Prevalence of osteoporotic vertebral fracture among community-dwelling elderly in Shanghai

The correlation between traditional Chinese medicine constitution and primary osteoporosis: A systematic review and meta-analysis

BACKGROUND

In recent years, as societal awareness of the risks associated with primary osteoporosis (POP) has deepened, numerous studies have explored the relationship between POP and Traditional Chinese Medicine (TCM) constitution types. To further clarify the TCM constitution types closely associated with POP and provide evidence-based medical support for the prevention and treatment of osteoporosis from a TCM perspective, we have employed evidence-based methods to investigate the relationship between POP and TCM constitution types.

METHODS

We conducted a comprehensive search of observational studies on the relationship between POP and TCM constitutional types in databases, including PubMed, Embase, MEDLINE, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific Journal Database (VIP), up to October 2023.

RESULTS

After literature selection, data extraction, and bias assessment, 29 studies were included in the meta-analysis, comprising 20 cross-sectional studies and 9 case-control studies. Using R software (version 4.2.3), we analyzed the distribution of TCM constitutional types in POP patients and compared the TCM constitutional types between POP patients and healthy individuals. The meta-analysis results revealed that in POP patients, Yang-deficiency constitution accounted for 22.7% (95% CI: 19.8-25.8%), Yin-deficiency constitution accounted for 15.8% (95% CI: 13.0-18.6%), and Qi-deficiency constitution accounted for 14.1% (95% CI: 12.2-16.0%). The proportions of the three mentioned TCM constitutions all exceed that of the Balanced constitution, with the balanced constitution accounting for 12.3% (95% CI: 7.4-18.1%). The proportions of Yang-deficiency, Yin-deficiency, and Qi-deficiency constitutions were higher in POP patients compared to healthy individuals, with odds ratios (OR) of 2.36 (95% CI: 1.43-3.89), 1.69 (95% CI: 1.36-2.04), and 1.80 (95% CI: 1.23-2.64), respectively, while the Balanced type was lower in POP patients with an OR of 0.16 (95% CI: 0.11-0.23) compared to healthy individuals.

CONCLUSION

The evidence suggests that the Yang-deficiency constitution, Yin-deficiency constitution, and Qi-deficiency constitution are the predominant TCM constitutional types in POP patients. Furthermore, Yang-deficiency constitution, Yin-deficiency constitution, and Qi-deficiency constitution may serve as potential risk factors for POP, while the Balanced constitution may act as a protective factor.

Value of Hounsfield units measured by chest computed tomography for assessing bone density in the thoracolumbar segment of the thoracic spine

STUDY DESIGN

A retrospective study.

PURPOSE

To investigate the correlation between Hounsfield unit (HU) values measured by chest computed tomography (CT) and dual-energy Xray absorptiometry (DXA) T-scores. HU-based thoracolumbar (T11 and T12) cutoff thresholds were calculated for a cohort of Chinese patients.

OVERVIEW OF LITERATURE

For patients with osteoporosis, the incidence of fractures in the thoracolumbar segment is significantly higher than that in other sites. However, most current clinical studies have focused on L1.

METHODS

This retrospective study analyzed patients who underwent chest CT and DXA at our hospital between August 2021 and August 2022. Thoracic thoracolumbar segment HU values, lumbar T-scores, and hip T-scores were computed for comparison, and thoracic thoracolumbar segment HU thresholds suggestive of potential bone density abnormalities were established using receiver operating characteristic curves.

RESULTS

In total, 470 patients (72.4% women; mean age, 65.5±12.3 years) were included in this study. DXA revealed that of the 470 patients, 90 (19%) had osteoporosis, 180 (38%) had reduced osteopenia, and 200 (43%) had normal bone mineral density (BMD). To differentiate osteoporosis from osteopenia, the HU threshold was established as 105.1 (sensitivity, 54.4%; specificity, 72.2%) for T11 and 85.7 (sensitivity, 69.4%; specificity, 61.1%) for T12. To differentiate between osteopenia and normal BMD, the HU threshold was 146.7 for T11 (sensitivity, 57.5%; specificity, 84.4%) and 135.7 for T12 (sensitivity, 59.5%; specificity, 80%).

CONCLUSIONS

This study supports the significance of HU values from chest CT for BMD assessment. Chest CT provides a new method for clinical opportunistic screening of osteoporosis. When the T11 HU is >146.7 or the T12 HU is >135.7, additional osteoporosis testing is not needed unless a vertebral fracture is detected. If the T11 HU is <105.1 or the T12 HU is <85.7, further DXA testing is strongly advised. In addition, vertebral HU values that fall faster than those of the T11 and L1 vertebrae may explain the high incidence of T12 vertebral fractures.

Prevalence and risk factors of osteoporotic fracture among the elderly population in China: a multicenter cross-sectional study

PURPOSE

Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order.

METHODS

A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF.

RESULTS

The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF.

CONCLUSION

High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults.

