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Chen YP, Chan WP, Zhang HW, Tsai ZR, Peng HC, Huang SW, Jang YC, Kuo YJ. Automated osteoporosis classification and T-score prediction using hip radiographs via deep learning algorithm. Ther Adv Musculoskelet Dis 2024; 16:1759720X241237872. [PMID: 38665415 PMCID: PMC11044771 DOI: 10.1177/1759720x241237872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background Despite being the gold standard for diagnosing osteoporosis, dual-energy X-ray absorptiometry (DXA) is an underutilized screening tool for osteoporosis. Objectives This study proposed and validated a controllable feature layer of a convolutional neural network (CNN) model with a preprocessing image algorithm to classify osteoporosis and predict T-score on the proximal hip region via simple hip radiographs. Design This was a single-center, retrospective study. Methods An image dataset of 3460 unilateral hip images from 1730 patients (age ⩾50 years) was retrospectively collected with matched DXA assessment for T-score for the targeted proximal hip regions to train (2473 unilateral hip images from 1430 patients) and test (497 unilateral hip images from 300 patients) the proposed CNN model. All images were processed with a fully automated CNN model, X1AI-Osteo. Results The proposed screening tool illustrated a better performance (sensitivity: 97.2%; specificity: 95.6%; positive predictive value: 95.7%; negative predictive value: 97.1%; area under the curve: 0.96) than the open-sourced CNN models in predicting osteoporosis. Moreover, when combining variables, including age, body mass index, and sex as features in the training metric, there was high consistency in the T-score on the targeted hip regions between the proposed CNN model and the DXA (r = 0.996, p < 0.001). Conclusion The proposed CNN model may identify osteoporosis and predict T-scores on the targeted hip regions from simple hip radiographs with high accuracy, highlighting the future application for population-based opportunistic osteoporosis screening with low cost and high adaptability for a broader population at risk. Trial registration TMU-JIRB N201909036.
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Affiliation(s)
- Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Wing P. Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Han-Wei Zhang
- Biomedica Corporation, New Taipei City, Taiwan
- Program for Aging, China Medical University, Taichung City, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Yang Ming Chiao Tung University, Hsinchu City, Hsinchu County, Taiwan
| | - Zhi-Ren Tsai
- Department of Computer Science and Information Engineering, Asia University, Taichung City, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan
- Center for Precision Medicine Research, Asia University, Taichung City, Taiwann
| | | | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Yeu-Chai Jang
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Road, Wenshan, Taipei 11696, Taiwan (R.O.C.)
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Banks KP, Farrell MB, Gunther RS, McWhorter NE, Byerly DW, Peacock JG. Improving DXA Quality by Avoiding Common Technical and Diagnostic Pitfalls: Part 1. J Nucl Med Technol 2023; 51:167-175. [PMID: 36195442 DOI: 10.2967/jnmt.122.264885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Dual-energy x-ray absorptiometry (DXA) is an accurate means to assess bone mineral density, determine the risk of a fragility fracture, and monitor response to therapy. Despite its seemingly straightforward nature-the review of 2-to-3 nondiagnostic images and a few automatically generated numbers-the proper performance and interpretation of DXA can often be complex. It is complex because it is highly dependent on many factors, such as image acquisition, processing, analysis, and subsequent examination interpretation. Each step is subject to potential errors, artifacts, and diagnostic pitfalls; hence, meticulous attention must be paid to the technique by both the technologist and the interpreting physician to provide high-quality results and, in turn, maximize the examination's clinical utility. This article is part 1 of a 2-part series. Part 1 will begin with a review of bone physiology and osteoporosis etiology, followed by a discussion of the principles underlying DXA and the technical procedure. Part 2 will focus on DXA interpretation and discuss scanning pitfalls and clues to recognizing issues and improving scan quality.
