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Force Field X (FFX) is an open-source software package for atomic resolution modeling of genetic variants and organic crystals that leverages advanced potential energy functions and experimental data. FFX currently consists of nine modular packages with novel algorithms that include global optimization via a many-body expansion, acid–base chemistry using polarizable constant-pH molecular dynamics, estimation of free energy differences, generalized Kirkwood implicit solvent models, and many more. Applications of FFX focus on the use and development of a crystal structure prediction pipeline, biomolecular structure refinement against experimental datasets, and estimation of the thermodynamic effects of genetic variants on both proteins and nucleic acids. The use of Parallel Java and OpenMM combines to offer shared memory, message passing, and graphics processing unit parallelization for high performance simulations. Overall, the FFX platform serves as a computational microscope to study systems ranging from organic crystals to solvated biomolecular systems. [ABSTRACT FROM AUTHOR]

Detecting individuals with low bone mineral density (BMD) before clinical fractures occur may help improve the outcomes of osteoporosis and osteopenia. Although computed tomography (CT) is useful for opportunistic BMD measurement, the modality most suitable for opportunistic screening remains unclear. In this retrospective study, we compared the diagnostic performance of low-dose chest CT (LDCT) and contrast-enhanced abdominopelvic CT (APCT) for measuring BMD at L1 level using dual-energy X-ray absorptiometry (DEXA) as a reference in individuals who underwent LDCT, APCT, and DEXA assessments on the same day. We included 512 individuals (median age: 60 years; interquartile range, 55−65 years; 307 men). Both LDCT (r = 0.706; P < 0.001) and APCT (r = 0.643; P < 0.001) exhibited strong correlation with DEXA T-scores. As T-scores decreased, the relative difference between LDCT and APCT Hounsfield unit values increased (b = − 6.456; P < 0.001). LDCT outperformed APCT in diagnosing both osteoporosis (AUC, 0.865 vs. 0.833; P = 0.035) and low BMD (AUC, 0.844 vs. 0.815; P = 0.006), which may be attributable to the greater effect of intravenous contrast media on CT scan characteristics in individuals with lower T-scores. These results may help inform the selection of imaging methods suitable for screening. [ABSTRACT FROM AUTHOR]

Background & aims: Sarcopenia is common in patients with liver disease and both sarcopenia and short telomeres are associated with mortality, however their relationship in patients with liver disease remains unknown. Methods: A cohort of 16,072 adults from the National Health and Nutrition Examination Survey from 1999 to 2006 was analyzed. Liver disease was defined by aminotransferases and classified into etiology-based categories. Sarcopenia was defined by dual-energy x-ray absorptiometry. All analyses were conducted separately on each multiple imputation data set and combined via Rubin's rules. P-values for group comparisons were calculated by testing logistic regression parameter estimates. Cox proportional hazards regression was used for mortality analysis with mortality data available until 2015. Results: Sarcopenia was present in 9.5% of patients with liver disease. Age, race, income, education, physical inactivity, and certain medical comorbidities were associated with sarcopenia. Patients with liver disease and sarcopenia had significantly shorter telomeres than patients with liver disease without sarcopenia when unadjusted for age. The interaction between telomere length and sarcopenia was significantly associated with all-cause mortality. Conclusions: The implications of telomere length on all-cause mortality in patients with liver disease varied by age and sarcopenia status. Shorter telomeres appear to be more highly associated with increased mortality in older patients without sarcopenia. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Near‐infrared reactance spectroscopy (NIRS) has become increasingly popular in personal and professional settings now that it has been adapted to provide comprehensive body composition assessments. However, whether NIRS agrees with criterion methods remains unknown. Thus, this study aimed to determine the agreement between NIRS and DXA‐derived body composition estimates.Ninety‐seven participants completed body composition assessments using DXA, and first‐generation (NIRSG1), second‐generation (NIRSG2), and muscle‐specific NIRS (NIRSFIT) devices. On a separate day, a subset of participants (n = 63) performed maximal voluntary contractions (MVC) on a handgrip dynamometer, which were used in conjunction with total appendicular lean mass (ALM) estimates to provide ratios (MVC/total ALM or MVC/ALM of the arms only) depicting muscle quality index (MQI).Fat mass, fat‐free mass, body fat %, and ALM, from NIRSG2, but not bone mineral content (BMC), and NIRSFIT demonstrated equivalence (using equivalence tests) with DXA with R2 from 0.83 to 0.97; though BMC revealed concordance coefficients of 0.83 and an R2 of 0.88. MQI using total ALM from NIRS was not equivalent to DXA, but demonstrated low root mean squared error (0.08 kg/kg) and 95% limits of agreement (±0.21 kg/kg). Indices of visceral adipose tissue (iVAT) from NIRSG1 and NIRSG2 were significantly different (p < 0.001), but were both significantly associated with DXA VAT (NIRSG1 R2: 0.53; NIRSG2 R2: 0.62; both p < 0.001).NIRS appears to demonstrate acceptable agreement with DXA and continual improvements could make NIRS a viable alternative for comprehensive body composition assessments. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Sarcopenia and osteoporosis adversely impact the clinical outcomes of patients with chronic liver disease (CLD). The Japan Society of Hepatology (JSH) sarcopenia criteria utilize bioelectrical impedance analysis (BIA) for assessing muscle mass rather than dual‐energy X‐ray absorptiometry (DXA), which can simultaneously diagnose these comorbidities. We investigated the correlations and interchangeability between the appendicular skeletal muscle mass index (ASMI) values determined using BIA and DXA and evaluated the diagnostic ability of DXA for sarcopenia and osteosarcopenia in patients with CLD.This cross‐sectional study included 173 patients with CLD. Sarcopenia was defined as low ASMIBIA according to the JSH and Asian Working Group for Sarcopenia (AWGS) criteria (ASMIBIA cutoff) or low ASMIDXA according to the AWGS criteria (ASMIDXA cutoff) and low handgrip strength. For women, a provisional cutoff value was set for ASMIDXA using the ASMIBIA cutoff (ASMIDXA‐altered cutoff).We found that ASMIBIA and ASMIDXA were significantly correlated (r = 0.921; P < 0.001). The Bland–Altman plots demonstrated substantial agreement between ASMIBIA and ASMIDXA, with a mean difference of 0.0116 kg/m2. The prevalence rates of sarcopenia and osteosarcopenia diagnosed using the ASMIBIA cutoff were 26.0% and 17.3%, respectively. The kappa coefficients for the prevalence of sarcopenia and osteosarcopenia were 0.759 and 0.775 between ASMIBIA cutoff and ASMIDXA cutoff and 0.780 and 0.806 between ASMIBIA cutoff and ASMIDXA‐altered cutoff, respectively.The utilization of DXA can facilitate the comprehensive assessment and management of musculoskeletal comorbidities in patients with CLD. [ABSTRACT FROM AUTHOR]

Summary: This is the first study to report that TBS seems not only unaffected by bone artifacts, but also is superior to BMD in the discrimination of vertebral fractures in SAPHO patients, which highlights the importance of adding TBS measurement to DXA images in routine clinical evaluation. Purpose: To investigate the impact of bone artifacts on trabecular bone score (TBS) and lumbar spine (LS) bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and analyze the clinical utility of TBS evaluation for vertebral fracture (VF) risk assessment in SAPHO patients compared with BMD assessment. Methods: Seventy SAPHO patients (mean age 50.1 (10.7) years, 81% women) and an equal number of age- and sex-matched controls were enrolled. TBS and BMD were assessed using DXA. Bone artifacts and VF of the spine were evaluated using whole-spine CT. Univariate logistic regression analysis was performed to identify factors associated with VF. Odds ratios (ORs) per standard deviation decrease in TBS and BMDs were estimated from logistic regression models with adjustment for age. Results: In patients with bone artifacts, TBS, but not LS BMD, was lower than matched controls, and in those without bone artifacts, both BMDs and TBS were lower than controls. After adjustment, LS BMD was significantly lower in the SAPHO group than in controls. TBS and LS BMD (OR [95% confidence interval], 12.0 [3.6, 40.4] and 4.7 [2.0, 10.9]) showed statistically significant ORs but the others did not. For evaluating VF in SAPHO patients, TBS showed the greatest AUC in the ROC curve, with a value of 0.920 compared with 0.777, 0.690, and 0.652 for LS, FN, and TH BMD, respectively. Conclusion: TBS seems not to be influenced by bone artifacts in opposition to LS BMD and has a better discriminatory value than BMD for VF in SAPHO patients. [ABSTRACT FROM AUTHOR]

