Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study

Prevalence of pregnancy- and lactation-associated osteoporosis in the postpartum period: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to estimate the prevalence of pregnancy- and lactation-associated osteoporosis in postpartum women within 1 year of delivery. We searched MEDLINE via PubMed and Igaku Chuo Zasshi for articles published in English or Japanese from the inception of the database to September 2021. Two researchers independently screened and included observational studies reporting the prevalence of pregnancy- and lactation-associated osteoporosis in postpartum women within 1 year of delivery. Of the 3,425 screened records, 8 articles centered on postpartum women were included in the review. Seven studies used dual-energy X-ray absorptiometry for assessing bone mineral density, while one used a quantitative ultrasound method. In the seven studies that used dual-energy X-ray absorptiometry, the parameters used to define osteoporosis were the T-score (two studies), Z-score (three studies), both T- and Z-scores (one study), and young adult mean (one study). Evaluation timeframes included 1 week (three studies), 1-2 months postpartum (three studies), and 1 week to 12 months postpartum (one study). The estimated prevalence of pregnancy- and lactation-associated osteoporosis defined by dual-energy X-ray absorptiometry was as follows: lumbar spine (six studies), 5% (95% confidence interval [CI], 0-13; heterogeneity [I2] = 99%) and femoral neck (three studies), 12% (95% CI, 0-30; I2 = 99%). Pregnancy and lactation were found to elevate the fracture risk in women, underscoring the necessity for a standardized assessment in diagnosing pregnancy- and lactation-associated osteoporosis. This imperative step aims to enable early detection and treatment of bone mineral loss among postpartum women.

The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques

The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.

Diagnosing Osteoporosis in Diabetes-A Systematic Review on BMD and Fractures

PURPOSE OF REVIEW

Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T-score of - 2.0 in patients with diabetes should be interpreted as equivalent to - 2.5 in people without diabetes. We aimed to evaluate the most recent findings concerning the bone mineral density (BMD)-derived T-score and risk of fractures related to osteoporosis in subjects with diabetes.

RECENT FINDINGS

The dual-energy X-ray absorptiometry (DXA) scan is the golden standard for evaluating BMD. The BMD-derived T-score is central to fracture prediction and signifies both diagnosis and treatment for osteoporosis. However, the increased fracture risk in diabetes is not sufficiently explained by the T-score, complicating the identification and management of fracture risk in these patients. Recent findings agree that subjects with type 2 diabetes (T2D) have a higher T-score and higher fracture risk compared with subjects without diabetes. However, the actual number of studies evaluating the direct association of higher fracture risk at higher T-score levels is scant. Some studies support the adjustment based on the 0.5 BMD T-score difference between subjects with T2D and subjects without diabetes. However, further data from longitudinal studies is warranted to validate if the T-score treatment threshold necessitates modification to prevent fractures in subjects with diabetes.

Can Ultrasonographic Measurement of Bone Cortical Thickness Predict Osteoporosis?

RATIONALE AND OBJECTIVES

In this study, we aimed to describe a more accessible and safe diagnostic tool for osteoporosis or osteopenia diagnosis. We utilized cortical thickness (CoT) measurement of various bones via ultrasonography and evaluated the method's accuracy relative to bone mineral density (BMD) results determined by dual-energy X-ray absorptiometry (DXA).

MATERIALS AND METHODS

A total of 200 volunteers (all female) who agreed to participate in the study and had undergone BMD measurement (femoral or vertebral) were included in the study. Patients with normal BMD result (≥-1.0 T-score) were defined as controls. CoT measurements were made from three bones (radius, tibia, and second metatarsal) for each patient via ultrasonography.

RESULTS

Radius CoT and tibial CoT measurements of both femoral and vertebral osteoporotic or osteopenic patients were significantly higher compared to controls. Second metatarsal CoT of femoral osteoporotic and osteopenic patients was also found to be significantly higher than the control group. We found tibia CoT and radius CoT to have high sensitivity and positive predictive value in identifying patients with abnormal femoral T-scores (<-1). In multivariable analyzes, radius CoT was found to be independently predictive in distinguishing patients with abnormal T-score (<-1) from controls in both the femur and vertebral BMD groups.

CONCLUSION

Radius CoT and tibia CoT values appear to have value in predicting patients with abnormal T-scores measured via DXA. This method may be a very simple technique that can be used for early detection of osteoporosis and osteopenia, but its results need to be supported by more comprehensive studies.

Early Pixel Value Ratios to Assess Bone Healing During Distraction Osteogenesis

Background: Distraction osteogenesis (DO) is an approach for bone lengthening and reconstruction. The pixel value ratio (PVR), an indicator calculated from X-ray images, is reported to assess the final timing for the external fixator removal. However, the early PVR and its potential influencing factors and the relationship between the early PVR and clinical outcomes are rarely discussed. Therefore, this study was employed to address these issues.

Methods: A total of 125 patients with bone lengthening were investigated retrospectively. The early PVR of regenerated bone was monitored in the first 3 months after osteotomy. The potential effect of sex, chronological age, BMI, lengthening site, and involvement of internal fixation during the consolidation period was analyzed. Moreover, the associations of the healing index (HI) and lengthening index (LI) with early PVR were also investigated.

Results: The early PVRs were 0.78 ± 0.10, 0.87 ± 0.06, and 0.93 ± 0.06 in the first 3 months after osteotomy, respectively. Moreover, the PVR in juvenile was significantly higher than that in adults in the first 3 months after osteotomy (0.80 ± 0.09 vs. 0.74 ± 0.10; p = 0.008), (0.89 ± 0.06 vs. 0.83 ± 0.06; p = 0.018), and (0.94 ± 0.05 vs. 0.87 ± 0.05; p = 0.003). In addition, the PVR in males was significantly higher than that in females in the first month after osteotomy (0.80 ± 0.09 vs. 0.76 ± 0.10; p = 0.015), and the PVR in femur site was significantly higher than that in the tibia site in the second and third months after osteotomy (0.88 ± 0.07 vs. 0.87 ± 0.06; p = 0.015) and (0.93 ± 0.06 vs. 0.92 ± 0.06, p = 0.037). However, the BMI and involvement of the internal fixator during the consolidation period seem to not influence the early PVR of regenerated callus during DO. Interestingly, the early PVR seems to be moderately inversely associated with HI (mean = 44.98 ± 49.44, r = -0.211, and p = 0.029) and LI (mean = 0.78 ± 0.77, r = -0.210, and p = 0.029), respectively.

Conclusion: The early PVR is gradually increasing in the first 3 months after osteotomy, which may be significantly influenced by chronological age, sex, and the lengthening site. Moreover, the early PVR of callus may reflect the potential clinical outcome for DO. Our results may be beneficial to the clinical management of the subjects with bone lengthening.