Search

Summary: Compared to healthy bone, the intrinsic bone materials properties in the pre-existing lamellar bone are altered in jaw bone sequesters of bisphosphonates (BP)-related osteonecrosis. Introduction: The aim of this study was to evaluate the human jaw bone quality, especially intrinsic bone material properties among sequesters of osteonecrosis of the jaw (ONJ) induced by BP. Methods: Bone sequesters were obtained from 24 patients suffering from ONJ following a BP treatment. Within BP-exposed bone samples, benign-BP and malignant-BP groups were distinguished in relation to the underlying disease: osteoporosis and bone metastases or multiple myeloma, respectively. Healthy cadaveric cortical jaw bone samples were used as controls. The physicochemical parameters of bone samples - mineral/organic ratio, relative proteoglycan content, crystallinity, monohydrogen phosphate content, and type-B carbonate substitution - were evaluated by Raman microspectroscopy. Representative Raman spectral features of bones control and BP-exposed bone sequesters were identified with the Partial-Least-Square Discriminant Analysis (PLS-DA). Results: BP-exposed bone sequesters are characterized by a significant increase of mineral to organic ratio (+12 %) and a significant decrease of relative proteoglycan content (−35 %), thus regulating initial collagen matrix mineral deposition. Structural changes on mineral components are revealed by a significant decrease of both crystallinity (−2 %) and mineral maturation (−41 %) in the BP-exposed bone sequesters compared to healthy bones. These modifications were also observed distinctly in both benign-BP and malignant-BP groups. In addition, a shift of the phosphate ν band was highlighted by PLS-DA between bones control and BP-exposed bone sequesters, revealing a disruption of the apatitic phosphate environment in the jaw bone sequesters. Conclusions: The present data show that jaw bone quality can be altered with an overmineralization and ultrastructural modifications of apatitic mineral in bone sequesters of BP-related ONJ. [ABSTRACT FROM AUTHOR]

Plusieurs acides hyaluroniques sont actuellement disponibles dans la prise en charge thérapeutique de la gonarthrose, mais peu d'essais cliniques comparatifs ont été réalisé. L'objectif principal de la présente étude était de démontrer la non-infériorité à 24 semaines de l'acide hyaluronique testée (SYNOLIS VA®) comparativement au SYNVISC ONE ® sur le soulagement de la douleur chez des patients atteints de gonarthrose (stade radiologique II ou III de Kellgren et Lawrence) et chez lesquels le traitement antalgique et/ou AINS avait échoué. Il s'agissait d'une étude prospective, multicentrique, comparative, randomisée et en double aveugle (un médecin évaluateur indépendant - un médecin réalisant l'injection), comparant deux viscosuppléments : l'un contenant une solution d'acide hyaluronique (SYNOLIS VA® 80 mg d'acide hyaluronique et 160 mg de sorbitol - groupe HA1) et l'autre contenant de l'Hylan (SYNVISC ONE ® 48 mg d'Hylane GF-20 - groupe HA2) sur une période de 24 semaines. À l'inclusion, la douleur moyenne sur L'EVA (1–100) était de 62,5. Les patients ont été randomisés en 2 groupes parallèles à j0 et suivis jusqu'à j168. Ils ont reçu une injection de HA1 ou de HA2. L'efficacité a été évaluée principalement à l'aide de l'indice de douleur WOMAC (évalué quotidiennement par le patient pendant les sept jours suivant l'injection, puis à j14). Lors des visites de suivi (D28-D84-D168), les scores WOMAC douleur, raideur et fonction ont été évalués en tant qu'objectifs secondaires. À j168, l'efficacité et la satisfaction ont également été évaluées par l'évaluateur et par le patient à l'aide de l'échelle de Likert (7 points). De plus, le nombre de répondeurs de chaque groupe a été évalué selon les critères OMERACT-OARSI. Comme cela est habituel dans ce type d'étude, l'analyse par protocole (PP) a été utilisée comme analyse primaire. La population PP comprenait tous les patients de la population en intention de traiter (ITT) qui ont terminé l'étude sans violation majeure du protocole. Au total, 202 patients ont été randomisés (population ITT, 96 dans le groupe HA1 et 106 dans le groupe HA2). Les patients étaient majoritairement des femmes (66 %). L'âge médian était de 65 ans et l'indice de masse corporelle médian de 27,4 kg/m2. Aucune différence statistiquement significative entre les deux groupes de traitement n'a été observée lors de l'inclusion concernant les caractéristiques démographiques. À j168, 197 patients ne présentaient aucune violation du protocole (94 dans le groupe HA1 et 103 dans le groupe HA2). Une diminution du score WOMAC douleur a été observée : −29,2 ± 24,1 dans le groupe HA1 et −31,6 ± 25,5 dans le groupe HA2 confirmant la non-infériorité (p = 0,57 pour la différence entre les groupes). En ce qui concerne les paramètres secondaires, aucune différence significative n'a été observée à j14, j28, j84, j168, dans la population PP pour tous les résultats, à l'exception du WOMAC raideur à j28 (p = 0,02). Il n'y avait pas non plus de différence entre les taux de réponse dans deux groupes (79 % pour HA1 et 77 % pour HA2). En termes de sécurité d'utilisation, les deux produits ont été bien tolérés. Aucun cas d'allergie ou d'infection au cours de l'injection n'a été signalé. Des effets indésirables graves ont été signalés pour 4 patients dans le groupe HA1 et 3 dans le groupe HA2. Ce travail est en faveur de la non-infériorité du SYNOLIS VA® 80 mg comparativement au SYNVISC ONE ® avec une tolérance comparable et satisfaisante. [ABSTRACT FROM AUTHOR]

