Evaluation of Singh Index and Osteoporosis Self-Assessment Tool for Asians as risk assessment tools of hip fracture in patients with type 2 diabetes mellitus

Automated Screening of Hip X-rays for Osteoporosis by Singh's Index Using Machine Learning Algorithms

Introduction

Osteoporosis is a significant and growing global public health problem, projected to increase in the next decade. The Singh Index (SI) is a simple, semi-quantitative evaluation tool for diagnosing osteoporosis with plain hip radiographs based on the visibility of the trabecular pattern in the proximal femur. This work aims to develop an automated tool to diagnose osteoporosis using SI of hip radiograph images with the help of machine learning algorithms.

Methods

We used 830 hip X-ray images collected from Indian men and women aged between 20 and 70 which were annotated and labeled for appropriate SI. We employed three state-of-the-art machine learning algorithms-Vision Transformer (ViT), MobileNet-V3, and a Stacked Convolutional Neural Network (CNN)-for image pre-processing, feature extraction, and automation. Each algorithm was evaluated and compared for accuracy, precision, recall, and generalization capabilities to diagnose osteoporosis.

Results

The ViT model achieved an overall accuracy of 62.6% with macro-averages of 0.672, 0.597, and 0.622 for precision, recall, and F1 score, respectively. MobileNet-V3 presented a more encouraging accuracy of 69.6% with macro-averages for precision, recall, and F1 score of 0.845, 0.636, and 0.652, respectively. The stacked CNN model demonstrated the strongest performance, achieving an accuracy of 93.6% with well-balanced precision, recall, and F1-score metrics.

Conclusion

The superior accuracy, precision-recall balance, and high F1-scores of the stacked CNN model make it the most reliable tool for screening radiographs and diagnosing osteoporosis using the SI.

Association Between Osteoporosis Self-Assessment Tool for Asians and Airflow Limitation in Japanese Post-Menopausal Women

Purpose

This study aimed to reveal the association between the osteoporosis self-assessment tool for Asians (OSTA) and airflow limitation (AL) in post-menopausal Japanese women.

Participants and Methods

This cross-sectional study included 1580 participants undergoing a comprehensive health examination using spirometry and dual-energy X-ray absorptiometry. The OSTA was calculated by subtracting the age in years from the body weight (BW) in kilograms, and the result was multiplied by 0.2. The OSTA risk level was defined as low (>-1), moderate (-4 to -1), or high (<-4). AL was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) <0.7. The association between the OSTA and AL was assessed using logistic regression analysis.

Results

The prevalence of AL was significantly higher in the high OSTA group (15.3%) than in the low OSTA group (3.1%) (p<0.001). In multiple linear regression analysis, the OSTA was independently associated with FEV1/FVC. In logistic regression models adjusted for smoking status, alcohol consumption, current use of medication for diabetes, hyperglycemia, rheumatoid arthritis, second-hand smoke, and ovary removal showed a significantly higher risk of AL (odds ratio: 5.48; 95% confidence interval: 2.90-10.37; p<0.001) in participants with OSTA high risk than in those with OSTA low risk.

Conclusion

These results suggest that the OSTA high risk indicates reduced BMD at the femoral neck and presence of AL in Japanese post-menopausal women aged ≥45 years.

Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial

Background

The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent.

Methods

This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS).

Results

Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001).

Conclusion

Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.

Bibliometric and visualized analysis of type 2 diabetic osteoporosis from 2013 to 2022

Type 2 diabetic osteoporosis (T2DOP) has received increasing attention from researchers. In this study, a total of 453 publications related to T2DOP from 2013 to 2022 were analyzed using bibliometric and visual analysis to identify the research trends and research hotspots in the field of T2DOP.

PURPOSE

The objective of this study was to conduct a comprehensive bibliometric analysis of T2DOP-related publications from 2013 to 2022 to determine global research trends in T2DOP in terms of number of publications, countries/regions, institutions, authors, journals, funding agencies, and keywords.

