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Bonaccorsi G, Sciavicco G, Rinaudo L, Brigato A, Fiorella G, Carnevale A, Ulivieri FM, Messina C. Usefulness of DXA-based bone strain index in postmenopausal women with type 2 diabetes mellitus. Arch Osteoporos 2024; 19:54. [PMID: 38926167 PMCID: PMC11208269 DOI: 10.1007/s11657-024-01411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Bone Strain Index (BSI) is a new dual-energy x-ray absorptiometry (DXA)-based index. We retrospectively evaluated data from 153 postmenopausal women with a history of type 2 diabetes mellitus (T2DM). Lumbar spine and femoral Bone Strain Index (BSI) were sensitive to skeletal impairment in postmenopausal women suffering from T2DM. PURPOSE Bone Strain Index (BSI) is a new dual-energy X-ray absorptiometry (DXA)-based measurement. We evaluated the performance of BSI in predicting the presence of fragility fractures in type 2 diabetes mellitus (T2DM) postmenopausal women. METHODS We retrospectively evaluated data from a case-control study of 153 postmenopausal women with a history of at least 5 years of T2DM (age from 40 to 90 years). For each subject, we assessed the personal or familiar history of previous fragility fractures and menopause age, and we collected data about bone mineral density (BMD), BSI, and Trabecular Bone Score (TBS) measurements. Statistical analysis was performed having as outcome the history of fragility fractures. RESULTS Out of a total of 153 subjects, n = 22 (14.4%) presented at least one major fragility fracture. A negative correlation was found between lumbar BSI and lumbar BMD (r = - 0.49, p < 0.001) and between total femur BSI and total femur BMD (r = - 0.49, p < 0.001). A negative correlation was found between femoral neck BSI and femoral neck BMD (r = - 0.22, p < 0.001). Most DXA-based variables were individually able to discriminate between fractured and non-fractured subjects (p < 0.05), and lumbar BSI was the index with the most relative difference between the two populations, followed by femoral BSI. CONCLUSION Lumbar spine and femoral BSI are sensitive to skeletal impairment in postmenopausal women suffering from T2DM. The use of BSI in conjunction with BMD and TBS can improve fracture risk assessment.
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Affiliation(s)
- Gloria Bonaccorsi
- Department of Translational Medicine, Menopause and Osteoporosis Center, University of Ferrara, Ferrara, Italy
| | - Guido Sciavicco
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Luca Rinaudo
- Tecnologie Avanzate T.A. S.R.L, Lungo Dora Voghera 36/A, Turin, Italy
| | - Andrea Brigato
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Giuliana Fiorella
- Tecnologie Avanzate T.A. S.R.L, Lungo Dora Voghera 36/A, Turin, Italy
| | - Aldo Carnevale
- Department of Translational Medicine - Section of Radiology, University of Ferrara, Ferrara, Italy
| | | | - Carmelo Messina
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 20122, Milan, Italy.
- Dipartimento Di Scienze Biomediche Per La Salute, Università Degli Studi Di Milano, Via Pascal, 36, Milan, Italy.
