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There is a strong association between total hip bone mineral density (THBMD) changes after 24 mo of treatment and reduced fracture risk. We examined whether changes in THBMD after 12 and 18 mo of treatment are also associated with fracture risk reduction. We used individual patient data (n = 122 235 participants) from 22 randomized, placebo-controlled, double-blind trials of osteoporosis medications. We calculated the difference in mean percent change in THBMD (active-placebo) at 12, 18, and 24 mo using data available for each trial. We determined the treatment-related fracture reductions for the entire follow-up period, using logistic regression for radiologic vertebral fractures and Cox regression for hip, non-vertebral, all (combination of non-vertebral, clinical vertebral, and radiologic vertebral) fractures and all clinical fractures (combination of non-vertebral and clinical vertebral). We performed meta-regression to estimate the study-level association (r2 and 95% confidence interval) between treatment-related differences in THBMD changes for each BMD measurement interval and fracture risk reduction. The meta-regression revealed that for vertebral fractures, the r2 (95% confidence interval) was 0.59 (0.19, 0.75), 0.69 (0.32, 0.82), and 0.73 (0.33, 0.84) for 12, 18, and 24 mo, respectively. Similar patterns were observed for hip: r2 = 0.27 (0.00, 0.54), 0.39 (0.02, 0.63), and 0.41 (0.02, 0.65); non-vertebral: r2 = 0.27 (0.01, 0.52), 0.49 (0.10, 0.69), and 0.53 (0.11, 0.72); all fractures: r2 = 0.44 (0.10, 0.64), 0.63 (0.24, 0.77), and 0.66 (0.25, 0.80); and all clinical fractures: r2 = 0.46 (0.11, 0.65), 0.64 (0.26, 0.78), and 0.71 (0.32, 0.83), for 12-, 18-, and 24-mo changes in THBMD, respectively. These findings demonstrate that treatment-related THBMD changes at 12, 18, and 24 mo are associated with fracture risk reductions across trials. We conclude that BMD measurement intervals as short as 12 mo could be used to assess fracture efficacy, but the association is stronger with longer BMD measurement intervals.

BackgroundAdults undergoing spine surgery often have underlying osteoporosis, which may be a risk factor for postoperative complications. Although these associations have been described, osteoporosis remains profoundly underdiagnosed and undertreated in the spine surgery population. A thorough, comprehensive systematic review summarizing the relationships between bone mineral density (BMD) and specific complications of lumbar fusion surgery could be a valuable resource for raising awareness and supporting clinical practice changes.MethodsPubMed, Embase, and Web of Science databases were searched for original clinical research articles reporting on BMD, or surrogate measure, as a predictor of complications in adults undergoing elective lumbar fusion for degenerative disease or deformity. Endpoints included cage subsidence, screw loosening, pseudarthrosis, vertebral fracture, junctional complications, and reoperation.ResultsA total of 71 studies comprising 12,278 patients were included. Overall, considerable heterogeneity in study populations, methods of bone health assessment, and definition and evaluation of clinical endpoints precluded meta-analysis. Nevertheless, low BMD was associated with higher rates of implant failures like cage subsidence and screw loosening, which were often diagnosed with concomitant pseudarthrosis. Osteoporosis was also a significant risk factor for proximal junctional kyphosis, particularly due to fracture. Many studies found surgical site-specific BMD to best predict focal complications. Functional outcomes were inconsistently addressed.ConclusionsOur findings suggest osteoporosis is a significant risk factor for mechanical complications of lumbar fusion. These results emphasize the importance of preoperative osteoporosis screening, which allows for medical and surgical optimization of high-risk patients. This review also highlights current practical challenges facing bone health evaluation in patients undergoing elective surgery. Future prospective studies using standardized methods are necessary to strengthen existing evidence, identify optimal predictive thresholds, and establish specialty-specific practice guidelines. In the meantime, an awareness of the surgical implications of osteoporosis and utility of preoperative screening can provide for more informed, effective patient care.

Objectives: To assess the effects of a gluten-free diet on bone structure in children with celiac disease using fractal analysis on panoramic radiographs. Method and materials: A total of 49 patients with celiac disease aged 6 to 13 years, separated into two groups as previously and newly diagnosed, and a control group of 32 healthy individuals were evaluated. In previously and newly diagnosed patients with celiac disease, body mass index Z-scores were calculated, calcium, alkaline phosphatase, vitamin D3, and parathormone levels were measured, and bone mineral density Z-scores were obtained from dual energy x-ray absorptiometry. In all patients, the fractal dimensions of the right and left temporomandibular condyles were evaluated with the fractal analysis method on panoramic radiographs. Results: The mean values of serum biomarker levels and the body mass index and bone mineral density Z-scores for both celiac groups were within the normal reference range. No statistically significant difference was determined between right and left condyle fractal dimensions values in the three groups examined. In terms of both right and left condyle fractal dimensions values, there was a statistically significant difference between groups. The highest fractal dimensions values were determined in the previously diagnosed group. Conclusions: Differences in fractal dimensions values were observed among patients with celiac disease following the gluten-free diet. Utilizing fractal analysis on panoramic radiographs can prove valuable for dental practitioners in evaluating bone mineral density due to its cost-effect iveness, easy accessibility, and reduced radiation exposure for patients, enabling them to provide comprehensive oral health care and potential early interventions for patients with celiac disease. [ABSTRACT FROM AUTHOR]

Fracture is one of the most important health problems in people’s life. Millions of people have fractures every year. However, there is no unified standard for fracture healing in the clinic. Most definitions of complete fracture healing are subjective evaluations based on X-ray films. However, it is not reliable to evaluate the biomechanical strength of bone according to the number of callus on X-ray, and the imaging time of callus lags behind the actual callus, which is not conducive to the evaluation of early fracture healing time. In addition, although more and more fracture patients have achieved imaging healing after injury, the bone quality and bone strength of the whole body and local fracture have not returned to the normal level, and the probability of re-fracture has increased significantly, which has brought great pain to their families. Fracture healing is affected by many factors, such as age, fracture site, whether to fix the fracture site, and osteoporosis. Therefore, when evaluating the fracture healing status of patients, we should not only evaluate whether the fracture is healed but also evaluate its healing. By analyzing the previous research methods of fracture healing, in this paper, we systematically summarize the evaluation methods of fracture healing from the perspectives of computer tomography, ultrasound, bone density, biosensors, and biomechanics by analyzing previous research methods of fracture healing, aiming to provide reference for researchers in related fields. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya.The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre‐enrolment regimen. At enrolment, dual‐energy x‐ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T‐scores calculated for BMD. Osteoporosis was defined as T‐score −2.5 or lower and osteopenia as T‐score between −1 and −2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®‐HIV and BMD assessed.Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60–77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm2 (interquartile range [IQR] 0.78–0.99), 0.89 g/cm2 (IQR 0.79–1.01), and 0.75 g/cm2 (IQR 0.67–0.84), respectively, with median T‐scores of −1.9 (IQR −2.8 to −0.7), −1.0 (IQR −1.9 to −0.3), and −1.5 (IQR −2.2 to −0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10‐year median probabilities using FRAX®‐HIV were 3.4% (IQR 2.8–4.6) and 1.0% (IQR 0.7–1.3). Correlation coefficients between these FRAX®‐HIV probabilities and femoral neck BMD were −0.204 for major osteoporotic fracture and −0.338 for hip fracture.The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population‐specific risk calculators. [ABSTRACT FROM AUTHOR]

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]

