Journal of Clinical Densitometry最新文献

{"title":"Artificial intelligence for opportunistic osteoporosis screening with a Hounsfield Unit in chronic obstructive pulmonary disease patients","authors":"Yali Li,&nbsp;Yan Wu","doi":"10.1016/j.jocd.2025.101576","DOIUrl":"10.1016/j.jocd.2025.101576","url":null,"abstract":"<div><div><em>Introduction:</em> To investigate the accuracy of an artificial intelligence (AI) prototype in determining bone mineral density (BMD) in chronic obstructive pulmonary disease (COPD) patients using chest computed tomography (CT) scans.</div><div><em>Methodology:</em> This study involved 1276 health checkups and 1877 COPD patients who underwent chest CT scans from April 2020 to December 2021. Automated identification, segmentation, and Hounsfield Unit (HU) measurement of the thoracic vertebrae were performed using the musculoskeletal module of the AI-Rad Companion Chest CT (Siemens Healthineers, Er langen, Germany). Patients were divided into three groups: normal BMD, osteopenia, and osteoporosis, with quantitative CT (QCT) as the standard for analysis. The correlation between the HU and BMD values from T8 to T12 and T11-T12 vertebrae was analyzed using Linear regression analysis. The diagnostic performance of the HU values from T8 to T12 and T11-T12 vertebrae for osteoporosis was evaluated using the receiver operating characteristic curve.</div><div><em>Results:</em> The HU values strongly correlated with BMD values in health checkups and COPD patients (R²=0.881‒0.936 and 0.863‒0.927, <em>P</em> &lt; 0.001). The Box-and-Whisker plot showed significant differences between HU and BMD values for T11-T12 vertebrae in normal BMD, osteopenia, and osteoporosis groups in two datasets (<em>P</em> &lt; 0.001). The AUC was 0.970-0.982 and 0.944-0.961 in health checkups and COPD patients for detecting osteoporosis, with a sensitivity of 92.27 %‒97.42 % and 79.48 %‒90.24 % and a specificity of 86.35 %‒92.69 % and 82.81 %‒90.94 %. The optimal thresholds were 99.5‒120.5 HU and 104.5‒123.5 HU, respectively.</div><div><em>Conclusions:</em> The AI software achieved high accuracy for automatic opportunistic osteoporosis screening in COPD patients, which may be a complementary method for quickly screening the population at high risk of osteoporosis.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101576"},"PeriodicalIF":1.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143549597","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 quality is associated with fragility fracture in patients with hemoglobinopathies","authors":"Ellen B. Fung ,&nbsp;Iman Sarsour ,&nbsp;Raquel Manzo ,&nbsp;Ashutosh Lal","doi":"10.1016/j.jocd.2025.101565","DOIUrl":"10.1016/j.jocd.2025.101565","url":null,"abstract":"<div><div><em>Background:</em> Low bone mass, defined as a bone mineral density (BMD) Z-score ≤-2.0, is common in adults with thalassemia (Thal) and sickle cell disease (SCD), though disease-specific artifacts may contribute to inaccuracies in BMD assessment. Trabecular bone score (TBS), an indicator of bone quality, is not susceptible to these challenges and may improve fracture risk prediction.</div><div><em>Methods:</em> A retrospective chart review was conducted in patients with Thal or SCD who had at least one spine BMD scan by DXA in the past 10 years. The most recent scan was reanalyzed for bone quality with abnormal defined as TBS &lt;1.2. Fracture prevalence was determined by patient report with medical record validation. Patients were compared to healthy controls who participated in previous research.</div><div><em>Results:</em> Data were abstracted from 126 patients with Thal (31.7 ± 11.9 yrs, 51 % Male), 170 with SCD (24.6 ± 13.5 yrs, 43 % Male), and 64 controls (25.9 ± 8.0 yrs, 17 % Male). Abnormal TBS was more common in Thal (26 %) or SCD (7 %) compared to controls (0 %, <em>p</em> &lt; 0.001). Fracture prevalence was greater in Thal (36 %) compared to SCD (23 %) and controls (16 %, <em>p</em> = 0.005). Fragility fractures were not observed in controls but constituted 21 % of fractures in Thal and 15 % in SCD. After adjusting for age and hypogonadism, low bone mass was associated with an increased fracture prevalence (OR: 1.8, 95 % CI: 1.03, 3.23; <em>p</em> = 0.041), but not with fragility fracture. In contrast, abnormal TBS was strongly associated with fragility fracture after adjustment for age, sex, and BMI (OR: 11.4, 95 % CI: 2.2, 59.1, <em>p</em> = 0.004).