Construction of hyaluronic acid-functionalized magnolol nanoparticles for ulcerative colitis treatment

Oral targeted anti-inflammatory drugs have garnered significant interest in treating ulcerative colitis (UC) due to their potential in reducing medical costs and enhancing treatment efficacy. Magnolol (Mag), a natural anti-inflammatory compound, has demonstrated protective effects against UC. However, its application as an alternative therapeutic agent for UC is limited by poor gastrointestinal stability and inadequate accumulation at inflamed colonic lesions. This study introduces a novel nanoparticle (NPs) formulation based on Mag, functionalized with hyaluronic acid (HA) for targeted UC therapy. Bovine serum albumin (BSA) was modified with 2-thiamine hydrochloride to synthesize BSA·SH. Thiol-ene click reaction with Mag led to the formation of BSA·SH-Mag NPs, which were further modified with HA through dehydration condensation, regular spherical inflammation-targeting HA-BSA·SH-Mag nanoparticles with a charge of -23.6 mV and a particle size of 403 ± 4 nm were formed. In vitro studies revealed significant macrophage targeting and enhanced uptake by colon epithelial cells. Oral administration of HA-BSA·SH-Mag facilitated colon mucosal barrier repair by modulating pro-inflammatory cytokines (TNF-α, IL-6, IL-1β), anti-inflammatory cytokines (IL-10), and tight junction proteins (ZO-1, Claudin, Occludin). Crucially, HA-BSA·SH-Mag was found to inhibit the JAK2/STAT3/NF-κB signaling pathway, reducing DSS-induced colon tissue inflammation. This research provides valuable insights into the oral use of natural compounds in UC therapy, highlighting the therapeutic potential of HA-BSA·SH-Mag NPs.

Differences in Vertebral Morphology and bone Mineral Density between Grade 1 Vertebral Fracture and Non-Fractured Participants in the Chinese Population

PURPOSE

To investigate the difference in vertebral morphology and bone mineral density (BMD) between grade 1 VFs and non-fractured participants in the Chinese population to shed light on the clinical significance of grade 1 VFs from various perspectives.

METHODS

This retrospective cohort study included patients who received a chest low-dose computed tomography (LDCT) scan for health examination and visited the First Affiliated Hospital of Zhengzhou University, Henan, China, from October 2019 to August 2022. Data were analyzed from March 2023 to July 2023. The main outcome of this study was the difference in morphological parameters and BMD between grade 1 VFs and non-fractured participants. The prevalence of grade 1 VFs in China populations was calculated. The difference in BMD of three fracture types in the Grade 1 group was also evaluated.

RESULTS

A total of 3652 participants (1799 males, 54.85 ± 9.02 years, range, 40-92 years; 1853 females, 56.00 ± 9.08 years, range, 40-93 years) were included. The prevalence of grade 2 and 3 increase with age. The prevalence of grade 1 VFs gradually increases ≤ 50y to 60-69y group, but there is a decrease in the ≥ 70 years male group (6.6%) and a rise in the female group (25.5%). There was no significant statistical difference observed in vertebral shape indices (VSI) and BMD between the Grade 1 group and the no-fractured group aged < 50 years old except the wedge index in male. The biconcavity index did not differ between the non-fractured group and the Grade 1 group in men aged 50-59 years, whereas a significant statistical difference was observed in women. Additionally, the results of BMD were consistent with these findings. For the 40-59 years age group, there were significant differences between the compression deformity group and the other groups.

CONCLUSIONS

The grade 1 group had higher VSI and lower BMD than the non-fractured group, suggesting an association between the Grade 1 group and osteoporosis in individuals aged over 50 for women and over 60 for men. Different fracture types have significant variations in BMD among middle-aged people. The prevalence of grade 1 VFs exhibits an age-related increase in both genders, with opposite trends observed between older males and females. We suggested VSI can aid physicians in the diagnosis of grade 1 VFs.

Related factors of severe osteoporotic vertebral compression fracture and clinical outcomes of percutaneous kyphoplasty: A retrospective study

BACKGROUND

Osteoporosis is the most common disease in postmenopausal women and the elderly, which can lead to vertebral compression fracture.

OBJECTIVE

To investigate the related factors of severe osteoporotic vertebral compression fracture (SOVCF) and evaluate the long-term outcomes of percutaneous kyphoplasty (PKP) for treating SOVCF through comparison with mild OVCF (MOVCF).

METHODS

From September 2015 to March 2019, 294 osteoporotic vertebral compression fracture (OVCF) patients treated with PKP were analyzed. Compression of the anterior margin of the fractured vertebral body beyond 2/3 of the original height was defined as SOVCF. Baseline data, clinical and imaging findings before and after surgery and at the last follow-up were recorded. Numerical Rating Scale (NRS) was used to evaluate low back pain, the Oswestry Disability Index (ODI) was used to evaluate activity of daily life. Anterior vertebral height (AVH) and local kyphosis angle (LKA) was used to evaluate radiographic outcomes. During the follow-up, patients with recurrent back pain were examined by MRI to identify new fractures and the incidence of adjacent vertebral fracture (AVF) was recorded. Age, sex, body mass index (BMI), dual energy X-ray absorptiometry based T value, duration of symptom, history of trauma, steroid use, and fracture site were collected for univariate logistic regression analysis Variables with a P-value of less than 0.05 were then included in multivariate analysis to determine the related factors for SOVCF.

