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The introduction of dual-energy X-ray absorptiometry (DXA) technology in the 1980s revolutionized the diagnosis, management and monitoring of osteoporosis, providing a clinical tool which is now available worldwide. However, DXA measurements are influenced by many technical factors, including the quality control procedures for the instrument, positioning of the patient, and approach to analysis. Reporting of DXA results may be confounded by factors such as selection of reference ranges for T-scores and Z-scores, as well as inadequate knowledge of current standards for interpretation. These points are addressed at length in many international guidelines but are not always easily assimilated by practising clinicians and technicians. Our aim in this report is to identify key elements pertaining to the use of DXA in clinical practice, considering both technical and clinical aspects. Here, we discuss technical aspects of DXA procedures, approaches to interpretation and integration into clinical practice, and the use of non-bone mineral density measurements, such as a vertebral fracture assessment, in clinical risk assessment. [ABSTRACT FROM AUTHOR]

Rett syndrome (RS) is a rare neurodevelopmental disorder primarily caused by mutations in the X-linked methyl-CpG binding protein 2 (MECP2) gene, responsible for encoding MECP2 which plays a pivotal role in regulating gene expression. The neurological and non-neurological manifestations of RS vary widely in severity depending on the specific mutation type. Bone complications, mostly scoliosis but also osteoporosis, hip displacement, and a high rate of fractures, are among the most prevalent non-neurological comorbidities observed in girls with RS. Low bone mineral density (BMD) is primarily due to a slow rate of bone formation due to dysfunctional osteoblast activity. The use of anticonvulsants, immobilization, low physical activity, poor nutrition, and inadequate vitamin D intake all significantly hamper skeletal maturation and the accumulation of bone mass in RS girls, making them more susceptible to fragility fractures. In RS patients, the upper and lower limbs are the most common sites for fractures which are due to both a reduced BMD and a diminished bone size. This review summarizes the knowledge on risk factors for fragility fracture in patients with RS and proposes a potential diagnostic and therapeutic pathway to enhance low BMD and mitigate the risk of fragility fractures. In particular, this review focused on the importance of clinical and instrumental evaluation of bone status as a basis for adequate planning of nutritional, pharmacological, and surgical interventions to be undertaken. Additionally, the management of bone defects in individuals with RS should be customized to meet each person’s specific needs, abilities, and general health. [ABSTRACT FROM AUTHOR]

Hip fractures contribute significantly to mortality in older adults. New methods to identify those at risk use dual-energy X-ray absorptiometry (DXA) images and advanced image processing. However, DXA images have an overlapping femur and pelvis and may contain boundary lines, making automation challenging. Herein, a 5-layer U-net convolutional neural network (CNN) was developed to segment the femur from hip DXA images. Images were used from the Canadian Longitudinal Study on Aging (CLSA, N=104) and Canadian Multicentre Osteoporosis Study (CaMos, N=105) databases for training, with manual contour drawing defining the 'true output' of each image. An algorithm was then developed to mask each hip image, and trained to predict subsequent masks. The CNN was tested with 44 additional CLSA images and 42 CaMos images. This proposed approach had an accuracy and intersection over union (IoU) of 97% and 0.57, and 93% and 0.51, for CaMos and CLSA scans, respectively. Furthermore, a series of augmentation techniques was applied to increase the data size, with accuracies of 96% and 94%, and IoU of 0.53 and 0.50. Overall, our strategy automatically determined the contour of the proximal femur using various clinical DXA images, a key step to automate fracture risk assessment in clinical practice. [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]

