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Detecting individuals with low bone mineral density (BMD) before clinical fractures occur may help improve the outcomes of osteoporosis and osteopenia. Although computed tomography (CT) is useful for opportunistic BMD measurement, the modality most suitable for opportunistic screening remains unclear. In this retrospective study, we compared the diagnostic performance of low-dose chest CT (LDCT) and contrast-enhanced abdominopelvic CT (APCT) for measuring BMD at L1 level using dual-energy X-ray absorptiometry (DEXA) as a reference in individuals who underwent LDCT, APCT, and DEXA assessments on the same day. We included 512 individuals (median age: 60 years; interquartile range, 55−65 years; 307 men). Both LDCT (r = 0.706; P < 0.001) and APCT (r = 0.643; P < 0.001) exhibited strong correlation with DEXA T-scores. As T-scores decreased, the relative difference between LDCT and APCT Hounsfield unit values increased (b = − 6.456; P < 0.001). LDCT outperformed APCT in diagnosing both osteoporosis (AUC, 0.865 vs. 0.833; P = 0.035) and low BMD (AUC, 0.844 vs. 0.815; P = 0.006), which may be attributable to the greater effect of intravenous contrast media on CT scan characteristics in individuals with lower T-scores. These results may help inform the selection of imaging methods suitable for screening. [ABSTRACT FROM AUTHOR]

Osteoporosis is underdiagnosed and undertreated. To improve timely fracture risk assessment optimized densitometry methods are required such as opportunistic spinal quantitative computed tomography (QCT). However, it is unclear how to best calibrate these scans and correct for potential scanner drift of QCT when used for monitoring bone mineral density (BMD) changes. We compared gold standard simultaneous calibration with asynchronous calibration methods, assessing mid-term (12 weeks) and long-term (1.5 years) reproducibility of BMD measurements. Cortical and trabecular compartments of the European Spine Phantom were studied with ten different protocols including low dose and high resolution (HR)-modes. Based on weekly phantom data, we compared simultaneous calibration to asynchronous single (termed global) or monthly calibration. The accuracy was better for trabecular measurements than for cortical measurements for all calibration methods. Reproducibility was excellent for all methods and slightly better for asynchronous than for simultaneous calibration both for trabecular and cortical bone. For HR protocols, reproducibility was better than for low dose measurements. In trabecular compartments averaged HR-BMD remained stable for global (− 0.1%/year, ns) but not for simultaneous calibration (− 1.5%/year, p < 0.001). No significant drifts could be detected for averaged low dose BMD (− 0.9 to + 0.8%/year) for either calibration method. Our data suggest that with regard to precision and accuracy measurements with asynchronous calibration are suitable for vertebral BMD assessment (no contrast agents) in clinical practice. Regular (e.g., monthly) stability tests using a calibration phantom could assure long term stability of at least 1 year. [ABSTRACT FROM AUTHOR]

MTX is an effective and widely used immunomodulatory drug for rheumatoid diseases. MTX osteopathy is a very rare and specific side effect, characterized by stress fractures at multiple locations in the lower extremity, hampering the patient's mobility by pain and loss of function. In clinical practice, osteoporosis and MTX osteopathy are repeatedly confused and a comparative workup is needed to clarity it's specifics. Furthermore, specific treatment options for MTX osteopathy need to be established. We compared patients suffering from MTX osteopathy to patients with osteoporosis (OPO). Patients underwent an extensive clinical workup including blood sampling, bone mineral density measurements, high-resolution peripheral quantitative computed tomography and muscular performance testing. Furthermore, treatment regimes in MTX osteopathy were compared with respect to regain of mobility and pain reduction. 83 patients with MTX osteopathy and 89 with OPO were included. Patients with MTX osteopathy did exhibit fractures predominantly at the lower extremity and pain scores were significantly higher (MTX: 6.75 ± 1.86 vs. OPO: 3.62 ± 2.95, p < 0.0001). MTX-caused mobility restriction was successfully reduced by treatment only if MTX was discontinued (pre-treatment: 2.16 ± 1.19 vs. post-treatment: 1.04 ± 0.87, p < 0.0001). Most mobility gain was achieved by involving anabolic treatment (anabolic: 2.1 ± 1.02 vs. antiresorptive: 1.09 ± 0.94, p < 0.05). In summary, MTX osteopathy is characterized by distinct lower extremity stress fractures leading to severe pain and immobility. Discontinuation of MTX is essential to enable treatment success and involving anabolic treatment seems to be more effectively in mobility regain as antiresorptive treatment alone. [ABSTRACT FROM AUTHOR]

The incidence of osteoporosis and related fractures increases significantly with age, impacting public health and associated costs. Postmenopausal osteoporosis results from increased bone resorption due to decreased estrogen levels. The endocannabinoid system, especially cannabidiol (CBD), has shown therapeutic potential in modulating bone formation. This study investigated the effects of administration of CBD in rats after the onset of with ovariectomy-induced osteopenia (OVX). Forty-eight female Sprague‒Dawley rats were divided into four groups (n = 12): OVX + CBD, SHAM + CBD, OVX + vehicle, and SHAM + vehicle. CBD was administered intraperitoneally for 3 weeks. After euthanasia, the bone quality, mechanical properties, and bone microarchitecture of the femurs and lumbar vertebrae were assessed by microcomputed tomography (micro-CT), bone densitometry, mechanical tests, and histological and immunohistochemical analyses. CBD treatment improved the bone mineral density (BMD) of the lumbar vertebrae and increased the BV/TV% and Tb.N in the femoral neck. There were also improvements in the mechanical properties, such as the maximum force and stiffness of the femurs and vertebrae. CBD significantly increased the bone matrix in osteopenic femurs and vertebrae, Although did not significantly influence the expression of RANKL and OPG, in ovariectomized animals, there was an increase in osteoblasts and a decrease in osteoclasts. Determining the optimal timing for CBD use in relation to postovariectomy bone loss remains a crucial issue. Understanding when and how CBD can be most effective in preventing or treating bone loss is essential to emphasize the importance of early diagnosis and treatment of osteoporosis. However, further studies are needed to explore in more detail the efficacy and safety of CBD in the treatment of postmenopausal osteoporosis. [ABSTRACT FROM AUTHOR]

Age-at-death estimation is an important issue in forensic medicine and anthropology. Initially, methods relied on morphological criteria, but with the advancement of radiology, new techniques such as morphological studies on multi-slice computed tomography (CT) reconstructions have emerged. Recent studies have shown promising results by investigating the correlation between age and bone mineral density (BMD). However, there is currently a lack of data on post-mortem CTs (PMCT) involving decomposed bodies, and limited information exists regarding changes in Hounsfield Units measurement in a post-mortem context. In light of these gaps, our study aimed to examine the relationship between age at death and pubic and ilium BMD using a sample of forensic bodies. We also aimed to determine whether post-mortem processes, such as putrefaction, could interfere with this correlation. Our retrospective analysis encompassed 637 PMCTs conducted before medicolegal autopsies at Tours University Hospital. Utilizing simple and multiple linear regressions, we investigated the correlation between age and pubic and ilium BMD, as well as the relationship between BMD and the radiologic alteration index (RAI), a scale employed to quantify the degree of putrefaction. Our findings indicate promising outcomes in age-at-death estimation using pubic and/or ilium BMD for bodies exhibiting no or moderate decomposition (RAI < 80), particularly among individuals under 40 years old. However, for highly decomposed corpses (RAI ≥ 80), the presence of gas infiltration significantly influences the BMD of both the ilium and pubis. Consequently, we advocate for the incorporation of the RAI score into the age estimation equation to enhance the accuracy of our results in such cases. Further investigation involving a larger cohort of decomposed bodies could facilitate refinement and validation of our method within this specific population. [ABSTRACT FROM AUTHOR]

