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Copyright of Revista Paulista de Pediatria is the property of Assocoacao de Pediatria de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Osteoporosis is a major public health concern affecting millions of people worldwide and resulting in significant economic costs. The condition is characterized by changes in bone homeostasis, which lead to reduced bone mass, impaired bone quality, and an increased risk of fractures. The pathophysiology of osteoporosis is complex and multifactorial, involving imbalances in hormones, cytokines, and growth factors. Understanding the cellular and molecular mechanisms underlying osteoporosis is essential for appropriate diagnosis and management of the condition. This paper provides a comprehensive review of the normal cellular and molecular mechanisms of bone homeostasis, followed by an in-depth discussion of the proposed pathophysiology of osteoporosis through the osteoimmunological, gut microbiome, and cellular senescence models. Furthermore, the diagnostic tools used to assess osteoporosis, including bone mineral density measurements, biochemical markers of bone turnover, and diagnostic imaging modalities, are also discussed. Finally, both the current pharmacological and non-pharmacological treatment algorithms and management options for osteoporosis, including an exploration of the management of osteoporotic fragility fractures, are highlighted. This review reveals the need for further research to fully elucidate the molecular mechanisms underlying the condition and to develop more effective therapeutic strategies. [ABSTRACT FROM AUTHOR]

Featured Application: Potential to be used for feature generation within AI/ML technology for osteoporosis detection. Machine learning (ML) and artificial intelligence (AI) are widely applied in many disciplines including medicine. Pattern recognition or automatization has been successfully implemented in various field studies. Similarly, multiple efforts have been made in medicine to implement AI/ML technology to solve medical problems, for example, for automating osteoporosis detection. In general, the success of AI/ML technology is highly dependent on the amount of available data, especially during the training stage. Feature generation is a common technique that allows the manipulation of available data for the training stages. This paper aims to study the feasibility of adopting signal-processing techniques for feature generation in medical image processing. Signal attributes from signal processing workflow were adopted and applied to image processing of CT and DEXA scanning data to differentiate between normal and osteoporotic bone. Five attributes, namely amplitude, frequency, instantaneous phase, roughness, and first derivative or contrast attributes, have been tested. An attribute index number is formulated to indicate the attribute's strength at the selected region of interest (ROI). A case study applying these attributes to the CNN model is presented. More than five hundred CT scan images of normal and osteoporosis bone were used during the training stage to test classification performance with and without developed attributes as an input. From the ten selected CT scan images used to test the CNN model, 90% were well predicted in the scenario only utilizing the grayscale as input. However, when including the developed attributes, the CNN can predict all the images well (100% were well predicted). In conclusion, the technique adopted from the signal-processing technique has the potential to enhance feature generation in image processing, whereby the results can be used for the early application of AI/ML in osteoporosis identification. Further research testing this proposed method in different image modalities needs to be conducted to verify the robustness of the proposed method. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to demonstrate the additional benefit of ultrasound in the diagnosis of chronic osteolysis and osteonecrosis (bone marrow defects) of the jaw shown in a clinical case report. Patients and Methods: A case of chronic fatigue syndrome (CFS) in a young man presenting the typical, ambiguous symptoms, which were accompanied by headaches and tinnitus. X-ray techniques, namely panoramic radiographs (OPG) and cone beam computed tomography (DVT/CBCT), failed to produce any remarkable findings of bone marrow defects (BMDJ) in the jawbone. However, the measurement of bone density using trans-alveolar ultrasound (TAU) indicated a possible bone marrow defect in the lower left jawbone. Results: Surgery was undertaken at the conspicuous area. Additional to softened, ischemic, fatty tissue, a black area was revealed, which was surprisingly subsequently identified as aspergillosis by histopathological analysis. In addition, the excessive local RANTES/CCL5 expression found in the affected area confirmed the necessity for surgical debridement and additional findings of TAU. Conclusion: In contrast to radiography, complementary TAU imaging of the BMDJ revealed chronic inflammatory signaling RANTES/CCL5 pathways and fungal colonization. This case report supports the need for additional diagnostic techniques beyond radiographic modalities, which can help to elucidate the diagnostic composition and knowledge of the bone manifestations of systemic diseases. [ABSTRACT FROM AUTHOR]

Osteoporosis is a metabolic disease characterized by an imbalance between bone formation and resorption, that results in an increasing risk of fracture. The aim of the present study was to investigate changes in the thermal pattern of a 50-year-old female patient after intravenous infusion of zaledronic acid Aclasta® in the treatment of osteoporosis. Thermal images were acquired in orthostatic position of the dorsal region between the lumbar and sacral portions using a FLIR® T530 camera with a thermal sensitivity (NETD) < 30 mK and the sensor array size of 320 x 240 pixels, with an accuracy of ±2% of the reading. The image analysis was performed using the Flir Tools® 6.4 software in order to identify the minimum, average and maximum temperature values in the region of interest; and MATLAB® 2017a software to extract histograms from images. The results present a good agreement between the temperature measurements and the painful symptomatology of the sacroiliac region of the vertebral column affected by the disease. Thermography might be a promising method for monitoring bone healing process. [ABSTRACT FROM AUTHOR]

Background: To investigate the reproducibility of automated volumetric bone mineral density (vBMD) measurements from routine thoracoabdominal computed tomography (CT) assessed with segmentations by a convolutional neural network and automated correction of contrast phases, on diverse scanners, with scanner-specific asynchronous or scanner-agnostic calibrations. Methods: We obtained 679 observations from 278 CT scans in 121 patients (77 males, 63.6%) studied from 04/2019 to 06/2020. Observations consisted of two vBMD measurements from Δdifferent reconstruction kernels (n = 169), Δcontrast phases (n = 133), scan Δsessions (n = 123), Δscanners (n = 63), or Δall of the aforementioned (n = 20), and observations lacking scanner-specific calibration (n = 171). Precision was assessed using root-mean-square error (RMSE) and root-mean-square coefficient of variation (RMSCV). Cross-measurement agreement was assessed using Bland-Altman plots; outliers within 95% confidence interval of the limits of agreement were reviewed. Results: Repeated measurements from Δdifferent reconstruction kernels were highly precise (RMSE 3.0 mg/cm3; RMSCV 1.3%), even for consecutive scans with different Δcontrast phases (RMSCV 2.9%). Measurements from different Δscan sessions or Δscanners showed decreased precision (RMSCV 4.7% and 4.9%, respectively). Plot-review identified 12 outliers from different scan Δsessions, with signs of hydropic decompensation. Observations with Δall differences showed decreased precision compared to those lacking scanner-specific calibration (RMSCV 5.9 and 3.7, respectively). Conclusion: Automatic vBMD assessment from routine CT is precise across varying setups, when calibrated appropriately. Low precision was found in patients with signs of new or worsening hydropic decompensation, what should be considered an exclusion criterion for both opportunistic and dedicated quantitative CT. Relevance statement: Automated CT-based vBMD measurements are precise in various scenarios, including cross-session and cross-scanner settings, and may therefore facilitate opportunistic screening for osteoporosis and surveillance of BMD in patients undergoing routine clinical CT scans. Key Points: Artificial intelligence-based tools facilitate BMD measurements in routine clinical CT datasets. Automated BMD measurements are highly reproducible in various settings. Reliable, automated opportunistic osteoporosis diagnostics allow for large-scale application. [ABSTRACT FROM AUTHOR]