Objective: To investigate whether body mass index (BMI) affects the accuracy of vertebral bone quality (VBQ) in determining bone mineral density (BMD) in patients undergoing lumbar fusion surgery. Methods: In this retrospective study, patients with preoperative noncontrast T1-weighted MRI were included. Restricted Cubic Spline (RCS) was employed to explore the nonlinear relationship between BMI and VBQ. Then patients were stratified according to the threshold of BMI. Pearson correlation analysis and linear regression were used to analyze the correlation between VBQ and the BMD in different groups. Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was used to assess diagnostic efficacy according to BMI. Results: A total of 328 patients (201 female and 127 male patients) with a mean age of 68.3 ± 3.3 years were included in the study. Significant nonlinear relationship was observed given the results of RCS. In patients with BMI < 23.8 kg/m2, the correlation coefficient between VBQ and the lowest BMD was − 0.32 and significant distribution difference of VBQ score was observed between osteoporosis and normal as well as osteopenia subgroups. However, in patients with BMI ≥ 23.8 kg/m2, the correlation coefficient between VBQ and the lowest BMD was − 0.39 and significant distribution difference of VBQ score was observed in all three subgroups. In addition, the ROC analysis revealed that the predictive performance in determining low BMD was superior in patients with BMI ≥ 23.8 kg/m2 (AUC 0.80 vs. AUC 0.66, p = 0.034). Conclusions: In this study, significant nonlinear relationship between BMI and VBQ was observed. Compared with patients with BMI < 23.8 kg/m2, VBQ has better discrimination between higher BMI (≥ 23.8 kg/m2) patients with low BMD and those with normal bone density. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions To investigate the effects of surgical menopause on bone mineral density and bone quality because bilateral salpingo‐oophorectomy for the treatment of gynecological malignancies is common even in premenopausal patients. This study is prospective one of bone mineral density and quality measurements after surgery for perimenopausal gynecologic malignancies.In 50 women who underwent surgical menopause for a diagnosis of gynecological malignancies, bone mineral density (BMD), blood levels of tartrate‐resistant acid phosphatase 5b (TRACP‐5b) and bone‐specific alkaline phosphatase (BAP) as bone metabolism markers, and urinary pentosidine level as bone quality marker were measured before surgery and at multiple points up to 24 months after surgery.In a group of 22 patients who did not undergo hormone replacement therapy (HRT) (HRT− group), BMD of the lumbar spine and total hip continued to decrease significantly from 6 months postoperatively. Percentages of changes in BMD progressively increased over time after surgery. TRACP‐5b and urinary pentosidine levels significantly increased 6 months postoperatively compared with preoperative levels. Comparisons between 10 patients who underwent HRT (HRT+ group) and the HRT− group revealed significant reductions in the percentage of change in lumbar spine BMD only and TRACP‐5b and urinary pentosidine levels 12 months postoperatively in the former group.In this pilot study, we showed that BMD and bone‐related markers are altered in patients with surgical menopause. It also suggested that HRT may reduce these influences on bone metabolism. [ABSTRACT FROM AUTHOR]

Background: Vitamin D is critical to bone health by regulating intestinal absorption of calcium, whereas proinflammatory cytokines, including IL-1, IL-6, IL-12, and TNF-α, are known to increase bone resorption. We hypothesized that vitamin D and these cytokines at the time of breast cancer diagnosis were predictive for fragility fractures in women receiving aromatase inhibitors (AIs). Methods: In a prospective cohort of 1,709 breast cancer patients treated with AIs, we measured the levels of 25-hydroxyvitamin D (25OHD), IL-1β, IL-6, IL-12, and TNF-α from baseline blood samples. The associations of these biomarkers were analyzed with bone turnover markers (BALP and TRACP), bone regulatory markers (OPG and RANKL), bone mineral density (BMD) close to cancer diagnosis, and risk of fragility fractures during a median of 7.5 years of follow up. Results: Compared to patients with vitamin D deficiency, patients with sufficient levels had higher bone turnover, lower BMD, and higher fracture risk; the latter became non-significant after controlling for covariates including BMD and no longer existed when patients taking vitamin D supplement or bisphosphonates or with history of fracture or osteoporosis were excluded. There was a non-significant trend of higher levels of IL-1β and TNF-α associated with higher risk of fracture (highest vs. lowest tertile, IL-1β: adjusted HR=1.37, 95% CI=0.94-1.99; TNF-α: adjusted HR=1.38, 95% CI=0.96-1.98). Conclusions: Our results do not support proinflammatory cytokines or vitamin D levels as predictors for risk of fragility fractures in women receiving AIs for breast cancer. [ABSTRACT FROM AUTHOR]

Summary: This is the first study to report that TBS seems not only unaffected by bone artifacts, but also is superior to BMD in the discrimination of vertebral fractures in SAPHO patients, which highlights the importance of adding TBS measurement to DXA images in routine clinical evaluation. Purpose: To investigate the impact of bone artifacts on trabecular bone score (TBS) and lumbar spine (LS) bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and analyze the clinical utility of TBS evaluation for vertebral fracture (VF) risk assessment in SAPHO patients compared with BMD assessment. Methods: Seventy SAPHO patients (mean age 50.1 (10.7) years, 81% women) and an equal number of age- and sex-matched controls were enrolled. TBS and BMD were assessed using DXA. Bone artifacts and VF of the spine were evaluated using whole-spine CT. Univariate logistic regression analysis was performed to identify factors associated with VF. Odds ratios (ORs) per standard deviation decrease in TBS and BMDs were estimated from logistic regression models with adjustment for age. Results: In patients with bone artifacts, TBS, but not LS BMD, was lower than matched controls, and in those without bone artifacts, both BMDs and TBS were lower than controls. After adjustment, LS BMD was significantly lower in the SAPHO group than in controls. TBS and LS BMD (OR [95% confidence interval], 12.0 [3.6, 40.4] and 4.7 [2.0, 10.9]) showed statistically significant ORs but the others did not. For evaluating VF in SAPHO patients, TBS showed the greatest AUC in the ROC curve, with a value of 0.920 compared with 0.777, 0.690, and 0.652 for LS, FN, and TH BMD, respectively. Conclusion: TBS seems not to be influenced by bone artifacts in opposition to LS BMD and has a better discriminatory value than BMD for VF in SAPHO patients. [ABSTRACT FROM AUTHOR]

Objective To analyze the correlation and comorbid factors between osteoporosis and lumbar disc herniation, as well as to assess the influencing factors for the occurrence of osteoporosis. This analysis aims to provide new insights for the clinical diagnosis and treatment of these two conditions and to offer reference points for the onset factors of osteoporosis. Methods Independent sample t-tests were utilized to compare clinical data across different groups. The Spearman method was employed for variable correlation tests, and multifactorial logistic regression analysis was conducted to study the influencing factors of osteoporosis in females. Results Comparing the lumbar disc herniation group with the non-lumbar disc herniation group, differences were found in age, height, bone density, and the incidence of osteoporosis P < 0.05 for all). Between the osteoporosis group and the non- osteoporosis group, differences were observed in age, duration of menopause, weight, BMI, and the incidence of lumbar disc herniation P < 0.05 for all). Logistic regression analysis indicated that a higher BMI is a protective factor against osteoporosis in females (OR < 1 P < 0.05), while the duration of menopause is a risk factor (OR > 1 P < 0). Conclusion There is a certain correlation between lumbar disc herniation and osteoporosis. Factors such as the presence of lumbar disc herniation, BMI, and the duration of menopause influence the occurrence of osteoporosis. Clinically, these findings can be used to provide more rational diagnostic and treatment plans and recommendations for patients. [ABSTRACT FROM AUTHOR]

Objective To examine the association between metabolic score of insulin resistance (METS-IR) and bone mineral density (BMD), as well as osteoporosis in patients with type 2 diabetes mellitus (T2DM). Methods A total of 370 patients with type 2 diabetes mellitus were divided into osteoporosis group and non-osteoporosis group. General data and bone mineral density of patients were collected and METS-IR was calculated. The relationship between METS-IR and bone mineral density was analyzed. Results The level of METS-IRin male T2DM patients with osteoporosis was notably lower than that in the non-osteoporosis group P < 0.05 ) Analysis using Spearman correlation revealed a significant positive relationship between METS-IR and total hip bone mineral density (BMD), as well as lumbar spine and femoral neck BMD (all P < 0.001 ) Upon controlling for potential confounders, logistic regression analysis demonstrated that male and female patients with with T2DM, METS-IR levels served as a protective factor against osteoporosis OR = 0.916, 95% CI:0.870-0.964, P = 0.001 ) and ( OR = 0.945, 95% CI: 0.898-0.995, P = 0.033 ), respectively. Conclusion In patients with T2DM, the METS-IR is closely associated with BMD in the femoral neck, hip, and lumbar spine. METS-IR may serve as a protective factor for bone density, indicating potential clinical reference value. [ABSTRACT FROM AUTHOR]

