Journal of Clinical Densitometry最新文献

{"title":"Proceedings of the 2023 Santa Fe bone symposium: Progress and controversies in the management of patients with skeletal diseases","authors":"E. Michael Lewiecki ,&nbsp;Teresita Bellido ,&nbsp;John P. Bilezikian ,&nbsp;Jacques P. Brown ,&nbsp;Azeez Farooki ,&nbsp;Christopher S. Kovacs ,&nbsp;Brendan Lee ,&nbsp;William D. Leslie ,&nbsp;Michael R. McClung ,&nbsp;Mark L. Prasarn ,&nbsp;Deborah E. Sellmeyer","doi":"10.1016/j.jocd.2023.101432","DOIUrl":"10.1016/j.jocd.2023.101432","url":null,"abstract":"<div><p>The Santa Fe Bone Symposium (SFBS) held its 23rd annual event on August 5-6, 2023, in Santa Fe, New Mexico, USA. Attendees participated in-person and remotely, representing many states and countries. The program included plenary presentations, panel discussions, satellite symposia, a Project ECHO workshop, and a session on healthcare policy and reimbursement for fracture liaison programs. A broad range of topics were addressed, including transitions of osteoporosis treatments over a lifetime; controversies in vitamin D; update on Official Positions of the International Society for Clinical Densitometry; spine surgery and bone health; clinical applications of bone turnover markers; basic bone biology for clinicians; premenopausal-, pregnancy-, and lactation-associated osteoporosis; cancer treatment induced bone loss in patients with breast cancer and prostate cancer; genetic testing for skeletal diseases; and an update on nutrition and bone health. There were also sessions on rare bone diseases, including managing patients with hypophosphatasia; treatment of X-linked hypophosphatemia; and assessment and treatment of patients with hypoparathyroidism. There were oral presentations of abstracts by endocrinology fellows selected from those who participated in the Santa Fe Fellows Workshop on Metabolic Bone Diseases, held the 2 days prior to the SFBS. These proceedings of the 2023 SFBS present the clinical highlights and insights generated from many formal and informal discussions in Santa Fe.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101432"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1094695023000823/pdfft?md5=0e263a5fd19d230046f06c0a41287d18&pid=1-s2.0-S1094695023000823-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Value of Vertebral Bone Density in the CT Scans of Sepsis Patients Admitted to the Intensive Care Unit","authors":"Veysel Kaya ,&nbsp;Mehmet Tahtabasi ,&nbsp;Yasin Akin ,&nbsp;Ergin Karaman ,&nbsp;Mehmet Gezer ,&nbsp;Nihat Kilicaslan","doi":"10.1016/j.jocd.2023.101417","DOIUrl":"10.1016/j.jocd.2023.101417","url":null,"abstract":"<div><p><em>Aim</em><span>: To evaluate the prognostic value of vertebral bone mineral density (BMD) and its relationship with mortality using the computed tomography (CT) scans of sepsis patients admitted to the intensive care unit. </span><em>Methods</em><span>: In this retrospective study, patients diagnosed with sepsis at the intensive care unit between January and December 2022 were evaluated. Bone density was manually measured from the vertebral body<span> using axial CT images. The relationship of clinical variables and patient outcomes with vertebral BMD, mortality, and mechanical ventilation was investigated. A lower BMD (osteoporosis) was defined as ≤100 HU. </span></span><em>Results</em>: The study included 213 patients (95 females, 44.6%). The mean age of all patients was 60.1±18.7 years. At least one comorbidity was present in 64.7% (n=138) of the patients, and the most common comorbidity was hypertension (n=73, 34.2%). The mortality rate was 21.1% (n=45), and the mechanical ventilation rate was 17.4% (n=37), both being statistically significantly higher among the patients with a lower BMD (36.4 vs. 12.9%; <em>p</em>&lt;0.001 and 29.7 vs. 10.8%; <em>p</em>=0.001, respectively). The rate of a lower BMD was significantly higher in the mortality group (59.5 vs. 29.5%; p=0.001). In the regression analysis, a lower BMD [odds ratio (OR), 2.785; 95% confidence interval (CI): 1.231–6.346, <em>p</em>=0.014] was a significant independent predictor of mortality. Interobserver agreement for BMD measurement was excellent, with an intraclass correlation coefficient of 0.919 (95% CI: 0.904−0.951). <em>Conclusion</em>: Vertebral BMD is a strong independent predictor of mortality and can be easily and reproducible evaluated on the thoracoabdominal CT images of patients admitted to the intensive care unit with a diagnosis of sepsis.