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Roux JP, Duboeuf F, Sornay-Rendu E, Rinaudo L, Ulivieri FM, Wegrzyn J, Chapurlat R. The relationship between bone strain index, bone mass, microarchitecture and mechanical behavior in human vertebrae: an ex vivo study. Osteoporos Int 2024; 35:1069-1075. [PMID: 38520505 DOI: 10.1007/s00198-024-07066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
The aim of this study was to determine whether the Bone Strain Index (BSI), a recent DXA-based bone index, is related to bone mechanical behavior, microarchitecture and finally, to determine whether BSI improves the prediction of bone strength and the predictive role of BMD in clinical practice. PURPOSE Bone Strain Index (BSI) is a new DXA-based bone index that represents the finite element analysis of the bone deformation under load. The current study aimed to assess whether the BSI is associated with 3D microarchitecture and the mechanical behavior of human lumbar vertebrae. METHODS Lumbar vertebrae (L3) were harvested fresh from 31 human donors. The anteroposterior BMC (g) and aBMD (g/cm2) of the vertebral body were measured using DXA, and then the BSI was automatically derived. The trabecular bone volume (Tb.BV/TV), trabecular thickness (Tb.Th), degree of anisotropy (DA), and structure model index (SMI) were measured using µCT with a 35-µm isotropic voxel size. Quasi-static uniaxial compressive testing was performed on L3 vertebral bodies under displacement control to assess failure load and stiffness. RESULTS The BSI was significantly correlated with failure load and stiffness (r = -0.60 and -0.59; p < 0.0001), aBMD and BMC (r = -0.93 and -0.86; p < 0.0001); Tb.BV/TV and SMI (r = -0.58 and 0.51; p = 0.001 and 0.004 respectively). After adjustment for aBMD, the association between BSI and stiffness, BSI and SMI remained significant (r = -0.51; p = 0.004 and r = -0.39; p = 0.03 respectively, partial correlations) and the relation between BSI and failure load was close to significance (r = -0.35; p = 0.06). CONCLUSION The BSI was significantly correlated with the microarchitecture and mechanical behavior of L3 vertebrae, and these associations remained statistically significant regardless of aBMD.
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Affiliation(s)
| | | | | | | | | | - Julien Wegrzyn
- Univ Lyon, INSERM, UMR 1033, 69008, Lyon, France
- Department of Orthopedic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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3
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Jaafar S, Cristofolini G, Morenghi E, Rinaudo L, Birtolo MF, Sala E, Ferrante E, Mungari R, Lavezzi E, Leonardi L, Ragucci P, Ulivieri FM, Balzarini L, Mantovani G, Lania AG, Mazziotti G. DXA-derived lumbar bone strain index corrected for kyphosis is associated with vertebral fractures and trabecular bone score in acromegaly. Endocrine 2024:10.1007/s12020-024-03863-8. [PMID: 38809345 DOI: 10.1007/s12020-024-03863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE The bone strain index (BSI) is a marker of bone deformation based on a finite element analysis inferred from dual X-ray absorptiometry (DXA) scans, that has been proposed as a predictor of fractures in osteoporosis (i.e., higher BSI indicates a lower bone's resistance to loads with consequent higher risk of fractures). We aimed to investigate the association between lumbar BSI and vertebral fractures (VFs) in acromegaly. METHODS Twenty-three patients with acromegaly (13 males, mean age 58 years; three with active disease) were evaluated for morphometric VFs, trabecular bone score (TBS), bone mineral density (BMD) and BSI at lumbar spine, the latter being corrected for the kyphosis as measured by low-dose X-ray imaging system (EOS®-2D/3D). RESULTS Lumbar BSI was significantly higher in patients with VFs as compared to those without fractures (2.90 ± 1.46 vs. 1.78 ± 0.33, p = 0.041). BSI was inversely associated with TBS (rho -0.44; p = 0.034), without significant associations with BMD (p = 0.151), age (p = 0.500), BMI (p = 0.957), serum IGF-I (p = 0.889), duration of active disease (p = 0.434) and sex (p = 0.563). CONCLUSIONS Lumbar BSI corrected for kyphosis could be proposed as integrated parameter of spine arthropathy and osteopathy in acromegaly helping the clinicians in identifying patients with skeletal fragility possibly predisposed to VFs.
