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Gokcek A, Karabay EO, Yegin MA, Cakmakci E, Gencer S. Can Ultrasonographic Measurement of Bone Cortical Thickness Predict Osteoporosis? Acad Radiol 2023; 30:516-527. [PMID: 36050265 DOI: 10.1016/j.acra.2022.07.021] [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: 06/14/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES In this study, we aimed to describe a more accessible and safe diagnostic tool for osteoporosis or osteopenia diagnosis. We utilized cortical thickness (CoT) measurement of various bones via ultrasonography and evaluated the method's accuracy relative to bone mineral density (BMD) results determined by dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS A total of 200 volunteers (all female) who agreed to participate in the study and had undergone BMD measurement (femoral or vertebral) were included in the study. Patients with normal BMD result (≥-1.0 T-score) were defined as controls. CoT measurements were made from three bones (radius, tibia, and second metatarsal) for each patient via ultrasonography. RESULTS Radius CoT and tibial CoT measurements of both femoral and vertebral osteoporotic or osteopenic patients were significantly higher compared to controls. Second metatarsal CoT of femoral osteoporotic and osteopenic patients was also found to be significantly higher than the control group. We found tibia CoT and radius CoT to have high sensitivity and positive predictive value in identifying patients with abnormal femoral T-scores (<-1). In multivariable analyzes, radius CoT was found to be independently predictive in distinguishing patients with abnormal T-score (<-1) from controls in both the femur and vertebral BMD groups. CONCLUSION Radius CoT and tibia CoT values appear to have value in predicting patients with abnormal T-scores measured via DXA. This method may be a very simple technique that can be used for early detection of osteoporosis and osteopenia, but its results need to be supported by more comprehensive studies.
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Affiliation(s)
- Atila Gokcek
- Department of Radiology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | | | - Merve Aktimur Yegin
- Department of Physical Therapy and Rehabilitation, Iskenderun State Hospital, Hatay, Turkey
| | - Emin Cakmakci
- Department of Radiology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey.
| | - Serap Gencer
- Department of Radiology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
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2
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Kim Y, Kim GT. Positive Effects of Biologics on Osteoporosis in Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2023; 30:3-17. [PMID: 37476528 PMCID: PMC10351356 DOI: 10.4078/jrd.22.0046] [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: 10/11/2022] [Revised: 12/10/2022] [Accepted: 12/10/2022] [Indexed: 07/22/2023]
Abstract
Osteoporosis is a systemic skeletal disorder that causes vulnerability of bones to fracture owing to reduction in bone density and deterioration of the bone tissue microstructure. The prevalence of osteoporosis is higher in patients with autoimmune inflammatory rheumatic diseases, including rheumatoid arthritis (RA), than in those of the general population. In this autoimmune inflammatory rheumatic disease, in addition to known risk factors for osteoporosis, various factors such as chronic inflammation, autoantibodies, metabolic disorders, drugs, and decreased physical activity contribute to additional risk. In RA, disease-related inflammation plays an important role in local or systemic bone loss, and active treatment for inflammation can help prevent osteoporosis. In addition to conventional synthetic disease-modifying anti-rheumatic drugs that have been traditionally used for treatment of RA, biologic DMARDs and targeted synthetic DMARDs have been widely used. These agents can be employed more selectively and precisely based on disease pathogenesis. It has been reported that these drugs can inhibit bone loss by not only reducing inflammation in RA, but also by inhibiting bone resorption and promoting bone formation. In this review, the pathogenesis and research results of the increase in osteoporosis in RA are reviewed, and the effects of biological agents on osteoporosis are discussed.