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101417"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9927180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Proof of Concept Evaluation of Sacral BMD Measurement in Women with Gynecologic Cancers","authors":"Gretta Borchardt BS (Primary Author) ,&nbsp;Diane Krueger BS (Contributing Author) ,&nbsp;Neil Binkley MD (Contributing Author) ,&nbsp;Paul A. Anderson MD (Contributing Author) ,&nbsp;Janelle Sobecki MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101408","DOIUrl":"10.1016/j.jocd.2023.101408","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To evaluate a potential DXA approach to sacral BMD measurement using extended field and standard L1-4 scans in women with gynecologic cancer.</p></div><div><h3>Rationale/Background</h3><p>Few data exist regarding bone status in women with gynecologic cancer despite known bone toxic effects of treatment-induced menopause, chemotherapy, and pelvic radiation. Cancer treatment-induced bone loss almost certainly increases subsequent fracture risk. Pelvic insufficiency fracture is a potentially catastrophic complication occurring in up to 7.8% of women. It is plausible that sacral BMD measurement could identify women at higher risk for this complication. Whether sacral BMD can be measured as part of routine DXA scanning has not been explored.</p></div><div><h3>Methods</h3><p>Subjects were from a study evaluating BMD change in women treated for gynecologic cancers. Standard clinical spine, hip, forearm and VFA scans, along with an extended length spine scan to include the sacrum, were acquired. Using a GE Lunar iDXA, sacral scans were obtained from the pubic tubercle cranially to the standard spine termination at T12. Sacral regions of interest (ROIs) were placed by outlining the sacrum (ROI 1) then this ROI was divided in half horizontally (ROIs 2 and 3; Figure 1). L1-L4 BMD from standard and extended scans were compared by Pearsons correlation and Bland-Altman analyses. Sacral ROI BMD was correlated by Pearsons with mean total hip, L1-4 and 0.3 radius BMD.</p></div><div><h3>Results</h3><p>Ten women, mean (SD) age and BMI of 53.7 (11.0) years and 32.9 (9.5) kg/m2 were studied. All subjects underwent hysterectomy<span> with bilateral oophorectomy within 35 (14.9) days of baseline DXA scan. Mean L1-4 BMD was 1.146 (0.177) g/cm2 and lowest T-score -0.3 (1.5). Sacral BMD at ROIs 1, 2 &amp; 3 was 0.808 (0.192), 0.897 (0.170) and 0.771 (0.210) g/cm2 respectively. Extended spine scan L1-4 BMD was highly correlated (r = 0.996) with standard L1-4 spine BMD and demonstrated a low bias, -0.006 g/cm2. Sacral BMD of all ROIs correlated with L1-4 (r = 0.88 – 0.93; p &lt; 0.001) and mean total hip BMD (r = 0.79 – 0.84; p &lt; 0.05), but not 0.3 radius (r = -0.23 to -0.12).</span></p></div><div><h3>Implications</h3><p>These data suggest that lumbar spine<span> BMD can be measured using longer scan length DXA, equivalent to standard L1-4 measurements. That sacral BMD corelates with trabecular (spine and hip) but not a cortical sites (0.3 radius) could be expected and may suggest potential utility to monitor BMD change following gyn cancer therapy. Future research will focus on sacral BMD reproducibility and change post treatment.</span></p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101408"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48710596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Health in Pediatric Charcot-Marie-Tooth (CMT) Patients: The Baseline Experience in a Multidisciplinary Neuromuscular Program at a Pediatric Tertiary Care Center","authors":"Martha L. Finch MD (Primary Author) ,&nbsp;Jennifer L. Miller MD (Contributing Author) ,&nbsp;Meghan C. Kostyk APRN-NP, MSN, CPNP, CCD (Contributing Author) ,&nbsp;Vamshi Rao MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101413","DOIUrl":"10.1016/j.jocd.2023.101413","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>Adults with CMT have increased fracture risk, but data in children is lacking. We examine current bone health data in CMT at Lurie Children's Hospital (LCH) to inform clinical care, optimize bone health, and improve long- term morbidity and fracture risk.