Factors influencing lumbar spine bone mineral density assessment by dual-energy X-ray absorptiometry: comparison with lumbar spinal radiogram

Association of cardiovascular disease prevalence with BMD and fracture in men with T2DM

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) are predisposed to cardiovascular disease (CVD). Bone mineral density (BMD) is linked to CVD, but most studies focused on women. Our analysis aims to explore the association of BMD and fracture with the prevalence of CVD in men with T2DM.

METHODS

In this retrospective cross-sectional study, 856 men with T2DM were enrolled. BMDs at the lumbar spine (L2-4), femoral neck (FN), and total hip (TH) were measured by dual-energy X-ray absorptiometry (DXA). The CVD outcome was determined as the sum of the following conditions: congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, the requirement for coronary artery revascularization, and stroke. The relationship between BMDs and CVD was investigated by restricted cubic spline curves and logistic regression models.

RESULTS

A total of 163 (19.0%) patients developed CVD. The restricted cubic spline curve revealed a linear and negative association between FN-BMD, TH-BMD, and CVD. After full adjustments for confounding covariates, the odds ratios were 1.34 (95% confidence interval [CI] [1.11-1.61], p < .05), 1.3 (95% CI [1.05-1.60], p < .05), and 1.26 (95% CI [1.02-1.55], p < .05) for each 1-SD decrease in BMDs of L2-4, FN and TH, respectively. T-scores of < -1 for BMD of L2-4 and FN were independently associated with CVD (p < .05). Subgroup analyses further supported our findings.

CONCLUSIONS

The prevalence of CVD was inversely correlated with BMD levels in men with T2DM, particularly at the FN. We hypothesized that monitoring FN-BMD and early intervention would help reduce CVD risk in men with T2DM, especially those with hypertension.

Age-Dependent Association of Height Loss with Incident Fracture Risk in Postmenopausal Korean Women

BACKGRUOUND

Height loss is a simple clinical measure associated with increased fracture risk. However, limited data exists on the association between height loss and fracture risk in postmenopausal Korean women. It is unknown whether this association varies with age.

METHODS

Data on height loss over a 6-year period were collected from a community-based longitudinal follow-up cohort (Ansung cohort of the Korean Genome and Epidemiology Study). Incident fractures were defined based on self-reported fractures after excluding those due to severe trauma or toes/fingers. The association between incident fractures and height loss was investigated using a Cox proportional hazards model.

RESULTS

During a median follow-up of 10 years after the second visit, 259/1,806 participants (median age, 64 years) experienced incident fractures. Overall, a 1 standard deviation (SD) decrease in height (1.6 cm/median 5.8 years) was associated with 9% increased risk of fracture (hazard ratio [HR], 1.09; P=0.037), which lost statistical significance after adjustment for covariates. When stratified into age groups (50-59, 60-69, 70 years or older), a 1 SD decrease in height remained a robust predictor of fracture in the 50 to 59 years age group after adjusting for covariates (adjusted hazard ratio [aHR], 1.52; P=0.003), whereas height loss was not an independent predictor of fracture in the 60 to 69 (aHR, 1.06; P=0.333) or the 70 years or older age groups (aHR, 1.05; P=0.700; P for interaction <0.05, for all).

CONCLUSION

Height loss during the previous 6 years was associated with an increased 10-year fracture risk in postmenopausal women in their 50s.

Comparison of volumetric and areal bone mineral density in CT and scout scans using spectral detector technology

BACKGROUND

To determine whether denoised areal bone mineral density (BMD) measurements from scout scans in spectral detector computed tomography (CT) correlate with volumetric trabecular BMD for opportunistic osteoporosis screening.

METHODS

A 64-slice single-source dual-layer spectral CT scanner was used to acquire scout scan data of 228 lumbar vertebral bodies within 57 patients. Scout scans in anterior-posterior (AP) view were performed with a dose of < 0.06 mSv and spectrally decomposed into areal BMD (aBMD) values. A spectral dictionary denoising algorithm was applied to increase the signal-to-noise ratio (SNR). Volumetric trabecular bone mineral density (vBMD) was determined via material decomposition. A 3D convolutional network for image segmentation and labeling was applied for automated vBMD quantification. Projected maps were used to compare the classification accuracy of AP and lateral scout scans.

RESULTS

The denoising algorithm led to the minimization of anticorrelated noise in spectral maps and an SNR increase from 5.23 to 13.4 (p < 0.002). Correlation analysis between vBMD and measured AP aBMD, projected AP, and lateral aBMD showed a Pearson correlation coefficient of 0.68, 0.81, and 0.90, respectively. The sensitivity and specificity for the osteoporosis classification task were higher in lateral projection images than in AP crystallizing in an increased area under the curve value of 0.99 versus 0.90.

CONCLUSION

Denoised material-specific aBMD maps show a positive correlation to vBMD, enabling spectral scout scans as an opportunistic predictor for osteoporotic patients. This could be applied routinely as a screening tool in patients undergoing a CT examination.

RELEVANCE STATEMENT

Scout-based DEXA could be applied routinely as a screening tool in patients undergoing a CT examination.

KEY POINTS

• Spectral scout scans can be used as a dual-energy x-ray absorptiometry-like screening tool. • Spectral dictionary denoising on projection images increases the signal-to-noise ratio. • Positive correlation between volumetric and areal bone mineral density is observed. • Lateral projections increase osteoporosis classification accuracy compared to anterior-posterior projections.

Age-Related Changes in Trabecular Bone Score and Bone Mineral Density in Chinese Men: A Cross-Sectional and Longitudinal Study

Purpose

This study was designed to explore age-related changes in trabecular bone score (TBS) and bone mineral density (BMD) in Chinese men through cross-sectional and longitudinal studies.

Patients and Methods

We included adult men who had at least twice TBS and BMD examinations in our hospital between January 2013 and December 2020. All men were divided into an age subgroup per 10 years, comparing differences in baseline lumbar spine (LS) TBS and BMD at various parts between each age group and analyzing age-related changes in TBS and BMD during follow-up.