Introduction: Bone loss is a common feature in several autoimmune and chronic inflammatory diseases, such as rheumatoid arthritis (RA). Indeed, the high levels of pro-inflammatory cytokines seem to enhance bone resorption and to diminish bone formation, thus producing an uncoupling between osteoclast and osteoblast function and favoring the onset of juxtarticular as well as systemic osteoporosis. Many papers underline the high prevalence of osteoporosis in RA, as well as the negative correlation between interleukin 6 (IL-6) serum levels and bone mineral density (BMD). The aim of this study was to assess the effectiveness of one-year treatment with tocilizumab (TCZ), the first approved IL-6 receptor inhibitor, in reducing bone loss in RA. Material and methods: We enrolled 18 patients fulfilling 2010 ACR and EULAR criteria for RA from our arthritis outpatient clinic, assessing clinical and biochemical parameters during a 12-month period. The patients received TCZ 8 mg/kg i.v. every 4 weeks and underwent dual energy X-ray absorptiometry (DXA) for the measurement of bone mineral density (BMD) at baseline and at the end of study. Serum levels of C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), IL-6, serum CrossLaps, osteoprotegerin (OPG), receptor activator of nuclear factor κβ ligand (RANK-L) and dickkopf-1 (DKK-1) were measured at baseline, at 6 months and 1 year. Results: No significant difference in IL-6, RANK-L, DKK-1, OPG and serum CrossLaps levels between baseline, 6 months and 1 year were found. A significant increase of lumbar spine BMD was evidenced after 1 year of TCZ treatment. No difference in total body and femoral neck BMD was documented the end of the study. Conclusions: This study suggest the bone-sparing effect of TCZ in RA affected individuals. [ABSTRACT FROM AUTHOR]

In this paper, the authors present a case of osteo-arthtritis of the hip secondary to a septic event which was surgically treated with a hip prosthesis and complicated by intraoperative fracture due to a localized disuse osteoporosis. Disuse osteoporosis is an induced rapid bone loss in human skeleton that occurs mostly after a cord injury or muscle paralysis. Hypodynamia can also be a risk factor for osteoporosis. In this case the author describe the onset of a femoral intraoperative fragility fracture in a 58 year old woman affected by an erosive septic osteoarthritis. Our case suggest that disuse osteoporosis presence should be diagnosed and treated before surgery to help prevent major surgical or post-operative complications beginning a pharmacological antiresorptive treatment before the surgery. [ABSTRACT FROM AUTHOR]

Background: Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. Objectives: We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. Design: Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. Methods: Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. Results: Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. Conclusion: Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. Brief summary: Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer. [ABSTRACT FROM AUTHOR]

Study design: Diagnostic accuracy study. Objectives: Previous studies have reported the clinical application of the Vertebral Bone Quality (VBQ) scores for assessing bone density in operative lumbar spine patients. We aim to explore whether the method could be modified and applicable for patients undergoing cervical spine surgery. Methods: Adult patients receiving cervical spine surgery for degenerative diseases between September 2020 and March 2022 with non-contrast T1-weighted MRI and DEXA were included. Correlation between cervical VBQ scores and DEXA T-scores was analyzed using Pearson's correlation. Student's t test was used to present the discrepancy between the VBQ of patients with normal bone density (T ≥ -1.0) and patients with osteopenia/osteoporosis (T < -1.0). Statistical significance was set at P <. 05. Results: Eighty-three patients (20 patients with T ≥ -1.0 vs 63 patients with T < -1.0) were included. Significant difference was found between the cervical VBQ between groups (2.99 ±.79 vs 3.80 ±.81, P <.001). Interclass correlation coefficient for inter-rater reliability was.82 (95% CI:.70-.93) and.91(95% CI:.84-.97) for intra-rater reliability. The area under the ROC curve was.78 (95% CI:.65-.90). The DEXA T-score of the femoral neck, total hip and the lowest DEXA T-score were found to be significantly correlated with the cervical VBQ score according to Pearson correlation analysis (P <. 001). Conclusions: This is the first study to apply the VBQ method to assess the bone density in preoperative cervical spine patients. Cervical VBQ scores were significantly correlated with DEXA T-score. With an overall accuracy of.78, the radiation-free and cost-effective method could be a potential tool for screening patients with osteopenia and osteoporosis before surgery. [ABSTRACT FROM AUTHOR]

Osteoporosis treatment plays a crucial role in preventing fractures, particularly in bedridden patients. We conducted a questionnaire survey presenting hypothetical clinical cases in 2015 and 2020 to investigate trends over a 5-year period. The target population included physicians working in clinics and hospitals within our neighbourhood. The cases were presented, and the questionnaire was administered in a confidential format. The orthopaedic surgeons were matched for age and practice, resulting in 74 cases being included in the analysis. Comparing the 2015 and 2020 results, we observed a notable increase in physicians who would perform "bone mineral density measurements of the lumbar spine and hip." Furthermore, there was a significant rise in the percentage of respondents willing to test for bone metabolic markers, such as serum type I collagen cross-linked N-telopeptide (NTX), procollagen I N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b (TRACP-5b). Regarding therapeutic agents, bisphosphonates decreased in usage, whereas parathyroid hormone and romosozumab witnessed an increase. In conclusion, the percentage of physicians requesting bone mineral density measurements of the lumbar spine and hip increased over the five-year period. In addition, more physicians chose to utilise bone metabolic markers due to their ease of measurement through blood tests and reduced diurnal variation. Finally, there was a marked trend towards the administration of drugs capable of rapidly and effectively increasing bone mineral density at an early stage of treatment. [ABSTRACT FROM AUTHOR]

Background: Among the risk factors for nonunion are unchangeable patient factors such as the type of injury and comorbidities, and factors that can be influenced by the surgeon such as fracture treatment and the postoperative course. While there are numerous studies analyzing unchangeable factors, there is poor evidence for factors that can be affected by the physician. This raises the need to fill the existing knowledge gaps and lay the foundations for future prevention and in-depth treatment strategies. Therefore, the goal of this study was to illuminate knowledge about nonunion in general and uncover the possible reasons for their development; Methods: This was a retrospective analysis of 327 patients from 2015 to 2020 from a level I trauma center in Germany. Information about patient characteristics, comorbidities, alcohol and nicotine abuse, fracture classification, type of osteosynthesis, etc., was collected. Matched pair analysis was performed, and statistical testing performed specifically for atrophic long-bone nonunion; Results: The type of osteosynthesis significantly affected the development of nonunion, with plate osteosynthesis being a predictor for nonunion. The use of wire cerclage did not affect the development of nonunion, nor did the use of NSAIDs, smoking, alcohol, osteoporosis and BMI; Conclusion: Knowledge about predictors for nonunion and strategies to avoid them can benefit the medical care of patients, possibly preventing the development of nonunion. [ABSTRACT FROM AUTHOR]

