surgical intervention within 48 h is critical for reducing mortality and morbidity in patients with hip fractures. However, occult hip fractures are often missed, leading to treatment delays. Dual-energy computed tomography allows visualization of bone marrow edema and bone contusions, which are challenging to detect using conventional computed tomography. This study aimed to evaluate the effectiveness of dual-energy computed tomography in diagnosing occult hip fractures.

Methods

Eighteen dual-energy computed tomography scans obtained between May 2018 and March 2024 were analyzed. Magnetic resonance imaging was performed in all cases. A trained musculoskeletal radiologist interpreted the dual-energy computed tomography and magnetic resonance imaging scans, which were then reviewed by two senior orthopedic surgeons. The confirmed diagnoses included 14 femoral trochanteric fractures and 4 femoral neck fractures. Four junior orthopedic surgeons independently reviewed the dual-energy computed tomography scans only and conducted diagnostic examinations. Patients were subsequently categorized into two groups: those with unanimous diagnostic agreement (unanimity group) and those with discrepancies (objection group).

Results

For femoral trochanteric fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 94%, 81%, 0.91, and 0.75, respectively. For femoral neck fractures, sensitivity, specificity, accuracy, and Cohen's kappa coefficient were 68%, 96%, 0.90, and 0.69, respectively. A significant difference in diagnostic ease was noted (p = 0.04), with agreement achieved for 12 of the 14 femoral trochanteric fractures and one of the four femoral neck fractures. Logistic regression analysis yielded a regression coefficient for femoral trochanteric fractures of 3.05 (p = 0.03), indicating that these fractures were more easily diagnosed than femoral neck fractures.

Conclusions

Dual-energy computed tomography demonstrated high sensitivity and specificity in detecting occult hip fractures, particularly those of the femoral trochanter. However, its sensitivity was lower for femoral neck fractures, indicating limited reliability in their diagnosis. Further investigation and magnetic resonance imaging scans are recommended for suspected femoral neck fractures.

Real-world safety and effectiveness of romosozumab following daily or weekly administration of teriparatide in primary and secondary osteoporosis

Romosozumab is an anti-sclerostin antibody that increases bone formation and decreases bone resorption, and it became available for patients at high risk of osteoporotic fractures in Japan in 2019. The aim of this study was to clarify the clinical effects, safety, and predictors of the effectiveness of 12 months of romosozumab therapy following daily or weekly administration of teriparatide. The study had an observational pre-post design and included 171 female patients. Romosozumab was administered at a dose of 210 mg subcutaneously every 4 weeks for 12 months following daily or weekly administration of teriparatide. The incidence of new fractures, safety, and changes in bone mineral density (BMD) and bone turnover markers were recorded. New fractures occurred in 3 cases (2.2 %). Four patients (2.3 %) with secondary osteoporosis experienced cardiovascular events, which were fatal in 1 patient (0.6 %). The percent changes in BMD at the spine and total hip at 12 months from baseline were + 7.9 % and + 2.4 %, respectively. The percent change in spine BMD did not significantly differ according to whether daily or weekly teriparatide was given as previous treatment. Romosozumab following teriparatide showed greater effectiveness in patients with primary osteoporosis, high P1NP level at 1 month, and low percent changes in TRACP-5b after 12 months of treatment. Romosozumab after treatment with daily or weekly teriparatide was relatively safe and more effective in patients with primary osteoporosis than in those with secondary osteoporosis.

Longitudinal assessment of bone mineral density in prostate cancer patients: comparing metastatic and non-metastatic regions

OBJECTIVES

Prostate cancer patients receiving androgen deprivation therapy (ADT) have increased risks of decreased bone mineral density (BMD). However, there are no established guidelines for assessing BMD in patients with bone metastases. The aim of this study was to assess the effects of ADT on bone health by comparing longitudinal changes in BMD between prostate cancer patients with and without bone metastases.

METHODS

A single-center observational study was conducted from February 2020 to January 2023 at Kobe University Hospital. BMD at the lumbar vertebrae, total hip, and femoral neck was measured at baseline, 6, and 12 months using dual-energy X-ray absorptiometry. Bones were classified into Metastatic Site (with metastases), Non-metastatic Sites (from patients with bone metastases), and Control (patients without metastases) groups. All patients received luteinizing hormone-releasing hormone antagonists or agonists plus oral ARSI or bicalutamide for 1 year.

RESULTS

Among the 78 patients, 35, 110, and 245 bones were classified into the Metastatic Site group, Non-metastatic Sites group, and Control group, respectively. The Metastatic Site group exhibited significantly higher T-scores compared with the other groups (P < 0.001). Repeated measures analysis revealed a statistically significant reduction in T-scores over time across all groups (P < 0.001). However, no significant interaction was observed between group classification and time (P = 0.817).

CONCLUSION

The present study demonstrates that BMD changes at non-metastatic sites in patients with bone metastases are similar to those in patients without metastases. Monitoring BMD at non-metastatic sites may provide valuable insights into ADT's effects on bone health in prostate cancer patients.

The Association Between Severity of Constipation and Oral Frailty Index-8 in the JUSTICE-TOKYO Study: A Cross-Sectional Study

Background/Objectives: Reports on oral frailty as a risk factor for chronic constipation are scarce. In this study, we examined the relationship between Oral Frailty Index-8 (OFI-8) and constipation severity. Methods: This cross-sectional analysis involved patients aged ≥65 years (outpatients between November 2020 and November 2021). Patient background (age, sex, body mass index, medical history, lifestyle history, and oral medications), a constipation severity questionnaire (Constipation Scoring System [CSS]), grip strength, walking speed, skeletal muscle mass index (dual-energy X-ray absorptiometry), a frailty questionnaire, an oral frailty questionnaire (OFI-8), an abdominal symptoms quality of life (QOL) questionnaire (Izumo scale), a swallowing evaluation questionnaire (10-item Eating Assessment Tool [EAT-10]), a chronic obstructive pulmonary disease (COPD) evaluation questionnaire (COPD assessment test [CAT]), a simplified QOL evaluation (EuroQol-five dimensions [EQ-5D]), the Dietary Variety Score, a nutritional evaluation (CONtrolling NUTritional Status [CONUT] score), and the 15-item Geriatric Depression Scale (GDS-15) were analyzed. Risk factors for constipation severity (CSS) were examined using multivariate analysis. Patients with advanced gastrointestinal cancer, inflammatory bowel disease, and active gastroduodenal ulcer were excluded. Results: In total, 1029 patients (male/female: 450/579; mean age: 78.3 ± 6.1 years; mean body mass index: 22.9 ± 3) were included. Multivariate analysis demonstrated a significant association between CSS and OFI-8 (β = 0.065), EAT-10 (β = 0.061), sarcopenia (β = 0.050), laxative (β = 0.126), constipation-related QOL score (β = 0.625), diarrhea-related QOL score (β = -0.064), and CAT (β = 0.061). Conclusions: Comprehensive risk factors associated with CSS included a high oral frailty score, impaired swallowing (EAT-10), sarcopenia, laxative use, a high constipation QOL score, a low diarrhea QOL score, and COPD assessment through CAT.

Utility of osteoporosis screening based on estimation of bone mineral density using bidirectional chest radiographs with deep learning models

Introduction

Osteoporosis increases the risk of fragility fractures, especially of the lumbar spine and femur. As fractures affect life expectancy, it is crucial to detect the early stages of osteoporosis. Dual X-ray absorptiometry (DXA) is the gold standard for bone mineral density (BMD) measurement and the diagnosis of osteoporosis; however, its low screening usage is problematic. The accurate estimation of BMD using chest radiographs (CXR) could expand screening opportunities. This study aimed to indicate the clinical utility of osteoporosis screening using deep-learning-based estimation of BMD using bidirectional CXRs.

Methods

This study included 1,624 patients aged ≥ 20 years who underwent DXA and bidirectional (frontal and lateral) chest radiography at a medical facility. A dataset was created using BMD and bidirectional CXR images. Inception-ResNet-V2-based models were trained using three CXR input types (frontal, lateral, and bidirectional). We compared and evaluated the BMD estimation performances of the models with different input information.

Results

In the comparison of models, the model with bidirectional CXR showed the highest accuracy. The correlation coefficients between the model estimates and DXA measurements were 0.766 and 0.683 for the lumbar spine and femoral BMD, respectively. Osteoporosis detection based on bidirectional CXR showed higher sensitivity and specificity than the models with single-view CXR input, especially for osteoporosis based on T-score ≤ -2.5, with 92.8% sensitivity at 50.0% specificity.

Discussion

These results suggest that bidirectional CXR contributes to improved accuracy of BMD estimation and osteoporosis screening compared with single-view CXR. This study proposes a new approach for early detection of osteoporosis using a deep learning model with frontal and lateral CXR inputs. BMD estimation using bidirectional CXR showed improved detection performance for low bone mass and osteoporosis, and has the potential to be used as a clinical decision criterion. The proposed method shows potential for more appropriate screening decisions, suggesting its usefulness in clinical practice.