Results

Baseline data showed that in men aged 36 to 85 years, BMD in the hip region showed a decreasing trend with age (P for trend < 0.01). However, TBS reached a high value around the age of 50, after which it decreased with age (P for trend = 0.03). During a mean follow-up of 3 years, the average annual change rate at TBS was −0.17% in men aged 36 to 85 years, with the fastest decrease rate −1.08% at 66 to 75 years (P < 0.05). The mean annual rate of change in LS BMD in different age subgroups increased with age (P for trend = 0.001). There was no significant decrease in mean annual change in BMD in hip regions.

Conclusion

In men aged 36~85 years, the trend of TBS was inconsistent with BMD. Men experience a high value of LS TBS around age 50, later than the commonly believed age of peak BMD, which may reflect developmental differences between bone microstructure and bone minerals. The TBS may be used as a better indicator of changes in bone strength than BMD in adult men at short-term follow-up. The rapid loss of TBS at age 66 to 75 may have implications for the prevention and medication of osteoporosis in men.

Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study

Introduction

In older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults.

Aim

To assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD.

Methods

We evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD).

Results

43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion.

Conclusion

In the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults.

•

Diagnosis of osteoporosis (OP) in the elderly with cardiovascular disease is challenging.

•

We evaluated the sensitivity of distal forearm (DF) BMD vs. lumbar spine (LS) BMD.

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LS BMD did not diagnose OP in 27/100, and DF BMD in 9/100 (p = 0.001).

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LS BMD did not identify OP in 31/100, and DF BMD in 5/100 (p < 0.001) aged ≥80 years.

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DF BMD showed higher sensitivity for diagnosing osteoporosis, regardless of gender.

DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis

Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.

Associations between bone mineral density in different measurement locations and coronary artery disease: a cross-sectional study

The bone mineral density (BMD) loss is closely related to coronary heart disease (CAD). The BMD measured at different locations differ in BMD values, the risk to CAD, and the capability to identify CAD. An average BMD of the right and left femoral neck being below - 1.70 has the ability to indicate risk of CAD.

PURPOSE

Previous studies have reported that low bone mineral density (BMD) is closely related to coronary artery disease (CAD); however, it is not clear that the BMD loss at which location to what extent has the greatest effect in identifying risk of CAD. This study aimed to evaluate the ability of different measurement sites of BMD in identifying CAD and analyze the best measurement sites and the optimal cut-off of BMD for CAD.

METHODS

This was a cross-sectional study in which 180 of 817 participants were diagnosed with CAD. All participants in the study were measured by dual-energy X-ray absorptiometry (DEXA) for BMD at 8 locations, and following measurements were derived: the average BMD of lumbar spine (L1-L4), femoral neck (left and right), and total proximal femur (left and right). The association between BMD at different locations and CAD was analyzed using logistic regression. The receiver operating characteristic (ROC) curve was used to select the optimal measurement location and cut-off value of the BMD for identifying CAD.

RESULTS

There were significant differences in BMD at 3 different measurement locations. Higher BMD is a protective factor against CAD, which is more pronounced in the femoral neck and total proximal femur (ORs = 0.47 ~ 0.66, P < 0.001) than in the lumbar spine (ORs = 0.74 ~ 0.79, P < 0.001). The optimal site for predicting the risk of CAD by BMD is the femoral neck, with the AUC (area under the ROC curve) is 0.72 (95% CI: 0.67 ~ 0.76) and the cut-off is - 1.70.

CONCLUSION

The BMD below particular cut-off of the femoral neck rather than of the lumbar spine may have certain further research value for revealing the risk of CAD.

Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

PET imaging with ¹⁸F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include ¹⁸F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.

Total-Body PET Imaging of Musculoskeletal Disorders

Imaging of musculoskeletal disorders, including arthritis, infection, osteoporosis, sarcopenia, and malignancies, is often limited when using conventional modalities such as radiography, computed tomography (CT), and MR imaging. As a result of recent advances in Positron Emission Tomography (PET) instrumentation, total-body PET/CT offers a longer axial field-of-view, higher geometric sensitivity, and higher spatial resolution compared with standard PET systems. This article discusses the potential applications of total-body PET/CT imaging in the assessment of musculoskeletal disorders.

Association between Trunk Muscle Strength, Lumbar Spine Bone Mineral Density, Lumbar Scoliosis Angle, and Skeletal Muscle Volume and Locomotive Syndrome in Elderly Individuals: A Dual-Energy X-ray Absorptiometry Study

Introduction

The present study aimed to investigate the association between trunk muscle strength, lumbar spine bone mineral density (BMD), lumbar scoliosis angle (LSA), and appendicular skeletal muscle mass index (ASMI) and the severity locomotive syndrome (LS) using dual-energy X-ray absorptiometry (DXA) technology in elderly individuals.

Methods

In this cross-sectional study, we enrolled 168 individuals aged >60 years. We measured their trunk muscle strength (flexion and extension) and BMD, LSA, and ASMI using DXA. We defined degenerative lumbar scoliosis (DLS) as LSA ≥ 10° by the Cobb method using the DXA image. The locomotor function was evaluated using the timed up-and-go (TUG) test and the 25-question Geriatric Locomotive Function Scale (GLFS-25) score. Normal locomotor function, LS-1, and LS-2 were defined as a GLFS-25 score of <7, ≥7 and <16, and ≥16, respectively. We compared the three groups, analyzing the associations between all variables and the locomotor function using univariate and multivariate analyses.