Background and Objectives: Androgen deprivation therapy (ADT) for prostate cancer has greatly improved treatment outcomes. As patient survival rates have increased, reports of decreased bone density and increased bone fractures as side effects of ADT have emerged. The prevalence of osteoporosis in Japanese men was 4.6%. The purpose of this study was to evaluate the effect of osteoporosis treatment in prostate cancer patients who underwent ADT in Japan. Materials and Methods: The subjects were 33 male patients who had undergone ADT for prostate cancer, who were noted to have decreased bone density. Mean age was 76.2 ± 7.7 years (64–87). Medications included vitamin D in one case, bisphosphonates (BP) in 27 cases, and denosumab in five cases. The evaluation method examined the rate of change in bone mineral density (BMD) before osteoporosis treatment and 1 year after. For comparison, a group without osteoporosis treatment intervention (n = 33) was selected, and matched for prostate cancer treatment and age. The rate of change in trabecular bone score (TBS) was also calculated. Results: The percentage changes in BMD before and 1 year after treatment were as follows: lumbar spine, 7.1 ± 5.8% in the treatment group versus −3.9 ± 4.1% in the no treatment group; femoral neck, 5.5 ± 6.2% in the treatment group versus −0.9 ± 3.9% in the no treatment group; total femur, 6.6 ± 6.4% in the treatment group versus the no treatment group which was −1.7 ± 3.2%. In all cases, there was a clear significant difference (p < 0.01). The percent change in TBS was further calculated in the same manner. There was no significant difference between the two groups: +1.7 ± 3.8% in the treated group versus +0.3 ± 4.1% in the untreated group. Conclusions: Osteoporosis treatment in Japanese patients with prostate cancer on ADT therapy was found to significantly increase BMD compared to the untreated group. BP and denosumab were found to be very effective in increasing BMD. [ABSTRACT FROM AUTHOR]

Bone mineral density measurements have been criticized on the grounds that they are not a worth-while screening tool. In this paper we argue that bone mineral measurements can be an efficient diagnostic tool even if they are not of proven value for screening. There is complex relationship between the costs of a measurement, the intervention and the predictive value of the test all of which must be accounted for when assessing the value of a bone density measurement. For bone density measurements to be used for screening, a wider evaluation needs to be undertaken compared with that for their use as a diagnostic tool. We address some common objections, for example, that low compliance with screening would undermine efficiency, and show that these are not relevant. Evaluations of screening need to address issues that are likely to affect efficiency. [ABSTRACT FROM AUTHOR]

Background: To achieve good bone fusion in anterior column reconstruction for vertebral fractures, not only bone mineral density (BMD) and bone metabolism markers but also lever arms due to bone bridging between vertebral bodies should be evaluated. However, until now, no lever arm index has been devised. Therefore, we believe that the maximum number of vertebral bodies that are bony and cross-linked with the contiguous adjacent vertebrae (maxVB) can be used as a measure for lever arms. The purpose of this study is to investigate the surgical outcomes of anterior column reconstruction for spinal fractures and to determine the effect of bone bridging between vertebral bodies on the rate of bone fusion using the maxVB as an indicator of the length of the lever arm. Methods: The clinical data of 81 patients who underwent anterior column reconstruction for spinal fracture between 2014 and 2022 were evaluated. The bone fusion rate, back pain score, between the maxVB = 0 and the maxVB ≥ 2 patients were adjusted for confounding factors (age, smoking history, diabetes mellitus history, BMD, osteoporosis drugs, surgical technique, number of fixed vertebrae, materials used for the anterior props, etc.) and analysed with multivariate or multiple regression analyses. The bone healing rate and incidence of postoperative back pain were compared among the three groups (maxVB = 0, 2 maxVB 8, maxVB ≧ 9) and divided by the maxVB after adjusting for confounding factors. Results: Patients with a maxVB ≥ 2 had a significantly higher bone fusion rate (p < 0.01) and postoperative back pain score (p < 0.01) than those with a maxVB = 0. Among the three groups, the bone fusion rate and back pain score were significantly higher in the 2 maxVB 8 group (p = 0.01, p < 0.01). Conclusions: Examination of the maxVB as an indicator of the use of a lever arm is beneficial for anterior column reconstruction for vertebral fractures. Patients with no intervertebral bone bridging or a high number of bone bridges are in more need of measures to promote bone fusion than patients with a moderate number of bone bridges are. [ABSTRACT FROM AUTHOR]

In the recent decades, remarkable successes have been recorded in the treatment of Hodgkin's lymphoma to the point that today it represents one of the neoplasms with the highest rates of cure and with the highest life expectancy. Nonetheless, this raises the concern for the health of long-term survivors. Late side effects of treatments in synergy with other risk factors expose survivors to increased morbidity and impaired quality of life. In the complexity of the topics concerning these last aspects, an area of growing interest is that of bone damage that follows Hodgkin Lymphoma and its treatments. In this narrative review, we conducted our work through assessment of available evidence focusing on several aspects linking bone damage and quality of life with Hodgkin lymphoma and its treatments. At present, the problem of osteopenia and osteoporosis in Hodgkin lymphoma survivors is a theme for which awareness and knowledge need to be implemented. [ABSTRACT FROM AUTHOR]

Long-term Glucocorticoid (GC) use results in compromised bone strength and fractures, and several treatment recommendations have been developed to prevent fractures, but none have been validated in a real-world setting. This study aims to create a treatment decision tool and compares this tool to the treatment suggestions from the American College of Rheumatology (ACR), International Osteoporosis Foundation and European Calcified Tissue Society (IOF-ECTS), and GC-adjusted Fracture Risk Assessment Tool (GC-FRAX), above the intervention threshold. We utilized registry data gathered at Chang Gung Memorial Hospital at Kaohsiung, Taiwan, between September 2014 and April 2021. This research is a single-center, observational, and case-controlled study. We recruited participants using prednisone for at least 2.5 mg/day or the equivalent dose for over 3 months, excluding those younger than 40, those with malignancies, or those currently undergoing anti-osteoporosis therapy. The primary endpoint was new fragility fractures within 3 years, including morphometric vertebral fractures detected at baseline and with a follow-up thoracic–lumbar spine X-ray. Participants were randomly allocated into derivation and validation sets. We developed the Steroid-Associated Fracture Evaluation (SAFE) tool in the derivation cohort by assessing the weights of exploratory variables via logistic regression. Prediction performance was compared in the validation set by the receiver operating characteristic (ROC) curve, the area under the curve (AUC), and sensitivity and specificity. A total of 424 treatment-naïve subjects were enrolled, and 83 (19.6%) experienced new fractures within 3 years. The final formula of the SAFE tool includes osteoporosis (1 point), an accumulated GC dose ≥ 750 mg within 6 months (or equivalent prednisolone of ≥4.5 mg/day for 6 months) (1 point), a BMI ≥ 23.5 (1 point), previous fractures (1 point), and elderliness of ≥70 years (2 points). In the validation set, a treatment decision based on the SAFE ≥ 2 points demonstrated an AUC of 0.65, with a sensitivity/specificity/accuracy of 75.9/54.0/58.9, with an ACR of 0.56 (100.0/11.0/31.0), IOF-ECTS 0.61 (75.9/46.0/52.7), and GC-FRAX 0.62 (82.8/42.0/51.2). Among current GIOP recommendations, the SAFE score serves as an appropriate treatment decision tool with increased accuracy and specificity. [ABSTRACT FROM AUTHOR]