Short stem prostheses were originally designed for younger and more active patients. In recent years, they have been increasingly offered to older patients. This study evaluates the mid-to long-term survival of a short stem prosthesis and the changes in periprosthetic bone density following implantation of a cementless short hip stem in patients over 60 years of age. 118 patients aged over 60 received short stem prostheses. Clinical examination included Harris Hip Score (HHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS). 93 patients were followed clinically for at least five years. 53 patients underwent dual-energy x-ray absorptiometry (DXA) and radiographic evaluation. Follow-up intervals were preoperative and postoperative (t 0), at approximately six months (t 1), at approximately two years (t 2), and at approximately five years or later (t 3). Over a mean 6.7-year observation period for all 118 patients, one stem revision occurred due to a traumatic periprosthetic stem fracture. The five-year survival rate for the endpoint survival of the Metha® stem in 95 at-risk patients is 99.2%. HHS improved significantly from t 0 55.3 ± 11.5 (range 30–79) to t 3 95.3 ± 8.6 (range 57–100) at a mean of 8.0 years (p < 0.001). HOOS improved significantly in each subscale (p < 0.001). Bone mineral density (BMD) was available for review in 53 patients after a mean of 7.1 years. BMD increased from t 0 to t 3 in region of interest (ROI) 3 (+0.4%) and ROI 6 (+2.9%) and decreased in ROI 1 (−10.3%), ROI 2 (−9.8%), ROI 4 (−5.3%), ROI 5 (−3.4%) and ROI 7 (−23.1%). The evaluated short stem prosthesis shows a remarkably high survival rate in elderly patients, accompanied by excellent clinical results. Load transfer measurements show a metaphyseal-diaphyseal pattern with a trend towards increased diaphyseal transfer over the period observed. [ABSTRACT FROM AUTHOR]

Abstract Background Familial Partial Lipodystrophy (FPLD) is a disease with wide clinical and genetic variation, with seven different subtypes described. Until genetic testing becomes feasible in clinical practice, non-invasive tools are used to evaluate body composition in lipodystrophic patients. This study aimed to analyze the different anthropometric parameters used for screening and diagnosis of FPLD, such as thigh skinfold thickness (TS), Köb index (Köbi), leg fat percentage (LFP), fat mass ratio (FMR) and leg-to-total fat mass ratio in grams (LTR), by dual-energy X-ray absorptiometry, focusing on determining cutoff points for TS and LFP within a Brazilian population. Methods Thirty-seven patients with FPLD and seventy-four healthy controls matched for body mass index, sex and age were studied. Data were collected through medical record review after signing informed consent. All participants had body fat distribution evaluated by skinfolds and DXA measures. Fasting blood samples were collected to evaluate glycemic and lipid profiles. Genetic studies were carried out on all patients. Two groups were categorized based on genetic testing and/or anthropometric characteristics: FPLD+ (positive genetic test) and FPLD1 (negative genetic testing, but positive clinical/anthropometric criteria for FPLD). Results Eighteen (48.6%) patients were classified as FPLD+, and 19 (51.4%) as FPLD1. Unlike what is described in the literature, the LMNA variant in codon 582 was the most common. Among the main diagnostic parameters of FPLD, a statistical difference was observed between the groups for, Köbi, TS, LFP, FMR, and LTR. A cutoff point of 20 mm for TS in FPLD women was found, which is lower than the value classically described in the literature for the diagnosis of FPLD. Additionally, an LFP