Thalassemic osteopathy includes low bone mass and impaired bone microarchitecture. We aimed to evaluate the prevalence and determinants of bone quantity (osteoporosis) and quality (microarchitecture) in a cohort of adult patients with transfusion-dependent thalassemia (TDT). Patients with TDT (n = 63) and age- and BMI-matched controls (n = 63) were recruited in the study. Areal bone mineral density (BMD) was measured using DXA Hologic scanner. P1NP and β-CTX were estimated by electrochemiluminescence assay. Bone geometry and volumetric BMD (vBMD) were estimated by second-generation high-resolution peripheral quantitative computed tomography. Bone turnover marker β-CTX was significantly lower in the TDT group, but there was no difference in P1NP levels. Low bone mass (Z ≤ −2) was present in greater proportion of patients both at lumbar spine (LS) (54 vs 0%; p = .001) and femoral neck (FN) (33 vs 8%; p = .001). Hypogonadism was associated with low BMD at FN (OR 10.0; 95% CI, 1.2–86; p = .01) and low hemoglobin with low BMD at LS (OR 1.58; 95% CI, 0.96–2.60; p = .07). The mean trabecular bone score was also significantly lower in patients compared with controls (1.261 ± 0.072 vs 1.389 ± 0.058). Total, cortical and trabecular vBMD were significantly lower in cases than controls. The trabecular number and cortical thickness were significantly lower and trabecular separation higher in cases than controls. Adults with TDT have significantly lower areal, cortical and trabecular vBMD. The bone microarchitecture is also significantly impaired in terms of lower number and wider spacing of trabeculae as well as lower cortical thickness and area at both radius and tibia. Graphical Abstract Lay Summary: Bone quantity and quality are likely to be affected in patients with thalassemia who are dependent on regular blood transfusions. This study evaluated bone health in adults with transfusion-dependent thalassemia (TDT) by comparing bone density and microarchitecture with age- and BMI-matched controls. Adults with TDT had significantly lower bone mineral density (both areal and volumetric), suggesting low bone quantity compared to healthy controls. Trabecular and cortical microarchitecture were also adversely affected, suggesting impaired bone quality. Overall, the study highlights that adults with TDT have significantly compromised bone quantity and quality, increasing their risk for osteoporosis and related fractures. [ABSTRACT FROM AUTHOR]

The systematic review from the Croatian Medical Journal examines the relationship between bone mineral density (BMD) and chronic obstructive pulmonary disease (COPD) patients using chest CT scans. Some studies suggest a decrease in BMD in COPD patients, while others indicate that milder forms of COPD may not be strongly associated with osteopenia or osteoporosis in the spine. Factors like age, sex, BMI, and corticosteroid therapy can impact BMD values in COPD patients. The review underscores the importance of assessing BMD in COPD patients to understand fracture risks and overall bone health, particularly in relation to spine surgery and conditions like corticosteroid-induced osteoporosis. [Extracted from the article]

Osteoporosis in children and young adults is relatively rare. Hereditary causes are often overlooked in the absence of a positive family history. We report a 29-year-old male presenting with recurrent fragility fractures since 6 years of age. Secondary causes, such as celiac disease, inflammatory disorders, and hypogonadism, were ruled out. Family history was negative for any bone disease. Exome sequencing revealed 2 variants of LRP5 gene—intron 5 c.1015 + 1G > A and exon 5 c.892C > T. Although the former variant has been described in literature as a cause of osteoporosis in homozygous state only, it manifested as osteoporosis in our patient, in the heterozygous state, in presence of a second variant of uncertain significance. However, eye involvement, which is classically seen in "osteoporosis-pseudoglioma syndrome" homozygote, was absent in our patient. Genetic analysis of the parents revealed father to be a carrier of intron 5 c.1015 + 1G > A and mother exon 5 c.892C > T variants of the LRP5 gene. However, none of them had osteoporosis on bone densitometry. The patient was subsequently treated with IV zoledronic acid (planned to be administered annually) and showed improvement in bone density by 11% at the spine and 9.5% at the left femur; there were no further fractures over 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Background: Previous studies have primarily focused on the links between fine particulate matter (PM2.5) and bone health among the general population instead of PM2.5 components and the specific population. We aimed to investigate the associations between PM2.5 components and bone health among middle-aged and elderly women. Methods: A total of 748 middle-aged and elderly women were randomly sampled from 32 streets/villages in Hubei Province. The concentrations of ambient PM2.5 and its components were extracted across various residential areas from the Tracking Air Pollution in China (TAP) dataset. Bone mineral density measurements were obtained from dual-energy X-ray absorptiometry scans of study participants. Multivariable logistic and linear models were employed to assess the relationship between PM2.5 and its components and bone loss. Results: Per interquartile range (IQR) increase in nitrate (NO3−) and ammonium (NH4+) concentrations were associated with 1.65 [95% confidence intervals (CI): 1.13, 2.30] and 1.77 (95% CI: 1.26, 2.49) times higher odds of osteoporosis, respectively. Long-term exposure to sulfate (SO42−), NO3−, and NH4+ was negatively associated with T-scores and bone mineral density in L1-L4 lumbar vertebrae. In addition, the elderly, women who have experienced menarche after the age of 14, and postmenopausal women were more susceptible to the water-soluble inorganic salts of PM2.5. Conclusion: The study emphasizes the need for comprehensive policies addressing air quality, with a specific focus on vulnerable populations such as middle-aged and elderly women. Public health interventions aimed at reducing ambient PM2.5 concentrations and minimizing exposure to its harmful components are crucial in mitigating the adverse impact on skeletal health and improving the overall well-being of communities. [ABSTRACT FROM AUTHOR]

Twenty years have passed since the introduction of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess human bone microarchitecture. During that time, the technique has emerged as an important research tool used by clinicians and scientists to learn about the pathophysiology of bone adaptation in the context of osteoporosis and many other bone-affected conditions. Its rich three-dimensional data is well suited for precise longitudinal monitoring of bone microarchitecture and associated patient-specific estimated bone strength. However, uptake of HR-pQCT as a clinical diagnostic tool has been limited, in part due to challenges such as availability, regulatory approvals, and demonstrated cost effectiveness. New research suggests fracture risk assessment using HR-pQCT is comparable with current standards based on traditional bone densitometry, but its contribution to clinical care is best suited to two areas: (1) leveraging microarchitectural information to assist in treatment decisions for the large subset of patients who lie in the so-called gray zone by current fracture risk assessment, and (2) longitudinal monitoring that establishes highly refined trajectories of bone adaptation and can inform decisions to initiate treatment, monitor treatment effects, and inform cessation. [ABSTRACT FROM AUTHOR]

Some studies have used physical techniques for the assessment of bone structure and composition. However, very few studies applied multiple techniques, such as those described below, at the same time. The aim of our study was to determine the chemical and mineralogical/organic composition of bovine tibial bone samples using geophysical/geochemical reference techniques. X-ray diffraction (XRD), thermogravimetry (TG), Fourier-transform infrared spectrometry with attenuated total reflectance accessory (FTIR-ATR), inductively coupled mass spectrometry (ICP-MS) and inductively coupled optical emission spectrometry (ICP-OES) were applied to measure the organic and inorganic composition of 14 bovine bone samples. In addition, peripheral quantitative CT (QCT) was used to assess BMD in these bones. We were able to define the total composition of the studied bone samples. ICP-OES and ICP-MS techniques were used to determine the major and trace element composition. The X-ray analysis could detect inorganic crystalline compounds of bones, such as bioapatite, and its degree of ordering, indicating whether the bones belong to a younger or older individual. The total volatile content of the samples was calculated using TG and resulted in about 35 weight% (wt%). This, together with the 65 wt% total resulting from the chemical analysis (i.e., inorganic components), yielded a total approaching 100 wt%. As a large portion of the volatile content (H2O, CO2, etc.) was liberated from the organic components and, subordinately, from bioapatite, it could be concluded that the volatile-to-solid ratio of the examined bone samples was ~35:65. The FTIR-ATR analysis revealed that the organic portion consists of collagens containing amide groups, as their typical bands (OH, CH, CO, NC) were clearly identified in the infrared spectra. Numerous parameters of bone composition correlated with BMD as determined by QCT. In conclusion, we performed a complex evaluation of bovine bones to test multiple geophysical/geochemical techniques in bone research in association with QCT bone densitometry. From a medical point of view, the composition of the studied bones could be reliably examined by these methods. [ABSTRACT FROM AUTHOR]

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]