Objective(s): Long-term consumption of pump inhibitors causes osteoporosis. Some possible mechanisms are gastrin over-secretion and hypochlorhydria. Octreotide is a somatostatin analog that inhibits the secretion of many hormones such as gastrin. This study aimed to assess the effects of pantoprazole on the bone when used with octreotide in an animal model. Materials and Methods: Forty-eight male Wistar rats were randomly assigned into 4 groups: A) pantoprazole 3 mg/Kg/day orally; B) Sandostatin LAR 1 mg/month intramuscular injection; C) Pantoprazole and Sandostatin LAR; and D) Control group. After 90 days of the experiment, bone densitometry was done and serum and urine samples were collected for analysis. Results: The results indicated a significant decrease in the global, spine, femur, and tibia bone mineral density (BMD) and bone mineral content (BMC) in the pantoprazole group compared to the control group (P<0.05). There was a significant increase in the levels of PTH, gastrin, and alkaline phosphatase (ALP) in the pantoprazole group compared to the control group (P<0.05). There was no significant difference in the serum levels of gastrin, PTH, ALP, and also BMD in the rats that received sandostatin+ pantoprazole or sandostatin alone, compared to the control group. Conclusion: This study showed that the pantoprazole-induced bone loss, through elevation of serum gastrin and PTH, was preventable by concomitant use of a long-acting somatostatin analog. [ABSTRACT FROM AUTHOR]

Objective: In this paper, we assess the feasibility of using two detectors in a slot-scanning digital radiography system to acquire images for measuring bone mineral density (BMD) of the middle phalanx of the middle finger using dual-energy X-ray absorptiometry (DXA). Methods: Simulations were used to evaluate the spectral separation of the low- and high-energy spectra and detective quantum efficiency was used for assessing image quality. Scan parameters were chosen to optimize spectral separation, image quality, and radiation dose. We introduce the measurement of volumetric BMD (vBMD) using basis material decomposition. We assess the accuracy of our methods by comparing measurements taken using bone images against reference data derived from subsequent incineration of the bones. In vivo scans were conducted to evaluate the system precision (repeatability) and agreement with a clinical densitometer. Results: Average errors for bone mineral content (BMC), areal BMD (aBMD), and vBMD were 4.85%, 5.49%, and 12.77%, respectively. Our system had good agreement with a clinical densitometer based on concordance correlation coefficient values of 0.92 and 0.98 for aBMD and BMC, respectively. Precision studies yielded coefficient of variation (CV) values of 1.35% for aBMD, 1.48% for BMC, and 1.80% for vBMD. The CV values of all measurements were within 2%, indicating that the methods have clinically acceptable precision. Conclusion: We conclude that our techniques yield bone measurements with high accuracy, clinically acceptable precision, and good agreement with a clinical densitometer. Significance: We have shown the clinical potential of phalangeal DXA measurements of aBMD and vBMD on a slot-scanning digital radiography system. [ABSTRACT FROM PUBLISHER]

Primary bone lymphoma is a rare neoplasm that can initially present as local pain, a palpable mass, and pathologic fracture. It can also be discovered as an incidental finding on an imaging examination. It is defined as a bone marrow tumor with no involvement of other sites, lasting at least six months. The diagnosis is confirmed by biopsy and immunohistochemical analysis. Although the imaging characteristics are nonspecific, there are certain findings that, when correlated with clinical and epidemiological aspects, can increase the level of suspicion of primary bone lymphoma. The classic imaging aspect is a bone lesion with a soft-tissue component that preserves the cortical layer more than would be expected given the invasive nature of the lesion. Magnetic resonance imaging is the best imaging method to evaluate the extent of involvement of adjacent compartments, whereas computed tomography depicts the cortical layer in greater detail, as well as being an important tool for biopsy guidance. Other imaging modalities are also discussed, such as X-ray, ultrasound, bone scintigraphy, and positron emission tomography/computed tomography. The aim of this paper is to describe the most common findings obtained with the various imaging methods used in patients with a confirmed diagnosis of primary bone lymphoma. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Gut microbiome is critical to our human health and is related to postmenopausal osteoporosis (PMO). Strontium ranelate (SrR) is an anti-osteoporosis oral drug that can promote osteoblast formation and inhibit osteoclast formation. However, the effect of SrR on gut microbiome has been rarely studied. Therefore, we investigated the effect of oral SrR on gut microbiome and metabolic profiles. Results: In this study, we used ovariectomized (OVX) Sprague–Dawley rats to construct a PMO model and applied oral SrR for 6 weeks. The relative abundance of intestinal microbiome was investigated by 16S rRNA metagenomic sequencing. Ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS) was used to analyze changes in metabolites of intestinal contents. Results demonstrated that 6-week oral SrR alleviated osteoporosis and significantly changed the composition of the gut microbiome and metabolic profiles of OVX rats. Ruminococcus, Akkermansia and Oscillospira were significantly enriched in the gut of OVX rats after 6-week oral SrR. Especially, the species R. albus showed the greatest importance by a random forest classifier between OVX and OVX_Sr group. The enrichment of R. albus in the gut was positively correlated with bone mineral density and the accumulation of lycopene and glutaric acid, which also significantly elevated after oral SrR. Conclusions: We discovered that oral SrR can improve bone health while stimulate the accumulation of gut microbe R. albus and metabolites (lycopene and glutaric acid). The results suggested possible connections between oral SrR and the gut-bone axis, which may provide new insight into the treatment/prevention of osteoporosis. [ABSTRACT FROM AUTHOR]