Osteoporosis screening using X-ray assessment and osteoporosis self-assessment tool for Asians in hip surgery patients

OBJECTIVES

As many patients with osteoporosis remain undiagnosed, we aimed to develop a simple method to efficiently screen for osteoporosis using a combination of anteroposterior hip X-ray assessment and the Osteoporosis Self-Assessment Tool for Asians (OSTA), which is calculated as (body weight - age) × 0.2.

METHODS

One hundred Japanese women (age: 73 ± 11 years, body weight: 54.4 ± 11.1 kg) who underwent hip surgery, anteroposterior hip X-ray, and DXA were included. Based on the DXA results of the total proximal femur, 35 cases were diagnosed with osteoporosis. Fifteen orthopaedic surgeons visually inspected the hip X-ray images and scored the suspicion of osteoporosis on a scale of 1-4 (1: very unlikely, 4: very suspicious), which is referred to as "pred-score." In addition, OSTA was calculated as a continuous variable (OSTA score). Osteoporosis was screened using the pred-score and OSTA score, and both scores were analyzed using the receiver operating characteristic curves.

RESULTS

The area under the curves (AUCs) of the pred-score and OSTA score were 0.626-0.875 and 0.817 across surgeons, respectively. When both scores were used, the AUC for screening osteoporosis ranged from 0.821 to 0.915 across surgeons. Significant improvement from AUCs calculated with the pred-score or OSTA score was found in 11 surgeons (73.3%).

CONCLUSION

The combination of X-ray assessment and OSTA can be used to screen for osteoporosis and has the potential to be used as a new simple screening tool in daily clinical practice.

Diet-related quality of life may directly and indirectly affect health-related quality of life through protein intake and frailty in patients with osteoporosis: Results from a prospective cohort study

AIM

We aimed to examine the direct and indirect associations between diet-related quality of life (DRQOL) and health-related quality of life (HRQOL) in patients with osteoporosis.

METHODS

Cross-sectional and longitudinal analyses were conducted using data from a 1-year prospective cohort survey of 532 consecutive patients with osteoporosis. The DRQOL was assessed using a short version of the Diet-Related Quality of Life Scale. Dietary intake statuses were assessed using the brief-type self-administered diet history questionnaire. Frailty was assessed using the Kihon Checklist (KCL). HRQOL was assessed using the EuroQol 5-dimensions 5-level (EQ-5D-5L) score. The association between the DRQOL scores and each item was analyzed using multivariable logistic regression, path analysis, and a cross-lagged panel model.

RESULTS

In the baseline cross-sectional analysis, DRQOL scores at the ≥75th percentile of the cohort were associated with protein intake (odds ratio [OR] 2.18; 95% confidence intervals [CIs]: 1.20, 3.96), frailty (OR: 0.14; 95% CIs: 0.06, 0.33), and having a full EQ-5D-5L score (OR: 2.37; 95% CIs: 1.33, 4.21). In the path analysis, the DRQOL score was directly related to the EQ-5D-5L score and indirectly related via protein intake and the KCL score (standardized direct effect: 0.08, standardized indirect effect: 0.11). In the cross-lagged panel model, DRQOL scores at baseline were indirectly positively associated with EQ-5D-5L scores at 1 year (standardized direct effect: -0.06, standardized indirect effect: 0.23).

CONCLUSIONS

The DRQOL in patients with osteoporosis may be directly and indirectly related to the HRQOL via protein intake and frailty. Geriatr Gerontol Int 2025; 25: 243-250.

Interest in Osteoporosis among Nurses and Physicians before Introduction of a Fracture Liaison Service: A Questionnaire-Based Study

BACKGROUND

Osteoporosis-related fragility fractures such as proximal femoral and vertebral fractures are associated with decreased activities of daily living and a shorter life span. Many persons with osteoporosis do not receive testing or treatment. Introducing fracture liaison services (FLSs) to hospitals is an effective approach for reducing this treatment gap. Understanding interest in osteoporosis among nurses and physicians, their knowledge of osteoporosis, and their thoughts on team medicine for treatment of osteoporosis might be helpful when implementing FLSs.

METHODS

An FLS had not been introduced at our hospital. We conducted a questionnaire survey of nurses and physicians at our hospital regarding their interest in osteoporosis, their knowledge of osteoporosis, and their thoughts on team medicine for osteoporosis.

RESULTS

About half of the nurses and physicians were interested in osteoporosis. About 70% of nurses and physicians believed that team medicine was necessary for treating osteoporosis, and 50-60% believed that it should be introduced in the hospital. Only 5% of nurses and 18% of physicians had knowledge of FLSs.

CONCLUSION

Staff perceptions of team care for osteoporosis were generally supportive in our hospital. However, the introduction of an FLS to the hospital required educational activities for staff. The results of this survey will be helpful to other hospitals introducing FLSs.

Use of raloxifene as a sequential therapy after romosozumab : an observational study

OBJECTIVE

There have been no studies on the effectiveness of raloxifene as an antiresorptive agentfollowing discontinuation of romosozumab. The aim of this study was to investigate the potential effectiveness of raloxifene following a romosozumab therapy.

METHODS

This study had an observational pre-post design and included 23 patients. Romosozumab 210 mg was administered subcutaneously once every 4 weeks for 12 months, after which all patients received raloxifene 60 mg/day for 24 months. We investigated the incidence of new fractures, safety, and bone mineral density (BMD).

RESULTS

We found no new fractures or adverse events. After the treatment with romosozumab, percent changes from baseline in BMD at the spine and total hip in treatment-naïve patients with primary osteoporosis (the Naïve-P group) were 12.3% and 4.6%, respectively. After subsequent administration of raloxifene, spinal and total hip BMD in the Naïve-P group decreased to baseline levels at 36 months and 30 months, respectively. Six months after switching to raloxifene, the respective percent changes from baseline in spinal and total hip BMD were 12.0% and 5.8%.

CONCLUSION

Romosozumab followed by raloxifene is acceptable for use for only 6 months in the Naïve-P group. However, more aggressive use of this agent is not recommended. J. Med. Invest. 72 : 124-133, February, 2025.

Cardiovascular safety of osteoanabolic agents

PURPOSE

Several osteoanabolic agents have been developed to build new bone more efficiently than anti-resorptive drugs. Among them, romosozumab, an anti-sclerostin antibody, is a potent pharmacological tool to prevent fractures in osteoporosis patients. The efficacy of romosozumab in preventing osteoporotic fractures is robust. However, there remains a concern about increased cardiovascular (CV) adverse events related to romosozumab. Available data have been reviewed to address this concern.

METHODS

Published articles on romosozumab of which pivotal randomized controlled trials (RCTs), meta-analyses of RCTs, pharmacovigilance investigations, and retrospective observational clinical studies using real-world data were collected through PubMed and other available tools.

RESULTS

Meta-analyses of RCTs of romosozumab compared to placebo and other anti-osteoporosis drugs have left room for controversy in the CV safety of romosozumab. Investigations of the real-world data also provide no conclusive evidence in this issue.

CONCLUSION

We need more robust evidence to establish an appropriate and reasonable guide to prescribe romosozumab in our clinical practice.

Association Between Gastrointestinal-Related Quality of Life and Frailty Using Baseline Data of the Prospective Cohort Study (JUSTICE-TOKYO Study)

Objective: To determine the prevalence of frailty and examine its association with gastrointestinal-related quality of life (QOL) among older outpatients in a geriatric hospital. Methods: This cross-sectional study involved 1042 outpatients (age: ≥65 years) diagnosed using the revised Japanese version of the cardiovascular health study criteria. Data collection was performed by a multidisciplinary team. Results: Of the 1039 eligible subjects (male: n = 460 [44.3%]; mean age: 78.2 ± 6.1 years), 172 (16.6%) had frailty (male: n = 77 [44.8%]; mean age: 80.9 ± 6.2 years). The multivariate analysis revealed that age (odds ratio [OR]: 1.070, p < 0.001), QOL (OR: 0.982, p = 0.009), a history of falls (OR: 1.702, p = 0.029), sarcopenia (OR: 4.708, p < 0.001), steroid use (OR: 3.741, p = 0.001), analgesic drug use (OR: 2.056, p = 0.014), Mini Mental State Examination (OR: 0.915, p = 0.011), Geriatric Depression Scale 15 (OR: 1.101, p = 0.008), fullness-related QOL score (OR: 1.119, p = 0.010), chronic obstructive pulmonary disease assessment test (OR: 1.048, p = 0.007), and 10-item Eating Assessment Tool (OR: 1.071, p = 0.009) were related to frailty. Conclusions: The prevalence rate of frailty in older outpatients at a university hospital specializing in geriatric medicine was higher than that previously reported in community-dwelling individuals. Our study clarified that the fullness-related QOL score was related to frailty.

Drug utilization pattern of romosozumab and other osteoporosis treatments in Japan, 2019-2021

INTRODUCTION

Describe real-world treatment of osteoporosis and romosozumab treatment patterns in Japan.

MATERIALS AND METHODS

Data for patients initiating romosozumab or other antiosteoporotic medications between March 01, 2018, and May 31, 2022, were extracted from the Medical Data Vision (MDV) and Japan Medical Data Center (JMDC) databases. Patients were categorized into four cohorts: those who newly initiated romosozumab within the first (MDV: n = 4782; JMDC: n = 2578) or second (MDV: n = 3888; JMDC: n = 2446) year after launch and those who initiated teriparatide (TPTD; MDV: n = 14,576; JMDC: n = 8259) or non-TPTD antiosteoporotic medications within the first year of romosozumab launch (MDV: n = 352,142; JMDC: n = 185,785).