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Affiliation(s)
- Kevin P Banks
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | | | - Rutger S Gunther
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
| | - Nathan E McWhorter
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | - Doug W Byerly
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
| | - Justin G Peacock
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas
- Department of Radiology, Uniformed Services University, Bethesda, Maryland; and
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Muacevic A, Adler JR. The Impact of Angiotensin Converting Enzyme-2 (ACE-2) on Bone Remodeling Marker Osteoprotegerin (OPG) in Post-COVID-19 Iraqi Patients. Cureus 2022; 14:e29926. [PMID: 36348825 PMCID: PMC9633432 DOI: 10.7759/cureus.29926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction As COVID-19 affects human genes in several types of peripheral tissue, numerous disorders occur after recovery. The virus enters host cells via angiotensin-converting enzyme-2 (ACE-2) receptors that affect bone remodeling, leading to osteopenia or osteoporosis, which is characterized by low bone mineral density (BMD). The adult skeleton undergoes about 10% remodeling annually, which is crucial for preventing fatigue damage and preserving calcium homeostasis. An imbalance in the rates of bone production and resorption causes bone loss. Osteoprotegerin (OPG) is one of the regulators involved in the bone remodeling mechanism, it decreases the activity of NF-B receptors that activates the receptor activators of NF-B ligand (RANKL) pathway, which maintains the bone homeostasis balance. This study aims to find out the disruption of bone homeostasis balance in Iraqi post-COVID-19 patients. Materials and methods It is a case-control study that includes 130 Iraqi subjects enrolled. They were divided into two groups - the first group consisted of 80 post-COVID-19 infection patients, while the second group consisted of 50 who were not infected with COVID-19. Also, the levels of ACE-2 and OPG were measured in the serum by the ELISA technique. The BMD was measured by the DEXA scan technique. Results This study found that there is an effect of coronavirus infection on the bone strength measured by the Mean of the OPG level, which was found to be highly significant in the serum of post-COVID-19 patients when compared with non-COVID-19 subjects (P-value = 0.001), but the Mean of ACE-2 level was statistically non-significant between the two groups (P-value = 0.13). Also, the BMD of post-COVID-19 patients that was measured by DEXA scan had a statistically highly significant T-score% between the two groups. Conclusion The current study found that there was an effect of COVID-19 on the bone remodeling mechanism, which may be causing osteopenia or osteoporosis for Iraqi subjects enrolled in the current study. Also, analyzing the OPG level in the serum could be helpful in predicting low BMD.
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Coronary calcification and bone microarchitecture by high-resolution peripheral quantitative computed tomography from the São Paulo Ageing and Health (SPAH) Study. Sci Rep 2022; 12:5282. [PMID: 35347151 PMCID: PMC8960801 DOI: 10.1038/s41598-022-08839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 03/09/2022] [Indexed: 12/25/2022] Open
Abstract
Epidemiological studies reveal a link between osteoporosis and the risk of ischemic cardiovascular disease. We illustrate an association between coronary calcification and bone microarchitecture in older adults based on the SPAH study. This cross-sectional research comprised 256 individuals subjected to cardiac coronary computed tomography angiography (CCTA) for coronary artery calcification (CAC), high-resolution peripheral quantitative computed tomography (HR-pQCT) at the tibia and radius with standardized z score parameters, and dual-energy X-ray absorptiometry (DXA) to evaluate bone status. We used Student’s t test and the Mann–Whitney and Chi-squared tests for comparison of basal measurements. Association analysis was performed using the Poisson regression model with adjustment for CAC and sex. Multivariate analysis revealed different bone variables for predicting CAC in DXA and HR-pQCT scenarios. Although most of the bone parameters are related to vascular calcification, only cortical porosity (Ct.Po) remained uniform by HR-pQCT. Results for were as follows: the tibia—women (exp β = 1.12 (95% CI 1.10–1.13, p < 0.001) and men (exp β = 1.44, 95% CI 1.42–1.46, p < 0.001); the radius—women (exp β = 1.07 (95% CI 1.07–1.08, p < 0.001) and men (exp β = 1.33 (95% CI 1.30–1.37, p < 0.001). These findings suggest an inverse relationship between CAC and cortical bone content, as assessed by HR-pQCT, with higher coronary calcification in individuals older than 65 years.
