Search

Background: Osteoporosis with low trabecular bone quality (OLB) in patients with breast cancer receiving aromatase inhibitor (AI) therapy is associated with an increased risk of vertebral fractures. The capability of chemical shift‐encoded MRI (CSE‐MRI) in detecting OLB needs to be investigated. Purpose: To assess the diagnostic performance of proton density fat fraction (PDFF) and R2* measurements from CSE‐MRI for detecting OLB in postmenopausal women with breast cancer undergoing AI therapy. Study Type: Prospective. Population: 126 postmenopausal females (mean age: 69.5 ± 8.8 years) receiving AIs (average period: 41.6 ± 26.5 months) after breast cancer surgery. Field Strength/Sequence: 1.5‐T, three‐dimensional CSE‐MRI (six echoes), T1‐weighted Dixon, short tau inversion recovery, and diffusion‐weighted images. Assessment: Both CSE‐MRI and dual‐energy x‐ray absorptiometry were performed on the same day. Measurements included averaged PDFF, R2*, bone mineral density (BMD), and trabecular bone score (TBS) from L1 to L4 vertebrae. A T‐score ≤ −2.5 from BMD measurements indicated osteoporosis, whereas T‐scores of ≤ − 2.5 plus TBS ≤‐3.7 indicated OLB. The diagnostic performance of PDFF, R2*, and the combination of PDFF and R2* for identifying osteoporosis or OLB was assessed. Statistical Tests: Student's t‐test; Mann–Whitney U test; χ2 or Fisher exact tests; Pearson correlation; multivariate analysis; Receiver operating characteristic (ROC) analysis with the area under the curve (AUC); logistic regression model; intraclass correlation coefficient. A P‐value <0.05 was considered statistically significant. Results: For detecting osteoporosis, AUC values were 0.59 (PDFF), 0.66 (R2*), and 0.65 (combined PDFF and R2*). Significant mean differences were noted between patients with and without OLB for PDFF (66.11 ± 5.36 vs. 57.49 ± 6.43) and R2* (46.62 ± 9.24 vs. 63.36 ± 12.44). AUC values for detecting OLB were 0.75 (PDFF), 0.82 (R2*), and 0.84 (combined PDFF and R2*). Data Conclusion: R2* may perform better than PDFF for identifying OLB in patients with breast cancer receiving AIs. Level of Evidence: 2 Technical Efficacy: Stage 4 [ABSTRACT FROM AUTHOR]

Limited guidelines exist regarding osteoporosis prevention in the general population. Despite being a subject of controversy, the majority of research suggests that decreased vitamin D levels correlate with increased bone turnover, that is, an important risk factor for osteoporosis development. In most guidelines, daily vitamin D supplementation is recommended. In persons with epilepsy (PWE), the situation is more complex, as other factors can increase the chance of being vitamin D deficient. Currently, there are no internationally accepted guidelines regarding monitoring bone health in PWE. Our aim was to review the existing evidence in PWE on: (1) risk factors for vitamin D deficiency, (2) the identification of higher risk groups, and (3) the optimal ways to monitor bone health. Our narrative review shows that: (1) anti‐seizure medication (ASM) use, especially enzyme‐inducing ASM (EIASM) and valproic acid, is identified as an important risk factor for impaired bone health (e.g., increased risk for osteoporosis/fractures and/or vitamin D deficiency); (2) higher risk groups within the PWE population are present: intellectual or physical disability, institutionalized patients, puberty, early onset epilepsy and developmental epileptic encephalopathies, postmenopausal women, and use of multiple ASM/concomitant drugs (e.g. corticosteroids); and (3) a monitoring scheme can be suggested including laboratory tests, bone density measurements, managing of risk factors, and/or vitamin D supplementation. Overall, regular vitamin D measurement in PWE is a cost‐effective and practical method for monitoring vitamin D deficiency, whereas in high‐risk patients the combination of vitamin D measurement and bone densitometry is recommended. There is not enough evidence to advocate continuous vitamin D supplementation in all PWE. Children with epilepsy should receive the recommended daily intake of vitamin D for age and additional monitoring and supplementation if at higher risk of deficiency. There is a need for prospective trials exploring the potential benefit of vitamin D supplementation in PWE. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the correlation between changes in bone mineral density (BMD) in postmenopausal women and circulating inflammatory markers. Methods: This retrospective study focused on postmenopausal women admitted to the orthopedic department of Suzhou Benq Medical Center from June 2022 to December 2023, following predetermined inclusion and exclusion criteria. We retrospectively collected data on initial blood routine test results and bone density measurements for all study subjects upon admission, including parameters such as white blood cell count (WBC), C‐reactive protein, interleukin‐6 (IL‐6), and procalcitonin (PCT). Additionally, the systemic immune‐inflammation index (SII) was calculated using neutrophil count, lymphocyte count, and platelet count. Statistical analyses using SPSS and GraphPad software were performed to assess the correlation between bone density and inflammatory markers. Results: Patients were classified into three groups based on BMD results, including 60 individuals in the osteoporosis (OP) group, 127 individuals in the osteopenia group, and 37 individuals in the Normal group, respectively. Principal component analysis analysis suggested that WBC, SII, and postmenopausal OP (PMOP) held significant feature values. Correlation analysis indicated a correlation between WBC (p = 0.021), IL‐6 (p = 0.044), SII (p = 0.034), and PMOP. One‐way ANOVA analysis revealed significant differences in IL‐6 (p = 0.0179), SII (p = 0.0210), and PCT (p = 0.0200) among the three groups. Finally, ROC curve analysis demonstrated that SII (area under the curve = 0.716) has predictive value for PMOP. Conclusion: This study identified a certain predictive value for PMOP through the assessment of inflammatory markers in peripheral blood using routine blood tests. [ABSTRACT FROM AUTHOR]

Osteoporosis is a major public health threat with significant physical, psychosocial, and financial consequences. The calcaneus bone has been used as a measurement site for risk prediction of osteoporosis by noninvasive quantitative ultrasound (QUS). By adding optical contrast to QUS, our previous studies indicate that a combination of photoacoustic (PA) and QUS, that is, PAQUS, provides a novel opportunity to assess the health of human calcaneus. Calibration of the PAQUS system is crucial to realize quantitative and repeatable measurements of the calcaneus. Therefore, a phantom which simulates the optical, ultrasound, and architectural properties of the human calcaneus, for PAQUS system calibration, is required. Additionally, a controllable phantom offers researchers a versatile framework for developing versatile structures, allowing more controlled assessment of how varying bone structures cause defined alterations in PA and QUS signals. In this work, we present the first semi‐anthropomorphic calcaneus phantom for PAQUS. The phantom was developed based on nano computed‐tomography (nano‐CT) and stereolithography 3D printing, aiming to maximize accuracy in the approximation of both trabecular and cortical bone microstructures. Compared with the original digital input calcaneus model from a human cadaveric donor, the printed model achieved accuracies of 71.15% in total structure and 87.21% in bone volume fraction. Inorganic materials including synthetic blood, mineral oil, intralipid, and agar gel were used to model the substitutes of bone marrow and soft tissue, filling and covering the calcaneus phantom. The ultrasound and optical properties of this phantom were measured, and the results were consistent with those measured by a commercialized device and from previous in vivo studies. In addition, a short‐term stability test was conducted for this phantom, demonstrating that the optical and ultrasound properties of the phantom were stable without significant variation over 1 month. This semi‐anthropomorphic calcaneus phantom shows structural, ultrasound, and optical properties similar to those from a human calcaneus in vivo and, thereby, can serve as an effective source for equipment calibration and the comprehensive study of human patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Any pregnant or lactating woman with severe constant back pain, PLO must be kept in mind due to its effect on the quality of life of the mother and her child. A 22‐year‐old woman, who delivered her first child 5 months ago and is now breastfeeding her baby, presented with mid‐back pain. After investigations, including laboratory tests, X‐rays, and bone density measurements, the diagnosis was PLO. The patient is being treated with calcium, vitamin D, and alendronate besides discontinuation of lactation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: For diagnosis of osteoporosis, a T‐score of ≤−2.5 is recommended for all transgender and gender‐diverse patients aged 50 years or older, regardless of hormonal status. This case series presents 3 transgender individuals younger than 50 years undergoing gender‐affirming hormone therapy (GAHT) who had DXA scores suggestive of osteoporosis. We highlight possible discrepancies in DXA scan interpretations, especially in forearm bone mineral density measurements. We present the baseline (prior to beginning GAHT), 6‐month, and 1‐year follow‐up DXA data along with pertinent labs to include 25‐OH vitamin D, calcium, and alkaline phosphatase, for 2 transgender males (assigned female at birth) and 1 transgender female (assigned male at birth) undergoing GAHT who had low Z‐scores and T‐scores suggestive of osteoporosis. Multiple studies have analyzed the BMD data of individuals taking GAHT over time, which identify possible causes for low baseline Z‐scores for transgender females, but less so for transgender males. Other than positional statements, guidelines remain unclear regarding diagnostic approaches to osteoporosis and low Z‐scores in transgender individuals who are premenopausal or under 50 years of age. This case series addresses discrepancies in interpretation that may be encountered by clinicians with baseline and follow‐up DXAs, especially involving the forearm, during the course of GAHT. This highlights the importance of establishing clearer guidelines for the diagnosis and treatment of osteoporosis and low BMD for chronological age in the transgender population. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health‐related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC‐scale), and Euro‐QoL‐5D‐3L questionnaires. Results: A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non‐dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non‐dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion: Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence: 2b. [ABSTRACT FROM AUTHOR]