</div><div><em>Conclusions:</em> Bone quality by TBS may be a valuable tool in predicting the risk of fragility fractures in young adults with hemoglobinopathies and should be considered when making decisions for anti-resorptive therapy in those with low BMD naive to fracture or where disease-specific artifacts complicate accurate spine assessment by BMD alone.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101565"},"PeriodicalIF":1.7,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142900","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":"Evaluating lower limits of body fat percentage in athletes using DXA","authors":"Tamara Hew-Butler ,&nbsp;Edward Kerr III ,&nbsp;Gloria Martinez Perez ,&nbsp;Jordan Sabourin ,&nbsp;Valerie Smith-Hale ,&nbsp;Ruben Mendoza","doi":"10.1016/j.jocd.2025.101564","DOIUrl":"10.1016/j.jocd.2025.101564","url":null,"abstract":"<div><div>Body fat percentage (BF%) is routinely measured in athletes to monitor training and dietary interventions. Dual energy x-ray absorptiometry (DXA) is widely considered the gold standard body composition measurement technique, but DXA BF% values measure consistently higher than other techniques. Therefore, the main purpose of this study is to determine the lowest DXA-estimated whole-body fat mass in free-living athletes with unrestricted access to food. In this cross-sectional analyses, 732 participants across 18 competitive sports (643 athletes; 88 %) plus two (male and female) “non-athlete” male and female cohorts (89 non-athletes; 12 %) underwent a whole-body DXA scan using a Horizon A Hologic™ device (software version 13.6.0.5; TBAR 1209), performed and analyzed by a single operator. The average BF % in 454 males (20.9 ± 3.8 years) was 18.2 ± 4.9 % (range 10.3 - 37.2 %), with basketball players having the lowest BF% (15.3 ± 2.6 %) and non-athletes having the highest BF% (21.6 ± 5.4 %) (1-way ANOVA between 10 teams: F = 12.3; p &lt; 0.0001). The average BF% in 278 females (21.3 ± 5.5 years) was 27.1 ± 5.1 % (range 16.2 - 45.3 %), with runners having the lowest BF% (23.5 ± 3.5 %) and non-athletes having the highest BF% (31.7 ± 6.3 %) (1-way ANOVA between 10 teams F = 12.9; p &lt; 0.0001). In absolute values (kg), the average body fat for males was 19.9 ± 8.0 kg (range 6.7 - 62.0 kg) and 18.9 ± 6.4 kg (range 9.2 - 49.7 kg) for females. These data suggest that the lower limits of whole-body fat mass in free-living competitive athletes is approximately 10 % for males and 16 % for females. Whether these DXA-derived fat thresholds represent “healthy” levels, or how much of these DXA-derived fat depots represent essential fat stores located within lean soft tissue mass, remains unclear.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101564"},"PeriodicalIF":1.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054071","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":"Influence of two strength training modalities (hypertrophy vs. contrast training) on muscular strength, bone health parameters and quality of life in a group of older adults with low skeletal muscle mass index","authors":"Amal Antoun ,&nbsp;Eric Watelain ,&nbsp;Antonio Pinti ,&nbsp;Nour Khalil ,&nbsp;Abdel-Jalil Berro ,&nbsp;Elie Maliha ,&nbsp;Youssef Bassim ,&nbsp;Rawad El Hage","doi":"10.1016/j.jocd.2025.101563","DOIUrl":"10.1016/j.jocd.2025.101563","url":null,"abstract":"<div><div>The main aim of the current study was to compare the effects of two strength training modalities (hypertrophy vs. contrast training) on bone health parameters, physical performance and quality of life in a group of subjects aged 60 and above with low skeletal muscle mass index (SMI). 45 older adults voluntarily participated in this study, but only 41 (22 women and 19 men) completed it. The participants were assigned to 3 different groups: control group (CG; <em>n</em> = 15), contrast training group (CTG; <em>n</em> = 13) and hypertrophy training group (HTG; <em>n</em> = 13). The duration of the training protocol was six months. The experimental groups performed two sessions of strength training per week; the duration of each session was forty-five minutes. Several measurements (which included anthropometrics, body composition, bone parameters, maximal strength parameters, physical performance parameters, fracture risk and quality of life) were performed in the three groups before and after the six-month training period. The different measurements of the protocol were carried out under the same conditions with identical materials and