This study addresses the pressing need for improved methods to predict lean mass in adults, and in particular lean body mass (LBM), appendicular lean mass (ALM), and appendicular skeletal muscle mass (ASMM) for the early detection and management of sarcopenia, a condition characterized by muscle loss and dysfunction. Sarcopenia presents significant health risks, especially in populations with chronic diseases like cancer and the elderly. Current assessment methods, primarily relying on Dual-energy X-ray absorptiometry (DXA) scans, lack widespread applicability, hindering timely intervention. Leveraging machine learning techniques, this research aimed to develop and validate predictive models using data from the National Health and Nutrition Examination Survey (NHANES) and the Action for Health in Diabetes (Look AHEAD) study. The models were trained on anthropometric data, demographic factors, and DXA-derived metrics to accurately estimate LBM, ALM, and ASMM normalized to weight. Results demonstrated consistent performance across various machine learning algorithms, with LassoNet, a non-linear extension of the popular LASSO method, exhibiting superior predictive accuracy. Notably, the integration of bone mineral density measurements into the models had minimal impact on predictive accuracy, suggesting potential alternatives to DXA scans for lean mass assessment in the general population. Despite the robustness of the models, limitations include the absence of outcome measures and cohorts highly vulnerable to muscle mass loss. Nonetheless, these findings hold promise for revolutionizing lean mass assessment paradigms, offering implications for chronic disease management and personalized health interventions. Future research endeavors should focus on validating these models in diverse populations and addressing clinical complexities to enhance prediction accuracy and clinical utility in managing sarcopenia. [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]

Idiopathic juvenile osteoporosis (IJO) is a rare condition presenting with vertebral and metaphyseal fractures that affects otherwise healthy prepubertal children. Bone mineral density (BMD) measurements are very low. The primary problem appears to be deficient bone formation, with a failure to accrue bone normally during growth. The onset in childhood suggests IJO is a genetic disorder, and a number of reports indicate that some children carry heterozygous pathogenic variants in genes known to be associated with defective osteoblast function and low bone mass, most commonly LRP5 or PLS3. However, a positive family history is unusual in IJO, suggesting the genetic background can be complex. We describe a young man with classical IJO who was investigated with a bone fragility gene panel and whole genome sequencing. The proband was found to carry four variants in three different genes potentially affecting osteoblast function. From his mother he had inherited mutations in ALPL (p.Asn417Ser) and LRP5 (p.Arg1036Gln), and from his father mutations in LRP5 (p.Asp1551Alsfs*13) and activating transcription factor 4 (ATF4) (p.Leu306Ile). His sister had also inherited the LRP5 (p.Asp1551Alsfs*13) from her father, but not the ATF4 mutation. Their spinal BMD z-scores differed substantially (sister –1.6, father –3.2) pointing to the potential importance of the ATF4 mutation. Activating transcription factor 4 acts downstream from RUNX2 and osterix and plays an important role in osteoblast differentiation and function. This case, together with others recently published, supports the view that IJO can result from clustering of mutations in genes related to osteoblast development and function. Novel genes in these pathways may be involved. Our case also emphasizes the value of detailed study of other family members. After a bone biopsy had excluded a mineralization defect due to hypophosphatasia, the proband was treated with zoledronate infusions with good clinical effect. Lay Summary: Idiopathic juvenile osteoporosis (IJO) is a rare but disabling condition presenting with vertebral and metaphyseal fractures that affects otherwise healthy prepubertal children. Bone mineral density measurements are very low. The primary problem appears to be deficient bone formation, with a failure to accrue bone normally during growth. The onset in childhood suggests IJO is a genetic disorder, but a positive family history is unusual, suggesting that its genetic basis can be complex. We describe a young man with classical IJO who was investigated with a bone fragility gene panel and whole genome sequencing. He was found to have inherited four variants in three different genes potentially affecting osteoblast function: from his mother an ALPL mutation and an LRP5 mutation, and from his father a different LRP5 mutation and a mutation in AFT4, which codes for a transcription factor important in osteoblast differentiation. Together with some recently published cases, the findings in this family indicate that IJO may have a polygenic etiology. Graphical Abstract [ABSTRACT FROM AUTHOR]

This manuscript introduces a radical solution for early prediction of patient's bone health, employing a simply devised Hexagonal Ring Wearable Textile Antenna (HRWTA) exploiting the electromagnetic band gap (EBG) structures for Low Specific Absorption Rate (SAR). It is constructed using low loss woven polyester fabric as substrate and integrates conductive electro-textile fabric as a radiating unit. It has an on-body simulated and measured impedance (VSWR ≤ 2) bandwidth (BW) of 350 MHz (3.39-3.74 GHz, 10%) and 320 MHz (3.35-3.67 GHz, 9.2 %) without EBG respectively. HRWTA with EBG has bandwidth of 190 MHz (3.38-3.57 GHz, 5.4%) and 180 MHz (4.16-4.34GHz, 5.14%). The measured results are in good agreement with simulated. The shift in resonant frequency has been noticed for HRWTA #1 (2.45 GHz) and HRWTA#2 (4.2 GHz) while HRWTA#3 resonates at 3.5 GHz. This is due to fabrication tolerance and dielectric variation of fabrics due to trapped air bubble. Hence, HRWTA 3 is constructed with more precision which resonates at 3.5 GHz. It has a peak gain of 2.5 dB at 3.5 GHz and gain variation over the band is within 1 dB. By exploiting an EBG structure, electromagnetic radiation absorption is minimized and SAR obtained is within the allowable range ensuring safer interaction with the human body. HRWTA exhibits decent radiation characteristics, ample gain and agreeable act under bended condition makes it fit for wearable applications. HRWTA covers 3.4 GHz to 3.6 GHz band which holds specific significance in medical field for bone density measurement (BDM). [ABSTRACT FROM AUTHOR]

Copyright of Baghdad Science Journal is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SPORMETRE: The Journal of Physical Education & Sport Sciences / Beden Eğitimi ve Spor Bilimleri Dergisi is the property of SPORMETRE: The Journal of Physical Education & Sport Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study is to investigate the relationship between the use of high doses of levothyroxine (L-T4) and hearing loss in patients who have undergone surgery for thyroid cancer. Material method: After total thyroidectomy for thyroid cancer, patients were divided into two groups according to L-T4 dose below 150 µg and above 150 µg. Demographic characteristics, postoperative duration, radioactive iodine treatment, bone densitometry scans with LDxa and FDxa, and right and left ear hearing levels were statistically compared in both groups. Results: The study included 62 patients, 85.5% (n = 53) of whom were female, with a mean age of 48.8 ± 11.7 years. While 56.45% (n = 35) of the patients were taking L-T4 below 150 µg 43.55% (n = 27) were taking L-T4 above 150 µg. The mean postoperative duration of the participants was 4.1 ± 2.7 years, osteopenic 30.7% and osteoporotic 16.13% according to LDxa, osteopenic 29.0% and osteoporotic 1.6% according to FDxa. Hearing loss in both right and left ears was 41.9% and sensorineural hearing loss in both ears was 22.6%. Age, LDxa, FDxa, hearing loss in the right and left ear were found to be significantly different in the two groups above and below 150 µg according to the dose of L-T4 used (p < 0.05). However, no differences were found according to sex, height, weight, body mass index, postoperative period, or radioactive iodine treatment (p > 0.05). Both osteopenia and osteoporosis, as well as hearing loss in both the right and left ear, were significantly higher in the group taking L-T4 150 µg or more (p < 0.05). Conclusion: In our study, we found that patients taking 150 µg or more of L-T4 daily were more osteopenic and osteoporotic and had more hearing loss in both ears. [ABSTRACT FROM AUTHOR]