RESULTS

Logistic regression analysis indicated that longer duration of symptom (OR = 1.109, 95%CI: 1.038-1.185, P= 0.002), lower T value (OR = 0.332, 95%CI: 0.139-0.763, P= 0.001), and steroid use (OR = 31.294, 95%CI: 1.020-960.449, P= 0.049) were related factors of SOVCF. Compared with the MOVCF group, the SOVCF group had longer operation time (57.3 ± 13.51 minutes vs 44.9 ± 8.13 minutes, P< 0.001), more radiation exposure (39.9 ± 7.98 times vs 25.5 ± 4.01 times, P< 0.001), and higher cement leakage rate (55.81% vs 18.73%, P< 0.001). At the last follow-up, the SOVCF group had higher NRS (2.28 ± 0.85 vs 1.30 ± 0.71, P< 0.001), and ODI (16.23 ± 4.43 vs 12.88 ± 3.34, P< 0.001). After operation and at the last follow-up, the SOVCF group had higher LKA and lower AVH (all P< 0.05). The AVF rate at the last follow-up was higher in the SOVCF group at the last follow-up (4.78% vs 18.60%, P< 0.001).

CONCLUSION

Lower T value, longer duration of disease, and steroid use were related factors of SOVCF. Compared with MOVCF, PKP for SOVCF had longer operation time, more radiation exposure, and higher cement leakage rate, and the long-term outcomes were worsen.

Association Between CTSK Gene Polymorphisms and Response to Alendronate Treatment in Postmenopausal Chinese Women with Low Bone Mineral Density

Purpose

The aim of this study was to explore the association between CTSK polymorphisms and the response to alendronate treatment in postmenopausal Chinese women with low bone mineral density.

Patients and Methods

In this study, 460 postmenopausal women from Shanghai were included. All of them were treated with weekly oral alendronate 70 mg, daily calcium 600 mg and vitamin D 125 IU for a year. Four tag single nucleotide polymorphisms (SNPs) in CTSK gene were genotyped. Bone mineral densities of lumbar spine (L1-L4), femoral neck and total hip were measured at baseline and after 12 months of treatment, respectively.

Results

After 1-year of treatment, there was no significant differences in BMI between baseline and follow-up. After alendronate treatment, the BMD of L1-4, femoral neck and total hip all increased significantly (all P < 0.001), with average increases of 4.33 ± 6.42%, 1.85 ± 4.20%, and 2.36 ± 3.79%, respectively. There was no significant difference in BMD at L1-L4, the femoral neck and total hip between different genotype groups at baseline (P>0.05). After 1-year treatment with alendronate, rs12746973 and rs10847 were associated with the % change of BMD at L1-L4 (P=0.038) and % change of BMD at femoral neck (P=0.038), respectively. Furthermore, rs10847 was associated with BMD response at femoral neck (P=0.013). However, the associations were not significant after Bonferroni correction.

Conclusion

We concluded that the common variations of CTSK gene were potentially associated with the therapeutic response to alendronate treatment in Chinese women with low bone mineral density. However, further validation is needed.

Using Artificial Intelligence to Diagnose Osteoporotic Vertebral Fractures on Plain Radiographs

Osteoporotic vertebral fracture (OVF) is a risk factor for morbidity and mortality in elderly population, and accurate diagnosis is important for improving treatment outcomes. OVF diagnosis suffers from high misdiagnosis and underdiagnosis rates, as well as high workload. Deep learning methods applied to plain radiographs, a simple, fast, and inexpensive examination, might solve this problem. We developed and validated a deep-learning-based vertebral fracture diagnostic system using area loss ratio, which assisted a multitasking network to perform skeletal position detection and segmentation and identify and grade vertebral fractures. As the training set and internal validation set, we used 11,397 plain radiographs from six community centers in Shanghai. For the external validation set, 1276 participants were recruited from the outpatient clinic of the Shanghai Sixth People's Hospital (1276 plain radiographs). Radiologists performed all X-ray images and used the Genant semiquantitative tool for fracture diagnosis and grading as the ground truth data. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were used to evaluate diagnostic performance. The AI_OVF_SH system demonstrated high accuracy and computational speed in skeletal position detection and segmentation. In the internal validation set, the accuracy, sensitivity, and specificity with the AI_OVF_SH model were 97.41%, 84.08%, and 97.25%, respectively, for all fractures. The sensitivity and specificity for moderate fractures were 88.55% and 99.74%, respectively, and for severe fractures, they were 92.30% and 99.92%. In the external validation set, the accuracy, sensitivity, and specificity for all fractures were 96.85%, 83.35%, and 94.70%, respectively. For moderate fractures, the sensitivity and specificity were 85.61% and 99.85%, respectively, and 93.46% and 99.92% for severe fractures. Therefore, the AI_OVF_SH system is an efficient tool to assist radiologists and clinicians to improve the diagnosing of vertebral fractures. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

A phase III randomized, double-blind, placebo-controlled trial of the denosumab biosimilar QL1206 in postmenopausal Chinese women with osteoporosis and high fracture risk