Electric fields used in bone stimulation are based on the application of direct current, but some drawbacks exist, such as the need for an external power source. Piezoelectric poly(vinylidene fluoride) (PVDF) has attracted interest for biomedical applications due to its flexibility, low toxicity, and the piezoelectric response to mechanical stimuli. This study aimed to investigate the effects of PVDF films on bone regeneration in rabbit tibias to assess the potential improvement in osteogenesis. An initial exploratory experiment was performed to determine optimal parameters for regulating the marrow blood supply. The second experiment focused on examining the effects of ultrasound stimulation on the implant's osteogenic capacity. The results showed that PVDF films have a notable impact on the extraskeletal bone formation and bone density in a secluded microenvironment with and without microperforations. At 60 days after surgery, tibias with marrow blood supply reached higher bone volumes and density and they were consistent with the cellular activity. Our results suggest that piezoelectric PVDF films have osteogenic characteristics and can be used to enhance new bone formation in a secluded space, thus reinforcing their biocompatibility nature. Additional studies are required to analyze the benefits of ultrasound stimulation. [ABSTRACT FROM AUTHOR]

Purpose: The agreement between the Stratos DR and Discovery A densitometers was assessed for measurements of whole‐body (WB) and regional fat mass (FM), fat‐free soft tissue (FFST) and bone mineral density (BMD). Moreover, the precision of the Stratos DR was also evaluated. Methods: Fifty participants (35 women, 70%) were measured consecutively, once on the Discovery A and once on the Stratos DR. In a subgroup of participants (n = 29), two successive measurements with the Stratos DR were also performed. Results: FM, FFST and BMD measured with the two devices were highly correlated, with a coefficient of correlation ranging from 0.80 to 0.99. Bland‐Altman analyses indicated significant bias between the two devices for all measurements. Thus, compared to the Discovery A, the Stratos DR underestimated WB BMD and WB and regional FM and FFST, with the exception of trunk FM and visceral adipose tissue (VAT), which were overestimated. Precision error for the Stratos DR, when expressed as root mean square‐coefficient of variation (RMS‐CV%) for FM, was 1.4% for WB, 3.0% for the gynoid and android regions, and 15.9% for VAT. The RMS‐CV% for FFST was 1.0% for WB. The root mean square of standard deviation for WB BMD was 0.018 g/cm², corresponding to a 1.4% CV. The least significant change was 0.050 g/cm² (SD), and 4.0% was considered to be a significant biological change. Conclusions: Differences between the Stratos DR and Discovery A measurements are significant and require the use of translational cross‐calibration equations. For most of the BMD and body composition parameters, our results demonstrated good Stratos DR precision. [ABSTRACT FROM AUTHOR]

Bone density is not a standard parameter examined during anthropological analysis, although researchers increasingly attempt to assess bone mineral density (BMD) in prehistoric populations. Computed tomography (CT) has great potential in this type of research. Micro CT is a precise and universal tool for bone density measurement based on CT value (attenuation factor of the X‐rays at a given point in space). Thirty‐four archaeological human radial bone samples from four chronologically and geographically different sites from southern Poland were examined here. Real BMD was measured (mass/volume) and compared with BMD obtained with the use of CT value results to verify correlation between those two parameters. The micro CT density values were estimated with an uncertainty of less than 0.03 g/cm3 in more than 75% of samples. This method does not require any special sample preparation and any substitute of soft tissues. This technique enables measurement of the cortical and cancellous bone separately in even partial or damaged bones. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between subjective (slit lamp examination [SLE]) and objective (densitometry) measurements of corneal haze after accelerated corneal crosslinking (aCXL), assess the relationship between densitometry and corrected distance visual acuity (CDVA), and determine the effect of baseline characteristics on densitometry after aCXL in eyes with progressive keratoconus and other ectasias. Setting: Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada. Design Retrospective analysis of a prospective interventional cohort study. Methods: Scheimpflug‐derived corneal densitometry, CDVA, maximum keratometry (Kmax), and central corneal thickness were measured preoperatively and up to 1 year after aCXL, and post‐operative haze was estimated with SLE (n = 483 eyes). A random effect model was used to examine the relationship between post‐operative subjective haze with SLE and densitometry. Linear mixed models were used to examine the relationship between densitometry, pre‐operative baseline characteristics, and CDVA. Results: There was a significant association between subjective haze with SLE and densitometry (p < 0.001). There was a significant relationship between CDVA and densitometry: for every 10 GSUs of increased densitometry in the 0–2 mm zone, CDVA worsened by approximately half a Snellen line (p < 0.001). Age and pre‐operative Kmax were significant predictors of densitometry. For every 10 years of age, densitometry increased by 0.68 GSUs (95% CI [0.27 to 1.07], p < 0.001). For every 10 D of increased preoperative Kmax, densitometry increased by 0.69 GSUs (95% CI [0.41 to 0.98], p < 0.001). Conclusions: Subjective haze after aCXL estimated with SLE, is significantly associated with densitometry. Increased densitometry after aCXL is associated with a reduction in CDVA. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and characterize a closed intra-articular fracture (IAF) mediated post-traumatic osteoarthritis (PTOA) model in rats to serve as a testbed for putative disease modifying interventions. Methods: Male rats were subject to a 0 Joule (J), 1 J, 3 J, or 5 J blunt-force impact to the lateral aspect of the knee and allowed to heal for 14 and 56 days. Micro-CT was performed at time of injury and at the specified endpoints to assess bone morphometry and bone mineral density measurements. Cytokines and osteochondral degradation markers were assayed from serum and synovial fluid via immunoassays. Histopathological analyses were performed on decalcified tissues and assessed for evidence of osteochondral degradation. Results: High-energy (5 J) blunt impacts consistently induced IAF to the proximal tibia, distal femur, or both while lower energy (1 J and 3 J) impacts did not. CCL2 was found to be elevated in the synovial fluid of rats with IAF at both 14- and 56-days post-injury while COMP and NTX-1 were upregulated chronically relative to sham controls. Histological analysis showed increased immune cell infiltration, increased osteoclasts and osteochondral degradation with IAF relative to sham. Conclusion: Based on results from the current study, our data indicates that a 5 J blunt-forced impact adequately and consistently induces hallmark osteoarthritic changes to the articular surface and subchondral bone at 56 days after IAF. Marked development of PTOA pathobiology suggest this model will provide a robust testbed for screening putative disease modifying interventions that might be translated to the clinic for militarily relevant, high-energy joint injuries. [ABSTRACT FROM AUTHOR]

Aim: Osteopenia and sarcopenia, features of the aging process, are recognized as major health problems in an aging society. This study investigated the prognostic impact of osteosarcopenia, the coexistence of osteopenia and sarcopenia, in older adults undergoing curative resection for colorectal cancer. Methods: We retrospectively reviewed data of older adults aged 65–98 y who had undergone curative resection for colorectal cancer. Osteopenia was evaluated by bone mineral density measurement in the midvertebral core of the 11th thoracic vertebra on preoperative computed tomography images. Sarcopenia was evaluated by measuring the skeletal muscle cross‐sectional area at the third lumbar vertebra level. Osteosarcopenia was defined as the coexistence of osteopenia and sarcopenia. We explored the relationship of preoperative osteosarcopenia with the disease‐free and overall survival after curative resection. Results: Among the 325 patients included, those with osteosarcopenia had significantly lower overall survival rates than those with osteopenia or sarcopenia alone (P < 0.01). In the multivariate analysis, male sex (P = 0.045), C‐reactive protein‐to‐albumin ratio (P < 0.01), osteosarcopenia (P < 0.01), pathological T4 stage (P = 0.023), and pathological N1/N2 stage (P < 0.01) were independent predictors of disease‐free survival, while age (P < 0.01), male sex (P = 0.049), C‐reactive protein‐to‐albumin ratio (P < 0.01), osteosarcopenia (P < 0.01), pathological T4 stage (P = 0.036), pathological N1/N2 stage (P < 0.01), and carbohydrate antigen 19–9 (P = 0.041) were independent predictors of overall survival. Conclusion: Osteosarcopenia was a strong predictor of poor outcomes in older adults undergoing curative resection for colorectal cancer, suggesting an important role of osteosarcopenia in an aging society. [ABSTRACT FROM AUTHOR]

Objective: At present, it is still uncertain whether single screw has the same stability as double screws in the treatment of ulnar coronal process basal fracture (Regan–Morry type III). So, we aimed to compare the pull‐out force and anti‐rotation torque of anterior single/double screw‐cancellous bone fixation (aSSBF, aDSBF) in this fracture, and further study the influencing factors on anatomical and biomechanical stability of smart screw internal fixations. Methods: A total of 63 adult volunteers with no history of elbow injury underwent elbow CT scanning with associated three‐dimensional reconstruction that enabled the measurements of bone density and fixed length of the proximal ulna and coronoid. The models of coronal process basal fracture, aSSBF and aDSBF, were developed and validated. Using the finite element model test, the sensitivity analysis of pull‐out force and rotational torque was carried out. Results: The pull‐out force of aSSBF model was positively correlated with the density of the cancellous bone and linearly related to the fixed depth of the screw. The load pattern of pull‐out force of aDSBF model was similar to that of aSSBF model. The ultimate torque of aDSBF model was higher than that of aSSBF model, but the load pattern of ultimate torque of both models was similar to each other when the fracture reset was satisfactory, and the screw nut attaches closely to coronoid process. Moreover, with enhancement of initial pre‐tightening force, the increase of ultimate torque of both models was small. Conclusions: In addition to three pull‐out stability factors of smart screw fixations, fracture surface fitting degree and nut fitting degree are the other two important anatomical and biomechanical stability factors of smart screw fixations both for rotational stability. When all pull‐out stability and rotational stability factors meet reasonable conditions simultaneously, single or double screw fixation methods are stable for the treatments of ulnar coronoid basal fractures. [ABSTRACT FROM AUTHOR]

