Journal of Clinical Densitometry最新文献

{"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}

{"title":"Inter-observer Reliability of CT Attenuation Measurement of Lumbar Vertebral Bodies","authors":"Gary K. Schneider DO (Primary Author Fellow Physician)","doi":"10.1016/j.jocd.2023.101404","DOIUrl":"10.1016/j.jocd.2023.101404","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To assess reliability of lumbar vertebral body computed tomography (CT) attenuation measurement between different observers.</p></div><div><h3>Rationale/Background</h3><p>The International Society for Clinical Densitometry<span><span> (ISCD) guidelines for DXA interpretation include assessment of “opportunistic CT” as a surrogate for DXA scan using L1 vertebral body attenuation, with threshold &gt;150 and &lt; 100 Hounsfield units (HU) estimating the likelihood of normal bone density and osteoporosis, respectively. ISCD guidelines include precision analysis of DXA, but there are no formal guidelines for assessing precision error when assessing bone mineral density (BMD) by </span>CT attenuation of lumbar vertebral body. Measurement of precision have been published and we sought to determine inter-rater reliability and to assess precision by test-retest of the same patient.</span></p></div><div><h3>Methods</h3><p>Utilizing Visage PACS to view CT images, six observers each measured CT attenuation of L1 and L5 vertebral bodies of the same set of 31 separate CT scans. Measurements were performed as previously described.3 Average HU within an elliptical region of interest (ROI) of the L1 and L5 vertebral bodies were recorded for each measurement, as well as L1 and L5 ROI area. Intra-class correlation (ICC) was calculated for each of these variables, with &gt;0.9 indicating excellent agreement, 0.75-0.9 indicating good agreement, 0.5-0.75 indicating moderate agreement, and &lt; 0.5 indicating poor agreement. ICC was calculated of L1 attenuation measured by a single observer on a separate set of 12 patients with CT scans done within 30 days of each other. Additionally we calculated root mean square–coefficient of variation (RMS-CV) of L1 vertebral body attenuation on this set of 12 patients.</p></div><div><h3>Results</h3><p>ICC of L1 attenuation and L5 attenuation were 0.94 and 0.92, respectively, indicating excellent agreement between observers. ICC of ROI areas at L1 and L5 ROI were 0.04 and 0.03, respectively, indicating poor agreement (Table 1). ICC of L1 CT attenuation on repeat scans within 30 days by a single observer was 0.97, indicating excellent agreement between two readings . Root mean square-SD was 14.6 HU. Least significant change was 40.4 HU. Percent coefficient of variation was 34.6.</p></div><div><h3>Implications</h3><p>This study demonstrates that measurement of CT attenuation at L1 and L5 between different observers is reliable while area of region of interest at L1 and L5 between observers showed poor agreement. In test-retest of scans performed within 30 days on the same patient, a short time period in which little change is expected, measurement of CT attenuation also showed excellent agreement.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101404"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49593436","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":"Custom Femur and Tibia BMD Precision in Elective Total Knee Arthroplasty Patients","authors":"Lucas Andersen BS (Primary Author) ,&nbsp;Diane Krueger BS, CBDT (Contributing Author) ,&nbsp;Gretta Borchardt BS (Contributing Author) ,&nbsp;Brian Nickel MD (Contributing Author) ,&nbsp;Paul A. Anderson MD (Contributing Author) ,&nbsp;Neil Binkley MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101395","DOIUrl":"10.1016/j.jocd.2023.101395","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To compare bone mineral density (BMD) precision of knee custom regions of interest (ROI) with and without total knee arthroplasty (TKA).</p></div><div><h3>Rationale/Background</h3><p>TKA is a common procedure that results in 10 to 15% BMD loss at the distal femur<span>. This could contribute to complications such as periprosthetic fracture<span>, especially if osteoporosis is present at the time of TKA. Prior work supports measuring BMD around the knee using custom ROIs, this study investigates precision error of such an approach.</span></span></p></div><div><h3>Methods</h3><p><span>Thirty participants from a study evaluating BMD pre- and post-TKA had duplicate posteroanterior (PA) and lateral (LAT) scans in TKA and non-TKA knees with repositioning between. Scans were acquired on a Lunar iDXA with the orthopedic<span> knee feature (GE enCORE software v18). Custom ROIs were manually placed on PA and LAT scans at the distal femur condyle (ROI 1), metaphysis (ROI 2) and shaft (ROI 3), and the </span></span>proximal tibia<span> (ROI 4) and tibial shaft (ROI 5) (Figure 1). The prosthesis was identified as artifact by the software. Precision error was calculated using the ISCD Advanced Precision Calculator and differences between TKA vs non-TKA legs were assessed by F-test.