investigators for all the participants and for each approach. The current study has demonstrated that the two training modalities show common benefits such as improving maximal strength, physical performance and quality of life parameters but have no significant effects on bone mineral density (BMD) and bone mineral content (BMC). The influence of training was marked more for improving maximal strength and reducing fracture risk for the contrast training group (who performs movements at high speed) compared to the hypertrophy training group (who performs movements at spontaneous speed). In conclusion, this study shows that both resistance training programs are effective in improving maximal strength, physical performance and quality of life in older adults with low SMI. However, this 6-month intervention was not sufficient to significantly increase BMC nor BMD values in this population.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101563"},"PeriodicalIF":1.7,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048455","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":"Evaluation of lumbar vertebral bone quality using T1-weighted MRI: Can it differentiate normal, osteopenia, and osteoporosis?","authors":"Sevde Nur Emir,&nbsp;Gülbanu Güner","doi":"10.1016/j.jocd.2025.101561","DOIUrl":"10.1016/j.jocd.2025.101561","url":null,"abstract":"<div><div><em>Background:</em> Osteoporosis, a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, poses a significant public health challenge globally. While the gold standard for diagnosing osteoporosis is dual-energy X-ray absorptiometry (DXA), its use is limited by factors like spinal deformities and artifacts. This study aims to explore the potential of routine T1-weighted MRI sequences in predicting osteopenia and osteoporosis through the vertebral bone signal (VB) to cerebrospinal fluid signal (CSF) ratio.</div><div><em>Methodology:</em> We conducted a retrospective study of patients who underwent both DXA and lumbar MRI within a six-month interval between 2020 and 2023. Excluding patients with known vertebral fractures, bone tumors, heterogeneous bone marrow, or endplate signal changes due to degenerative alterations, we divided the patients into normal, osteopenic, and osteoporotic groups based on their DXA T-scores. The T1-weighted sagittal MRI sequences were analyzed, and the T1 VB/CSF ratios were calculated for each vertebra (L1–L4).</div><div><em>Results:</em> The study included 376 patients, with an average age of 60.8 ± 9.1 years. Statistically significant differences were found in the T1 VB/CSF ratios across the normal, osteopenic, and osteoporotic groups (<em>p</em> &lt; 0.05). The L1 vertebra demonstrated the highest diagnostic performance for predicting osteoporosis, with an AUC of 0.75, a sensitivity of 88.1 %, and a specificity of 84.5 %. For differentiating osteopenia from normal, the L1 vertebra achieved an AUC of 0.68, with a sensitivity of 78.2 % and a specificity of 76.4 %. The optimal cut-off values were determined as 3.62 for osteopenia and 3.80 for osteoporosis.</div><div><em>Conclusion:</em> The T1 VB/CSF ratio derived from routine lumbar MRI sequences provides a promising, radiation-free tool for opportunistic screening of osteoporosis and osteopenia. Given the frequent use of lumbar MRI for patients with spinal complaints, this method could facilitate early diagnosis and intervention, guiding high-risk patients towards further DXA evaluation and management.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101561"},"PeriodicalIF":1.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143041926","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":"Development of an Algorithm to Predict Appendicular Lean Mass Index From Regional Spine and Hip Dxa Scans","authors":"Krista Rossum ,&nbsp;Mackenzie R. Alexiuk ,&nbsp;Clara Bohm ,&nbsp;William D. Leslie ,&nbsp;Navdeep Tangri","doi":"10.1016/j.jocd.2024.101560","DOIUrl":"10.1016/j.jocd.2024.101560","url":null,"abstract":"<div><div><em>Introduction:</em> Sarcopenia is characterized by progressive muscle loss with reduced physical function and/or reduced muscle strength. Operational definitions of sarcopenia include a measurement of muscle mass, most often from dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass. Appendicular lean mass can be derived from whole-body dual-DXA scans; however, these scans are performed less commonly than hip and spine scans as part of clinical care. The objective of our study was to develop an algorithm to predict appendicular lean mass index (ALMI) from regional spine and hip dual-energy X-ray absorptiometry (DXA) scans.