Background: Cardiorespiratory fitness (CRF) is a vital indicator of health. However, accurately measuring peak oxygen consumption ( V ˙ O2peak) to determine CRF in children can be challenging. The oxygen uptake efficiency slope (OUES) has been proposed as an alternative metric for predicting V ˙ O2peak in children, but its accuracy and agreement with measured V ˙ O2peak remain unclear. Methods: A post hoc analysis was conducted in 94 children (ages 7–10 years) who completed an incremental cycle ergometer test to measure V ˙ O2peak. Body composition (Dual-energy X-ray absorptiometry) was measured, and fat mass index (FMI, kg/m2) and fat-free mass index (FFMI, kg/m2) were calculated. OUES was determined using all respiratory data (OUES100%) collected during the cycle ergometer test and using data only up to 60% of heart rate reserve (OUES60%HRR). Regression equations to predict V ˙ O2peak (Pred- V ˙ O2peak) were derived from simple and multiple linear regression analysis. Bland-Altman analysis assessed the level of agreement between Pred- V ˙ O2peak and measured V ˙ O2peak. Results: OUES60%HRR (β = 0.46, p < 0.0001), age (β = 56.0, p = 0.0004), White race (β = 173.3, p < 0.0003), FFMI (β = 0.98.6, p < 0.000), and FMI (β = −0.40.8, p < 0.000) were retained in the final model. The difference between measured V ˙ O2peak and Pred- V ˙ O2peak was not different from zero (p = 0.999). There was a positive association between the difference of measured V ˙ O2peak and Pred- V ˙ O2peak and the average of the two methods (β = 0.79, p = 0.0028). Conclusion: There was no mean bias between measured V ˙ O2peak and Pred- V ˙ O2peak. However, magnitude bias was present even after considering other significant predictors of V ˙ O2peak (FMI, FFMI, race, and age) in the regression equation. Caution is advised when using OUES to predict V ˙ O2peak in children. [ABSTRACT FROM AUTHOR]

Background: Adequate nutritional intake plays a crucial role in maximizing skeletal acquisition. The specific effects of a general food restriction and refeeding on fracture healing are yet to be fully understood. The aim of this study was to assess the impact of general food restriction and refeeding on fracture repair. Methods: Fifty-four male Wistar Hannover rats were randomly assigned into three groups: (1) Sham: Sham rats with femoral fracture; (2) FRes: Food-restricted rats with fracture, (3) Fres+Ref: Fres rats with refeeding. Following weaning, the FRes and Fres+Ref groups received 50% of the food amount provided to the Shams. In the sixth week of the experiment, all animals underwent a mid-right femur bone fracture, which was subsequently surgically stabilized. Following the fracture, the Fres+Ref group was refed, while the other groups maintained their pre-fracture diet. Bone calluses were analyzed on the fifth-day post-fracture by gene expression and on the sixth-week post-fracture using dual-energy X-ray absorptiometry, morphometry, histomorphometry, immunohistochemistry, computed microtomography, and torsion mechanical testing. Statistical significance was determined at a probability level of less than 0.05, and comparisons were made using the ANOVA test. Results: Food restriction resulted in significant phenotypic changes in bone calluses when compared to sham rats characterized by deterioration in microstructure (i.e., BV, BV/TV, Tb.N, and Conn.D) reduced collagen deposition, bone mineral density, and mechanical strength (i.e., torque at failure, energy, and stiffness). Moreover, a higher rate of immature bone indicated a decrease in bone callus quality. Refeeding stimulated bone callus collagen formation, reduced local resorption, and effectively restored the microstructural (i.e., SMI, BCa.BV/TV, Tb.Sp, Tb.N, and Conn.D) and mechanical changes (i.e., torque at failure, energy, and angular displacement at failure) caused by food restriction. Despite these positive effects, the density of the bone callus, collagen deposition, and OPG expression remained lower when compared to the shams. Gene expression analysis didn't evidence any significant differences among the groups. Conclusions: Food restriction had detrimental effects on osseous healing, which was partially improved by refeeding. Based on these findings, new research can be developed to create targeted nutritional strategies to treat and improve fracture healing. [ABSTRACT FROM AUTHOR]

Summary: Osteoporosis affects over half of older women, whether urban compared to rural residents have different risk of osteoporosis is unclear. This 23-year longitudinal study of Australian women found lower risk of osteoporosis and fractures among women living in rural compared with urban areas, which may relate to distribution of risk factors and/or screening opportunities. Purpose: To determine whether the prevalence of osteoporosis, fractures, and dual-X-ray absorptiometry (DXA) differs between Australian women living in rural compared with urban areas. Methods: The Australian Longitudinal Study on Women's Health, a prospective longitudinal study of Australian women, includes a cohort of women born 1946–1951, surveyed nine times from 1996–2019. Data from administrative health records were linked to survey data. Geographic area was classified as major city, inner regional, outer regional, or remote. Generalised estimating equations (GEE) explored outcomes of osteoporosis, fracture, and DXA rates. Univariable and multivariable regression were performed and bootstrapping with 100 repetitions at 95% sampling of the original dataset to ensure robust results. Results: A total of 13,712 women were included: 5000 (36.5%) living in major cities, 5214 (38.0%) inner regional, 2798 (20.41%) outer regional, and 700 (5.1%) remote areas. Baseline age, 47.6 (1.46) years (mean (SD)), was similar; but education, marital status, country of birth, smoking, BMI, and comorbidities varied between areas. Over 23 years, 2956 (21.6%) were diagnosed with osteoporosis, 3185 (23.2%) had an incident fracture, and 8151 (59.4%) had a DXA. On univariable analysis, women living outside major cities had lower risk of osteoporosis (inner regional OR 0.92; 95% CI 0.84, 0.99; outer regional 0.70; 0.63, 0.79; remote 0.43; 0.34, 0.53), and lower risk of fractures (inner regional area OR 0.92, 95% CI 0.84, 0.99; outer regional 0.81; 0.73, 0.90; remote 0.54; 0.42, 0.67), than women living in major cities. These differences were no longer significant on multivariable analysis, suggesting differences might be related to the distribution of risk factors. Women living in inner regional and outer regional areas were significantly less likely to have a DXA, than those living in a major city (OR 0.75, 95% CI 0.70, 0.81; OR 0.72; 95% CI 0.64, 0.77, respectively), and this remained significant on multivariable analysis. Conclusion(s): Osteoporosis or fracture affected one-third of older Australian women, and women living outside major cities had lower rates of osteoporosis, fractures, and DXA completion. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either 'low-plane' distal humeral fractures or 'non-low-plane' distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of −2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as 'low-plane' fractures. Postoperative complications occurred in 11% of patients (64% of cases among 'low-plane' fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of 'low-plane' fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal 'low-plane' fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with 'low-plane' fractures in order to reduce complications and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop machine learning methods to estimate bone mineral density and detect osteopenia/osteoporosis from conventional lumbar MRI (T1-weighted and T2-weighted images) and planar radiography in combination with clinical data and imaging parameters of the acquisition protocol. Methods: A database of 429 patients subjected to lumbar MRI, radiographs and dual-energy x-ray absorptiometry within 6 months was created from an institutional database. Several machine learning models were trained and tested (373 patients for training, 86 for testing) with the following objectives: (1) direct estimation of the vertebral bone mineral density; (2) classification of T-score lower than − 1 or (3) lower than − 2.5. The models took as inputs either the images or radiomics features derived from them, alone or in combination with metadata (age, sex, body size, vertebral level, parameters of the imaging protocol). Results: The best-performing models achieved mean absolute errors of 0.15–0.16 g/cm2 for the direct estimation of bone mineral density, and areas under the receiver operating characteristic curve of 0.82 (MRIs) − 0.80 (radiographs) for the classification of T-scores lower than − 1, and 0.80 (MRIs) − 0.65 (radiographs) for T-scores lower than − 2.5. Conclusions: The models showed good discriminative performances in detecting cases of low bone mineral density, and more limited capabilities for the direct estimation of its value. Being based on routine imaging and readily available data, such models are promising tools to retrospectively analyse existing datasets as well as for the opportunistic investigation of bone disorders. [ABSTRACT FROM AUTHOR]

It is unclear whether blood concentrations of copper (Cu), magnesium (Mg), and calcium (Ca) influence skeletal muscle mass and strength in children. We aimed to explore the associations between plasma Cu, Mg, and Ca and skeletal muscle indicators in Chinese children. A total of 452 children aged 6 to 9 years old were recruited for this cross-sectional study. Whole body lean soft tissue mass (WLSTM), trunk lean soft tissue mass (TLSTM), and appendicular skeletal muscle mass (ASMM) were measured using dual-energy X-ray absorptiometry. Parameters of these indicators divided by Height2 (Ht2) and Weight (Wt) at the corresponding sites were calculated. Handgrip strength was also measured. Parameters of skeletal muscle indicators and handgrip strength that were below the sex-specific 20th percentile were considered low levels. Plasma concentrations of Cu, Mg, and Ca were measured using ICP-MS. After adjusting for several potential covariates, among the total subjects, for every one standard deviation increase in Cu concentrations, there was a 0.939% decrease in WLSTM/Wt, a 0.415% decrease in TLSTM/Wt, and a 0.47% decrease in ASMM/Wt. For every one standard deviation increase in Cu concentrations, there was a higher odd (OR: 1.36, 95%CI 1.06, 1.75) of low WLSTM/Wt, TLSTM/Wt (OR: 1.33, 95%CI 1.03, 1.71), ASMM/Ht2 (OR: 1.32, 95%CI 1.02, 1.69), as well as ASMM/Wt (OR: 1.56, 95%CI 1.23, 1.99). No significant associations were found between Mg, Ca, and most skeletal muscle indicators. Higher plasma Cu concentrations were adversely associated with skeletal muscle indicators at multiple sites in Chinese children. [ABSTRACT FROM AUTHOR]

Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable. [ABSTRACT FROM AUTHOR]

Fibroblast Growth Factor (FGF) receptor signalling is important for skeletal development. The FGF19 subfamily which includes FGF19 and FGF21 are involved in bone metabolism, although their effects on bone mineral density (BMD) and bone strength remain unclear. To further characterise the influence of these two factors on the skeleton, we studied the association between circulating concentrations of FGF19 and 21 with BMD and parameters of hip geometry and strength in post-menopausal osteoporosis (PMO). The study cohort consisted of 374 women aged (mean [SD]) 68.7[12.3] years with PMO. FGF19 and FGF21 were measured in serum by ELISA. BMD was measured at the lumbar spine (LS), total hip (TH) and femoral neck (FN) (n = 277) by dual energy X-ray absorptiometry (DXA) and hip structural analysis (HSA) parameters (n = 263) at the narrow neck of the femur (NN), Intertrochanter (IT) and Femoral shaft (FS) were derived from DXA scans. FGF19 and 21 were not associated with prevalent fractures or BMD when corrected for covariates; age, BMI, smoking habits and alcohol intake. Log-transformed FGF 21 was negatively associated with HSA parameters including Outer Diameter (OD) (p = 0.019), Cross-sectional area (CSA) (p = 0.01), cross-sectional moment of inertia (CSMI) (p = 0.011), Section modulus (Z) (p = 0.002) and cortical thickness (Co Th) (p = 0.026) at the IT only. CSA, CSMI, Z and Co Th were significantly lower (p < 0.05) in women with FGF21 concentrations greater than the median (> 103.5 pg/ml). Our data suggest that FGF 21 may have potentially adverse effects on the skeleton. Further characterisation is needed, particularly as FGF 21 analogues or agonists may be used to treat obesity-related metabolic disorders. [ABSTRACT FROM AUTHOR]

Purpose: Patients with osteoporosis are at risk of fractures, which can lead to immobility and reduced quality of life. Early diagnosis and treatment are crucial for preventing fractures, but many patients are not diagnosed until after a fracture has occurred. This study aimed to evaluate the performance of 10 osteoporosis screening tools (OSTs) in rural communities of Taiwan. In this prospective study, a total of 567 senior citizens from rural communities underwent bone mineral density (BMD) measurement using dual-energy X-ray absorptiometry (DXA) and ten OSTs were administered. Discrimination analysis was performed using the area under the receiver operating characteristic curve (AUROC). Primary outcomes included area under curve (AUC) value, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The DXA examination revealed that 63.0% of females and 22.4% of males had osteoporosis. Among females, Osteoporosis Index of Risk (OSIRIS) and Osteoporosis Self-Assessment Tool for Asians (OSTA) presented the best AUC value with 0.71 (0.66–0.76) and 0.70 (0.66–0.75), respectively. Among males, BWC had the best AUC value of 0.77 (0.67–0.86), followed by OSTA, Simple Calculated Osteoporosis Risk Estimation (SCORE), and OSIRIS. OSTA and OSIRIS showed acceptable performance in both genders. The specificity of Fracture Risk Assessment Tool (FRAX-H), SCORE, National Osteoporosis Foundation Score, OSIRIS, Osteoporosis Risk Assessment Instrument, Age, Bulk, One or Never Estrogen (ABONE), and Body weight criteria increased in both genders after applying the optimum cut-off. Considering it high AUC and simplicity of use, OSTA appeared to be the recommended tool for seniors of both genders among the ten OSTs. This study provides a viable reference for future development of OSTs in Taiwan. Further adjustment according to epidemiological data and risk factors is recommended while applying OSTs to different cohorts. [ABSTRACT FROM AUTHOR]

The importance of osteoporosis assessment before lumbar surgery is well recognized. The MRI-based Vertebral Bone Quality (VBQ) score is introduced to evaluate bone quality; however, its diagnostic value has not been well documented. The purpose of this meta-analysis was to summarize the diagnostic value of the VBQ score for osteoporosis or osteopenia in patients undergoing lumbar surgery. We comprehensively searched electronic databases for studies exploring the diagnostic accuracy of the VBQ score for osteoporosis/osteopenia in patients with lumbar disease following the PRISMA guidelines. The quality of the included studies was assessed. The VBQ scores were compared between the groups, and the pooled sensitivity, specificity, and summary receiver operating characteristic (ROC) were calculated. Publication bias was assessed, and meta-regression was conducted. We included 17 studies with a total of 2815 patients, with a mean age of 66.4 years and a percentage of females of 72.5%. According to the QUADAS-2 tool, the quality of the included studies was relatively high. The results showed a significantly higher VBQ score in the osteoporosis/osteopenia group compared with the control group. According to the mean VBQ cutoff value of 3.02 ± 0.38 for the diagnosis of osteoporosis, the pooled sensitivity and specificity were 0.76 and 0.74, respectively, and the AUC was 0.81. According to the mean VBQ cutoff value of 2.31 ± 0.18 for the diagnosis of osteopenia, the pooled sensitivity and specificity were 0.78 and 0.58, respectively, and the AUC was 0.76. The MRI-based VBQ score could provide useful information for identifying patients with low bone mass who need further evaluation. Future prospective studies are still needed to evaluate the complementary role of the VBQ score. [ABSTRACT FROM AUTHOR]

Objective: To examine the correlation between serum insulin-like growth factor 1 (IGF-1) and osteoporosis (OP) in Parkinson's disease (PD). Methods: We retrospectively analyzed clinical data from 105 PD patients (PD group) and 78 individuals in the health examination group (HC group). We compared general clinical data and serum IGF-1 levels between the two groups. PD patients were further categorized into PD with OP (50 cases) and PD without OP (55 cases) based on dual-energy X-ray absorptiometry (DXA) results for bone density. We compared general clinical data and serum IGF-1 levels between these two subgroups. Pearson correlation coefficient analysis was conducted to assess the relationship between serum IGF-1 levels and bone density at the lumbar spine and left femoral neck. Multifactorial logistic regression analysis was performed to identify risk factors for PD with OP. Results: Serum IGF-1 levels were significantly lower in the PD group compared to the HC group (P < 0.05). Pearson correlation analysis revealed a positive association between serum IGF-1 levels and both lumbar spine and left femoral neck bone densities (r = 0.653, P < 0.001; r = 0.625, P < 0.001). Multivariate logistic regression analysis identified decreased serum IGF-1 levels, lower uric acid levels, and higher H-Y stage as risk factors for PD with OP (P < 0.05). Conclusion: Reduced levels of serum IGF-1, uric acid, and an increased H-Y stage are closely linked to osteoporosis in PD. Elevating serum levels of IGF-1 and uric acid may potentially offer therapeutic avenues for PD with osteoporosis. [ABSTRACT FROM AUTHOR]

Introduction: The role of uric acid (UA) on bone metabolism is controversially discussed. Higher UA levels have been associated with higher T-scores and a reduced incidence of fractures in postmenopausal women. However, in the context of rheumatoid arthritis (RA), the role of UA remains unclear. This pilot study aimed to investigate the association of UA levels with bone mineral density in RA female and male patients. Methods: This pilot study analyzed patients with RA to explore preliminary associations. We utilized data from the Rh-GIOP cohort, a prospective monocentric observational study focusing on bone health in chronic rheumatic diseases. To assess the association between UA levels and the lowest T-scores measured at the lumbar spine, hip, or femur, we used linear regression with adjustment for various confounders. An interaction term was included to evaluate differential associations in pre- and postmenopausal women. Results: Data on dual X-ray absorptiometry (DXA) measurements and serum UA levels were analyzed in a total of 206 patients. Among the 167 women 16 were premenopausal (age 40 ± 8 years) and 149 postmenopausal (age 65 ± 10 years). As expected, postmenopausal had lower T-scores than premenopausal patients (-1.53 ± 1.01 versus − 0.41 ± 1.29, respectively). No association of UA levels with T-scores was found when analyzing the whole cohort (Slope β: -0.04; p = 0.45). However, a significant negative correlation of UA with T-scores in premenopausal (Slope β: -0.98; p = 0.014), but not postmenopausal (Slope β: -0.04; p > 0.05) women was found. Conclusion: Uric acid appears to be negatively associated with bone mineral density in premenopausal but not in postmenopausal women with RA. Thus, the impact of UA on bone health seems to depend on the hormonal status of women. Further investigations are required to validate these results in a larger cohort of patients and to investigate the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: To report osteoporosis screening utilization rates among Asian American (AsA) populations in the USA. Methods: We retrospectively assessed the use of dual-energy X-ray absorptiometry (DXA) screening using the Medicare 5% Research Identifiable Files. Using Current Procedural Terminology (CPT) codes indicative of a DXA scan, we identified patients recommended for DXA screening according to the ACR-SPR-SSR Practice Parameters (females ≥ 65 years, males ≥ 70 years). Sociodemographic factors and their association with screening were evaluated using chi-square tests. Results: There were 80,439 eligible AsA beneficiaries, and 12,102 (15.1%) received osteoporosis screening. DXA rate for women was approximately four times greater than the rate for men (19.8% vs. 5.0%; p < 0.001). AsA beneficiaries in zip codes with higher mean household income (MHI) were more likely to have DXA than those in lower MHI areas (17.6% vs. 14.3%, p < 0.001). AsA beneficiaries aged < 80 were more likely to receive DXA (15.5%) than those aged ≥ 80 (14.1%, p < 0.001). There were 2,979,801 eligible non-AsA beneficiaries, and 496,957 (16.7%) received osteoporosis screening during the study period. Non-Hispanic white beneficiaries had the highest overall screening rate (17.5%), followed by North American Native (13.0%), Black (11.8%), and Hispanic (11.1%) beneficiaries. Comparing AsA to non-AsA populations, there were significantly lower DXA rates among AsA beneficiaries when controlling for years of Medicare eligibility, patient age, sex, location, and mean income (p < 0.001). Conclusion: We found lower than expected DXA screening rates for AsA patients. A better understanding of the barriers and facilitators to AsA osteoporosis screening is needed to improve patient care. [ABSTRACT FROM AUTHOR]