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Affiliation(s)
- Simona Jaafar
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giacomo Cristofolini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Emanuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Biostatistics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Maria Francesca Birtolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elisa Sala
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Emanuele Ferrante
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Roberta Mungari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
| | - Elisabetta Lavezzi
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lorenzo Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pasquala Ragucci
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fabio M Ulivieri
- Bone Metabolic Unit, Casa di Cura la Madonnina Milan, Milan, Italy
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanna Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Rinaudo L, Cuttone S, Messina C, Magni V, Capra D, Sconfienza LM, Sardanelli F, Ulivieri FM. Generation and Validation of Normative, Age-Specific Reference Curves for Bone Strain Index in Women. Diagnostics (Basel) 2024; 14:1046. [PMID: 38786344 PMCID: PMC11120451 DOI: 10.3390/diagnostics14101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Bone Strain Index (BSI), based on dual-energy X-ray absorptiometry (DXA), is a densitometric index of bone strength of the femur and lumbar spine. Higher BSI values indicate a higher strain applied to bone, predisposing to higher fracture risk. This retrospective, multicentric study on Italian women reports the BSI normative age-specific reference curves. A cohort of Caucasian Italian women aged 20 to 90 years was selected from three different clinical centres. Bone mineral density (BMD) and BSI measurements were obtained for the lumbar spine vertebrae (L1-L4) and for the femur (neck, trochanter and intertrochanter) using Hologic densitometers scans. The data were compared with BMD normative values provided by the densitometer manufacturer. Then, the age-specific BSI curve for the femur and lumbar spine was generated. No significant difference was found between the BMD of the subjects in this study and BMD reference data provided by Hologic (p = 0.68 for femur and p = 0.90 for lumbar spine). Spine BSI values (L1-L4) increase by 84% between 20 and 90 years of age. The mean BSI of the total femur increases about 38% in the same age range. The BSI age-specific reference curve could help clinicians improve osteoporosis patient management, allowing an appropriate patient classification according to the bone resistance to the applied loads and fragility fracture risk assessment.
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Affiliation(s)
- Luca Rinaudo
- Tecnologie Avanzate T.A. srl, Lungo Dora Voghera 36/A, 10153 Torino, Italy
| | - Sofia Cuttone
- Tecnologie Avanzate T.A. srl, Lungo Dora Voghera 36/A, 10153 Torino, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milano, Italy
| | - Veronica Magni
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milano, Italy
| | - Davide Capra
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milano, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milano, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20122 Milano, Italy
- IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Fabio Massimo Ulivieri
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy
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Jerban S, Barrere V, Namiranian B, Wu Y, Alenezi S, Dorthe E, Dlima D, Shah SB, Chung CB, Du J, Andre MP, Chang EY. Ultrasound attenuation of cortical bone correlates with biomechanical, microstructural, and compositional properties. Eur Radiol Exp 2024; 8:21. [PMID: 38316687 PMCID: PMC10844174 DOI: 10.1186/s41747-023-00418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/09/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND We investigated the relationship of two commonly used quantitative ultrasound (QUS) parameters, speed of sound (SoS) and attenuation coefficient (α), with water and macromolecular contents of bovine cortical bone strips as measured with ultrashort echo time (UTE) magnetic resonance imaging (MRI). METHODS SoS and α were measured in 36 bovine cortical bone strips utilizing a single-element transducer with nominal 5 MHz center frequency based on the time of flight principles after accommodating for reflection losses. Specimens were then scanned using UTE MRI to measure total, bound, and pore water proton density (TWPD, BWPD, and PWPD) as well as macromolecular proton fraction and macromolecular transverse relaxation time (T2-MM). Specimens were also scanned using microcomputed tomography (μCT) at 9-μm isometric voxel size to measure bone mineral density (BMD), porosity, and pore size. The elastic modulus (E) of each specimen was measured using a 4-point bending test. RESULTS α demonstrated significant positive Spearman correlations with E (R = 0.69) and BMD (R = 0.44) while showing significant negative correlations with porosity (R = -0.41), T2-MM (R = -0.47), TWPD (R = -0.68), BWPD (R = -0.67), and PWPD (R = -0.45). CONCLUSIONS The negative correlation between α and T2-MM is likely indicating the relationship between QUS and collagen matrix organization. The higher correlations of α with BWPD than with PWPD may indicate that water organized in finer structure (bound to matrix) provides lower acoustic impedance than water in larger pores, which is yet to be investigated thoroughly. RELEVANCE STATEMENT This study highlights the importance of future investigations exploring the relationship between QUS measures and all major components of the bone, including the collagenous matrix and water. Investigating the full potential of QUS and its validation facilitates a more affordable and accessible tool for bone health monitoring in clinics. KEY POINTS • Ultrasound attenuation demonstrated significant positive correlations with bone mechanics and mineral density. • Ultrasound attenuation demonstrated significant negative correlations with porosity and bone water contents. • This study highlights the importance of future investigations exploring the relationship between QUS measures and all major components of the bone.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
| | - Victor Barrere
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Behnam Namiranian
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Yuanshan Wu
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Salem Alenezi
- Research and Laboratories Sector, Saudi Food and Drug Authority, Riyadh, Kingdom of Saudi Arabia
| | - Erik Dorthe
- Shiley Center for Orthopedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Darryl Dlima
- Shiley Center for Orthopedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Sameer B Shah
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
- Department of Orthopaedic Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Michael P Andre
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Research Service, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA.