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Affiliation(s)
- Yunkyung Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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3
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Yu JS, Krishna NG, Fox MG, Blankenbaker DG, Frick MA, Jawetz ST, Li G, Reitman C, Said N, Stensby JD, Subhas N, Tulchinsky M, Walker EA, Beaman FD. ACR Appropriateness Criteria® Osteoporosis and Bone Mineral Density: 2022 Update. J Am Coll Radiol 2022; 19:S417-S432. [PMID: 36436967 DOI: 10.1016/j.jacr.2022.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Osteoporosis constitutes a significant public health risk. An estimated 10.2 million adults in the United States >50 years of age have osteoporosis, a systemic condition that weakens the bones increasing the susceptibility for fractures. Approximately one-half of women and nearly one-third of men >50 years of age will sustain an osteoporotic fracture. These fractures are associated with a decrease in quality of life, diminished physical function, and reduced independence. Dual-energy X-ray absorptiometry (DXA) is the primary imaging modality used to screen for osteoporosis in women >65 years of age and men >70 years of age. DXA may be used in patients <65 years of age to evaluate bone mass density if there are additional risk factors. In certain situations, vertebral fracture assessment and trabecular bone score may further predict fracture risk, particularly in patients who are not yet osteoporotic but are in the range of osteopenia. Quantitative CT is useful in patients with advanced degenerative changes in the spine. Given the proven efficacy of pharmacologic therapy, the role of imaging to appropriately identify and monitor high-risk individuals is critical in substantially reducing osteoporosis-associated morbidity and mortality, and reducing the considerable cost to the health care system. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Joseph S Yu
- The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Nidhi G Krishna
- Research Author, Service Leader, Bone Densitometry, Ohio State University, Columbus, Ohio
| | - Michael G Fox
- Panel Chair, Diagnostic Radiology Program Director, Mayo Clinic Arizona, Phoenix, Arizona
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Matthew A Frick
- Chair of MSK Division, Chair of Education, Mayo Clinic, Rochester, Minnesota
| | - Shari T Jawetz
- Director, Radiology Quality Assurance, Director, Radiology Resident and Medical Student Education, Chief, Division of Body CT, Hospital for Special Surgery, New York, New York
| | - Guibin Li
- Geriatric Fellowship Program Director, The Ohio State University Wexner Medical Center, Columbus, Ohio, Primary care physician
| | - Charles Reitman
- Vice Chairman, MUSC Orthopaedics and Physical Medicine, Co-Director, MUSC Spine Center, Medical University of South Carolina, Charleston, South Carolina; North American Spine Society
| | - Nicholas Said
- Medical Director of MRI, Access Champion, Director of MSK Intervention, Duke University Medical Center, Durham, North Carolina
| | | | - Naveen Subhas
- Institute Vice-Chair, Cleveland Clinic, Cleveland, Ohio
| | - Mark Tulchinsky
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Commission on Nuclear Medicine and Molecular Imaging; Member of the Board of Directors for the ACNM
| | - Eric A Walker
- PRS President, MSK Section Chief, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland
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4
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Najafi M, Najafi M, Mahdavi-Mazdeh M, Maziar S, Keshtkar AA, Sedaghat M, Zare-Bidaki F, Larijani B, Hamidi Z. Quantitative Ultrasound of Phalanx in Primary and Secondary Osteoporosis: Mini-review and Practical Experience. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211070247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Dual x-ray absorptiometry (DXA) is gold standard of bone densitometry, but quantitative ultrasound (QUS) of bone is less expensive and portable. This study was designed to assess its usefulness in secondary osteoporosis diagnosis. Materials and Methods: There were 200 secondary osteoporosis cases (rheumatoid arthritis, hemodialysis, kidney transplant patients, and levothyroxine users) and of those, their phalanx QUS results were compared with normal controls. Also, the QUS and DXA results were compared to find any correlation of these methods for diagnosing osteoporosis. Results: There was not significantly different results compared with normal controls, except for those of hemodialysis patients ( P = .00). Also, the comparison of QUS with DXA results showed no significant correlation except in hemodialysis patients, in both spinal and femoral regions ( P = .023 and .21, respectively), as well as the levothyroxine group’s spinal region ( P = .005). Conclusion: These results suggest that QUS of phalanx may be useful in screening secondary osteoporosis but for establishment of diagnosis, DXA measurements are still needed.
