Journal of Clinical Densitometry最新文献

{"title":"Cross-Calibration Study of The Stratos And Hologic QDR 4500A Dual-Energy X-Ray Absorptiometers to Assess Bone Mineral Density And Body Composition","authors":"Laurent Maïmoun ,&nbsp;Sandrine Alonso ,&nbsp;Krishna Kunal Mahadea ,&nbsp;Vincent Boudousq ,&nbsp;Thibault Mura ,&nbsp;Denis Mariano-Goulart","doi":"10.1016/j.jocd.2023.101434","DOIUrl":"10.1016/j.jocd.2023.101434","url":null,"abstract":"<div><p>The objective of the study was to assess the agreement between the Stratos (DMS) and QDR 4500A (Hologic) DXAs in determining whole body and regional aBMD, as well as whole body composition.</p><p>Fifty-five individuals (46 women: 84%) with a mean age of 41 ± 13.0 years (range: 20 to 64) and a mean BMI of 31.9 ± 10 kg/m² (range: 12.2 to 49.5) were consecutively scanned on the same day using the two devices. Predictive equations for areal bone mineral density (aBMD) and whole body composition (WBC) were derived from linear regression of the data.</p><p>The two DXAs were highly correlated (p&lt;0.001 for all parameters) with a correlation coefficient (r) ranging from 0.89 to 0.99 for aBMD (r=0.89 for whole body, r=0.92 for radius, r=0.95 for femoral neck, r=0.96 for total hip, and r=0.99 for L1-L4). For WBC, the r value was 0.98 for lean tissue mass (LTM) and 1.0 for fat mass (FM). Paired t-tests indicated a statistically significant bias between the two DXAs for the majority of measurements, requiring the determination of specific cross-calibration equations. Compared to QDR 4500A, Stratos underestimated whole body aBMD and LTM and overestimated neck and hip aBMD and whole body FM. Conversely, no significant bias was demonstrated for mean aBMD at L1-L4 and radius. For whole body aBMD and FM, the concordance between the two DXAs was influenced by BMI.</p><p>Despite a high concordance between the two DXAs, the systematic bias for aBMD and WBC measurements illustrates the need to define cross-calibration equations to compare data across systems.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101434"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211686","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":"Is there a correlation between radiographic absorptiometry of the phalanges of the hand and radiomorphometric indices of the mandible?","authors":"Ângela Jordão Camargo ,&nbsp;Giovani Antonio Rodrigues ,&nbsp;Plauto Christopher Aranha Watanabe","doi":"10.1016/j.jocd.2023.101431","DOIUrl":"https://doi.org/10.1016/j.jocd.2023.101431","url":null,"abstract":"<div><p><em>Objectives:</em><span> The aim of this study was to correlate the mandibular bone quality through radiomorphometric indices in panoramic radiograph with bone quality of non-dominant hand phalanges by radiographic absorptiometry phalanx (RA). </span><em>Methods:</em> The sample consisted of 167 patients (128 women and 39 men) with a mean age of 52.09 (± 11.5) divided into four groups according to RA test: (A) 92; (B) 36; (C) 25 and (D) with 14.9. A panoramic radiograph was taken of each patient and one observer made measurements of cortical thickness at the mental foramen (mental index, MI) and gonion (goniac index, GI) regions and fractal dimension (FD) analyze in mandibular ramus. In phalangeal radiograph was made measurements of cortical thickness at the intermediate (medial phalange index, MPI) and proximal (proximal phalange index, PPI) phalangeal. <em>Results:</em> The results showed correlation (<em>p &lt;</em> 0.00037) between Klemetti index with RA. Variance analysis MI, GI, MPI, PPI shown significant differences (<em>p &lt;</em> 0.05) between the two groups (normal and low bone mineral density - BMD). Area under the ROC curve was 0.74 (sensitivity = 97.4%, specificity = 78%) for MI, 0.79 (sensitivity = 94, specificity = 54%) for GI, 0.77 (sensitivity = 94.8%, specificity = 64%) for MPI, 0.76 (sensitivity = 93.1%, specificity = 62%) for PPI, 0.71 (sensitivity = 96.5%, specificity = 86%) for FD. <em>Conclusions</em>: Our results suggest that the analysis of radiomorphometric indices showed moderate accuracy for detecting changes in mandibular bone quality according to AR.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101431"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91989564","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":"FRAX® adjustment using renormalized trabecular bone score (TBS) from L1 alone may be optimal for fracture prediction: The Manitoba BMD registry","authors":"William D. Leslie ,&nbsp;Neil Binkley ,&nbsp;Heenam Goel ,&nbsp;Eugene V. McCloskey ,&nbsp;Didier Hans","doi":"10.1016/j.jocd.2023.101430","DOIUrl":"10.1016/j.jocd.2023.101430","url":null,"abstract":"<div><p><span>Lumbar spine<span> trabecular bone<span> score (TBS) used in conjunction with FRAX® improves 10-year fracture prediction. The derived FRAX risk adjustment is based upon TBS measured from L1-L4, designated TBS</span></span></span>_L1-L4<span>-FRAX. In prior studies, TBS measurements that include L1 and exclude L4 give better fracture stratification than