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Allam AK, Anand A, Flores AR, Ropper AE. Computer Vision in Osteoporotic Vertebral Fracture Risk Prediction: A Systematic Review. Neurospine 2023; 20:1112-1123. [PMID: 38171281 PMCID: PMC10762393 DOI: 10.14245/ns.2347022.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Osteoporotic vertebral fractures (OVFs) are a significant health concern linked to increased morbidity, mortality, and diminished quality of life. Traditional OVF risk assessment tools like bone mineral density (BMD) only capture a fraction of the risk profile. Artificial intelligence, specifically computer vision, has revolutionized other fields of medicine through analysis of videos, histopathology slides and radiological scans. In this review, we provide an overview of computer vision algorithms and current computer vision models used in predicting OVF risk. We highlight the clinical applications, future directions and limitations of computer vision in OVF risk prediction.
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Affiliation(s)
- Anthony K. Allam
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex R. Flores
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Saisirivechakun P, Mahakkanukrauh A, Pongchaiyakul C, Boonya-Ussadorn T, Narongroeknawin P, Pakchotanon R, Assavatanabodee P, Chaiamnuay S. Prevalence of low trabecular bone score and its association with disease severity and activity in patients with axial spondyloarthritis. Sci Rep 2023; 13:16258. [PMID: 37758825 PMCID: PMC10533482 DOI: 10.1038/s41598-023-43321-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
Axial spondyloarthritis (axSpA) increases the risk of osteoporosis and vertebral fractures. Bone mineral density (BMD) measured by dual X-ray absorptiometry (DXA) has limitations in axSpA patients. Trabecular bone score (TBS) indirectly assesses bone microarchitecture and can be used to predict fracture risk. However, few studies have investigated the role of TBS in axSpA patients. The objective of this study were to compare TBS between axSpA patients and 1:1 sex- and age-matched healthy volunteers and determine factors associated with low TBS in axSpA patients. A cross-sectional study was conducted in two tertiary-care hospitals. A total of 137 axSpA patients and healthy volunteers were enrolled. Demographics, disease characteristics, and risk factors for osteoporosis were recorded. TBS, BMD at the lumbar spine, hip, and vertebral fractures were assessed by DXA. Low TBS was defined as a TBS value < 1.230. Factors associated with low TBS were examined by logistic regression. Most patients were male (75.9%) and tested positive for HLA-B27 (88.3%). The mean (SD) age was 42.8 (12.0) years. The mean (SD) of TBS in the axSpA patients was lower than those in the healthy volunteers [1.402 (0.107) vs 1.440 (0.086), respectively; p = 0.002]. The mean (SD) of lumbar BMD in the axSpA patients was higher than in healthy volunteers [1.186 (0.212) vs 1.087 (0.124), p < 0.001], whereas the mean (SD) of femoral neck BMD in the axSpA group was lower than that in the healthy volunteers [0.867 (0.136) vs 0.904 (0.155), p = 0.038]. Disease severity as indicated by sacroiliac joint fusion and a high ASDAS score were associated with low TBS with the odds ratios (95% confidence interval) of 11.8 (1.2-115.4) and 5.2 (1.6-16.9), respectively. In conclusion, axSpA patients had a higher prevalence of low TBS than healthy volunteers. Sacroiliac joint fusion and a high ASDAS score were associated with low TBS.