Results

Although there was no significant difference in sex ratio, BMD, ASMI, and trunk-flexor strength, significant differences were observed in age (p < 0.01), the prevalence of DLS (p = 0.02), trunk-extensor strength (p < 0.01), and trunk-extensor/flexor strength ratio (p < 0.01) among the three groups. In multiple regression analyses, the significant risk factors of the TUG test were age (β = 0.26), body mass index (β = 0.36), LSA (β = 0.15), ASMI (β = -0.30), and trunk-extensor strength (β = -0.19), whereas the significant factor of the GLFS-25 score was trunk-extensor strength (β = -0.31).

Conclusions

The results indicate that it is clinically important for LS to pay careful attention not only to BMD but also to lumbar scoliosis when DXA examination of the lumbar spine is routinely conducted. Moreover, it is essential to note that trunk-extensor strength is more important than trunk-flexor strength in maintaining locomotor function in elderly individuals.

Low bone mineral density is associated with global coronary atherosclerotic plaque burden in stable angina patients

Background

Accelerated atherosclerosis is considered to be the linking factor between low bone mineral density (BMD) and increased cardiovascular events and mortality, while some coronary angiographic studies do not support this point. In this study, we attempt to provide a distinct comprehensive view of the relationship between BMD and the angiographically determined coronary atherosclerotic burden.

Methods

A total of 459 consecutive patients with stable chest pain suspected of coronary artery disease (CAD) underwent both dual-energy X-ray absorptiometry scan and selective coronary angiography. The association between BMD and global coronary atherosclerotic plaque burden as represented by the multivessel involvement and the modified Gensini score was analyzed.

Results

Multivariable analysis revealed that the low BMD at femoral neck and total hip was an independent correlate of multivessel CAD. The T-scores measured at femoral neck and total hip were both negatively and independently associated to the modified Gensini score. These inversely correlated relationships between BMD and CAD were not observed at lumbar spine 1–4.

Conclusion

This cross-sectional study elucidated an inverse relationship between hip BMD and the modified Gensini score, and low hip BMD values (T-scores) were significantly and independently associated with increased risk of multivessel coronary disease in patients hospitalized for stable chest pain.

Cortical Thickness Index of the Proximal Femur: A Radiographic Parameter for Preliminary Assessment of Bone Mineral Density and Osteoporosis Status in the Age 50 Years and Over Population

BACKGROUND

Bone mineral density (BMD) is the indicator of bone quality in at-risk individuals. Along with the fracture risk assessment tool (FRAX), a quick assessment of BMD from routine radiographs may be useful in the case of lacking X-ray absorptiometry data. This study aimed to investigate the correlation of cortical thickness index (CTI) and canal flare index (CFI) with BMD and FRAX and to evaluate their ability to predict femoral neck BMD (nBMD) and FRAX in the general elderly population.

METHODS

A total of 560 volunteers (age ≥ 50 years) who underwent hip-spine X-ray, BMD scanning and FRAX calculation were retrospectively reviewed. CTI and CFI were measured on anteroposterior radiographs and analyzed for their correlation with BMD and FRAX and for their ability to predict nBMD. The ability of CTI to predict osteoporosis status (OPS) and fracture risk status (FRS) was also investigated and the threshold values were calculated. All the analyses were performed separately on male and female subjects.

RESULTS

Significant differences in CTI, CFI, nBMD and FRAX between males and females were observed. CTI and CFI demonstrated significant positive correlation with nBMD and FRAX (all p < 0.001) in both males and females. CTI, height, and weight significantly predicted nBMD. CTI statistically predicted OPS and FRS, and the values of 0.56 and 0.62 were computed as CTI thresholds for males and females, respectively.

CONCLUSIONS

CTI was significantly correlated with nBMD and it predicted nBMD at good prediction levels. Therefore, CTI may be used as a supportive tool in the assessment of OPS and FRS besides BMD and FRAX in clinical practice.

Lumbar disc degeneration was not related to spine and hip bone mineral densities in Chinese: facet joint osteoarthritis may confound the association

A sample of 512 Chinese was studied and we observed that greater disc degeneration on MRI was associated with greater spine DXA BMD. Yet, this association may be confounded by facet joint osteoarthritis. BMD may not be a risk factor for lumbar disc degeneration in Chinese.

PURPOSE

Evidence suggested that lumbar vertebral bone and intervertebral disc interact with each other in multiple ways. The current paper aims to determine the association between bone mineral density (BMD) and lumbar disc degeneration using a sample of Chinese.

METHODS

We studied 165 patients with back disorders and 347 general subjects from China. All subjects had lumbar spine magnetic resonance (MR) imaging and dual- energy X-ray absorptiometry (DXA) spine BMD studies, and a subset of general subjects had additional hip BMD measurements. On T2-weighted MR images, Pfirrmann score was used to evaluate the degree of lumbar disc degeneration and facet joint osteoarthritis was assessed as none, slight-moderate, and severe. Regression analyses were used to examine the associations between lumbar and hip BMD and disc degeneration, adjusting for age, gender, body mass index (BMI), lumbar region, and facet joint osteoarthritis.

RESULTS

Greater facet joint osteoarthritis was associated with greater spine BMD (P < 0.01) in both patients and general subjects. For general subjects, greater spine BMD was associated with severe disc degeneration, controlling for age, gender, BMI, and lumbar region. When facet joint osteoarthritis entered the regression model, however, greater spine BMD was associated with greater facet joint osteoarthritis (P < 0.01) but not greater disc degeneration (P > 0.05). No statistical association was observed between spine BMD and lumbar disc degeneration in patients with back disorders (P > 0.05), and between hip BMD and disc degeneration in general subjects (P > 0.05).

CONCLUSION

BMD may not be a risk factor for lumbar disc degeneration in Chinese. Facet joint osteoarthritis inflates DXA spine BMD measurements and therefore, may confound the association between spine BMD and disc degeneration.

Lumbar computed tomography scans are not appropriate surrogates for bone mineral density scans in primary adult spinal deformity

OBJECTIVE

The authors examined the correlation between lumbar spine CT Hounsfield unit (HU) measurements and bone mineral density measurements in an adult spinal deformity (ASD) population.