</p></div><div><h3>Rationale/Background</h3><p>Poor pediatric bone health increases lifelong risk of osteoporosis, with associated morbidity and mortality. CMT, the most common chronic peripheral neuropathy in childhood, is genetically and clinically heterogeneous, with milder, demyelinating (CMT-D), and more severe, axonal (CMT-A) subtypes.</p><p>Presentation includes distal leg weakness or deformity, mobility or balance issues, and muscle cramping. There are no disease-modifying therapies in children; early recognition, symptomatic care, and rehabilitation are critical.</p></div><div><h3>Brief Description of the Undertaking/Best Practice</h3><p>Retrospective chart review of 38 patients (pts) with CMT seen at LCH from 2012-22 revealed 21 pts (age 7-24 years(y)) who had Dual-energy X-ray Absorptiometry (DXA). Lumbar (LS) and total body less head (TBLH) bone mineral density (BMD, g/cm2) were measured (GE/Lunar iDXA). DXA Z-scores, ambulatory status, scoliosis, fracture, vitamin D supplementation, and 25OH vitamin D (25OHD) levels were assessed.</p></div><div><h3>Outcomes achieved/documented</h3><p>Seventeen pts had CMT-D; 4 had CMT-A. 18 pts were weight bearing (WB). The 2 non-WB (NWB), and 1 WB with assistance pts all had CMT-A. 3 pts had scoliosis (1 was NWB; 2 had CMT-D). 2 pts had a history of 1 fracture (not vertebral). 16 took supplemental vitamin D; 13 had 25OHD results, 1 was &lt; 20 ng/ml. Pts were 5- 17y at initial DXA and had 1-7 DXA's completed. At initial DXA, 3 had low BMD (TBLH) (9, 12, 15y). One NWB pt later developed low LS BMD, and another with initial normal BMD had low BMD at 9y (NWB). Three pts with low BMD had CMT-A. Patients with fracture and low 25OHD had normal BMD, and 1 pt with scoliosis had low BMD.</p></div><div><h3>Conclusions</h3><p>Patients with CMT-A had a more severe phenotype and associated bone health measures in this cohort (3 NWB, and 3 with low BMD). Guidelines for pediatric CMT recommend improving muscle strength to slow progression of weakness, without specific bone health recommendations. Given the peripheral nature of CMT, DXA of lateral distal femur or distal 1/3 radius, or peripheral quantitative computed tomography (pQCT) may more accurately characterize bone health status. This study was limited by small sample size and 17/38 pts did not have DXA data. The LCH Neuromuscular program (neurologists, dietitians, physical and occupational therapists, and bone health specialists), seeks to monitor pts with CMT longitudinally, assessing 25OHD, calcium status, and BMD serially, to optimize bone health and prevent fractures and long-term morbidity.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101413"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49250010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Testosterone Pellet Therapy on Bone Mineral Density in Postmenopausal Women","authors":"Gayle Frazzetta MD, FAAFP (Primary Author)","doi":"10.1016/j.jocd.2023.101392","DOIUrl":"10.1016/j.jocd.2023.101392","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aims&lt;/h3&gt;&lt;p&gt;&lt;span&gt;Estrogen therapies&lt;span&gt;&lt;span&gt; have been proven efficacious for the improvement of BMD and fracture risk reduction. Estradiol(E2) and testosterone(T) therapy using pellets have been shown to improve BMD. Current trends in hormone pellet therapy include T with minimal or no E2. Lower doses of E2 minimize the occurrence of adverse effects such as vaginal bleeding, fibroid enlargement, bloating, and &lt;/span&gt;breast tenderness. Studies have reported improved &lt;/span&gt;&lt;/span&gt;climacteric symptoms&lt;span&gt; and sexual health with the use of T pellets though the effects on BMD remain less clear with current treatment trends. This study addresses the effect on BMD of T with little or no E2.