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Affiliation(s)
- Minoo Najafi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Najafi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Mahdavi-Mazdeh
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Maziar
- Department of Nephrology, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zare-Bidaki
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Hamidi
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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5
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Anna UM, Maria S, Kerstin B. Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study. Diabetes Res Clin Pract 2021; 180:109064. [PMID: 34562510 DOI: 10.1016/j.diabres.2021.109064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022]
Abstract
AIMS Compare quantitative ultrasound (QUS) of calcaneus and dual energy X-ray absorptiometry (DXA) as measurements of bone density, calculate 20-year fracture incidence in patients with T1DM and T2DM and multiple complications, and compare the methods' predictive ability. METHODS Sixty-two hospital foot clinic patients with T1DM or T2DM and complications were followed (1995-2015; 610 person-years). Clinical assessments and QUS of calcaneus were performed on all at inclusion and DXA of the spine and femoral neck on a subgroup (n = 34). Fracture incidence was assessed at follow-up and compared to incidence in the general population. We evaluated the correlation between QUS of calcaneus and DXA (Pearson's correlation test) and the association between bone density and fracture incidence at follow-up (logistic regression). RESULTS Bone density (QUS of calcaneus) correlated with hip bone density (DXA). Incidence of all fractures (30/62 patients; 48%) and hip fractures (6/62 patients; 10%) was higher in patients than the general population. Twelve (19%) experienced foot fracture. QUS of calcaneus predicted hip, lower leg, and foot fractures; DXA did not. CONCLUSIONS Because QUS of calcaneus predicted fractures in patients with diabetes and multiple complications, it seems appropriate to test QUS of calcaneus as a fracture risk predictor in primary care.
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Affiliation(s)
- Ugarph-Morawski Anna
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), SE-171 76 Stockholm, Sweden.
| | - Sääf Maria
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), SE-171 76 Stockholm, Sweden
| | - Brismar Kerstin
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), SE-171 76 Stockholm, Sweden; The Rolf Luft Research Center for Diabetes and Endocrinology, Box 1421, 111 84 Stockholm, Sweden
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6
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Sudoł-Szopińska I, Giraudo C, Oei EH, Jans L. Imaging update in inflammatory arthritis. J Clin Orthop Trauma 2021; 20:101491. [PMID: 34290958 PMCID: PMC8274298 DOI: 10.1016/j.jcot.2021.101491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022] Open
Abstract
Ultrasonography and magnetic resonance imaging have become important imaging modalities in rheumatological disorders next to standard radiography. Due to their ability to assess both morphological and functional changes they play a significant role in early diagnosis and treatment monitoring. This review presents the latest advancements in imaging of inflammatory arthritis with a focus on two main groups of rheumatic diseases: connective tissue diseases and spondyloarthritis. New developments related to peripheral and sacroiliac joints imaging are discussed, including Superb Micro Flow Imaging and Shear Wave Elastography in ultrasonography, as well as Whole Body MRI, quantitative MRI, and the recent advances in cartilage imaging in MRI, including T2-and T1p-mapping, and dGEMRIC. The role of emerging imaging techniques in the early diagnosis of inflammatory arthritis is discussed, including DECT, VIBE, BoneMRI, and pQCT.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Chiara Giraudo
- Chiara Giraudo, Department of Medicine – DIMED, University of Padova, Padova, Italy
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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7
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Chandrasekaran V, Pasco JA, Stuart AL, Brennan-Olsen SL, Berk M, Hodge JM, Samarasinghe RM, Williams LJ. Anticonvulsant use and bone health in a population-based study of men and women: cross-sectional data from the Geelong Osteoporosis Study. BMC Musculoskelet Disord 2021; 22:172. [PMID: 33573610 PMCID: PMC7879513 DOI: 10.1186/s12891-021-04042-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background Anticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women. Methods Data from 926 men (24-73 yr) and 1070 women (21-94 yr) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders. Results Seventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. In women, BMD tended to be lower at the hip compared to non-users as with the bone quality measure, BUA. No significant associations were observed at the spine or the other bone quality measures, SOS and SI. Conclusion Our data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.
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Affiliation(s)
- Vinoomika Chandrasekaran
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.