</span></p></div><div><h3>Results</h3><p><span>Study participants (n = 30; 6M, 24F) with mean (SD) age and BMI of 69.2 (6.5) years and 31.6 ± 4.9 kg/m2 respectively were included. Precision at various ROIs (Table 1) on non-TKA legs ranged from 1.2 - 3.8% on PA and 2.5 – 5.6% on LAT projections. Similarly, TKA leg ROI %CV ranged from 1.5 - 5.4% and 1.0 – 4.1% on PA and LAT respectively. PA precision differed (p &lt; 0.001) between TKA and non-TKA legs at the distal femur condyle and tibia shaft. LAT precision differed between legs (p &lt; 0.05) at the femur metaphysis, shaft, and tibia shaft. In the non-TKA leg, lateral positioning precision was numerically poorer at all ROIs; a generally similar pattern was observed in the TKA leg. The bone area post-TKA was small in the most distal femur and proximal tibia ROIs due to implant artifact. Tibial PA shaft reproducibility was confounded by fibular overlap in 23% of non-TKA scans but none post-TKA. However, </span>fibula overlap was present on LAT view in 30% and 43% of non-TKA and TKA legs respectively.</p></div><div><h3>Implications</h3><p>Distal femur and proximal tibia BMD measurement may have utility for surgical planning and is best assessed in the PA projection. Based on precision, monitoring is best at the PA femur shaft and postoperatively at the tibial shaft. It is reasonable to expect precision improvement with automated ROI placement.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101395"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46930638","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":"The relationship between entered height, weight, sex, and changes in patient thickness on Trabecular Bone Score using a Hologic Horizon Dual Energy X-ray Bone Densitometer - A cadaveric spine phantom study","authors":"Lawrence G. Jankowski CBDT (Primary Author) ,&nbsp;Michelle Kochanski RT (Contributing Author) ,&nbsp;Ami K. Kothari MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101384","DOIUrl":"10.1016/j.jocd.2023.101384","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aims&lt;/h3&gt;&lt;p&gt;To explore the sensitivity and precision of Trabecular Bone Score (TBS) calculations to changes in the entered weight, height, sex, and scan mode on a Hologic Horizon-A densitometer, using a radiographic cadaveric spine torso phantom.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Rationale/Background&lt;/h3&gt;&lt;p&gt;Currently, TBS adjusts the score using BMI of the patient, using calibration points derived from a TBS Calibration Phantom that has segments with differing attenuation over the targets within it. If patient thickness is different than predicted by BMI, or if data entry error occurs this can impact both TBS, and FRAX, and TBS-adjusted FRAX. Sex selected alters TBS, and this can have implications for those undergoing gender transition.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A cadaveric bone torso phantom (Radiology Support Devices, Inc, Long Beach, CA, USA) was scanned on a Hologic Horizon A, using Apex Version 5.6.1.2 Rev 009 software, five times each, using array and fast-array spine scan modes, and again with the addition of one or two 4mm thick acrylic plates to simulate changes in soft-tissue thickness. All scans were done without repositioning of the phantom during sets. (FIGURE 1) The default auto-analysis was accepted after verification of intervertebral line placements for the first scan in each series of five, and the “Auto-Compare” analysis of the remaining scans to reduce operator effects on results. For the fast array scans using two acrylic plates, the software applied “Auto low-density” analysis algorithm. Upon calculating the average Effective Epoxy Thickness (TH) values of the phantom without absorbers, an index height and weight was determined using the average height and weight of a convenience sample of patients with matching TH values, taken from the scanner database. TBS values were then calculated (TBS iNsight version 3.1.2) after varying the height in 1 inch increments or the weight in 5 pound increments across the BMI range permitted for TBS (BMI range 15-37 kg/m2). The results at each height/weight were recorded for both sexes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Precision error, as the SD of the five scans in each scan mode, for TBS, BMD, and TH were smaller for array scans than fast-array of the phantom. But this was reversed for BMD and TH with 4 and 8cm of absorber. TBS SD, however was consistently poorer in fast-array at all three phantom thicknesses. There was a slight increase