Studies of skeletal metabolism using measurements of bone metabolic flux (Ki) obtained with [18F] sodium fluoride ([18F]NaF) positron emission tomography (PET) scans have been used in clinical research for the last 30 years. The technique has proven useful as an imaging biomarker in trials of novel drug treatments for osteoporosis and investigating other metabolic bone diseases, including chronic kidney disease mineral and bone disorder. It has also been shown to be valuable in metastatic bone disease in breast cancer patients and may have potential in other cancer types, such as prostate cancer, to assess early bone fracture risk. However, these studies have usually required a 60-min dynamic PET scan and measurement of the arterial input function (AIF),making them difficult to translate into the clinic for diagnostic purposes. We have previously proposed a simplified method that estimates the Ki value at an imaging site from a short (4-min) static scan and venous blood samples.A key advantage of this method is that, by acquiring a series of static scans, values of Ki can be quickly measured at multiple sites using a single injection of the tracer. To date, the widespread use of [18F]NaF PET has been limited by the need to measure the AIF required for the mathematical modeling of tracer kinetics to derive Ki and other kinetic parameters. In this report, we review different methods of measuring the AIF, including direct arterial sampling, the use of a semi-population input function (SP-AIF), and image-derived input function,the latter two requiring only two or three venous blood samples obtained between 30 and 60 min after injection. We provide an SP-AIF model and a spreadsheet for calculating Ki values using the static scan method that others can use to study bone metabolism in metabolic and metastatic bone diseases without requiring invasive arterial blood sampling. The method shortens scan times, simplifies procedures, and reduces the cost of multicenter trials without losing accuracy or precision. [ABSTRACT FROM AUTHOR]

This study was aimed to provide anatomical atlas of the ovine metacarpo/metatarsophalangeal joints using computed tomography (CT) scan and magnetic resonance imaging (MRI), as well as to investigate bone mineral density (BMD) and morphometric features of this joint. The limbs of twenty adult Sanjabi sheep were examined. Imaging was performed using a 16‐slice multi‐detector CT scanner and a 1.5 Tesla MRI scanner. The obtained images were correlated with corresponding anatomical sections. BMD was measured by Dual Energy X‐ray Absorptiometry (DEXA) method. Also morphometric features included distance between metacarpal and metatarsal heads, width of metacarpal and metatarsal head, length, width and the height of the proximal sesamoid bones were measured. In MRI images, compact bones, ligaments and tendons showed less signal intensity (hypointense). The fatty tissue and bone marrow had more signal intensity (hyperintense), but articular cartilage and synovial fluid showed moderate signal intensity. BMD in the left hind limb was significantly higher than other three limbs (p ≤ 0.05). The length of proximal sesamoid bones in left forelimb was higher than right forelimb (p ≤ 0.05). The thickness of proximal sesamoid bones in left limbs was higher than those in their counterparts (p ≤ 0.05). The width of the medial head in the forelimbs was significantly greater than the hind limbs (p ≤ 0.05). The present results might be useful in managing the clinical techniques on this joint. Larger volume of the proximal sesamoid bones and wider medial head in the forelimbs compared to the hindlimbs impel this speculation that the centre of gravity is closer to the forelimbs. [ABSTRACT FROM AUTHOR]

Automated color measurement systems have become significant components of offset lithographic printing presses for better process control and reduced job waste. Some European press manufacturers are known to offer automated color measurement equipment that is confined to polarized density readings, which is uncommon in US. Introducing polarized densitometry into an environment where unpolarized densitometry is utilized can be problematic. Print professionals are on the lookout for a solution that is evidenced by a recent feature in a post from the IDEAlliance G7 Professionals forum seeking for a methodology to convert polarized to unpolarized readings. The present study applies the Bland–Altman method together with other statistical analyses to determine if a conversion between polarized and unpolarized densitometry can be established within a limited set of parameters. Three spectrodensitometers were used to record densitometric readings of wet and dry process inks on coated and uncoated drawdown proofs. The results showed that coated papers had significantly less variation between instruments compared to uncoated papers. Wet inks had more minor variations compared to dry inks. Furthermore, pure difference values and a Mann–Whitney U test indicated differences between unpolarized and polarized densitometric readings in all cases. Finally, t‐tests performed on the resulting difference data for both unpolarized versus polarized and unpolarized versus predicted polarized that showed fixed bias by means of the computed p‐values. [ABSTRACT FROM AUTHOR]

Aims: To assess the presence of alterations suggestive of reduced bone mineral density (BMD) by using mandibular cortical index (MCI) in panoramic radiographs of cirrhotic individuals and to evaluate their relationship with other characteristics of hepatic cirrhosis (HC). Methods and Results: This is an observational case‐control study assessing the medical records of 165 cirrhotic patients matched by sex and age with healthy individuals. MELD (model of end stage liver disease) score, etiology, complications, comorbidities, and serum levels of vitamin D were collected. MCI was used to obtain BMD. Binary logistic regression was used to test associations and the risk estimates were expressed in odds ratio. Most of the sample consisted of men (73.93%) with median age of 56 years old. In the study group, the mean value of MELD was 16.5 and hepatitis C was the main etiology of HC (33.9%). Cirrhotic individuals are 3.99 times more likely to present alterations suggestive of reduced BMD (p <.01). There was no statistical significance in the association of MCI with levels of vitamin D, comorbidities, etiology or cirrhosis complications. Conclusions: MCI suggestive of reduced BMD is more likely to be identified in panoramic radiographs of cirrhotic individuals than of healthy ones. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and the deterioration in bone microarchitecture, which might be related to age and space travel. An unmet need exists for the development of novel imaging technologies to characterize osteoporosis. Purpose: The purpose of our study is to investigate the feasibility of X‐ray‐induced acoustic computed tomography (XACT) imaging for osteoporosis detection. Methods: An in‐house simulation workflow was developed to assess the ability of XACT for osteoporosis detection. To evaluate this simulation workflow, a three‐dimensional digital bone phantom for XACT imaging was created by a series of two‐dimensional micro‐computed tomography (micro‐CT) slices of normal and osteoporotic bones in mice. In XACT imaging, the initial acoustic pressure rise caused by the X‐ray induce acoustic (XA) effect is proportional to bone density. First, region growing was deployed for image segmentation of different materials inside the bone. Then k‐wave simulations were deployed to model XA wave propagation, attenuation, and detection. Finally, the time‐varying pressure signals detected at each transducer location were used to reconstruct the XACT image with a time‐reversal reconstruction algorithm. Results: Through the simulated XACT images, cortical porosity has been calculated, and XA signal spectra slopes have been analyzed for the detection of osteoporosis. The results have demonstrated that osteoporotic bones have lower bone mineral density and higher spectra slopes. These findings from XACT images were in good agreement with porosity calculation from micro‐CT images. Conclusion: This work explores the feasibility of using XACT imaging as a new imaging tool for Osteoporosis detection. Considering that acoustic signals are generated by X‐ray absorption, XACT imaging can be combined with traditional X‐ray imaging that holds potential for clinical management of osteoporosis and other bone diseases. [ABSTRACT FROM AUTHOR]

Combination of computed tomography (CT) radiography and deep learning to predict subsequent osteoporotic vertebral compression fracture (OVCF) has not been reported. To do so, we analyzed retrospectively CT images from 103 patients who experienced twice OVCF in Tongji Hospital from 2011 to 2022. Meanwhile, CT images from 70 age‐matched osteoporotic patients without vertebral fracture were used as the negative control. Convolutional neural network was used for classification and the Adam optimizer combining the momentum and exponentially weighted moving average gradients methods were used to update the weights of the networks. In the prediction model, we split 80% data of each type of the patient as the training group, while the other 20% was held as the independent testing group. We found that the number of subsequent fracture in women is higher than that in men (81 vs. 22). Additionally, the incidence rate of adjacent vertebral fracture is higher than that of remote vertebral fracture (64.1 vs. 35.9%), while the onset time of the former was 11.9 ± 12.8 months, significantly less than 22.3 ± 18.2 months of the latter (p <.001). For the prediction of subsequent fracture, our model attained.839 of accuracy and.883 of receiver operating characteristic–area under curve on the whole testing dataset. Furthermore, our model gained.867 and.719 of accuracy on the single‐class testing dataset separated from the former,.817 of accuracy on the independent test. In conclusion, we managed to generate a deep learning‐based model, which is able to predict subsequent OVCF in a precise and unbiased way just using CT images. [ABSTRACT FROM AUTHOR]