Summary: Bone mineral density (BMD; measured by DXA) changes were observed at all sites at 1 year in 146 patients with anorexia nervosa. Four independent factors accounted for the variation in BMD at the spine: duration of anorexia, bone-specific alkaline phosphatase (BAP), cross-linked carboxyterminal telopeptide region of type I collagen (ICTP), and triiodothyronine (T3). No change in BMD was observed from 1 to 2 years during follow-up. Introduction: The purpose of this study was to assess changes in BMD at 1 and 2 years in anorexia nervosa patients, and to explore the relationships between change in BMD and various clinical and biological parameters measured at the first visit. Methods: BMD was measured in anorexia nervosa patients at inclusion, at 1-year follow-up ( n = 146) and at 2-year follow-up ( n = 89). Results: Bone loss was observed at all sites at 1 year. When multivariate analyses were performed, four independent factors accounted for the variation in BMD at the spine: duration of anorexia nervosa, BAP, ICTP, and T3. At the total hip site, leptin level was the main factor accounting for the variation in BMD. Strong correlations were also observed between weight at 1 year and change in BMD at 2 years. At the 2-year follow-up, no significant change in BMD was observed at the spine or femoral neck. In patients who were no longer amenorrheic at 1 year, a significant improvement in BMD at 2 years was observed at the total hip (+1.2%, p = 0.02) and femoral neck (+3.7%, p = 0.02). Similarly, in patients with a body mass index >17 kg/m at 1 year, an improvement in BMD at the total hip at 2 years was observed (+3%, p = 0.02) Conclusion: Bone loss in anorexia nervosa patients occurs at an early stage, and the factors influencing such are different at the spine and hip. [ABSTRACT FROM AUTHOR]

The diagnosis of osteoporosis rests on areal bone mineral density (BMD) measurement using DXA. Cancellous bone microarchitecture is a key determinant of bone strength but cannot be measured using DXA. To meet the need for a clinical tool capable of assessing bone microarchitecture, the TBS was developed. The TBS is a texture parameter that evaluates pixel gray-level variations in DXA images of the lumbar spine. The TBS variations may reflect bone microarchitecture. We explain the general principles used to compute the TBS, and we report the correlations between TBS and microarchitectural parameters. Several limitations of the TBS as it is used now are pointed out. We discuss data from currently available clinical studies on the ability of the TBS to identify patients with fractures and to evaluate the fracture risk. We conclude that this new index emphasizes the failure of the BMD T-score to fully capture the fragility fracture risk. However, although microarchitecture may influence the TBS, today, to the best of our understanding, there is no sufficient evidence that a TBS measurement provides reliable information on the status of the bone microarchitecture for a given patient. The TBS depends on gray-level variations and in a projectional image obtained in vivo, these variations can have many causes. Nevertheless, as clinical studies suggest that the TBS predicts the risk of fracture even after adjustment for BMD, we are encouraged to learn more about this score. Additional studies will have to be performed to assess the advantages and limitations of the TBS, in order to ensure that it is used appropriately in clinical practice. [ABSTRACT FROM AUTHOR]