L1-L4. We compared risk stratification from TBS-adjusted FRAX using TBS derived from different combinations of upper lumbar vertebral levels renormalized for level-specific differences in individuals from the Manitoba Bone Density Program aged &gt;40 years with baseline assessment of TBS and FRAX. TBS measurements for L1-L3, L1-L2 and L1 alone were calculated after renormalization for level-specific differences. Corresponding TBS-adjusted FRAX scores designated TBS</span>_L1-L3-FRAX, TBS_L1-L2-FRAX and TBS_L1-FRAX were compared with TBS_L1-L4<span>-FRAX for fracture risk stratification. Incident major osteoporotic fractures<span> (MOF) and hip fractures were assessed. The primary outcome was incremental change in area under the curve (ΔAUC). The study population included 71,209 individuals (mean age 64 years, 89.8% female). Before renormalization, mean TBS for L1-3, L1-L2 and L1 was significantly lower and TBS-adjusted FRAX significantly higher than from using TBS</span></span>_L1-L4. These differences were largely eliminated when TBS was renormalized for level-specific differences. During mean follow-up of 8.7 years 6745 individuals sustained incident MOF and 2039 sustained incident hip fractures. Compared with TBS_L1-L4-FRAX, use of FRAX without TBS was associated with lower stratification (ΔAUC = −0.009, <em>p</em> &lt; 0.001). There was progressive improvement in MOF stratification using TBSL_1-L3-FRAX (ΔAUC = +0.001, <em>p</em> &lt; 0.001), TBS_L1-L2-FRAX (ΔAUC = +0.004, <em>p</em> &lt; 0.001) and TBS_L1-FRAX (ΔAUC = +0.005, <em>p</em> &lt; 0.001). TBS_L1-FRAX was significantly better than all other combinations for MOF prediction (<em>p</em><span> &lt; 0.001). Incremental improvement in AUC for hip fracture prediction showed a similar but smaller trend. In conclusion, this single large cohort study found that TBS-adjusted FRAX performance for fracture prediction was improved when limited to the upper lumbar vertebral levels and was best using L1 alone.</span></p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101430"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41158491","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":"Adjusting Trabecular Bone Score (TBS) for level-specific differences reduces FRAX®-based treatment reclassification in patients with vertebral exclusions: The Manitoba BMD Registry","authors":"William D. Leslie ,&nbsp;Neil Binkley ,&nbsp;Heenam Goel ,&nbsp;Didier Hans ,&nbsp;Eugene V. McCloskey","doi":"10.1016/j.jocd.2023.101429","DOIUrl":"10.1016/j.jocd.2023.101429","url":null,"abstract":"<div><p><span>Trabecular bone score (TBS) is a FRAX®-independent risk factor for fracture prediction. TBS values increase from cranial to caudal, with the following mean differences between TBS</span>_L1-L4<span><span> and individual lumbar vertebrae: L1 −0.093, L2 −0.008, L3 +0.055 and L4 +0.046. Excluding vertebral levels can affect FRAX-based </span>treatment<span> recommendations close to the intervention threshold. We examined the effect of adjusting for level-specific TBS differences in individuals with vertebral exclusions due to structural artifact on TBS-adjusted FRAX-based treatment recommendations. We identified 71,209 individuals aged ≥40 years with TBS and FRAX calculations through the Manitoba Bone Density Program. In the 24,428 individuals with vertebral exclusions, adjusting TBS using these level-specific factors agreed with TBS</span></span>_L1-L4 (mean difference −0.001). We compared FRAX-based treatment recommendations for TBS_L1-L4<span> and for non-excluded vertebral levels before and after adjusting for level-specific TBS differences. Among those with baseline major osteoporotic fracture risk ≥15 %, TBS with vertebral exclusions reclassified FRAX-based treatment in 10.6 % of individuals compared with TBS</span>_L1-L4<span>, and was reduced to 7.2 % after adjusting for level-specific differences. In 11,131 patients where L1–L2 was used for BMD reporting (the most common exclusion pattern with the largest TBS effect), treatment reclassification was reduced from 13.9 % to 2.4 %, respectively. Among individuals with baseline hip fracture risk ≥2 %, TBS vertebral exclusions reclassified 7.1 % compared with TBS</span>_L1-L4, but only 4.5 % after adjusting for level-specific differences. When L1–L2 was used for BMD reporting, treatment reclassification from hip fracture risk was reduced from 9.2 % to 5.2 %. In conclusion, TBS and TBS-adjusted FRAX-based treatment recommendations are affected by vertebral level exclusions for structural artifact. Adjusting for level-specific differences in TBS reduces reclassification in FRAX-based treatment recommendations.