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E E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G, Carey JJ. The Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) for Osteoporosis Project. BMJ Open 2020; 10:e040488. [PMID: 33371026 PMCID: PMC7751214 DOI: 10.1136/bmjopen-2020-040488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The purpose of the Irish dual-energy X-ray absorptiometry (DXA) Health Informatics Prediction (HIP) for Osteoporosis Project is to create a large retrospective cohort of adults in Ireland to examine the validity of DXA diagnostic classification, risk assessment tools and management strategies for osteoporosis and osteoporotic fractures for our population. PARTICIPANTS The cohort includes 36 590 men and women aged 4-104 years who had a DXA scan between January 2000 and November 2018 at one of 3 centres in the West of Ireland. FINDINGS TO DATE 36 590 patients had at least 1 DXA scan, 6868 (18.77%) had 2 scans and 3823 (10.45%) had 3 or more scans. There are 364 unique medical disorders, 186 unique medications and 46 DXA variables identified and available for analysis. The cohort includes 10 349 (28.3%) individuals who underwent a screening DXA scan without a clear fracture risk factor (other than age), and 9947 (27.2%) with prevalent fractures at 1 of 44 skeletal sites. FUTURE PLANS The Irish DXA HIP Project plans to assess current diagnostic classification and risk prediction algorithms for osteoporosis and fractures, identify the risk predictors for osteoporosis and develop novel, accurate and personalised risk prediction tools, by using the large multicentre longitudinal follow-up cohort. Furthermore, the dataset may be used to assess, and possibly support, multimorbidity management due to the large number of variables collected in this project.
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Affiliation(s)
- Erjiang E
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lan Yang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bryan Whelan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Ireland
| | - Miriam O'Sullivan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Ireland
| | - Bridie Rooney
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - Aoife McPartland
- Department of Rheumatology, Our Lady's University Hospital, Manorhamilton, Ireland
| | - Gráinne O'Malley
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
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Schousboe JT, Lewis JR, Kiel DP. Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance. Bone 2017; 104:91-100. [PMID: 28119178 DOI: 10.1016/j.bone.2017.01.025] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Abdominal aortic calcification (AAC) can be accurately recognized on lateral spine images intended for vertebral fracture assessment, that are obtained with dual-energy X-ray absorptiometry (DXA). Greater amounts of AAC are common in the older population for whom DXA is routinely done, and have been consistently associated with incident atherosclerotic cardiovascular disease (ASCVD) events. AAC has also been associated with incident fractures in some prospective studies, but not in others. However, further research is needed to quantify the extent to which measurement of AAC improves prediction of ASCVD events and its impact on physician and patient ASCVD risk management. Additionally, research to develop better, more precise, automated, quantitative methods of AAC assessment on lateral spine densitometric images will hopefully lead to better prediction of clinical outcomes. In conclusion, although the prime indication for densitometric lateral spine imaging remains vertebral fracture assessment, AAC that is found incidentally on lateral spine images should be reported, so that patients and their health care providers are aware of its presence.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc., Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - Joshua R Lewis
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew Senior Life, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Elmasri K, Hicks Y, Yang X, Sun X, Pettit R, Evans W. Automatic Detection and Quantification of Abdominal Aortic Calcification in Dual Energy X-ray Absorptiometry. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.procs.2016.08.116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Lewis JR, Schousboe JT, Lim WH, Wong G, Zhu K, Lim EM, Wilson KE, Thompson PL, Kiel DP, Prince RL. Abdominal Aortic Calcification Identified on Lateral Spine Images From Bone Densitometers Are a Marker of Generalized Atherosclerosis in Elderly Women. Arterioscler Thromb Vasc Biol 2015; 36:166-173. [PMID: 26603153 DOI: 10.1161/atvbaha.115.306383] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/15/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dual-energy x-ray absorptiometry is a low-cost, minimal radiation technique used to improve fracture prediction. Dual-energy x-ray absorptiometry machines can also capture single-energy lateral spine images, and abdominal aortic calcification (AAC) is commonly seen on these images. APPROACH AND RESULTS We investigated whether dual-energy x-ray absorptiometry-derived measures of AAC were related to an established test of generalized atherosclerosis in 892 elderly white women aged >70 years with images captured during bone density testing in 1998/1999 and B-mode carotid ultrasound in 2001. AAC scores were calculated using a validated 24-point scale into low (AAC24 score, 0 or 1), moderate (AAC24 scores, 2-5), and severe AAC (AAC24 scores, >5) seen in 45%, 36%, and 19%, respectively. AAC24 scores were correlated with mean and maximum common carotid artery intimal medial thickness (rs=0.12, P<0.001 and rs=0.14, P<0.001). Compared with individuals with low AAC, those with moderate or severe calcification were more likely to have carotid atherosclerotic plaque (adjusted prevalence ratio (PR), 1.35; 95% confidence interval, 1.14-1.61; P<0.001 and prevalence ratio, 1.94; 95% confidence interval, 1.65-2.32; P<0.001, respectively) and moderate carotid stenosis (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.39-3.54; P=0.001 and adjusted prevalence ratio, 4.82; 95% confidence interval, 3.09-7.050; P<0.001, respectively). The addition of AAC24 scores to traditional risk factors improved identification of women with carotid atherosclerosis as quantified by C-statistic (+0.075, P<0.001), net reclassification (0.249, P<0.001), and integrated discrimination (0.065, P<0.001). CONCLUSIONS AAC identified on images from a dual-energy x-ray absorptiometry machine were strongly related to carotid ultrasound measures of atherosclerosis. This low-cost, minimal radiation technique used widely for osteoporosis screening is a promising marker of generalized extracoronary atherosclerosis.