Summary: We developed and validated a specific 12-item questionnaire to evaluate adherence to oral antiresorptive medication by post-menopausal osteoporotic women in everyday practice. Over the following 9 months, an index of ≤16 was associated with an increase in the risk of treatment discontinuation of 1.69 and of 2.10 for new patients who had started treatment within the previous year. Introduction: Adherence to medication in osteoporosis is poor. The goal of this study was to develop and validate a disease-specific questionnaire to evaluate adherence to treatment of women with post-menopausal osteoporosis taking oral antiresorptive medication. Methods: A prototype adherence questionnaire with 45 items developed from patient interview, literature review, and physician opinion was evaluated in a sample of 350 post-menopausal women with osteoporosis treated in primary care. Item responses were matched against scores on the Morisky Medication Adherence Scale (MMAS). The most discriminant items were retained in the final questionnaire. Concurrent and predictive validity were assessed. Results: Twelve items were associated with MMAS score at a probability level of 0.05. These were retained in the final questionnaire which provided an adherence index ranging from 0 to 22. An index of ≥20 was associated with a high probability of persistence and an index ≤ 16 with a high probability of treatment discontinuation in the following 9 months. Conclusions: The ADEOS-12 is a simple patient-reported measure to determine adherence to osteoporosis treatments with good concurrent and discriminant validity. This is the first disease-specific adherence measure to have been developed for osteoporosis. [ABSTRACT FROM AUTHOR]

lthough osteoporosis has been the subject of a considerable number of publications in recent years, very few studies have investigated the effects of osteopososis on the process of tissue repair. Most of the studies are based on animal data, using the ovariectomized rat model, and in most cases, fractures were obtained by femoral osteotomy. This model is imperfect in several aspects to fit with postmenopausal osteoporosis which is a complex, multifactorial disorder. Furthermore, a surgically induced fracture is not exactly the same as a fracture which occurs as a result of bone fragility. However, and despite contradictory results in some of the studies, in ovariectomized rats a delay in bone consolidation has been reported in the model, associated locally with a decrease in bone mineral density and mechanical resistance. Very few human data are available, which confirm the existence of a delay in consolidation subsequent to femoral fractures in aged patients compared to young patients. [ABSTRACT FROM AUTHOR]

Summary: We evaluated the impact of high dose of zoledronic acid on the superficial vascular network parameters of a membranous bone site. During a 5-day follow-up, significant reduction of the vascular density is observed only in the treated group. Introduction: The superficial vascularization is of great importance in membranous bone-healing process. A new rat calvarium intravital model was developed to study the short-term effect of a single high dose of zoledronic acid infusion on the superficial vascularization. Methods: Optical bone chambers were implanted in the bone tissue surface of Sprague-Dawley rats' calvarium. Nine rats were injected i.v. with 400 µg/kg of zoledronic acid (Z group), and nine rats were injected with vehicle (PSS group). A 5-day follow-up of the vascular network was made by the use of pictures analysis method. Results: The vascular density significantly decreases only in Z group but there was no significant difference between groups at individual time points. The total length of the vascular network decreases significantly in Z group only ( p = 0.003) with a significant higher decrease at D3 ( p = 0.04) and D5 ( p = 0.02) compared with control. The vascular density related to the smaller vessels (width, 5-10 µm) decreases significantly between T0 and D5 in Z group only ( p = 0.002). Conclusions: With the help of an original intravital animal model a significant modifications on the total length of the vascular network and the vascular density of small vessels are highlighted on a membranous bone site. [ABSTRACT FROM AUTHOR]