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Rationale/Background&lt;/h3&gt;&lt;p&gt;&lt;span&gt;&lt;span&gt;The risk of osteoporosis is well-established in &lt;/span&gt;postmenopausal women&lt;span&gt;&lt;span&gt;, as is the role of hormone therapy to decrease the risks of vertebral and non-vertebral fractures. The use of hormone therapy is controversial due to the misrepresentation of results from the Women's Health&lt;span&gt; Initiative (WHI) Study in 2002. Accordingly, the incidence of hip fractures has continued to rise. The mechanisms by which estrogen and testosterone affect bone &lt;/span&gt;&lt;/span&gt;homeostasis are synergistic and multifactorial. The conversion of T to E2 via &lt;/span&gt;&lt;/span&gt;aromatase&lt;span&gt;&lt;span&gt; occurs in the ovaries, gonads, and end-organ sites, including bone. T and E2 are equally important for men and women. Testosterone is critical for the physical and mental health of women and plays an important role in wellness, bone density, strength, energy, sleep, sexual function, &lt;/span&gt;urinary&lt;span&gt; continence&lt;span&gt;, and quality of life.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;BMD was measured in 35 postmenopausal women aged 53-84 years, receiving low-dose E2/T pellet therapy. Pellets were administered every 3 to 5 months. Replacement of T alone or with 10 mg or less of E2 was considered minimal or no E, while T in combination with greater than 10 mg was considered low E2. BMD at hip and spine was measured at baseline or within three months of initiating pellet therapy and repeated every 12 ± 5 months. All patients received counseling regarding exercise, vitamin D and calcium.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;All patients in this study had improved BMD or cessation of bone loss. The average BMD improvement was 1.6% at the hip and 6.2% at the spine. Patients who received low-dose E2 had greater improvement of BMD at the spine than those who received minimal or no E2, 6.8% vs. 5.4%. The change at the hip was more closely correlated 1.6% vs. 1.7% respectively.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Implications&lt;/h3&gt;&lt;p&gt;Osteoporosis remains a significant health risk in women and hormones have been poorly addressed since the publication of the WHI trial. In this study, testosterone pellet therapy alone or in combination with low-dose E2 pellet therapy improved spine and hip BMD. Little or no E2 exposure minim","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101392"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49447969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Analysis Protocol Improves Quality of Pediatric Hip Structural Analysis","authors":"Devon Cataldi PhD.c (Primary Autho) ,&nbsp;John Shepherd PhD (Contributing Author) ,&nbsp;Struan Grant PhD (Contributing Author) ,&nbsp;Heidi Kalkwarf PhD (Contributing Author) ,&nbsp;Leila Kazemi MSc, CMRI/CBDT (Contributing Author) ,&nbsp;Brandon Quon MS (Contributing Author) ,&nbsp;Jonathan Mitchell PhD (Contributing Author) ,&nbsp;Andrea Kelly PhD (Contributing Author) ,&nbsp;Shana McCormack PhD (Contributing Author) ,&nbsp;Babette Zemel PhD (Contributing Author)","doi":"10.1016/j.jocd.2023.101409","DOIUrl":"10.1016/j.jocd.2023.101409","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aims&lt;/h3&gt;&lt;p&gt;To determine the precision, accuracy, and unique analysis challenges of HSA in children.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Rationale/Background&lt;/h3&gt;&lt;p&gt;Hip structural analysis (HSA) variables, a collection of 10 measures including cross-sectional area (CSA), cross-sectional inertia (CSI), and buckling ratio (BR), have been shown to be independent risk factors in determining fracture risk in adults, but there have been few studies reporting the utility and accuracy of HSA in children. Previous work has described the precision of HSA in adults, but the precision and unique challenges of the HSA protocol in children is unexplored. Here we describe the unique challenges, precision, and quality assurance protocol of pediatric HSA measures in a large cohort of over 2,500 children.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;This is a retrospective analysis of prospectively collected DXA scans acquired as part of two studies, the Bone Mineral Density in Childhood Study (BMDCS) and the Genome-wide Analysis Study (GWAS). The combined sample consisted of 2,514 children (10,787 scans, 1,271 girls) aged from 5 to 21 years. The proximal femur&lt;span&gt; DXA scans were acquired on five Hologic systems (Hologic, Inc., Marlborough, MA) of similar models (A and W) with up to eight years of annual follow-up between 2002 and 2009. All scans were analyzed centrally by the authors using one technologist using APEX 3.4 software. A unique and