Tibiotalocalcaneal (TTC) arthrodesis is a procedure to treat severe ankle and subtalar arthropathy by providing pain free and stable fusion using IM nails. These nails can be manufactured with multiple materials and some feature the ability to dynamize the arthrodesis construct. However, the impact of IM nail material and nail dynamization on load-sharing and in the setting of bone resorption have not been quantified. This work utilized a patient-specific finite element analysis model of TTC arthrodesis to investigate IM nails with differing material moduli and the impact of nail dynamization on load-sharing and intersegmental compression in the setting of bone resorption. Each nail was virtually inserted into a patient-specific model of a hindfoot, which was segmented into the three bones of the TTC complex and assigned material properties based on the densitometry of the bone. Compression, amount of load-sharing, and stress distributions after simulated bone resorption were quantified and compared between the varying IM nails. Simulations revealed that bone segments were only subjected to 17% and 22% of dynamic gait forces in the titanium and carbon fiber nail constructs, whereas the pseudoelastic NiTi nail constructs allowed for 67% of the same. The titanium and carbon fiber nails lost all initial compression in less than 0.13mm of bone resorption, whereas the NiTi nail maintained compression through all simulated values of bone resorption. These data highlight the poor load-sharing of static nail TTC arthrodesis constructs and the ability of a pseudoelastic IM nail construct to maintain intersegmental compression when challenged with bone resorption. [ABSTRACT FROM AUTHOR]

The possible association between osteoporosis and osteoarthritis represents an ongoing matter of debate. It was considered, for decades, that both diseases were mutually exclusive due to the anthropometric characteristics and the difference in bone mass that patients with osteoporosis and osteoarthritis often present. However, in recent years, it was pointed out that both processes can coexist, and even that they may have a direct relationship. In this paper we review some aspects of the association between both diseases from a temporal perspective. [ABSTRACT FROM AUTHOR]

The aim of the paper was to examine the relation between bone density and certain parameters of lipid status in postmenopausal women. The research involved 300 women referred to densitometric examination as they belonged to the risk group of postmenopausal women. All the examinees had the following biochemical parameters determined: total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, glycemia, serum Ca and P. Univariate logistic regression analyses showed that each year of age, menopause duration, AH are significantly connected to risk increase for the appearance of osteopenia or osteoporosis. Increase in values of SBP, DBP, cholesterol, LDL and triglyceride are connected with significant risk increase for the appearance of osteopenia or osteoporosis. Patients with AH are connected to 11 times elevated risk for the appearance of osteopenia or osteoporosis, cigarette smoking increased the risk by seven times, physical inactivity even by 52 times, CVD in the family anamnesis by eight times, and osteoporosis in the family anamnesis is connected to the risk by four times. In our research, atherogenic lipoproteins negatively correlate with lumbar bone density. Disturbed lipide status is a risk factor for cardiovascular diseases, but also a risk factor for the appearance of osteoporosis. [ABSTRACT FROM AUTHOR]

Background. Osteoporosis is a chronic disease that can significantly impact numerous aspects of health and wellness. The individual consequences of osteoporosis can be devastating, often resulting in substantial loss of independence and sometimes death. One of the few illnesses with greater disease burden than low bone mineral density (BMD) is major depressive disorder (MDD). Both depression and antidepressant use have been identified as secondary causes of osteoporosis. The objective of this paper is to review and summarize the current findings on the relationship between antidepressant use and BMD. Methods. Relevant sources were identified from the Pubmed and MEDLINE databases, citing articles from the first relevant publication to September 1st, 2010. Results. 2001 articles initially met the search criteria, and 35 studies were thoroughly reviewed for evidence of an association between SSRI use and BMD, and 8 clinical studies were detailed and summarized in this paper. Conclusions. Current findings suggest a link between mental illness and osteoporosis that is of clinical relevance. Additional longitudinal studies and further research on possible mechanisms surrounding the association between SSRI use on bone metabolism need to be conducted. Treatment algorithms need to recognize this association to ensure that vulnerable populations are screened. [ABSTRACT FROM AUTHOR]

The introduction of dual-energy X-ray absorptiometry (DXA) in the 1980s for the assessment of areal bone mineral density (BMD) greatly benefited the field of bone imaging and the ability to diagnose and monitor osteoporosis. The additional capability of DXA to differentiate between bone mineral, fat tissue, and lean tissue has contributed to its emergence as a popular tool to assess body composition. Throughout the past 2 decades, technological advancements such as the transition from the original pencil-beam densitometers to the most recent narrow fan-beam densitometers have allowed for faster scan times and better resolution. The majority of reports that have compared DXA-derived body composition measurements to the gold standard method of body composition appraisal, the four-compartment model, have observed significant differences with this criterion method; however, the extent to which the technological advancements of the DXA have impacted its ability to accurately assess body composition remains unclear. Thus, this paper reviews the evidence regarding the trueness and precision of DXA body composition measurements from the pencil-beam to the narrow fan-beam densitometers. [ABSTRACT FROM AUTHOR]

In this paper, we propose an automated approach for the joint detection of major sold on cortical surfaces. By representing sulci as nodes in a graphical model, we incorporate Markovian relations between sold and formulate their detection as a maximum a posteriori (MAP) estimation problem over the joint space of major sulci. To make the inference tractable, a sample space with a finite number of candidate curves is automatically generated at each node based on the Hamilton-Jacobi skeleton of sulcal regions. Using the AdaBoost algorithm, we learn both individual and pairwise shape priors of sulcal curves from training data, which, are then used to define potential functions in the graphical model based on the connection between AdaBoost and logistic regression. Finally belief propagation is used to perform the MAP inference and select the joint detection results from the sample spaces of candidate curves. In our experiments. we quantitatively validate our algorithm with manually traced curves and demonstrate the automatically detected curves can capture the main body of sulci very accurately. A comparison with independently detected results is also conducted to illustrate the advantage of the joint detection approach. [ABSTRACT FROM AUTHOR]

Copyright of International Orthopaedics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wehren LE, Siris ES (University of Maryland School of Medicine, Baltimore, MD; and Columbia University College of Physicians and Surgeons, New York, NY) Beyond bone mineral density: can existing clinical risk assessment instruments identify women at increased risk of osteoporosis? (Review).J Intern Med2004;256: 375–380.Although osteoporosis and fragility fracture are common amongst postmenopausal women, the extent of risk varies, and measurement of bone mineral density (BMD) is the standard tool used to diagnose and assess fracture risk. Rates of diagnosis remain relatively low, and several groups have developed instruments to help identify individuals who would most benefit from BMD testing. In this paper, we review and compare the performance of these instruments to identify those most useful in the primary care setting.Review of screening instruments comprised osteoporosis clinical risk factors and comparison of the sensitivity and specificity of these algorithms.Validated instruments have varying complexity, but similar sensitivity and specificity for identifying individuals who are likely to have low BMD. The area under the receiver operating characteristic curve ranges from 0.75 (SOFSURF) to 0.81 (SCORE). The simplest of the instruments (OST) uses only age and weight and has an AUC of 0.79.The Osteoporosis Self-assessment Tool, the simplest of the instruments, performs as well as more complex tools and, because of its simplicity, may be the most useful means for the busy clinician to identify postmenopausal women who would most benefit from BMD testing. [ABSTRACT FROM AUTHOR]