METHODS

Patients with ASD were identified in the records of a single institution. Lumbar CT scans were reviewed, and the mean HU measurements from L1–4 were recorded. Bone mineral density (BMD) was assessed using femoral neck and lumbar spine dual-energy x-ray absorptiometry (DEXA). The number of patients who met criteria for osteoporosis was determined for each imaging modality.

RESULTS

Forty-eight patients underwent both preoperative DEXA and CT scanning. Forty-three patients were female and 5 were male. Forty-seven patients were Caucasian and one was African American. The mean age of the patients was 62.1 years. Femoral neck DEXA was more likely to identify osteopenia (n = 26) than lumbar spine DEXA (n = 8) or lumbar CT HU measurements (n = 6) (p < 0.001). There was a low-moderate correlation between lumbar spine CT and lumbar spine DEXA (r = 0.463, p < 0.001), and there was poor correlation between lumbar spine CT and femoral neck DEXA (r = 0.303, p = 0.036).

CONCLUSIONS

Despite the opportunistic utility of lumbar spine CT HU measurements in identifying osteoporosis in patients undergoing single-level fusion, these measurements were not useful in this cohort of ASD patients. The correlation between femoral neck DEXA and HU measurements was poor. DEXA assessment of BMD in ASD patients is essential to optimize the care of these complicated cases.

Genetic analysis of the Vitamin D receptor start codon polymorphism (FokI) in cervical vertebra and lumbar spine pathologies: a meta-analysis

BACKGROUND

Vitamin D receptor (VDR) FokI polymorphism has been reported to influence the risk of spinal diseases. However, several studies suggest inconsistent results. Therefore, we performed this analysis to reveal the accurate relationship between VDR FokI polymorphism and spinal diseases.

MATERIALS AND METHODS

8 articles accord with the strict inclusion and exclusion criteria. 1116 cases and 1263 controls are entered into this analysis. The pooled odds ratios (ORs) and 95% confidence intervals (CI) are calculated to evaluate the association between VDR gene polymorphism and spinal diseases.

RESULT

The results suggest that allele F is a risk factor for spinal diseases and the difference is significant (F vs. f: OR = 1.151, 95% CI, 1.020-1.300). For the genotype analysis of VDR FokI, no statistical differences exist in the models of heterozygote comparison (Ff vs. ff), homozygote comparison (FF vs. ff) and dominant model (FF + Ff vs. ff) (p > 0.05). However, in recessive model (FF vs. Ff + ff), there is a significant association between VDR polymorphism and spinal diseases (OR = 1.209, 95% CI, 1.017-1.436). In subgroup analysis, the results show that allele F is a risk factor for spinal diseases in each estimation. In hospital-based subgroup, the significant differences exist in FF vs. ff and FF vs. Ff + FF models. In degenerative spine diseases group, the results are consistent with that of overall studies.

CONCLUSIONS

According to results of this meta-analysis, allele F is associated with the increased risk of spinal diseases. FF genotype may contribute to the susceptibility of spinal diseases. Therefore, VDR FokI polymorphism is related with spinal diseases.

Bone health in subjects with type 1 diabetes for more than 50 years

AIMS

Few data regarding prevalence of and risk factors for poor bone health in aging individuals with long-standing T1D are available. In this study, we aim to describe the prevalence of bone fragility and to identify factors associated with low bone density in individuals with long-term T1D.

METHODS

We examined the prevalence of non-vertebral fractures in 985 subjects enrolled in the Joslin 50-Year Medalist Study and measured bone mineral density (BMD) by dual-energy X-ray absorptiometry at the femoral neck, lumbar spine and radius in a subset (65 subjects, mean age 62.6 years, duration 52.5 years, HbA1c 7.1%) with no significant clinical or demographic differences from the rest of the cohort.

RESULTS

Medalists have low prevalence of fractures (0.20% hip and 0.91% wrist) and normal Z-score values (spine +1.15, total hip +0.23, femoral neck -0.01, radius +0.26; p > 0.05 for differences vs. 0 at all sites). A significant relationship was found between lower BMD and higher total cholesterol, triglycerides and LDL levels, but not HbA1c. Low BMD at the femoral neck was associated with cardiovascular disease after adjustment for confounding factors: prevalence risk ratio of CVD [95% CI] 4.6 [1.2-18.1], p = 0.03. No other diabetic vascular complication was found to be associated with low BMD.

CONCLUSIONS

These are the first data regarding bone health in aging individuals who have had diabetes for 50 or more years. The low rates of non-vertebral fractures and the normal Z-score suggest the long T1D diabetes duration did not increase the risk of bone fractures in Medalists compared to non-diabetic peers. Additionally, the association with cardiovascular disease demonstrates the BMD differences in groups are likely not due to glycemic control alone.

Prevalence of lumbar spondylosis and its association with low back pain among community-dwelling Japanese women

Background

Lumbar spondylosis is more prevalent among the middle-aged and elderly, but few population-based studies have been conducted, especially in Japan. The purpose of this study was to explore the prevalence of lumbar spondylosis and its associations with low back pain among community-dwelling Japanese women.

Methods

Lateral radiographs of the lumbar spine were obtained from 490 Japanese women ≥ 40 years old, and scored for lumbar spondylosis using the Kellgren-Lawrence (KL) grade at lumbar intervertebral level from L1/2 to L5/S1. Height and weight were measured, and body mass index (BMI) was calculated. Low back pain in subjects was assessed using a self-administered questionnaire. Stiffness index (bone mass) was measured at the calcaneal bone using quantitative ultrasound.

Results

Prevalence of radiographic lumbar spondylosis for KL ≥ 2, KL ≥ 3 and low back pain were 76.7%, 38.8% and 20.0%, respectively. Age was positively associated with radiographic lumbar spondylosis (KL = 2, KL ≥ 3) and low back pain. Greater BMI was associated with lumbar spondylosis with KL = 2, but not with KL ≥ 3. Stiffness index was associated with neither radiographic lumbar spondylosis nor low back pain. Multiple logistic regression analysis identified radiographic lumbar spondylosis (KL ≥ 3) at L3/4, L4/5 and L5/S1 was associated with low back pain, independent of age, BMI and stiffness index.