The current study evaluated the efficacy and safety of a denosumab biosimilar, QL1206 (60 mg), compared to placebo in postmenopausal Chinese women with osteoporosis and high fracture risk. At 31 study centers in China, a total of 455 postmenopausal women with osteoporosis and high fracture risk were randomly assigned to receive QL1206 (60 mg subcutaneously every 6 months) or placebo. From baseline to the 12-month follow-up, the participants who received QL1206 showed significantly increased bone mineral density (BMD) values (mean difference and 95% CI) in the lumbar spine: 4.780% (3.880%, 5.681%), total hip :3.930% (3.136%, 4.725%), femoral neck 2.733% (1.877%, 3.589%) and trochanter: 4.058% (2.791%, 5.325%) compared with the participants who received the placebo. In addition, QL1206 injection significantly decreased the serum levels of C-terminal crosslinked telopeptides of type 1 collagen (CTX): -77.352% (-87.080%, -66.844%), and N-terminal procollagen of type l collagen (P1NP): -50.867% (-57.184%, -45.217%) compared with the placebo over the period from baseline to 12 months. No new or unexpected adverse events were observed. We concluded that compared with placebo, QL1206 effectively increased the BMD of the lumbar spine, total hip, femoral neck and trochanter in postmenopausal Chinese women with osteoporosis and rapidly decreased bone turnover markers. This study demonstrated that QL1206 has beneficial effects on postmenopausal Chinese women with osteoporosis and high fracture risk.

Prevalent vertebral fractures among urban-dwelling Chinese postmenopausal women: a population-based, randomized-sampling, cross-sectional study

In this population-based, cross-sectional study, we investigated vertebral fracture (VF) prevalence among Chinese postmenopausal women. We found 14.7% of population had VFs, which increased with age. Age ≥ 65 years, hip fracture, and densitometric osteoporosis were significantly associated with VFs. The prevalence of osteoporosis was remarkably high.

PURPOSE

To investigate VF prevalence among Chinese postmenopausal women in this population-based, randomized-sampling, cross-sectional study.

METHODS

The investigator obtained lists of women from communities. Randomization was performed using SAS programming based on age group in each region. Postmenopausal women aged ≥ 50 years in the urban community were included. The investigator interviewed subjects to collect self-reported data and measured BMD. Spine radiographs were adjudicated by Genant's semi-quantitative method. VFs were defined as fractures of at least one vertebra classified by Genant's score 1-3 and were analyzed using descriptive statistics.

RESULTS

A total of 31,205 women listed for randomized sampling from 10 Tier-3 hospitals at 5 regions. Of 2634 women in the full analysis set, 14.7% (388/2634, 95% CI: 13.4, 17.1) had prevalent VFs. VF prevalence increased with age (Cochran-Armitage test p < 0.0001) and was significantly higher in women aged ≥ 65. VF prevalence did not differ between North (14.4%, 95% CI: 12.5, 16.4) and South China (15.1%, 95% CI: 13.3, 17.1). In women with no prior VFs, prevalent VFs were 12.4% (95% CI: 11.2, 13.7). Age ≥ 65 years (OR: 2.57, 95% CI: 1.91, 3.48), hip fracture (OR: 2.28, 95% CI: 1.09, 4.76), and densitometric osteoporosis (OR: 2.52, 95% CI: 1.96, 3.22) were significantly associated with prevalent VFs. Prevalence of osteoporosis was 32.9% measured by BMD and 40.8% using NOF/IOF clinical diagnosis criteria.

CONCLUSION

VFs are prevalent among Chinese postmenopausal women who were ≥ 50 years and community-dwelled. Osteoporosis prevalence is remarkable when fragile fractures were part of clinical diagnosis.

Efficacy of generic teriparatide and alendronate in Chinese postmenopausal women with osteoporosis: a prospective study

The efficacy of generic teriparatide in improving BMD at lumbar spine in patients with osteoporosis was similar to that of alendronate. It provided a new choice for osteoporosis treatment in Chinese population.

INTRODUCTION

To determine whether the efficacy of generic teriparatide is noninferior to alendronate for Chinese postmenopausal women with osteoporosis.

METHODS

Eligible patients were randomly assigned (2:1) in a 48-week, open-label design to receive 20 µg sc daily teriparatide or 70 mg oral weekly alendronate. Primary outcome was percentage change in BMD at the lumbar spine from baseline to 48 weeks and was assessed for non-inferiority. The same outcome was further assessed for superiority as a secondary endpoint.

RESULTS

Three hundred ninety-one and 196 participants were randomly assigned to the teriparatide or alendronate group, of whom 379 and 194 receiving at least one dose of teriparatide and alendronate treatment were eligible for the efficacy analysis. Teriparatide was non-inferior to alendronate for BMD change at lumbar spine (treatment difference: 0.7%, 95% CI: - 0.3 to 1.7%), which excluded the predefined non-inferiority margin of - 1.5%. However, teriparatide was not statistically superior to alendronate in improving BMD at lumbar spine (P = 0.169). At 48 weeks, changes in BMD at total hip were - 1.0% and 2.2% in teriparatide and alendronate group, respectively (P < 0.001). The incidence of new fracture showed no statistical difference between groups (P = 0.128). Serum P1NP and β-CTX levels significantly increased in the teriparatide group and markedly decreased in alendronate group (all P < 0.001 vs baseline). The adverse events (AEs) and serious AEs were more common in the teriparatide group than in the alendronate group, which were mainly teriparatide-related hypercalcemia, elevated alkaline phosphatase or parathyroid hormone, dizziness, and arthralgia.