Intra-articular fractures (IAF) result in significant and prolonged inflammation, increasing the chances of developing post-traumatic osteoarthritis (PTOA). Interleukin-one beta (IL-1β) and Tumor Necrosis Factor-alpha (TNF-α) are key inflammatory factors shown to be involved in osteochondral degradation following IAF. As such, use of targeted biologics such as Infliximab (INX), a TNF-α inhibitor, and Anakinra (ANR), an interleukin-one (IL-1) receptor antagonist (IL1RA), may protect against PTOA by damping the inflammatory response to IAF and reducing osteochondral degradation. To test this hypothesis, IAFs were induced in the hindlimb knee joints of rats treated with INX at 10 mg/kg/day, ANR at 100 g/kg/day, or saline (vehicle control) by subcutaneous infusion for a period of two weeks and healing was evaluated at 8-weeks post injury. Serum and synovial fluid (SF) were analyzed for soluble factors. In-vivo microcomputed tomography (µCT) scans assessed bone mineral density and bone morphometry measurements. Cationic CA4+ agent assessed articular cartilage composition via ex vivo µCT. Scoring according to the Osteoarthritis Research Society International (OARSI) guidelines was performed on stained histologic tibia sections at the 56-day endpoint on a 0–6 scale. Systemically, ANR reduced many pro-inflammatory cytokines and reduced osteochondral degradation markers Cross Linked C-Telopeptide Of Type II (CTXII, p < 0.05) and tartrate-resistant acid phosphatase (TRAP, p < 0.05). ANR treatment resulted in increased chemokines; macrophage-chemotractant protein-1 (MCP-1), MPC-3, macrophage inhibitory protein 2 (MIP2) with a concomitant decrease in proinflammatory interleukin-17A (IL17A) at 14 days post-injury within the SF. Microcomputed tomography (µCT) at 56 days post-injury revealed ANR Treatment decreased epiphyseal degree of anisotropy (DA) (p < 0.05) relative to saline. No differences were found with OARSI scoring but contrast-enhanced µCT revealed a reduction in glycosaminoglycan content with ANR treatment. These findings suggest targeted cytokine inhibition, specifically IL-1 signaling, as a monotherapy has minimal utility for improving IAF healing outcomes but may have utility for promoting a more permissive inflammatory environment that would allow more potent disease modifying osteoarthritis drugs to mitigate the progression of PTOA after IAF. [ABSTRACT FROM AUTHOR]

Photobiomodulation therapy (cold laser or low-level laser therapy) has been evaluated in human and small animal medicine; however, there is a lack of knowledge about the role photobiomodulation therapy could play in reptile rehabilitation and release. This study used a quantifiable unit, Hounsfield units (bone density measurement), in computed tomography (CT) to evaluate if photobiomodulation therapy showed a significant healing difference between groups treated with photobiomodulation and those that were not. This study included 20 eastern box turtles (Terrapene carolina) presented to a rehabilitation center that sustained shell fractures without penetrating the coelom. They all received similar medical treatments, except that the photobiomodulation group received 250 Hz of red light laser for three minutes three times a week for eight weeks. The turtles were evaluated over the course of two months of therapy. Computed tomography scans were performed prior to therapy, at the midpoint of treatment (one month postinjury), and at the end of the study (two months postinjury). The average Hounsfield units of the fractures were evaluated using nonparametric means, the Wilcoxon/Kruskal–Wallis tests (ranked sums), and found that there were no significant differences in shell density between the photobiomodulation and control groups amongst the scans. This study did find that there was a significant difference (p = 0.0455) between the two groups in regard to the width of the fracture between pre- and post-treatment scans. This study found that the photobiomodulation group had a significantly decreased width of the fracture site between pre-treatment and post-treatment measurements, showing that photobiomodulation could be a relatively easy and effective treatment to promote healing of fractured turtle shells. [ABSTRACT FROM AUTHOR]

Background. The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade. Methods. The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient. Results. Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of −1.86 ± 1.04 compared to −1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up. Conclusions. Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop and characterize a closed intra-articular fracture (IAF) mediated post-traumatic osteoarthritis (PTOA) model in rats to serve as a testbed for putative disease modifying interventions. Methods: Male rats were subject to a 0 Joule (J), 1 J, 3 J, or 5 J blunt-force impact to the lateral aspect of the knee and allowed to heal for 14 and 56 days. Micro-CT was performed at time of injury and at the specified endpoints to assess bone morphometry and bone mineral density measurements. Cytokines and osteochondral degradation markers were assayed from serum and synovial fluid via immunoassays. Histopathological analyses were performed on decalcified tissues and assessed for evidence of osteochondral degradation. Results: High-energy (5 J) blunt impacts consistently induced IAF to the proximal tibia, distal femur, or both while lower energy (1 J and 3 J) impacts did not. CCL2 was found to be elevated in the synovial fluid of rats with IAF at both 14- and 56-days post-injury while COMP and NTX-1 were upregulated chronically relative to sham controls. Histological analysis showed increased immune cell infiltration, increased osteoclasts and osteochondral degradation with IAF relative to sham. Conclusion: Based on results from the current study, our data indicates that a 5 J blunt-forced impact adequately and consistently induces hallmark osteoarthritic changes to the articular surface and subchondral bone at 56 days after IAF. Marked development of PTOA pathobiology suggest this model will provide a robust testbed for screening putative disease modifying interventions that might be translated to the clinic for militarily relevant, high-energy joint injuries. [ABSTRACT FROM AUTHOR]