Background/Objectives: Monoclonal gammopathies, such as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM), are conditions marked by the overproduction of specific monoclonal proteins. Patients with these conditions are known to have a higher risk of fractures compared to the general population, yet there are no established guidelines for assessing or managing their skeletal health. The Trabecular Bone Score (TBS), which can be calculated from DXA images of the lumbar spine, provides additional insights into bone microarchitecture. Methods: This study aimed to determine whether TBS can serve as a supplementary tool in assessing bone loss in MGUS and SMM patients. Conducted from 2020 to 2023, the study involved 148 participants—74 diagnosed with a myeloma precursor state and 74 healthy controls—who underwent simultaneous DXA and TBS measurements. Results: The results indicated a weak positive correlation (R = 0.405) between DXA and TBS T-scores, suggesting that other factors may influence the measurements. When analyzed separately, the correlations remained weak for both MGUS (R = 0.250) and SMM (R = 0.485). Interestingly, discrepancies were noted in T-score classifications; for instance, a patient classified as normal via DXA could be deemed osteopenic or osteoporotic with TBS. Conclusions: Overall, the findings suggest that incorporating TBS alongside DXA can enhance the accuracy of bone density assessments, facilitating earlier diagnosis and treatment initiation for osteoporosis in asymptomatic patients with monoclonal gammopathies. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of −2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

The aim of the study was to explore the clinical efficacy of bisphosphonates in patients with osteoporosis in diabetes patients by meta-analysis. Six databases were systematically searched from inception to January 30,2023. Studies evaluating the treatment of diabetic osteoporosis with bisphosphonates were included. Key outcome measures, such as bone mineral density (BMD), bone metabolism markers, pain improvement, and safety assessments, were extracted and analyzed. STATA MP V17.0 was used to calculate the combined effect size. After searching Chinese and English databases, 15 studies met the inclusion criteria of this study. The results of the meta-analysis showed that the BMD of patients with osteoporosis in diabetes increased significantly after bisphosphonate treatment, and the lumbar BMD increased by 0.08 g/cm² (95% CI: 0.05–0.11). Femoral neck BMD increased by 0.06 g/cm² (95% CI: 0.01–0.11); Ward's triangle BMD increased 0.07 g/cm² (95% CI: 0.04–0.09); and trochanter BMD increased by 0.06 g/cm² (95% CI: 0.04–0.08). In addition, bone alkaline phosphatase increased 1.95 μg/l (95% CI: 1.18–2.72), while serum tartrate-resistant acid phosphatase-5b decreased 1.28 U/l (95% CI: –1.81–0.75). Moreover, improvements in pain were statistically significant. The effects of bisphosphonates on osteocalcin (MD: –0.07; 95% CI: –1.12–1.25), serum calcium (MD: 0.01; 95% CI: –0.03–0.04), serum phosphorus (MD: 0.04; 95% CI: –0.03–0.10) and medication safety (OR: 1.75; 95% CI: 1.29–2.37) were not statistically significant. Bisphosphonates have a significant positive effect on bone mineral density and bone metabolism in patients with osteoporosis in diabetes and have good safety. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop machine learning methods to estimate bone mineral density and detect osteopenia/osteoporosis from conventional lumbar MRI (T1-weighted and T2-weighted images) and planar radiography in combination with clinical data and imaging parameters of the acquisition protocol. Methods: A database of 429 patients subjected to lumbar MRI, radiographs and dual-energy x-ray absorptiometry within 6 months was created from an institutional database. Several machine learning models were trained and tested (373 patients for training, 86 for testing) with the following objectives: (1) direct estimation of the vertebral bone mineral density; (2) classification of T-score lower than − 1 or (3) lower than − 2.5. The models took as inputs either the images or radiomics features derived from them, alone or in combination with metadata (age, sex, body size, vertebral level, parameters of the imaging protocol). Results: The best-performing models achieved mean absolute errors of 0.15–0.16 g/cm2 for the direct estimation of bone mineral density, and areas under the receiver operating characteristic curve of 0.82 (MRIs) − 0.80 (radiographs) for the classification of T-scores lower than − 1, and 0.80 (MRIs) − 0.65 (radiographs) for T-scores lower than − 2.5. Conclusions: The models showed good discriminative performances in detecting cases of low bone mineral density, and more limited capabilities for the direct estimation of its value. Being based on routine imaging and readily available data, such models are promising tools to retrospectively analyse existing datasets as well as for the opportunistic investigation of bone disorders. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) is a complex skeletal disorder characterized by reduced bone mass, microarchitectural deterioration of bone tissue, and increased susceptibility to fractures. Bone mineral density (BMD), as the best indicator of bone mineral content per unit area of bone, is one of the key diagnostic factors for OP. Platelets (PLT), serving as important immune cells and components of the coagulation system, have been demonstrated to be associated with bone formation, resorption, and remodeling processes. However, no research has established the relationship between BMD and platelet count (PC) in the American population thus far. This study aims to investigate the correlation between BMD and PC among the American population, and to appraise the effects of additional risk factors on this association. Methods: This investigation examined the relationship between BMD and PC by analyzing data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. A weighted multivariate logistic regression analysis was employed to assess this correlation. Additionally, subgroup and smooth curve analyses were conducted to delve deeper into the BMD-PC relationship and to identify other potential determinants of PC. Results: This study reveals a significant negative correlation between BMD and PC in the American adult population (β=-15.05, 95% CI: -22.07 to -8.03, p < 0.0001). Subgroup analysis highlights notable differences in this correlation between genders and various racial groups. Smooth curve fitting and generalized additive models were applied to further explore the relationship between BMD and PC, considering the influence of multiple factors. Conclusion: The present study investigated the correlation between BMD and PC in adults, with a particular focus on the potential risk factors for thrombocytopenia. This negative correlation was found to be markedly pronounced in males, an association not observed in females. Additionally, a potential inverse relationship between BMD and hemoglobin (HGB) levels was identified. Consequently, for individuals with elevated bone mass or osteoporosis (OP), we advocate for routine complete blood count monitoring to identify hematological irregularities. Considering the significant variations by sex, age, and race, special vigilance is advised for changes in PC among non-Hispanic white males under the age of 55. [ABSTRACT FROM AUTHOR]

Glycogen storage disease (GSD) is the most prevalent inherited disorder of glycogen metabolism for which no causal treatment is available. In recent years, thanks to the improved clinical management, the life expectancy of these patients extended, disclosing previously unidentified adverse conditions in other organs. In this study, we evaluated the clinical bone complications and the cellular responses in 20 patients (aged 14.1 ± 3.4 years) affected by GSD type I. Fragility fractures were reported in 35% of the patients, which were older than unfractured patients. They involved appendicular skeletal segments, while no vertebral deformity was detected. 60% of the patients had a bone mineral density (BMD) "below the expected range for age", and lumbar spine (LS) BMD Z-scores positively correlated with muscle strength. Circulating mineral and bone markers showed reduction in the older subjects, with no increase in the pubertal age. Significant correlations could not be detected between circulating markers and LS BMD Z-scores, except for sclerostin levels, which also correlated with muscle strength. The osteoclasts differentiated from patients' peripheral blood mononuclear cells did not show cell-autonomous alterations. However, circulating osteoclast precursors from healthy individuals cultured in the presence of patients' sera exhibited increased osteoclastogenesis compared to control sera suggesting that GSD type I serum factors could affect osteoclast function in a non-autonomous manner. In contrast, circulating osteoprogenitors were unremarkable. [ABSTRACT FROM AUTHOR]