comprehensive quality assurance check was completed for all scans including a review of the acquisition criteria set by ISCD and a review of the automatically placed HSA region's narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS) region of interests. During processing, regions were either repositioned or eliminated on DXA imaging. Duplicate scans were performed on 150 children (71 girls) for precision assessment. Specific HSA quality control (QC) codes were generated for this particular analysis in accordance with the author's criteria. Short-term precision estimates were calculated as the RMSE and %CV. QA codes were assigned to the NN, IT, and FS boxes that were either incorrectly positioned or invalidated.&lt;/span&gt;&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Of the entire dataset under 10% of NN and FS boxes needed to be repositioned and none were invalidated. Figure 1 provides an example of proper placement of the IT box (at a 45-degree angle) in between the greater and lesser trochanter&lt;span&gt;. If the angle of the IT box is either &lt; 10 or &gt;25 degrees, the IT box was invalidated. In this study, 100% of the IT boxes needed to be repositioned and 54% remained invalid. Multiple reasons were identified for an invalid scan region including the unavoidable presence of a growth plate in the hip scans for participants less than 15 years old, as shown in Figure 1. All HSA precision over all age groups ranged was less than 6% CV except for the NN Buckling ratio and Cross-sectional Inertia. In general, the precision error was lower in t","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101409"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44604818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of bone mineral density and muscle mass with fracture risk assessed by FRAX for postmenopausal women in Inner Mongolia","authors":"Dr. MEI DONG (Primary Author)","doi":"10.1016/j.jocd.2023.101414","DOIUrl":"10.1016/j.jocd.2023.101414","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>The purpose of the study is to identify the relationship between the risk of osteoporotic fracture in postmenopausal women with reduced bone mineral density and appendicular lean mass.</p></div><div><h3>Rationale/Background</h3><p>We hypothesized that limb muscle mass could be used as an independent risk predictor for FRAX. In the present study, we explored the correlation between BMD, limb muscle mass and FRAX in postmenopausal women in Inner Mongolia, adjusting for potential confounders.</p></div><div><h3>Brief Description of the Undertaking/Best</h3><p>Practice Methods A cross-sectional study was conducted on 1032 postmenopausal women who were treated at the Second Affiliated Hospital of Inner Mongolia Medical University. The whole body, spine, and hip bone mineral density and body composition were measured by dual-energy x-ray absorptiometry, and the fracture risk assessment was calculated using WHO FRAX risk assessment for the risk of major fractures and hip fracture.</p></div><div><h3>Outcomes achieved/documented</h3><p>Results There were 1032 women with a mean age of 64 years (range, 40 to 90 years). Mean values of lumbar spine BMD, femoral neck BMD, total hip BMD, and ALM were found to be 0.78±0.16g/cm2, 0.64±0.14g/cm2, 0.76±0.15g/cm2, and 15.9±2.4 kg, respectively. The fracture risk calculated in 10 years by using the FRAX for hip fracture and the major fracture was 4.2%(2.8,6.9) and 1%(0.3,2.4), respectively. The appendicular lean mass index showed a significantly higher association with major fracture and hip fracture risk.</p></div><div><h3>Conclusions Conclusion</h3><p>The results of this study suggest that the appendicular lean mass index correlates with an increased risk of a major fracture or hip fracture.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101414"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45893324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-energy X-ray Performance Among Medicare Beneficiaries: 2005-2019","authors":"Tyler Prout MD (Primary Author) ,&nbsp;Casey E. Pelzl MPH (Contributing Author) ,&nbsp;Eric W. Christensen PhD (Contributing Author) ,&nbsp;Neil Binkley MD (Contributing Author) ,&nbsp;John Schousboe MD (Contributing Author) ,&nbsp;Diane Krueger BS, CBDT (Contributing Author)","doi":"10.1016/j.jocd.2023.101385","DOIUrl":"10.1016/j.jocd.2023.101385","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To provide updated trends in DXA number, utilization rates, place of service and interpreter specialty based on a Medicare population dataset.