Background: Familial Partial Lipodystrophy (FPLD) is a disease with wide clinical and genetic variation, with seven different subtypes described. Until genetic testing becomes feasible in clinical practice, non-invasive tools are used to evaluate body composition in lipodystrophic patients. This study aimed to analyze the different anthropometric parameters used for screening and diagnosis of FPLD, such as thigh skinfold thickness (TS), Köb index (Köbi), leg fat percentage (LFP), fat mass ratio (FMR) and leg-to-total fat mass ratio in grams (LTR), by dual-energy X-ray absorptiometry, focusing on determining cutoff points for TS and LFP within a Brazilian population. Methods: Thirty-seven patients with FPLD and seventy-four healthy controls matched for body mass index, sex and age were studied. Data were collected through medical record review after signing informed consent. All participants had body fat distribution evaluated by skinfolds and DXA measures. Fasting blood samples were collected to evaluate glycemic and lipid profiles. Genetic studies were carried out on all patients. Two groups were categorized based on genetic testing and/or anthropometric characteristics: FPLD+ (positive genetic test) and FPLD1 (negative genetic testing, but positive clinical/anthropometric criteria for FPLD). Results: Eighteen (48.6%) patients were classified as FPLD+, and 19 (51.4%) as FPLD1. Unlike what is described in the literature, the LMNA variant in codon 582 was the most common. Among the main diagnostic parameters of FPLD, a statistical difference was observed between the groups for, Köbi, TS, LFP, FMR, and LTR. A cutoff point of 20 mm for TS in FPLD women was found, which is lower than the value classically described in the literature for the diagnosis of FPLD. Additionally, an LFP < 29.6% appears to be a useful tool to aid in the diagnosis of these women. Conclusion: Combining anthropometric measurements to assess body fat distribution can lead to a more accurate diagnosis of FPLD. This study suggests new cutoff points for thigh skinfold and leg fat percentage in women with suspected FPLD in Brazil. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Advanced laboratory methods play a crucial role in bone research, allowing researchers and scientists to study the complex biology and nature of the skeleton. Dual-energy X-ray absorptiometry (DXA) is a non-invasive method of measuring bone mass, which is an important parameter for the diagnosis and treatment of several bone diseases. Micro-computed tomography (μCT) is a very high-resolution technique that can be used to investigate the 3D microstructure of trabecular bone. Dynamic bone histomorphometry is used to assess histological indices of bone formation and resorption using fluorochromes embedded into newly formed bone. Mechanical testing is used to measure bone strength and stiffness, providing important information about bone quality and fracture risk. All these methods are widely used in preclinical in vivo studies using rodents and in most clinical studies. Therefore, it is important for both researchers and scientists within the field of bone biology, and those in neighboring fields, to be familiar with their use, strengths, limitations, and important technical aspects. Several guidelines and protocols about the topic have been published, but are very exhaustive. The present review aimed to provide instructions for early-career researchers and outline important concepts and technical aspects of DXA, μCT, dynamic bone histomorphometry, and mechanical testing in bone research. [ABSTRACT FROM AUTHOR]

Diabetic osteopathy is a frequent complication in patients with type 2 diabetes mellitus (T2DM). The association between T2DM and increased fracture risk has led to study the impact of new antidiabetic drugs on bone metabolism. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are incretin mimetic drugs which have many pleiotropic properties. The relationship between GLP-1RAs and bone is very complex: while in vitro and animal studies have demonstrated a protective effect on bone, human studies are scarce. We led a 12 months longitudinal study evaluating bone changes in 65 patients withT2DM for whom a therapy with GLP-1RAs had been planned. Fifty-four T2DM patients completed the 12-month study period; of them, 30 had been treated with weekly dulaglutide and 24 with weekly semaglutide. One-year therapy with GLP-1RAs resulted in a significant reduction in weight and BMI. Bone mineral density (BMD), bone metabolism, trabecular bone score (TBS), adiponectin, and myostatin were evaluated before and after 12 months of GLP-1RAs therapy. After 12 months of therapy bone turnover markers and adiponectin showed a significant increase, while myostatin values showed a modest but significant reduction. BMD-LS by DXA presented a significant reduction while the reduction in BMD-LS by REMS was not significant and TBS values showed a marginal increase. Both DXA and REMS techniques showed a modest but significant reduction in femoral BMD. In conclusion, the use of GLP-1RAs for 12 months preserves bone quality and reactivates bone turnover. Further studies are needed to confirm whether GLP-1RAs could represent a useful therapeutic option for patients with T2DM and osteoporosis. [ABSTRACT FROM AUTHOR]