CONCLUSIONS

Teriparatide was not inferior to alendronate in increasing BMD at lumbar spine in Chinese postmenopausal women, and they achieved these effects through different mechanisms.

PFN1 Gene Polymorphisms and the Bone Mineral Density Response to Alendronate Therapy in Postmenopausal Chinese Women with Low Bone Mass

Purpose

Alendronate is a widely used anti-osteoporotic drug. PFN1 gene is a newly identified early-onset Paget’s disease pathogenic gene. The purpose of this study is to study whether the genetic variations in this gene affect the clinical efficacy of alendronate in postmenopausal Chinese women with low bone mass.

Patients and Methods

Seven single nucleotide polymorphisms in PFN1 gene were genotyped. A total of 500 postmenopausal women with osteoporosis or osteopenia were included. All participants were treated with weekly alendronate 70 mg for 12 months. A total of 466 subjects completed the follow-up. Bone mineral density (BMD) of lumbar spine, femoral neck and total hip were measured at baseline and after treatment.

Results

After 12 months of treatment, the BMD of lumbar spine, femoral neck and total hip all increased significantly (all P < 0.001), with an average increase of 4.72 ± 5.31%, 2.08 ± 4.45%, and 2.42 ± 3.46%, respectively. At baseline, there were no significant differences in BMD at lumbar spine, femoral neck and total hip between different genotype groups (P > 0.05). We failed to identify any significant association between the genotypes or haplotypes of PFN1 and the BMD response to alendronate therapy.

Conclusion

Genetic polymorphisms of PFN1 may not be a major contributor to the therapeutic response to alendronate treatment in Chinese women with low bone mass.

Deep-learning image reconstruction for image quality evaluation and accurate bone mineral density measurement on quantitative CT: A phantom-patient study

BACKGROUND AND PURPOSE

To investigate the image quality and accurate bone mineral density (BMD) on quantitative CT (QCT) for osteoporosis screening by deep-learning image reconstruction (DLIR) based on a multi-phantom and patient study.

MATERIALS AND METHODS

High-contrast spatial resolution, low-contrast detectability, modulation function test (MTF), noise power spectrum (NPS), and image noise were evaluated for physical image quality on Caphan 500 phantom. Three calcium hydroxyapatite (HA) inserts were used for accurate BMD measurement on European Spine Phantom (ESP). CT images were reconstructed with filtered back projection (FBP), adaptive statistical iterative reconstruction-veo 50% (ASiR-V50%), and three levels of DLIR(L/M/H). Subjective evaluation of the image high-contrast spatial resolution and low-contrast detectability were compared visually by qualified radiologists, whilst the statistical difference in the objective evaluation of the image high-contrast spatial resolution and low-contrast detectability, image noise, and relative measurement error were compared using one-way analysis of variance (ANOVA). Cohen's kappa coefficient (k) was performed to determine the interobserver agreement in qualitative evaluation between two radiologists.

RESULTS

Overall, for three levels of DLIR, 50% MTF was about 4.50 (lp/cm), better than FBP (4.12 lp/cm) and ASiR-V50% (4.00 lp/cm); the 2 mm low-contrast object was clearly resolved at a 0.5% contrast level, while 3mm at FBP and ASiR-V50%. As the strength level decreased and radiation dose increased, DLIR at three levels showed a higher NPS peak frequency and lower noise level, leading to leftward and rightward shifts, respectively. Measured L1, L2, and L3 were slightly lower than that of nominal HA inserts (44.8, 95.9, 194.9 versus 50.2, 100.6, 199.2mg/cm³) with a relative measurement error of 9.84%, 4.08%, and 2.60%. Coefficients of variance for the L1, L2, and L3 HA inserts were 1.51%, 1.41%, and 1.18%. DLIR-M and DLIR-H scored significantly better than ASiR-V50% in image noise (4.83 ± 0.34, 4.50 ± 0.50 versus 4.17 ± 0.37), image contrast (4.67 ± 0.73, 4.50 ± 0.70 versus 3.80 ± 0.99), small structure visibility (4.83 ± 0.70, 4.17 ± 0.73 versus 3.83 ± 1.05), image sharpness (3.83 ± 1.12, 3.53 ± 0.90 versus 3.27 ± 1.16), and artifacts (3.83 ± 0.90, 3.42 ± 0.37 versus 3.10 ± 0.83). The CT value, image noise, contrast noise ratio, and image artifacts in DLIR-M and DLIR-H outperformed ASiR-V50% and FBP (P<0.001), whilst it showed no statistically significant between DLIR-L and ASiR-V50% (P>0.05). The prevalence of osteoporosis was 74 (24.67%) in women and 49 (11.79%) in men, whilst the osteoporotic vertebral fracture rate was 26 (8.67%) in women and (5.29%) in men.