Summary: Methods: Leptin levels were measured in 103 consecutive women with anorexia nervosa. Results: Spine BMD and Z-score values were found to be significantly lower in the low tertile compared with the highest tertile. Duration of amenorrhea and leptin level accounted for 27% of the variance in lumbar spine BMD. Introduction: The purpose of this study was to assess leptin levels and other biological variables in a population of anorexia nervosa patients. Methods: Leptin levels were measured consecutively in 103 women with anorexia nervosa (AN) with a mean age of 24.9 ± 7.4 years. Osteodensitometry was also performed by dual energy X-ray absorptiometry (DXA). Results: Spine bone mineral density (BMD) and Z-score values were found to be significantly lower in the low tertile compared with the highest tertile. Duration of amenorrhea and leptin level accounted for 27% of the variance in lumbar spine BMD. The mean leptin level was 3.9 ± 4.6 ng/mL (normal values, 3.5-11 ng/mL). The distribution of leptin values was not a Gaussian distribution, and a log-transformed was therefore performed. A significant correlation was found between leptin level and spinal BMD ( r = 0.3; p = 0.002); significant correlations were observed for both femoral neck and total hip BMDs. When leptin level values were divided into tertiles, spine BMD and Z-score values were found to be significantly lower in the lower tertile ( p = 0.04 and p = 0.02) compared with the highest tertile. For femoral neck BMDs, the T-score was slightly lower between low and high tertile, but the difference was not statistically significant ( p = 0.07). When multivariate analyses were performed, two independent factors which could possibly account for the variance in spinal BMDs were found. Duration of amenorrhea and leptin level accounted for 27% of the variance ( p < 0.0001). Conclusion: The mechanisms underlying bone loss in AN patients remain unclear and complex, involving hypoestrogenia as well as nutritional factors such as insulin-like growth factor and leptin. [ABSTRACT FROM AUTHOR]

Observational studies have indicated a high but heterogeneous prevalence of low bone mineral density for adult patients with cystic fibrosis. Fracture complications were also described. The objective of this study was to determine the prevalence of osteoporosis, osteopenia, and fractures among adult patients with cystic fibrosis. A systematic literature review was conducted using electronic databases. The keywords used were “cystic fibrosis [MeSH] AND bone density.” Original studies were eligible if they reported the prevalence of osteoporosis and/or osteopenia and/or fractures in adult patients with cystic fibrosis. A meta-analysis of pooled proportions was performed. Heterogeneity was tested with the Cochran Q statistic, and in the case of heterogeneity a random effect model was used. Of 117 studies, 12 were selected, i.e., that represented a total of 1055 patients. Mean age ranged from 18.5 to 32 years (median: 28.2 years). Mean body mass index ranged from 19.9 to 22.4 (median: 20.7); 53.8% were men. The pooled prevalence of osteoporosis in adults with cystic fibrosis was 23.5% (95% CI, 16.6–31.0). The pooled prevalence of osteopenia was 38% (95% CI, 28.2–48.3). The pooled prevalences of radiological vertebral fractures and nonvertebral fractures were 14% (95% CI, 7.8–21.7) and 19.7% (95% CI, 6.0–38.8), respectively. In conclusion, this systematic literature review with meta-analysis emphasized the high prevalence of osteopenia and osteoporosis in young adults with cystic fibrosis. The prevalence of fracture was also high. [ABSTRACT FROM AUTHOR]

The article presents a study which discusses the effects of bone anabolic agents on bone ultrastructure. It mentions that apatite crystal plays an essential role in bone metabolism and homeostasy and relates that bone remodelling markers only accounts for a partial effect of the drugs. It further provides the result of drugs such as teriparatide and parathormone in treating patients.

Copyright of Oncologie (Tech Science Press) is the property of Tech Science Press 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.)