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Eid MM, El-Gendy AM, Abdelbasset WK, Elkholi SM, Abdel-fattah MS. The effect of magnetic therapy and moderate aerobic exercise on osteoporotic patients: A randomized clinical study. Medicine (Baltimore) 2021; 100:e27379. [PMID: 34596156 PMCID: PMC8483884 DOI: 10.1097/md.0000000000027379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/13/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Osteoporosis is a frequent musculoskeletal condition with significant complications that would be a global health problem and one of the major causes of mortality and morbidity. OBJECTIVES The current study aimed to ascertain the impact of pulsed magnetic therapy, aerobic exercise, and a combination of both modalities on osteoporotic female patients postthyroidectomy. METHODS Between May 2018 and September 2019, 45 female patients with osteoporosis were included in the randomized clinical study, their age ranged from 40 to 50 years, had thyroidectomy for at least 6 months ago, and had an inactive lifestyle for at least the previous 6 months. Patients were assigned randomly into 3 equal groups. Group A (magnetic therapy group): received routine medical treatment (bisphosphonates, calcium, and vitamin D) in addition to pulsed magnetic therapy on the hip region for 12 weeks (3 sessions/week). Group B (exercise group): received routine medical treatment plus moderate-intensity aerobic exercise for 12 weeks (3 sessions/week). Group C (combined magnetic therapy and exercise therapy group): received routine medical treatment plus pulsed magnetic therapy and moderate-intensity aerobic exercise for 12 weeks (3 sessions/week). The 3 groups were assessed for bone mineral density (BMD) at baseline by dual-energy x-ray absorptiometry and after 12 weeks of treatment. RESULTS The results showed that within-group analysis a statistically significant increase was reveled (P < .05) for BMD in the 3 studied groups. Comparing the results among the 3 tested groups revealed a significant increase (P < .05) in posttesting mean values of BMD in group (C) compared to group (A) and group (B). No significant statistical difference in BMD means values between the 2 groups (A) and (B) after testing was detected. CONCLUSION Combination of both pulsed magnetic therapy and moderate-intensity aerobic exercise showed significant improvement in BMD at the hip region than using any of the 2 modalities alone.
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Affiliation(s)
- Marwa M. Eid
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Amira M. El-Gendy
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Safaa Mostafa Elkholi
- Department of Rehabilitation Sciences, Faculty of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mostafa S. Abdel-fattah
- Department of Physical Therapy for Cardiovascular/Respiratory Disorder and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Sawicki P, Tałałaj M, Życińska K, Zgliczyński WS, Wierzba W. Current Applications and Selected Technical Details of Dual-Energy X-Ray Absorptiometry. Med Sci Monit 2021; 27:e930839. [PMID: 34131097 PMCID: PMC8216008 DOI: 10.12659/msm.930839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The application of dual-energy X-ray absorptiometry (DXA) examinations in the assessment of bone mineral density (BMD) in the lumbar spine, hip, and forearm is the basic diagnostic method for recognition of osteoporosis. The constant development of DXA technique is due to the aging of societies and the increasing importance of osteoporosis as a public health problem. In order to assess the degree of bone demineralization in patients with hyperparathyroidism, forearm DXA examination is recommended. The vertebral fracture assessment (VFA) of the thoracic and lumbar spine, performed by a highly-skilled technician, is an interesting alternative to the X-ray examination. The DXA total body examination can be useful in the evaluation of fat redistribution among patients after bariatric surgery, in patients infected with HIV and receiving antiretroviral therapy, and in patients with metabolic diseases and suspected to have sarcopenia. The assessment of visceral adipose tissue (VAT) and detection of abdominal aortic calcifications may be useful in the prediction of cardiovascular events. The positive effect of anti-resorptive therapy may affect some parameters of DXA hip structure analysis (HSA). Long-term anti-resorptive therapy, especially with the use of bisphosphonates, may result in changes in the DXA image, which may herald atypical femur fractures (AFF). Reduction of the periprosthetic BMD in the DXA measurements can be used to estimate the likelihood of loosening the prosthesis and periprosthetic fractures. The present review aims to present current applications and selected technical details of DXA.