CONCLUSION

Image quality with DLIR was high-qualified without affecting the accuracy of BMD measurement. It has a potential clinical utility in osteoporosis screening.

Health-related quality of life in men with osteoporosis: a systematic review and meta-analysis

PURPOSE

The increased social and economic burdens make osteoporosis in men an emerging public health issue. However, the quality of life among men with osteoporosis is still unclear. This systematic review and meta-analysis aimed to evaluate the health-related quality of life (HRQoL) among men with osteoporosis or osteoporotic fracture.

METHODS

PubMed, EMBASE, and the Cochrane Library database were systematically searched from inception to May 2021. Studies were included if they used validated questionnaires to measure HRQoL among osteoporotic men. A meta-analysis was performed using a random-effects model or fixed-effects model to calculate the standard mean difference (SMD) or mean difference (MD) with 95% confidential interval (95% CI).

RESULTS

14 studies involving 6338 male participants were chosen for systematic review, of which 10 were included in the meta-analysis. Men with osteoporosis had poorer global HRQoL and multiple dimensions of HRQoL than men without osteoporosis. Hip fracture, vertebral fractures, or wrist fractures dramatically impaired HRQoL of men, and physical function was declined even before hip fracture (SMD = -0.60, 95% CI, -0.82 to -0.39). Femoral and lumbar BMD was positively correlated with HRQoL, and a number of fragility fractures and time since fracture had negative effects on HRQoL. Effective anti-osteoporotic drugs could improve HRQoL of men.

CONCLUSION

The health-related life quality of men was significantly impaired by osteoporosis and fracture of the hip, vertebral, or wrist. We should pay more attention to the diagnosis and treatment of male osteoporosis to improve the life quality of men.

Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study

IMPORTANCE

The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known.

OBJECTIVE

To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China.

DESIGN, SETTING. AND PARTICIPANTS

This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate.

MAIN OUTCOMES AND MEASURES

Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography.

RESULTS

A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.

Does spinal sagittal imbalance lead to future vertebral compression fractures in osteoporosis patients?

BACKGROUND CONTEXT

Many risk factors for osteoporotic vertebral compression fractures (OVCFs) have been reported. However, there are few reports on the relationship between spine sagittal parameters in patients with osteoporosis.

PURPOSE

To explore whether: spinal sagittal imbalance is associated with future vertebral compression fractures in osteoporosis patients; spinal sagittal parameters in patients with osteoporosis can predict the occurrence of vertebral compression fractures.

STUDY DESIGN

A retrospective cohort study.

PATIENT SAMPLE

Patients with osteoporosis.

OUTCOME MEASURES

Occurrence of OVCFs during the follow-up period.

METHODS

From January 2017 to October 2019, eligible patients with osteoporosis at the initial visit were enrolled. They were followed up to November 1, 2020. Based on whether OVCFs occurred during the follow-up, the patients were divided into two groups: the experimental group (vertebral compression fracture group) and the control group (no vertebral compression fracture group). Intragroup analysis was performed as follows: Pearson and Spearman correlation coefficients were used to calculate the correlation between each parameter. Intergroup analysis was performed as follows. For categorical variables, the chi-square test was used; for normally distributed continuous variables, an independent sample t-test was used; and for non-normally distributed variables, a two-sample nonparametric test was used. Binary logistic regression analysis and receiver operating characteristic (ROC) curves were used to determine independent risk factors and critical values, respectively.

RESULTS

A total of 340 patients with osteoporosis were enrolled. The longest and shortest follow-up periods were 44 months and 12 months, respectively, with an average of 25.2±10.2 months. There were significant differences in age, bone mineral density (femur and lumbar), smoking history, medication treatment regularity, Thoracolumbar Kyphosis (TLK), Pelvic Tilt (PT), C7-S1 Sagittal Vertical Axis (C7-S1 SVA), and C2-7 Sagittal Vertical Axis (C2-7 SVA) between the experimental and control groups. There were no significant differences in sex, body mass index (BMI), alcohol consumption history, hypertension, diabetes, coronary heart disease, family history of osteoporosis, physical activity, Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Incidence (PI), Sacral Slope (SS), C2-C7 Cobb Angle (CL), T1 slope (T1S) or blood parameters. Through binary logistic regression analysis, we found that BMD, medication treatment regularity and C7-S1 SVA were independent risk factors for future vertebral compression fractures. According to the ROC curve, the prediction accuracy of C7-S1 SVA was the highest. Through the calculation of critical values, we found that when C7-S1 SVA was more than 3.81 cm, future OVCFs were more likely to occur, and for every 1cm increase in C7-S1 SVA, the incidence of future OVCFs would increase by 0.324 times (p<.001, OR=1.324). Through intragroup analysis, we further found that C7-S1 SVA was positively correlated with the percentage of vertebral body wedging.

CONCLUSIONS

For patients with osteoporosis, a C7-S1 SVA more than 3.81cm is significantly associated with a greater risk for vertebral compression fractures in the future.