</div><div><em>Methods:</em> We performed a retrospective cross-sectional study using a subset of patients from the Manitoba Bone Mineral Density Registry who had hip, spine, and whole-body DXA scans at the same visit. We developed the algorithm using the following candidate covariates: age, sex, height, weight, DXA-derived spine and hip fat fraction, DXA-derived spine and hip tissue thickness. We internally validated the algorithm using the bootstrap method. Mean bootstrap parameter estimates were used as the final equation.</div><div><em>Results:</em> DXA scans from 676 patients were included in the analytic dataset. Mean ALMI was 6.73 (SD 1.43) kg/m². The final predictive model included sex, age, height, weight, spine fat fraction and hip fat fraction. Sex also acted as an interaction term on weight and hip fat fraction. After bootstrap validation, model adjusted R2 was 0.863, root mean square error was 0.529 kg/m², and AUROC to predict low ALMI per the European Working Group on Sarcopenia version 2 was 0.88.</div><div><em>Conclusion:</em> Hip and spine DXA scans can be used to predict appendicular lean mass index. Future studies should test whether these predictions can be used to assess relationships between sarcopenia and other clinical conditions.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 2","pages":"Article 101560"},"PeriodicalIF":1.7,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464576","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":"Corrigendum to “Follow-up Bone Mineral Density Testing: 2023 Official Positions of the International Society for Clinical Densitometry” Journal of Clinical Densitometry: Assessment and Management of Musculoskeletal Health Vol 27(1), 101440,2024","authors":"Linsey U. Gani ,&nbsp;Chanika Sritara ,&nbsp;Robert D. Blank ,&nbsp;WeiWen Chen ,&nbsp;Julie Gilmour ,&nbsp;Ruban Dhaliwal ,&nbsp;Ranjodh Gill","doi":"10.1016/j.jocd.2024.101540","DOIUrl":"10.1016/j.jocd.2024.101540","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 1","pages":"Article 101540"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830604","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 a High-Impact Exercise Program on Hip Strength Indices in a Group of Obese Women after Bariatric Surgery","authors":"Emne Hammoud ,&nbsp;Christophe Jacob ,&nbsp;Antonio Pinti ,&nbsp;Nour Khalil ,&nbsp;Zaher El Hage ,&nbsp;Hechmi Toumi ,&nbsp;Rawad El Hage","doi":"10.1016/j.jocd.2024.101556","DOIUrl":"10.1016/j.jocd.2024.101556","url":null,"abstract":"<div><div>The purpose of this study was to explore the influence of a 12-month high-impact physical training program (descending stairs) on bone health in a group of young obese women who had undergone bariatric surgery (type sleeve). Fifty-two premenopausal women with a body mass index (BMI) &gt; 35 kg/m² (range: 35.06–60.97 kg/m²), aged 19–47 years old were included in this study. Patients were randomized to either exercise group (EG), control group (CG) or observational group (OG). 2 to 3 weeks post-bariatric surgery (BS), EG underwent a 12-month semi-supervised high impact (descending stairs) exercise program, CG performed a 12-month oriental dance activity while the third OG received only standard medical care. Patients were assessed before BS and 12 months post-BS for body composition, bone mineral density (BMD) and femoral neck geometry. Bone parameters were evaluated by DXA. At baseline, there were no significant differences among the three groups in the clinical characteristics and the bone variables. 12 months after the surgery, there were some group*time interactions. The 3 groups showed significantly lower whole body BMD (−1.8; −2.9; −4.2 % respectively for EG; CG and OG). The EG showed a significant increase of the femoral neck BMD (+1.4 %; <em>p</em> &lt; 0.05), the femoral neck cross-sectional area (+4.6 %; <em>p</em> &lt; 0.05), and the femoral neck cross-sectional moment of inertia (+15.7 %; <em>p</em> &lt; 0.01) while all these values decreased significantly in the 2 other groups. The total hip BMD decreased in all groups, but the EG showed less significant total hip variation, and lumbar spine BMD decreased significantly only in the OG. This study mainly shows that the stair descent can be considered as an effective high-impact physical exercise for obese women who have undergone bariatric surgery. This kind of exercise has significant effects in maintaining or reducing the loss of BMD at the femoral neck and the total hip. Finally, since the EG group showed significant increases in femoral neck geometry variables, this study suggests that this kind of training could be efficient at reducing the hip fracture risk.