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Affiliation(s)
- Piotr Sawicki
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland
| | - Marek Tałałaj
- Department of Geriatrics, Internal Medicine and Metabolic Bone Diseases, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Katarzyna Życińska
- Department of Rheumatology, Systemic Connective Tissue Diseases and Rare Diseases, Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,Department of Family Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | - Waldemar Wierzba
- Central Clinical Hospital MSWiA in Warsaw, Warsaw, Poland.,UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, Warsaw, Poland
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Tous N, Tarradas J, Francesch M, Font-i-Furnols M, Ader P, Torrallardona D. Effects of Exogenous 6-Phytase (EC 3.1.3.26) Supplementation on Performance, Calcium and Phosphorous Digestibility, and Bone Mineralisation and Density in Weaned Piglets. Animals (Basel) 2021; 11:ani11061787. [PMID: 34203822 PMCID: PMC8232799 DOI: 10.3390/ani11061787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Supplementation with a low dose (up to 500 FTU/kg feed) of a new 6-phytase, obtained by assembling gene sequences of various phytase-producing bacteria, increases phosphorous and calcium availability in phosphorus-limiting piglet diets. Therefore, this phytase can be used to reduce the use of unsustainable sources of inorganic phosphorous without compromising piglets’ performance and bone mineralization and density, and the higher phosphorous utilization will also reduce its excretion to the environment. This study also demonstrates that the effects of phytase on bone density can be evaluated using computed tomography, which may be useful for studies with live animals. Abstract Phosphorus (P) is an essential mineral for growing piglets, which is poorly accessible in vegetable feedstuffs as it is stored as phytates. Thus, phytase supplementation is essential to increase P availability. Two experiments were conducted to evaluate a novel 6-phytase (EC 3.1.3.26) in weaned pigs fed low-P diets. In each experiment, one hundred and twenty piglets were fed a positive control (PC; adequate in Ca and P), a negative control (NC; limiting in Ca and P), or NC supplemented with 125, 250, or 500 FTU/kg of phytase (NC125, NC250, and NC500, respectively). P content was lower in diets of Experiment 1 than diets of Experiment 2. In Experiment 1, piglets offered PC or phytase diets had higher growth and efficiency compared with NC diets. In Experiment 2, similar effects were obtained, but the effects were less significant. In both experiments, P and Ca ATTD and bone density were significantly increased with phytase supplementation. Moreover, PC and NC500 had higher P concentrations and lower alkaline phosphatase activity in plasma than NC. To conclude, supplementation with the new 6-phytase at doses up to 500 FTU/kg enhanced P utilization, growth performance, and bone density in piglets fed P-limiting diets.
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Affiliation(s)
- Núria Tous
- Animal Nutrition, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Centre Mas Bové, Ctra. Reus-El Morell km. 3.8, 43120 Constantí, Spain; (N.T.); (J.T.); (M.F.)
| | - Joan Tarradas
- Animal Nutrition, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Centre Mas Bové, Ctra. Reus-El Morell km. 3.8, 43120 Constantí, Spain; (N.T.); (J.T.); (M.F.)
| | - Maria Francesch
- Animal Nutrition, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Centre Mas Bové, Ctra. Reus-El Morell km. 3.8, 43120 Constantí, Spain; (N.T.); (J.T.); (M.F.)
| | - Maria Font-i-Furnols
- Product Quality and Technology, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Finca Camps i Armet, 17121 Monells, Spain;
| | - Peter Ader
- BASF SE, Animal Nutrition, Europe. Chemiestrasse 22, 68623 Lampertheim, Germany;
| | - David Torrallardona
- Animal Nutrition, Institut de Recerca i Tecnologia Agroalimentàries (IRTA), Centre Mas Bové, Ctra. Reus-El Morell km. 3.8, 43120 Constantí, Spain; (N.T.); (J.T.); (M.F.)
- Correspondence:
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Sweeney MR, O’Leary KG, Jeney Z, Braunlin MC, Gibb HJ. Systematic review and quality ranking of studies of two phthalate metabolites and anogenital distance, bone health, inflammation, and oxidative stress. Crit Rev Toxicol 2019; 49:281-301. [DOI: 10.1080/10408444.2019.1605332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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9
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EKİN EE, ALTUNRENDE ME. The association of reduced bone density with paraspinal muscle atrophy and adipose
tissue in geriatric patients: a cross-sectional CT study. Turk J Med Sci 2019; 49:538-542. [PMID: 30866604 PMCID: PMC7024431 DOI: 10.3906/sag-1809-48] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background/aim The aim of the study is to examine the relationship among bone density, adipose tissue, and muscle mass with abdominal CT in geriatric patients. Materials and methods The study is a retrospective cohort study of patients 65 years and over who underwent abdominal CT for any reason between October 2017 and July 2018. Third lumbar vertebra density, fatty degeneration of the paraspinal muscle, subcutaneous adipose tissue, and mesenteric adipose tissue ratio were evaluated. Results A total of 312 patients, 144 females and 168 males, were included in the study. Reduced bone density was found in 237 (76%) patients. Reduced bone density and muscle atrophy was more frequent in females (P < 0.001). Muscle atrophy was found to occur 5.7 times more frequently in cases of reduced bone density (OR, 95% CI = 5.74 (3.27–10.09), P < 0.001). There was no significant relationship found between reduced bone density and subcutaneous adipose tissue thickness or mesenteric adipose tissue ratio (P = 0.073, P = 0.939, respectively). Conclusion In the geriatric age group, reduced bone density and muscle atrophy were quite common and were significantly more frequent in women. Furthermore, a strong association between reduced bone density and muscle atrophy was found. No relationship was found between reduced bone density and subcutaneous adipose tissue thickness–mesenteric adipose ratio.