RESULTS

Mean age, sex, baseline cardiovascular history, comorbidities, and concomitant medications were similar across cohorts. In the MDV database, fracture history was higher in the romosozumab year-1 (59.3%), year-2 (64.1%), and TPTD (65.5%) cohorts versus the non-TPTD cohort (24.4%). Similar rates were identified in the JMDC database: romosozumab year-1 (64.7%), year-2 (66.6%), TPTD (67.5%), and non-TPTD (27.8%). Vertebral fractures were most common in all cohorts. 12-month romosozumab discontinuation varied between the year-1 and year-2 cohorts in MDV (62.4% and 58.8%) and JMDC (57.1% and 52.7%), whereas mean number of injections remained consistent (MDV: 9.7 and 9.8; JMDC: 7.3 and 7.8). Romosozumab persistence was lower in year-1 versus year-2 (MDV: 37.6% and 42.9%; JMDC: 41.2% and 47.3%).

CONCLUSION

Patients initiating romosozumab and TPTD had a high fracture history. Given the dual effects of promoting bone formation and suppressing resorption, improving romosozumab adherence and persistence over time may be important for antiosteoporotic therapy.

Predictors of discontinuation of osteoporosis treatment: sub-analysis of the Japanese osteoporosis intervention trial-05 (JOINT-05)

INTRODUCTION

To identify predictors of discontinuing treatment with teriparatide (TPTD) and alendronate (ALN), data from a randomized, controlled trial (JOINT-05) involving postmenopausal Japanese women at high risk of fracture were re-analyzed.

MATERIALS AND METHODS

Participants received sequential therapy with once-weekly TPTD for 72 weeks followed by ALN for 48 weeks (TPTD-ALN group) or monotherapy with ALN for 120 weeks (ALN group). Background data including comorbidities, fracture prevalence, cognitive function, quality of life, activities of daily living, bone metabolism parameters, and nutrient intake were collected. The endpoints were 3 types of discontinuations by the reason: a poor compliance, adverse events (AEs), or any reason including those unrelated to AEs or poor compliance. Odds ratios (ORs) of baseline predictors of discontinuation were evaluated by single or multiple regression analysis.

RESULTS

A total of 234 (49.0%) patients in the TPTD-ALN group and 167 (34.2%) patients in the ALN group discontinued. In the TPTD-ALN group, a lower serum calcium level was a significant predictor of compliance-related discontinuation. Serum 25-hydroxyvitamin D levels were lower in patients with lower serum calcium levels than with higher serum calcium levels. In the ALN group, poor cognitive function was significantly associated with compliance-related discontinuation, and higher body mass index and alcohol intake were predictors of AE-related discontinuation. Predictors of discontinuation were drug-specific. Lower serum calcium levels and poor cognitive function were predictors of discontinuing once-weekly TPTD and ALN, respectively.

CONCLUSION

When starting TPTD and ALN treatment, careful attention to patients with lower serum calcium levels and poor cognitive function, respectively, may be needed for better treatment continuity.

Temporal declines in bone mineral density and trabecular bone score during androgen deprivation therapy

INTRODUCTION

The trabecular bone score (TBS) has emerged as a convenient measure for assessing the microstructure of trabecular bone in the second through fourth lumbar vertebrae (L2-4) and can be conducted concurrently with bone mineral density (BMD) assessment. This study was performed to evaluate changes in BMD and the TBS during ADT for prostate cancer.

MATERIALS AND METHODS

Consecutive patients who had prostate cancer without bone metastases at Kobe University Hospital were studied from March 2020 to December 2021. BMD and TBS were measured every 6 months from the start of treatment using Hologic Horizon devices (Hologic, Inc., Marlborough, MA, USA).

RESULTS

Thirty-four patients were followed for 2 years. Significant declines in BMD (-3.8% for femoral neck, -4.2% for total hip, and -6.1% for lumbar spine) and TBS (-16.6%) were noted after 2 years of ADT. Correlation analyses revealed a weak correlation between lumbar spine BMD and TBS at ADT initiation, but this correlation strengthened after 2 years. The multiple regression analysis results suggested that the rate of BMD loss may be slower in patients with a preserved pretreatment TBS.

CONCLUSION

In patients without bone metastases undergoing ADT for prostate cancer, notable decreases were found in both BMD and TBS over a 2-year treatment period. Factors influencing the TBS decline remain unclear; however, patients with a lower pretreatment TBS exhibited a more rapid decline in BMD.

Comparison of Denosumab with Romosozumab in the treatment of male osteoporosis: a retrospective cohort study

We aimed to investigate the efficacy of romosozumab treatment compared with that of denosumab in especially male osteoporosis patients. This retrospective cohort study included 174 Japanese male patients receiving either denosumab or romosozumab for 12 months. Propensity score matching extracted 50 patients per treatment group for standardization of group characteristics. The endpoints include the rate of change in the bone mineral density (BMD) of the lumbar spine, total hip, and femoral neck after 12 months of treatment as well as the changes in serum bone metabolism markers. The mean 12-month percentage increase in the lumbar spine BMD from baseline was significantly greater with romosozumab (13.0% ±1.7%) than with denosumab (4.5%±0.6%) (P < 0.01). The total hip and femoral neck BMD exhibited a similar trend at 12 months; however, no significant between-group differences were observed. With denosumab, bone formation, and resorption marker levels significantly decreased at 6 and 12 months. Conversely, with romosozumab, the levels of bone formation markers increased transiently at 6 months before returning to baseline, whereas bone resorption markers significantly decreased at both time points. Romosozumab demonstrated significantly superior effects over denosumab in improving BMD, especially of the lumbar spine, suggesting that romosozumab can be used for treating male osteoporosis.

Influence of Spinal Sagittal Alignment in Sitting Posture on the Swallowing Speed of Older Adult Women: A Cross-Sectional Study

Thoracolumbar kyphosis in sitting posture is associated with forward head posture and may adversely affect swallowing function. However, few studies have investigated the effect of spinal alignment in the sitting posture on the swallowing function of older adults. This cross-sectional study aimed to investigate whether spinal alignment in the sitting posture influences the swallowing function of older adult women. Overall, 18 older adult women (mean age, 69.78 ± 3.66 years) without dysphagia were enrolled. Participants were positioned in two sitting postures, namely, comfortable sitting (CS) and thoracic upright sitting (TUS). In each sitting posture, the kyphosis index (using a flexicurve), sagittal angles (head, cervical, shoulder, and pelvic angles; using a digital camera), and cervical range of motion (ROM) were evaluated. Swallowing speed (100-mL water swallowing test), maximum tongue pressure (MTP), and oral diadochokinesis (ODK) were also evaluated. Compared with TUS, CS showed a greater kyphosis index, anterior head translation, and posterior pelvic tilt. CS had greater flexion (p < 0.001) and less extension (p < 0.001) of cervical ROM than TUS. Swallowing speed was significantly decreased in CS compared with TUS (p = 0.008). MTP and ODK were not significantly different between CS and TUS. Thus, changes in sitting posture with spinal alignment may affect swallowing speed. Consequently, adjustments to reduce sitting postural kyphosis in older adult women may improve swallowing speed.

Former Olympians had remained on high bone mineral density for a long period: Consecutive checkup of the 1964 Tokyo Olympic Japanese contestants for over 50 years

INTRODUCTION

We performed consecutive checkups of the 1964 Tokyo Olympic contestants every 4 years for 50 years. This study evaluated bone mineral density (BMD) and its related factors in former Tokyo Olympic athletes.

OBJECTIVES

The study population comprised 181 former Olympians (141 men and 40 women) who had undergone BMD measurement in at least one of the four checkups performed every 4 years since 2005. The mean age of the 104 subjects who participated in the last checkup in 2016 was 76.1 years for men and 74.0 years for women.

METHODS

Health-related information regarding medical history, regular physical activity, alcohol consumption, and smoking was obtained using questionnaires. The areal BMD of the total body was measured using dual-energy X-ray absorptiometry (DXA). The relationship between BMD and anthropometric measurements, medical history, and health behaviors was examined. Furthermore, we assessed the influence of the mode and magnitude of weight-bearing and impact loading during athletic events during their active careers on BMD.

RESULTS

The mean Z-scores of BMD of the total body, lumbar spine, pelvis, and upper and lower limbs were > 0 in both male and female subjects at each checkup. The subjects had a higher mean height and weight than the Japanese age- and sex-matched individuals. Furthermore, the subjects had higher grip strength than the age- and sex-matched individuals. BMD showed a positive correlation with body weight, lean body mass (LBM), muscle mass, and grip strength, with higher correlation coefficients found between BMD of the pelvis or lower limbs and LBM or muscle mass volume. When the association with current participation in sports activities was examined, male subjects who exercised weekly had significantly higher grip strength and greater muscle mass volume; however, no significant differences were observed among female subjects. After adjusting for age and LMB, BMD was significantly higher in both the lumbar spine and lower limbs of male subjects with relatively more impact loading in sports events during their active careers.