</p></div><div><h3>Rationale/Background</h3><p>DXA exam utilization rate, place of service and interpreters have changed since 2005.</p></div><div><h3>Methods</h3><p>The Medicare Physician/Supplier Procedure Summary Limited Data Set between 2005-2019 was used. All claims with CPT DXA codes 76075, 76076, 77080, 77081 were retained. Annual counts of DXA scans and rates per 10,000 Medicare beneficiaries were calculated. Annual distributions (%) of DXA scans performed by place of service (Office, Outpatient hospital<span><span><span><span> [OH], Other), provider type (Radiologist, Non-Radiologist, Advanced Practice Practitioner [APP]), and interpreter specialty (Radiology, Primary Care, Ob/Gyn, </span>Rheumatology, </span>Endocrinology, Other) were described. </span>Linear regression was used to identify significant trends (significance assigned at p &lt; 0.05) of the mean annual share of DXA utilization by place of service, provider type, and specialty.</span></p></div><div><h3>Results</h3><p>Annual DXA use/10,000 beneficiaries peaked in 2008 at 832, declined to 656 in 2015 and subsequently increased (p &lt; 0.001) by a mean of ∼38 to 807 in 2019 (Figure 1). In 2005, 70.7% of DXAs were performed in office settings with 28.6% acquired in OH. Since 2005, number of DXAs performed in OH increased 1.8%/yr, reaching 51.7% in 2019, and decreased (p &lt; 0.001) 1.8% at office sites. In 2005, 53.7% were interpreted by non-Radiologists and 43.5% by Radiologists. Across the study period the mean proportion interpreted by Radiologists increased (p-values for trend &lt; 0.001) in both office (0.3%/yr) and OH (2.0%/yr) settings, such that by 2019, Radiologists read 73.5% of DXA exams and non-Radiologists 22.8% (Figure 2). A decline in interpretation (p &lt; 0.001) was observed for Primary Care (mean 1.5%/yr), Rheumatology (mean 0.3%/yr) and Ob/Gyn (mean 0.2%/yr) with no significant change for Endocrinology. The share of DXA interpreted by APPs increased by a mean of 0.1%/yr (p &lt; 0.001) from 2005-2019.</p></div><div><h3>Implications</h3><p>DXA number and utilization rate among Medicare beneficiaries has increased since 2015 and returned to 2005 levels. Office DXA rates have declined since 2005 with 51.7% of all scans now occurring in an outpatient hospital setting. DXA interpretation by Radiologists and APPs increased while most other specialties declined. Radiologist DXA interpretation has increased in both settings such that Radiology interpreted 73.5% of all DXAs submitted to Covered Medical Services for reimbursement in 2019.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101385"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42760735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"6 year old with Duchenne's Muscular Dystrophy with extremely low BMD and BMC calculations secondary to local edema from acute vertebral fracture","authors":"Virginia A. Kaperick MD (Primary Author)","doi":"10.1016/j.jocd.2023.101383","DOIUrl":"10.1016/j.jocd.2023.101383","url":null,"abstract":"<div><h3>Case Description</h3><p><span>6 year old with Duchenne's Muscular Dystrophy (DMD), on chronic daily </span>glucocorticoids<span>, presented for his scheduled DXA<span> screening, as per 2018 DMD Care Considerations Guidelines. He fell on his bottom the night before his appointment resulting in acute severe midline low back pain. GE Lunar iDXA densitometer was unable to automatically detect bone edges requiring manual ROI placement to complete the study. The Lumbar Spine<span> L1-L4 BMD Z-score was - 7.5, with very low BMC of 0.93 grams. On Whole Body scan<span> the Total Body Less Head (TBLH) Z-score= -2.0. No prior x- ray or DXA imaging available. Spine X-rays had subtle changes concerning for possible early vertebral compression. His pain remained moderate to severe over following 8 days, and had slow improvement with supportive care over subsequent weeks. Vertebral fracture was confirmed on repeat spine x-ray eight weeks after original study when noted to have 25% ht loss of L5, as well as compressive changes to L2, L3. Repeat DXA at this time showed L1-L4 BMD Z-score = -2.2 with BMC= 8.67g and TBLH Z-score remained -2.0. Acute injury, with its associated inflammation, edema, and possibly local hemorrhage, led to difficulties in edge detection and discrimination of bone versus soft tissue. This is not commonly reported in the manufacture or scientific literature as a source of error. Provider knowledge of this potential source of internal artifact should lead to either delay of imaging, or to repeat the study at an appropriate time if findings are inconsistent with expected outcomes in the setting of acute injury.