Conclusion

Severe lumbar spondylosis at the middle or lower level may contribute to low back pain.

Correlation between degenerative spine disease and bone marrow density: a retrospective investigation

BACKGROUND

Spondylosis leads to an overestimation of bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) but not with quantitative computed tomography (QCT). The correlation between degenerative changes of the spine and QCT-BMD was therefore investigated for the first time.

METHODS

One hundred thirty-four patients (66 female and 68 male) with a mean age of 49.0 ± 14.6 years (range: 19-88 years) who received a CT scan and QCT-BMD measurements of spine and hip were evaluated retrospectively. The occurrence and severity of spondylosis, osteochondrosis, and spondylarthrosis and the height of the vertebral bodies were assessed.

RESULTS

A negative correlation was found between spinal BMD and number of spondylophytes (ρ = -0.35; p < 0.01), disc heights (r = -0.33; p < 0.01), number of discal air inclusions (ρ = -0.34; p < 0.01), the number of Schmorl nodules (ρ = -0.25; p < 0.01), the number (ρ = -0.219; p < 0.05) and the degree (ρ = -0.220; p < 0.05) of spondylarthrosis. Spinal and hip BMD correlated moderately, but the latter did not correlate with degenerative changes of the spine. In linear regression models age, osteochondrosis and spondylarthrosis were factors influencing spinal BMD.

CONCLUSION

Degenerative spinal changes may be associated with reduced regional spinal mineralization. This knowledge could lead to a modification of treatment of degenerative spine disease with early treatment of osteopenia to prevent secondary fractures.

Variation in the PTH2R gene is associated with age-related degenerative changes in the lumbar spine

In the elderly, degenerative changes in the lumbar spine are common, contributing to falsely elevated bone mineral density (BMD) values. The parathyroid hormone (PTH) system plays an important role in the regulation of bone turnover and we explore the hypothesis that polymorphisms (SNPs) within genes in this pathway (PTH, PTHLH, PTH1R and PTH2R) contribute to degenerative manifestations of the spine in elderly women. The study included 1,004 Swedish women aged 75 years from the population-based OPRA cohort who attended follow-up at 5 and 10 years. Lumbar spine BMD was assessed by dual energy X-ray absorptiometry (DXA) and each individual vertebra was evaluated visually on the DXA image for apparent degenerative manifestations. Six SNPs in PTH and 3 SNPs each in PTH1R, PTH2R and PTHLH were analysed. Among women with degenerative manifestations at the lumbar spine, there was an over-representation at baseline of those carrying the PTH2R SNP rs897083 A-allele (p = 0.0021; odds ratio 1.5 95 % CI 1.2-2.0) and across the duration of follow-up (p = 0.0008). No association was observed between degenerative manifestations and variation in the other genes. None of the PTH hormone system genes were associated with vertebral fracture. Variation in the PTH2R gene (Chr2q34, rs897083) may contribute to the age-associated degenerative manifestations that develop at the lumbar spine.

Cervical vertebral trabecular bone mineral density in Great Danes with and without osseous-associated cervical spondylomyelopathy

Background

Great Danes (GDs) with osseous‐associated cervical spondylomyelopathy (CSM) have osteoarthritis (OA) of the cervical vertebrae. OA is often associated with increases in bone mineral density (BMD) in people and dogs.

Hypothesis/Objectives

To compare the trabecular BMD of the cervical vertebrae between clinically normal (control) GDs and GDs with osseous‐associated CSM by using computed tomography (CT). We hypothesized that the vertebral trabecular BMD of CSM‐affected GDs would be higher than that of control GDs.

Animals

Client‐owned GDs: 12 controls, 10 CSM affected.

Methods

Prospective study. CT of the cervical vertebral column was obtained alongside a calibration phantom. By placing a circular region of interest at the articular process joints, vertebral body, pedicles, and within each rod of the calibration phantom, trabecular BMD was measured in Hounsfield units, which were converted to diphosphate equivalent densities. Trabecular BMD measurements were compared between CSM‐affected and control dogs, and between males and females within the control group.

Results

Differences between CSM‐affected and control dogs were not significant for the articular processes (mean = −39; P = .37; 95% CI: −102 to 24), vertebral bodies (mean = −62; P = .08; 95% CI: −129 to 6), or pedicles (mean = −36; P = .51; 95% CI: −105 to 33). Differences between female and male were not significant.

Conclusions and Clinical Importance

This study revealed no difference in BMD between control and CSM‐affected GDs. Based on our findings no association was detected between cervical OA and BMD in GDs with CSM.

Ultrasonographic assessment of the femoral cartilage in osteoarthritis patients with and without osteoporosis

BACKGROUND

The relationship between osteoporosis (OP) and osteoarthritis (OA) is yet unclear.

AIM

To evaluate the possible effect of OP on the femoral cartilage thickness in female patients with knee OA.

MATERIALS AND METHODS

Eighty patients with a diagnosis of knee OA were enrolled. Forty subjects who also had OP comprised Group I and the remaining 40 OA subjects comprised Group II. Antero-posterior knee radiographs were obtained in standing position and they were evaluated according to Kelgren-Lawrence (K-L) grading scale. Femoral cartilage evaluations were performed using a linear array US probe (7-12 MHz). In addition, ultrasonographic femoral cartilage grading was also performed for each knee.

RESULTS

Left knee scores pertaining to both gradings were found to be lower (p = 0.02, p = 0.04, respectively) in Group I when compared with those of Group II. The two grading scores were positively correlated for both knees-statistically significant only for the right side (r = 0.727, p = 0.01). No significant difference was found between the groups in terms of femoral cartilage thicknesses (all p > 0.05).