DXA-measured visceral adipose tissue (VAT DXA) is associated with adverse cardiometabolic risk profiles in cross-sectional studies, but longitudinal associations have not been investigated. We examined the longitudinal associations of baseline and change in VAT DXA with future cardiometabolic risk in Australian participants of the Busselton Healthy Ageing study. We studied 3569 participants (54.7% female, aged 46–70 years) with data on VAT DXA (GE Lunar Prodigy) and cardiometabolic risk factors at baseline and 6 years follow-up. The associations were examined using logistic and linear regression models, adjusting for baseline age and lifestyle factors. Mean baseline VAT DXA mass was 1653 ± 880 g and 855 ± 580 g, and mean change in VAT DXA +99 ± 500 g and +58 ± 312 g in males and females, respectively. Among all participants, 182 males (11.3%) and 197 females (10.1%) developed incident metabolic syndrome (MetS). Baseline VAT DXA was associated with incident MetS with an adjusted odds ratio of 2.53 (95% CI: 2.03, 3.15) in males and 2.78 (2.30, 3.36) in females per SD increment. There was a graded positive association between longitudinal change in VAT DXA and MetS severity z score in both sexes adjusted for baseline VAT (P < 0.001). All the above associations remained significant after further adjustment for baseline or change in BMI, waist circumference or waist-to-hip ratio in respective models (all P < 0.001). Higher baseline and greater longitudinal increase in VAT DXA are independently associated with raised cardiometabolic risk over time, and may serve as useful markers for identifying middle-aged individuals at increased cardiometabolic risk. [Display omitted] • In middle-to-older aged adults, higher baseline VAT DXA associated with greater risk for incident MetS over 6 years. • Greater longitudinal increase in VAT DXA associated with greater increase in MetS severity z score over time in both sexes. • Associations remained significant after further adjustment for baseline or change in BMI, WC or WHR in respective models. • DXA-measured VAT might be a useful marker to identify individuals at increased risk for cardiometabolic diseases. [ABSTRACT FROM AUTHOR]

Vitamin D measurements and dual energy x-ray absorptiometry (DXA) scans are recommended in people with intellectual disability and/or epilepsy in order to prevent bone-linked harm. The prevalence of vitamin D supplementation and bone mineral density screening were evaluated in 68 people with epilepsy and intellectual disability (EID) and 68 matched controls with epilepsy without intellectual disability. DXA scans were not performed in any of the people with EID but were performed in 11.8% of the people in the control group. People with EID had a higher vitamin D supplementation rate and were treated with more antiepileptic drugs (AEDs) and more AED combinations, including first generation AEDs. Increased awareness of bone health screening in people with epilepsy and especially EID is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) may be desired by transgender and gender-diverse (TGD) individuals who want to affirm their gender identity. Testosterone is the basis of GAHT for transgender individuals assigned female at birth (AFAB), whereas GAS can involve hysterectomy, bilateral salpingectomy, bilateral oophorectomy (BO), thorax masculinization, and phalloplasty. Our study aimed to evaluate the effects of GAHT on the bone health of TGD AFAB individuals who have undergone or not undergone BO. Methods: This was a single-center, longitudinal study with retrospectively collected data. TGD AFAB GAHT-naïve individuals were enrolled and underwent dual-energy X-ray absorptiometry scans and laboratory tests (hormonal and bone metabolism parameters) at baseline and after 5 and 10 years of GAHT. Results: Two hundred and forty-three TGD AFAB people were included in this study. Seventy-five subjects had completed data for 5 years and 19 subjects for 10 years of GAHT. At baseline, low bone density (Z-score < –2.0) was found in 2.5% (6/243) of subjects for lumbar spine (LS), whereas total hip (TH) and femoral neck (FN) Z-scores and laboratory tests were within the normal female range. After stratifying by physical activity, the physically active group showed significantly higher LS BMD and Z-scores (p ≤ 0.05). Five years after the start of GAHT, a significant reduction in LS (p ≤ 0.05), TH (p ≤ 0.001), and FN (p ≤ 0.01) Z-scores was detected. A significant reduction in the Z-scores of all three bone sites was observed only in the subgroup that had undergone BO. After 5 years of GAHT, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.001). Significantly higher estradiol levels were detected in the 5-year no-BO subgroup compared to those in the 5-year BO subgroup (p ≤ 0.001). A significant reduction in LS and TH Z-scores were observed after 10 years of GAHT. At this time, estradiol levels were significantly decreased compared to those in baseline (p ≤ 0.01). Conclusion: Bone density in TGD AFAB individuals is comparable to that in their peers prior to GAHT and BO, but those subjects who underwent BO had a reduced Z-score at LS, FN, and TH after 5 years and at LS after 10 years of GAHT. [ABSTRACT FROM AUTHOR]

Purpose: This research aimed to assess the correlation between the Adjusted Body Shape Index (ABSI) and the presence of abdominal aortic calcification (AAC) among middle-aged and older American adults. Methods: Employing a cross-sectional design, this study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), focusing on 3077 participants aged 40 and above. AAC detection was conducted using dual-energy X-ray absorptiometry (DXA). ABSI was determined based on waist circumference (WC), weight, and height data. The association between ABSI and AAC was examined through multiple linear regression, smoothed curve analysis, threshold effect evaluation, subgroup analysis, and interaction testing. Results: The study encompassed 3077 individuals aged 40 and above. Findings indicated a noteworthy positive relationship between ABSI and AAC when adjusting various covariates. Analysis of threshold effects identified a K-point at 0.0908, showing no significant effect to its left but a significant effect to its right. Further, subgroup and interaction analyses highlighted the ABSI-AAC connection specifically within different age groups and among individuals with diabetes. Conclusion: Higher ABSI was correlated with higher AAC score. [ABSTRACT FROM AUTHOR]

Obesity is a pervasive public health problem that causes debilitating complications across the life course. One opportunity for preventing the onset of obesity is to focus on its social determinants. Socioeconomic status (SES), which includes factors such as income, educational attainment, occupational prestige, and access to resources, is a key determinant of obesity. In this scoping mini-review, we summarized review articles and meta-analyses of the SES-obesity association. From the 1980s to the present, cross-sectional studies have demonstrated a persistent socioeconomic gradient in obesity in which the association is negative in developed countries and positive in developing countries. Longitudinal studies have revealed the bidirectionality of the SES-obesity association; some studies demonstrate that socioeconomic adversity precedes the onset of obesity, while others provide evidence of reverse causality. While earlier studies relied on anthropometric assessments of weight and height to define obesity, the use of modern technologies like dual-energy x-ray absorptiometry and bioelectrical impedance have demonstrated that the socioeconomic gradient in obesity is robust across multiple indicators of body composition, including direct measures of lean and fat mass. More recently, examination of mediators and moderators of the SES-obesity association have highlighted causal pathways and potential intervention targets, with a focus on health behaviors, environmental conditions, psychological factors, and biological processes. We describe current gaps in knowledge and propose opportunities for future innovation to reduce the burden of obesity and related socioeconomic disparities. [ABSTRACT FROM AUTHOR]

Context Adipose steroid metabolism modifies body fat development in polycystic ovary syndrome (PCOS). Objective To determine whether subcutaneous (SC) abdominal adipose aldo-keto reductase 1C3 (AKR1C3; a marker of testosterone generation) is increased in normal-weight women with PCOS vs age- and body mass index (BMI)-matched normoandrogenic ovulatory women (controls) and is related to SC abdominal adipose activator protein-1 (AP-1; a marker of adipocyte differentiation) and/or androgen receptor (AR) protein expression in predicting fat accretion. Design Prospective cohort study. Setting Academic center. Patients Eighteen normal-weight PCOS women; 17 age- and BMI-matched controls. Intervention(s) Circulating hormone/metabolic determinations, intravenous glucose tolerance testing, total body dual-energy x-ray absorptiometry, SC abdominal fat biopsy, immunohistochemistry. Main Outcome Measure(s) Clinical characteristics, hormonal concentrations, body fat distribution, SC adipose AKR1C3, AR, and AP-1 protein expression. Results Women with PCOS had significantly higher serum androgen levels and greater android/gynoid fat mass ratios than controls. SC adipose AKR1C3, AR, and AP-1 protein expressions were comparable between the study groups, but groups differed in correlations. In PCOS women vs controls, SC adipose AKR1C3 protein expression correlated positively with android and gynoid fat masses and negatively with SC adipose AP-1 protein expression. SC adipose AR protein expression correlated negatively with fasting serum free fatty acid and high-density lipoprotein levels. In both study groups, SC adipose AKR1C3 protein expression negatively correlated with serum cortisol levels. Conclusion In normal-weight PCOS women, SC abdominal adipose AKR1C3 protein expression, in combination with intra-adipose AP-1 and AR-dependent events, predicts fat accretion in the presence of physiological cortisol levels. [ABSTRACT FROM AUTHOR]