| | - Julie A Pasco
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
| | - Amanda L Stuart
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia.,Deakin University, School of Health and Social Development, Geelong, Waterfront, Australia.,Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jason M Hodge
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Geelong Centre for Emerging Infectious Diseases, Geelong, Australia
| | - Rasika M Samarasinghe
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
| | - Lana J Williams
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
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8
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Liu Y, Bi Y, Chai L, Song L, Huang J, Wang Q, Li Y, Zhou K. Development of epimedin A complex drugs for treating the osteoporosis. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:17. [PMID: 33506368 PMCID: PMC7840628 DOI: 10.1007/s10856-020-06472-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Osteoporosis is the most common disease involving bone degeneration. As the age of the population increases, the prevalence of the disease is expected to rise. However, current treatment methods do not provide a desirable solution for the restoration of the function of degenerated bones in patients with osteoporosis. This led to emergence of controlled delivery systems to increase drug bioavailability and efficacy specifically at the bone regeneration. In this study, an epimedin A (EA) complex drug system was prepared by solution blending method. In vitro cell-based experiments showed that the EA complex drug could significantly promote the differentiation and proliferation of osteoblasts and increase the alkaline phosphatase activity, calcium nodule formation, and the expression of osteogenesis-related genes and proteins. In vivo experiments further demonstrated that this novel drugs remarkably enhanced bone regeneration. These results suggest that EA may be used for the treatment of osteoporosis.
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Affiliation(s)
- Ying Liu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, 010018, China
| | - Yanan Bi
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
| | - Lijuan Chai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin, 301617, China
| | - Lei Song
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Tianjin Key Laboratory of Chinese Medicine Pharmacology, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Juyang Huang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
| | - Qin Wang
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin, 301617, China
| | - Yunzhang Li
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot, 010018, China.
| | - Kun Zhou
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin, 301617, China.
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9
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Ross RD, Shah RC, Leurgans SE, Buchman AS, Bennett DA. Association of Heel Bone Mineral Density With Incident Disability and Mortality in Community-Dwelling Older Adults. JBMR Plus 2020; 4:e10390. [PMID: 32995693 PMCID: PMC7507511 DOI: 10.1002/jbm4.10390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022] Open
Abstract
Age‐related bone loss is common in older adults. However, the association of low bone mass with incident disability and mortality is not well established. A sample of 738 participants in the Rush Memory and Aging Project (MAP) was evaluated at baseline for bone mineral density (BMD) using quantitative ultrasound at the calcaneus. An annual interview assessed basic activities of daily living (BADL), instrumental activities of daily living (IADL), mobility disability, and history of hip fracture. The associations between baseline BMD and risk of death; incident BADL, IADL, and mobility disability; and hip fracture were investigated using Cox hazard models, adjusting for age, sex, education, race, and body mass index (BMI). The robustness of our findings was evaluated by adjusting for confounding factors and health conditions including joint pain, musculoskeletal medications, smoking status, motor function, global cognition, falls, cardiovascular events, and diabetes. Participants were on average (mean ± SD) 80.9 ± 7.0 years old, 72% female, and 3.8% black, with a baseline BMI of 27.3 ± 5.4 kg/m2, and a baseline of BMD of 0.44 ± 0.14 g/cm2. In models adjusted for age, sex, education, race, and BMI, lower BMD was associated with a higher rate of death (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.08–1.33), incident BADL disability (HR 1.20; 95% CI, 1.05–1.37), and hip fracture (HR 2.57; 95% CI, 1.72–3.82), but not of IADL disability (HR 1.00; 95% CI, 0.85–1.17) or mobility disability (HR 1.13; 95% CI, 0.97–1.32). The association between BMD and mortality was not significant in fully adjusted models, but the BMD and BADL associations remained significant in models adjusting for both demographic variables and BMD‐modifying health conditions. BMD is associated with incident disability in older adults. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ryan D Ross
- Department of Cell & Molecular Medicine Rush University Medical Center Chicago IL USA.,Department of Orthopedic Surgery Rush University Medical Center Chicago IL USA
| | - Raj C Shah
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Family Medicine Rush University Medical Center Chicago IL USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
| | - David A Bennett
- Rush Alzheimer's Disease Center Rush University Medical Center Chicago IL USA.,Department of Neurological Sciences Rush University Medical Center Chicago IL USA
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10
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Jafarpisheh N, Rosado-Mendez IM, Hall TJ, Rivaz H. Regularized Estimation of Effective Scatterer Size and Acoustic Concentration Quantitative Ultrasound Parameters Using Dynamic Programming .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:13-16. [PMID: 33017919 PMCID: PMC7545313 DOI: 10.1109/embc44109.2020.9176714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The objective of quantitative ultrasound (QUS) is to characterize tissue microstructure by parametrizing backscattered radiofrequency (RF) signals from clinical ultrasound scanners. Herein, we develop a novel technique based on dynamic programming (DP) to simultaneously estimate the acoustic attenuation, the effective scatterer size (ESS), and the acoustic concentration (AC) from ultrasound backscattered power spectra. This is achieved through two different approaches: (1) using a Gaussian form factor (GFF) and (2) using a general form factor (gFF) that is more flexible than the Gaussian form factor but involves estimating more parameters. Both DP methods are compared to an adaptation of a previously proposed least-squares (LSQ) method. Simulation results show that in the GFF approach, the variance of DP is on average 88%, 75% and 32% lower than that of LSQ for the three estimated QUS parameters. The gFF approach also yields similar improvements.