DISCUSSION

Ultrasonographic and roentgenographic gradings were consistent and patients with OP had lower scores for both gradings. On the other hand, the presence of OP did not seem to have any effect on cartilage thickness measurements.

CONCLUSIONS

To the best knowledge of the authors, this study is the first to have explored the impact of OP on OA using US in the literature.

Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women

Degenerative changes of the lumbar spine may lead to misinterpretation of bone mineral density (BMD) measurements and cause underdiagnosis of osteoporosis. This longitudinal study of 1,044 women, 75 years at inclusion and followed for 10 years, shows that identification of apparent degenerative changes on the dual energy X-ray absorptiometry (DXA) scan can increase the proportion diagnosed.

INTRODUCTION

In the elderly, degenerative manifestations in the lumbar spine may result in falsely elevated BMD values, consequently missing a large proportion of those with osteoporosis. Our aim was to determine the distribution and impact of degenerative changes on lumbar spine DXA over time and its clinical implications.

METHODS

Participants were 1,044 women from the population-based Osteoporosis Risk Assessment cohort. All women were 75 years old at invitation and followed up after 5 years (n=715) and 10 years (n=382). Degenerative changes were evaluated visually on the DXA image for each vertebra L1 to L4 (intraobserver precision kappa values of 0.66-0.70).

RESULTS

At baseline, apparent degenerative changes were more frequent in the inferior segments of the lumbar spine [5% (L1), 15% (L2), 26% (L3), and 36% (L4)] and increased over time. At 10 years, the prevalences were 20% (L1), 39% (L2), 59% (L3), 72% (L4), resulting in a significant increase in overall BMD. In women without apparent degenerative changes, BMD remained stable between 75 and 85 rather than an expected bone loss. At baseline, 37% had osteoporosis (BMD<-2.5) at L1-L4; exclusion of women with apparent degenerative changes increased this proportion to 47%. Using L1-L2, which was less prone to degenerative changes, 46% of women were classified as osteoporotic regardless of degenerative changes.

CONCLUSION

Degenerative changes were very common in elderly women, accelerated disproportionately over time, were increasingly frequent from vertebrae L1 to L4, and had significant impact on diagnosing osteoporosis. This suggests that routine reporting of spine BMD at L1-L2 would add valuable information for reassessment and monitoring.

Weight in infancy and adult calcium absorption as determinants of bone mineral density in adult men: the Hertfordshire cohort study

Adult bone mass is modified by early life environmental influences, but the mechanism of this association is uncertain. Data support an inverse relationship between intestinal calcium absorption (αCa) and birth weight in women. However, little is known regarding determinants in men. This study examines the association between weight in infancy and adult αCa in healthy men and whether this could be a mechanism by which the early life environment may influence bone mass. Men were recruited from the MRC Hertfordshire Cohort Study, for whom detailed early life records were available. Areal bone mineral density (aBMD) was measured using a Hologic QDR 4500 at the femoral neck (FN) and lumbar spine. We randomly selected 123 men stratified by birth weight and assessed αCa using the stable strontium absorption test. The mean age was 63.6 (SD 2.5) years. αCa was not associated with birth weight or weight at 1 year. FN aBMD was associated with both weight at 1 year (r = 0.20, p = 0.03) and αCa (r = 0.20, p = 0.03). Both of these associations remained statistically significant in a mutually adjusted, multivariable model but would account for only ~4 % variance in BMD. We demonstrated a positive association between weight at 1 year and aBMD and between αCa and FN BMD, but no association was found between birth weight and αCa. This suggests that in men, although αCa is a contributing factor in FN bone density, it is not the main mechanism whereby the early environment modifies adult BMD.

Divergent Significance of Bone Mineral Density Changes in Aging Depending on Sites and Sex Revealed through Separate Analyses of Bone Mineral Content and Area

Bone mineral density (aBMD) is equivalent to bone mineral content (BMC) divided by area. We rechecked the significance of aBMD changes in aging by examining BMC and area separately. Subjects were 1167 community-dwelling Japanese men and women, aged 40-79 years. ABMDs of femoral neck and lumbar spine were assessed by DXA twice, at 6-year intervals. The change rates of BMC and area, as well as aBMD, were calculated and described separately by the age stratum and by sex. In the femoral neck region, aBMDs were significantly decreased in all age strata by an increase in area as well as BMC loss in the same pattern in both sexes. In the lumbar spine region, aBMDs decreased until the age of 60 in women, caused by the significant BMC decrease accompanying the small area change. Very differently in men, aBMDs increased after their 50s due to BMC increase, accompanied by an area increase. Separate analyses of BMC and area change revealed that the significance of aBMD changes in aging was very divergent among sites and between sexes. This may explain in part the dissociation of aBMD change and bone strength, suggesting that we should be more cautious when interpreting the meaning of aBMD change.

Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship--is osteoarthritis a predictor for osteoporosis or vice versa?: the Miyama study

SUMMARY

In a 10-year follow-up of a population-based cohort of Japanese subjects, incidences of and causal relationships between osteoporosis (OP) and osteoarthritis (OA) at the lumbar spine were clarified. OP might reduce the risk of subsequent OA at the spine in women, but not in men.

INTRODUCTION

The aim of this study is to clarify the contribution of osteoarthritis (OA) to osteoporosis (OP) and vice versa.

METHODS

A population-based, epidemiological study was conducted in a Japanese rural community. From 1,543 participants aged 40-79 years, 200 men and 200 women were selected and followed up for 10 years. Bone mineral density measurements were repeated after 3, 7, and 10 years, and X-rays were repeated after 10 years.