Les recommandations des sociétés savantes nationales (GRIO-SFR) [1] préconisent la mesure de la densité minérale osseuse (DMO) par ostéodensitométrie (DXA) pour guider les décisions thérapeutiques chez les femmes souffrant d'ostéoporose post ménopausique (OPM). Peu de données sont disponibles sur l'application de ces recommandations par les médecins généralistes (MG). Nous avons évalué l'impact des résultats de la DXA sur les décisions prises par des MG concernant la poursuite d'un traitement de 1ère ligne par bisphosphonate oral (BPo).. Cette étude de cohorte multicentrique interventionnelle a inclus des femmes souffrant d'OPM traitées par BPo depuis 2 à 5 ans sans interruption, et chez qui une DXA de référence avait été réalisée dans les 2 ans précédant l'initiation du BPo. Les MG participants devaient prescrire une DXA de suivi afin de décider de la suite du traitement. s Cent dix sept patientes ont été incluses par 23 MG entre janvier 2018 et novembre 2019. Quatre vingt dix neuf dont les résultats des DXA initiale et de suivi étaient disponibles ont été incluses dans l'analyse. À l'entrée dans l'étude, l'âge moyen des patientes était de 71,8 (8,6) ans, la durée moyenne (DS) du traitement par BPo de 2,9 (0,8) ans. 9,2 % (9/99) avaient un antécédent de fracture ostéoporotique avant traitement. La décision des MG concernant la suite à donner au traitement d'après les données densitométriques a été en accord avec celle des experts pour 60 % des patientes. Cependant, et bien que cette information ne soit pas requise par le protocole, les experts ont estimé que ce traitement n'aurait dû être initié que pour 39,4 % des patientes. Dans ce sous-groupe, la décision concernant la suite du traitement était en accord avec les recommandations pour 72 % des patientes. Dans 91 % des cas, les 2 DXA ont été prises en compte par les MG. Les paramètres considérés ont été les T-scores dans 77 % des cas (78/99), plus rarement les valeurs brutes de DMO (35,4 % des cas [35/99], versus 81 % [80/99] pour les experts). Le site le plus souvent considéré a été le col fémoral (76 % des cas [75/99] pour les MG, 90 % [89/99] pour les experts). D'après les DXA seules, les experts auraient poursuivi le traitement chez moins de patientes que les MG (58 % [56/99] versus 77 % [78/99]). De ce fait, un changement de traitement a été décidé plus rarement par les MG (11 % [11/99]) que par les experts (20 % [19/99]). Le taux de décisions d'arrêt était comparable entre MG et experts (12,1 % [12/99], et 13 % [13/99]). La prise en compte de paramètres autres que la DXA (Contre-indications aux BPo ou effets secondaires, observance, fracture sous traitement, demande de la patiente, âge de la patiente, condition pouvant aggraver l'OPM) n'a pas modifié les décisions des MG ni des experts. Cette étude suggère une connaissance ou une application insuffisantes des recommandations par les MG pour l'initiation et le suivi du traitement de l'OPM. Il est urgent de renforcer la formation des MG à ces recommandations. Cependant, ces données doivent être interprétées avec prudence compte tenu du faible nombre de médecins ayant participé à l'étude. [ABSTRACT FROM AUTHOR]

L'objectif de l'étude était d'analyser dans une population de femmes françaises avec une fracture vertébrale ostéoporotique, les circonstances du diagnostic et les modalités de prise en charge de la maladie osseuse en pratique de ville, au sein d'un groupe représentatif de médecins rhumatologues (RH) et de médecins généralistes (MG) Étude observationnelle rétrospective réalisée auprès de 178 médecins français (88 RH et 90 MG) entre janvier et mars 2021. Ces médecins ont répondu à un questionnaire en ligne construit pour l'étude, composé de 44 questions, à partir de l'analyse des dossiers de leurs 5 dernières patientes vues en consultation depuis le 1er janvier 2018 pour un diagnostic avéré de fracture vertébrale non traumatique. L'analyse a porté sur 805 patientes (RH: 462–MG: 343). L'âge moyen des patientes au moment du diagnostic était de 68,3 ± 9,9 ans et 37 % d'entre elles avaient un surpoids ou une obésité (RH: 31 %–MG 45 %). On observait un antécédent familial d'ostéoporose dans 29 % des cas, la prise antérieure de corticoïdes (18 %), un tabagisme actif (10 %) ou ancien (27 %), ainsi que des comorbidités chroniques fréquentes (HTA:55 %, diabète de type 2: 25 %, bronchopathie chronique obstructive: 17 % et pathologies rhumatologiques inflammatoires: RH 20 %–MG 7 %). Le diagnostic était établi suite à une consultation médicale à l'initiative de la patiente dans 40 % des cas majoritairement pour la survenue de douleurs rachidiennes (71 %). Dans 40 % des cas, le diagnostic était posé de manière fortuite lors d'un examen d'imagerie ou d'une consultation de suivi pour un autre motif. Au moment du diagnostic, 44 % des patientes vues par le RH avaient des fractures vertébrales multiples (≥ 2 fractures vertébrales) vs 26 % chez le MG. Les patientes ont eu une mesure de DMO suite au diagnostic dans 64 % des cas chez le RH et 34 % des cas chez les MG avec la mise en évidence d'une ostéoporose densitométrique dans 70 % et 68 % des cas, respectivement. Les traitements spécifiques de l'ostéoporose (bisphosphonates, tériparatide, raloxifène, dénosumab) ont été prescrits dans 95 % des cas chez le RH vs 75 % chez le MG; il s'agissait majoritairement de bisphosphonates (55 % également répartis entre forme orale et injectable chez le RH, 63 % en grande majorité sous forme orale chez le MG). En cas de fractures vertébrales multiples, le teriparatide était prescrit dans 59 % des cas par le RH versus 0 % par le MG. Dans le cadre de la prise en charge de la fracture vertébrale elle-même, le port d'un corset ou la réalisation d'une vertébroplastie était limité (respectivement 14 et 7 % des cas). Dans cet échantillon de médecins RH ou MG ayant accepté de répondre à une analyse de pratique par questionnaire, la prise en charge de l'ostéoporose révélée par une fracture vertébrale conduisait à la mise sous traitement spécifique anti-ostéoporotique dans un pourcentage de cas beaucoup plus élevé que la moyenne nationale suggérant que la formation et l'implication du médecin indépendamment de sa spécialité est un élément déterminant dans l'initiation d'un traitement. Quelques différences étaient observées entre RH et MG dans leurs pratiques, notamment la mesure de DMO avant l'initiation du traitement et la prescription de tériparatide pour les patients avec fractures vertébrales multiples [ABSTRACT FROM AUTHOR]

