Osteoporosis Screening and Treatment: A Collaborative Approach

Recommendations for Improving Women's Bone Health Throughout the Lifespan

Osteoporosis is a common condition in which deteriorating bone tissue results in an increased risk of low trauma fracture. Influenced by the role of estrogen in building and maintaining bone mineral density, women have different patterns of bone accrual and loss compared with men, resulting in a lower peak bone mass and a greater lifetime fracture risk. Moreover, fracture risk increases significantly in postmenopausal women who have depleted estrogen levels. Osteoporotic fractures pose serious consequences-ranging from an inability to perform basic tasks and an increased risk of repeat fracture to the need for assisted living and even death. There is also a large economic toll associated with the health care costs required for post-fracture care. The Society for Women's Health Research (SWHR) convened an interdisciplinary Bone Health Working Group to review the current state of science and practice concerning women's bone health and osteoporosis care and to explore strategies to address gaps in screening, diagnosis, and treatment of bone disease in women. Women's bone health care must shift its paradigm from one of postmenopausal and post-fracture care to a preventive model that engages touchpoints throughout the lifespan. To achieve this paradigm shift, the Working Group recommends prioritizing efforts to build public awareness and clinical education of preventive bone health care for women, increase access to screening tools, improve patient-provider communication, and treat osteoporosis using a broader risk stratification approach.

Improving referrals to a fracture liaison service: Screening for osteoporosis

With the elderly population living longer and 'baby boomer's now reaching the age of 65, there is great concern regarding a lack of diagnosis and treatment of osteoporosis. Osteoporosis is a well-known problem, yet there continue to be gaps regarding screening and treatment. An orthopaedic practice in the Southeastern United States specializing in bone health has an internal Fracture Liaison Service (FLS) that was not being fully utilized by the providers. A quality improvement project was implemented following the recommended FLS guidelines to identify individuals that should receive referral to the FLS. Chart audits were completed to analyze both pre- and post-implementation phases. An alert button was introduced into the electronic health record to prompt orthopaedic surgeons to refer to the FLS clinic when individuals met the requirements of age and a first-time fragility fracture. Descriptive data showed 5% FLS referrals in 2019. After implementation of the alert button the FLS referrals for 2020 were 19%, providing a 14% overall improvement rate. Evidence supports using standardized screening processes and that referring to an FLS is best practice for improving the treatment of osteoporosis and for decreasing morbidity, mortality, and health care cost.

Deep learning approach for automatic segmentation of ulna and radius in dual-energy X-ray imaging

BACKGROUND

Segmentation of the ulna and radius is a crucial step for the measurement of bone mineral density (BMD) in dual-energy X-ray imaging in patients suspected of having osteoporosis.

PURPOSE

This work aimed to propose a deep learning approach for the accurate automatic segmentation of the ulna and radius in dual-energy X-ray imaging.

METHODS AND MATERIALS

We developed a deep learning model with residual block (Resblock) for the segmentation of the ulna and radius. Three hundred and sixty subjects were included in the study, and five-fold cross-validation was used to evaluate the performance of the proposed network. The Dice coefficient and Jaccard index were calculated to evaluate the results of segmentation in this study.

RESULTS

The proposed network model had a better segmentation performance than the previous deep learning-based methods with respect to the automatic segmentation of the ulna and radius. The evaluation results suggested that the average Dice coefficients of the ulna and radius were 0.9835 and 0.9874, with average Jaccard indexes of 0.9680 and 0.9751, respectively.

CONCLUSION

The deep learning-based method developed in this study improved the segmentation performance of the ulna and radius in dual-energy X-ray imaging.

Analyses of the Association between Thyroid Cancer and Osteoporosis/Fracture Histories: A Cross-Sectional Study Using KoGES HEXA Data

(1) Background: The purpose of this study was to determine the association among thyroid cancer, osteoporosis and fracture history. (2) Methods: The data collected from 2004 through 2016 for the Korean Genome and Epidemiology Study were retrieved. For a total of 1349 participants with thyroid cancer and 163,629 control participants, the odds ratios (ORs) with 95% confidence intervals (CIs) of osteoporosis and fracture history were evaluated using a logistic regression model. (3) Results: The adjusted ORs of osteoporosis comparing thyroid cancer with the control group were 1.41 (95% CI = 1.18–1.70, p < 0.001) for all participants and 1.43 (95% CI = 1.19–1.71, p < 0.001) for women. The adjusted ORs of fracture history comparing these two groups were not significantly associated within the entire group of participants, men only or women only. (4) Conclusions: The adjusted OR of osteoporosis was significantly higher than 1, comparing thyroid cancer with the control group, especially in women. The adjusted OR of fractures was not significantly higher than 1, comparing the thyroid cancer group with the control group.

Supramolecular nanoassemblies of salmon calcitonin and aspartame for fibrillation inhibition and osteogenesis improvement

Osteoporosis therapy consists of inhibiting the osteoclasts' activity and promoting osteoblasts' osteogenesis. Salmon calcitonin (sCT) could realize both requirements, however, it is limited by the low bioavailability caused by fibrillation. Supramolecular assembly of sCT and biocompatible agents into nanoassemblies provides an opportunity to overcome these shortcomings. Herein, we used a facile method to fabricate salmon calcitonin-aspartame (sCT-APM) nanoassemblies. Supramolecular interactions could not only delay fibrillation time (from 36.9 h to 50.4 h), but also achieve sustained sCT release. Moreover, sCT-APM showed good biocompatibility and higher osteoinductive capacity than free sCT, revealing an osteogenesis improvement effect. Moreover, in vivo studies showed that sCT-APM has enhanced relative bioavailability (2.42-fold of sCT) and increased relative therapeutic efficacy (3.55-fold of sCT) through subcutaneous injection. These findings provide a convenient alternative strategy for osteoporosis therapy via supramolecular assemblies.

The opposite effects of Antarctic krill oil and arachidonic acid-rich oil on bone resorption in ovariectomized mice

The opposite effects and mechanism of AKO and AAO in the regulation of bone resorption in postmenopausal osteoporosis were systematically investigated to support the recommendations on fatty acid types in dietary oils for people with osteoporosis.