METHODS

All data were collected from the Web of Science Core Collection (WoSCC). All original research publications regarding T2DOP from 2013 to 2022 were retrieved. VOSviewer and Microsoft Office Excel were used to conduct the bibliometric and visual analysis.

RESULTS

From 2013 to 2022, 515 relevant publications were published, with a peak in 2022 in the annual number of publications. The countries leading the research were USA and China. Sugimoto was the most influential authors. Capital Medical University and Nanjing Medical University were the most prolific institutions. Osteoporosis International was the most productive journal concerning T2DOP research. National Natural Science Foundation of China was the primary funding source for this research area. "Bone-mineral density", "fracture risk", and "postmenopausal women" were the most high-frequency keywords over the past 10 years.

CONCLUSION

This was the first bibliometric study of diabetes mellitus and osteoporosis to exclusively examine type 2 diabetes mellitus. Our findings would provide guidance to understand the research frontiers and hot directions in the near future.

Benchmarking institutional geriatric hip fracture management: a prelude to a care quality improvement initiative

BACKGROUND

Fractures around the hip in older adults have increased in the last two decades, and the numbers are projected to rise over the next 30 years with estimates that half of them will occur in Asia. Proximal hip fractures should be operated within 48 h of injury to prevent poor outcomes. This study aims to benchmark current hip fracture care using quality improvement tools of care structure, care processes, and outcomes in a tertiary care hospital in Eastern India and determine the evidence-practice gaps and barriers to implementing the six best practices that reduce mortality and morbidity in fragility hip fractures.

METHODS

A total of 101 consecutive patients above 50 years of age with proximal femoral fractures after a trivial fall were included. Patients were divided into two groups: those operated within [Group A] and beyond [Group B] 72 h of admission. Care structure assessment included delays in admission, delay in surgery, and anesthesia risk grading. Care processes included the type of surgery performed and postoperative complications. The primary outcomes were the 30-day and 1-year mortality and the secondary outcomes included the length of stay, mobility at 6 months, return to pre-fracture independence, activity limitations, pressure sores, and readmission to the hospital.

RESULTS

Group A comprised 26 individuals, and the remaining 75 were in Group B. There were two deaths in Group A as compared to one death in Group B at 30 days; however, there were no new deaths at 1 year in Group A and 14 deaths in Group B (p = 0.187). Group B had lengthier hospital stays, poorer mobility, and higher physical and mental difficulties. No patients had re-operation on the initial fracture.

CONCLUSION

This study emphasizes the importance of early admission and fast provision of surgical fixation to reduce mortality and morbidity. Benchmarking institutional practices allows for defining the evidence-practice gaps and barriers to best practice implementation. This is an essential step to begin care quality improvement for geriatric patients with proximal femur fragility fractures.

Assessing the utility of osteoporosis self-assessment tool for Asians in patients undergoing hip surgery

Objectives

Diagnosis and treatment of osteoporosis are instrumental in obtaining good outcomes of hip surgery. Measuring bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. However, due to limited access to DXA, there is a need for a screening tool to identify patients at a higher risk of osteoporosis. We analyzed the potential utility of the Osteoporosis Self-assessment Tool for Asians (OSTA) as a screening tool for osteoporosis.

Methods

A total of 1378 female patients who underwent hip surgery at 8 institutions were analyzed. For each patient, the BMD of the proximal femoral region was measured by DXA (DXA-BMD), and the correlation with OSTA score (as a continuous variable) was assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of OSTA score to predict osteoporosis. Lastly, the OSTA score was truncated to yield an integer (OSTA index) to clarify the percentage of patients with osteoporosis for each index.

Results

DXA-BMD showed a strong correlation with OSTA (r = 0.683; P < 0.001). On ROC curve analysis, the optimal OSTA score cut-off value of -5.4 was associated with 73.8% sensitivity and 80.9% specificity for diagnosis of osteoporosis (area under the curve: 0.842). A decrease in the OSTA index by 1 unit was associated with a 7.3% increase in the probability of osteoporosis.