CONCLUSION

The Tokyo Olympic contestants maintained a high muscle mass even at an older age, regardless of their medical history, which may be one of the reasons for their ability to maintain a high BMD.

Real-world effects, safety, and predictors of the effectiveness of romosozumab in primary and secondary osteoporosis: An observational study

Romosozumab is an anti-sclerostin antibody that increases bone formation and decreases bone resorption. It became available for patients at high risk of osteoporotic fractures in Japan in 2019. The aim of this study was to clarify the clinical effects, safety, and predictors of the effectiveness of 12 months of romosozumab therapy. The study had an observational pre-post design and included 460 patients. Romosozumab was administered at a dose of 210 mg subcutaneously every 4 weeks for 12 months. The incidence of new fractures, safety, and changes in bone mineral density (BMD) and bone turnover markers were recorded. New fractures occurred in 11 cases (3.0 %). Nine patients (2.0 %) experienced cardiovascular events, which were fatal in 3 (0.65 %). Percent changes in BMD at the spine and total hip at 12 months from baseline were +7.7 % and +1.8 %, respectively. Romosozumab had better effects in patients with good renal function, low spine BMD, and high TRACP-5b at baseline and low TRACP-5b or high P1NP after 1 month of treatment. The percent change in spine BMD at 12 months was significantly lower in patients transitioning from denosumab than in those not previously treated with other anti-osteoporosis agents. Romosozumab is considered to be relatively safe in patients with primary osteoporosis compared to those with secondary osteoporosis. Romosozumab resulted in larger increases in spine BMD in patients with primary osteoporosis who were not previously treated with other anti-osteoporosis therapies and those with low spine BMD at the start of treatment.

Diagnostic accuracy of chest X-ray and CT using artificial intelligence for osteoporosis: systematic review and meta-analysis

INTRODUCTION

Artificial intelligence (AI)-based systems using chest images are potentially reliable for diagnosing osteoporosis.

METHODS

We performed a systematic review and meta-analysis to assess the diagnostic accuracy of chest X-ray and computed tomography (CT) scans using AI for osteoporosis in accordance with the diagnostic test accuracy guidelines. We included any type of study investigating the diagnostic accuracy of index test for osteoporosis. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and IEEE Xplore Digital Library on November 8, 2023. The main outcome measures were the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for osteoporosis and osteopenia. We described forest plots for sensitivity, specificity, and AUC. The summary points were estimated from the bivariate random-effects models. We summarized the overall quality of evidence using the Grades of Recommendation, Assessment, Development, and Evaluation approach.

RESULTS

Nine studies with 11,369 participants were included in this review. The pooled sensitivity, specificity, and AUC of chest X-rays for the diagnosis of osteoporosis were 0.83 (95% confidence interval [CI] 0.75, 0.89), 0.76 (95% CI 0.71, 0.80), and 0.86 (95% CI 0.83, 0.89), respectively (certainty of the evidence, low). The pooled sensitivity and specificity of chest CT for the diagnosis of osteoporosis and osteopenia were 0.83 (95% CI 0.69, 0.92) and 0.70 (95% CI 0.61, 0.77), respectively (certainty of the evidence, low and very low).

CONCLUSIONS

This review suggests that chest X-ray with AI has a high sensitivity for the diagnosis of osteoporosis, highlighting its potential for opportunistic screening. However, the risk of bias of patient selection in most studies were high. More research with adequate participants' selection criteria for screening tool will be needed in the future.

A crossover comparison of patient satisfaction with two teriparatide regimens: primary results of the Japanese Osteoporosis Intervention Trial 06 (JOINT-06)

INTRODUCTION

This study aimed to compare treatment satisfaction with two dosing regimens (two teriparatide [TPTD] self-injection systems) in osteoporosis patients at high risk of fracture.

MATERIALS AND METHODS

In this open-label crossover randomized trial comparing self-injected once-daily (1/D)-TPTD with self-injected twice-weekly (2/W)-TPTD, three satisfaction variables were evaluated by questionnaire for 2 years. The primary endpoint was overall satisfaction and secondary endpoints were satisfaction with treatment effectiveness and with utility of the self-injection device. Changes in quality of life (QOL) assessed by EuroQol-5 Dimension, pain assessed by visual analogue scale (VAS), and anthropometric parameters were also analyzed. Safety was evaluated based on the incidence and severity of adverse events (AEs).

RESULTS

The 1/D-TPTD and 2/W-TPTD groups consisted of 180 (75.9 ± 7.3 years) and 179 (age: 75.5 ± 6.9 years) patients, respectively. After 26 weeks of treatment, no significant between-group difference in the persistence rate (79.4% vs 72.6% in the 1/D-TPTD and 2/W-TPTD groups, respectively), distributions of overall satisfaction scores, and satisfaction with treatment (p > 0.05) were observed. However, several items of satisfaction with the utility of the injection device were significantly higher in the 2/W-TPTD group (p < 0.05). Statistical improvements from baseline values were observed in QOL and pain VAS in both groups (p < 0.05). No serious AEs were reported.

CONCLUSION

The between-group similarity of overall treatment satisfaction and effectiveness scores and between-group difference in satisfaction with the utility of the self-injection device was useful information for real-world treatment of osteoporosis. Both medication regimens were well tolerated.

Association of denosumab with serum cytokines, chemokines, and bone-related factors in patients with rheumatoid arthritis: A post hoc analysis of a multicentre, open-label, randomised, parallel-group study

OBJECTIVES

To clarify changes in serum cytokines, chemokines, and bone-related factors during denosumab treatment in rheumatoid arthritis (RA) patients.

METHODS

This was a post hoc analysis of a multicentre, open-label, randomised, parallel-group study. Patients were randomly assigned to continue treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) plus receive treatment with denosumab (csDMARDs plus denosumab group) or to continue treatment with csDMARD therapy alone for 12 months. Serum biomarker levels were measured at baseline and at 6 and 12 months.

RESULTS

Baseline and 6-month data from the csDMARDs plus denosumab (n = 22) and csDMARD therapy alone (n = 22) groups were analysed. Statistically significant changes from baseline were seen: Dickkopf-related protein 1 decreased at 6 and 12 months (both groups); osteopontin decreased at 6 months in the csDMARDs plus denosumab group; osteopontin and soluble CD40 ligand increased at 6 and 12 months in the csDMARD therapy alone group; osteocalcin decreased at 6 and 12 months, epidermal growth factor decreased at 12 months, and macrophage-derived chemokine decreased at 6 months in the csDMARDs plus denosumab group; and interferon gamma-induced protein-10 increased at 12 months in the csDMARD therapy alone group.

CONCLUSIONS

Denosumab may inhibit bone destruction by suppressing bone-related factors/chemokines.

Association between dietary variety status and sarcopenia as defined by the Asian Working Group for Sarcopenia 2019 consensus in older outpatients at a hospital specializing in geriatric medicine: A cross‑sectional study with baseline data of prospective cohort study (JUSTICE‑TOKYO study)

To the best of our knowledge, little is known about the association between dietary variety status and sarcopenia in university-affiliated geriatric hospital in elderly. The present study aimed to investigate, in a multidisciplinary setting, the prevalence of sarcopenia and association between dietary variety status and sarcopenia in older outpatients at Juntendo Tokyo Koto Geriatric Medical Center (Tokyo, Japan). Between October 2020 and December 2021, a cross-sectional study of outpatients aged ≥65 years [458 male (44%) and 584 female (56%); mean age, 78.2±6.1 years] was conducted to assess prevalence of sarcopenia, according to Asian Working Group for Sarcopenia 2019 criteria, and the relationship between dietary variety status and sarcopenia. Patient profile, comorbidities, drug use, neuropsychological data, abdominal symptoms, pulmonary function and dietary variety status were collected. Of 1,042 subjects, there were 223 (21.4%) with [142 male (63.7%) and 81 female (36.3%); mean age, 80.6±6.3 years] and 819 (78.6%) without sarcopenia [316 male (38.6%) and 503 female (61.4%); mean age, 77.6±5.8]. In multivariate analysis, older age, male sex, low body mass index, high Brinkman Index and phase angle, low quality of life, history of daycare use, diabetes mellitus, osteoporosis and low Mini-Mental State Examination and Dietary Variety Score were related to sarcopenia. The prevalence of sarcopenia was higher in than in community-dwelling individuals. Dietary variety status was associated with sarcopenia.

Biological/targeted synthetic DMARDs do not arrest bone loss in patients with rheumatoid arthritis: a multicenter prospective observational study

OBJECTIVE

To elucidate the differential effects of biological/target synthesized DMARDs (b/tsDMARDs) on bone metabolism in patients with rheumatoid arthritis (RA) in a real-world cohort.

METHODS

This was a multicentre prospective observational study of RA patients enrolled at the time of first b/tsDMARDs administration. Bone mineral density (BMD) and bone turnover markers (BTMs) were measured during the 52-week observation. The study was designed to enrol all eligible RA patients. The end-points were differences in changes in BMD according to b/tsDMARD type, and the correlation between BMD and BTMs.