Introduction: Older women are at increased risk of spinal misalignment and its associated complications. This study investigated the influence of age, grip strength, and various sagittal spinal parameters on spinal alignment. The results indicate the need for comprehensive management strategies. Methods: This cross-sectional study included 200 older women who underwent bone health evaluations at the orthopedic department of a hospital. The study participants underwent dual-energy X-ray absorptiometry, grip strength measurement, and full-length spine radiography. Clinical and radiographic parameters were analyzed through Pearson correlation and linear regression analyses. Results: Significant correlations were identified between grip strength and spinal parameters such as C7 slope and global tilt, indicating that muscle strength affects spinal alignment. Advanced age was associated with changes in sagittal spinal parameters, indicating that changes occur in body compensation over time. Furthermore, pelvic parameters such as pelvic tilt and sacral slope were significantly correlated with spinal curvature, indicating their critical roles in maintaining spinal stability. Conclusions: This study revealed the critical roles of muscle strength and pelvic alignment in the management of spinal health in older women with low bone mass. Targeted interventions for increasing muscle strength, correcting posture, and achieving hormonal balance can notably improve spinal stability and reduce the risk of associated complications. Longitudinal studies should be conducted to validate and refine the intervention strategies and to extend the study findings. [ABSTRACT FROM AUTHOR]

The complex relationship between the gut microbiome and host metabolic health has been an emerging research area. Several recent studies have highlighted the potential effects of the microbiome's diversity, composition and metabolic production capabilities on Body Mass Index (BMI), liver health, glucose homeostasis and Type-2 Diabetes (T2D). The majority of these studies were constrained by relatively small cohorts, mostly focusing on individuals with metabolic disorders, limiting a comprehensive understanding of the microbiome's role in metabolic health. Leveraging a large-scale, comprehensive cohort of nearly 9000 individuals, measured using Continuous Glucose Monitoring (CGM), Dual-energy X-ray absorptiometry (DXA) scan and liver Ultrasound (US) we examined the functional profile of the gut microbiome, and its relation to 38 metabolic health measures. We identified 145 unique bacterial pathways significantly correlated with metabolic health measures, with 86.9% of these showing significant associations with more than one metabolic health measure. Furthermore, 87,678 unique bacterial gene families were found to be significantly associated with at least one metabolic health measure. Notably, "key" bacterial pathways such as purine ribonucleosides degradation and anaerobic energy metabolism demonstrated multiple robust associations across various metabolic health measures, highlighting their potential roles in regulating metabolic processes. Our results remained largely unchanged after adjustments for nutritional habits and for BMI they were replicated in a geographically independent cohort. These insights pave the way for future research and potentially the development of microbiome-targeted interventions to enhance metabolic health. Here, employing a large cohort of nearly 9000 individuals, the authors reveal associations between gut microbiome functions and metabolic measures, highlighting bacterial gene families and pathways affecting host metabolic health. [ABSTRACT FROM AUTHOR]

Introduction: Renal dysfunction is a recognized complication of obesity with an incompletely characterized pathophysiology. Improvement of glomerular filtration rate (GFR) after metabolic and bariatric surgery (MBS) has been reported across all classes of renal function. Inter-gender differences with regard to correlates of renal function have been described, but the influence of body composition is an understudied area. We aimed to explore determinants of renal function in obesity and to assess its variations after MBS, with a focus on body composition parameters in males and females, respectively. Materials, methods: We conducted a retrospective study on 196 patients who underwent laparoscopic sleeve gastrectomy, evaluated preoperatively and 6 months after the intervention. Recorded data included clinical and biochemical assessment, as well as body composition estimation via dual-energy X-ray absorptiometry. Serum creatinine-based formulas were used for the estimation of GFR. Results: We included a total of 196 patients (80 males and 116 females), with a mean age of 41.43 ± 10.79. Median baseline body mass index was 42.6 (6.61) kg/ m2 and 6 months excess weight loss (EWL) reached 71.43 ± 17.18%, in females, estimated GFR correlated negatively with visceral adipose tissue (VAT) mass (rho=-.368) and this correlation was stronger in females with type 2 diabetes mellitus. Moreover, women in the third VAT mass tertile were 5 times more likely to have reduced GFR compared to the first tertile. Renal function improved after MBS across all classes of filtration. In males, this improvement correlated with EWL (rho=.358) and lean mass variation (rho=-.412), while in females it correlated with VAT mass variation (rho=-.266). Conclusions: Our results are consistent with previous findings on the positive impact of MBS on renal function and suggest a more prominent impact of visceral adiposity on GFR in females. [ABSTRACT FROM AUTHOR]

Background: Sarcopenia is a common condition in women with breast cancer, however still presents limitations for an effective diagnosis. This study aimed to evaluate the agreement and diagnostic accuracy of an anthropometric equation in diagnosing sarcopenia in women with breast cancer based on different constructs. Methods: Cross-sectional study carried out with women with breast cancer aged ≥ 20 years. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was obtained by the handgrip strength test (HGS) and muscle mass (MM) by dual-energy x-ray absorptiometry (DXA) and by the anthropometric predictive equation. For the diagnosis of sarcopenia, eight constructs were proposed based on the MM assessment method (equation or DXA) and different cutoff points. Agreement analyses using Cohen's Kappa test and diagnostic performance measures were performed. The significance level for all tests was 5%. Results: A total of 122 women, with a mean age of 55.3 ± 11.4 years, were evaluated. There was a predominance of brown participants (50.8%), insufficiently active (57.4%), with diagnosis time ≤ 3 months (54.1%), and with invasive breast carcinoma (69.7%). The prevalence of sarcopenia ranged from 3.3 to 8.2%, depending on the construct used. The constructs determined from the cutoff points < 16.0 kg/< 7.58 m² and < 23.0 kg/< 7.58 m² were the ones that showed the best ability to detect sarcopenia. Conclusion: The anthropometric equation showed sufficient diagnostic capacity to be used as an alternative in identifying sarcopenia in women with breast cancer. [ABSTRACT FROM AUTHOR]

Background: SELENON-related myopathy (SELENON-RM) is a rare congenital myopathy characterized by slowly progressive axial muscle weakness, rigidity of the spine, scoliosis, and respiratory insufficiency. Laminin-a2-related muscular dystrophy (LAMA2-MD) has a similar clinical phenotype, which ranges from severe, early-onset congenital muscular dystrophy type 1A (MDC1A) to milder forms presenting as childhood- or adult-onset limb-girdle type muscular dystrophy. The first 1.5-year natural history follow-up showed that 90% of the patients had low bone quality, respiratory impairments were found in all SELENON-RM and most of the LAMA2-MD patients, and many had cardiac risk factors. However, further extensive knowledge on long-term natural history data, and clinical and functional outcome measures is needed to reach trial readiness. Therefore, we extended the natural history study with 3- and 5-year follow-up visits (Extended LAST STRONG). Methods: The Extended LAST STRONG is a long-term natural history study in Dutch-speaking patients of all ages diagnosed with genetically confirmed SELENON-RM or LAMA2-MD, starting in September 2023. Patients visit our hospital twice over a period of 2 years to complete a 5-year follow up from the initial LAST-STRONG study. At both visits, they undergo standardized neurological examination, hand-held dynamometry (age ≥ 5 years), functional measurements, muscle ultrasound, respiratory assessments (spirometry, maximal inspiratory and expiratory pressure, sniff nasal inspiratory pressure; age ≥ 5 years), Dual-energy X-ray absorptiometry (DEXA-)scan (age ≥ 2 years), X-ray of the left hand (age ≤ 17 years), lower extremity MRI (age ≥ 10 years), accelerometry for 8 days (age ≥ 2 years), and questionnaires (patient report and/or parent proxy; age ≥ 2 years). All examinations are adapted to the patient's age and functional abilities. Disease progression between all subsequent visits and relationships between outcome measures will be assessed. Discussion: This study will provide valuable insights into the 5-year natural history of patients with SELENON-RM and LAMA2-MD and contribute to further selecting relevant and sensitive to change clinical and functional outcome measures. Furthermore, this data will help optimize natural history data collection in clinical care and help develop clinical care guidelines. Trial registration: This study protocol including the patient information and consent forms has been approved by medical ethical reviewing committee ('METC Oost-Nederland'; https://www.ccmo.nl/metcs/erkende-metcs/metc-oost-nederland, file number: 2023–16401). It is registered at ClinicalTrials.gov (NCT06132750; study registration date: 2023-10-05; study first passed date: 2023-11-15). [ABSTRACT FROM AUTHOR]