Osteoporosis is a bone disorder characterized by bone loss and decreased bone strength. The most widely used technique for detection of osteoporosis is the measurement of bone mineral density (BMD) using dual energy X-ray absorptiometry (DXA). But DXA scans are expensive and not widely available in low-income economies. In this paper, we propose a low cost pre-screening tool for the detection of low bone mass, using cortical radiogrammetry of third metacarpal bone and trabecular texture analysis of distal radius from hand and wrist radiographs. An automatic segmentation algorithm to automatically locate and segment the third metacarpal bone and distal radius region of interest (ROI) is proposed. Cortical measurements such as combined cortical thickness (CCT), cortical area (CA), percent cortical area (PCA) and Barnett Nordin index (BNI) were taken from the shaft of third metacarpal bone. Texture analysis of trabecular network at the distal radius was performed using features obtained from histogram, gray level Co-occurrence matrix (GLCM) and morphological gradient method (MGM). The significant cortical and texture features were selected using independent sample t -test and used to train classifiers to classify healthy subjects and people with low bone mass. The proposed pre-screening tool was validated on two ethnic groups, Indian sample population and Swiss sample population. Data of 134 subjects from Indian sample population and 65 subjects from Swiss sample population were analysed. The proposed automatic segmentation approach shows a detection accuracy of 86% in detecting the third metacarpal bone shaft and 90% in accurately locating the distal radius ROI. Comparison of the automatic radiogrammetry to the ground truth provided by experts show a mean absolute error of 0.04 mm for cortical width of healthy group, 0.12 mm for cortical width of low bone mass group, 0.22 mm for medullary width of healthy group, and 0.26 mm for medullary width of low bone mass group. Independent sample t -test was used to select the most discriminant features, to be used as input for training the classifiers. Pearson correlation analysis of the extracted features with DXA-BMD of lumbar spine (DXA-LS) shows significantly high correlation values. Classifiers were trained with the most significant features in the Indian and Swiss sample data. Weighted KNN classifier shows the best test accuracy of 78% for Indian sample data and 100% for Swiss sample data. Hence, combined automatic radiogrammetry and texture analysis is shown to be an effective low cost pre-screening tool for early diagnosis of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: The incidence of distal forearm fracture due to minimal/moderate trauma shows a bimodal distribution for age at event, with one peak occurring during early adolescence, in both boys and girls and the other one in postmenopausal females. The aim of this study was, therefore, to document whether the relationship between bone mineral density and fracture is different in young children compared with adolescents. Methods: A matched-pair, case-control study has been conducted to evaluate bone mineral density in 469 young children and 387 adolescents of both sexes, with/without fracture due to minimal/moderate trauma with assurance that the compared groups were equally susceptible to the outcome event. All fractures were radiographically confirmed. The study utilized bone mineral areal density of the total body, spine, hips, and forearm; volumetric bone mineral density of the forearm; and metacarpal radiogrammetry measurements. The study controlled for skeletal development, bone geometry, body composition, hand grip strength, calcium intake, and vitamin D status. Results: Adolescents with distal forearm fracture have reduced bone mineral density at multiple skeletal regions of interest. This was documented by the bone mineral areal density measurements at multiple skeletal sites (p < 0.001), volumetric bone mineral density measurements of the forearm (p < 0.0001), and metacarpal radiogrammetry (p < 0.001). Adolescent females with fracture had reduced cross-sectional areas of the radius and metacarpals. The bone status of young female and male children with fracture was no different to its controls. Increased body fatness was more prevalent among fracture cases than in controls. Around 72% of young female and male children with fracture had serum 25-hydroxyvitamin D levels below the threshold of 31 ng/ml, compared with only 42% of female controls and to 51% of male controls. Conclusions: Adolescents with bone fragility fracture had reduced bone mineral density at multiple skeletal regions of interest, whereas this was not the case with younger children. The results of the study may have implications for the prevention of bone fragility in this segment of the pediatric population. [ABSTRACT FROM AUTHOR]

Background and objectives: Osteoporosis and vitamin D3 deficiency may be risk factors of benign paroxysmal positional vertigo (BPPV). The aim of this study was to assess the prevalence of osteoporosis and 25(OH) vitamin D3 deficiency in a group of patients with idiopathic benign paroxysmal positional vertigo. Materials and Methods: Thirty-five patients (twenty-eight women and seven men) with posterior semicircular canal BPPV were enrolled in the study. The subjects underwent hearing assessment (tonal audiometry and impedance audiometry) and the Dix-Hallpike maneuver. Serum 25(OH) vitamin D3 levels were determined and lumbar spine bone densitometry was performed. The relationships between sex, age, height, Body Mass Index (BMI), vitamin D3 levels and bone densitometry results were assessed. Results: The diagnosis of osteoporosis was confirmed in 1 patient (3%), 3 subjects were osteopenic (8.6%), and normal bone densitometry was found in 31 (88.6%) patients. Conclusions: We found no statistically significant relationships between age, BMI or vitamin D3 levels and bone densitometry results in patients with idiopathic BPPV. [ABSTRACT FROM AUTHOR]

Objective: At present, it is still uncertain whether single screw has the same stability as double screws in the treatment of ulnar coronal process basal fracture (Regan–Morry type III). So, we aimed to compare the pull‐out force and anti‐rotation torque of anterior single/double screw‐cancellous bone fixation (aSSBF, aDSBF) in this fracture, and further study the influencing factors on anatomical and biomechanical stability of smart screw internal fixations. Methods: A total of 63 adult volunteers with no history of elbow injury underwent elbow CT scanning with associated three‐dimensional reconstruction that enabled the measurements of bone density and fixed length of the proximal ulna and coronoid. The models of coronal process basal fracture, aSSBF and aDSBF, were developed and validated. Using the finite element model test, the sensitivity analysis of pull‐out force and rotational torque was carried out. Results: The pull‐out force of aSSBF model was positively correlated with the density of the cancellous bone and linearly related to the fixed depth of the screw. The load pattern of pull‐out force of aDSBF model was similar to that of aSSBF model. The ultimate torque of aDSBF model was higher than that of aSSBF model, but the load pattern of ultimate torque of both models was similar to each other when the fracture reset was satisfactory, and the screw nut attaches closely to coronoid process. Moreover, with enhancement of initial pre‐tightening force, the increase of ultimate torque of both models was small. Conclusions: In addition to three pull‐out stability factors of smart screw fixations, fracture surface fitting degree and nut fitting degree are the other two important anatomical and biomechanical stability factors of smart screw fixations both for rotational stability. When all pull‐out stability and rotational stability factors meet reasonable conditions simultaneously, single or double screw fixation methods are stable for the treatments of ulnar coronoid basal fractures. [ABSTRACT FROM AUTHOR]

The estimation of sex is a central step to establish the biological profile of an anonymous skeletal individual. Imaging techniques, including bone densitometry, have been used to evaluate sex in remains incompletely skeletonized. In this paper, we present a technique for sex estimation using the total area (TA) of the proximal femur, a two-dimensional areal measurement determined through densitometry. TA was acquired from a training sample (112 females; 112 males) from the Coimbra Identified Skeletal Collection (University of Coimbra, Portugal). Logistic regression (LR), linear discriminant analysis (LDA), reduce error pruning trees (REPTree), and classification and regression trees (CART) were employed in order to obtain models that could predict sex in unidentified skeletal remains. Under cross-validation, the proposed models correctly estimated sex in 90.2-92.0% of cases (bias ranging from 1.8% to 4.5%). The models were evaluated in an independent test sample (30 females; 30 males) from the 21st Century Identified Skeletal Collection (University of Coimbra, Portugal), with a sex allocation accuracy ranging from 90.0% to 91.7% (bias from 3.3% to 10.0%). Overall, data mining classifiers, especially the REPTree, performed better than the traditional classifiers (LR and LDA), maximizing overall accuracy and minimizing bias. This study emphasizes the significant value of bone densitometry to estimate sex in cadaveric remains in diverse states of preservation and completeness, even human remains with soft tissues. [ABSTRACT FROM AUTHOR]