RESULTS

A total of 1164 patients were enrolled in this study. b/tsDMARDs improved RA disease activity from mean CDAI 25.5 at baseline to 4.5 at week 26. Patients not receiving anti-osteoporotic agents (anti-OP) at baseline with no history of fracture experienced a significant decrease in both femoral neck (F: mean 0.666-0.655 g/cm3) and radial (R: 0.518-0.514) BMD at week 26. Despite maintaining low CDAI levels during weeks 26-52 (5.3-4.4), there was a continued decline in BMD (F: 0.653, R: 0.509. Weeks 52). None of the b/tsDMARDs type preserved BMD. Conversely, patients receiving anti-OP at baseline maintained stable BMD throughout the study (Weeks 0/26/52. F: 0.551/0.551/0.555, R: 0.415/0.416/0.415). Although BTMs were changed by b/tsDMARDs, the changes were unrelated to those in BMD.

CONCLUSION

Our study suggested the progression of osteoporosis in RA patients during b/tsDMARDs treatment without anti-OP. BTMs may not reflect BMD change. Regular monitoring of BMD in RA should be considered for early management of osteoporosis.

Prevalence of Osteosarcopenic Adiposity in Apparently Healthy Adults and Appraisal of Age, Sex, and Ethnic Differences

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC®, which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men (p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study's population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

Effects of differences in dose and frequency of teriparatide on bone structure in Proximal Femur. - Analysis by DXA-based 3D-modeling (3D-SHAPER Software) -TRIPLE-BONE study (The effects of TeRIParatide preparation on bone mineraL density increase and BONE structure)

Trends toward more favorable improvement of the cortical bone parameters by once-weekly (56.5 μg once a week) and twice-weekly teriparatide (28.2 μg twice a week), and that of the trabecular bone parameters by once-daily (1/D) teriparatide (20 μg/day once a day) were shown.

PURPOSE

To examine the effects of differences in the amount of teriparatide (TPTD) per administration and its dosing frequency on the bone structure in the proximal femur by dual-energy X-ray absorptiometry (DXA)-based 3D-modeling (3D-SHAPER software).

METHODS

This was a multicenter retrospective study. Patients aged 50 years or older with primary osteoporosis who continuously received once-/twice-weekly (1・2/W, n = 60) or 1/D TPTD (n = 14) administration for at least one year were included in the study. Measurement regions included the femoral neck (FN), trochanter (TR), femoral shaft (FS), and total proximal hip (TH). Concurrently, the bone mineral density (BMD) and Trabecular Bone Score (TBS) were measured.

RESULTS

The cross-sectional area, cross-sectional moment of inertia, and section modulus in the FS were significantly improved in the 1・2/W TPTD group, as compared to the 1/D TPTD group. However, significant improvement of the cortical thickness and buckling ratio in the FN was observed in the 1/D TPTD group, as compared to the 1・2/W TPTD group. Trabecular BMD values in the FS and TH were significantly increased in the 1/D TPTD group, as compared to the 1・2/W TPTD group, while the cortical BMD values in the TR, FS, and TH were significantly increased in the 1・2/W TPTD group, as compared to the 1/D TPTD group.

CONCLUSION

Trends toward more favorable improvement of the cortical bone by 1・2/W TPTD and that of the trabecular bones by 1/D TPTD were observed.

Osteosarcopenic adiposity (OSA) phenotype and its connection with cardiometabolic disorders: Is there a cause-and-effect?

The objectives were to examine if there is a causal relationship between osteosarcopenic adiposity (OSA) syndrome (coexistence of osteopenia/osteoporosis, sarcopenia, and excess adiposity) and cardiometabolic disorders or if these disorders initiate the development of OSA and its worsening. The search was conducted in PubMed, Scopus, and Web of Science to include articles up to the end of 2023. Of n=539 articles retrieved, n=15 met the eligibility criteria. Only studies conducted in adults and with all three body composition compartments (bone, muscle/lean, adipose) measured were considered. The results revealed that several cardiometabolic disorders, namely, hypertension, dyslipidemia (elevated total and LDL-cholesterol, lower HDL-cholesterol), insulin resistance, hyperglycemia, lower serum vitamin D, and some inflammatory markers were accompanied by OSA. In most cases, the OSA phenotype was associated with worse outcomes than cases with healthy or less impaired body composition. Our initial questions about the reciprocal cause-and-effect relationships could be surmised with more certainty for the OSA and some cardiovascular risks (hypertension, dyslipidemia) and some metabolic abnormalities (several inflammatory markers). The results of this review underscore the importance of body composition in health and from a clinical perspective, all three body composition compartments should be measured by standardized technologies using regulated diagnostic criteria to identify OSA. Randomized trials and prospective studies in diverse groups of older and younger individuals are necessary to determine if the relationships between OSA and clinical endpoints are causal and reversible through intervention and to uncover the mechanisms.

Predictive role of FRAX© for postoperative proximal junctional kyphosis with vertebral fracture after adult spinal deformity surgery

PURPOSE

To identify risk factors, including FRAX (a tool for assessing osteoporosis) scores, for development of proximal junctional kyphosis (PJK), defined as Type 2 in the Yagi-Boachie classification (bone failure), with vertebral fracture (VF) after surgery for symptomatic adult spinal deformity.

METHODS

This was a retrospective, single institution study of 127 adults who had undergone corrective long spinal fusion of six or more spinal segments for spinal deformity and been followed up for at least 2 years. The main outcome was postoperative development of PJK with VF. Possible predictors of this outcome studied included age at surgery, BMI, selected radiographic measurements, bone mineral density, and 10-year probability of major osteoporotic fracture (MOF) as determined by FRAX. We also analyzed use of medications for osteoporosis. Associations between the selected variables and PJK with VF were assessed by the Mann-Whitney, Fishers exact, and Wilcoxon signed-rank tests, and Kaplan-Meier analysis, as indicated.

RESULTS

Forty patients (31.5%) developed PJK with VF postoperatively,73% of them within 6 months of surgery. Statistical analysis of the selected variables found that only a preoperative estimate by FRAX of a > 15% risk of MOF within 10 years, pelvic tilt > 30° at first standing postoperatively and lower instrumented level (fusion terminating at the pelvis) were significantly associated with development of PJK with VF.

CONCLUSION

Preoperative assessment of severity of osteoporosis using FRAX provides an accurate estimate of risk of postoperative PJK with VF after surgery for adult spinal deformity.

Thick Skin on the Dorsal Spine in Osteoproliferative Disease: Ossification of the Posterior Longitudinal Ligament and Diffuse Idiopathic Skeletal Hyperostosis

Background Although the correlation between reduced skin thickness and reduced bone density has been investigated, no study has evaluated skin thickness and osteoproliferative diseases, including ossification of the posterior longitudinal ligament (OPLL) and diffuse idiopathic skeletal hyperostosis (DISH). Methodology This retrospective cohort study consisted of 99 consecutive patients aged ≥60 years treated for spinal surgery at our hospital between January 2022 and March 2023. Skin thickness was measured at the dorsal side of the cervical, thoracic, and lumbar vertebrae on the sagittal cross-section image of whole-spine CT. Based on the median value, skin thickness was categorized into two groups based on a median thickness of 4 mm. Bone mineral density (BMD) was assessed. The sum of the vertebral body and intervertebral bridging osteophytes of the anterior longitudinal and posterior longitudinal ligament were defined as the OALL index and OPLL index. Serum levels of bone metabolism-related markers, such as tartrate-resistant acid phosphatase type 5b, procollagen I N-propeptide, 25-hydroxyvitamin D, and periostin, were measured. To assess the association between skin thickness and imaging findings, we calculated the adjusted odds ratios, adjusting for age, sex, and body mass index (BMI) and using univariate and multivariate logistic regression analyses. Results No significant differences were found in skin thickness in the three dorsal regions of the cervical, thoracic, and lumbar spine (median = 3.3 mm versus 3.5 mm versus 3.4 mm, p = 0.357) and bone metabolism-related markers. Adjusting for age, sex, and BMI, cervical, thoracic, and lumbar skin thicknesses were related to DISH, the OPLL index, and the OPLL and OPLL index, respectively. Conclusions Skin thickness did not correlate with BMD but with the amount of spinal ossification. A correlation was found between skin thickness and vertebral and intervertebral ossification; vertebral osteophytes, OPLL, and DISH may be more common in thicker skin.

Nutritional and inflammation factors associated with current frailty level and effect of co-morbidities on the progression of frailty

AIM

Frailty is defined as extreme vulnerability, a syndrome that exposes the individual to a higher risk of disability. While risk factors for frailty have been gradually uncovered, the full identification of biochemical factors and co-morbidities influencing frailty remains incomplete.

METHODS

Cross-sectional and longitudinal analyses were performed to elucidate the risk factors for the prevalence and progression of frailty. The study included 1035 Japanese female outpatients. At baseline, biochemical markers were measured. Co-morbidities included diabetes mellitus, dyslipidemia, hypertension, vertebral osteoarthritis, and osteoporosis. Frailty levels were assessed using frailty scores ranging from 0 to 5. Prevalence of frailty was judged by a score of 3 or above, and progression was judged by an increase in the frailty score during the observation period. Multiple regression analysis was used for the cross-sectional analysis, and the Cox hazard model was used for the longitudinal analysis.