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Affiliation(s)
- Elif Evrim EKİN
- Department of Radiology, GOP Taksim Training and Research Hospital, Health Sciences University, İstanbulTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Muhittin Emre ALTUNRENDE
- Department of Radiology, GOP Taksim Training and Research Hospital, Health Sciences University, İstanbulTurkey
- Clinic of Neurosurgery, GOP Taksim Training and Research Hospital, Health Sciences University, İstanbulTurkey
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Krueger D, Shives E, Siglinsky E, Libber J, Buehring B, Hansen KE, Binkley N. DXA Errors Are Common and Reduced by Use of a Reporting Template. J Clin Densitom 2019; 22:115-124. [PMID: 30327243 DOI: 10.1016/j.jocd.2018.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE High quality dual energy X-ray absorptiometry (DXA) acquisition, analysis, and reporting demands technical and interpretive excellence. We hypothesized that DXA errors are common and of such magnitude that incorrect clinical decisions might result. In this 2-phase study, we evaluated DXA technical and interpretation error rates in a clinical population and subsequently assessed if implementing an interpretation template reduced errors. METHODS In phase 1, DXA scans of 345 osteoporosis clinic referrals were reviewed by International Society for Clinical Densitometry-certified technologists (n = 3) and physicians (n = 3). Technologists applied International Society for Clinical Densitometry performance standards to assess technical quality. Physicians assessed reporting compliance with published guidance, relevance of technical errors and determined overall and major error prevalence. Major errors were defined as "provision of inaccurate information that could potentially lead to incorrect patient care decisions." In phase 2, a DXA reporting template was implemented at 2 clinical DXA sites after which the 3 physicians reviewed 200 images and reports as above. The error prevalence was compared with the 298 patients in phase 1 from these sites. RESULTS In phase 1, technical errors were identified in 90% of patients and affected interpretation in 13%. Interpretation errors were present in 80% of patients; 42% were major. The most common major errors were reporting incorrect information on bone mineral density change (70%) and incorrect diagnosis (22%). In phase 2, at these 2 clinical sites, major errors were present in 37% before and 17% after template implementation. Template usage reduced the odds of major error by 66% (odds ratio 0.34, 95% confidence interval 0.21, 0.53, and p < 0.0001). CONCLUSION DXA technical and interpretation errors are extremely common and likely adversely affect patient care. Implementing a DXA reporting template reduces major errors and should become common practice. Additional interventions, such as requiring initial and ongoing training and/or certification for technologists and interpreters, are suggested.
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Affiliation(s)
- D Krueger
- University of Wisconsin-Madison, Madison, WI, USA.
| | - E Shives
- University of Wisconsin-Madison, Madison, WI, USA
| | - E Siglinsky
- University of Wisconsin-Madison, Madison, WI, USA
| | - J Libber
- University of Wisconsin-Madison, Madison, WI, USA
| | - B Buehring
- University of Wisconsin-Madison, Madison, WI, USA
| | - K E Hansen
- University of Wisconsin-Madison, Madison, WI, USA
| | - N Binkley
- University of Wisconsin-Madison, Madison, WI, USA
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Salamanna F, Borsari V, Brogini S, Giavaresi G, Parrilli A, Cepollaro S, Cadossi M, Martini L, Mazzotti A, Fini M. An in vitro 3D bone metastasis model by using a human bone tissue culture and human sex-related cancer cells. Oncotarget 2018; 7:76966-76983. [PMID: 27765913 PMCID: PMC5363563 DOI: 10.18632/oncotarget.12763] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 09/27/2016] [Indexed: 01/08/2023] Open
Abstract
One of the main limitations, when studying cancer-bone metastasis, is the complex nature of the native bone environment and the lack of reliable, simple, inexpensive models that closely mimic the biological processes occurring in patients and allowing the correct translation of results. To enhance the understanding of the mechanisms underlying human bone metastases and in order to find new therapies, we developed an in vitro three-dimensional (3D) cancer-bone metastasis model by culturing human breast or prostate cancer cells with human bone tissue isolated from female and male patients, respectively. Bone tissue discarded from total hip replacement surgery was cultured in a rolling apparatus system in a normoxic or hypoxic environment. Gene expression profile, protein levels, histological, immunohistochemical and four-dimensional (4D) micro-CT analyses showed a noticeable specificity of breast and prostate cancer cells for bone colonization and ingrowth, thus highlighting the species-specific and sex-specific osteotropism and the need to widen the current knowledge on cancer-bone metastasis spread in human bone tissues. The results of this study support the application of this model in preclinical studies on bone metastases and also follow the 3R principles, the guiding principles, aimed at replacing/reducing/refining (3R) animal use and their suffering for scientific purposes.