Vocacapsaicin is a novel prodrug of trans‐capsaicin (trans‐8‐methyl‐N‐vanillyl‐6‐nonenamide) being developed as a nonopioid, long‐lasting, site‐specific treatment for postsurgical pain management. The objective of these studies was to examine the safety and tolerability of vocacapsaicin in an osteotomy model in two animal species and to evaluate bone healing parameters. Rats undergoing unilateral femoral osteotomy received a single perioperative administration (by instillation) of vocacapsaicin (vehicle, 0.15, 0.3, and 0.6 mg/kg). Rabbits undergoing unilateral ulnar osteotomy received a single perioperative administration (by infiltration and instillation) of vocacapsaicin (vehicle, 0.256 and 0.52 mg) alone or in combination with 0.5% ropivacaine. Clinical signs, body weights, food consumption, radiography, histopathologic examinations, ex vivo bone mineral density measurements (rats only), and biomechanical testing were evaluated at 4 and 8 weeks in rats and at 2 and 10 weeks in rabbits. Plasma samples were also collected in rabbits. There were no vocacapsaicin‐related effects on mortality, clinical observations, body weight, or food consumption in either species. Systemic exposure to vocacapsaicin and its metabolites, including capsaicin, was transient. In rats, vocacapsaicin was devoid of deleterious effects on bone healing parameters, and there was a trend for enhanced bone healing in rats treated with the mid‐dose. In rabbits, vocacapsaicin administered alone or in combination with ropivacaine did not adversely affect bone healing parameters. In conclusion, a single perioperative administration of vocacapsaicin in unilateral osteotomy models was well tolerated, locally and systemically, supporting its continued development as a novel, nonopioid treatment for postsurgical pain management. [ABSTRACT FROM AUTHOR]

Objective: The bone mass around the prosthesis plays an important role in the stability of the prosthesis. This study aimed to assess the effect of postoperative activity on bone mineral density (BMD) in the proximal tibia 5 years after total knee arthroplasty (TKA). To provide a scientific guidance for postoperative functional exercise. Methods: 110 patients underwent unilateral primary TKA were divided into three groups based on the University of California Los Angeles (UCLA) activity scale: low activity group (LA group, UCLA = 4, 5); medium activity group (MA group, UCLA = 6, 7); and high activity group (HA group, UCLA = 8, 9). The primary observation was a comparison of the BMD and BMD change percentage (ΔBMD (%)) in the periprosthetic tibia among the LA, MA and HA groups at 1 year, 3 years and 5 years. The secondary observations were radiographic evaluation (prosthetic stability, periprosthetic fractures, aseptic loosening and periprosthetic joint infection) and clinical evaluation (Knee Society Score (KSS), visual analogue score scores and range of motion (ROM)). A one‐way ANOVA was used to compare the clinical scores and BMD among the three groups. Results: The BMD of medial region decreased by 10.80%, 12.64%, 13.61% at 1, 3, and 5 years respectively; these were 5.72%, 6.26%, 7.83% in lateral region and 1.42%, 1.78%, 3.28% in diaphyseal region. For medial metaphyseal region, the BMD of the MA group was significantly greater than that of the LA and HA groups at 1 and 3 years (108.9 ± 5.2 vs. 106.1 ± 6.69 vs. 105.4 ± 5.2 and 108.5 ± 6.0 vs. 101.2 ± 6.76 vs. 103.0 ± 6.8, P < 0.01 and P < 0.001), and the BMD changes (ΔBMD (%)) in the MA group were significantly smaller than those in the LA and HA groups (8.75 ± 5.36 vs. 11.92 ± 5.49 vs. 12.70 ± 5.21 and 9.11 ± 5.11 vs. 16.04 ± 4.79 vs. 14.82 ± 4.26, P < 0.01 and P < 0.001). Regarding secondary observations, all of the prostheses were assessed as stable, without periprosthetic fractures, aseptic loosening and periprosthetic joint infection. Regarding KSS scores, there was no significant difference among the three groups. However, the VAS and ROM of the HA group were better than those of the MA and LA groups (1.65 ± 0.79 vs. 2.63 ± 0.77 vs. 3.00 ± 1.17, p < 0.001, and 111.90 ± 9.17 vs. 110.20 ± 6.78 vs. 102.90 ± 8.48, P < 0.001). Conclusion: Medium activity prevented periprosthetic bone loss in the medial metaphyseal region of the tibia after posterior‐stabilized TKA, and moderate‐intensity exercise is recommended for patients after TKA to reduce periprosthetic bone loss. [ABSTRACT FROM AUTHOR]

Objective: The indication of surgery in primary hyperparathyroidism has been controversial, as many patients experience mild disease. The primary aim was to evaluate fracture incidence in a contemporary population‐based cohort of patients having surgery for primary hyperparathyroidism. The secondary aim was to investigate whether preoperative serum calcium, adenoma weight or multiglandular disease influence fracture incidence. Design: A retrospective cohort study with population controls. Primary outcomes, defined by discharge diagnoses and prescriptions, were any fracture and fragility fracture, secondary outcomes were multiple fractures anytime and osteoporosis. Subjects were followed 10 years pre‐ and up to 10 years postoperatively (or 31 December 2015). Multiple events per subject were allowed. Fracture incidence rate ratios (IRRs) for patients pre‐ and postoperatively were tabulated and evaluated with mixed‐effects Poisson regression. Secondary outcomes were evaluated using conditional logistic regression. Patients: A Swedish nationwide cohort of patients having surgery for primary hyperparathyroidism (n = 5009) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery between 2003 and 2013 was matched with population controls (n = 14,983). Data were cross‐linked with Statistics Sweden and the National Board of Health and Welfare. Measurements: Preoperative serum calcium and adenoma weight at pathological examination. Results: Patients had an increased incidence rate of any fracture preoperatively, IRR 1.27 (95% confidence interval: 1.11–1.46), highest in the last year before surgery. Fracture incidence was not increased postoperatively. Serum calcium, adenoma weight and multiglandular disease were not associated with fracture incidence. Conclusions: Fracture incidence is higher in patients with primary hyperparathyroidism but is normalized after surgery. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well‐known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro‐CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild‐to‐moderate and severe OA reveals strong correlations to micro‐CT (35 µm), high inter‐ and intraobserver reliability, and small relative differences. In vivo, normal, mild‐to‐moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild‐to‐moderate from severe OA (except mild‐to‐moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro‐CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture. [ABSTRACT FROM AUTHOR]

Objective: Phthalates induce inflammation and are ubiquitously used in daily life. We aim to study the impact of di‐(2‐ethylhexyl) phthalate (DEHP) exposure on inflammation and osteoporosis in premenopausal and postmenopausal females. Methods: Female 8‐week‐old C57BL/6JNarl mice received an ovariectomy (OVX) or a sham operation and were fed with DEHP or vehicle by oral gavage for 4 or 8 weeks. Their femurs were isolated for micro‐computed tomography, and their serum was collected for inflammatory cytokine assays. Correlations between urinary phthalate metabolites and the lumbar spine bone mineral density (BMD) in premenopausal and postmenopausal volunteers were performed. Results: Among the OVX mice treated for 4 weeks, significant lower bone volume, bone volume/tissue volume, and trabecular number but significant higher trabecular bone pattern factor and structure model index were identified in the mice treated with DEHP than with vehicle. The OVX mice treated with DEHP for 4 weeks had significantly higher serum interleukin (IL)‐1β, IL‐10, IL‐17A, interferon (IFN)‐γ, tumor necrosis factor (TNF)‐α, and Dickkopf‐1 levels than those treated with vehicle. The sham mice treated with DEHP for 8 weeks showed an impaired femur trabecular microstructure and had significantly higher serum IL‐1β, IL‐6, IL‐10, IL‐17A, IFN‐γ, and TNF‐α than those treated with vehicle. DEHP metabolites were inversely correlated with the BMD of premenopausal women and the T‐score of postmenopausal women. Conclusion: DEHP treatment in OVX and sham mice results in osteoporosis and impairs the microstructure of the femur trabecula through inflammation. Phthalate exposure negatively affects the bone mass in both premenopausal and postmenopausal women. Thus, long‐term avoidance is suggested. [ABSTRACT FROM AUTHOR]

Objective: Thyrotropin (TSH) suppression therapy is a standard treatment after surgery for differentiated thyroid carcinoma (DTC). It may be associated with osteoporosis in postmenopausal women. However, there are no guidelines for bone mineral density (BMD) testing intervals to screen for osteoporosis in these patients. Therefore, we evaluated the timing of repeated BMD testing in DTC patients with TSH suppression according to baseline T‐scores. Design, Patients, and Measurement: We retrospectively evaluated 658 DTC patients who underwent BMD testing more than twice between January 2007 and January 2020. A 1:3 propensity score matching was conducted to compare the timing of repeated BMD tests between the DTC and non‐DTC groups. We stratified the participants into four groups based on their baseline T‐scores: normal (−1.00 or higher), mild osteopenia (−1.01 to −1.49), moderate osteopenia (−1.50 to −1.99), and severe osteopenia (−2.00 to −2.49). Additionally, the 10% of patients in each group that transitioned to osteoporosis were analysed. Results: The estimated BMD testing interval for 10% of patients who developed osteoporosis was 85 months for patients with initially mild osteopenia, 65 months for those with moderate osteopenia, and 15 months for those with severe osteopenia in the DTC group. In the non‐DTC group, the testing intervals for mild, moderate, and severe osteopenia were 98, 57, and 13 months, respectively. On multivariate analysis, baseline T‐score (mild osteopenia: hazard ratio [HR] 5.91, p =.105; moderate osteopenia: HR, 25.27, p =.02; and severe osteopenia: HR, 134.82, p <.001) and duration of TSH suppression (tertile 2: HR, 2.25, p =.005; Tertile 3: 1.78, p =.033) were independent risk factors for osteoporosis in the DTC group. Conclusion: This study provides guidance for the timing of repeated BMD tests in women over 50 years of age with TSH suppression. The rescreening interval for BMD testing can be modified based on the baseline T‐score. The appropriate BMD testing intervals in female DTC patients were similar to those in non‐DTC females. [ABSTRACT FROM AUTHOR]