Accelerated sub-lesional bone loss is common in the first 2–3 years after traumatic spinal cord injury (TSCI), particularly in the distal femur and proximal tibia. Few studies have explored efficacy of antiresorptives for acute bone loss prevention post-TSCI, with limited data for knee bone mineral density (BMD) or beyond two years follow-up. An open-label non-randomized study was performed at Royal North Shore Hospital and Royal Rehab Centre, Sydney between 2018 and 2023. An 'acute interventional cohort' (n = 11) with TSCI (duration ≤ 12-weeks) received a single infusion of 4 mg zoledronic acid (ZOL) at baseline. A 'chronic non-interventional cohort' (n = 9) with TSCI (duration 1–5-years) did not receive ZOL. All participants underwent baseline and 6-monthly blood tests (including CTx and P1NP) and 12-monthly DXA BMD scans (including distal femur and proximal tibia). Participants were predominantly Caucasian and male (mean age 38.4 years). At baseline, the 'acute' cohort had higher serum CTx, P1NP and sclerostin concentrations, while the 'chronic' cohort had lower left hip and knee BMD. Majority with acute TSCI experienced an acute phase reaction after ZOL (9/11; 82%). In the acute cohort, left hip BMD fell by mean ~ 15% by 48 months. Left distal femoral and proximal tibial BMD declined by mean ~ 6–13% at 12 months and ~ 20–23% at 48 months, with a tendency towards greater BMD loss in motor-complete TSCI. A single early ZOL infusion in acute TSCI could not attenuate rapidly declining hip and knee BMD. Prospective controlled studies are required to establish the optimal strategy for preventing early bone loss after acute TSCI. [ABSTRACT FROM AUTHOR]

Early fusion is crucial in interbody procedures to minimize mechanical complications resulting from delayed union, especially for patients with osteoporosis. Bone morphogenetic proteins (BMPs) are used in spinal fusion procedures; however, limited evaluation exists regarding time-to-fusion for BMP use, particularly in patients with osteoporosis. To evaluate the difference in time-to-fusion after single-level transforaminal lumbar interbody fusion (TLIF) surgery between recombinant human bone morphogenetic protein-2 (rhBMP-2) usage and nonusage groups according to bone density. Retrospective single-center cohort study. This study enrolled 132 patients (mean age, 65.25±8.66; male patients, 40.9%) who underwent single-level TLIF for degenerative disorders between February 2012 and December 2021, with pre- and postoperative computed tomography (CT). The interbody fusion mass and bone graft status on postoperative CT scans was obtained annually, and time-to-fusion was recorded for each patient. The patients were divided into 2 groups based on rhBMP-2 use during the interbody fusion procedure. Patients were further divided into osteoporosis, osteopenia, and normal groups based on preoperative L1 vertebral body attenuation values, using cutoffs of 90 and 120 Hounsfield units. It was strictly defined that fusion is considered complete when a trabecular bone bridge was formed, and therefore, the time-to-fusion was measured in years. Time-to-fusion was statistically compared between BMP group and non-BMP groups, followed by further comparison according to bone density. The time-to-fusion differed significantly between BMP and non-BMP groups, with half of the patients achieving fusion within 2.5 years in the BMP group compared with 4 years in the non-BMP group (p<.001). The fusion rate varied based on bone density, with the maximum difference observed in the osteoporosis group, when half of the patients achieved fusion within 3 years in the BMP group compared to 5 years in the non-BMP group (p<.001). Subgroup analysis was conducted, revealing no significant associations between time-to-fusion and factors known to influence the fusion process, including age, gender, medical history, smoking and alcohol use, and medication history, except for rh-BMP2 use and bone density. RhBMP-2 usage significantly reduced time-to-fusion in single-level TLIF, especially in patients with osteoporosis. Level III. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates sex differences and predictors of anti-osteoporosis medication (AOM) use following a hip fracture, with a focus on older men who exhibit higher mortality rates post-fracture compared to women over the age of 65. Methods: Participants included 151 men and 161 women aged 65 and older with hip fractures. The outcome, AOM use, was assessed at baseline (≤ 22 days of hospitalization) and at 2, 6, and 12 months post-hip fracture. Generalized estimating equations (GEE) modeled sex differences and predictors of AOM use during the year post-fracture in 255 participants with complete baseline data and ≥ 1 follow-up observation. Results: Of the 312 participants, only 53 used AOM at baseline, and 35 initiated use during follow-up. In the unadjusted GEE model, AOM use was significantly less likely in men (OR = 0.42; 95% CI, 0.22–0.78) compared to women. For both men and women, baseline use of AOM was a significant predictor (OR = 28.3; 95% CI, 5.4–148.0 vs. 41.6; 95% CI, 14.0–123.0). The other significant predictors by sex were osteoporosis diagnosis (OR = 3.19; 95% CI, 1.16–8.77) and minimal alcohol use (OR = 3.26; 95% CI, 1.34–7.94) for women versus age (OR = 1.09; 95% CI, 1.01–1.18) for men. Conclusion: In older adults with hip fractures, AOM use is low over the year post-fracture and men are less likely to report AOM use compared to women which has implications for important sex differences in predictors of use. Further research is needed to address overall disparities and sex differences in AOM use. [ABSTRACT FROM AUTHOR]

Purpose: Periacetabular bone loss poses a considerable challenge in the longevity and stability of acetabular implants used in total hip arthroplasty (THA). Innovations in implant design, specifically the introduction of three-dimensional (3D) porous titanium constructs, might reduce bone resorption. The purpose of this study was to build upon our previous randomized controlled trial, which found no change in periacetabular bone loss between a 3D porous none-hydroxyapatite coated titanium cup and a standard porous hydroxyapatite coated cup over a two year follow-up period by extending the follow-up duration to ten years post-surgery. Methods: This was a single-centre, long-term follow-up study conducted over a ten year period in patients who had previously participated in a randomized controlled trial comparing a 3D porous titanium construct shell (PTC group) with a standard porous hydroxyapatite coated titanium shell (PC-group). The primary outcome measured was the change in bone mineral density (BMD) within four specific periacetabular zones, alongside overall bone loss, which was assessed through BMD in the lumbar spine at two, six and ten years postoperatively. Secondary outcomes included clinical outcome measures. Results: In total, 18 in the PTC and 20 in the PC group were analysed for the primary endpoint up to ten years. The mean bone mineral density in zones 1–4 was 3.7% higher in the PTC group than in the PC group at six years postoperatively and 12.0% higher at ten years. Clinical outcomes, and the frequency of adverse events did not differ between the groups. Conclusions: The PTC group displayed superior long-term bone preservation compared to the PC group while maintaining similar clinical outcomes up to ten years postoperatively. Although with a small sample size, our findings suggest that porous titanium cups have the potential to minimize BMD loss around the cup which could contribute to improving THA outcomes and implant durability. [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]

The aim of this study was to investigate the potential of using multidetector computed tomography (MDCT) to measure the bone mineral density (BMD) in the medial meta-epiphyseal region of clavicle (MERC) for adult age estimation. A total of 1064 chest MDCT scans from individuals aged 21 to 102 years were utilized to determine the MERC BMD. The Mimics software was used for the BMD measurements, and the average BMD of both MERC was also calculated. Regression analysis was conducted with chronological age as a dependent variable and MERC BMD as an independent variable to establish a mathematical model for age estimation. The mean absolute error (MAE) was calculated to evaluate the accuracy of the regression model using an independent validation sample. Among all the models, the cubic regression model showed the highest correlation between MERC BMD and chronological age and also provided the most accurate age prediction for both males and females (MAE = 9.41 for males, MAE = 10.38 for females). Our study suggests that BMD measured by MERC can be utilized for age estimation in adults when more reliable indicators are not available. [ABSTRACT FROM AUTHOR]

Resonance frequency analysis (RFA) is valuable for assessing implant status. In a previous investigation, acetabular cup fixation was assessed using laser RFA and the pull‐down force was predicted in an in vitro setting. While the pull‐down force alone is sufficient for initial fixation evaluation, it is desirable to evaluate the bone strength of the foundation for subsequent fixation. Diminished bone quality causes micromotion, migration, and protracted osseointegration, consequently elevating susceptibility to periprosthetic fractures and failure of ingrained trabecular bone. Limited research exists on the evaluation of bone mineral density (BMD) around the cup using RFA. For in vivo application of laser RFA, we implemented the sweep pulse excitation method and engineered an innovative laser RFA device having low laser energy and small dimensions. We focused on a specific frequency range (2500–4500 Hz), where the peak frequency was presumed to be influenced by foundational density. Quantitative computed tomography with a phantom was employed to assess periprosthetic BMD. Correlation between the resonance frequency within the designated range and the density around the cup was evaluated both in the laboratory and in vivo using the novel laser RFA device. The Kruskal–Wallis test showed robust correlations in both experiments (laboratory study: R = 0.728, p < 0.001; in vivo study: R = 0.619, p < 0.001). Our laser RFA system can assess the quality of bone surrounding the cup. Laser RFA holds promise in predicting the risk of loosening and might aid in the decision‐making process for additional fixation through screw insertion. [ABSTRACT FROM AUTHOR]