Conclusions

OSTA is a potentially useful tool for screening osteoporosis in patients undergoing hip surgery. Our findings may help identify high-risk patients who require further investigation using DXA.

Diagnostic Value of Radiographic Singh Index Compared to Dual-Energy X-Ray Absorptiometry Scan in Diagnosing Osteoporosis: A Systematic Review

Objectives

Since various medications can control the rate of fractures and subsequent complications of osteoporosis, the early detection of the disease is crucial. This systematic study aimed to compare the diagnostic accuracy of Singh index (SI) with dual-energy X-ray absorptiometry (DEXA) as a benchmark standard for diagnosing osteoporosis.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were utilized in the current study. A detailed search was carried out using PubMed and Scopus from inception to 30 May 2022. Examining quality of the studies was performed by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).

Results

A total of 22 studies were included. In general, 50% of the studies considered SI a poor screening tool for detecting osteoporosis due to a negligible inter-observer agreement between SI and DEXA or a poor correlation of SI with the bone mineral density (BMD) category or DEXA T-score. A moderate inter-observer agreement was reported for SI in 5 (55.6%) studies. Among the studies assessing the sensitivity and specificity of SI compared to DEXA (n=13), six studies estimated a low sensitivity for SI.

Conclusion

While there is supporting evidence indicating the potential usefulness of SI for predicting femoral neck fractures in individuals with suspected osteoporosis, numerous studies challenge its reliability and diagnostic value as a screening tool for identifying femoral neck osteoporosis. Further primary studies are required to verify the effectiveness of the SI index in identifying populations at risk of osteoporosis.

Age-Related changes in the morphological features of medial column of the proximal humerus in the Chinese population

Background

Age-related changes in the medial column (MC) of the proximal humerus have a major impact on fracture management; however, the changes in the morphological features remain unclear. This study aimed to investigate the age-related changes in the morphological features of MC and present the morphological grading.

Methods

One hundred computed tomography (CT) images of the proximal humerus of 100 individuals (19-95 years) were retrospectively obtained. The individuals were categorized into five age groups to quantify the differences among different ages; the youngest group (18-44 years) served as the baseline group. Parameters of the morphological features were measured on CT images with multiplanar reconstruction based on an explicit definition of MC, including length, thickness, width, oblique thickness (DSM), humeral head diameter (DHM), and ratio (RSM) of DSM to DHM. The morphological grading of MC was presented based on the value of RSM deviating different standard deviations (SD) from the mean value in the baseline group.

Results

Significant negative correlations were observed between age and the morphological parameters of MC (r ranged from -0.875 to -0.926; all P < 0.05), excluding DHM (r = 0.081, P = 0.422). Significant differences in the values of morphological feature parameters were detected among the five age groups (all P < 0.001). The highest mean values of morphological feature parameters were observed in the youngest group (18-44 years), which decreased gradually with increasing age until the lowest mean values were observed in the oldest group (≥90 years) (all P < 0.05). The morphological features of MC were categorized into three grades based on the value of RSM deviating 1.5 SD or 3 SD from the mean value in the baseline group.

Conclusion

Our study shows that the parameter values of morphological features of MC decreased with increasing age. The morphological features of MC could be categorized into three grades. Our findings may provide a more comprehensive insight into age-related changes in the morphological features of MC that facilitate risk stratification and optimize the management of proximal humeral fractures.

Risk of primary osteoporosis score (RPOPs): an algorithm model for primary osteoporosis risk assessment in grass-roots hospital

BACKGROUND

This study aimed to develop and validate a lasso regression algorithm model which was established by correlation factors of bone mineral density (BMD) and could be accurately predicted a high-risk population of primary osteoporosis (POP). It provides a rapid, economical and acceptable early screening method for osteoporosis in grass-roots hospitals.