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Affiliation(s)
- Pannarat Saisirivechakun
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Ajanee Mahakkanukrauh
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Trirat Boonya-Ussadorn
- Division of Nuclear Medicine, Department of Radiology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Pongthorn Narongroeknawin
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Rattapol Pakchotanon
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Paijit Assavatanabodee
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand
| | - Sumapa Chaiamnuay
- Rheumatic Diseases Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Ratchathewi District, Bangkok, 10400, Thailand.
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8
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Franco AS, Murai IH, Takayama L, Caparbo VF, Marchi LL, Velloso EDRP, Pereira RMR. Assessment of Bone Microarchitecture in Patients with Systemic Mastocytosis and its Association with Clinical and Biochemical Parameters of the Disease. Calcif Tissue Int 2023; 113:276-285. [PMID: 37294314 DOI: 10.1007/s00223-023-01107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Patients with systemic mastocytosis (SM) are at high risk of bone deterioration. However, the evaluation of bone microarchitecture in this disease remains unclear. We aimed to assess bone microarchitecture in patients with SM. This was a cross-sectional study of 21 adult patients with SM conducted in a quaternary referral hospital in Sao Paulo, Brazil. A healthy, age-, weight-, and sex-matched cohort of 63 participants was used to provide reference values for bone microarchitecture, assessed by high resolution peripheral quantitative computed tomography (HR-pQCT). Total volumetric bone mineral density (vBMD), cortical vBMD, and cortical thickness at the radius were significantly lower in the control group compared with the SM group (all P < 0.001). Patients with aggressive SM had significantly lower trabecular number (Tb.N) (P = 0.035) and estimated failure load (F.load) (P = 0.032) at the tibia compared with those with indolent SM. Handgrip strength was significantly higher in patients who had more Tb.N at the radius (ρ, 0.46; P = 0.036) and tibia (ρ, 0.49; P = 0.002), and lower who had more trabecular separation at the radius (ρ, -0.46; P = 0.035) and tibia (ρ, -0.52; P = 0.016). Strong and positive associations between F.load (ρ, 0.75; P < 0.001) and stiffness (ρ, 0.70; P < 0.001) at the radius, and between F.load at the tibia (ρ, 0.45; P = 0.038) were observed with handgrip strength. In this cross-sectional study, aggressive SM was more susceptible to bone deterioration compared with indolent SM. In addition, the findings demonstrated that handgrip strength was associated with bone microarchitecture and bone strength.
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Affiliation(s)
- Andre S Franco
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
- Faculdade de Medicina, FMUSP da Universidade de São Paulo, Av Dr Arnaldo, 455 - Reumatologia, 3º Andar, Sala 3193, Cerqueira César, Sao Paulo, 01246-903, Brazil.
| | - Igor H Murai
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Liliam Takayama
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria F Caparbo
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luan L Marchi
- Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31) HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Elvira D R P Velloso
- Service of Hematology, Transfusion and Cell Therapy and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31) HCFMUSP, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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Dimai HP. New Horizons: Artificial Intelligence Tools for Managing Osteoporosis. J Clin Endocrinol Metab 2023; 108:775-783. [PMID: 36477337 PMCID: PMC9999362 DOI: 10.1210/clinem/dgac702] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration leading to increased bone fragility and fracture risk. Typically, osteoporotic fractures occur at the spine, hip, distal forearm, and proximal humerus, but other skeletal sites may be affected as well. One of the major challenges in the management of osteoporosis lies in the fact that although the operational diagnosis is based on bone mineral density (BMD) as measured by dual x-ray absorptiometry, the majority of fractures occur at nonosteoporotic BMD values. Furthermore, osteoporosis often remains undiagnosed regardless of the low severity of the underlying trauma. Also, there is only weak consensus among the major guidelines worldwide, when to treat, whom to treat, and which drug to use. Against this background, increasing efforts have been undertaken in the past few years by artificial intelligence (AI) developers to support and improve the management of this disease. The performance of many of these newly developed AI algorithms have been shown to be at least comparable to that of physician experts, or even superior. However, even if study results appear promising at a first glance, they should always be interpreted with caution. Use of inadequate reference standards or selection of variables that are of little or no value in clinical practice are limitations not infrequently found. Consequently, there is a clear need for high-quality clinical research in this field of AI. This could, eg, be achieved by establishing an internationally consented "best practice framework" that considers all relevant stakeholders.