Objective: To examine the correlation between serum insulin-like growth factor 1 (IGF-1) and osteoporosis (OP) in Parkinson's disease (PD). Methods: We retrospectively analyzed clinical data from 105 PD patients (PD group) and 78 individuals in the health examination group (HC group). We compared general clinical data and serum IGF-1 levels between the two groups. PD patients were further categorized into PD with OP (50 cases) and PD without OP (55 cases) based on dual-energy X-ray absorptiometry (DXA) results for bone density. We compared general clinical data and serum IGF-1 levels between these two subgroups. Pearson correlation coefficient analysis was conducted to assess the relationship between serum IGF-1 levels and bone density at the lumbar spine and left femoral neck. Multifactorial logistic regression analysis was performed to identify risk factors for PD with OP. Results: Serum IGF-1 levels were significantly lower in the PD group compared to the HC group (P < 0.05). Pearson correlation analysis revealed a positive association between serum IGF-1 levels and both lumbar spine and left femoral neck bone densities (r = 0.653, P < 0.001; r = 0.625, P < 0.001). Multivariate logistic regression analysis identified decreased serum IGF-1 levels, lower uric acid levels, and higher H-Y stage as risk factors for PD with OP (P < 0.05). Conclusion: Reduced levels of serum IGF-1, uric acid, and an increased H-Y stage are closely linked to osteoporosis in PD. Elevating serum levels of IGF-1 and uric acid may potentially offer therapeutic avenues for PD with osteoporosis. [ABSTRACT FROM AUTHOR]

Preventing the decrease in bone mineral density (BMD) is significant for postmenopausal women. We previously discovered that rhamnose, a deoxy monosaccharide used as a food additive, could suppress bone resorption; however, studies confirming this effect in postmenopausal women are lacking. Therefore, this pilot study aimed to explore whether rhamnose could help maintain BMD via bone resorption suppression in postmenopausal women. The participants consumed either 1.0 or 0.5 g/day of rhamnose or placebo for 24 weeks, and BMD (lumbar spine and femur) and bone turnover markers were measured. After 24 weeks, the group consuming rhamnose 1.0 g/day exhibited a significantly higher BMD of the lumbar spine than the placebo group. Furthermore, the levels of tartrate-resistant acid phosphatase 5b, a bone resorption marker, were significantly lower in both rhamnose groups. These results indicated that rhamnose might contribute to the maintenance of BMD by suppressing bone resorption in healthy postmenopausal women (UMIN000046570). [ABSTRACT FROM AUTHOR]

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9 years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ −2.5, whereas 53% had T-scores between −1.0 and −2.5 and 37% had T-scores ≥−1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range. [ABSTRACT FROM AUTHOR]

Background: Adherence to the World Health Organization's 24-hour movement behavior (24-HMB) guidelines is associated with various health outcomes. However, its relationship with bone mineral density (BMD) in young children has not been investigated. This study aimed to examine the cross-sectional and longitudinal associations between adherence to the 24-HMB guidelines and BMD in young children. Methods: A total of 120 children aged 3–5 years were recruited from three kindergartens in Changsha, Hunan, China. Physical activity (PA) was objectively measured using ActiGraph wGT3X-BT accelerometers, and BMD was assessed using the Sunlight Omnisense 7000P ultrasound device. Screen time (ST) and sleep duration (SD) were reported by parents. Logistic regression was used to analyze the associations between guideline adherence and BMD. Results: Only 5.5% of the participants met all three guidelines for PA, ST, and SD, while 16.5% did not meet any. In the cross-sectional analysis, young children who met both ST and SD guidelines (OR = 0.29, 95% CI: 0.09, 0.95) had a lower risk of insufficient BMD compared to those who met none. In the one-year cohort follow-up, young children who met the PA guideline at baseline (OR = 0.22, 95% CI: 0.07, 0.71), as well as those who met both the PA and ST guidelines (OR = 0.18, 95% CI: 0.04, 0.83) or all three (OR = 0.13, 95% CI: 0.03, 0.69), had a lower risk of insufficient BMD at one year. Conclusions: Adherence to the 24-HMB guidelines may promote bone health in young children. Future research should prioritize achievable goals, such as limiting ST and ensuring adequate SD, while gradually increasing MVPA to optimize bone development. [ABSTRACT FROM AUTHOR]

Vitamin D measurements and dual energy x-ray absorptiometry (DXA) scans are recommended in people with intellectual disability and/or epilepsy in order to prevent bone-linked harm. The prevalence of vitamin D supplementation and bone mineral density screening were evaluated in 68 people with epilepsy and intellectual disability (EID) and 68 matched controls with epilepsy without intellectual disability. DXA scans were not performed in any of the people with EID but were performed in 11.8% of the people in the control group. People with EID had a higher vitamin D supplementation rate and were treated with more antiepileptic drugs (AEDs) and more AED combinations, including first generation AEDs. Increased awareness of bone health screening in people with epilepsy and especially EID is warranted. [ABSTRACT FROM AUTHOR]

Background: Secondary osteoporosis is associated with type 2 diabetes mellitus (T2DM), and there is conflicting evidence regarding the relationship between insulin-like growth factor-1 (IGF-1) and bone mineral density (BMD) in different populations. The objective of this study was to investigate the relationship between serum IGF-1 levels and BMD in patients with T2DM. Method: A retrospective cross-sectional study was performed on a cohort of 363 patients with T2DM, comprising men aged over 50 and women who are postmenopausal. Those with no significant medical history or medication affecting BMD or IGF-1 were considered. Data analyzed included IGF-1 levels, markers of bone metabolism, and measurements of BMD. To account for age and gender variations, we calculated IGF-1 standard deviation scores (IGF-1 SDS) for further investigation. Results: A significant increase in BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) was observed as IGF-1 SDS tertiles rose. We revealed a nonlinear correlation between IGF-1 SDS and BMD at these sites, with a common inflection point identified at an IGF-1 SDS level of -1.68. Additionally, our multivariate piecewise linear regression analysis highlighted a positive association between IGF-1 SDS and BMD at LS, FN, and TH when IGF-1 SDS exceeded the inflection point (b 0.02, 95% CI 0.01, 0.04 for LS; b 0.02, 95% CI 0.01, 0.03 for FN; b 0.02, 95% CI 0.01, 0.03 for TH). Conversely, below the inflection point, this association was not significant (b -0.04, 95% CI -0.10, 0.01 for LS; b -0.04, 95% CI-0.08, 0.01 for FN; b -0.03, 95% CI -0.08, 0.01 for TH). Conclusion: These findings reveal a nonlinear relationship between IGF-1 SDS and BMD in T2DM patients. Higher serum IGF-1 levels were connected to increased bone density only after surpassing a certain threshold. [ABSTRACT FROM AUTHOR]