in BMD with additional attenuation, but no significant differences between BMD in array or fast array at each phantom thickness. TBS scores decreased with additional absorber while BMD increased slightly with additional absorber. (TABLE 1) When altering BMI whether by weight or height, TBS was proportional to BMI based on data entry. At all values of BMI, males have are higher TBS than females but the slopes remain similar until a BMI of around 27 kg/m2, where the slope for males increases compared females. Fast-array values are consistently higher","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101384"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42102791","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":"Experimental study on the establishment of Aromatase inhibitor associated bone loss model after premenopausal breast cancer and the mechanism of bone loss","authors":"Meiling Chu (Primary Author),&nbsp;Yulian Yin (Contributing Author),&nbsp;Hongfeng Chen (Contributing Author)","doi":"10.1016/j.jocd.2023.101405","DOIUrl":"10.1016/j.jocd.2023.101405","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aims&lt;/h3&gt;&lt;p&gt;To construct a nude mouse model of aromatase inhibitor-associated bone loss (AIBL) after premenopausal breast cancer surgery, and to explore the possible mechanism of letrozole-induced bone loss.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Rationale/Background&lt;/h3&gt;&lt;p&gt;At present, clinical and experimental research on AIBL mainly focuses on postmenopausal breast cancer patients, ignoring the premenopausal population of AIs combined with Ovarian Function Suppression. The mechanism of AIBL is not only the well-known sharp decline of estrogen, but also the lack of exploration of the cellular mechanism and factors related to bone metabolism. H-type blood vessels contribute to angiogenesis and bone formation in the bone microenvironment. It is a sensitive indicator for evaluating bone mass andSlit guided ligand 3 (SLIT3) is a type of angiogenic factor secreted by osteoblasts. Knocking out SLIT3 will lead to the reduction of H-type vascular endothelial cells in bone and resulting in a decrease in bone mass. Based on this, it will be helpful to establish AIBL animal model and explore the mechanism of bone loss, which will help optimize the endocrine therapy regimen.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;The postoperative AIBL model of premenopausal breast cancer was established by inoculation and resection of breast cancer xenografts, bilateral ovariectomy and letrozole gavage. BALB/c nude mice were randomly divided into 5 groups: Control group (Control group), postoperative group (MX group), castration group (MX+OVX group), model group A (MX+OVX+Le group), model group B (OVX+Le group). The eyeball blood of mice was collected to detect the related bone metabolism and bone-related hormones by ELISA. The bone mineral density and trabecular microstructure of the femur and tibia were evaluated by mirco-CT, the bone tissue was evaluated by HE staining, the activity of osteoblasts was evaluated by OCN immunohistochemistry, and the activity of osteoclasts was evaluated by TRAP immunohistochemistry. Immunofluorescence staining of type H blood vessel (CD31hiEmcnhi) was used to explore the potential mechanism and related targets of AIBL.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Compared with the control group, there were significant differences in serum E2, P1NP, CTX-1, GH and SLIT3 in model A and model B groups (P&lt; 0.05). Bone mineral density was significantly reduced by mirco-CT (P&lt; 0.05), and the decrease in model group A was more significant. In HE staining, the number of bone trabeculae in the model A group was significantly reduced. In addition, TRAP and OCN immunohistochemical staining showed that the trabeculae of model A group were surrounded by more osteoclasts and fewer osteoblasts. Compared to the control group, H-type blood vessels in model A group were smaller under immunofluorescence.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Implications&lt;/h3&gt;&lt;p&gt;Model group A is more suitable as an AIBL animal model after premenopausal breast cancer surgery. Mirco- CT combined with pathological","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101405"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42515886","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":"Factors affecting Patient Compliance in the Treatment of Osteoporosis.","authors":"Madhu Pamganamamula M.D., BC-ADM, CDCES, CCD, CPI (Contributing Author Program Director),&nbsp;Srinidhi Manchiraju MBBS (Contributing Author),&nbsp;Harshavardhini Kommavarapu MBBS (Primary Author),&nbsp;Gowtham Dronavalli MPA, MBA, MBBS (Contributing Author Clinical Administrator),&nbsp;Tejasvi Pamg MBA (Contributing Author Practice Administrator)","doi":"10.1016/j.jocd.2023.101400","DOIUrl":"10.1016/j.jocd.2023.101400","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose/Aims&lt;/h3&gt;&lt;p&gt;To evaluate the incidence of patients declining osteoporotic pharmacologic treatment and to identify factors affecting patient refusal or deferment of treatment options.