Bone is a complex tissue that fulfills the role of a resistance structure. This quality is most commonly assessed by bone densitometry, but bone strength may not only be related to bone mineral density but also to the preservation of bone cytoarchitectonics. The study included two groups of rats, ovariectomized and non-ovariectomized. Each group was divided into three batches: control, simvastatin-treated, and fenofibrate-treated. In the ovariectomized group, hypolipidemic treatment was instituted at 12 weeks post ovariectomy. One rat from each of the 6 batches was sacrificed 8 weeks after the start of treatment in the group. The experimental study was performed using a Bruker Minispec mq 20 spectrometer operating at a frequency of 20 MHz, subsequently also performed by 1H T2-T2 molecular exchange maps. The results were represented by T2-T2 molecular exchange maps that showed, comparatively, both pore size and their interconnectivity at the level of the femoral epiphysis, being able to evaluate both the effect of estrogen on bone tissue biology and the effect of the lipid-lowering medication, simvastatin, and fenofibrate, in both the presence and absence of estrogen. T2-T2 molecular exchange maps showed that the absence of estrogen results in an increase in bone tissue pore size and interconnectivity. In the presence of estrogen, lipid-lowering medication, both simvastatin and fenofibrate alter bone tissue cytoarchitectonics by reducing pore interconnectivity. In the absence of estrogen, fenofibrate improves bone tissue cytoarchitectonics, the T2-T2 molecular exchange map being similar to that of non-osteoporotic bone tissue. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of inflammatory bowel diseases (IBDs) has increased in recent decades. The incidence of osteoporosis in the population with IBD is higher than in the normal population. Therefore, it seems necessary to carefully examine the risk factors associated with decreased bone mineral density (BMD) among these patients.Methods and Materials: Patients with IBD completed a questionnaire including demographic data, drug history, underlying disease (past medical history), and family history, then their bone density was measured with a DEXA device. Also, laboratory samples were prepared. Densitometry results were placed in three groups: normal, osteoporotic, and osteopenia. All of the data was analyzed by SPSS version 23 software.Results: This study was conducted on 63 patients (58 patients with ulcerative colitis (UC) and 5 patients with Crohn's disease (CD)). The bone density was normal in 40 patients, 16 had osteopenia and 7 had osteoporosis. There was a significant relationship between bone density and age (P < 0.001), smoking (P=0.049), past medical history (P< 0.001), extraintestinal involvement (P=0.008), duration (P=0.023) and menopause (P=0.002). Also, the amount of use of corticosteroid drugs (P=0.014), the level of calcium (P=0.017), and vitamin D (P< 0.001) in the blood had a significant relationship with bone density.Conclusion: In our study, we showed that age, smoking status, underlying conditions, extraintestinal involvement, corticosteroid use, levels of vitamin D and calcium, and menopause are risk factors for an increased risk for decreased BMD in IBD patients.

This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p < 0.001), although regression analyses revealed a strong linear association between these measures (R2 = 0.84). A statistical model for the prediction of TNC-VCa CT attenuation was established (TNC-VCa[HU] = − 6.81 + 0.87 × VP-VCa[HU]-0.55 × body weight[kg]) and yielded good agreement between observed and predicted values. Furthermore, a L1 CT attenuation threshold of 293 HU in VP-VCa showed a sensitivity of 90% and a specificity of 96% for detecting osteoporosis. The application of contrast media leads to an overestimation of L1 CT attenuation in VCa. However, CT attenuation values from VP-VCa can be used within CT-based opportunistic osteoporosis screening eighter by applying a separate threshold of 293 HU or by converting measured data to TNC-VCa CT attenuation with the given regression equation. [ABSTRACT FROM AUTHOR]

Little is known about the impact of vitamin D supplementation on hand grip strength (HGS) and health-related quality of life (HRQoL) in children and adolescents with sickle cell disease (SCD). We aimed to evaluate the safety and efficacy of monthly high-dose vitamin D3 supplementation and its implications on bone mineral density (BMD), HGS, and HRQoL in patients with SCD and healthy controls. The study included 42 children with SCD and 42 healthy matched controls. The study participants were supplemented with high-dose monthly oral vitamin D3. Changes in the serum level of 25(OH) vitamin D3, maximum HGS, and BMD from baseline to 6 months were assessed, and the HRQoL questionnaire and Childhood Health Assessment Questionnaire (CHAQ) were used to evaluate the functional capacity. At baseline, SCD subjects had poorer growth status indicated by negative Z scores. Suboptimal BMD was detected by significantly lower Z score, and lower HGS and worse HRQL parameters were found compared to the controls (P < 0.001). Median 25(OH) vitamin D3 was significantly lower in SCD patients compared to controls (16.5 vs. 28 ng/mL, respectively (P < 0.001)). After 6 months of vitamin D supplementation, there was significant improvement in the DEXA Z-score (P < 0.001), limitation of physical health (P = 0.02), pain scores (P < 0.001), and CHAQ grades (P = 0.01) in SCD patients. A significant improvement in HGS (P < 0.001 and P = 0.005) as well as the CHAQ score (P < 0.001 and P = 0.003) was detected in the SCD group and controls, respectively. There were no reported clinical adverse events (AEs) or new concomitant medications (CMs) during the study duration, and safe levels of Ca and 25 (OH) D3 were observed at 3 and 6 months for both groups. There was a significant positive correlation between HGS and total physical score (r = 0.831, P < 0.001) and a negative correlation with CHAQ score (r = − 0.685, P < 0.001). We also detected a significant positive correlation between vitamin D levels at 6 months and HGS (r = 0.584, P < 0.001), pain score (r = 0.446, P < 0.001), and a negative correlation with CHAQ score (r = − 0.399, P < 0.001). Conclusion: Monthly oral high-dose vitamin D supplementation was safe and effective in improving vitamin D levels, HGS, and HRQoL in SCD children and healthy subjects, and BMD scores in SCD patients. Further randomized controlled trials are warranted to assess an optimal dosing strategy and to investigate the impact on clinically significant outcomes in children and adolescents with SCD and their healthy counterparts. Trial registration: ClinicalTrials.gov, identifier NCT06274203, date of registration: 23/02/2024, retrospectively registered. What is known: • Several studies have reported a high prevalence of vitamin D deficiency and suboptimal bone mineral density (BMD) in sickle cell disease (SCD) patients. • Musculoskeletal dysfunction is reported in SCD patients with a negative impact on physical activity and health-related quality of life (HRQL). • Little is known regarding the impact of vitamin D3 supplementation in children and adolescents with SCD. What is new: • We found that monthly oral high-dose vitamin D3 supplementation was safe, tolerated, and effective in improving serum vitamin D levels, HGS, BMD scores, and HRQL in SCD patients. [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]

Background: To investigate the reproducibility of automated volumetric bone mineral density (vBMD) measurements from routine thoracoabdominal computed tomography (CT) assessed with segmentations by a convolutional neural network and automated correction of contrast phases, on diverse scanners, with scanner-specific asynchronous or scanner-agnostic calibrations. Methods: We obtained 679 observations from 278 CT scans in 121 patients (77 males, 63.6%) studied from 04/2019 to 06/2020. Observations consisted of two vBMD measurements from Δdifferent reconstruction kernels (n = 169), Δcontrast phases (n = 133), scan Δsessions (n = 123), Δscanners (n = 63), or Δall of the aforementioned (n = 20), and observations lacking scanner-specific calibration (n = 171). Precision was assessed using root-mean-square error (RMSE) and root-mean-square coefficient of variation (RMSCV). Cross-measurement agreement was assessed using Bland-Altman plots; outliers within 95% confidence interval of the limits of agreement were reviewed. Results: Repeated measurements from Δdifferent reconstruction kernels were highly precise (RMSE 3.0 mg/cm3; RMSCV 1.3%), even for consecutive scans with different Δcontrast phases (RMSCV 2.9%). Measurements from different Δscan sessions or Δscanners showed decreased precision (RMSCV 4.7% and 4.9%, respectively). Plot-review identified 12 outliers from different scan Δsessions, with signs of hydropic decompensation. Observations with Δall differences showed decreased precision compared to those lacking scanner-specific calibration (RMSCV 5.9 and 3.7, respectively). Conclusion: Automatic vBMD assessment from routine CT is precise across varying setups, when calibrated appropriately. Low precision was found in patients with signs of new or worsening hydropic decompensation, what should be considered an exclusion criterion for both opportunistic and dedicated quantitative CT. Relevance statement: Automated CT-based vBMD measurements are precise in various scenarios, including cross-session and cross-scanner settings, and may therefore facilitate opportunistic screening for osteoporosis and surveillance of BMD in patients undergoing routine clinical CT scans. Key Points: Artificial intelligence-based tools facilitate BMD measurements in routine clinical CT datasets. Automated BMD measurements are highly reproducible in various settings. Reliable, automated opportunistic osteoporosis diagnostics allow for large-scale application. [ABSTRACT FROM AUTHOR]