METHODS

We collected 120 subjects from primary osteoporosis screening population in Zhejiang Quhua Hospital between May 2021 and November 2021 who were divided into three groups (normal, osteopenia and osteoporosis) according to the BMD T-score. The levels of three micro-RNAs in the plasma of these people were detected and assessed by qRT-PCR. At the same time, the levels of β-CTX and t-P1NP in serum of the three groups were determined. Based on the cluster random sampling method, 84 subjects (84/120, 70%) were selected as the training set and the rest were the test set. Lasso regression was used to screen characteristic variables and establish an algorithm model to evaluate the population at high risk of POP which was evaluated and tested in an independent test cohort. The feature variable screening process was used 10-fold cross validation to find the optimal lambda.

RESULTS

The osteoporosis risk score was established in the training set: Risk of primary osteoporosis score (RPOPs) = -0.1497785 + 2.52Age - 0.19miR21 + 0.35miR182 + 0.17β-CTx. The sensitivity, precision and accuracy of RPOPs in an independent test cohort were 79.17%, 82.61% and 75%, respectively. The AUC in the test set was 0.80. Some risk factors have a significant impact on the abnormal bone mass of the subjects. These risk factors were female (p = 0.00013), older than 55 (p < 2.2e-16) and BMI < 24 (p = 0.0091) who should pay more attention to their bone health.

CONCLUSION

In this study, we successfully constructed and validated an early screening model of osteoporosis that is able to recognize people at high risk for developing osteoporosis and remind them to take preventive measures. But it is necessary to conduct further external and prospective validation research in large sample size for RPOPs prediction models.

The predictive value of the Singh index for the risk of InterTAN intramedullary fixation failure in elderly patients with intertrochanteric fractures

Background

To investigate the predictive value of the Singh index for the risk of InterTAN intramedullary fixation failure in elderly patients with intertrochanteric fracture to guide clinical treatment.

Methods

A total of 360 patients were divided into the Singh (I ~ II) (n = 120), Singh (III ~ IV) (n = 120) and Singh (V ~ VI) (n = 120) groups. Visual analog scale (VAS) and Harris scores were recorded at 1, 6, 12, 18 and 24 months after the operation. The correlation between the Singh index and the T-score of the total hip and femoral neck was analyzed. Logistic regression was used to analyze the relationship between the Singh index and internal fixation failure; the types of internal fixation failure were also analyzed.

Results

The Harris scores of the Singh (I ~ II) group were lower than those of the Singh (III ~ IV) and Singh (V ~ VI) groups 12, 18 and 24 months after surgery (P < 0.05). The Singh index was significantly correlated with the T-score of the total hip and femoral neck (P = 0.00, r = 0.89; P = 0.00, r = 0.83). The Singh (I ~ II) group had the lowest internal fixation survival rate within 24 months (P = 0.01). The Singh index was an independent predictor of internal fixation failure (P < 0.05). Lag screw cutting-out was the main type of internal fixation failure in the three groups (P = 0.00).

Conclusion

The Singh index is significantly correlated with the bone mineral density of the femoral neck and total hip. The Singh (I ~ II) group had lower Harris scores and a lower internal fixation survival rate than the other two groups. The Singh index is an independent predictor of internal fixation failure, especially lag screw cutting-out, after InterTAN fixation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05741-8.

Evaluation of community-based screening tools for the early screening of osteoporosis in postmenopausal Vietnamese women

Background

Osteoporosis affects people worldwide. However, there are few validated tools for the early screening of osteoporosis in Vietnam. We set out to evaluate the performance of the osteoporosis self-assessment tool for Asians (OSTA) and the osteoporosis screening tool for Chinese (OSTC) for the early screening of osteoporosis in postmenopausal Vietnamese women.

Methods

We analyzed retrospective data from 797 postmenopausal Vietnamese women. The bone mineral density (BMD) in the lumbar vertebrae (L1–L4) and the left and right femoral necks of all participants were measured using dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as the BMD (T-score) < -2.5. The OSTA and OSTC scores were calculated from the age and weight of participants. Receiver operating characteristic analysis was conducted to compare the performance of the two tools with the BMD measurements by DXA at different anatomical sites.