Objectives: Dual energy X-ray absorptiometry (DXA) is the most widely used technique to measure bone mineral density (BMD). Appropriate and accurate use of DXA is of great importance, and several guidelines have been developed in the last years. Our aim was to evaluate the quality of published guidelines on DXA for adults. Methods: Between June and July 2016 we conducted an online search for DXA guidelines, which were evaluated by four independent readers blinded to each other using the AGREE II instrument. A fifth independent reviewer calculated scores per each domain and agreement between reviewers' scores. Results: Four out of 59 guidelines met inclusion criteria and were included. They were published between 2005 and 2014. Three out of four guidelines reached a high level of quality, having at least five domain scores higher than 60%. Domain 1 (Scope and Purpose) achieved the highest result (total score = 86.8 ± 3.7%). Domain 6 (Editorial Independence) had the lowest score (total score = 54.7 ± 12.5%). Interobserver agreement ranged from fair (0.230) to good (0.702). Conclusions: Overall, the quality of DXA guidelines is satisfactory when evaluated using the AGREE II instrument. The Editorial Independence domain was the most critical, thus deserving more attention when developing future guidelines. Main messages: • Three of four guidelines on DXA had a high quality level (>60%). • Scope/purpose had the highest score (86.8 ± 3.7%). • Editorial Independence had the lowest score (54.7 ± 12.5%). • Interobserver agreement ranged from fair (0.230) to good (0.702). [ABSTRACT FROM AUTHOR]

Background: To quantitatively investigate corneal changes and the correlation between corneal densitometry (CD) and endothelial parameters after phacovitrectomy. Methods: Thirty-eight eyes with idiopathic full-thickness macular holes (iFTMHs) and cataracts underwent phacovitrectomy. Examinations were conducted at baseline and Day 1, Day 7, Month 1, and Month 3 postoperatively. CD and central corneal thickness (CCT) were measured using Pentacam. Corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX) were measured using specular microscopy. Results: ECD and HEX significantly decreased after surgery and the change in HEX occurred prior to CV. CCT increased immediately after surgery and recovered 3 months postoperatively. CD values increased significantly 1 day after surgery and then gradually decreased. For CD in the 0–2 mm zone, it took 1 month to recover in the central and posterior layers and 3 months in the anterior and total layers. For CD in the 2–6 mm zone, the central layer recovered at Day 7, the anterior and total layers recovered at 1 month, and the posterior layer did not recover until 3 months postoperatively. The CD within all layers in the 0–2 mm zone was positively correlated with CCT. Posterior CD in the 0–2 mm zone was negatively correlated with ECD and HEX. Conclusions: CD is not only correlated with CCT, ECD, and HEX but also reflects the state of the whole cornea and each layer. CD can be an objective, rapid, and noninvasive tool that reflects corneal health and undetectable edema and monitors the process of lesion repair. Trial registration: This study was registered with the Chinese Clinical Trial Registry (31/10/2021, ChiCTR2100052554). [ABSTRACT FROM AUTHOR]

The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis causes an increased fracture risk. Clinically, osteoporosis is diagnosed late, usually after the first fracture occurs. This emphasizes the need for an early diagnosis of osteoporosis. However, computed tomography (CT) as routinely used for polytrauma scans cannot be used in the form of quantitative computed tomography (QCT) diagnosis because QCT can only be applied natively, i.e., without any contrast agent application. Here, we tested whether and how contrast agent application could be used for bone densitometry measurements. Methods: Bone mineral density (BMD) was determined by QCT in the spine region of patients with and without the contrast agent Imeron 350. Corresponding scans were performed in the hip region to evaluate possible location-specific differences. Results: Measurements with and without contrast agent administration between spine and hip bones indicate that the corresponding BMD values were reproducibly different between spine and hips, indicating that Imeron 350 application has a location-specific effect. We determined location-specific conversion factors that allow us then to determine the BMD values relevant for osteoporosis diagnosis. Conclusions: Results show that contrast administration cannot be used directly for CT diagnostics because the agent significantly alters BMD values. However, location-specific conversion factors can be established, which are likely to depend on additional parameters such as the weight and corresponding BMI of the patient. [ABSTRACT FROM AUTHOR]

The popularity of living-donor organ donation has increased recently as an alternative to deceased-organ donation due to the growing need for organs and a shortage of deceased-donor organs. This procedure requires an in-depth health assessment of candidates, who must be in excellent physical and mental health. We present a potential living-kidney donor withdrawn from donation due to a newly diagnosed Paget's disease of bone (PDB). The patient underwent computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, and bone densitometry with trabecular bone score (TBS) assessment. The sole lumbar vertebra affected by PDB was investigated comprehensively, non-invasively, quantitatively, and qualitatively. [ABSTRACT FROM AUTHOR]

Background. The method of recruiting the study subjects is an important element of the study design. It can have a strong influence on the results. Different recruitment schedules can give a different picture of the studied phenomenon. Objectives. The aim of the study was to compare bone health in a group of female patients treated for osteoporosis with a population-based sample. Materials and methods. A cohort of women from GO Study from 1 outpatient osteoporotic clinic (n = 1442, mean age 65.8 ±6.7 years) and population-based female sample of RAC-OST-POL Study (n = 963, mean age 65.8 ±7.5 years) were studied. Mean age did not differ between groups. Mean weight, height and body mass index (BMI) in subjects from GO Study and RAC-OST-POL Study were 69.5 ±13.1 kg, 157.8 ±6.1 cm and 27.9 ±5.1 kg/m2, and 74.2 ±13.7 kg, 156.0 ±6.0 cm and 30.5 ±5.4 kg/m2, respectively, and differed significantly (p < 0.0001 for each variable). Data on clinical risk factors for osteoporosis and fractures were collected. Bone densitometry at hip was performed using a Prodigy or Lunar DPX device (GE Healthcare, Waukesha, USA). Fracture risk was established using FRAX, Garvan and POL-RISK. Results. Mean values of T-score for femoral neck in subjects from GO Study and RAC-OST-POL Study were -1.67 ±0.91 and -1.27 ±0.91 and differed significantly (p < 0.0001). In GO Study and RAC-OST-POL Study, there were 518 (35.9%) and 280 (29.1%) subjects with fractures, respectively. The fracture frequency was significantly higher in the GO Study group (p < 0.001). Among clinical risk factors, only rheumatoid arthritis (p < 0.0001) secondary osteoporosis (p < 0.0001) and falls (p < 0.0001) were more frequent in RAC-OSTPOL Study. Fracture risk established using FRAX, Garvan and POL-RISK calculators was significantly greater in patients enrolled in the GO Study than in subjects from the RAC-OST-POL population-based sample (p < 0.0001 for each variable). Conclusions. Differences noted between female patients treated for osteoporosis and population-based sample, especially in regard to fracture risk, reveal a strong influence of recruitment criteria on study results in the field of bone health and osteoporosis. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Medianae is the property of Acta Medica Medianae and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)