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11
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Abstract
PURPOSE OF REVIEW Patients with inflammatory arthropathies have a high rate of fragility fractures. Diagnostic assessment and monitoring of bone density and quality are therefore critically important. Here, we review standard and advanced techniques to measure bone density and quality, specifically focusing on patients with inflammatory arthropathies. RECENT FINDINGS Current standard procedures are dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). DXA-based newer methods include trabecular bone score (TBS) and vertebral fracture assessment (VFA). More advanced imaging methods to measure bone quality include high-resolution peripheral quantitative computed tomography (HR-pQCT) as well as multi-detector CT (MD-CT) and magnetic resonance imaging (MRI). Quantitative ultrasound has shown promise but is not standard to assess bone fragility. While there are limitations, DXA remains the standard technique to measure density in patients with rheumatological disorders. Newer modalities to measure bone quality may allow better characterization of bone fragility but currently are not standard of care procedures.
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12
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Chin KY, Wong SK, Ekeuku SO, Pang KL. Relationship Between Metabolic Syndrome and Bone Health - An Evaluation of Epidemiological Studies and Mechanisms Involved. Diabetes Metab Syndr Obes 2020; 13:3667-3690. [PMID: 33116718 PMCID: PMC7569044 DOI: 10.2147/dmso.s275560] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MetS) and osteoporosis are two medical problems plaguing the ageing populations worldwide. Though seemingly distinctive to each other, metabolic derangements are shown to influence bone health. This review summarises the relationship between MetS and bone health derived from epidemiological studies and explains the mechanistic basis of this relationship. The discourse focuses on the link between MetS and bone mineral density, quantitative sonometric indices, geometry and fracture risk in humans. The interesting sex-specific trend in the relationship, probably due to factors related to body composition and hormonal status, is discussed. Mechanistically, each component of MetS affects the bone distinctly, forming a complex interacting network influencing the skeleton. Lastly, the effects of MetS management, such as pharmacotherapies, exercise and bariatric surgery, on bone, are presented. This review aims to highlight the significant relationship between MetS and bone, and proper management of MetS with the skeletal system in mind could prevent cardiovascular and bone complications.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Kok-Yong Chin Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, MalaysiaTel +60 3-9145 9573 Email
| | - Sok Kuan Wong
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sophia Ogechi Ekeuku
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok-Lun Pang
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Jones CW, Choi DS, Sun P, Chiu YF, Lipman JD, Lyman S, Bostrom MPG, Sculco PK. Clinical and design factors influence the survivorship of custom flange acetabular components. Bone Joint J 2019; 101-B:68-76. [PMID: 31146558 DOI: 10.1302/0301-620x.101b6.bjj-2018-1455.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Custom flange acetabular components (CFACs) are a patient-specific option for addressing large acetabular defects at revision total hip arthroplasty (THA), but patient and implant characteristics that affect survivorship remain unknown. This study aimed to identify patient and design factors related to survivorship. PATIENTS AND METHODS A retrospective review of 91 patients who underwent revision THA using 96 CFACs was undertaken, comparing features between radiologically failed and successful cases. Patient characteristics (demographic, clinical, and radiological) and implant features (design characteristics and intraoperative features) were collected. There were 74 women and 22 men; their mean age was 62 years (31 to 85). The mean follow-up was 24.9 months (sd 27.6; 0 to 116). Two sets of statistical analyses were performed: 1) univariate analyses (Pearson's chi-squared and independent-samples Student's t-tests) for each feature; and 2) bivariable logistic regressions using features identified from a random forest analysis. RESULTS Radiological failure and revision rates were 23% and 12.5%, respectively. Revisions were undertaken at a mean of 25.1 months (sd 26.4) postoperatively. Patients with radiological failure were younger at the time of the initial procedure, were less likely to have a diagnosis of primary osteoarthritis (OA), were more likely to have had ischial screws in previous surgery, had fewer ischial screw holes in their CFAC design, and had more proximal ischial fixation. Random forest analysis identified the age of the patient and the number of locking and non-locking screws used for inclusion in subsequent bivariable logistic regression, but only age (odds ratio 0.93 per year) was found to be significant. CONCLUSION We identified both patient and design features predictive of CFAC survivorship. We found a higher rate of failure in younger patients, those whose primary diagnosis was not OA, and those with more proximal ischial fixation or fewer ischial fixation options. Cite this article: Bone Joint J 2019;101-B(6 Supple B):68-76.