Background: Treatment of osteoporosis with bisphosphonates can lead to important reductions in fracture rates. The effectiveness of bisphosphonates is however limited by inadequate treatment persistence. The introduction of weekly administered forms has been associated with improved treatment persistence.Objectives: This modelling study was designed to estimate the gain in persistence associated with a monthly treatment and the subsequent impact on fracture rates.Methods: Osteoporosis treatment rates and persistence rates were obtained from a French general practice registry for weekly and daily bisphosphonates and from a US managed care database for monthly bisphosphonates. Survival analyses were used to assess persistence. Fracture, hospitalisation and fracture rates were attributed based on data from clinical trials with bisphosphonates and epidemiological data.Results: Using a monthly treatment regimen, the reduction in the risk of vertebral and non-vertebral fractures with respect to untreated subjects was estimated to be 21.2% and 9.5% respectively. The reduction in risk of hospitalisation was estimated at 17.0% and the reduction of mortality at 18.1%. These reductions are around 60% higher as those estimated for daily bisphosphonate treatment and 25% higher than for weekly bisphosphonate treatment.Conclusion: This modelling approach supports the notion that increased treatment persistence associated with use of monthly bisphosphonate treatment regimens may result in a significant impact on osteoporotic fracture rates and consequent hospitalisation and mortality rates. [ABSTRACT FROM AUTHOR]

The present study aimed to characterize the relationships between several variables reflecting bone microarchitecture assessed by both computed tomographic (CT) image analysis and histomorphometry (conventional CT system) at the calcaneus. A total of 24 cadaveric specimens were studied. The mean age at death was 78 ± 10 years (range, 53–93 years). A total of 15 sagittal sections (1 mm in width and spaced 2 mm apart) were selected for CT analysis; 6 undecalcified sections (7 μm) were analyzed for histomorphometry. The histomorphometric analysis was performed on a Leica Quantimet Q570 image analyzer. Features measured by both methods were: bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), interconnectivity index (ICI), number of nodes (N Nd), number of terminus (N Tm), node-to-node strut count (NNS), node-to-terminus strut count (NTS), terminus-to-terminus strut count (TTS), marrow space star volume (SV), Euler number (EN), and fractal dimension (FD). The coefficient of correlations’ values (simple linear regression) between histomorphometry and CT image analysis varied according to the parameters selected. R values were high for BV/TV, Tb.N, and Tb.Sp (range, 0.69–0.90; P < 0.01). R values were less significant for some variables also obtained from the binary image: SV (0.5, P < 0.05) and EN (0.43, P < 0.05). Finally R values were also significant for (two) variables obtained from skeletonized images, i.e., N Nd (0.4, P < 0.05) and N Tm (0.61, P < 0.01). Other correlations were not statistically significant. Moreover, for some variables the relationships between the two methods (CT analysis and histomorphometry) seemed best-described by using nonlinear models. For example, a logarithmic model was more appropriate for SV (r = 0.71, P < 0.01), N Nd (r = 0.52, P < 0.01). Finally the relationship between apparent (App) N Tm and N Tm was most satisfying when using an exponential model (r = 0.64, P < 0.01). In conclusion, trabecular bone structure measures determined on CT images show highly significant correlations with those determined using histomorphometry. The level of correlation varies according to the type of method used for characterizing bone structure, however, and the strongest correlations were found for the most basic features (Parfitt’s parameters). Finally, for some variables, nonlinear models seem more appropriate. [ABSTRACT FROM AUTHOR]