Exploring the Relationship of Bone Turnover Markers and Bone Mineral Density in Community-Dwelling Postmenopausal Women

Aims

To explore the relationships of procollagen type 1 N-terminal propeptide (P1NP) and β cross-linked C-telopeptide of type 1 collagen (β-CTX) with bone mineral density (BMD) in postmenopausal women.

Methods

All postmenopausal women were selected from a community-based case-control study. The anteroposterior L1-L4 and left proximal femur BMD were measured. P1NP and β-CTX were also collected and tested. The main correlation analysis was applied to explore the relationships of BMD, P1NP, and β-CTX.

Results

The total 1055 postmenopausal women were enrolled. The BMD at all sites kept a decrease continually with age (P < 0.01). In addition, the level of β-CTX increased significantly from 45 to 50 years old and remained at a high level in the later stage, while the level of P1NP changed little or even decreased with age. Logistic regression model showed that β-CTX has better ability to predict BMD than P1NP, as demonstrated by an area under the curve (AUC) of 0.63.

Conclusion

P1NP and β-CTX are important markers to monitor bone metabolism. This trial is registered with ChiCTR-SOC-17013090. The date of registration is Oct. 23, 2017.

Opportunistic Screening Using Low-Dose CT and the Prevalence of Osteoporosis in China: A Nationwide, Multicenter Study

Opportunistic screening for osteoporosis can be performed using low-dose computed tomography (LDCT) imaging obtained for other clinical indications. In this study we explored the CT-derived bone mineral density (BMD) and prevalence of osteoporosis from thoracic LDCT in a large population cohort of Chinese men and women. A total of 69,095 adults (40,733 men and 28,362 women) received a thoracic LDCT scan for the purpose of lung cancer screening between 2018 and 2019, and data were obtained for analysis from the China Biobank Project, a prospective nationwide multicenter population study. Lumbar spine (L₁ -L₂ ) trabecular volumetric bone mineral density (vBMD) was derived from these scans using quantitative computed tomography (QCT) software and the American College of Radiology QCT diagnostic criteria for osteoporosis were applied. Geographic regional differences in the prevalence of osteoporosis were assessed and the age-standardized, population prevalence of osteoporosis in Chinese men and women was estimated from the 2010 China census. The prevalence of osteoporosis by QCT for the Chinese population aged >50 years was 29.0% for women and 13.5% for men, equating to 49.0 million and 22.8 million, respectively. In women, this rate is comparable to estimates from dual-energy X-ray absorptiometry (DXA), but in men, the prevalence is double. Prevalence varied geographically across China, with higher rates in the southwest and lower rates in the northeast. Trabecular vBMD decreased with age in both men and women. Women had higher peak trabecular vBMD (185.4 mg/cm³ ) than men (176.6 mg/cm³ ) at age 30 to 34 years, but older women had lower trabecular vBMD (62.4 mg/cm³ ) than men (92.1 mg/cm³ ) at age 80 years. We show that LDCT-based opportunistic screening could identify large numbers of patients with low lumbar vBMD, and that future cohort studies are now required to evaluate the clinical utility of such screening in terms of fracture prevention and supporting national health economic analyses. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..

The Assessment of the Osteoporosis Self-Assessment Tool for Asians and Calcaneal Quantitative Ultrasound in Identifying Osteoporotic Fractures and Falls Among Chinese People

The lack of DXA has made the diagnosis and treatment of osteoporosis extremely difficult in the vast rural areas of China, which has the largest population with high risks of osteoporosis. The aims of this cross-sectional study were to evaluate the association between the osteoporosis self-assessment tool for Asians (OSTA) and calcaneus quantitative ultrasound (QUS) in populations residing in Shanghai, China, and their assessment in predicting osteoporotic fractures and falls. A population of 12,033 participants, including 1272 males (average age 68.3 ± 9.8 years, range 28-100 years) and 10,761 females (average 56.8 ± 11.4 years, range 23-99 years), was gathered. OSTA and calcaneus QUS (Sonost 2000, OsteoSys) values were measured. Spearman's correlation and Cohen's kappa were used to determine the association and agreement between the OSTA and QUS. Receiver operating characteristic (ROC) curves were adapted to assess the performance and optimal cutoff values for the OSTA and QUS in osteoporotic fracture and fall screening. In total, the prevalence of osteoporotic fractures (low-trauma fractures including fractures of the spine, hip, forearm, humerus and ribs) was 15.2% in women, and 17.7% reported a history of falls (falling from standing height more than once in the past year). The percentages of men with the same history were 8.4% and 11.7%, respectively. The association between the OSTA and QUS was found to be r_s = 0.393, κ = 0.137, p < 0.001. The OSTA (cutoff < -1) revealed an area under ROC curve (AUC) of 0.590 in identifying female individuals with moderate or high risk of osteoporosis defined by QUS (T-score < -1). The QUS T-score lower than -1.55 or -1.40 in postmenopausal women may lead to an increased risk of falls or osteoporotic fractures, respectively. The agreement between QUS and the OSTA seemed to be limited in determining individuals at risk of osteoporosis. Measuring bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) may still be necessary in the clinical diagnosis of osteoporosis. OSTA and QUS T-scores less than the respective cutoff values may indicate an increased risk of osteoporotic fractures and falls that individual should be further treated and screened by DXA.