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Affiliation(s)
- Hans Peter Dimai
- Correspondence: Hans Peter Dimai, MD, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria.
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Novel Polyethylene Terephthalate Screw Sleeve Implant: Salvage Treatment in a Case of Spine Instability after Vertebroplasty Failure. MEDICINES (BASEL, SWITZERLAND) 2022; 10:medicines10010006. [PMID: 36662490 PMCID: PMC9861514 DOI: 10.3390/medicines10010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The management of osteoporotic fractures is sometimes rather challenging for spinal surgeons, and considering the longer life expectancy induced by improved living conditions, their prevalence is expected to increase. At present, the approaches to osteoporotic fractures differ depending on their severity, location, and the patient's age. State-of-the-art treatments range from vertebroplasty/kyphoplasty to hardware-based spinal stabilization in which screw augmentation with cement is the gold standard. CASE PRESENTATION We describe the case of a 74-year-old man with an L5 osteoporotic fracture. The patient underwent a vertebroplasty (VP) procedure, which was complicated by a symptomatic cement leakage in the right L4-L5 neuroforamen. We urgently decompressed the affected pedicle via hemilaminectomy. At that point, the column required stability. The extravasation of cement had ruled out the use of cement-augmented pedicle screws but leaving the pedicular screws alone was not considered sufficient to achieve stability. We decided to cover the screws with a polyethylene terephthalate sleeve (OGmend®) to avoid additional cement leakage and to reinforce the screw strength required by the poor bone quality. CONCLUSION In the evolving technologies used for spinal surgery, screws sleeve implants such as OGmend® are a useful addition to the surgeon's armamentarium when an increased pull-out strength is required and other options are not available.
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Identifying vertebral fractures in the Japanese population using the trabecular bone score: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:976. [DOI: 10.1186/s12891-022-05839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The trabecular bone score (TBS) is reported to be an independent predictor of fracture risk in patients with primary or secondary osteoporosis. However, there have been few reports on its use in the Japanese population. This study aimed to investigate the risk factors for vertebral fracture in the Japanese population and to evaluate the usefulness of TBS.
Methods
This cross-sectional study involved 279 patients aged 60–90 years in whom bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). TBS was calculated based on the DXA scans. The presence or absence of vertebral fractures was assessed from T11 to L5. The patients were divided into those with vertebral fractures (VF group, n = 104) and those without vertebral fractures (non-VF group, n = 175).
Results
Of the 104 patients in the VF group, 75 had 1 vertebral fracture and 29 had 2 or more fractures. The mean TBS was 1.28 in the VF group and 1.35 in the non-VF group (p < 0.001). The mean BMD values at the lumbar spine and femoral neck were lower in the VF group (p < 0.001). The areas under the receiver-operating characteristic curve for incidence of vertebral fractures were 0.700, 0.737, and 0.689 for TBS, lumbar spine BMD, and femoral neck BMD, respectively. Multiple logistic regression analysis identified lumbar spine BMD, TBS, and female sex as significant risk factors for vertebral fractures. The proportion of patients in the group with osteoporosis or osteopenia who had vertebral fractures was higher in those with a low TBS (≤ 1.23) than in those with a non-low TBS (> 1.23).
Conclusion
TBS was a significant indicator of vertebral fractures in the Japanese population and might contribute to identifying patients with vertebral fractures, particularly those with osteopenia who need pharmacologic therapy.
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Ulivieri FM, Rinaudo L, Messina C, Aliprandi A, Sconfienza LM, Sardanelli F, Cesana BM. Bone Strain Index: preliminary distributional characteristics in a population of women with normal bone mass, osteopenia and osteoporosis. Radiol Med 2022; 127:1151-1158. [DOI: 10.1007/s11547-022-01543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
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