Relationships among quantitative ultrasound of bone (QUS), bone mineral density (BMD) and bone microarchitecture have been poorly investigated in human calcaneus. .Twenty-four specimens, from 12 men and 12 women (mean age 78 ± 10 years; range 53–93), removed from cadavers were studied. The feet were axially sectioned above the ankle. Two variables were measured for QUS (Achilles®, Lunar): broadband ultrasound attenuation (BUA) and speed of sound (SOS). A third variable, the stiffness index (SI), which is a combination of both BUA and SOS, was also calculated. BMD (a lateral view) was measured on a QDR 2000 densitometer (Hologic). Bone microarchitecture was assessed by computed tomography (CT) using a conventional CT-system. Fifteen sagittal sections (1 mm in width and 2 mm apart) were selected for CT. Methods used for characterizing bone microarchitecture consisted in structural (trabecular network characterization) and a fractal analyses. The relationships between QUS and bone microarchitecture were assessed by simple linear regression analysis with and without adjustment for BMD (partial correlation) and by backward stepwise regression analysis. Strong relationships were found between BMD and QUS. Adjusted r2 values were 0.545 for SOS and 0.717 for SI. Two microarchitectural variables were also significantly correlated with both SOS and SI: apparent trabecular separation (App Tr Sp) and trabecular bone pattern factor (App TBPF). After adjustment for BMD few correlations between QUS and microarchitectural variables were always significant. Adjusted squared semipartial coefficients of correlation (rsp2) values between SOS and bone microarchitecture were 6%, 6.8%, 13.2% and 4.6% for App BV/TV, App Tr Sp, App TBPF and fractal dimension (FD), respectively. For SI, corresponding figures were 3.7%, 4.1%, 5.2% and 3.2%. Backward stepwise regression analysis using BMD and microarchitecture showed a slight increase of r2 values that varied from 8.4% for SI to 17.8% for SOS, compared with BMD alone. The current study suggests that although BMD is a major determinant of acoustic properties of human calcaneus, significant density independent relationships with bone microarchitecture should also be taken into account. [ABSTRACT FROM AUTHOR]

: Quantitative ultrasound (QUS) measurement, a different approach to bone fragility assessment, has already been attempted in women with osteoporosis but rarely in men. In order to test its value and ability to identify osteoporotic men, a case–control prospective study was conducted using the Lunar Achilles, a device that measures attenuation and velocity parameters. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI), a composite parameter, were assessed through the heel of 66 osteoporotic patients, and compared with the results in 35 controls. Patients had sustained a low-trauma fracture and/or had a lumbar and/or femoral bone mineral density (BMD) more than 2.5 SD below the young male reference value. As expected, all QUS parameters were statistically lower in patients, as were the dual-energy X-ray absorptiometry (DXA) measurements at the hip and lumbar spine. The two methods were compared for their ability to predict the risk of osteoporotic fractures. The odds ratios (ORs), with their 95% confidence limits, for fractures per 1 SD decrease were significant, especially for SOS and SI (OR = 2.3 [1.4–3.6] and 2.1 [1.3-3.3] respectively) and to a lesser extent for BUA (1.6 [1.0–2.4]). Our study suggests that QUS is associated with a history of low-trauma fracture in men; sensitivity is, however, less than when results are compared with BMD measurements (OR = 2.8 [1.6–5.0] and 3.4 [1.6–7.0] for lumbar spine and hip, respectively). Prospective studies are required before QUS can be recommended for clinical use in male osteoporosis. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting" published in the perodical.