Currently, little is known regarding bone health surveillance for glucocorticoid-exposed non-infectious uveitis (NIU) patients or their baseline risks of skeletal fragility outcomes. Using claims data, we calculated rates of dual-energy x-ray absorptiometry (DXA) screening for glucocorticoid-exposed NIU and rheumatoid arthritis (RA) patients. Separately, we compared risks of skeletal fragility metrics amongst NIU patients, RA patients, and controls, independent of glucocorticoid use. The adjusted hazard ratio (aHR) of NIU patients to have a DXA scan was 0.64 (95% CI, 0.63–0.65; p <.001) compared to RA patients. The aHR for any skeletal fragility outcome amongst NIU patients was 0.97 (p <.02) compared to normal controls, while RA patients had excess risk (aHR, 1.15; p <.001). NIU patients are 36% less likely to receive a DXA scan after high-dose glucocorticoid exposure compared with RA patients. No elevated risk of osteoporosis for NIU patients was found compared to normal controls. [ABSTRACT FROM AUTHOR]

Osteoporosis is the most prevalent skeletal disorder, a condition that is associated with significant social and healthcare burden. In the elderly, osteoporosis is commonly associated with sarcopenia, further increasing the risk of fracture. Several imaging techniques are available for a non-invasive evaluation of osteoporosis and sarcopenia. This review focuses on dual-energy X-ray absorptiometry (DXA), as this technique offers the possibility to evaluate bone mineral density and body composition parameters with good precision and accuracy. DXA is also able to evaluate the amount of aortic calcification for cardiovascular risk estimation. Additionally, new DXA-based parameters have been developed in recent years to further refine fracture risk estimation, such as the Trabecular Bone Score and the Bone Strain Index. Finally, we describe the recent advances of a newly developed ultrasound-based technology known as Radiofrequency Echographic Multi-Spectrometry, which represent the latest non-ionizing approach for osteoporosis evaluation at central sites. [ABSTRACT FROM AUTHOR]

Advanced laboratory methods play a crucial role in bone research, allowing researchers and scientists to study the complex biology and nature of the skeleton. Dual-energy X-ray absorptiometry (DXA) is a non-invasive method of measuring bone mass, which is an important parameter for the diagnosis and treatment of several bone diseases. Micro-computed tomography (μCT) is a very high-resolution technique that can be used to investigate the 3D microstructure of trabecular bone. Dynamic bone histomorphometry is used to assess histological indices of bone formation and resorption using fluorochromes embedded into newly formed bone. Mechanical testing is used to measure bone strength and stiffness, providing important information about bone quality and fracture risk. All these methods are widely used in preclinical in vivo studies using rodents and in most clinical studies. Therefore, it is important for both researchers and scientists within the field of bone biology, and those in neighboring fields, to be familiar with their use, strengths, limitations, and important technical aspects. Several guidelines and protocols about the topic have been published, but are very exhaustive. The present review aimed to provide instructions for early-career researchers and outline important concepts and technical aspects of DXA, μCT, dynamic bone histomorphometry, and mechanical testing in bone research.

The aim of this study was to study the effects of tepy2 diabetes (T2DM) and treatment cortisone on the foot bones. A total of 123 Iraqi men and women participated in the study (18 males and 105 females), with type 2 diabetes receiving cortisone therapy. Quantitative Ultrasound (QUS) was used to evaluate osteoporosis, speed of sound (SOS), broadband ultrasound attenuation (BUA), and calcaneus bone quality index (BQI). A dual x-ray absorptiometry (DXA) was used to determine abdominal fat percentage. The results indicate that the correlation between T-score and heel bone mineral density (BMD) for cortisone, as well as Z-score and heel BMD, is a linear relationship that has statistical significance P-value

Abstract Background Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment. Methods We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020–2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis. Results The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model—incorporating sex, age, BMI, T4 HU value, and PMI—demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively. Conclusions The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation.