Previous studies about metal exposures and bone mineral density (BMD) have mainly focused on individual metals. The objective of this study was to explore the association of single and multiple metal exposures with BMD among Chinese adults. We recruited 2922 participants from Tongji Hospital in Wuhan, China. The urinary concentrations of 21 metals were measured by the inductively coupled plasma mass spectrometer. BMD was measured using dual-energy X-ray absorptiometry. We applied linear regression and Bayesian kernel machine regression (BKMR) to examine the association of single and multiple metal exposure with BMD, respectively. The linear regression model showed that cadmium (Cd) and strontium (Sr) were associated with lower BMD (all P-trend < 0.05). Compared with the lowest quantiles, the β (95% CI) of BMD in the highest quartile of Cd and Sr was − 0.032 (− 0.049, − 0.016) and − 0.033 (− 0.049, − 0.018), respectively. The BKMR results showed that co-exposure to 21 metals was negatively associated with BMD among the total participants and males. Our study suggested that exposure to multiple metals was negatively associated with BMD, particularly among males. More prospective studies are needed to identify these associations and reveal the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Context Bone marrow adiposity (BMAT) alterations in patients with type 2 diabetes mellitus (T2DM) may contribute to adverse bone effects. Objective Characterization of BMAT content and composition in patients with well-controlled T2DM. Methods This cross-sectional study included 2 groups of postmenopausal women: one with T2DM and the other without. The proton density fat fraction (PDFF) of the lumbar spine and proximal femur, comprising the femoral head, neck, and diaphysis, was assessed using chemical shift-based water-fat separation imaging (WFI). Magnetic resonance imaging with spectroscopy (1H-MRS) was performed in a subgroup of participants to confirm the PDFF measurements and determine the apparent lipid unsaturation level (aLUL) at the L3 vertebrae and femoral neck. The association of imaging-based PDFFs and aLUL between diabetes groups was investigated by adjusting for confounding factors using a linear mixed model. Results Among 199 participants, patients with T2DM (n = 29) were significantly heavier (P <.001) and had a higher bone mineral density (BMD) (P <.001 for all sites) than nondiabetic patients (n = 170). When PDFFs were compared after adjusting for age, body mass index (BMI), and BMD, the femoral head WFI-based PDFF was lower in patients with T2DM (mean [standard error] 88.0% [0.7] vs 90.6% [0.3], P <.001). Moreover, the aLUL at the L3 vertebrae was lower in patients with T2DM (n = 16) than in without (n = 97) (mean [standard error] 3.9% [0.1] vs 4.3% [0.1], P =.02). Conclusion The content and composition of BMAT are modified in postmenopausal women with T2DM and these changes occur at specific sites. [ABSTRACT FROM AUTHOR]

Current therapeutic approaches for osteoporosis predominantly involve antiresorptive agents, but the emergence of bone anabolic therapy, such as romosozumab, presents a promising alternative. Romosozumab, a monoclonal antibody targeting sclerostin, exhibits both bone anabolic and antiresorptive effects, offering the potential to enhance bone mineral density and mitigate fracture risk. Evidence from several studies demonstrating the efficacy of romosozumab is now established in improving bone mineral density and reducing fracture rates in postmenopausal women and men. This review critically evaluates the role of romosozumab in osteoporosis management, emphasizing findings from real-world studies to facilitate its practical application in clinical settings. Adverse effects, comparative effectiveness with other osteoporotic agents, and challenges in sequential therapy are also discussed, providing insights for informed decision-making by physicians, particularly in the context of pre-treatment considerations. Additionally, the review examines global prescribing guidelines and highlights challenges associated with romosozumab utilization in special patient subgroups, aiming to optimize its clinical use. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have indicated that exposure to heavy metals related to bone health is primarily limited to some common harmful metals, and the impact of lead has not been fully understood. This study aims to explore the relationship between urine lead exposure and bone density. Methods: 1,310 adults were included from the NHANES database (2015-2018), and through generalized linear regression analysis and constrained cubic spline models, the association between lead levels and total bone density as well as lumbar spine bone density was explored. The study also examined the impact of combined exposure to lead and cadmium on bone density. Results and conclusions: Urinary lead levels were significantly negatively correlated with total bone mineral density (b: -0.015; 95%CI: -0.024, -0.007) and lumbar spine bone mineral density (b: -0.019; 95%CI: -0.031, -0.006). Compared to the lowest three quartiles of lead levels, the adjusted odds ratios for T3 changes in total bone mineral density and lumbar spine bone mineral density were 0.974 (95%CI: 0.959, 0.990) and 0.967 (95%CI: 0.943, 0.991), indicating a significant negative trend. Further analysis with constrained cubic spline models revealed a non-linear decreasing relationship between urinary lead and total bone mineral density as well as lumbar spine bone mineral density. Stratified analyses suggested that the relationship between urinary lead levels and bone mineral density might be significantly influenced by age, while gender showed no significant impact on the relationship. Moreover, combined exposure to lead and cadmium was found to be associated with decreased bone mineral density, emphasizing the potential synergistic effects between lead and cadmium on bone health. However, the specific mechanisms of lead and its effects on different populations require further comprehensive research. This study provides valuable insights for further exploration and development of relevant public health policies. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin-to-Red Cell Distribution Width Ratio (HRR) represents novel prognostic markers for diseases. However, there remains a lack of systematic research into the relationship between HRR and Bone Mineral Density (BMD) or osteoporosis in older adults. Methods: This study utilized information from the NHANES database, selecting individuals over 50 years of age with complete femoral DXA scans and full blood counts. The relationship between HRR and femoral BMD was investigated using weighted linear models and restricted cubic spline (RCS) models. Moreover, the association between HRR and osteoporosis was further explored using logistic regression models and RCS models, with subgroup analysis conducted to test the robustness of the results. Results: This study included a total of 7,149 participants, and the BMD of the group with higher HRR was significantly greater than that of the group with lower HRR. Weighted linear regression analysis found a linear positive correlation between HRR and femoral BMD. When HRR was converted from a continuous variable to a categorical variable, this relationship remained stable. In addition, multivariate logistic regression analysis showed that for each 1-unit increase in HRR, the prevalence of osteoporosis significantly decreased (OR = 0.25, 95% CI: 0.12–0.51), further confirming the findings of this study. Subgroup analysis showed that this association was not significantly affected by confounding factors across different populations. Conclusion: HRR may serve as one of the potential indicators for evaluating BMD and assessing the prevalence of osteoporosis in the elderly. Elevating HRR levels may play a crucial role in the prevention and slowing of osteoporosis progression. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis has been recognized as a significant health issue in Thailand. Pharmacological interventions are important way to prevent fracture. However, one of the main challenges in selecting a medication is high cost, particularly for brand-name drugs. Data on generic bisphosphonate use in Thai are still lacking. Therefore, our study aimed to assess the efficacy and safety of generic risedronate in postmenopausal Thai women with osteoporosis. Methods: This prospective study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from December 2022 to January 2024. Serum C-terminal cross-linking telopeptide of type I collagen (CTX) and procollagen type I N-propeptide (P1NP) were measured at baseline. All participants subsequently received 35 milligrams of oral risedronate once weekly for 52 weeks. Serum CTX and P1NP were remeasured at different time points. BMD was reevaluated at 52 weeks after risedronate treatment initiation. Results: A total of 80 participants were included. The mean age was 65.2 ± 6.6 years. The mean body mass index (BMI) was 23.45 ± 3.49 kg/m2. The median (IQR) serum CTX level at 12 weeks was significantly lower than that at baseline (0.28 (0.16–0.46) ng/mL versus 0.44 (0.26–0.64) ng/mL, respectively; p value < 0.01). The suppression of serum CTX was confirmed at 52 weeks after treatment initiation. Compared with those at baseline, the serum P1NP levels were significantly lower at 24 weeks after treatment initiation (30.33 (19.19–39.58) ng/mL versus 41.90 (30.33–68.67) ng/mL, respectively; p value < 0.01). In terms of the BMD assessment at 52 weeks, significant improvements were observed in both areal BMD (g/cm2) and T scores at all measured sites compared with baseline. The lumbar spine, femoral neck, and total hip BMD increased from baseline by 4.76%, 3.84% and 4.54%, respectively. Conclusion: Postmenopausal women with osteoporosis who were treated with generic risedronate demonstrated significant suppression of the bone remodelling process at 3, 6, and 12 months after treatment initiation. Additionally, significant improvements in the lumbar spine, femoral neck, and total hip BMD were observed at 12 months of therapy. These findings suggest that generic risedronate could be considered a reasonable and interesting option for treating postmenopausal women with osteoporosis in Thailand. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the value and age- and gender-specific threshold values of bone mineral density (BMD) by quantitative computed tomography (QCT) for the prediction of spontaneous thoracolumbar vertebral fractures and thoracolumbar junction fractures accompanying distant vertebral fractures. Methods: Among the 556 patients included, 68 patients had thoracolumbar vertebral fractures (12 patients with distant vertebral fractures, 56 patients without distant vertebral fractures) and 488 patients had no vertebral fractures. All patients were grouped by gender and age. According to the principle of Youden index, the threshold values were calculated from receiver operating characteristic (ROC) curves. Results: The threshold values for predicting thoracolumbar vertebral fractures were 89.8 mg/cm3 for all subjects, 90.1 mg/cm3 for men, and 88.6 mg/cm3 for women. The threshold values for men aged < 60 years old and ≥ 60 years old were 117.4 mg/cm3 and 87.5 mg/cm3, respectively. The threshold values for women aged < 60 years old and ≥ 60 years old were 88.6 and 68.4 mg/cm3, respectively. The threshold value for predicting spontaneous thoracolumbar junction fractures with distant vertebral fractures was 62.7 mg/cm3. Conclusions: QCT provides a good ability to predict age- and gender-specific spontaneous thoracolumbar vertebral fractures, and to further predict spontaneous thoracolumbar junction fractures with distant vertebral fractures. [ABSTRACT FROM AUTHOR]