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The purpose of this study was to evaluate the quantitative computed tomography (CT) volumetry and densitometry and in pediatric patients with pectus excavatum (PE). We measured pectus index (PI) and separated inspiratory and expiratory lung volumes and densities. We obtained the total lung volume (TLV) and mean lung density (MLD) during inspiration and expiration, and the ratio of end expiratory to inspiratory volume (E/I volume) and MLD (E/I density) were calculated. The difference between inspiratory and end expiratory volume (I-E volume) and MLD (I-E density) were also calculated. A total of 199 patients, including 164 PE patients and 35 controls, were included in this study. The result shows that the PE group had lower inspiratory TLV (mean, 2670.76±1364.22 ml) than the control group (3219.57±1313.87 ml; p = 0.027). In the PE group, the inspiratory (-787.21±52.27 HU vs. -804.94±63.3 HU) and expiratory MLD (-704.51±55.41 HU vs. -675.83±64.62 HU) were significantly lower than the indices obtained from the control group (p = 0.006). In addition, significantly lower values of TLV and MLD difference and higher value of TLV and MLD ratio were found in the PE group (p <0.0001). PE patients were divided into severe vs. mild groups based on the PI cutoff value of 3.5. The inspiratory MLD and TLV ratio in the severe PE group were lower than those in the mild PE group, respectively (p <0.05). In conclusion, quantitative pulmonary evaluation through CT in pediatric PE patients may provide further information in assessing the functional changes in lung parenchyma as a result of chest wall deformity. [ABSTRACT FROM AUTHOR]

Osteoporosis is a globally relevant public health issue. Our study aimed to summarize the knowledge on the proteomic biomarkers for low bone mineral density over the last years. We conducted a systematic review following the PRISMA guidelines; the scoured databases were PubMed, Web of Sciences, Scopus, and EBSCO, from inception to 2 June 2023. A total of 610 relevant studies were identified and 33 were assessed for eligibility. Finally, 29 studies met the criteria for this systematic review. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist tool. From the studies selected, 154 proteins were associated with changes of bone mineral density, from which only 10 were reported in at least two articles. The protein–protein network analysis indicated potential biomarkers involved in the skeletal system, immune system process, regulation of protein metabolic process, regulation of signaling, transport, cellular component assembly, cell differentiation, hemostasis, and extracellular matrix organization. Mass spectrometry-based proteomic profiling has allowed the discovery of new biomarkers with diagnostic potential. However, it is necessary to compare and validate the potential biomarkers in different populations to determine their association with bone metabolism and evaluate their translation to the clinical management of osteoporosis. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort study. Objective. Hounsfield units (HUs) are known to correlate with clinical outcomes, but no study has evaluated how they correlate with biomechanical computed tomography (BCT) and dual-energy x-ray absorptiometry (DXA) measurements. Summary of Background. Low bone mineral density (BMD) represents a major risk factor for fracture and poor outcomes following spine surgery. DXA can provide regional BMD measurements but has limitations. Opportunistic HUs provide targeted BMD estimates; however, they are not formally accepted for diagnosing osteoporosis in current guidelines. More recently, BCT analysis has emerged as a new modality endorsed by the International Society for Clinical Densitometry for assessing bone strength. Methods. Consecutive cases from 2017 to 2022 at a single institution were reviewed for patients who underwent BCT in the thoracolumbar spine. BCT-measured vertebral strength, trabecular BMD, and the corresponding American College of Radiology Classification were recorded. DXA studies within three months of the BCT were reviewed. Pearson Correlation Coefficients were calculated, and receiver-operating characteristic curves were constructed to assess the predictive capacity of HUs. Threshold analysis was performed to identify optimal HU values for identifying osteoporosis and low BMD. Results. Correlation analysis of 114 cases revealed a strong relationship between HUs and BCT vertebral strength (r= 0.69; P<0.0001; R²=0.47) and trabecular BMD (r =0.76; P<0.0001; R2=0.58). However, DXA poorly correlated with opportunistic HUs and BCT measurements. HUs accurately predicted osteoporosis and low BMD (Osteoporosis: C= 0.95, 95% CI 0.89--1.00; Low BMD: C=0.87, 95% CI 0.79--0.96). Threshold analysis revealed that 106 and 122 HUs represent optimal thresholds for detecting osteoporosis and low BMD. Conclusion. Opportunistic HUs strongly correlated with BCTbased measures, while neither correlated strongly with DXA-based BMD measures in the thoracolumbar spine. HUs are easy to perform at no additional cost and provide accurate BMD estimates at noninstrumented vertebral levels across all American College of Radiology-designated BMD categories. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate the effect of artificial high- and low-density materials on Bone mineral density (BMD) scans in dual-energy X-ray absorptiometry (DXA) method and emergence of black-hole artifact through GATE Monte Carlo simulation. Materials and Methods: GATE Monte Carlo code was utilized to simulate the artifact encountered in clinical scans acquired by HOLOGIC® bone densitometer. Two simplified phantoms were designed. The first one was a rectangular box with six smaller cubes inside and the second one was a body torso. Materials of cubes were spine bone, polymethyl methacrylate (PMMA), barium sulfate suspension in water, stainless steel, titanium alloy, and gold. The torso phantom contained objects of 5 vertebrae, bowel and 3 small spherical objects near the surface of the torso as piercing objects on the abdominal wall, each overlying the vertebrae. Using 100 and 140 kVp, spectral X-rays were generated to simulate DXA. For both phantoms, two simulations were carried out. The pair of projections acquired for each phantom were then subtracted and analyzed by curve fitting techniques. Results: Except for spine bone, in which radio-opacity decreases with increasing spectral X-ray energy (from 100 to 140 kVp), other squares exhibit little changes over different energies. PMMA shows consistently very low radio-opacity. Four other materials (barium sulfate in water, stainless steel alloy, titanium alloy, and gold), all attenuate the X-ray photons substantially. Except for spine bone, other materials are barely noticeable in pairwise subtracted images. In torso phantom, piercing objects are visualized as "holes" in vertebrae. Conclusion: Both artificial high- and low-density materials, compared to bone, are eliminated during the subtraction of dual-energy X-ray profiles and therefore, can create black-hole artifact. [ABSTRACT FROM AUTHOR]

In the ever-evolving landscape of pharmaceutical formulation, the demand for rapid, cost-effective, and precise analytical techniques is paramount. This abstract presents an overview of the burgeoning field of smartphone camera-based image scanning densitometry and its transformative impact on pharmaceutical formulation processes. Leveraging the ubiquitous presence of smartphones, this technology offers a powerful and accessible tool for quantifying critical parameters in pharmaceutical products. This abstract highlights the key elements covered in the article, including the role of smartphone cameras, their applications in pharmaceutical formulation, the advantages they offer over traditional methods, challenges to consider, and future trends. Through case studies and real-world examples, it illustrates the practical implementation and potential benefits of smartphone-based densitometry in the pharmaceutical industry, emphasizing its potential to enhance quality control, streamline processes, and improve regulatory compliance. As the pharmaceutical sector continues to embrace technological innovations, smartphone camera-based image scanning densitometry emerges as a promising avenue to meet the evolving demands of precision and efficiency in pharmaceutical formulation. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective review of prospectively collected data. Objective. The current study evaluates whether the addition of the Vertebral Bone Quality (VBQ) score to the Fusion Risk Score (FRS) improves its ability to predict perioperative outcomes. Summary of Background Data. The FRS was developed to assess preoperative risk in patients undergoing thoracic and lumbar fusions. It includes patient-derived and surgical variables, but it does not include one that directly accounts for bone health. The VBQ score allows assessment of bone quality and has been shown to correlate to DEXA-measured bone mineral density (BMD) scores. Methods. The VBQ score was weighted based on a regression model and then added to the FRS (FRS/VBQ). The ability of the two scores to predict the outcomes was then assessed using the area under the curve (AUC). Patient sample. Patients undergoing elective thoracic and lumbar spinal fusion from January 2019 to June 2020 were included. Outcome measures. The study evaluated various perioperative adverse outcomes, including major and minor adverse events, discharge other than home, extended length of stay, 90-day emergency department visits, 90-day readmission, and 90-day and 2-year reoperation rates. Results. A total of 353 met the inclusion and exclusion criteria. The FRS/VBQ demonstrated improved predictive ability compared with the FRS alone when evaluating 90-day reoperation. Both scores showed fair predictive ability for any adverse event, major adverse events, minor adverse events, and 2-year reoperation rates, with AUCs ranging from 0.700 to 0.737. Both had poor predictive ability for the other outcomes. Conclusions. Adding VBQ to the FRS significantly enhances its predictive accuracy for reoperation rate. This updated risk score provides a more comprehensive understanding of a patient's preoperative risk profile, aiding both patients and physicians in assessing surgical risks and optimizing outcomes through preoperative risk stratification. [ABSTRACT FROM AUTHOR]

