Journal of Clinical Densitometry最新文献

{"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}

{"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}