RESULTS

Of the 1035 selected participants, 212 were diagnosed with frailty. Advanced age and log IL-6 and branched-chain amino acids (BCAA) levels were significant independent risk factors for frailty. Subjects were followed for 7.7 ± 5.9 years and progression was observed in 130 subjects. Older age, the absence of hyperlipidemia, the presence of osteoporosis, and lower frailty scores were identified as significant risk factors for frailty progression.

CONCLUSIONS

Inflammatory and nutritional markers exhibited significant associations with the current frailty status, whereas co-morbidities such as osteoporosis or hyperlipidemia emerged as independent risk or protective factors of future frailty progression. Geriatr Gerontol Int 2024; 24: 523-528.

Achieving osteoporosis treat-to-target goals with teriparatide or alendronate: sub-analysis of Japanese Osteoporosis Intervention Trial-05 (JOINT-05)

INTRODUCTION

The purpose of this study was to evaluate whether bone mineral density (BMD) ≥ -2.5 SD could be used as the treat-to-target (T2T) goal when treating osteoporosis with teriparatide (TPTD) and alendronate (ALN), and to investigate the relationship with incident vertebral fracture by re-analyzing data from a randomized, controlled trial (JOINT-05) involving postmenopausal Japanese women at high fracture risk.

MATERIALS AND METHODS

Participants received sequential therapy with once-weekly TPTD for 72 weeks, followed by ALN for 48 weeks (TPTD-ALN group) or ALN monotherapy for 120 weeks (ALN group). BMDs were measured at the lumbar spine (L2-4), total hip, and femoral neck at 0, 24, 48, 72, and 120 weeks by dual-energy X-ray absorptiometry. The T2T goal was BMD ≥ -2.5 SD, and the endpoint was the proportion of participants with baseline BMD < -2.5 SD in three measurement sites achieving BMD ≥ -2.5 SD.

RESULTS

A total of 559 participants were selected. BMD ≥ -2.5 SD at 120 weeks in the L2-4, total hip, and femoral neck sites was achieved in 20.5%, 23.1%, and 5.9%, respectively, in the TPTD-ALN group and 22.2%, 11.7%, and 7.3%, respectively, in the ALN group. Incident vertebral fractures occurred in areas of both lower and high BMD.

CONCLUSION

During the 1.5-year treatment period, more than 20% of participants achieved BMD ≥ -2.5 SD as a T2T goal at L2-4. Since the achievement level differed depending on the BMD measurement site, the appropriate site should be selected according to the baseline BMD level.

Maintenance steroid therapy is associated with decreased risk of malignancy and better prognosis of patients with autoimmune pancreatitis: A multicenter cohort study in Japan

BACKGROUND/OBJECTIVES

The association between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) remains controversial. This study aimed to clarify the long-term prognosis and risk of malignancies in AIP patients in Japan.

METHODS

We conducted a multicenter retrospective cohort study on 1364 patients with type 1 AIP from 20 institutions in Japan. We calculated the standardized incidence ratio (SIR) for malignancies compared to that in the general population. We analyzed factors associated with overall survival, pancreatic exocrine insufficiency, diabetes mellitus, and osteoporosis.

RESULTS

The SIR for all malignancies was increased (1.21 [95 % confidence interval: 1.05-1.41]) in patients with AIP. Among all malignancies, the SIR was highest for PC (3.22 [1.99-5.13]) and increased within 2 years and after 5 years of AIP diagnosis. Steroid use for ≥6 months and ≥50 months increased the risk of subsequent development of diabetes mellitus and osteoporosis, respectively. Age ≥65 years at AIP diagnosis (hazard ratio [HR] = 3.73) and the development of malignancies (HR = 2.63), including PC (HR = 7.81), were associated with a poor prognosis, whereas maintenance steroid therapy was associated with a better prognosis (HR = 0.35) in the multivariate analysis. Maintenance steroid therapy was associated with a better prognosis even after propensity score matching for age and sex.

CONCLUSIONS

Patients with AIP are at increased risk of developing malignancy, especially PC. PC is a critical prognostic factor for patients with AIP. Although maintenance steroid therapy negatively impacts diabetes mellitus and osteoporosis, it is associated with decreased cancer risk and improved overall survival.

Association between pharmacotherapy and secondary vertebral fracture managed with a brace in a real-world setting: A nationwide database study in Japan

AIM

This retrospective cohort study assessed the association between the incidence of secondary vertebral fracture managed with a brace (SVF) and pharmacotherapy.

METHODS

The association between the incidence of SVF and the presence, type, and medication possession ratio (MPR) of pharmacotherapy was investigated using medical insurance data acquired from the National Database of Health Insurance Claims and Specific Health Checkups of Japan.

RESULTS

The data of female patients (n = 637 303) were analyzed. The 2-year incidence of SVF was 73.5 per 10 000 patients (n = 4687). Approximately 0.73% of patients without medications and 0.74% with medications had SVF. Patients taking bisphosphonates (0.87), denosumab (0.77), and selective estrogen receptor modulators (0.88) had significantly lower standardized incidence ratios (SIRs) than patients not taking medications after the occurrence of primary fracture; meanwhile, patients taking parathyroid hormone medications had considerably higher SIRs than those not taking medications. The non-SVF group (59.1%) had a significantly higher mean MPR than the SVF group (55.5%). Patients taking denosumab in the non-SVF group (68.2%) had the highest mean MPR. The proportion of patients taking denosumab with an MPR of ≥80% in the non-SVF group was significantly higher than that in the SVF group.

CONCLUSION

Patients taking medications were at a lower risk of developing SVF than those not taking medications. Although this study did not compare the medications' SVF prevention effects, patients taking denosumab had a 0.77 SIR of SVF in Japan. The effect of pharmacotherapy on SVF prevention might be affected by the MPR of each medication. Geriatr Gerontol Int 2024; 24: 390-397.

Assessing the utility of osteoporosis self-assessment tool for Asians in patients undergoing hip surgery

Objectives

Diagnosis and treatment of osteoporosis are instrumental in obtaining good outcomes of hip surgery. Measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, due to limited access to DXA, there is a need for a screening tool to identify patients at a higher risk of osteoporosis. We analyzed the potential utility of the Osteoporosis Self-assessment Tool for Asians (OSTA) as a screening tool for osteoporosis.

Methods

A total of 1378 female patients who underwent hip surgery at 8 institutions were analyzed. For each patient, the BMD of the proximal femoral region was measured by DXA (DXA-BMD), and the correlation with OSTA score (as a continuous variable) was assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of OSTA score to predict osteoporosis. Lastly, the OSTA score was truncated to yield an integer (OSTA index) to clarify the percentage of patients with osteoporosis for each index.

Results

DXA-BMD showed a strong correlation with OSTA (r = 0.683; P < 0.001). On ROC curve analysis, the optimal OSTA score cut-off value of -5.4 was associated with 73.8% sensitivity and 80.9% specificity for diagnosis of osteoporosis (area under the curve: 0.842). A decrease in the OSTA index by 1 unit was associated with a 7.3% increase in the probability of osteoporosis.

Conclusions

OSTA is a potentially useful tool for screening osteoporosis in patients undergoing hip surgery. Our findings may help identify high-risk patients who require further investigation using DXA.

Association between physical performance and bone mass in community-dwelling postmenopausal Japanese women: The Unzen study

BACKGROUND

Low bone mass is an independent risk factor for osteoporotic fractures. We examined the association between physical performance and bone mass using quantitative ultrasound in community-dwelling postmenopausal Japanese women.

METHODS

We conducted a cross-sectional study on 524 community-dwelling postmenopausal Japanese women who were not being administered osteoporosis medications. Physical performance was assessed on the basis of grip strength, chair stand time, and functional reach. The stiffness index was measured as a quantitative ultrasound parameter for heel bone mass.

RESULTS

Physical performance, assessed by grip strength, chair stand time, and functional reach, and the stiffness index significantly decreased with age (both p<0.001). The multiple linear regression analysis showed that grip strength (p = 0.001), chair stand time (p = 0.004), and functional reach (p = 0.048) were significantly associated with the stiffness index after adjusting for age, body mass index, smoking, drinking, and exercise.

CONCLUSIONS

Physical performance was significantly associated with heel bone mass in community-dwelling postmenopausal Japanese women.

DXA Reporting Updates: 2023 Official Positions of the International Society for Clinical Densitometry

INTRODUCTION

Professional guidance and standards assist radiologic interpreters in generating high quality reports. Initially DXA reporting Official Positions were provided by the ISCD in 2003; however, as the field has progressed, some of the current recommendations require revision and updating. This manuscript details the research approach and provides updated DXA reporting guidance.

METHODS

Key Questions were proposed by ISCD established protocols and approved by the Position Development Conference Steering Committee. Literature related to each question was accumulated by searching PubMed, and existing guidelines from other organizations were extracted from websites. Modifications and additions to the ISCD Official Positions were determined by an expert panel after reviewing the Task Force proposals and position papers.