Low bone mineral density (BMD) can predispose to vertebral body compression fractures and postoperative instrumentation failure. DEXA is considered the gold standard for measurement of BMD, however it is not obtained for all spine surgery patients preoperatively. There is a growing body of evidence suggesting that more routinely acquired spine imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) can be opportunistically used to measure BMD. Here we review available studies that assess the validity of opportunistic screening with CT-derived Hounsfield Units (HU) and MRI-derived vertebral vone quality (VBQ) to measure BMD of the spine as well the utility of these measures in predicting postoperative outcomes. Additionally, we provide screening thresholds based on HU and VBQ for prediction of osteopenia/ osteoporosis and postoperative outcomes such as cage subsidence, screw loosening, proximal junctional kyphosis, and implant failure. [ABSTRACT FROM AUTHOR]

Osteoporosis is prevalent among the elderly and requires precise diagnostic approaches for effective treatment and prevention. This work introduces a machine learning-based method for the accurate grading of osteoporosis via the analysis of high-resolution computed tomography (HRCT) images of the spine. This approach allows for the precise extraction of the trabecular component of vertebral bodies, thereby enabling accurate measurement of bone density. Evaluated in 183 individuals, our method demonstrated enhanced stability in bone density prediction and reduced bias when juxtaposed with traditional random sampling techniques. Despite the inherent risk of overestimation, the machine learning model more accurately approximates the actual bone quality compared to conventional clinical methods, which typically involve the random extraction of 3–4 trabecular bone slices from the spine. These findings offer a novel approach to the clinical assessment of osteoporosis, underscoring the significant potential of integrating machine learning into existing medical image analysis workflows. • HRCT. • Machine learning. • Changes in Bone Mineral Density. [ABSTRACT FROM AUTHOR]

Osteoclast differentiation is crucial for orchestrating both tooth movement and the maintenance of bone density. Therefore, the current study sought to explore the impact of low-level laser therapy (LLLT) on osteoclast differentiation, functional gene expression, molecular signaling pathways, and orthodontic tooth movement in clinical settings. The RAW 264.7 cell line served as the precursor for osteoclasts, and these cells underwent irradiation using a 808-nm LLLT. Osteoclast differentiation was assessed through tartrate-resistant acid phosphatase (TRAP) staining. Functional gene expression levels were evaluated using real-time quantitative polymerase chain reaction (RT-qPCR) while signaling molecules were examined through Western blot analysis. In the clinical study, 12 participants were enrolled. Their tooth movement was monitored using a TRIOS desktop scanner. Bone density measurements were conducted using Mimics software, which processed cone-beam computed tomography (CBCT) images exported in Digital Imaging and Communications in Medicine (DICOM) format. We found that LLLT effectively promoted receptor activator of nuclear factor-κB ligand (RANKL)-dependent osteoclast differentiation and the expression of osteoclast functional genes, including matrix metallopeptidase 9 (MMP9), nuclear factor of activated T-cells cytoplasmic 1(NFATc1), tartrate-resistant acid phosphatase (TRAP) and cathepsin K (CTSK) in RAW264.7 cells. Clinically, the cumulative tooth movement over 90 days was significantly higher in the laser group than in the control group. Our research demonstrates that LLLT not only significantly promotes osteoclast differentiation but is also a valuable adjunct in orthodontic therapy. [ABSTRACT FROM AUTHOR]

Orthopedic surgeons face a significant challenge in treating critical-size femoral defects (CSFD) caused by osteoporosis (OP), trauma, infection, or bone tumor resections. In this study for the first time, the application of photobiomodulation (PBM) and bone marrow mesenchymal stem cell-conditioned medium (BM-MSC-CM) to improve the osteogenic characteristics of mineralized bone scaffold (MBS) in ovariectomy-induced osteoporotic (OVX) rats with a CSFD was tested. Five groups of OVX rats with CSFD were created: (1) Control (C); (2) MBS; (3) MBS + CM; (4) MBS + PBM; (5) MBS + CM + PBM. Computed tomography scans (CT scans), compression indentation tests, and histological and stereological analyses were carried out after euthanasia at 12 weeks following implantation surgery. The CT scan results showed that CSFD in the MBS + CM, MBS + PBM, and MBS + CM + PBM groups was significantly smaller compared to the control group (p = 0.01, p = 0.04, and p = 0.000, respectively). Moreover, the CSFD size was substantially smaller in the MBS + CM + PBM treatment group than in the MBS, MBS + CM, and MBS + PBM treatment groups (p = 0.004, p = 0.04, and p = 0.01, respectively). The MBS + PBM and MBS + CM + PBM treatments had significantly increased maximum force relative to the control group (p = 0.01 and p = 0.03, respectively). Bending stiffness significantly increased in MBS (p = 0.006), MBS + CM, MBS + PBM, and MBS + CM + PBM treatments (all p = 0.004) relative to the control group. All treatment groups had considerably higher new trabecular bone volume (NTBV) than the control group (all, p = 0.004). Combined therapies with MBS + PBM and MBS + CM + PBM substantially increased the NTBV relative to the MBS group (all, p = 0.004). The MBS + CM + PBM treatment had a markedly higher NTBV than the MBS + PBM (p = 0.006) and MBS + CM (p = 0.004) treatments. MBS + CM + PBM, MBS + PBM, and MBS + CM treatments significantly accelerated bone regeneration of CSFD in OVX rats. PBM + CM enhanced the osteogenesis of the MBS compared to other treatment groups. [ABSTRACT FROM AUTHOR]

Background: Osteoporotic vertebral compression fractures (OVCF) in the elderly increase refracture risk post-surgery, leading to higher mortality rates. Genome-wide association studies (GWAS) have identified susceptibility genes for osteoporosis, but the phenotypic variance explained by these genes has been limited, indicating the need to explore additional causal factors. Epigenetic modifications, such as DNA methylation, may influence osteoporosis and refracture risk. However, prospective cohorts for assessing epigenetic alterations in Chinese elderly patients are lacking. Here, we propose to conduct a prospective cohort study to investigate the causal network of DNA polymorphisms, DNA methylation, and environmental factors on the development of osteoporosis and the risk of refracture. Methods: We will collect vertebral and peripheral blood from 500 elderly OVCF patients undergoing surgery, extract DNA, and generate whole genome genotype data and DNA methylation data. Observation indicators will be collected and combined with one-year follow-up data. A healthy control group will be selected from a natural population cohort. Epigenome-wide association studies (EWAS) of osteoporosis and bone mineral density will be conducted. Differential methylation analysis will compare candidate gene methylation patterns in patients with and without refracture. Multi-omics prediction models using genetic variants and DNA methylation sites will be built to predict OVCF risk. Discussion: This study will be the first large-scale population-based study of osteoporosis and bone mineral density phenotypes based on genome-wide data, multi-time point methylation data, and phenotype data. By analyzing methylation changes related to osteoporosis and bone mineral density in OVCF patients, the study will explore the feasibility of DNA methylation in evaluating postoperative osteoporosis intervention effects. The findings may identify new molecular markers for effective anti-osteoporosis treatment and inform individualized prevention and treatment strategies. Trial registration: chictr.org.cn ChiCTR2200065316, 02/11/2022. [ABSTRACT FROM AUTHOR]