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Rationale/Background&lt;/h3&gt;&lt;p&gt;Patient consumption of recent literature on the side effects of osteoporosis treatment protocols has dropped the usage of medications such as bisphosphonates by as much as half. This has posed a considerable obstacle in the proactive treatment of osteoporosis and the prevention of fractures.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Researchers studied data from 412 patients from a community-based primary care clinic who had undergone screening for osteoporosis utilizing a bone density or DEXA scan. The criteria for identifying individuals as having osteoporosis was based on International Osteoporosis Foundation criteria, which states that the threshold for qualification is a T-Score of less than or equal to -2.5 in one or more regions or the occurrence of a fragility fracture of the hip or vertebra. Of the 412 patients, 134 patients were confirmed to have had osteoporosis based on this criteria. Patient consent to treatment, side effects, reasons for refusal, and incidence of fractures were recorded for those 134 patients.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Of the 412 patients screened for osteoporosis, 83.9% were female (346/412), and 16% (66/412) were male. The average age for the sample group was 68.5 (68 for females and 73 for males), which is in line with expectations given that post-menopausal women are thought to be the population that requires the screening the most. There were 134 patients who were diagnosed with osteoporosis, and the average age of a person in that group was 71 (70 for females and 81 for males). The average T-Score on a bone density scan for those individuals was -2.8. There was no preference for which region (lumbar vs. hip) was most affected within the group studied. Of the 134 patients diagnosed with osteoporosis based on bone density scan results, 67.9% (91/134) agreed to start and continue a treatment plan for osteoporosis. While 28.4% (38/134) refused treatment for osteoporosis, 97% of that group(34/38) said the reason was lack of insurance or a high deductible on their plan. Only four people out of the group that refused treatment ended up stating that they preferred natural remedies for their condition. There was no evidence based on records that any of the patients experienced any side effects due to the treatment regimen. However, there were 5 cases where patients had fractures before the start of their respective treatments. Among the patients, there was a striking preference for Prolia (denosumab) as the treatment plan, with 68.1% (62/91) electing for that exclusively, whereas only 29.7% (27/91) elected to receive Reclast (zolendronate) exclusively. Only five people (5/91) elected for oral bisphosphonates.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Implications&lt;/h3&gt;&lt;p&gt;A strong patient advocacy team app","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101400"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43860755","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 single nucleotide polymorphism of ERα gene and aromatase inhibitor-associated musculoskeletal symptoms","authors":"Yulian Yin n/a (Primary Author),&nbsp;Yue Zhou (Contributing Author),&nbsp;Yiwei Fan (Contributing Author),&nbsp;Hongfeng Chen (Contributing Author)","doi":"10.1016/j.jocd.2023.101401","DOIUrl":"10.1016/j.jocd.2023.101401","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>The purpose of this study was to investigate the correlation between aromatase inhibitor-associated musculoskeletal symptoms (AIMSS) and ERα gene rs9340799,rs2234693 single nucleotide polymorphisms (SNPs) in breast cancer.</p></div><div><h3>Rationale/Background</h3><p>Aromatase inhibitor (AI) has a better effect on adjuvant therapy of hormone receptor-positive (HR+) breast cancers. AIs inhibit aromatase activity, reduce estrogen concentration, and improve survival rates for HR+ breast cancer patients. Despite the potential benefits, up to 50% of patients stop using AIs early. This is because AI can interfere with bone turnover, increasing the incidence of AIMSS. It has been confirmed that the risk of abnormal bone metabolism in healthy women is related to single nucleotide polymorphism (SNP) at two sites (rs9340799 and rs2234693) in the first intron of estrogen receptor alpha (ERα), but there have been few studies related to the risk of AIMSS. Our primary hypothesis was that ERα rs9340799 and rs2234693 would be associated with AIMSS.