Results

The rates of osteoporosis determined by BMD varied between anatomical sites, and ranged from 43.4% to 54.7% in the lumbar vertebrae and 29.2% and 8.9% in the left and right femoral necks, respectively. For the vertebrae, the area under the curve (AUC) for OSTA ranged from 70.9% to 73.9% and for OSTC ranged from 68.7% to 71.6%. The predictive value of both tools was higher for femoral necks, with the AUC of OSTA for the left and right femoral necks being 80.0% and 85.8%, respectively. The corresponding figures for OSTC were 80.5% and 86.4%, respectively. The highest sensitivity and specificity of OSTA were 74.6% and 81.4%, while these figures for OSTC were 73.9% and 82.6%, respectively.

Conclusion

OSTA and OSTC were shown to be useful self-assessment tools for osteoporosis detection in Vietnam postmenopausal women. Further research is encouraged to determine the applicability of tools for other populations and settings.

A Risk Assessment Tool for Identifying Osteoporosis in Older Women with Type 2 Diabetes Mellitus

PURPOSE

To develop a simple and clinically useful assessment tool for osteoporosis in older women with type 2 diabetes mellitus (T2DM).

METHODS

A total of 601 women over 60 years of age with T2DM were enrolled in this study. The levels of serum sex hormones and bone metabolism markers were compared between the osteoporosis and non-osteoporosis groups. The least absolute shrinkage and selection operator regularization (LASSO) model was applied to generate a risk assessment tool. The risk score formula was evaluated using receiver operating characteristic analysis and the relationship between the risk score and the bone mineral density (BMD) and T-value were investigated.

RESULTS

Serum sex hormone-binding globulin (SHBG), cross-linked C-telopeptide of type 1 collagen (CTX), and osteocalcin (OC) were significantly higher in the osteoporosis group. After adjustment for age and body mass index (BMI), SHBG was found to be correlated with the T-value or BMD. Then, a risk score was specifically generated with age, BMI, SHBG, and CTX using the LASSO model. The risk score was significantly negatively correlated with the T-value and BMD of the lumbar spine, femoral neck, and total hip (all P<0.05).

CONCLUSION

A risk score using age, BMI, SHBG, and CTX performs well for identifying osteoporosis in older women with T2DM.

Apelin/APJ system: A novel therapeutic target for locomotor system diseases

Apelin is an endogenous ligand of G protein-coupled receptor APJ. Apelin/APJ system is widely expressed in abundant tissues, especially bone, joint and muscle tissue. This review focus on the effects of apelin/APJ system on locomotor system. An increasing number of evidence suggests that apelin/APJ system plays a crucial role in many physiological and pathological processes of locomotor system. Physiologically, apelin/APJ system promotes bone formation, muscle metabolism and skeletal muscle production. Pathologically, apelin/APJ system exacerbates osteoarthritis pathogenesis, whereas it alleviates osteoporosis. Besides, the level of apelin expression is regulated by different training modes, including continuous aerobic exercise, high-intensity interval training and resistance exercises. More importantly, exercise-induced apelin may be a potent pharmacological agent for the treatment of diseases and the regulation of physiological processes. Considering the pleiotropic effects of apelin on locomotor system, apelin/APJ system may be an important therapeutic target for locomotor system diseases.

Serum levels of osteoprotegerin, RANK-L & vitamin D in different stages of osteoarthritis of the knee

BACKGROUND & OBJECTIVES

Osteoarthritis (OA) is the 11^th leading cause of disability in the modern world, but till date, there have been no effective markers for monitoring the progression of OA. The three proteins RANK/RANK-Ligand and Osteoprotegerin (OPG) have been found to be the key regulators of bone metabolism. Interaction of RANK-Ligand with its receptor RANK triggers differentiation of osteoclasts leading to bone resorption. OPG on the other hand is protective as it is expressed by osteoblasts and bind RANKL with higher affinity preventing its interaction with RANK. The levels of these serum proteins are regulated by vitamin D and parathyroid hormones. Therefore, the present study, aimed to study the association of serum RANKL, OPG and vitamin D with disease severity in patients with knee OA.