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Affiliation(s)
- C W Jones
- Hospital for Special Surgery, New York City, New York, USA
| | - D S Choi
- Hospital for Special Surgery, New York City, New York, USA
| | - P Sun
- Hospital for Special Surgery, New York City, New York, USA
| | - Y-F Chiu
- Hospital for Special Surgery, New York City, New York, USA
| | - J D Lipman
- Hospital for Special Surgery, New York City, New York, USA
| | - S Lyman
- Hospital for Special Surgery, New York City, New York, USA
| | - M P G Bostrom
- Hospital for Special Surgery, New York City, New York, USA
| | - P K Sculco
- Hospital for Special Surgery, New York City, New York, USA
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Yang KC, Wang ST, Lee JJ, Fann JCY, Chiu SYH, Chen SLS, Yen AMF, Chen HH, Chen MK, Hung HF. Bone mineral density as a dose-response predictor for osteoporosis: a propensity score analysis of longitudinal incident study (KCIS no. 39). QJM 2019; 112:327-333. [PMID: 30629251 DOI: 10.1093/qjmed/hcz009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Osteoporosis is a global disease burden for aging society. The role of quantitative ultrasound (QUS) in the prediction for osteoporosis in a dose-response manner is hardly addressed. AIM We aimed to show the dose-response of QUS measurement in the prediction for osteoporosis by a community-based study. DESIGN A prospective cohort study. METHODS Participants were recruited between 2000 and 2004. Demographic data and heel QUS measurement were collected at baseline. Diagnosis of osteoporosis was ascertained by the follow-up of this cohort over time. In order to reduce the imbalance of baseline characteristics in the observational study, we applied propensity score by using proportional odds regression analysis to match the quintiles of QUS T-score. RESULTS A total of 44 957 subjects composed of 17 678 men (39.3%) and 27 279 women (69.7%) were recruited. After adjustments for propensity score, an increase in one unit of QUB T-score led to 7% reduction in the risk for osteoporosis [adjusted odds ratio (OR) = 0.93, 95% confidence interval (CI): 0.89-0.96, P < 0.0001]. Higher quintile of QUS T-score yielded a lower risk of osteoporosis with a gradient relationship [OR: 0.82 (95%CI: 0.72-0.92); OR: 0.81 (95%CI: 0.71-0.91); OR: 0.77 (95%CI: 0.68-0.87) and OR: 0.76 (95%CI: 0.67-0.86)] from the second to highest quintile opposed to first quintile (P < 0.0001). The cumulative incidence of osteoporosis was higher in the lower quintile during follow-up (log-rank test, P < 0.001). CONCLUSION QUS is an independent predictor for osteoporosis in a dose-response manner using a large population-based cohort. Due to the lower cost and portability of QUS measurement, the pre-screening for osteoporosis by QUS can be considered in the area with limited resources can be a feasible and alternative method.
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Affiliation(s)
- K-C Yang
- Department of Family Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Health Science and Wellness Center, National Taiwan University, Taipei, Taiwan
| | - S-T Wang
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Health Management Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - J J Lee
- Department of Family Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - J C-Y Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Tao-Yuan, Taiwan
| | - S Y-H Chiu
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - S L-S Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - A M-F Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - H-H Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - M-K Chen
- Department of Community and Family Medicine, National Taiwan University Hospital Hsinchu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, Taiwan
| | - H-F Hung
- Department of Community and Family Medicine, National Taiwan University Hospital Hsinchu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, Taiwan
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