Sarcopenia is a prevalent condition with significant clinical implications, and it is expected to escalate globally, demanding for effective diagnostic strategies, possibly at an early stage of the disease. Imaging techniques play a pivotal role in comprehensively evaluating sarcopenia, offering insights into both muscle quantity and quality. Among all the imaging techniques currently used for the diagnosis and follow up of sarcopenia, it is possible to distinguish two classes: Rx based techniques, using ionizing radiations, and non-invasive techniques, which are based on the use of safe and low risk diagnostic procedures. Dual-energy x-ray Absorptiometry and Computed Tomography, while widely utilized, entail radiation exposure concerns. Ultrasound imaging offers portability, real-time imaging, and absence of ionizing radiation, making it a promising tool Magnetic Resonance Imaging, particularly T1-weighted and Dixon sequences, provides cross-sectional and high-resolution images and fat-water separation capabilities, facilitating precise sarcopenia quantification. Bioelectrical Impedance Analysis (BIA), a non-invasive technique, estimates body composition, including muscle mass, albeit influenced by hydration status. Standardized protocols, such as those proposed by the Sarcopenia through Ultrasound (SARCUS) Working Group, are imperative for ensuring consistency across assessments. Future research should focus on refining these techniques and harnessing the potential of radiomics and artificial intelligence to enhance diagnostic accuracy and prognostic capabilities in sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Individuals with class II/III obesity have a high percentage of body fat. Assessing body composition in cases of severe obesity can be difficult and controversial both in clinical practice and scientific research. Thus, it is essential to explore the different aspects of evaluating body composition and to discuss the available methods to assess it in this population. Aims: To summarise and discuss the methods used to measure body composition in adults with class II/III obesity and their potential in clinical practice and scientific research. Methods: This is a narrative review using data from PubMed, Scielo, and Lilacs databases. Original articles on body composition analysis in adults with class II/III obesity i.e., a BMI ≥ 35 kg/m2 were eligible. Body composition assessment methods were analysed and described. Results: Some imaging methods produced significantly accurate results. Dual-energy X-ray absorptiometry (DXA) significantly produces accurate results and has been used in clinical studies. However, due to its high cost, it is not applicable in clinical practice. Multifrequency bioelectrical impedance analysis (BIA) has good accuracy and is more appropriate for clinical practice than other methods. We have highlighted several aspects of the importance and applicability of performing body composition analysis in individuals with class II/III obesity. Conclusion: DXA has been considered the most adequate method for clinical research. Multifrequency BIA may be a viable alternative to DXA for use in clinical practice. Assessing body composition and its components is important for people with class II/III obesity. It can help improve the effectiveness of interventions and clinical treatments, especially in reducing the risk of losing muscle mass. Muscle loss can cause sarcopenic obesity and other clinical complications, so understanding body composition is crucial. Assessing body composition can also help understand the impact of interventions on bones and avoid clinical complications. [ABSTRACT FROM AUTHOR]

Background: Maternal preconception overweight status has been reported to be associated with an increased risk of overweight offspring. However, there are no published population-based studies on the association between maternal preconception weight and offspring body fat measured by dual-energy X-ray absorptiometry (DXA). The present population-based retrospective cohort study aimed to examine the association between maternal weight at conception and offspring body fat measured by DXA. Methods: The source population consisted of 5th-grade students (1244 students aged 11 years) registered at 8 municipal elementary schools in Kitakata, Fukuroi, Hamamatsu, and Himeji in Japan. The present analyses included 964 participants who provided complete information. Maternal body mass index (BMI) at conception was calculated using records in the Mother and Child Health Handbook (MCHH). Offspring body fat at age 11 years was measured with the same QDR-4500A DXA instrument in a mobile test room that was brought to each school. With regard to the prediction of excess fat in offspring, the area under the curve (AUC) calculated with receiver operating characteristic curve analysis was used to quantify the diagnostic accuracy of maternal BMI at conception. Results: Adjusted odds ratios for excess body fat in offspring of the overweight mother group (odds ratios, 4.93 to 15.32) were significantly higher than those in the non-overweight mother group. For the prediction of excess offspring fat, AUCs and 95% confidence intervals for maternal BMI at conception were greater than 0.5. Conclusion: Maternal overweight status at conception might be a risk factor for excess body fat in offspring. Maternal BMI values calculated using MCHH data have the potential to distinguish between the presence and absence of excess fat in the next generation. [ABSTRACT FROM AUTHOR]

Background/Objectives: Body composition (BC) affects the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN). Currently, dual-energy X-ray absorptiometry (DEXA) is considered the gold standard for assessing BC, even though it has some limitations, including immobility, ionizing radiation, and patient weight restrictions. The aim of the study was to evaluate the correlations of BC parameters measured by bioelectrical impedance analysis (BIA) with those measured by DEXA in patients with MASLD and HTN. Methods: Overall, 78 patients with MASLD and HTN underwent the following study procedures: compilation of an anamnesis, physical examination of a patient, laboratory tests, abdominal ultrasound, BIA, DEXA, and anthropometric measurements. Results: The agreement between BIA and DEXA in diagnosing reduced skeletal muscle mass (SMM) in patients with MASLD and HTN was moderate (kappa values were 0.440 and 0.404 in males and females, respectively). Significant strong direct correlations were found between fat mass (FM) and body fat percentage measured by BIA with corresponding measurements by DEXA (p < 0.001 for both). The area under the receiver operating characteristic curves (AUC) of SMM to body weight ratios calculated using BIA data were 0.834 and 0.929 for reduced appendicular SMM determined by DEXA in males and females with MASLD and HTN, respectively. Conclusions: In conclusion, BIA is an easy-to-use and widely available tool for assessing SMM and FM in patients with MASLD and HTN, demonstrating reliable agreement with DEXA measurement results and completely free of its limitations. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis, a systemic skeletal disorder, is expected to affect 60% of women over 50. While dual-energy X-ray absorptiometry (DXA) scans are the current gold standard for diagnosis, they are typically used only after fractures occur, highlighting the need for early detection tools. Initial studies have shown panoramic radiographs (PRs) to be a potential medium, but these have methodological flaws. This study aims to address these shortcomings by developing a robust AI application for accurate osteoporosis identification in PRs. Methods: A total of 348 PRs were used for development, 58 PRs for validation, and 51 PRs for hold-out testing. Initially, the YOLOv8 object detection model was employed to predict the regions of interest. Subsequently, the predicted regions of interest were extracted from the PRs and processed by the EfficientNet classification model. Results: The model for osteoporosis detection on a PR achieved an overall sensitivity of 0.83 and an F1-score of 0.53. The area under the curve (AUC) was 0.76. The lowest detection sensitivity was for the cropped angulus region (0.66), while the highest sensitivity was for the cropped mental foramen region (0.80). Conclusion: This research presents a proof-of-concept algorithm showing the potential of deep learning to identify osteoporosis in dental radiographs. Furthermore, our thorough evaluation of existing algorithms revealed that many optimistic outcomes lack credibility when subjected to rigorous methodological scrutiny. [ABSTRACT FROM AUTHOR]