METHODS

It was a cross-sectional study where 80 (43 women and 37 men) newly diagnosed subjects with OA knee were recruited. They were classified into four grades based on K-L grading and into two groups as early (grade 1+grade 2) and advanced (grade 3 + grade 4) based on the disease progression.

RESULTS

On comparing the biochemical parameters among the four grades decreasing vitamin D levels were seen with increasing severity of knee OA; an increasing trend of RANKL with increase in the severity of OA was seen; OPG was found to be elevated more in the early stages of OA. We also observed a strong association of RANKL/OPG ratio with disease severity.

INTERPRETATION & CONCLUSIONS

Overall the results suggest that OPG may be considered as an early marker of the diseases.

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.

Evaluation of two tools for the early screening of osteoporosis in postmenopausal Chinese women with type 2 diabetes mellitus

Objective

To evaluate two osteoporosis screening tools, the osteoporosis self-assessment tool for Asians (OSTA) and the osteoporosis screening tool for Chinese (OSTC), in postmenopausal Chinese women with type 2 diabetes mellitus (T2DM).

Methods

This retrospective study enrolled postmenopausal female patients with T2DM. Bone mineral density at the lumbar spine (L1–4) and left femoral neck was measured using dual-energy X-ray absorptiometry (DXA). The OSTA and OSTC scores were calculated and compared with bone mineral density at the two anatomical sites.

Results

A total of 404 patients with T2DM were enrolled in this study. The detection rates for osteoporosis in the lumbar spine (L1–L4) and left femoral neck by DXA were 22.5% (91 of 404 patients) and 21.8% (88 of 404 patients), respectively; 14.4% (58 of 404 patients) and 18.1% (73 of 404 patients) by OSTA, respectively; and 21.5% (87 of 404 patients) at both sites by OSTC. At the femoral neck, the areas under the curve (AUC) of OSTA and OSTC for predicting osteoporosis were 0.73 and 0.78, respectively. The sensitivity and specificity for OSTA were 64.9% and 72.7%, respectively; and for OSTC, they were 64.2% and 79.5%, respectively.

Conclusions

The OSTC assessment tool was superior to OSTA for osteoporosis screening in postmenopausal Chinese women with T2DM.

Performance of Osteoporosis Self-Assessment Tool (OST) in Predicting Osteoporosis-A Review

Bone health screening plays a vital role in the early diagnosis and treatment of osteoporosis to prevent fragility fractures among the elderly and high-risk individuals. Dual-energy X-ray absorptiometry (DXA), which detects bone mineral density, is the gold standard in diagnosing osteoporosis but is not suitable for screening. Therefore, many screening tools have been developed to identify individuals at risk for osteoporosis and prioritize them for DXA scanning. The Osteoporosis Self-assessment Tool (OST) is among the first tools established to predict osteoporosis in postmenopausal women. It can identify the population at risk for osteoporosis, but its performance varies according to ethnicity, gender, and age. Thus, these factors should be considered to ensure the optimal use of OST worldwide. Overall, OST is a simple and economical screening tool to predict osteoporosis and it can help to optimize the use of DXA.

Influence of Apelin-13 on osteoporosis in Type-2 diabetes mellitus: A clinical study

Objective:

To investigate the relationship between serum level of Apelin-13 and bone mineral density (BMD) as well as other parameters, and determine the influence of Apelin-13 on osteoporosis in patients with Type-2 diabetes mellitus.

Methods:

Seventy-six patients with Type-2 diabetes mellitus were recruited from Department of Endocrinology of our hospital between January 2013 and July2017. The clinical data, including age, gender, height, weight, body mass index (BMI) and disease duration were recorded for all patients. Blood sample was collected for measurement of Apelin-13, Procollagen type-I N propeptide (PINP) and Cross-linked carboxy terminal telopeptide of type-I collagen (ICTP), and BMD was tested with a dual-energy X-ray absorptiometry scanner.