Rationale: In osteoporosis research, strontium ions (Sr2+) have emerged as promising therapeutic agent in modified bone cements for better fracture healing. Modeling of Sr2+ dispersion in bone could be used as a predictive tool for the evaluation of functionalized biomaterials in future. Therefore, determination of experimental parameters for Sr2+ transport in bone is essential. In this study, we focus on the determination of Sr2+ diffusion in viscous bovine bone marrow by time‐of‐flight secondary ion mass spectrometry (ToF‐SIMS). Methods: For this comparatively fast diffusion (FD) experiment, a specific experimental protocol of ToF‐SIMS depth profiling under cryogenic conditions was developed. The validity of our experimental approach is proven by a time‐dependent experimental series. Furthermore, 2D and 3D mass spectrometric imaging analysis was used to study Sr2+ surface and bulk distribution within bovine bone marrow. Results: Detailed 2D and 3D mass spectrometric imaging analysis revealed that Sr2+ diffusion is slower in bone marrow areas with high intensity of lipid and fatty acid signals than in areas with less lipid content. The Sr2+ transport within this passive model can be described by Fickian diffusion. Average diffusion coefficients of Sr2+ in bovine bone marrow were obtained from diffusion profiles in FD areas (Dbovine,FD = [2.09 ± 2.39]·10−9 cm2s−1), slow diffusion areas (Dbovine,SD = [1.52 ± 1.80]·10−10 cm2s−1), and total area diffusion (Dbovine,TA = [1.94 ± 2.40]·10−9 cm2s−1). Conclusions: We were able to show that cryo‐ToF‐SIMS is a useful tool for the characterization of rapid diffusion in water‐containing highly viscous media. To the best of our knowledge, this is the first reported experimental approach for the investigation of the distribution of low concentrated therapeutic agents in bone marrow. Overall, our results provide important insights about Sr2+ diffusion in bovine bone marrow. [ABSTRACT FROM AUTHOR]

Purpose: Osteoporosis is a bone disease associated with enhanced bone loss, microstructural degeneration, and fracture‐risk. Finite element (FE) modeling is used to estimate trabecular bone (Tb) modulus from high‐resolution three‐dimensional (3‐D) imaging modalities including micro‐computed tomography (CT), magnetic resonance imaging (MRI), and high‐resolution peripheral quantitative CT (HR‐pQCT). This paper validates an application of voxel‐based continuum finite element analysis (FEA) to predict Tb modulus from clinical CT imaging under a condition similar to in vivo imaging by comparing with measures derived by micro‐CT and experimental approaches. Method: Voxel‐based continuum FEA methods for CT imaging were implemented using linear and nonlinear models and applied on distal tibial scans under a condition similar to in vivo imaging. First, tibial axis in a CT scan was aligned with the coordinate z‐axis at 150 μm isotropic voxels. FEA was applied on an upright cylindrical volume of interests (VOI) with its axis coinciding with the tibial bone axis. Voxel volume, edge, and vertex elements and their connectivity were defined as per the isotropic image grid. A calibration phantom was used to calibrate CT numbers in Hounsfield unit to bone mineral density (BMD) values, which was then converted into calcium hydroxyapatite (CHA) density. Mechanical properties at each voxel volume element was defined using its ash‐density defined on CT‐derived CHA density. For FEA, the bottom surface of the cylindrical VOI was fixed and a constant displacement was applied along the z‐direction at each vertex element on the top surface to simulate a physical axial compressive loading condition. Finally, a Poisson's ratio of 0.3 was applied, and Tb modulus (MPa) was computed as the ratio of average von Mises stress (MPa) of volume elements on the top surface and the applied displacement. FEA parameters including mesh element size, substep number, and different tolerance values were optimized. Results: CT‐derived Tb modulus values using continuum FEA showed high linear correlation with the micro‐CT‐derived reference values (r ∈ [0.87 0.90]) as well as experimentally measured values (r ∈ [0.80 0.87]). Linear correlation of computed modulus with their reference values using continuum FEA with linear modeling was comparable with that obtained by nonlinear modeling. Nonlinear continuum FEA‐based modulus values (mean of 1087.2 MPa) showed greater difference from their reference values (mean of 1498.9 MPa using micro‐CT‐based FEA) as compared with linear continuum methods. High repeat CT scan reproducibility (intra‐class correlation [ICC] = 0.98) was observed for computed modulus values using both linear and nonlinear continuum FEA. It was observed that high stress regions coincide with Tb microstructure as fuzzily characterized by BMD values. Distributions of von Mises stress over Tb microstructure and marrow regions were significantly different (p < 10–8). Conclusion: Voxel‐based continuum FEA offers surrogate measures of Tb modulus from CT imaging under a condition similar to in vivo imaging that alleviates the need for segmentation of Tb and marrow regions, while accounting for bone distribution at the microstructural level. This relaxation of binary segmentation will extend the scope of FEA application to assess mechanical properties of bone microstructure at relatively low‐resolution imaging. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to evaluate the accuracy of bone‐level assessments using either cone‐beam computed tomography (CBCT), intra‐oral peri‐apical (PA) radiographs or histology following reconstructive treatment of experimental peri‐implantitis. Materials and Methods: Six Labrador dogs were used. Experimental peri‐implantitis was induced 3 months after implant placement. Surgical treatment of peri‐implantitis was performed and peri‐implant defects were allocated to one of four treatment categories; no augmentation, bone graft materials with or without a barrier membrane. Six months later, intra‐oral PA radiographs and block biopsies from all implants sites were obtained. Marginal bone levels (MBLs) were measured using PA radiographs, CBCT and histology. Results: Significant correlations of MBL assessments were observed between the three methods. The measurements in PA radiographs consistently resulted in an overestimation of the bone level of about 0.3–0.4 mm. The agreement between the methods was not influenced by the use of bone substitute materials in the management of the osseous defects. Conclusions: Although MBL assessments obtained from PA radiographs showed an overestimation compared to MBL assessments on corresponding CBCT images and histological sections, PA radiographs can be considered a reliable technique for peri‐implant bone‐level evaluations following reconstructive surgical therapy of experimental peri‐implantitis. [ABSTRACT FROM AUTHOR]

Purpose: We investigate the feasibility of slot‐scan dual‐energy (DE) bone densitometry on motorized radiographic equipment. This approach will enable fast quantitative measurements of areal bone mineral density (aBMD) for opportunistic evaluation of osteoporosis. Methods: We investigated DE slot‐scan protocols to obtain aBMD measurements at the lumbar spine (L‐spine) and hip using a motorized x‐ray platform capable of synchronized translation of the x‐ray source and flat‐panel detector (FPD). The slot dimension was 5 × 20 cm2. The DE slot views were processed as follows: (1) convolution kernel‐based scatter correction, (2) unfiltered backprojection to tile the slots into long‐length radiographs, and (3) projection‐domain DE decomposition, consisting of an initial adipose–water decomposition in a bone‐free region followed by water–CaHA decomposition with adjustment for adipose content. The accuracy and reproducibility of slot‐scan aBMD measurements were investigated using a high‐fidelity simulator of a robotic x‐ray system (Siemens Multitom Rax) in a total of 48 body phantom realizations: four average bone density settings (cortical bone mass fraction: 10–40%), four body sizes (waist circumference, WC = 70–106 cm), and three lateral shifts of the body within the slot field of view (FOV) (centered and ±1 cm off‐center). Experimental validations included: (1) x‐ray test‐bench feasibility study of adipose–water decomposition and (2) initial demonstration of slot‐scan DE bone densitometry on the robotic x‐ray system using the European Spine Phantom (ESP) with added attenuation (polymethyl methacrylate [PMMA] slabs) ranging 2 to 6 cm thick. Results: For the L‐spine, the mean aBMD error across all WC settings ranged from 0.08 g/cm2 for phantoms with average cortical bone fraction wcortical = 10% to ∼0.01 g/cm2 for phantoms with wcortical = 40%. The L‐spine aBMD measurements were fairly robust to changes in body size and positioning, e.g., coefficient of variation (CV) for L1 with wcortical = 30% was ∼0.034 for various WC and ∼0.02 for an obese patient (WC = 106 cm) changing lateral shift. For the hip, the mean aBMD error across all phantom configurations was about 0.07 g/cm2 for a centered patient. The reproducibility of hip aBMD was slightly worse than in the L‐spine (e.g., in the femoral neck, the CV with respect to changing WC was ∼0.13 for phantom realizations with wcortical = 30%) due to more challenging scatter estimation in the presence of an air–tissue interface within the slot FOV. The aBMD of the hip was therefore sensitive to lateral positioning of the patient, especially for obese patients: e.g., the CV with respect to patient lateral shift for femoral neck with WC = 106 cm and wcortical = 30% was 0.14. Empirical evaluations confirmed substantial reduction in aBMD errors with the proposed adipose estimation procedure and demonstrated robust aBMD measurements on the robotic x‐ray system, with aBMD errors of ∼0.1 g/cm2 across all three simulated ESP vertebrae and all added PMMA attenuator settings. Conclusions: We demonstrated that accurate aBMD measurements can be obtained on a motorized FPD‐based x‐ray system using DE slot‐scans with kernel‐based scatter correction, backprojection‐based slot view tiling, and DE decomposition with adipose correction. [ABSTRACT FROM AUTHOR]