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Affiliation(s)
- Joshua R Lewis
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Wai H Lim
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kun Zhu
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ee M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,PathWest, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Peter L Thompson
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard L Prince
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
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Solow EB, Yu F, Thiele GM, Sokolove J, Robinson WH, Pruhs ZM, Michaud KD, Erickson AR, Sayles H, Kerr GS, Gaffo AL, Caplan L, Davis LA, Cannon GW, Reimold AM, Baker J, Schwab P, Anderson DR, Mikuls TR. Vascular calcifications on hand radiographs in rheumatoid arthritis and associations with autoantibodies, cardiovascular risk factors and mortality. Rheumatology (Oxford) 2015; 54:1587-95. [PMID: 25854268 DOI: 10.1093/rheumatology/kev027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To examine whether vascular calcifications on hand films in RA might aid in determining mortality risk. METHODS Hand radiographs from 906 RA patients were scored as positive or negative for vascular calcifications. Patient characteristics associated with vascular calcifications were assessed using multivariable logistic regression, and associations with mortality were examined using Cox proportional hazards regression. Cytokines and multiplex ACPA were measured in both groups. RESULTS A total of 99 patients (11%) demonstrated radiographic vascular calcifications. Factors independently associated with vascular calcifications included diabetes [odds ratio (OR) 2.85; 95% CI 1.43, 5.66], cardiovascular disease at enrolment (OR 2.48; 95% CI 1.01, 6.09), prednisone use (OR 1.90; 95% CI 1.25, 2.91), current smoking (OR 0.06; 95% CI 0.01, 0.23) and former smoking (OR 0.36; 95% CI 0.27, 0.48) vs never smoking. In cytokine and ACPA subtype analysis, IL-4 and anti-citrullinated apolipoprotein E were significantly increased in patients with vascular calcifications in fully adjusted multivariable models. After multivariable adjustment, vascular calcifications were associated with an increase in all-cause mortality (hazard ratio 1.41; 95% CI 1.12, 1.78; P = 0.004). CONCLUSION Vascular calcifications on hand radiographs were independently associated with increased all-cause mortality in RA. Mechanisms underpinning the associations of IL-4 and select ACPA with vascular calcifications and their utility as biomarkers predictive of cardiovascular disease risk in RA merit further study.
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Affiliation(s)
- E Blair Solow
- Division of Rheumatic Diseases, UT Southwestern, Dallas, TX
| | - Fang Yu
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Geoffrey M Thiele
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Jeremy Sokolove
- Division of Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA
| | - William H Robinson
- Division of Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA
| | - Zachary M Pruhs
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Kaleb D Michaud
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE, National Data Bank for Rheumatic Diseases, Wichita, KS
| | - Alan R Erickson
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Harlan Sayles
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE
| | - Gail S Kerr
- Department of Medicine, Veterans Affairs Medical Center, Washington, DC
| | - Angelo L Gaffo
- Department of Medicine, Birmingham Veterans Affairs Medical Center, Birmingham, AL
| | - Liron Caplan
- Division of Rheumatology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Lisa A Davis
- Division of Rheumatology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Grant W Cannon
- Division of Rheumatology, George Wahlen Veterans Affairs Medical Center, Salt Lake City, UT
| | - Andreas M Reimold
- Division of Rheumatic Diseases, UT Southwestern, Dallas, TX, Division of Rheumatology, Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Joshua Baker
- Division of Rheumatology, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
| | - Pascale Schwab
- Division of Rheumatology, Portland Veterans Affairs Medical Center, Portland, OR and
| | - Daniel R Anderson
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, Omaha Veterans Affairs Medical Center, Omaha, NE,
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Maricic M. Use of DXA-based technology for detection and assessment of risk of vertebral fracture in rheumatology practice. Curr Rheumatol Rep 2015; 16:436. [PMID: 24938441 DOI: 10.1007/s11926-014-0436-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is the recommended method for diagnosis of osteoporosis and assessment of future fracture risk. However, most patients who will suffer fractures do not have osteoporosis by DXA (T-score of -2.5 or less). Bone strength, which is most closely associated with resistance to fracture, is a composite of both bone density and bone quality, and the latter is not measured by DXA. Thus, other technology is needed for non-invasive and inexpensive assessment of bone strength and fracture risk. Vertebral fractures, the most common clinical fracture in the general population, are of even greater importance in rheumatoid arthritis and other rheumatic disorders. Vertebral fracture assessment (VFA) and trabecular bone scores (TBS), two techniques which can aid prediction of future fracture risk, can be used with currently available DXA machines. Description of these techniques and their potential application to clinical rheumatology practice will be the focus of this paper.
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Affiliation(s)
- Michael Maricic
- Catalina Pointe Rheumatology, 7520 N. Oracle Road, Suite 100, Tucson, AZ, 85704, USA,
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