RESULTS

The incidence of lumbar OP per 10,000 person-years for persons in their 40s, 50s, 60s, and 70s was 0, 0, 109.5, and 151.1 for men and 124.2, 384.0, 227.3, and 239.5 for women, respectively. The cumulative incidence of lumbar OA over 10 years aged 40-79 years was 25.8% in men and 45.2% in women. Cox's proportional hazards model showed no significant relationship between the presence of lumbar OA at the baseline and incidence of lumbar and femoral neck OP in both genders. A significant relationship was demonstrated between the presence of lumbar OP, not femoral neck OP, at the baseline and cumulative incidence of lumbar OA in women (odds ratio, 0.20; 95% confidence interval, 0.05-0.80; P = 0.02).

CONCLUSION

OP in women appears to reduce the future incidence of OA at the lumbar spine.

Management of non-neuronopathic Gaucher disease with special reference to pregnancy, splenectomy, bisphosphonate therapy, use of biomarkers and bone disease monitoring

Enzyme replacement was introduced as treatment for non-neuronopathic Gaucher disease more than 15 years ago. To ensure the best use of this costly ultra-orphan agent, a systematic disease management approach has been proposed by an international panel; this includes the development, by consensus, of achievable treatment goals. Here we critically review these goals and monitoring guidelines and incorporate emerging experience of the disease in the therapeutic era, as well as contemporary clinical research. This review makes recommendations related specifically to the management of pregnancy; the appropriate use of splenectomy and bisphosphonate treatment; the relevance of biochemical markers to disease monitoring; and the use of semi-quantitative methods for assessing bone marrow infiltration. In addition, we identify key areas for development, including the requirement for a validated index of disease severity; the need to correlate widely used biomarkers with long-term disease outcomes, and the desirability of establishing agreed standards for monitoring of bone disease particularly in infants and children with Gaucher disease.

Association of gene polymorphisms with intervertebral disc degeneration and vertebral osteophyte formation

STUDY DESIGN

Cross-sectional cohort study of elderly people.

OBJECTIVES

To examine the factors influencing osteophyte formation without lumbar disc degeneration and to estimate the implications of osteophytes from the viewpoint of low back pain and gene polymorphisms.

SUMMARY OF BACKGROUND DATA

The degenerative changes that occur in the intervertebral discs are the point of departure of osteophyte formation. Several studies on factors associated with genetic susceptibility to spinal osteophyte formation, such as VDR and TGF-beta1. However, there are no detailed studies concerning osteophytes not accompanied with disc degeneration.

METHODS

A total of 387 elderly persons were recruited, and disc degeneration and osteophyte formation were evaluated. The cases with osteophyte formation were classified into 3 groups: osteophyte formation with disc height narrowing (n = 217), osteophyte formation without disc height narrowing (n = 99), and control group defined as the cases without osteophyte formation (n = 71). Twelve genotypes were characterized. Correlations between these degenerative factors and the polymorphisms were analyzed.

RESULTS

The prevalence of low back pain was significantly greater in the group of osteophyte formation with disc height narrowing than the other 2 groups. In the polymorphism of alcohol dehydrogenase (ADH2), prevalence of osteophyte formation without disc height narrowing was less in His/Arg (odds ratio = 0.57, P = 0.041) and Arg/Arg (odds ratio = 0.41, P = 0.18) than His/His.

CONCLUSIONS

Patients with osteophyte formation preceding intervertebral disc narrowing had a lower risk of low back pain compared with those without osteophytes. The 47Arg polymorphism in the ADH2 may act to suppress osteophyte formation unaffected by disc degeneration.

Radiographic measure of aorta calcification is a site-specific predictor of bone loss and fracture risk at the hip

OBJECTIVE

To investigate whether aorta calcification (AC) - a surrogate marker of atherosclerosis - is an independent indicator of low bone mass density (BMD), accelerated bone loss, and risk of future fractures in postmenopausal women.

DESIGN

A prospective epidemiological study. Follow-up period was 7.5 years.

SETTING

Community-based sample followed by a research institute.

SUBJECTS

A total of 2662 generally healthy postmenopausal women with a mean age of 65.0 +/- 7.1 years at baseline.

MAIN OUTCOME MEASURES

Annual rate of changes in BMD (DEXA) and AC (X-rays), vertebral fractures (X-rays), hip fractures (questionnaire).

RESULTS

Advanced AC at baseline was significantly associated with lower BMD and accelerated bone loss from the proximal femur. In a multivariate logistic regression model, age (OR 1.1, 95% CI 1.0-1.2, P = 0.02), body mass index (BMI; OR 0.9, 95% CI 0.8-1.0, P = 0.03) and the severity of AC (OR 2.3, 95% CI 1.1-4.8, P = 0.03) were independent predictors of hip fractures. Adjusted OR for vertebral fracture was 1.2 (95% CI 1.0-1.5, P = 0.12).

CONCLUSIONS

Aorta calcification seems to independently contribute to the development of osteoporosis in the proximal femur. Further studies are needed to clarify whether effective atherosclerosis prevention lowers hip fracture risk.

Effects of alfacalcidol alone or in combination with elcatonin on incidence of osteoporotic vertebral fractures in postmenopausal women with spondylosis

Osteoporosis and spondylosis often occur simultaneously. However, there are no previous reports about the effects of osteoporosis medication on incidence of vertebral fractures in people with spondylosis. In this study, we conducted a retrospective investigation of the effects of alfacalcidol alone or in combination with elcatonin on incidence of osteoporotic vertebral fractures in women with spondylosis. The present subjects were 101 postmenopausal women with osteoporosis aged >60 years, divided into three groups: D group (n = 45), treated for >5 years with alfacalcidol; D+ECT group (n = 26), treated for >5 years with alfacalcidol plus elcatonin; control group (n = 30), who received no medications for >5 years. Over the 5-year treatment period, bone mineral density (BMD) of the lumbar spine and proximal femur did not significantly change in the D and D+ECT groups, but they significantly decreased in the control group (P < 0.05). The number of incident vertebral fractures per patient was significantly higher in the control group (2.9) than in the D group (1.2) and D+ECT group (1.5) (P < 0.01). There was no significant difference in BMD or incident vertebral fractures between the D and D+ECT groups. In all three groups, the number of incident vertebral fractures positively correlated with the number of prevalent vertebral fractures (0.303 </= r </= 0.434), and negatively correlated with baseline BMD (-0.703 </= r </= -0.326) and the osteophyte score representing the degree of spondylosis (-0.769 </= r </= -0.365). Further multiple regression analysis revealed that the medication (D or D+ECT, P < 0.001) and the osteophyte score (P < 0.001) were the most significant contributors for the number of incident vertebral fractures. In conclusion, elcatonin had no additive effects on BMD or prevention of vertebral fractures in postmenopausal women receiving alfacalcidol. Presence of spondylosis (indicated by a high osteophyte score) appears to have an effect on prevention of vertebral fractures.