Objective: Physical exercise has obvious effects on bone loss, pain relief, and improvement of bone metabolism indexes in patients with osteoporosis, but currently lacks sufficient evidence. The aim of this systematic review and meta‐analysis was to synthesize and present the best available evidence on the effectiveness and safety of exercises in the treatment of primary osteoporosis. Methods: Publications pertaining to the effectiveness of exercise on bone mineral density (BMD), visual analog scores (VAS), and biochemical markers of bone metabolism in primary osteoporosis (POP) from PubMed, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to April 2020. Results: A total of 20 studies with 1824 participants were included. The results of the meta‐analysis revealed that exercise therapy for lumbar spine and femoral neck BMD is statistically different from conventional therapy (lumbar spine BMD: SMD = 0.78, 95%CI: 0.46, 1.10, P < 0.00001, I2 = 85%; femoral neck BMD (SMD = 0.80, 95%CI: 0.34, 1.27, P = 0.0007, I2 = 88%), exercise therapy can significantly increase the lumbar spine BMD of patients with OP, especially in lumbar spine2‐4 BMD (SMD = 0.47; 95%CI: 0.20, 0.75; P = 0.0008; I2 = 69%). Compared with conventional treatment, kinesitherapy also has significant differences in alleviating the pain of POP patients (SMD = −1.39, 95%CI: −2.47,−0.31, P = 0.01, I2 = 97%). Compared with conventional therapy, kinesitherapy has no significant difference in improving biochemical markers of bone metabolism such as bone glaprotein (BGP) (SMD = 2.59, 95%CI:0.90, 4.28, P = 0.003, I2 = 98%), N‐terminal pro peptide of type I procollagen (PINP) (SMD = 0.77, 95%CI: −0.44 to 1.98, P = 0.21, I2 = 95%), serum phosphorus (SMD = 0.04, 95%CI: −0.13, 0.22, P = 0.61, I2 = 30%), alkaline phosphatase (ALP) (SMD = −0.08, 95%CI: −0.44, 0.27, P = 0.64, I2 = 76%), and serum calcium (SMD = 0.12, 95%CI: −0.18, 0.43, P = 0.42, I2 = 63%) in POP patients. Conclusions: Kinesitherapy significantly improved lumbar spine and femoral neck BMD, and relieve the pain of patients in the current low‐quality evidence. Additional high‐quality evidence is required to confirm the effect of exercise therapy on the biochemical markers of bone metabolism in POP patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the periprosthetic bone environment could be affected by activity during the early rehabilitation period after primary total hip arthroplasty (THA) and to evaluate the safety and efficacy of activity during the early rehabilitation period. Methods: This random clinical trial was conducted from January 2017 to July 2017. A total of 22 selected patients with advanced osteonecrosis of the femoral head (ONFH) who underwent primary unilateral THA were randomized (1:1) to a high activity level group (HA group) or a low activity level group (LA group). The HA group included nine men and two women, aged 53.18 ± 13.29 years. The LA group included five men and six women, aged 55.73 ± 11.73 years. The intervention was different postoperative daily walking distances guided by researchers: 1727.27 ± 564.08 m 0–2 months and 4272.73 ± 904.53 m 3–6 months postoperation for the HA group and 909.09 ± 583.87 m 0–2 months and 2409.09 ± 1068.13 m 3–6 months postoperation for LA group. The primary outcomes were radiographic evaluation (prosthetic stability and stress shielding based on the Engh scale) and bone mineral density (BMD) with a femoral prosthesis (individual and intergroup comparison using seven Gruen zones) at 6 months postoperatively. Secondary outcomes were set to confirm the safety and efficacy of activity during early rehabilitation, including day 1 erythrocyte sedimentation rate (ESR), day 1 hypersensitive C‐reactive protein (CRP), length of hospital stay (LOS), and the Harris hip score (HHS) at discharge, 2 months postoperatively, and 6 months postoperatively. Results: Patients were followed up for 6 months after surgery. Regarding primary outcomes, all prostheses were assessed as stable, with bone in‐growth. There were no adverse events in any cases. The HA group had a higher incidence of stress shielding than the LA group, but there was no statistical significance (63.64% vs 18.18%; P > 0.05). The degree of stress shielding had a different distribution for the two groups (P < 0.05). In the HA group and the LA group, the median percentage difference of the BMD on the operated side was −25% and was −13% in Zone 1, −8% and − 1% in Zone 2, +1% and 3% in Zone 3, +6% and + 6% in Zone 4, −2% and +2% in Zone 5, −3% and −1% in Zone 6, and −24% and −12% in Zone 7 compared with the unoperated side. The BMD was significantly reduced in the medial proximal femur (Zone 1) and the lateral proximal femur (Zone 7) in both groups (P < 0.05). Furthermore, it was increased in the distal femur (Zone 4) in the HA group (P < 0.05). No difference was found in the BMD when comparing between groups. Regarding secondary outcomes, there was no statistical difference in day 1 ESR and day 1 CPR. The average LOS was similar in the HA and LA groups (7.00 days vs 7.18 days, P > 0.05). The HHS on day of discharge was higher in the HA group than in the LA group (60.73 ± 5.37 points vs 51.18 ± 8.05 points, P < 0.05); however, no statistically significant difference was found in postoperative the HHS at 2 months (81.73 ± 6.92 points vs 78.36 ± 9.18 points, P > 0.05) and 6 months (90.45 ± 5.24 points vs 91.55 ± 4.03 points, P > 0.05). Conclusion: High activity levels during early rehabilitation after primary THA accelerate the process of bone remodeling and aggravate stress shielding, with no significant benefits for functional recovery. [ABSTRACT FROM AUTHOR]

Objective: This article aimed to investigate older adults visiting a geriatric institution for a bone density measurement who reported dizziness on a daily or weekly basis (but who are not seeking care for dizziness), according to BPPV, vestibular function, walking abilities, and frequency of falls. Methods: Patients coming for a bone density measurement answered questions regarding occurrence of dizziness. Patients having dizziness on a daily or weekly basis were considered eligible for the study and invited for investigation at the Ear, Nose, and Throat clinic at Södra Älvsborg Hospital, Sweden. The patients answered questions about history of dizziness, medications, and comorbidities. They were also investigated for BPPV, vestibular deficits using the video head impulse test (vHIT), walking speed, Timed Up and Go test (TUG), and for perception of verticality and horizontality and Romberg test. Results: A total of 55 patients with dizziness were included. Fifteen (27%) were diagnosed with BPPV. Forty (73%) patients reported falling during the previous year, including 11 with BPPV. Dizziness when turning in bed was more common among patients with BPPV and increased the risk of BPPV 8‐fold. Conclusion: BPPV is common among older adults with dizziness, including among those not seeking medical care. It is important to identify older adults with BPPV and treat the condition since BPPV may contribute to falls. Asking about dizziness when turning in bed can help to distinguish patients with increased risk for BPPV and older adults with dizziness should be investigated for BPPV even when typical history is lacking. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

We examined bone mineral density (BMD) in the pectoral flipper of the common bottlenose dolphin, Tursiops truncatus. These data addressed the need to define a comprehensive target site for osteodensitometric assessment and to provide a descriptive bone density data set for this species. We analyzed 388 radii from 279 bottlenose dolphins using dual energy X‐ray absorptiometry (DXA), the accepted standard in human medical studies. Radii were examined for differences based on sex, age, total body length, handedness, geographical affinity, and nutritional status at death. BMD increased with age and body length (R2 = 0.58, p <.05). No statistically significant differences were observed in BMD measurements for male and female dolphins (t = −1.60, p >.05) or right and left flippers (t = −1.76, p >.05). Additionally, no statistically significant differences were observed based on geographical region (t = −0.190, p >.05) or nutritional status (F = 0.83, p >.05). These results support the use of these findings as a preliminary descriptive data set for BMD in bottlenose dolphins and detail a primary skeletal site for clinical assessment of bone density for the species. As this study relies on archived museum specimens collected from dolphins at time of death, further studies regarding bone density may be better addressed using live dolphins with known health status. [ABSTRACT FROM AUTHOR]

Objective: Dual energy radiography (DER) makes it possible to obtain separate images for soft‐tissue and bony structures (tissue maps) based on the acquisition of two radiographs at different source peak‐kilovoltage values. Current DER studies are based on the weighted subtraction method, which requires either manual tuning or the use of precomputed tables, or on decomposition methods, which make use of a calibration to model soft‐tissue and bone components. In this study, we examined in depth the optimum method to perform this calibration. Methods: We used simulations to optimize the calibration protocol and evaluated the effect of the material and size of a calibration phantom composed of two wedges and its positioning in the system. Evaluated materials were water, PMMA and A‐150 as soft‐tissue equivalent, and Teflon, B‐100 and aluminum as bone equivalent, with sizes from 5 to 30 cm. Each material combination was compared with an ideal phantom composed of soft tissue and bone. Our simulation results enabled us to propose four designs that were tested with the NOVA FA X‐ray system with a realistic thorax phantom. Results: Calibration based on a very simple and inexpensive phantom with no strict requirements in its placement results in appropriate separation of the spine (a common focus in densitometry studies) and the identification of nodules as small as 6 mm, which have been reported to have a low rate of detection in radiography. Conclusion: The proposed method is completely automatic, avoiding the need for a radiology technician with expert knowledge of the protocol, as is the case in densitometry exams. The method provides real mass thickness values, enabling quantitative planar studies instead of relative comparisons. [ABSTRACT FROM AUTHOR]