For a long time, the decline in lung function has been regarded as a potential factor associated with the risk of osteoporosis (OP). Although several observational studies have investigated the relationship between lung function and OP, their conclusions have been inconsistent. Given that Mendelian randomization (MR) studies can help reduce the interference of confounding factors on outcomes, we adopted this approach to explore the causal relationship between lung function and OP at the genetic level. To investigate the potential causality between lung function (FVC, FEV1, FEV1/FVC, PEF) and OP, we conducted a MR analysis employing three approaches: inverse variance weighted (IVW), MR-Egger, and weighted median. We used Cochran's Q test to detect potential heterogeneity, MR-Egger regression to evaluate directional pleiotropy, and the MR-PRESSO method to evaluate horizontal pleiotropy. In addition, we used MR-PRESSO and MR radial methods to exclude SNPs exhibiting pleiotropic outliers. Upon identification of potential outliers, we removed them and subsequently ran MR analysis again to assess the reliability of our findings. The MR analysis suggested that there was no causal effect of lung function (FVC, PEF, FEV1/FVC, FEV1) on OP, which is consistent with the. results after excluding potential outliers using MR-PRESSO and MR radial. methods. Sensitivity analysis confirmed the reliability and consistency of these. results. The study concluded that there is no causal link between lung function and OP. The association found in observational studies might be attributable to shared risk factors. [ABSTRACT FROM AUTHOR]

Summary: A multi-feature fusion DCNN model for automated evaluation of lumbar vertebrae L1 on chest combined with clinical information and radiomics permits estimation of volumetric bone mineral density for evaluation of osteoporosis. Purpose: To develop a multi-feature deep learning model based on chest CT, combined with clinical information and radiomics to explore the feasibility in screening for osteoporosis based on estimation of volumetric bone mineral density. Methods: The chest CT images of 1048 health check subjects were retrospectively collected as the master dataset, and the images of 637 subjects obtained from a different CT scanner were used for the external validation cohort. The subjects were divided into three categories according to the quantitative CT (QCT) examination, namely, normal group, osteopenia group, and osteoporosis group. Firstly, a deep learning–based segmentation model was constructed. Then, classification models were established and selected, and then, an optimal model to build bone density value prediction regression model was chosen. Results: The DSC value was 0.951 ± 0.030 in the testing dataset and 0.947 ± 0.060 in the external validation cohort. The multi-feature fusion model based on the lumbar 1 vertebra had the best performance in the diagnosis. The area under the curve (AUC) of diagnosing normal, osteopenia, and osteoporosis was 0.992, 0.973, and 0.989. The mean absolute errors (MAEs) of the bone density prediction regression model in the test set and external testing dataset are 8.20 mg/cm3 and 9.23 mg/cm3, respectively, and the root mean square errors (RMSEs) are 10.25 mg/cm3 and 11.91 mg/cm3, respectively. The R-squared values are 0.942 and 0.923, respectively. The Pearson correlation coefficients are 0.972 and 0.965. Conclusion: The multi-feature fusion DCNN model based on only the lumbar 1 vertebrae and clinical variables can perform bone density three-classification diagnosis and estimate volumetric bone mineral density. If confirmed in independent populations, this automated opportunistic chest CT evaluation can help clinical screening of large-sample populations to identify subjects at high risk of osteoporotic fracture. [ABSTRACT FROM AUTHOR]

Background/Objectives: Renal function influences bone metabolism, as kidney failure can increase the risk of fractures. Denosumab is an approved osteoporosis treatment, but its efficacy in relation to renal function has not yet been studied in real-life scenarios. This study aimed to investigate the denosumab-induced change in bone mineral density (BMD) according to kidney function. Methods: A retrospective analysis was conducted at the outpatient clinic in postmenopausal women receiving denosumab (60 mg subcutaneously administered every 6 months). The glomerular filtration rate (eGFR) was measured by the 2021 CKD-EPI equation and patients were stratified for eGFR categories. BMD was measured by dual-energy X-ray absorptiometry. Results: 128 women (mean age 70.3 ± 9.4 years) were recruited. The mean denosumab treatment duration was 3.9 ± 1.4 years and all the participants had improved BMD values. In stepwise multiple regression analysis—after controlling for age, BMI, and treatment duration—the eGFR value (ß = −0.11, SE 0.04, p = 0.01) was independently associated with the lumbar spine BMD change. The same association remained when the eGFR categories were considered (ß = 3.564, SE 1.29, p = 0.007). In addition, after controlling for BMI and the duration of denosumab treatment, age (ß = −0.7915, SE 0.37, p = 0.03) and eGFR (ß = −0.3257, SE 0.1567, p = 0.04) were found to be associated with femoral neck BMD change. The association remained when considering eGFR categories (ß = 8.7339, SE 4.29, p = 0.04). Conclusions: This retrospective study suggests that eGFR is associated with denosumab efficacy in postmenopausal women treated for osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1–S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients—56 men and 47 women—were enrolled in the study and consecutively separated into two groups of different ages: 18–60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1–S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density. [ABSTRACT FROM AUTHOR]

Objective To construct a resistance band exercise training program through literature re- view and Delphi expert consultation method, and to evaluate its effects on glycemic and bone density indicators in patients with type 2 diabetes complicated with osteoporosis. Methods A total of 81 middle-aged and elderly patients admitted to the department of endocrine osteoporosis in Jiangxi Provincial People's Hospital/First Affiliated Hospital of Nanchang Medical University from April to August 2023 as the research subjects. They were divided into the observation group and the control group using the random number table method. The observation group was given a 3-month resistance band exercise training program in addition to routine treatment and nursing, while the control group was given routine treatment and nursing measures. The glycemic and bone density indicators of the two groups were compared. Results A total of 74 patients completed the study, including 36 in the observation group and 38 in the control group. The fasting blood glucose. postprandial 2-hour blood glucose, and hemoglobin Alc of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05); the number of compliance targets achieved by the two groups were compared, and the difference was statistically significant (P<0.01); the bone density of the two groups after intervention was compared, and there was no statistically significant difference (P>0.05). Conclusion The resistance band exercise training program can not only reduce the glycemic indicators of patients, but also effectively improve their compliance with exercise, but the effect on improving the patient s bone mineral density is not obvious. [ABSTRACT FROM AUTHOR]