Adjustment of DXA BMD measurements for anthropometric factors and its impact on the diagnosis of osteoporosis

We compared the effect of anthropometric factors on osteoporosis diagnosis by quantitative computed tomography (QCT) and dual energy X-ray absorptiometry (DXA) and found QCT spine volumetric bone mineral density (vBMD) was not associated with body weight, body mass index (BMI) or DXA anteroposterior spine thickness. In contrast, DXA spine and hip areal bone mineral density (aBMD) were strongly associated with all three factors. Adjustment of DXA aBMD measurements improved consistency with QCT vBMD.

PURPOSE

Although the diagnosis of osteoporosis using DXA T scores preferentially targets patients with BMI, there is evidence that obesity is not protective against fractures. The aim of this study was to compare the effect of anthropometric factors on osteoporosis diagnosis by QCT and DXA and investigate whether adjustment of DXA aBMD can achieve a more even distribution of diagnoses between slimmer and heavier individuals consistent with QCT.

METHODS

The participants were 964 men and 682 women referred for low-dose chest CT and DXA examinations as part of their employers' health check-up programs. QCT vBMD was measured in the L1-L2 vertebrae and DXA aBMD in the spine and hip. The prevalence of osteoporosis in each tertile of BMI in participants aged > 50 years was evaluated based on their QCT and DXA findings, and then re-evaluated after adjustment to the mean BMI in each sex. Similar investigations were performed for body weight and DXA anteroposterior (AP) spine thickness. The effect of the adjustment of DXA aBMD for anthropometric factors on the correlation with QCT vBMD was also examined.

RESULTS

For spine QCT, correlations of age adjusted vBMD residuals against BMI were not statistically significant in men (P = 0.44) or women (P = 0.32). In contrast, slopes for aBMD residuals were all highly statistically significant (P < 0.001). There were similar findings for weight and AP spine thickness. Adjustment of DXA aBMD for anthropometric factors resulted in a more equal spread of diagnoses of osteoporosis and greater consistency with QCT.

CONCLUSION

Our study highlights differences between DXA and QCT in their correlation with anthropometric factors and its effect on the diagnosis of osteoporosis. Adjustment of DXA T scores for anthropometric factors gave greater consistency with QCT vBMD. Further studies are required into whether adjusting DXA aBMD for anthropometric factors has a beneficial impact on the discriminative or predictive power for vertebral fracture.

Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density

With an aging society, osteoporosis is one of the most common diseases threatening the health of China's elderly population and is an issue that is raising increasing concern. Osteoporosis is characterized by bone loss and increased susceptibility to fragility fractures. Various imaging modalities such as X-ray, CT, MRI and nuclear medicine along with assessment of bone mineral density (BMD) play an important role in its diagnosis and management, and the treatment requires multidisciplinary teamwork. A lack of consensus in the approach to imaging and BMD measurement is hampering the quality of service and patient care in China. Therefore a panel of Chinese experts from the fields of radiology, orthopedics, endocrinology and nuclear medicine reviewed the international guidelines, consensus and literature with the most recent data from China and, taking account of current clinical practice in China, the panel reached this consensus to help guide the diagnosis of osteoporosis using imaging and BMD. This consensus report provides guidelines and standards for the imaging and BMD assessment of osteoporosis and criteria for the diagnosis of osteoporosis in China.

Association of HIVEP3 Gene and Lnc RNA with Femoral Neck Bone Mineral Content and Hip Geometry by Genome-Wide Association Analysis in Chinese People

PURPOSE

GWAS has successfully located and analyzed the pathogenic genes of osteoporosis. Genetic studies have found that heritability of BMD is 50%-85% while the other half is caused by hip geometric parameters and tissue horizontal characteristics. This study was designed to study the GWAS of osteoporosis in Shanghai Han population.

METHODS

We collected 1224 unrelated healthy young men (20-40 years old), young women (20-40 years old), and postmenopausal women (over 50 years old) who lived in Shanghai. BMD and hip geometric parameters were measured by dual-energy X-ray absorptiometry. The genomic DNA of peripheral blood was extracted and analyzed by using Illumina Human Asian Screening Array-24 + v1.0 (ASA) gene chip. Statistical analysis was carried out to evaluate the relationship between these SNPs and BMD and hip geometric parameters.

RESULTS

A total of 1155 subjects were included. We found that one SNP rs35282355 located in the human immunodeficiency virus type 1 enhancer-binding protein 3 gene (HIVEP3) and another 25 SNPs located in LINC RNA were significantly correlated with bone mineral content (BMC) in the femoral neck (P= 2.30 × 10^-9, P < 5 × 10^-8). We also found that the correlation between SNP rs35282355 and cross-sectional area (CSA) of hip geometry was a significant marginal statistical difference (P = 5.95 × 10^-8).

CONCLUSIONS

Through this study, we found that HIVEP3 gene and LINC RNA are potentially correlated with femoral neck BMC. These results provide important information for us to further understand the etiology and genetic pathogenesis of osteoporosis. In the future, we will expand the sample size to verify these loci and carry out molecular research.