Introduction: Bone maintenance after total hip arthroplasty (THA) is important for implant success. This study aimed to investigate the relationship between patient characteristics and periprosthetic bone maintenance after THA for better implant selection. Materials and methods: This retrospective cohort study enrolled 112 consecutive patients who underwent THA using full hydroxyapatite (HA) compaction with short (n = 55) or short-tapered wedge (n = 61) stems. Periprosthetic bone mineral density (BMD) was compared between the two groups after propensity score matching, and the relationship between periprosthetic BMD changes and patient background was analyzed. Results: Both groups showed similar periprosthetic BMD changes after adjusting for patient background using propensity score matching. Canal flare index > 3.7 in patients that underwent THA using tapered-wedge stem (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.3–7.9, p = 0.013) and baseline zone 1 BMD > 0.65 in patients that received with short HA compaction stems (OR, 430.0; 95% CI 1.3–1420, p = 0.040) were associated with proximal periprosthetic bone maintenance after THA. Conclusion: Considering their predictive value, canal flare index and zone 1 BMD assessment might be useful strategies for implant selection during THA. [ABSTRACT FROM AUTHOR]

Introduction: In recent decades, the prevalence of inflammatory bowel disease (IBD) has increased, and the incidence of osteoporosis is higher in the population with IBD than in the normal population. Therefore, it seems necessary to carefully examine the risk factors associated with decreased bone mineral density (BMD) among these patients. Methods: Patients with IBD completed a questionnaire including demographic characteristics, drug history, underlying disease (past medical history), and family history. Afterward, their bone density was measured with a DEXA device. Laboratory samples were also prepared, and densitometry results were placed in three groups: normal, osteoporotic, and osteopenia. The data were analyzed by SPSS software (version 23). Results: This study was conducted on 63 patients (58 with ulcerative colitis and 5 with Crohn's disease). Bone density was normal in 40 patients, while 16 had osteopenia, and 7 had osteoporosis. There was a significant relationship between bone density and age (P<0.001), smoking (P=0.049), past medical history (P<0.001), extraintestinal involvement (P=0.008), duration of the disease (P=0.023), and menopause (P=0.002). In addition, corticosteroid consumption (P=0.014), the level of calcium (P=0.017), and the level of vitamin D (P< 0.001) in the blood had a significant relationship with bone density. Conclusion: This study showed that age, smoking status, underlying conditions, extraintestinal involvement, corticosteroid consumption, the level of vitamin D and calcium, and menopause are risk factors associated with decreased BMD in IBD patients. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective study. Purpose: To investigate the correlation between Hounsfield unit (HU) values measured by chest computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) T-scores. HU-based thoracolumbar (T11 and T12) cutoff thresholds were calculated for a cohort of Chinese patients. Overview of Literature: For patients with osteoporosis, the incidence of fractures in the thoracolumbar segment is significantly higher than that in other sites. However, most current clinical studies have focused on L1. Methods: This retrospective study analyzed patients who underwent chest CT and DXA at our hospital between August 2021 and August 2022. Thoracic thoracolumbar segment HU values, lumbar T-scores, and hip T-scores were computed for comparison, and thoracic thoracolumbar segment HU thresholds suggestive of potential bone density abnormalities were established using receiver operating characteristic curves. Results: In total, 470 patients (72.4% women; mean age, 65.5±12.3 years) were included in this study. DXA revealed that of the 470 patients, 90 (19%) had osteoporosis, 180 (38%) had reduced osteopenia, and 200 (43%) had normal bone mineral density (BMD). To differentiate osteoporosis from osteopenia, the HU threshold was established as 105.1 (sensitivity, 54.4%; specificity, 72.2%) for T11 and 85.7 (sensitivity, 69.4%; specificity, 61.1%) for T12. To differentiate between osteopenia and normal BMD, the HU threshold was 146.7 for T11 (sensitivity, 57.5%; specificity, 84.4%) and 135.7 for T12 (sensitivity, 59.5%; specificity, 80%). Conclusions: This study supports the significance of HU values from chest CT for BMD assessment. Chest CT provides a new method for clinical opportunistic screening of osteoporosis. When the T11 HU is >146.7 or the T12 HU is >135.7, additional osteoporosis testing is not needed unless a vertebral fracture is detected. If the T11 HU is <105.1 or the T12 HU is <85.7, further DXA testing is strongly advised. In addition, vertebral HU values that fall faster than those of the T11 and L1 vertebrae may explain the high incidence of T12 vertebral fractures. [ABSTRACT FROM AUTHOR]

Objective(s): Wnt5a, which regulates the activities of osteoblasts and osteoclasts, is reportedly overexpressed in osteoarthritis (OA) tissues. The purpose of this study was to elucidate its role in the development of OA by deleting Wnt5a in osteocalcin (OCN)-expressing cells. Materials and Methods: Knee OA was induced by anterior cruciate ligament transection (ACLT) in OCN-Cre;Wnt5afl/fl knockout (Wnt5a-cKO) mice and control littermates. Eight weeks after surgery, histological changes, cell apoptosis, and matrix metabolism of cartilage were evaluated by toluidine blue, TUNEL staining, and im-immunohistochemistry analyses, respectively. In addition, the subchondral bone microarchitecture of mice was examined by micro-computed tomography (micro-CT). Results: Histological scores show substantial cartilage degeneration occurred in ACLT knees, coupled with decreased collagen type II expression and enhanced matrix metalloproteinase 13 expression, as well as higher proportions of apoptotic cells. Micro-CT results show that ACLT resulted in decreased bone mineral density, bone volume/trabecular volume, trabecular number, and structure model index of subchondral bones in both Wnt5a-cKO and control littermates; although Wnt5a-cKO mice display lower BMD and BV/TV values, no significant difference was observed between Wnt5a-cKO and control mice for any of these values. Conclusion: Our findings indicate that Wnt5a deficiency in OCN-expressing cells could not prevent an osteoarthritic phenotype in a mouse model of post-traumatic OA. [ABSTRACT FROM AUTHOR]

To investigate and compare the effectiveness of Nintendo Wii games and home exercises on balance functions in patients with osteoporosis, an important disease adversely affecting balance functions. The patients included in the study were randomized into two groups the Wii exercise group (n = 30) and the home exercise group (n = 30). Wii exercise group performed balance exercises with a Nintendo Wii device and balance board three times a week for 12 weeks under the supervision of a physiotherapist in the hospital, and home exercise group was prescribed home exercises three days a week for 12 weeks. Balance functions were evaluated with the timed up-and-go-test and Berg Balance Scale, and the fall risk was evaluated with the Falls Efficacy Scale at the beginning and end of 12 weeks of treatment. Comparison of pre- and post-treatment timed up-and-go-test, Berg Balance Scale, and Falls Efficacy Scale results in both groups revealed statistically significant improvements (p = 0.001; p < 0.05). Furthermore, post-treatment test scores between the two groups demonstrated a significant enhancement in Wii exercise group regarding the Berg Balance Scale score (Mean ± SD 52.9 ± 3.63) (p = 0.001; p < 0.05). Within the osteoporotic population, balance functions serve as robust predictors of fall risk. Improvement in balance functions is crucial for the prevention of falls and subsequent osteoporotic fractures. In our study, we found that balance exercises performed with Wii games are effective in improving balance functions in patients with osteoporosis. [ABSTRACT FROM AUTHOR]