Background/Objectives: Renal function influences bone metabolism, as kidney failure can increase the risk of fractures. Denosumab is an approved osteoporosis treatment, but its efficacy in relation to renal function has not yet been studied in real-life scenarios. This study aimed to investigate the denosumab-induced change in bone mineral density (BMD) according to kidney function. Methods: A retrospective analysis was conducted at the outpatient clinic in postmenopausal women receiving denosumab (60 mg subcutaneously administered every 6 months). The glomerular filtration rate (eGFR) was measured by the 2021 CKD-EPI equation and patients were stratified for eGFR categories. BMD was measured by dual-energy X-ray absorptiometry. Results: 128 women (mean age 70.3 ± 9.4 years) were recruited. The mean denosumab treatment duration was 3.9 ± 1.4 years and all the participants had improved BMD values. In stepwise multiple regression analysis—after controlling for age, BMI, and treatment duration—the eGFR value (ß = −0.11, SE 0.04, p = 0.01) was independently associated with the lumbar spine BMD change. The same association remained when the eGFR categories were considered (ß = 3.564, SE 1.29, p = 0.007). In addition, after controlling for BMI and the duration of denosumab treatment, age (ß = −0.7915, SE 0.37, p = 0.03) and eGFR (ß = −0.3257, SE 0.1567, p = 0.04) were found to be associated with femoral neck BMD change. The association remained when considering eGFR categories (ß = 8.7339, SE 4.29, p = 0.04). Conclusions: This retrospective study suggests that eGFR is associated with denosumab efficacy in postmenopausal women treated for osteoporosis. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionAlthough fragility hip fractures (HF) in the South African (SA) population are among the lowest worldwide, the incidence of HF is expected to more than double over the next few decades. Little is known about the contributors to increased hip fracture risk, including low bone mineral density (BMD), in our unique population. In addition, the ability of the recently calibrated SA Fracture Risk Assessment Tool (FRAX) to identify high fracture risk in the SA population accurately has not been validated.A retrospective, descriptive, cohort study of SA postmenopausal women and men ≥ 50 years who presented with fragility HFs was conducted. The ability of clinical risk factors (CRFs) and BMD measured by dual-energy X-ray absorptiometry (DXA), as well as calculated FRAX probability scores, to identify the known high fracture risk in SA patients were evaluated. The SA FRAX tool was used, and a high fracture risk defined if the United States (US) fixed thresholds for major osteoporotic (MOF) and/or HF risk were exceeded (≥ 20% and ≥ 3% over 10 years respectively).A total of 163 patients were included. The most useful predictive CRFs were age and gender, recreational toxins in men, and a history of falls. Most were females (71%), who were older than males. DXA-BMD and FRAX-HF calculations best identified the known high fracture risk in the study cohort. FRAX-MOF calculations performed poorly.Fracture risk assessment tools did not identify the known high fracture risk in all of the elderly study cohort with HF. Clinicians must continue to appreciate the important role of a good clinical assessment to ensure optimal fracture risk prediction. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the association between physical fitness and anthropometric parameters in HIV-diagnosed children and adolescents. Therefore, this study aimed to investigate the association between anthropometric parameters and physical fitness in this population. Methods: A cross-sectional study was conducted with HIV-diagnosed children and adolescents (aged 5–15 years). Body composition was assessed by anthropometric measurements and dual-energy X-ray absorptiometry, cardiorespiratory fitness by peak oxygen consumption (VO2peak), muscle strength/endurance by handgrip strength, standing broad jump, abdominal and modified push-up tests, and flexibility using the sit-to reach test. Linear regression analyses (simple and multiple) were applied to investigate the association between anthropometric parameters and physical fitness. Results: In total, 86 children and adolescents (mean age: 11.44 ± 2.20 years) participated in the study. A significant association was observed between anthropometric parameters, whereby the sum of four skinfolds could explain 69% of the fat mass percentage and 30% of VO2peak; the sum of two bone diameters could explain 70% of fat-free mass, 55% of bone mineral content, and 43% of bone mineral density; calf skinfold and subscapular skinfold tests could explain the distance of standing broad jump, and the number of modified push-ups explained 16% of the standing broad jump and 19% of the modified push-up test results. Conclusions: Adding the measurements of four skinfolds and two bone diameters to a follow-up routine can provide relevant information regarding fat accumulation, bone development, cardiorespiratory fitness, and muscle strength/endurance status in HIV-diagnosed children and adolescents, supporting decision-making and measures for the adequate development of this population. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is a major chronic disease worldwide and its risk factors have long been investigating in epidemiological studies. Our study aims to develop a body composition-based risk score and integrate it into the Framingham Risk Score (FRS) to improve CVD prediction among well-functioning older adults. We included 1882 older adults from the Health, Aging and Body Composition (Health ABC) study to screen body composition variables obtained from the Dual-energy X-ray absorptiometry (DXA). Three models were developed and compared: the 4-DXA model, the refit FRS, and the refit FRS plus 4-DXA model. C-statistics were 0.62 (95% CI: 0.59, 0.65) for the refit FRS, 0.58 (95% CI: 0.55, 0.61) for the 4-DXA model, and 0.63 (95% CI: 0.60, 0.66) for the refit FRS plus 4-DXA model. Compared to the refit FRS, the refit FRS plus 4-DXA model slightly improved CVD outcome prediction as the discrimination slope, net reclassification index, and the integrated discrimination index were 0.053 (95% CI: 0.041, 0.066), 0.098 (95% CI = – 0.0033, 0.20) and 0.013 (95% CI: 0.0069–0.019). This study provides a model for more accurate risk stratification and draws more attention on DXA-based indices in the clinical setting. It also encourages further research in validating the developed risk score in more diverse population and in investigating a broader range of CVD risk factors. [ABSTRACT FROM AUTHOR]

Epidemiological studies frequently use indices of adiposity related to mortality. However, no studies have validated prediction equations for body composition in adult cancer survivors. We aimed to develop and cross-validate prediction equations for body fat mass (BFM), lean body mass (LBM), trunk fat mass (TFM), and appendicular lean mass (ALM) in adult cancer survivors using sociodemographic, anthropometric, and laboratory test data. This study included adult cancer survivors from the Korean National Health and Nutrition Examination Survey 2008–2011 with complete data on Dual-energy X-ray absorptiometry (DXA) measurements. A total of 310 participants were randomly divided into development and cross-validation groups (5:5 ratio). Age, height, weight, waist circumference, serum creatinine levels, and lifestyle factors were included as independent variables The predictive equations were developed using a multiple linear regression and their predictive performances were primarily evaluated with R2 and Concordance Correlation Coefficient (CCC). The initial equations, which included age, height, weight, and waist circumference, showed different predictive abilities based on sex for BFM (total: R2 = 0.810, standard error of estimate [SEE] = 3.072 kg, CCC = 0.897; men: R2 = 0.848, SEE = 2.217 kg CCC = 0.855; women: R2 = 0.791, SEE = 2.194 kg, CCC = 0.840), LBM (total: R2 = 0.736, SEE = 3.321 kg, CCC = 0.838; men: R2 = 0.703, SEE = 2.450 kg, CCC = 0.774; women: R2 = 0.854, SEE = 2.234 kg, CCC = 0.902), TFM (total: R2 = 0.758, SEE = 1.932 kg, CCC = 0.844; men: R2 = 0.650, SEE = 1.745 kg, CCC = 0.794; women: R2 = 0.852, SEE = 1.504 kg, CCC = 0.890), and ALM (total: R2 = 0.775, SEE = 1.726 kg, CCC = 0.876; men: R2 = 0.805, SEE = 1.320 kg, CCC = 0.817; women: R2 = 0.726, SEE = 1.198 kg, CCC = 0.802). When additional factors, such as creatinine, smoking, alcohol consumption, and physically inactive were included in the initial equations the predictive performance of the equations were generally improved. The prediction equations for body composition derived from this study suggest a potential application in epidemiological investigations on adult cancer survivors. [ABSTRACT FROM AUTHOR]

Background: Obesity, and in particular abdominal obesity, is associated with an increased risk of developing a variety of chronic diseases. Obesity, aging, and menopause are each associated with differential shifts in the gut microbiome. Obesity causes chronic low-grade inflammation due to increased lipopolysaccharide (LPS) levels which is termed "metabolic endotoxemia." We examined the association of visceral adiposity tissue (VAT) area, circulating endotoxemia markers, and the gut bacterial microbiome in a cohort of aged postmenopausal women. Methods: Fifty postmenopausal women (mean age 78.8 ± 5.3 years) who had existing adipose measurements via dual x-ray absorptiometry (DXA) were selected from the extremes of VAT: n = 25 with low VAT area (45.6 ± 12.5 cm2) and n = 25 with high VAT area (177.5 ± 31.3 cm2). Dietary intake used to estimate the Healthy Eating Index (HEI) score was assessed with a food frequency questionnaire. Plasma LPS, LPS-binding protein (LBP), anti-LPS antibodies, anti-flagellin antibodies, and anti-lipoteichoic acid (LTA) antibodies were measured by ELISA. Metagenomic sequencing was performed on fecal DNA. Female C57BL/6 mice consuming a high-fat or low-fat diet were treated with 0.4 mg/kg diet-derived fecal isolated LPS modeling metabolic endotoxemia, and metabolic outcomes were measured after 6 weeks. Results: Women in the high VAT group showed increased Proteobacteria abundance and a lower Firmicutes/Bacteroidetes ratio. Plasma LBP concentration was positively associated with VAT area. Plasma anti-LPS, anti-LTA, and anti-flagellin IgA antibodies were significantly correlated with adiposity measurements. Women with high VAT showed significantly elevated LPS-expressing bacteria compared to low VAT women. Gut bacterial species that showed significant associations with both adiposity and inflammation (anti-LPS IgA and LBP) were Proteobacteria (Escherichia coli, Shigella spp., and Klebsiella spp.) and Veillonella atypica. Healthy eating index (HEI) scores negatively correlated with % body fat and anti-LPS IgA antibodies levels. Preclinical murine model showed that high-fat diet-fed mice administered a low-fat diet fecal-derived LPS displayed reduced body weight, decreased % body fat, and improved glucose tolerance test parameters when compared with saline-injected or high-fat diet fecal-derived LPS-treated groups consuming a high-fat diet. Conclusions: Increased VAT in postmenopausal women is associated with elevated gut Proteobacteria abundance and immunogenic metabolic endotoxemia markers. Low-fat diet-derived fecal-isolated LPS improved metabolic parameters in high-fat diet-fed mice giving mechanistic insights into potential pro-health signaling mediated by under-acylated LPS isoforms. 7yVbQmTTfsF9b4Af3tznWN Video Abstract [ABSTRACT FROM AUTHOR]