RESULTS

Since most DXA is now performed in radiology departments, an approach was endorsed that better aligns with standard radiologic reports. To achieve this, reporting elements were divided into required minimum or optional. Collectively, required components comprise a standard diagnostic report and are considered the minimum necessary to generate an acceptable report. Additional elements were retained and categorized as optional. These optional components were considered relevant but tailored to a consultative, clinically oriented report. Although this information is beneficial, not all interpreters have access to sufficient clinical information, or may not have the clinical expertise to expand beyond a diagnostic report. Consequently, these are not required for an acceptable report.

CONCLUSION

These updated ISCD positions conform with the DXA field's evolution over the past 20 years. Specifically, a basic diagnostic report better aligns with radiology standards, and additional elements (which are valued by treating clinicians) remain acceptable but are optional and not required. Additionally, reporting guidance for newer elements such as fracture risk assessment are incorporated. It is our expectation that these updated Official Positions will improve compliance with required standards and generate high quality DXA reports that are valuable to the recipient clinician and contribute to best patient care.

Different types of hip fragility fractures have different values of 25-hydroxyvitamin D and parathyroid hormone

BACKGROUND

Vitamin D insufficiency/deficiency is related to fragility fracture. In most previous studies, there was no assessment of vitamin D deficiency status separately for hip fracture types. The first aim is to evaluate vitamin D and parathyroid hormone (PTH) status in patients with hip fracture. The second objective is to determine whether there are differences in vitamin D and PTH between the femoral neck fracture and the femoral metaphyseal fracture group.

METHODS

62 men and 248 women with fragility hip fractures were enrolled. 25-hydroxyviamin D [25(OH)D] and intact PTH (iPTH) values were evaluated, and femoral neck bone mineral density (BMD) was measured on the uninjured side. Vertebral fractures (VFs) were assessed using radiographs of the thoracic and lumbar spine. We examined the relationships of 25(OH)D value with the number of prevalent VFs, T-score of femoral neck, and iPTH level. These analyses were also performed, neck fracture and trochanteric fracture separately.

RESULTS

Mean age was 85 years. The mean 25(OH)D was 11.2 (range, 4.0-26.1) ng/ml, whereas the mean iPTH value was 48.9 pg/ml (range, 9-429 pg/ml). The mean number of VFs was 1.5 (range, 0-11), and the mean T-score was -3.3 (range, -5.2 to -0.5). There was a weak correlation between the 25(OH)D value and the number of VFs. There was a weak but significant correlation between 25(OH)D and iPTH values. In the patients with trochanteric fractures, 25(OH)D value was significantly lower and iPTH value was significantly higher than those with neck fractures. There was a significant correlation between the 25(OH)D value and number of the VFs, 25(OH)D, and iPTH values only in trochanteric fractures.

CONCLUSIONS

Vitamin D deficiency was severe and PTH levels were higher in the trochanteric fractures. Both vitamin D deficiency and high PTH levels were suggested to have association with bone fragility.

The effect of forearm rotation on the bone mineral density measurements of the distal radius

INTRODUCTION

Forearm dual-energy X-ray absorptiometry (DXA) is often performed in clinics where central DXA is unavailable. Accurate bone mineral density (BMD) measurement is crucial for clinical assessment. Forearm rotation can affect BMD measurements, but this effect remains uncertain. Thus, we aimed to conduct a simulation study using CT images to clarify the effect of forearm rotation on BMD measurements.

MATERIALS AND METHODS

Forearm CT images of 60 women were analyzed. BMD was measured at the total, ultra-distal (UD), mid-distal (MD), and distal 33% radius regions with the radius located at the neutral position using digitally reconstructed radiographs generated from CT images. Then, the rotation was altered from - 30° to 30° (supination set as positive) with a one-degree increment, and the percent BMD changes from the neutral position were quantified for all regions at each angle for each patient.

RESULTS

The maximum mean BMD changes were 5.8%, 7.0%, 6.2%, and 7.2% for the total, UD, MD, and distal 33% radius regions, respectively. The analysis of the absolute values of the percent BMD changes from the neutral position showed that BMD changes of all patients remained within 2% when the rotation was between - 5° and 7° for the total region, between - 3° and 2° for the UD region, between - 4° and 3° for the MD region, and between - 3° and 1° for the distal 33% radius region.

CONCLUSION

Subtle rotational changes affected the BMD measurement of each region. The results showed the importance of forearm positioning when measuring the distal radius BMD.

Effectiveness of romosozumab in patients with osteoporosis at high fracture risk: a Japanese real-world study

INTRODUCTION

To describe the real-world use of romosozumab in Japan, we conducted a chart review of > 1000 Japanese patients with osteoporosis (OP) at high risk of fracture, across multiple medical institutions.

MATERIALS AND METHODS

Treatment-naïve and prior OP-treatment patients who received romosozumab for 12 months followed by ≥ 6 months of sequential OP treatment were included. The primary objective described the baseline demographics and clinical characteristics; secondary objectives evaluated changes in bone mineral density (BMD) and bone turnover markers in all patients and effectiveness of romosozumab in a sub-group of treatment-naïve patients using the fracture risk assessment tool (FRAX®).

RESULTS

Of the 1027 patients (92.4% female), 45.0% were treatment-naïve. The mean ± SD age of treatment-naïve versus prior OP-treatment patients was 76.8 ± 8.5 and 77.1 ± 8.5 years. The most frequent prior OP treatment was bisphosphonates (45.0%). Romosozumab treatment for 12 months increased BMD at the lumbar spine in all groups; the median percent change from baseline in lumbar spine BMD was higher in the treatment-naïve (13.4%) versus prior OP-treatment group (bisphosphonates [9.2%], teriparatide [11.3%], denosumab [DMAb, 4.5%]). DMAb, bisphosphonates, or teriparatide after romosozumab maintained the BMD gains at all skeletal sites at month 18 in treatment-naïve patients. Most treatment-naïve patients were at high risk of fracture, BMD increased consistently with romosozumab regardless of the baseline fracture risk assessed by FRAX.

CONCLUSION

This large-scale, multicenter chart review provides clinically relevant insights into the profiles of patients initiating romosozumab, effectiveness of real-world romosozumab use, and sequential therapy in Japanese patients at high risk of fracture.

Body mass index, height, and osteoporotic fracture risk in community-dwelling Japanese people aged 40-74 years

INTRODUCTION

The association between body size and fracture risk is complex and varies by sex and ethnicity. This study aimed to examine associations of body mass index (BMI) and height with osteoporotic fracture risk in middle-aged and older people.

MATERIALS AND METHODS

This 10-year cohort study included 13,151 community-dwelling Japanese people aged 40-74 years. A self-administered questionnaire survey was conducted at baseline to obtain information on demographic characteristics, body size, lifestyle, and disease history. BMI (kg/m2) was categorized as underweight (< 18.5), low-normal (18.5-21.7), high-normal (21.8-24.9), overweight (25.0-29.9), and obese (≥ 30.0). Height was categorized into quartiles. All incident cases of major osteoporotic fractures, including fractures of the distal radius, neck of the humerus, neck or trochanter of the femur, and vertebrae, were obtained from medical records during follow-up.

RESULTS

Mean participant age was 58.8 years. In men, the underweight group had a significantly higher hazard ratio (HR) for total fracture (adjusted HR = 2.46), and the obese group had significantly higher HRs for total (adjusted HR = 3.01) and vertebral (HR = 3.77) fractures relative to the reference (overweight) group. No significant associations were observed between BMI and risk of any fracture in women. Higher quartiles of height were associated with higher vertebral fracture risk (adjusted P for trend = 0.023) only in women.

CONCLUSION

BMI and osteoporotic fracture risk showed a U-shaped association in men, whereas higher height was associated with higher vertebral fracture risk in women, suggesting sex-dependent differences in these associations.

Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area

STUDY DESIGN

Cross-sectional cohort study.

PURPOSE

This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area.

OVERVIEW OF LITERATURE

Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors.

METHODS

This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12-15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis.

RESULTS

Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04-0.96) was an independent factor associated with a kyphosis index of ≥15.

CONCLUSIONS

Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

Denosumab improves bone mineral density and microarchitecture in rheumatoid arthritis: randomized controlled trial by HR-pQCT

INTRODUCTION

This pre-specified exploratory analysis investigated the effect of denosumab on bone mineral density (BMD) and bone microarchitecture in patients with rheumatoid arthritis (RA) treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs).

MATERIALS AND METHODS

In this open-label, parallel-group study, patients were randomly assigned (1:1) to continuous treatment with csDMARDs plus denosumab or continuous treatment with csDMARD therapy alone for 12 months. BMD and bone microarchitecture were measured by dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT).

RESULTS

Of 46 patients enrolled in the primary study, 43 were included in the full analysis set. The mean age was 65.3 years, 88.4% were female, and 60.5% had osteoporosis. Areal BMD of the lumbar spine increased from baseline to 6 and 12 months in both groups, but the increase was higher in the csDMARDs plus denosumab group. Areal BMD of the total hip and femoral neck increased from baseline to 6 and 12 months only in the csDMARDs plus denosumab group. Cortical volumetric BMD and cortical thickness of the distal tibia increased in the csDMARDs plus denosumab group at 6 and 12 months but decreased in the csDMARD therapy alone group. Trabecular bone parameters of the distal tibia improved only in the csDMARDs plus denosumab group at 12 months.