Overweight postmenopausal women lose bone with moderate weight reduction and 1 g/day calcium intake

Overweight postmenopausal women may be more susceptible to bone loss with weight reduction than previously studied obese women. The influence of energy restriction and Ca intake on BMD was assessed in 66 individuals. Weight reduction resulted in bone loss at several sites in women consuming 1 g Ca/day and was mitigated with higher calcium intake at 1.7 g/day.

INTRODUCTION

Bone loss is associated with weight loss in obese postmenopausal women and can be prevented with calcium (Ca) supplementation. However, because bone loss caused by weight loss may be greater in overweight than obese women, it is not clear whether Ca supplementation is also beneficial in overweight women.

MATERIALS AND METHODS

We assessed the influence of caloric restriction at two levels of Ca intake on BMD and BMC in 66 overweight postmenopausal women (age, 61 +/- 6 years; body mass index, 27.0 +/- 1.8 kg/m2). Subjects completed either a 6-month energy-restricted diet (WL, n = 47) and lost 9.3 +/- 3.9 % weight or maintained weight (WM; 1 g Ca/day, n = 19). Participants in the WL group were randomly assigned to either normal (1 g/day; WL NL-Ca) or high (1.7 g/day; WL Hi-Ca) Ca intake. Regional BMD and BMC were measured at baseline and after 6 months.

RESULTS

During normal Ca intake, trochanter BMD and BMC and total spine BMD were decreased more in WL than WM women (p < 0.05). The WL NL-Ca group lost more trochanter BMD (-4.2 +/- 4.1%) and BMC (-4.8 +/- 7.1%) than the WL Hi-Ca group (-1.4 +/- 5.6% and -1.1 +/- 8.1%, respectively; p < 0.05). There were no significant changes in BMD or BMC at the femoral neck in any group. Weight loss correlated with trochanter BMD loss (r = 0.687, p < 0.001) in the WL NL-Ca group.

CONCLUSION

Despite an intake of 1 g Ca/day, bone loss occurred at some sites because of weight loss. Calcium intake of 1.7 g/day will minimize bone loss during weight loss in postmenopausal overweight women.

Fractures of the Lumbar and Sacral Superior Articular Processes: Report of Two Cases

OBJECTIVE AND IMPORTANCE:

Injury to the posterior vertebral elements of the lumbar spine represents a common cause of lower back pain in athletes. However, associations between nontraumatic fracture, nonathletic populations, and treatment remain poorly described. Diagnosis and treatment of two extremely rare symptomatic fractures of the superior articular process are discussed.

CLINICAL PRESENTATION:

Two male nonathletes presented with sudden lower back and leg pain after usual daily activities. No obvious abnormalities were revealed by radiography, magnetic resonance imaging, or myelography.

INTERVENTION:

In both patients, small fractures of the superior articular facet compressing the root shoulder were recognized after further examination, including detailed neurological evaluation of symptoms and targeted thin-slice computed tomography. After failure of conservative treatment, surgical debridement and removal of nonunion fracture were accomplished.

CONCLUSION:

Symptoms were resolved surgically without further complications or rehabilitation. Fractures of the superior articular facet causing intolerable lower back and sciatic leg pain are rare. We present the first reported cases of these fractures.

Inverse relation between osteoporosis and spondylosis in postmenopausal women as evaluated by bone mineral density and semiquantitative scoring of spinal degeneration

STUDY DESIGN

The relation between bone mineral density and severity of spondylosis was evaluated in postmenopausal women.

OBJECTIVE

To examine the possible inverse relation between osteoporosis and spondylosis by evaluating the association between bone mineral density and osteophyte formation or intervertebral disc narrowing using a semiquantitative scoring system.

SUMMARY OF BACKGROUND DATA

The literature contains studies demonstrating an inverse relation between osteoporosis and spondylosis as well as those documenting insufficient support for such a relation. However, in these studies, only limited-range grading systems (e.g., Grades 1-4) were used to evaluate the severity of spondylosis.

METHODS

In this study, 104 postmenopausal women older than 60 years underwent bone mineral density measurement of the lumbar spine (anteroposterior, lateral, and midlateral) and proximal femur (femoral neck, trochanter, and Ward's triangle) using dual-energy x-ray absorptiometry. Raw data representing the semiquantitative osteophyte score and disc score as well as the number of vertebral fractures were obtained using spinal radiograph. Correlations between bone mineral density and the radiographic variable were then analyzed.

RESULTS

Significant negative correlations were found between all bone mineral density data and the number of vertebral fractures (-0.524 < or r= r < or = -0.347; P < 0.05). Marginal/moderate positive correlations were observed between the osteophyte score and the bone mineral density data (0.263 < or = r < or = 0.580, P < 0.05), and between the disc score and the bone mineral density data (0.233 < or = r < or = 0.570, P < 0.05).CONCLUSIONS On the basis of the finding that spondylotic changes in postmenopausal women exhibit positive correlations not only with the lumbar bone mineral density, but also with the remote-site bone mineral density, this study supports the view that osteoporosis has an inverse relation with spondylosis.