</p></div><div><h3>Methods</h3><p>From June 2015 to February 2022, 251 postmenopausal women with ER+ breast cancer who were receiving third-generation therapy were participated in this study. People with a medical history that included drug use or disease symptoms that were known to affect bone mineral metabolism were excluded. Each participant's peripheral blood was used to extract their entire genome, which was then amplified and sequenced for the chosen region. Dual energy X-ray absorptiometry was used to calculate the entire lumbar spine (spinal BMD) and the entire femur (femoral BMD).</p></div><div><h3>Results</h3><p>The BMD and T values of lumbar vertebrae in all ER α gene subtypes at rs9340799 were statistically significant (P=0.031,P&lt;0.01), and the T value of lumbar vertebrae in A/A was higher than those in A/G and G/G (-0.957 ± 1.112 vs -1.313 ± 1.289 vs -1.76 ± 1.304). There were also significant differences in BMD and T values of lumbar vertebrae among rs2234693 genotypes (P=0.011, P &lt; 0.01). The T values of T/T and C/T lumbar vertebrae were higher than those of C/C (-0.801 ± 1.085 vs -1.342 ± 1.067 vs -1.502 ± 1.591).</p><p>Although the femoral BMD trend of both SNPs is similar to that of lumbar vertebrae, there is no statistical difference.</p></div><div><h3>Implications</h3><p>Our findings suggest that C and G alleles may be susceptible genes for AMISS. These findings have potential clinical implications. In patients with C and G alleles, AMISS prevention is crucial, or tamoxifen may be appropriate for these patients to reduce risk.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101401"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44271868","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":"Precision of DXA-derived Visceral Adipose Tissue Measures in Children and their associations","authors":"Devon Cataldi PhD.c (Primary Author) ,&nbsp;John Shepherd PhD (Contributing Author) ,&nbsp;Struan Grant PhD (Contributing Author) ,&nbsp;Heidi Kalkwarf PhD (Contributing Author) ,&nbsp;Leila Kazemi MSc, CMRI/CBDT, CCRP (Contributing Author) ,&nbsp;Andrea Kelly PhD (Contributing Author) ,&nbsp;Shana McCormack PhD (Contributing Author) ,&nbsp;Jonathan Mitchell PhD (Contributing Author) ,&nbsp;Brandon Quon MS (Contributing Author) ,&nbsp;Babette Zemel PhD (Contributing Author)","doi":"10.1016/j.jocd.2023.101394","DOIUrl":"10.1016/j.jocd.2023.101394","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To investigate the precision and analysis protocol for VAT, SAT, and VAT/SAT ratio and explore precision covariates in a large prospective sample of children and young adults.</p></div><div><h3>Rationale/Background</h3><p>Visceral adipose tissue (VAT) has been linked to poor metabolic health, including obesity and metabolic syndrome. Excess VAT can have an early onset during childhood. VAT measured by DXA has been shown to well represent CT and MRI VAT in adults. However, few studies have shown repeatability and quality assurance issues for children.</p></div><div><h3>Methods</h3><p>These data have been collected as a part of 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 whole-body 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 VAT regions of interest. During processing, regions were either repositioned or eliminated on DXA imaging. Duplicate scans were available on up to 150 children (71 girls) for precision assessment which was used to evaluate test-retest precision, both overall and by age group. Short-term precision estimates were calculated as the root mean square error and percent coefficients of variation (RMSE %CV). VAT codes were broken up into either invalidated scans or incorrectly positioned and subsequently corrected.</p></div><div><h3>Results</h3><p>Precision for all children in terms of %CV and RMSE (g) was 7.9% (12.8g) and 4.1% (24.7g) for VAT and SAT respectively. See Table 1. In general, the late teen group had the lowest precision error CV% (3.1-9.0) when compared to all other groups, and preteens had the highest %CV range (4.6-11.4). A pair of scans is shown in Figure 1 where the auto analyzer correctly positioned the regions of interest for the first scan but not for the second scan. Seven percent (752 scans) of the total number of scans had to be manually adjusted.</p></div><div><h3>Implications</h3><p>We conclude that the precision of the VAT regions is dependent on age where the precision for late teens is similar to that of adults. All Hologic DXA whole body scans in children should be manually reviewed for region placement for the most accurate and precise results.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"26 3","pages":"Article 101394"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47390064","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}