Unstable pelvic ring fractures are severe and complex injuries, and surgical fixation is challenging and can be complicated by early failure due in part to difficulties with securely fixing screws in low‐density bone. There is limited information in the literature about how the density distribution across the pelvic bones changes with age and sex. In this study, we used 60 sets of calibrated bone density measurements obtained opportunistically from clinical computed tomography scans of the pelvis. Three‐dimensional models of the innominate bone were produced and the effects of age and sex on cortical bone density modeled. Overall trends and regions where these factors had a significant effect were identified, and the results visualized. Across the entire innominate bone, the mean loss of density was found to be 1.6 mg/cc per year, with several specific areas (pubic body, iliac fossa, posterior ilium, and anterior inferior iliac spine for example) showing significant rates of loss up to three times greater than the rest of the bone. Areas significantly affected by sex included the posterior pubic root, anterior aspect of the pubic body, and iliac crest. Despite overall trends of attenuation, there remains significant variability between individuals. This supports the need to further explore subject‐specific planning tools for pelvic fracture repair. Statement of clinical significance: Bone density changes across the innominate bone due to age and sex tend to vary between individuals, although consistent effects were seen at specific regions. This information may help in surgical planning of unstable fracture repairs. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness and safety of oral bisphosphonates in increasing bone mineral density (BMD), reducing fractures, and improving clinical function in patients with osteogenesis imperfecta (OI). Methods: Studies were eligible for inclusion if they were randomized controlled trials of directly comparing oral bisphosphonate therapy with placebo‐group in OI patients. Data synthesis regarding to bone mineral density as measured by dual‐energy X‐ray absorptiometry (DEXA), decreased fracture incidence, change in biochemical markers of bone and mineral metabolism, bone histology, growth, bone pain, quality of life, and others were assessed, and meta‐analysis done when possible. Results: From 98 potential references and six randomized controlled studies a total of 263 participants receiving oral bisphosphonates and 143 placebo treatments contributed data to meta‐analysis. Pooled meta‐analysis of three studies suggested that there was significant difference between bisphosphonate treated group and placebo in number of patients with at least one fracture (mean difference 0.53, 95% confidence interval 0.32–0.89, P = 0.02). Pooled meta‐analysis of two studies suggested that significant difference was noted between bisphosphonate treated group and placebo in mean percentage change in spine BMD (T‐score) (mean difference 28.43, 95% confidence interval 7.09‐49.77, P = 0.009). The similar effect was shown in the term of mean change (Z‐score) in spine BMD. Conclusions: Significant improvement in lumbar areal BMD in patients affected with OI has been shown when treated with oral bisphosphonates, even though only a small population was enrolled. We cannot draw a definite conclusion that the increase in BMD can be translated into fracture reduction and clinical functional improvement. The optimal method, dose, type, initiation, and duration of oral bisphosphonates therapy still remains unclear. Well‐designed, adequately‐powered, placebo‐controlled RCTs investigating the effects of oral bisphosphonates on fractures reduction and improvement in quality of life in both children and adults are studied here. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) technology has rapidly evolved since its introduction in the 1970s. It is a highly important diagnostic tool for clinicians as demonstrated by the significant increase in utilization over several decades. However, much of the effort to develop and advance CT applications has been focused on improving visual sensitivity and reducing radiation dose. In comparison to these areas, improvements in quantitative CT have lagged behind. While this could be a consequence of the technological limitations of conventional CT, advanced dual‐energy CT (DECT) and photon‐counting detector CT (PCD‐CT) offer new opportunities for quantitation. Routine use of DECT is becoming more widely available and PCD‐CT is rapidly developing. This review covers efforts to address an unmet need for improved quantitative imaging to better characterize disease, identify biomarkers, and evaluate therapeutic response, with an emphasis on multi‐energy CT applications. The review will primarily discuss applications that have utilized quantitative metrics using both conventional and DECT, such as bone mineral density measurement, evaluation of renal lesions, and diagnosis of fatty liver disease. Other topics that will be discussed include efforts to improve quantitative CT volumetry and radiomics. Finally, we will address the use of quantitative CT to enhance image‐guided techniques for surgery, radiotherapy and interventions and provide unique opportunities for development of new contrast agents. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Osteoporosis is known to be intimately related to sympathetic nerve activity. We examined the relationship of plasma leptin with cortical and trabecular bone components in patients with type 2 diabetes mellitus. Materials and Methods: The present cross‐sectional study included 182 type 2 diabetes mellitus patients (93 men, 89 women). Cortical thickness (CoTh) and trabecular bone mineral density (BMD) were determined at the 5.5% distal radius using an LD‐100 ultrasonic bone densitometry device. Plasma leptin along with physical and laboratory measurements was simultaneously determined. Results: Plasma leptin, but not body mass index (BMI), was inversely correlated with CoTh (ρ = −0.487, P < 0.001), while BMI, but not plasma leptin, was positively correlated with trabecular BMD (ρ = 0.369, P < 0.001). In multivariable regression analysis, after adjustments for age, sex, duration of diabetes, glycated hemoglobin A1c, albumin, estimated glomerular filtration rate, parathyroid hormone and handgrip strength, plasma leptin was inversely associated with CoTh (β = −0.258, P < 0.001), but not trabecular BMD. Furthermore, plasma leptin level retained a significant association with CoTh after further adjustment for BMI (β = −0.237, P < 0.001) and BMI plus waist‐to‐hip ratio (β = −0.243, P < 0.001). In contrast, the "sex × leptin" interaction was not significant (P = 0.596). Conclusions: Leptin level in plasma, independent of BMI and BMI plus waist‐to‐hip ratio, was shown to be inversely associated with CoTh, but not trabecular BMD, suggesting that hyperleptinemia resulting from obesity might contribute to cortical porosis in patients with type 2 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Osteopenia, loss of bone mineral density (BMD), was recently identified to be independently associated with early marker of deconditioning that precedes sarcopenia in patients with hepatocellular carcinoma (HCC). The aim of this study was to clarify the impact of osteopenia as the risk factor for mortality after living donor liver transplantation (LDLT) compared with already-reported biological markers. Methods: Data were collected retrospectively for all consecutive patients who underwent LDLT for HCC at our institution between January 1998 and December 2015. BMD was evaluated with computed tomographic measurement of pixel density in the midvertebral core of the 11th thoracic vertebra. Data related to clinicopathological parameters and prognosis were analyzed. Results: The median value of BMD was 163.6 Hounsfield units and osteopenia was identified in 103 (53.4%) of the 193 recipients, according to the age-specific formula. In addition to the other tumor burdens, such as tumor numbers ≥5 (HR 2.521, P = 0.027), DCP levels >200 mAU/mL (HR 2.678, P = 0.006), and neutrophil-to-lymphocyte ratio ≥3.01 (HR 2.068, P = 0.025), osteopenia (HR 2.106, P = 0.024) was independent risk factor for mortality by multivariate analysis. Overall survival of the patients who met the two risk factors and more was significantly lower than the others (HR 5.382, P < 0.001). Besides, the calibration plot for the 5-year overall survival using nomogram was predicted very well (C-index 0.746). Conclusions: Preoperative osteopenia was independently associated with post-LDLT mortality among patients with HCC. Moreover, risk score and nomogram with calibration curve were developed to confirm the clinical usefulness of osteopenia for post-LDLT patients. [ABSTRACT FROM AUTHOR]

Bone mineral density (BMD) is not the sole predictor of fracture development. Qualitative markers including bone collagen maturity contribute to bone fragility. Bone and related type I collagen containing connective tissues degenerate in parallel fashion. With aging, changes in skin collagen content and quality have been observed that can be detected on ultrasound (US) as a decrease in dermal thickness and an increase in reticular layer echogenicity. We hypothesized that US dermal thickness and echogenicity correlate with bone collagen maturity. Data of 43 prospectively enrolled patients (mean age 61 years, 24 females), who underwent instrumented, posterior lumbar fusion was analyzed. Besides preoperative quantitative computed tomography (QCT) and skin US measurements, intraoperative bone biopsies were obtained and analyzed with Fourier‐transform infrared spectroscopy. Among men, there was no correlation between US measurements and collagen maturity. Among women, dermal layer thickness correlated negatively with collagen maturity in trabecular bone of the iliac crest (r = −0.51, p = 0.01) and vertebra (r = −0.59, p = 0.01) as well as in cortical bone of the iliac crest (r = −0.50, p = 0.02) and vertebra (r = −0.50, p = 0.04). In addition, echogenicity correlated positively with collagen maturity in trabecular vertebral bone (r = 0.59, p = 0.01). In both genders, US measurements showed no correlation with QCT BMD. In summary, ultrasound skin parameters are associated with bone quality factors such as collagen maturity, rather than bone quantity (BMD). Ultrasound of the skin may thereby be an easy and accessible take off point for diagnosis of bone collagen maturity and connective tissue degeneration in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2508–2515, 2019 [ABSTRACT FROM AUTHOR]