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Affiliation(s)
- Francesca Salamanna
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy.,Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Veronica Borsari
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Silvia Brogini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Gianluca Giavaresi
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy.,Laboratory of Tissue Engineering-Innovative Technology Platforms for Tissue Engineering, Rizzoli Orthopedic Institute, Palermo, Italy
| | - Annapaola Parrilli
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Simona Cepollaro
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Matteo Cadossi
- I Orthopaedics and Trauma Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Lucia Martini
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy.,Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Antonio Mazzotti
- I Orthopaedics and Trauma Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Milena Fini
- Laboratory of Biocompatibility, Technological Innovation and Advanced Therapy, Rizzoli RIT, Rizzoli Orthopedic Institute, Bologna, Italy.,Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy
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Zarate YA, Steinraths M, Matthews A, Smith WE, Sun A, Wilson LC, Brain C, Allgove J, Jacobs B, Fish JL, Powell CM, Wasserman WW, van Karnebeek CD, Wakeling EL, Ma NS. Bone health and SATB2-associated syndrome. Clin Genet 2017; 93:588-594. [PMID: 28787087 DOI: 10.1111/cge.13121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 12/20/2022]
Abstract
SATB2-associated syndrome (SAS) is a rare disorder caused by alterations in the special AT-rich sequence-binding protein 2 (SATB2). Skeletal abnormalities such as tibial bowing, osteomalacia, osteopenia or osteoporosis have been reported suggesting a higher frequency of skeletal complications in SAS. The optimal timing, necessity, and methodology for routine assessment of bone health in individuals with SAS, however, remain unclear. We report molecular and phenotypic features of 7 individuals with SAS documented to have low bone mineral density (BMD) ascertained by dual-energy X-ray absorptiometry (DXA), often preceded by tibial bowing. The lowest BMD Z-scores ranged -2.3 to -5.6. In 4 individuals, total alkaline phosphatase levels were elevated (2 with elevated bone fraction) around the time of low BMD documentation. A clinically significant fracture history and a diagnosis of pediatric osteoporosis were present in 4 individuals. Pamidronate treatment in 2 children improved BMD. In conclusion, low BMD, fractures, and tibial bowing are relatively common skeletal complications in individuals with SAS. DXA is a useful tool when evaluating a child with SAS suspected to have low BMD and the results might alter clinical management.
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Affiliation(s)
- Y A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - M Steinraths
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - A Matthews
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - W E Smith
- Department of Pediatrics, The Barbara Bush Children's Hospital, Maine Medical Center, Portland, Maine
| | - A Sun
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
| | - L C Wilson
- Department of Genetics, Great Ormond Street for Children NHS Foundation Trust, London, UK
| | - C Brain
- Department of Endocrinology, Great Ormond Street for Children NHS Foundation Trust, London, UK
| | - J Allgove
- Department of Endocrinology, Great Ormond Street for Children NHS Foundation Trust, London, UK
| | - B Jacobs
- Department of Pediatrics, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - J L Fish
- Department of Biological Sciences, University of Massachusetts Lowell, Lowell, Massachusetts
| | - C M Powell
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - W W Wasserman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.,Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - C D van Karnebeek
- Centre for Molecular Medicine and Therapeutics, British Columbia Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada.,Department of Pediatrics and Clinical Genetics, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - E L Wakeling
- North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, Harrow, UK
| | - N S Ma
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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