This study examined the association of estimated heel bone mineral density (eBMD, derived from quantitative ultrasound) with: (1) prevalent and incident cardiovascular diseases (CVDs: ischemic heart disease (IHD), myocardial infarction (MI), heart failure (HF), non-ischemic cardiomyopathy (NICM), arrhythmia), (2) mortality (all-cause, CVD, IHD), and (3) cardiovascular magnetic resonance (CMR) measures of left ventricular and atrial structure and function and aortic distensibility, in the UK Biobank. Clinical outcomes were ascertained using health record linkage over 12.3 yr of prospective follow-up. Two-sample Mendelian randomization (MR) was conducted to assess causal associations between BMD and CMR metrics using genetic instrumental variables identified from published genome-wide association studies. The analysis included 485 257 participants (55% women, mean age 56.5 ±  8.1 yr). Higher heel eBMD was associated with lower odds of all prevalent CVDs considered. The greatest magnitude of effect was seen in association with HF and NICM, where 1-SD increase in eBMD was associated with 15% lower odds of HF and 16% lower odds of NICM. Association between eBMD and incident IHD and MI was non-significant; the strongest relationship was with incident HF (SHR: 0.90 [95% CI, 0.89–0.92]). Higher eBMD was associated with a decreased risk in all-cause, CVD, and IHD mortality, in the fully adjusted model. Higher eBMD was associated with greater aortic distensibility; associations with other CMR metrics were null. Higher heel eBMD is linked to reduced risk of a range of prevalent and incident CVD and mortality outcomes. Although observational analyses suggest associations between higher eBMD and greater aortic compliance, MR analysis did not support a causal relationship between genetically predicted BMD and CMR phenotypes. These findings support the notion that bone-cardiovascular associations reflect shared risk factors/mechanisms rather than direct causal pathways. [ABSTRACT FROM AUTHOR]

Quantitative computed tomography (QCT) has important technical advantages for the measurement of bone mineral density, and the technique is well suited for both the diagnosis of osteoporosis and the monitoring of treatment. Its use deserves a wider application than at present. The use of QCT in both research and in the clinic has recently garnered increasing attention. In this review, we update the advances and application of QCT in the study of osteoporosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim was to assess the association and predictive value of trabecular bone score (TBS), fracture risk assessment tool (FRAX), and TBS-adjusted FRAX with prevalent vertebral fractures (VFs) in patients with rheumatoid arthritis (RA). Methods: Patients diagnosed with RA were included in this cross-sectional study. Clinical data and laboratory tests were collected on the same day as the dual-energy x-ray absorptiometry (DXA) scan. TBS, bone mineral density (BMD), and vertebral fracture assessment (VFA) were obtained from the DXA scan. We used the FRAX tool to assess the 10-year probability of major osteoporotic fracture (MOF-FRAX) and hip fracture (HF-FRAX) with and without BMD. These parameters were further adjusted for TBS. Patients with prevalent VFs were defined as those with moderate to severe VFs from T4 to L4. VFs presence was used as the binary variable in the logistic regressions and receiving operator characteristics (ROC) curves analysis. Results: Sixty-nine patients were enrolled, with 55.1 % being postmenopausal. The mean TBS was 1.328 ± 0.104. Osteoporosis according to the WHO criteria was present in 39 patients (56.5 %), and six patients (8.7 %) had VFs with thoracic predominance (66.67 %). Univariate and multivariate logistic regression analyses did not show an association between TBS and vertebral fractures, but FRAX scores indicated such an association. The area under the curve (AUC) with 95 % confidence intervals (CI) for the MOF-FRAX score with BMD, MOF-FRAX score without BMD, TBS-adjusted MOF-FRAX score, and TBS were 0.837 [0.686–0.988], 0.795 [0.629–0.961], 0.778 [0.571–0.984], and 0.515 [0.298–0.731], respectively. Conclusion: In our RA patients, FRAX scores were associated with vertebral fractures (VFs), while TBS was not. The MOF-FRAX score combined with BMD, showed the best AUC for VFs in this population.

Background: Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. Objectives: We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. Design: Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. Methods: Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. Results: Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. Conclusion: Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. Brief summary: Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer. [ABSTRACT FROM AUTHOR]

Although dual-energy X-ray absorptiometry is still the gold standard for diagnosing osteoporosis, it can lead to inaccurate bone mineral density measurements due to lumbar degeneration and scoliosis. Many researchers have investigated diagnostic methods for osteoporosis in patients with degenerative lumbar scoliosis (DLS). This study aimed to investigate the differences between conventional vertebral bone quality (VBQ) scores and modified VBQ scores in patients with DLS and the influence of lumbar scoliosis on VBQ scores. We retrospectively collected the clinical and radiological data of 68 patients with DLS admitted to Sun Yat-sen Memorial Hospital from July 2018 to April 2023. The patients were classified into one of 2 groups based on the T score of the left femoral neck. VBQ scores relative to cerebrospinal fluid at different levels, VBQ scores on different planes and single-level VBQ scores were compared. Receiver operating characteristic analysis was also performed. Different modified VBQ scores were compared between the moderate scoliosis group (10°

Objective: Transient osteoporosis of the hip (TOH) is an uncommon, typically self-limited diagnosis of uncertain etiology. We hypothesize that TOH represents an underlying subchondral fracture, and a discrete fracture line can often be detected on high-resolution MRI. Materials and methods: A retrospective PACS query identified patients meeting imaging criteria for TOH with intense bone marrow edema (BME) in the femoral head on MRI. Those with poor quality studies, other underlying pathologies, or antecedent trauma were excluded. Three musculoskeletal radiologists independently reviewed each case for presence of a definite subchondral fracture line on small field of view (FOV) MR images of the affected hip. Extent of BME, reciprocal acetabular BME, and joint effusion size were also recorded. Binomial logistic regression was performed to determine statistically significant predictors of subchondral fracture. Results: Fifty patients met inclusion criteria (29 females, 0 pregnant). Mean age was 62±12 years (range 35–84). Average duration of symptoms before MRI was 102±135 days. Ten patients had bone densitometry within 2 years of MRI, six demonstrating osteopenia or osteoporosis. Subchondral fractures were unanimously identified in 44/50 (88%). Interclass correlation coefficient with absolute agreement was 0.73, 95% CI (0.57–0.84), indicating near-excellent agreement. Most cases demonstrated a large joint effusion (23/50, 46%) and acetabular BME (31/50, 62%). Increasing size of joint effusion was a statistically significant predictor of subchondral fracture (p=0.05), with 6.9 higher odds. There was a strong correlation with osteopenia/osteoporosis and fracture (p<0.001). Conclusion: Discrete subchondral fractures were identified unanimously on small FOV imaging in the majority of TOH cases. [ABSTRACT FROM AUTHOR]

Introduction: the prevalence of osteoporosis among candidates for lung transplantation is high and its pathophysiology is multifactorial. Objectives: to evaluate differences in bone mineral density, risk of fractures and bone remodeling markers in patients with terminal lung disease, at the time they are evaluated for lung transplantation, comparing two types of pathologies. Material and methods: fifty-nine subjects, proposed to receive a lung transplant due to advanced lung disease, were included in this study. They were divided into two groups according to their respiratory pathology: chronic obstructive pulmonary disease (COPD) and diffuse interstitial pulmonary disease (ILD). Demographic data were collected and bone densitometry, blood analysis with markers of bone remodeling, spirometry, six-minute walk test (6MWT), echocardiography and cardiac catheterization were performed Results: no differences were found between the groups, regarding their age, sex, BMI or exposure to tobacco. A higher prevalence of osteoporosis and a higher FRAX were observed in the group with COPD. Regarding bone remodeling markers, higher parathyroid hormone (PTH) and higher osteocalcin were found in the COPD group. Vitamin D was lower in COPD patients. Conclusions: two out of three of the patients evaluated for lung transplantation had osteopenia or osteoporosis. The prevalence of osteoporosis and FRAX is higher in COPD patients. Vitamin D supplementation should be considered in certain patients. Differences in bone remodeling markers may be useful for suspected osteoporosis and therapeutic management. [ABSTRACT FROM AUTHOR]

Osteoporosis is the most common bone disease, affecting one in three women and one in five men over the age of 50 worldwide, ultimately affecting nearly 70% of women over the age of 80. The clinical consequence of osteoporosis, which also constitutes its major complication, is a fragility fracture. Globally, it is estimated that osteoporosis is responsible for 9 million fractures each year, or one fracture every 3 seconds. Therefore, its screening in general medicine appears essential. This observation leads to several questions: what is the prescribing attitude of general practitioners? What importance do they give to this screening in their practice? What are the possible obstacles to this screening? [ABSTRACT FROM AUTHOR]