In marine mammal life history and health studies, knowledge of age is extremely important from both pathological and epidemiological perspectives, transcending population dynamic studies and allowing for a more complete assessment of an individual animal's overall biological health (Hohn [8], Stolen and Barlow [11]). Further, if bone density could serve as a proxy for age estimation, and if a technique to assess bone density of live dolphins in the field could be developed, an alternative to tooth extraction would be established. The practical applications of this approach would have excellent value in various marine mammal research settings but would require that bone density values at any given age have very limited variance and that the technique should be broadly applicable across all ages. [Extracted from the article]

Context: Bone loss is accelerated in the late perimenopause and early menopause. The date of the final menstrual period cannot be stated until 1 year after it has ended, and at that time, most of the rapid bone loss phase will have elapsed. Therefore, early detection of bone loss is crucial. Objectives: To evaluate the utility of bone turnover markers (BTM) to identify the women who are more likely to lose more bone mass during the transition to menopause and quantify the loss of bone quality measured by trabecular bone score (TBS). Design, patients and setting: Sixty‐four healthy premenopausal women, mean age between 44 and 57 years old, were enrolled and followed up for 5 years. Clinical features, lifestyle, bone densitometry, TBS and BTM (CTX, P1NP and osteocalcin) were measured at baseline and follow‐up. Results: All women had densitometrically normal bone at the time of enrolment. After 5 years, 48.4% had normal bone mineral density, 45.8% low bone mass and 6.3% osteoporosis. Women with osteopenia/osteoporosis at follow‐up had higher CTX and P1NP at enrolment compared with women with densitometrically normal bone. The areas under the curve for the prediction of low bone mass or osteoporosis were 0.69 (P = 0.011) for P1NP, 0.69 for CTX (P = 0.013) and 0.77 (P 0.001) for OC. A significant correlation was found between P1NP increase after 5 years and the decrease in lumbar bone density (r = −0.383, P = 0.002). At baseline, 7 (10.9%) women had deteriorated microarchitecture (TBS < 1.3). Three of these women developed osteoporosis and four osteopenia at follow‐up. Conclusions: Women with higher P1NP and CTX and lower TBS at baseline had lower BMD in the transition to menopause suggesting these novel tools could have potential use in identifying women at high risk of rapidly decreasing bone mass. [ABSTRACT FROM AUTHOR]

Introduction: Representatives appointed by relevant Australian medical societies used a systematic approach for adaptation of guidelines (ADAPTE) to formulate clinical consensus recommendations on assessment and management of bone health in women with oestrogen receptor-positive early breast cancer receiving endocrine therapy. The current evidence suggests that women receiving adjuvant aromatase inhibitors and pre-menopausal woman treated with tamoxifen have accelerated bone loss and that women receiving adjuvant aromatase inhibitors have increased fracture risk. Both bisphosphonates and denosumab prevent bone loss; additionally, denosumab has proven anti-fracture benefit in post-menopausal women receiving aromatase inhibitors for hormone receptor-positive breast cancer.Main Recommendations: Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density measurement, with monitoring based on risk factors. Weight-bearing exercise and vitamin D and calcium sufficiency are recommended routinely. Anti-resorptive treatment is indicated in women with prevalent or incident clinical or morphometric fragility fractures, and should be considered in women with a T score (or Z score in women aged < 50 years) of < - 2.0 at any site, or if annual bone loss is ≥ 5%, considering baseline bone mineral density and other fracture risk factors. Duration of anti-resorptive treatment can be individualised based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with anti-resorptive treatments are low.Changes in Management As Result Of the Position Statement: Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimised by non-pharmacological intervention and, where indicated, anti-resorptive treatment, in an individualised, multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) related to muscle weakness. Where weakness is asymmetrical, bone densitometry measured only on the stronger LE may misclassify BMD.Objective: To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck.Design: Retrospective study.Setting: Outpatient postpolio center.Participants: Patients >18 years old with complete relevant data.Main Outcome Measures: Bone densitometry T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score.Results: Forty-three patients had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had bone densitometry only on their weaker LE and 14 (32.5%) had bone densitometry only on their stronger LE. Of the 15 patients with bone densitometry done on both femoral necks, T scores (mean [SD]) were lower in the weaker LE (-1.73 [1.09]) than the stronger LE (-0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively).Conclusions: In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Bone mineral density (BMD) in the lumbar spine and femoral neck, the incidence of osteoporosis, and survival up to 10 years after heart transplantation (HT) were investigated in 169 patients who underwent HT at Skåne University Hospital in Lund, Sweden, 1988‐2016. Within the first year post‐transplantation, mean (SD) BMD decreased by 3.9% (10.1) (P < 0.001) and 9.0% (10.5) (P < 0.001) in the lumbar spine and femoral neck, respectively. The cumulative incidence of osteoporosis in the lumbar spine and femoral neck increased rapidly within the first year after HT and was detected in 17% and 13% of the patients, respectively. A higher T score before HT was a negative predictor of osteoporosis up to 10 years post‐HT in the lumbar spine (HR 0.13; 95% CI 0.063‐0.26; P < 0.001) and femoral neck (HR 0.54; 95% CI 0.34‐0.85; P < 0.001). Moreover, only 13%, 14%, and 6% of the HT patients received calcium, vitamin D, and/or bisphosphonates before HT. In conclusion, BMD drops significantly during the first postoperative year. Optimization of BMD early among HT candidates, potentially through usage of osteoporosis preventive treatment, may be a future means to prevent osteoporosis late postoperatively. [ABSTRACT FROM AUTHOR]

An experiment was conducted to evaluate the effects of phytase (PHY), alone or in combination with citric acid (CA), on growing Japanese quails under moderate and severe phosphorus (P) restriction. For this, 504 one‐day‐old female quails were distributed in a completely randomised design with seven treatments and six replications. Treatments consisted of the following diets: (a) positive control (PC): formulated according to quails nutritional requirements; (b) negative control 40% (NC40): PC with 40% less aP; (c) NC40+PHY; (d) NC40+PHY+CA; (e) negative control 65% (NC65): PC with 65% less aP; (f) NC65+PHY; (g) NC65+PHY+CA. Phytase and CA were included at 300 FTU/kg and 40 g/kg, respectively. Performance, bone mineralization and plasma mineral concentration were evaluated at day 35; calcium (Ca) and P metabolism, between days 36 and 39. No significant differences in performance, plasma Ca and P were detected between quails fed PC or NC40; however, NC40 decreased tibia ash (p < 0.01). Treatment NC65 impaired daily weight gain (p = 0.01), tibia ash (p < 0.01), and tibia optical densitometry (p = 0.03), as well as modified plasma Ca (p < 0.01) and P (p = 0.03) concentrations when compared to PC. Both NC40 and NC65 reduced P excretion (p < 0.01). Phytase alone restored tibia ash of NC40 quails to regular rates. Nevertheless, only PHY and CA combined returned plasma P, tibia ash, tibia optical densitometry, and daily weight gain of quails fed NC65 to similar values as those observed in PC. In conclusion, PHY alone suppresses the negative effects of moderate P restriction in growing Japanese quails, but fails in this task under severe P restriction. In such a situation, only the combination of PHY and CA ensures regular rates of growth and bone mineralization. This concept should be better explored by producers in order to take full advantage of the reduction in P excretion achieved by lowering dietary P concentrations. [ABSTRACT FROM AUTHOR]

Background: Earlier studies noted that young adults with IgE‐mediated cow's milk allergy (IgE‐CMA) have significantly lower bone mineral density (BMD) than age‐ and gender‐matched controls. We sought to identify additional risk factors contributing to the low BMD in IgE‐CMA patients. Methods: Postpubertal (defined by Tanner stage V) IgE‐CMA patients (n = 78; 16‐ to 30‐year‐old females and 17.5‐ to 30‐year‐old males) were evaluated prospectively for BMD using a DXA scan, serum values of bone turnover factor, and dietary and lifestyle questionnaires. Patients receiving > 2 short courses of systemic steroid treatments were excluded. Results: Abnormal BMD measurements (T‐ or Z‐scores < −1.0) of the lumbar vertebrae, femoral neck, or hip were noted in 60 patients, while normal BMD values were present in 18 patients, despite similarly decreased calcium intakes between the groups (P = 0.92). Patients with abnormal BMD were more likely to be asthmatic (P = 0.014), have a lower weight z‐score (P = 0.007), have a decreased percent caloric intake derived from fat (P = 0.01), and have an increased carbohydrate intake (P = 0.03), in comparison with the normal‐BMD group. Serum values of bone turnover were similar between the groups. On multivariate regression analysis, only asthma significantly (P = 0.006) increased the risk for osteopenia and osteoporosis (OR 38.5, 95% CI 2.8‐500). Fitting continuous z‐scores into a regression model, both asthma and weight z‐score were significant (adjusted r2 = 0.272). Asthma was significantly overrepresented in osteopenic and osteoporotic subpopulations while decreased weight only in patients with osteoporosis. Conclusions: In the context of a low calcium intake, asthma and weight are independent risk factors for decreased BMD in IgE‐CMA patients. [ABSTRACT FROM AUTHOR]