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 1","pages":"Article 101556"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911200","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 ECHO Case Report: Is it Paget's Disease?","authors":"Melissa F. Cohen ,&nbsp;Rachel Pessah-Pollack ,&nbsp;E. Michael Lewiecki","doi":"10.1016/j.jocd.2024.101550","DOIUrl":"10.1016/j.jocd.2024.101550","url":null,"abstract":"<div><div>A 54-year-old woman was referred by her rheumatologist for evaluation of an elevated serum alkaline phosphatase (ALP) in the setting of polyarthritis. The metabolic work-up was significant for an elevated bone fraction of alkaline phosphatase isoenzymes, and high bone turnover markers, including fasting C- telopeptide (CTX). A diagnosis of Paget's disease of bone (PDB) was considered. A whole-body nuclear bone scan showed diffuse increased uptake in the calvarium, suggestive of PDB, with no other localizing areas of increased uptake. Skull X-rays show mild sclerosis and medullary expansion of the posterior parietal bones and occiput, interpreted by the radiologist as unlikely to be PDB with a high level of uncertainty. Bone density testing with dual-energy X-ray absorptiometry showed low bone mass (osteopenia) with fracture probability that was below the treatment threshold. The case was presented and discussed on Bone Health ECHO, a virtual community of practice with the aim of enhancing global capacity to deliver best practice skeletal health care. The results of the discussion are presented here.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 1","pages":"Article 101550"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015007","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 ECHO Case Report: Rare Cases of Hypophosphatemia and Low-Traumatic Fractures in Patients with Type 1 Diabetes Mellitus","authors":"Zhanna Belaya ,&nbsp;Sofia Gronskaia ,&nbsp;Olga Golounina ,&nbsp;Mikhail Degtyarev ,&nbsp;Natalia Tarbaeva ,&nbsp;Liudmila Rozhinskaya ,&nbsp;Valentin Fadeyev ,&nbsp;Svetlana Rodionova ,&nbsp;Galina Melnichenko ,&nbsp;E. Michael Lewiecki","doi":"10.1016/j.jocd.2024.101552","DOIUrl":"10.1016/j.jocd.2024.101552","url":null,"abstract":"<div><div>Bone Health ECHO (Extension of Community Healthcare Outcomes) is a virtual community of practice that has been connecting healthcare professionals online once weekly for the past 10 years. A key component of each ECHO session is presentation and discussion of patient cases with diagnostic and treatment dilemmas. Here we present two wheelchair-bound female patients aged 47 years (Patient 1) and 34 years (Patient 2), both with type 1 diabetes mellitus (T1DM). They were admitted to our hospital due to multiple fractures and muscle weakness. Since age 8 years, both women suffered from T1DM. Patient 1 had extremely poor glycemic control over the whole period of diabetes with frequent cases of ketoacidosis (glycated hemoglobin [HbA1c] varied 10.0–14.2 %), with multiple end-stage complications of DM including anuria requiring hemodialysis from age 37 years. Patient 2 had minimal DM complications and maintained HbA1c within an individual goal (5.0–6.1 %). Both patients had low fasting phosphate and elevated alkaline phosphatase on laboratory evaluation. In the patient with anuria (Patient 1), after careful evaluation of all possible causes of hypophosphatemia, we found the most likely cause to be the effects of constantly repeated intracellular phosphate depletion due to poorly compensated T1DM. While achieving stable glucose control in hospital care, her phosphate levels gradually returned within the reference range. In the younger patient (Patient 2), tumor-induced osteomalacia (TIO) was diagnosed. After tumor removal her symptoms and laboratory results normalized.</div><div>These cases illustrate two different causes of hypophosphatemia in patients with similar skeletal presentations in association with T1DM.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 1","pages":"Article 101552"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958103","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}