Objective To investigate the application value of Yishen Huayu Xugu prescriptionin the management of osteoporotic lumbar compression fracture among elderly patients. Methods From March 2022 to August 2023, all elderly patients with osteoporotic lumbar compression fractures were enrolled in our hospital and randomly assigned into two groups. The patients were diagnosed with kidney deficiency and blood stasis syndrome through physical identification. After admission, both groups (85 cases each) underwent percutaneous kyphoplasty. The control group received conventional Western medicine treatment post-surgery, while the observation group was administered Yishen Huayu Xugu prescription. This herbal formula was prepared by decocting 300 mL of juice in water, divided into two doses, and taken warmly after breakfast and dinner for a duration of 12 weeks. Therapeutic effects were compared after completion of the 12-week treatment period. Results After treatment, the serum levels of D-dimer (D-dimer, D-D) were (5.02 ± 0.63), interleukin-17 (IL-17) was (53.68 ± 5.47), p-collagen special sequence (p-CTX) was (0.37 ± 0.06, interleukin-6 (IL-6) was (69.38 ± 8.27) compared to the control group; bone morphogenetic protein-2 (BMP-2) was (2.69 ± 0.31), 25-hydroxyvitamin D was (58.93 ± 7.17), and vascular endothelial growth factor (VEGF) was (309.81 ± 51.49) which were higher than those in the control group with more sig-nificant improvement observed in the intervention group (P < 0.05). Bone mineral density (BMD) increased at both week 6 and week12 after treatment with a more pronounced improvement seen in the intervention group (P < 0.05). After treatment, the observation group exhibited a more significant reduction in the total Traditional Chinese Medicine ( TCM ) symptom score, Cobb Angle, and ODI, compared to the control group (P < 0.05 ). Furthermore, the observation group demonstrated a higher total effective rate of 95.29% (81/85) compared to 85.88% (73/85) in the control group after treatment, "with a statistically significant difference between the two groups (P < 0.05). Conclusion The Yishen Huayu Xugu prescription holds significant positive implications for this particular medication, as it exhibits enhanced efficacy in reducing inflammation, regulating bone metabolism, improving lumbar function, promoting disease amelioration, and enhancing clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Children with spinal muscular atrophy (SMA) are at risk of low bone mineral density (BMD) and bone fragility. This study aims to assess lumbar spine BMD measured by quantitative computed tomography (QCT) and investigate influencing factors of low BMD in children with SMA without disease-modifying treatment. Methods: Demographic data, laboratory parameters, QCT data, and data on spinal radiographs were collected. A linear regression model was carried out to explore the correlations between BMD and its related factors. Results: Sixty-six patients with SMA who had complete records between July 2017 and July 2023 were analyzed, with SMA with a mean age of 5.4 years (range, 2.4–9.7 years), including type 1 in 14, type 2 in 37, and type 3 in 15. 28.8% of patients (19/66) were diagnosed with low BMD (Z-scores ≤ − 2), and the mean BMD Z-scores on QCT was − 1.5 ± 1.0. In our model, BMD Z-scores was associated with age (β=-0.153, p = 0.001). SMA phenotype and serum bone metabolism markers, such as serum phosphorus (P), alkaline phosphatase (ALP) and 25-Hydroxyvitamin D (25-OH-D) levels did not independently predict low BMD. ROC analysis showed that the age ≥ 6.3 years predicts a Z-scores ≤ -2.0 with a sensitivity of 68.4% and a specificity of 68.1%. Conclusions: Low BMD were highly prevalent in children with SMA without disease-modifying treatment in our centre. Regular monitoring of BMD is necessary for all types of SMA children, especially those aged ≥ 6.3 years. [ABSTRACT FROM AUTHOR]

Purpose: The difference of Hounsfield Unit (HU) value in different regions of L3 vertebra in middle-aged and elderly patients with lumbar degeneration diseases (LDD) was analyzed. To investigate the influence of proliferative tissue on HU value of cancellous bone and its correlation with bone mineral density (BMD). Methods: The medical records of middle-aged and elderly patients with LDD in our hospital from December 2020 to December 2023 were retrospectively analyzed. The patients were divided into osteophyte group and no-osteophyte group according to the presence or absence of osteophyte formation on lumbar spine X-ray. In osteophyte group, cancellous bone HU value, containing cortical bone overall HU value and containing osteophyte overall HU value in L3 vertebra were measured on the lumbar CT cross-section. In no-osteophyte group, only the cancellous bone HU value and the containing cortical bone overall HU value were measured. Differences in HU value in different regions of the L3 vertebral body were compared within and between groups of middle-aged and elderly patients with LDD, respectively. To investigate its effect on cancellous bone HU measurements and to do a correlation analysis with patients' BMD. Results: A total of 115 patients with LDD were included in this study, including 65 males and 50 females, with an average age of 67.83 ± 6.59 years. The results of the study showed no statistical differences in age (P = 0.15), gender (P = 0.57), smoking (P = 0.88), drinking history (P = 0.76), medical history (P > 0.05) and BMI(P = 0.29) between the two groups. In osteophyte group, the mean cancellous bone HU value was 98.00 ± 25.50 HU, the containing cortical bone overall HU value was 189.02 ± 46.18 HU, and the containing osteophyte overall HU value was 232.69 ± 56.01 HU. The overall HU values containing cortical bone and containing osteophyte were significantly higher than cancellous bone HU value (P < 0.001). In no-osteophyte group, the mean cancellous bone HU value was 102.04 ± 19.64 HU, and the containing cortical bone overall HU value was 175.00 ± 28.97 HU, which was statistically significantly different (P < 0.001). There was no significant difference in cancellous bone HU value and the containing cortical bone overall HU value between the two groups (P > 0.05). The results of the Pearson correlation analysis showed a significant correlation between the cancellous bone HU value of the L3 vertebrae and the QCT BMD value of the patients (r = 0.95, P < 0.001). However, there was no significant correlation between containing cortical bone overall HU value and containing osteophyte overall HU value and the patient's QCT BMD value (P > 0.05). Conclusions: Vertebral HU value is an alternative measurement that effectively reflects the patient's BMD. In middle-aged and elderly LDD patients, HU values in different areas of L3 vertebra are significantly different, and hyperplastic tissues such as cortical bone and osteophytes may exponentially lead to higher HU value in patients. Compared with other measurement areas, vertebral cancellous bone HU value have the advantage of accurately assessing patients' BMD. [ABSTRACT FROM AUTHOR]

Background and Objectives: Age-related hearing loss (ARHL) is a sensorineural disease that is associated with a number of factors. In addition to age, sex, environment, lifestyle, and comorbidities are all known to be related to ARHL as well. The prevalence of ARHL can be reduced by controlling the adjustable factors that cause it. Vitamin D levels are strongly related to calcium metabolism, which can affect ARHL. This study aimed to investigate the association between vitamin D and ARHL. Subjects and Methods: A total of 1,104 subjects aged >65 years were enrolled from the fifth Korean National Health and Nutrition Examination Survey, which was conducted from 2010-2012. Every participant received both an audiological assessment and a nutritional survey. The association between ARHL and serum vitamin D concentration was analyzed using logistic regression analyses with complex sampling adjusted for confounding factors such as alcohol consumption, smoking status, mobility, and bone mineral density. Results: Our multivariable analysis revealed that males in the group with lower serum levels of vitamin D (< 20 ng/mL) had a higher prevalence of ARHL (odds ratio, 1.638, 95% confidence interval, 1.058-2.538, p=0.027). Conclusions: This finding suggests that lower serum levels of vitamin D are associated with ARHL in the older male population. [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]

Dual-energy X-ray absorptiometry (DXA) and bone mineral density (BMD) pose several limitations in some patient categories, such as pregnant women and young people. This review article explores whether the innovative radiofrequency echographic multi-spectrometry (REMS) technology is beneficial for assessing the bone condition of various patient groups. Common consequences in patients with acromegalia, prostate cancer undergoing hormone therapy, osteogenesis imperfecta, anorexia nervosa, and in a peritoneal dialysis setting include decreased BMD and an increased risk of fragility fracture. DXA is currently regarded as the gold standard for BMD assessment. However, using the DXA technique has several drawbacks in a young patient who requires repeated BMD tests because it uses ionizing radiation. Because of its precision and consistency, the REMS technique may be a valuable tool to assess changes in bone condition in patients of all ages, particularly in female patients who are fertile or who are pregnant or nursing. [ABSTRACT FROM AUTHOR]

Since its introduction in 1987, dual-energy X-ray absorptiometry (DXA) has revolutionized bone assessment, becoming the gold standard for measuring bone mineral density (BMD). Its low radiation exposure and high accuracy have made it indispensable in diagnosing osteoporosis, aligning with World Health Organization criteria. However, DXA evolution extends beyond BMD measurement, with emerging tools like the Trabecular Bone Score (TBS) and the DXA-based Bone Strain Index (BSI). TBS provides insights into trabecular bone architecture, enhancing the prediction of fracture risk. Despite limitations like body mass index correlation, TBS aids in evaluating patients with conditions such as diabetes and glucocorticoid exposure. BSI, introduced in 2019, evaluates bone strength using finite element analysis, complementing BMD and TBS by assessing bone fatigue. Advancements in DXA-based tools extend to Hip Structural Analysis and three-dimensional DXA software, offering valuable insights into hip fracture risk. Moreover, DXA serves beyond bone assessment, aiding in abdominal aortic calcification assessment, enhancing cardiovascular risk stratification. In summary, the expanding capabilities of DXA promise comprehensive skeletal and cardiovascular health evaluation, contributing significantly to clinical management and prevention strategies. [ABSTRACT FROM AUTHOR]