CONCLUSION

Denosumab may be recommended for patients with RA treated with csDMARDs to increase BMD and improve bone microarchitecture.

A machine learning-based scoring system and ten factors associated with hip fracture occurrence in the elderly

Hip fractures are fragility fractures frequently seen in persons over 80-years-old. Although various factors, including decreased bone mineral density and a history of falls, are reported as hip fracture risks, few large-scale studies have confirmed their relevance to individuals older than 80, and tools to assess contributions of various risks to fracture development and the degree of risk are lacking. We recruited 1395 fresh hip fracture patients and 1075 controls without hip fractures and comprehensively evaluated various reported risk factors and their association with hip fracture development. We initially constructed a predictive model using Extreme Gradient Boosting (XGBoost), a machine learning algorithm, incorporating all 40 variables and evaluated the model's performance using the area under the receiver operating characteristic curve (AUC), yielding a value of 0.87. We also employed SHapley Additive exPlanation (SHAP) values to evaluate each feature importance and ranked the top 20. We then used a stepwise selection method to determine key factors sequentially until the AUC reached a plateau nearly equal to that of all variables and identified the top 10 sufficient to evaluate hip fracture risk. For each, we determined the cutoff value for hip fracture occurrence and calculated scores of each variable based on the respective feature importance. Individual scores were: serum 25(OH)D levels (<10 ng/ml, score 7), femoral neck T-score (<-3, score 5), Barthel index score (<100, score 3), maximal handgrip strength (<18 kg, score 3), GLFS-25 score (≥24, score 2), number of falls in previous 12 months (≥3, score 2), serum IGF-1 levels (<50 ng/ml, score 2), cups of tea/day (≥5, score -2), use of anti-osteoporosis drugs (yes, score -2), and BMI (<18.5 kg/m2, score 1). Using these scores, we performed receiver operating characteristic (ROC) analysis and the resultant optimal cutoff value was 7, with a specificity of 0.78, sensitivity of 0.75, and AUC of 0.85. These ten factors and the scoring system may represent tools useful to predict hip fracture.

Advantages and limitations of estrogen replacement therapy on hypogonadal survivors of childhood cancer

BACKGROUND

Hypogonadism is a significant late complication in childhood cancer survivors (CCS). The aim of this study was to elucidate the advantages and limitations of estrogen replacement therapy (ERT) for CCS with hypogonadism.

METHODS

Seventeen CCS were divided into two groups: gonadal hypogonadism (GH) group (n = 8) and central hypogonadism (CH) group (n = 9). Pearson correlation coefficients were used to investigate the impact of cancer management on final height, bone density, and uterine development.

RESULTS

Seven of GH group had hematologic malignancies, and all of them underwent total body irradiation before bone marrow transplantation. The GH group showed significant positive correlations between the onset age of disease treatment and final height (p < 0.05, R = 0.712) and uterine size following ERT (p < 0.05, R = 0.775). All CCS in the CH group had brain tumors, and seven of them received chemotherapy. There were trends towards positive and negative correlations between the onset age of disease treatment and final height (p = 0.09, R = 0.598) or uterine size (p = 0.07, R = - 0.669), respectively. A negative correlation trend was observed between the age at ERT initiation and final height (p = 0.07, R = - 0.769) or bone density (p = 0.18, R = - 0.626) in six CH patients who received growth hormone therapy. Five CCS in both groups experienced osteoporosis, despite receiving ERT.

CONCLUSION

Individualized management strategies beyond ERT are essential to reduce long-term complications in CCS with hypogonadism, considering the type and timing of cancer treatment.

Increasing baseline aortic valve peak flow velocity is associated with progression of aortic valve stenosis in osteoporosis patients-a possible link to low vitamin D status

PURPOSE

The purpose of this study was to investigate the morphological characteristics of the aortic valve and identify factors associated with the progression of aortic valve stenosis (AS) in osteoporosis patients.

METHODS

In this single-center prospective cohort study, we recruited 10 patients (mean age: 75 ± 7 years, 90% female) who were taking anti-resorptive medicines at the outpatient clinic of University of Miyazaki Hospital, Japan. Baseline assessments, including transthoracic echocardiogram, blood sampling, and dual energy X-ray absorptiometry, were performed. Follow-up assessments were conducted at 6, 12, 18, and 24 months.

RESULTS

During the 2-year follow-up, three patients with aortic valve peak flow velocity (AV PFV) ≥2 m/s at baseline developed moderate AS, which is defined as AV PFV ≥3 m/s. However, seven patients with AV PFV <2 m/s did not exhibit any progression of AS. There were significant variations in terms of bone mineral density, T-score values, and biomarkers associated with bone turnover (i.e., bone alkaline phosphatase, tartrate-resistance acid phosphatase-5b) among the enrolled patients, but none of these factors were found to be associated with the progression of AS. All patients exhibited low vitamin D status, with a median level of 16.1 ng/mL (25th percentile, 9.7 ng/mL; 75th percentile, 23 ng/mL). The baseline levels of AV PFV values were negatively correlated with 25-hydroxyvitamin D levels, determined by univariate linear regression analysis (beta coefficient = -0.756, 95% confidence interval, -0.136 ̶ -0.023, p = 0.011).

CONCLUSION

Our data suggest that low vitamin D status might be a potential risk factor for the progression of AS in osteoporosis patients undergoing treatment with anti-resorptive medicines. Elderly patients with osteoporosis patients exhibited a subset of aortic valve stenosis. Our data suggest that the baseline aortic valve peak flow velocity predicts the progression of aortic valve stenosis, and there might be an association between the progression and the co-existing low vitamin D status in these patients.

Development and validation of an open-source tool for opportunistic screening of osteoporosis from hip CT images

Aims

This study aimed to develop and validate a fully automated system that quantifies proximal femoral bone mineral density (BMD) from CT images.

Methods

The study analyzed 978 pairs of hip CT and dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur (DXA-BMD) collected from three institutions. From the CT images, the femur and a calibration phantom were automatically segmented using previously trained deep-learning models. The Hounsfield units of each voxel were converted into density (mg/cm3). Then, a deep-learning model trained by manual landmark selection of 315 cases was developed to select the landmarks at the proximal femur to rotate the CT volume to the neutral position. Finally, the CT volume of the femur was projected onto the coronal plane, and the areal BMD of the proximal femur (CT-aBMD) was quantified. CT-aBMD correlated to DXA-BMD, and a receiver operating characteristic (ROC) analysis quantified the accuracy in diagnosing osteoporosis.

Results

CT-aBMD was successfully measured in 976/978 hips (99.8%). A significant correlation was found between CT-aBMD and DXA-BMD (r = 0.941; p < 0.001). In the ROC analysis, the area under the curve to diagnose osteoporosis was 0.976. The diagnostic sensitivity and specificity were 88.9% and 96%, respectively, with the cutoff set at 0.625 g/cm2.

Conclusion

Accurate DXA-BMD measurements and diagnosis of osteoporosis were performed from CT images using the system developed herein. As the models are open-source, clinicians can use the proposed system to screen osteoporosis and determine the surgical strategy for hip surgery.

Adrenal steroid metabolites and bone status in patients with adrenal incidentalomas and hypercortisolism

BACKGROUND

Autonomous cortisol secretion (ACS), resulting from cortisol-producing adenomas (CPA), causes endogenous steroid-induced osteoporosis (SIOP). However, the risk of endogenous SIOP cannot be explained by cortisol excess alone, and how other steroid metabolites affect bone status is unclear.

METHODS

ACS was diagnosed as serum cortisol ≥1.8 μg/dL after the 1-mg dexamethasone suppression test (DST-cortisol). Using liquid chromatography tandem mass spectrometry, 21 plasma steroid metabolites were measured in 73 patients with ACS and 85 patients with non-functioning adrenal tumors (NFAT). Expression of steroidogenic enzymes and relevant steroid metabolites were analyzed in some of CPA tissues.

FINDINGS

Discriminant and principal component analyses distinguished steroid profiles between the ACS and NFAT groups in premenopausal women. Premenopausal women with ACS exhibited higher levels of a mineralocorticoid metabolite, 11-deoxycorticosterone (11-DOC), and lower levels of androgen metabolites, dehydroepiandrosterone-sulfate, and androsterone-glucuronide. In premenopausal women with ACS, DST-cortisol negatively correlated with trabecular bone score (TBS). Additionally, 11-DOC negatively correlated with lumbar spine-bone mineral density, whereas androsterone-glucuronide positively correlated with TBS. The CPA tissues showed increased 11-DOC levels with increased expression of CYP21A2, essential for 11-DOC synthesis. Adrenal non-tumor tissues were atrophied with reduced expression of CYB5A, required for androgen synthesis.

INTERPRETATION

This study demonstrates that unbalanced production of adrenal steroid metabolites, derived from both adrenal tumor and non-tumor tissues, contributes to the pathogenesis of endogenous SIOP in premenopausal women with ACS.

FUNDING

JSPS KAKENHI, Secom Science and Technology Foundation, Takeda Science Foundation, Japan Foundation for Applied Enzymology, AMED-CREST, JSTA-STEP, JST-Moonshot, and Ono Medical Research Foundation.