</span></span></span></span></p></div><div><h3>Credit</h3><p>Michelle Clausen, Lead Nuclear Medicine/PET Technologist Children's Wisconsin</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101383"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45363303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Physician Assessment during total hip arthroplasty correlates with DXA parameters","authors":"David P. Martin II MD (Primary Author) ,&nbsp;Samuel S. Lake MD Physician (Contributing Author) ,&nbsp;Michael A. Behun MD (Contributing Author) ,&nbsp;Diane Krueger BS, CBDT (Contributing Author) ,&nbsp;Radius Neil Binkley MD (Contributing Author) ,&nbsp;David Hennessy MD (Contributing Author) ,&nbsp;Brian Nickel MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101393","DOIUrl":"10.1016/j.jocd.2023.101393","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To evaluate Intraoperative Physician Assessment (IPA) during total hip arthroplasty (THA) as a quantitative measure of bone status based on tactile assessment. IPA was compared to DXA-measured bone mineral density (BMD), 3D-Shaper parameters, and radiographic indices to assess its validity for evaluating bone status.</p></div><div><h3>Rationale/Background</h3><p>The International Society for Clinical Densitometry (ISCD) Official Positions acknowledge the orthopedic surgeons’ ability to assess bone intraoperatively and recommend bone assessment for patients with poor bone quality. Currently, there is no validated method to quantify bone status intraoperatively and correlate it with DXA-parameters. This study sought to fill that void.</p></div><div><h3>Methods</h3><p>A retrospective analysis identified patients undergoing primary THA who had IPA recorded in the operative report<span> and a DXA within 2 years prior to surgery. Patients were excluded if they had prior surgery on the involved hip. 60 patients (64 hips) operated on by 2 fellowship-trained arthroplasty surgeons were included. Intraoperatively, surgeons subjectively assessed bone quality on a 5-point scale based on tactile feedback. This scale defined 1 as excellent and 5 as poor, as noted in Table 1. IPA score was compared to DXA BMD and T-score, 3D Shaper measurements, WHO classification, FRAX scores, radiographic Dorr classification and Cortical Index. IPA was correlated with bone parameters using the Pearson method for continuous variables and Spearman method for ordinal variables.</span></p></div><div><h3>Results</h3><p><span>Mean (SD) patient age and BMI were 69.1 (8.5) years and 27.7 (5.9) kg/m2 respectively; 54 (84%) were female. Patient demographic data and bone parameters were similar between surgeons. Mean IPA was 2.95 ± 0.98 with no difference between surgeons (p = 0.121). There was a moderate correlation between IPA score and total hip BMD (r = 0.386, p = 0.002) and 3D shaper measurements, including trabecular volumetric BMD (r = -0.326, p = 0.010), cortical surface BMD (r = -0.347, p = 0.006), and cortical thickness (r = -0.381, p = 0.002). There was a strong correlation (all p &lt; 0.001) between IPA score and lowest T-score (r = -0.485), WHO classification (r = 0.528), and FRAX major and hip fracture scores (r = 0.501, 0.622). All patients with below average or poor IPA score had </span>osteopenia<span> or osteoporosis by DXA.</span></p></div><div><h3>Implications</h3><p>IPA during THA is a simple, valuable tool for quantifying bone status based on tactile feedback. This information can be used to identify patients with poor bone quality that may benefit from bone health evaluation and treatment.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101393"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41311216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}