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101429"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41160681","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":"Effects of severe lumbar spine structural artifact on trabecular bone score (TBS): The Manitoba BMD Registry","authors":"William D. Leslie ,&nbsp;Neil Binkley ,&nbsp;Didier Hans","doi":"10.1016/j.jocd.2023.101433","DOIUrl":"10.1016/j.jocd.2023.101433","url":null,"abstract":"<div><p><span>Trabecular bone<span> score (TBS) is a bone mineral density (BMD)-independent risk factor for fracture. During DXA analysis and BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. Although TBS is relatively insensitive to degenerative artifact, it is uncertain whether TBS is still useful in the presence extreme structural artifact that precludes reliable spine BMD measurement even after vertebral exclusions. Among individuals aged 40 years and older undergoing baseline DXA assessment from September 2012 to March 2018 we identified three mutually exclusive groups: spine BMD reporting performed without exclusions (Group 1, N=12,865), spine BMD reporting performed with vertebral exclusions (Group 2, N=4867), and spine BMD reporting not performed due to severe structural artifact (Group 3, N=1541). No significant TBS difference was seen for Group 2 versus Group 1 (referent), whereas TBS was significantly greater in Group 3 (+0.041 partially adjusted, +0.043 fully adjusted). When analyzed by the reason for vertebral exclusion, multilevel degenerative changes significantly increased TBS (+0.041 partially adjusted, +0.042 fully adjusted), while instrumentation significantly reduced TBS (-0.059 partially adjusted, -0.051 fully adjusted). Similar results were seen when analyses were restricted to those in Group 3 with a single reason for vertebral exclusions, and when follow up scans were also included. During mean follow-up of 2.5 years there were 802 (4.2 %) individuals with one or more incident fractures. L1-L4 TBS showed significant fracture </span></span>risk stratification<span> in all groups including Group 3 (P-interaction &gt;0.4). In conclusion, lumbar spine TBS can be reliably measured in the majority of lumbar spine DXA scans, including those with artifact affecting up to two vertebral levels. However, TBS is significantly affected by the presence of extreme structural artifact in the lumbar spine, especially those with multilevel degenerative disc changes and/or instrumentation that precludes reliable BMD reporting.</span></p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101433"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684462","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":"Relationship between blood monocyte-HDL ratio and carotid intima media thickness in with postmenopausal women","authors":"Ender Erden ,&nbsp;Ayla Cagliyan Turk ,&nbsp;Nurdan Fidan ,&nbsp;Ebru Erden","doi":"10.1016/j.jocd.2023.101428","DOIUrl":"10.1016/j.jocd.2023.101428","url":null,"abstract":"<div><p><em>Introduction/Background:</em><span> The monocyte-to-high-density lipoprotein (HDL) ratio (MHR) and carotid intima media thickness<span> may be used as a marker of inflammation and oxidative stres. This study is aimed to investigate the role of MHR in etiopathogenesis and to determine the association between MHR and carotid intima media thickness, fracture risk, and quality of life<span> (QoL) in postmenopausal osteoporosis patients without comorbidities. </span></span></span><em>Methodology:</em><span><span> Sixty osteoporosis, sixty </span>osteopenia<span> and sixty control groups were included in the prospective study evaluating postmenapausal women. The monocyte<span>, HDL, and MHR values of all patients were evaluated. The bone mineral density of the participants was determined using the dual energy X-ray absorptiometry device. The fracture risk was assessed using the Turkish model of the Fracture Risk Assessment Tool. The QoL was determined using the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) scale, and carotid intima media thickness ultrasonography was used. </span></span></span><em>Results:</em><span> The age, body mass index<span><span>, duration of menopause, monocyte, HDL, and MHR were similar in all three groups. carotid intima media thickness was higher in the osteoporosis group than in the normal group (p=0.015). A positive correlation was found between L1-4 total T score and monocytes, major osteoporotic fracture risk and physical function from QUALEFFO-41 sub-headings, MHR and QUALEFFO-41 total score (p&lt;0.05). When all participants were evaluated, a positive correlation was found between </span>femoral neck T score and MHR, L1-4 total T score and monocytes, while a negative correlation was found between L1-4 total T score and CIMT (p&lt;0.05). </span></span><em>Conclusion:</em><span> Among postmenopausal women without comorbidities, MHR in the osteoporosis group was similar to that of the osteopenia and normal groups. Monocyte and MHR correlate with femoral neck T score and L1-4 total T score. CIMT was associated with a decreased L1–4 total T-score and an increased fracture risk, but not with MHR.</span></p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 4","pages":"Article 101428"},"PeriodicalIF":2.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956356","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":"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}