The systematic review from the Croatian Medical Journal examines the relationship between bone mineral density (BMD) and chronic obstructive pulmonary disease (COPD) patients using chest CT scans. Some studies suggest a decrease in BMD in COPD patients, while others indicate that milder forms of COPD may not be strongly associated with osteopenia or osteoporosis in the spine. Factors like age, sex, BMI, and corticosteroid therapy can impact BMD values in COPD patients. The review underscores the importance of assessing BMD in COPD patients to understand fracture risks and overall bone health, particularly in relation to spine surgery and conditions like corticosteroid-induced osteoporosis. [Extracted from the article]

Objective Bone mineral density (BMD) Z-scores decrease during puberty suppression in transgender youth. Assessment of treatment impact has been based on the assumption that without intervention, BMD Z-scores remain stable. However, the natural course of BMD in this population is unknown. Design Retrospective cross-sectional study. Methods Dual-energy X-ray absorptiometry scans prior to medical intervention were included from 333 individuals assigned male at birth (AMAB) and 556 individuals assigned female at birth (AFAB) aged 12–25 years. The relationship between age and BMD Z-scores of sex assigned at birth was analysed for the lumbar spine (LS), total hip (TH), femoral neck (FN), and total-body-less-head (TBLH), adjusted for height SDS, height-adjusted lean mass Z-score, and whole body percentage fat Z-score. Results In individuals AMAB, the BMD Z-score was negatively associated with age between 12 and 22 years: LS −0.13/year (95% confidence interval, CI −0.17; −0.10); TH −0.05/year (95% CI −0.08; −0.02); FN −0.06/year (95% CI −0.10; −0.03); and TBLH −0.12/year (95% CI −0.15; −0.09). Adjusting for height-adjusted lean mass Z-score attenuated the association at the LS and TBLH and eliminated the association at the TH and FN. BMD Z-scores and age were not associated between 22 and 25 years. In individuals AFAB, BMD Z-scores were only associated with age at the TBLH (−0.08/year, 95% CI −0.12; −0.04) between age 12 and 20 years. Conclusion In individuals AMAB aged 12–22 years prior to any treatment, BMD Z-scores were inversely correlated with age. This could imply that BMD increases less in individuals AMAB than in the general population, and that changes in Z-score during puberty suppression and subsequent hormone supplementation are not necessarily due to treatment, but possibly related to lifestyle factors. [ABSTRACT FROM AUTHOR]

GPR10 and neuropeptide FF receptor 2 (NPFFR2) play important role in the regulation of food intake and energy homeostasis. Understanding the interaction between these receptors and their specific ligands, such as prolactin-releasing peptide, is essential for developing stable peptide analogs with potential for treating obesity. By breeding and characterizing double knockout (dKO) mice fed standard or high-fat diet (HFD), we provide insights into the metabolic regulation associated with the GPR10 and NPFFR2 deficiency. Both WT and dKO mice were subjected to behavioral tests and an oral glucose tolerance test. Moreover, dual-energy X-ray absorptiometry (DEXA) followed by indirect calorimetry were performed to characterize dKO mice. dKO mice of both sexes, when exposed to an HFD, showed reduced glucose tolerance, hyperinsulinemia, and insulin resistance compared with controls. Moreover, they displayed increased liver weight with worsened hepatic steatosis. Mice displayed significantly increased body weight, which was more pronounced in dKO males and caused by higher caloric intake on a standard diet, while dKO females displayed obesity characterized by increased white adipose tissue and enhanced hepatic lipid accumulation on an HFD. Moreover, dKO females exhibited anxiety-like behavior in the open field test. dKO mice on a standard diet had a lower respiratory quotient, with no significant changes in energy expenditure. These results provide insights into alterations associated with disrupted GPR10 and NPFFR2 signaling, contributing to the development of potential anti-obesity treatment. Both authors contributed equally to this work. [ABSTRACT FROM AUTHOR]

Autoimmune polyglandular syndrome 1 (APS1) is an autosomal recessive disorder due to biallelic pathogenic variants in the autoimmune regulator (AIRE) gene that manifests with chronic mucocutaneous candidiasis, primary hypoparathyroidism, and adrenal insufficiency. We report a 39-year-old woman with APS1 who developed partial lipodystrophy during adulthood. She presented with diaper rashes, oral thrush, and tetany during infancy due to candidiasis and hypoparathyroidism. During childhood, she developed hypothyroidism, primary adrenal insufficiency, and ovarian insufficiency. At age 14, she received a sibling-matched allogenic bone marrow transplant due to multiple antibiotic-refractory fungal infections. At age 35, her serum triglycerides were 914 mg/dL (10.32 mmol/L) and she had loss of subcutaneous fat from the upper and lower extremities and hips. A whole-body dual-energy x-ray absorptiometry revealed lower-extremity fat at less than the first percentile. Whole-exome sequencing on DNA extracted from saliva revealed pathogenic variants, p.Leu28Pro and p.Arg257* in AIRE but none in the known lipodystrophy genes. Phage-immunoprecipitation-sequencing revealed the presence of autoantibodies to MAGEB1, MAGEB4, and RFX6, which have been previously reported in APS1. Our case suggests that patients with APS1 may develop partial lipodystrophy due to autoantibodies against novel adipocyte-expressed proteins. A causal relationship of high levels of autoantibodies in our patient to adipose tissue–expressed ODC1, NUCKS1, or FNBP1L and lipodystrophy remains uncertain. [ABSTRACT FROM AUTHOR]

Osteoporosis (OP) is an osteometabolic disorder characterized by a lesser bone mineral density (BMD) and the disruption of bone tissue micro—architecture, resulting in a greater bone fragility and higher likelihoods of fractures. OP emerges once the bone mass declines faster than the body's capacity to replenish it, leading to a significant reduction in the strength of bone. OP impacts each and every bone throughout the body and provides no clinical signs until a fracture happens. Aging leads to the reduction in BMD, and the rate of percentage of fractures rises over time, usually causing mortality and morbidity. Numerous BMD evaluation methods are available, and they are used in a variety of settings by considering the location of the fracture. Dual-energy x-ray absorptiometry (DEXA/DXA) is recognized as the gold standard for predicting the fracture, since it is the most advanced, technologically affirmed, and also has excellent performance. According to the findings, most researchers do not endeavour the identification and the segmentation of low bone masses from DEXA images. Medical image segmentation supports in analyzing and visualizing the bone's low bone mass. The envisaged hybrid approach, that integrates GLCM for feature extraction and AlexNet for a low bone mass variation classification, provides segmented images that assist in categorizing bone health as normal, osteopenia, or osteoporosis. The developed algorithm's performance metrics, including Dice Co-efficient, Sensitivity, and Specificity, were 92.35, 90.26, and 92.42%, respectively. The Orthopedicians ascertained the efficacy of the outcomes rendered by the proposed algorithm. [ABSTRACT FROM AUTHOR]

Background: Previous studies have primarily focused on the links between fine particulate matter (PM2.5) and bone health among the general population instead of PM2.5 components and the specific population. We aimed to investigate the associations between PM2.5 components and bone health among middle-aged and elderly women. Methods: A total of 748 middle-aged and elderly women were randomly sampled from 32 streets/villages in Hubei Province. The concentrations of ambient PM2.5 and its components were extracted across various residential areas from the Tracking Air Pollution in China (TAP) dataset. Bone mineral density measurements were obtained from dual-energy X-ray absorptiometry scans of study participants. Multivariable logistic and linear models were employed to assess the relationship between PM2.5 and its components and bone loss. Results: Per interquartile range (IQR) increase in nitrate (NO3−) and ammonium (NH4+) concentrations were associated with 1.65 [95% confidence intervals (CI): 1.13, 2.30] and 1.77 (95% CI: 1.26, 2.49) times higher odds of osteoporosis, respectively. Long-term exposure to sulfate (SO42−), NO3−, and NH4+ was negatively associated with T-scores and bone mineral density in L1-L4 lumbar vertebrae. In addition, the elderly, women who have experienced menarche after the age of 14, and postmenopausal women were more susceptible to the water-soluble inorganic salts of PM2.5. Conclusion: The study emphasizes the need for comprehensive policies addressing air quality, with a specific focus on vulnerable populations such as middle-aged and elderly women. Public health interventions aimed at reducing ambient PM2.5 concentrations and minimizing exposure to its harmful components are crucial in mitigating the adverse impact on skeletal health and improving the overall well-being of communities. [ABSTRACT FROM AUTHOR]

The Trabecular Bone Score (TBS), a gray-level textural assessment derived from dual-energy X-ray absorptiometry images, serves as a validated index of trabecular bone microarchitecture. Over the past decade, significant evidence has highlighted the usefulness of TBS in primary and secondary osteoporosis, leading to its integration with the Fracture Risk Assessment Tool (FRAX) and bone mineral density (BMD) T-score adjustments. This review explores the role of TBS in fracture prediction, treatment initiation, and monitoring. Studies confirm that TBS enhances fracture risk prediction in both primary and secondary osteoporosis when combined with BMD and clinical risk factors. Evidence also suggests that including TBS alongside BMD and FRAX offers significant potential for treatment stratification, considering the overall skeletal profile, such as bone mass, bone quality, and clinical risk factors. Consequently, TBS has become a standard part of clinical care worldwide. Future enhancements hope to adjust for soft tissue thickness, broadening the applicability of TBS across diverse body types and pediatric populations. [ABSTRACT FROM AUTHOR]