Results:

The patients were divided into three groups, in which 19 patients were assigned in osteoporosis group, 25 in osteopenia group and 32 in normal group. The level of Apelin-13 in osteoporosis group was significantly lower than that in osteopenia and normal groups (p<0.05), and the value in osteopenia group was significant lower than that in normal group (p<0.05). Correlation analysis showed in the included patients the level of Apelin-13 was positively correlated to the value of BMD and PINP (p<0.05), but negatively correlated to age and ICTP (p<0.05).

Conclusion:

In conclusion, this study demonstrated that there was a close relationship among Apelin-13, BMD, ICTP and PINP, and Apelin-13 plays an important role in the occurrence of osteoporosis in patients with Type-2 diabetes mellitus.

Epidemiology of Bone Fracture in Female Trauma Patients Based on Risks of Osteoporosis Assessed using the Osteoporosis Self-Assessment Tool for Asians Score

Background: Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma. However, the exclusion of high-level trauma fractures may result in underestimation of the contribution of osteoporosis to fractures. In this study, we aimed to investigate the fracture patterns of female trauma patients with various risks of osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians (OSTA) score. Methods: According to the data retrieved from the Trauma Registry System of a Level I trauma center between 1 January 2009 and 31 December 2015, a total of 6707 patients aged ≥40 years and hospitalized for the treatment of traumatic bone fracture were categorized as high-risk (OSTA < -4, n = 1585), medium-risk (-1 ≥ OSTA ≥ -4, n = 1985), and low-risk (OSTA > -1, n = 3137) patients. Two-sided Pearson's, chi-squared, or Fisher's exact tests were used to compare categorical data. Unpaired Student's t-test and Mann-Whitney U-test were used to analyze normally and non-normally distributed continuous data, respectively. Propensity-score matching in a 1:1 ratio was performed with injury mechanisms as adjusted variables to evaluate the effects of OSTA-related grouping on the fracture patterns. Results: High- and medium-risk patients were significantly older, had higher incidences of comorbidity, and were more frequently injured from a fall and bicycle accident than low-risk patients did. Compared to low-risk patients, high- and medium-risk patients had a higher injury severity and mortality. In the propensity-score matched population, the incidence of fractures was only different in the extremity regions between high- and low-risk patients as well as between medium- and low-risk patients. The incidences of femoral fractures were significantly higher in high-risk (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.73-4.24; p < 0.001) and medium-risk patients (OR, 1.4; 95% CI, 1.24-1.54; p < 0.001) than in low-risk patients. In addition, high-risk patients had significantly lower odds of humeral, radial, patellar, and tibial fractures; however, such lower odds were not found in medium- risk than low-risk patients. Conclusions: The fracture patterns of female trauma patients with high- and medium-risk osteoporosis were different from that of low-risk patients exclusively in the extremity region.

A review on the performance of osteoporosis self-assessment tool for Asians in determining osteoporosis and fracture risk

The prevalence of osteoporosis in Asian countries is growing. An effective screening method will enable patients at risk for osteoporosis to receive early diagnosis and treatment, and avoid overcrowding the limited dual-energy x-ray absorptiometry (DXA) machines available in Asian countries. Many simple osteoporosis screening algorithms have been developed but they are not validated for use in Asian populations. osteoporosis self-assessment tools for Asians (OSTA), established using a multinational Asian cohort, is the first screening algorithm that caters for the Asian populations. It considers only body weight and age in the algorithm. It shows consistently high performance and sensitivity in identifying postmenopausal women at risk for osteoporosis in many Asian countries. Its usage has been expanded for identifying osteoporosis in men, as well as determining fracture risk for both sexes. However, the performance of OSTA is influenced by age, sex, ethnicity and site of BMD measurement to define osteoporosis. Its usage is also limited in individuals without apparent risk factors. These limitations should be noted by physicians considering the use of OSTA in clinical setting. As a conclusion, OSTA is a cost-effective measure for osteoporosis screening in primary healthcare setting.