Background and Objective: Segmentation of the femur in Dual-Energy X-ray (DXA) images poses challenges due to reduced contrast, noise, bone shape variations, and inconsistent X-ray beam penetration. In this study, we investigate the relationship between noise and certain deep learning (DL) techniques for semantic segmentation of the femur to enhance segmentation and bone mineral density (BMD) accuracy by incorporating noise reduction methods into DL models. Methods: Convolutional neural network (CNN)-based models were employed to segment femurs in DXA images and evaluate the effects of noise reduction filters on segmentation accuracy and their effect on BMD calculation. Various noise reduction techniques were integrated into DL-based models to enhance image quality before training. We assessed the performance of the fully convolutional neural network (FCNN) in comparison to noise reduction algorithms and manual segmentation methods. Results: Our study demonstrated that the FCNN outperformed noise reduction algorithms in enhancing segmentation accuracy and enabling precise calculation of BMD. The FCNN-based segmentation approach achieved a segmentation accuracy of 98.84% and a correlation coefficient of 0.9928 for BMD measurements, indicating its effectiveness in the clinical diagnosis of osteoporosis. Conclusions: In conclusion, integrating noise reduction techniques into DL-based models significantly improves femur segmentation accuracy in DXA images. The FCNN model, in particular, shows promising results in enhancing BMD calculation and clinical diagnosis of osteoporosis. These findings highlight the potential of DL techniques in addressing segmentation challenges and improving diagnostic accuracy in medical imaging. [ABSTRACT FROM AUTHOR]

Chronic kidney disease–mineral and bone disorder (CKD-MBD) frequently occurs in hemodialysis patients and is a common cause of osteoporosis. Regular dual-energy X-ray absorptiometry (DXA) scans are used to monitor these patients, but frequent, cost-effective, and low-dose alternatives are needed. This study proposes an automatic CKD-MBD assessment model using histogram equalization and a squeeze-and-excitation block-based residual U-Net (SER-U-Net) with hand diagnostic radiography for preliminary classification. The process involves enhancing image contrast with histogram equalization, extracting features with the SE-ResNet model, and segmenting metacarpal bones using U-Net. Ultimately, a correlation analysis is carried out between the calculated dual metacarpal cortical percentage (dMCP) and DXA T-scores. The model's performance was validated by analyzing clinical data from 30 individuals, achieving a 93.33% accuracy in classifying bone density compared to DXA results. This automated method provides a rapid, effective tool for CKD-MBD assessment in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Existing studies have shown that computed tomography (CT) attenuation and skeletal muscle tissue are strongly associated with osteoporosis; however, few studies have examined whether vertebral HU values and the pectoral muscle index (PMI) measured at the level of the 4th thoracic vertebra (T4) are strongly associated with bone mineral density (BMD). In this study, we demonstrate that vertebral HU values and the PMI based on chest CT can be used to opportunistically screen for osteoporosis and reduce fracture risk through prompt treatment. Methods: We retrospectively evaluated 1000 patients who underwent chest CT and DXA scans from August 2020–2022. The T4 HU value and PMI were obtained using manual chest CT measurements. The participants were classified into normal, osteopenia, and osteoporosis groups based on the results of dual-energy X-ray (DXA) absorptiometry. We compared the clinical baseline data, T4 HU value, and PMI between the three groups of patients and analyzed the correlation between the T4 HU value, PMI, and BMD to further evaluate the diagnostic efficacy of the T4 HU value and PMI for patients with low BMD and osteoporosis. Results: The study ultimately enrolled 469 participants. The T4 HU value and PMI had a high screening capacity for both low BMD and osteoporosis. The combined diagnostic model—incorporating sex, age, BMI, T4 HU value, and PMI—demonstrated the best diagnostic efficacy, with areas under the receiver operating characteristic curve (AUC) of 0.887 and 0.892 for identifying low BMD and osteoporosis, respectively. Conclusions: The measurement of T4 HU value and PMI on chest CT can be used as an opportunistic screening tool for osteoporosis with excellent diagnostic efficacy. This approach allows the early prevention of osteoporotic fractures via the timely screening of individuals at high risk of osteoporosis without requiring additional radiation. [ABSTRACT FROM AUTHOR]

IntroductionGender-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.MethodsThis 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.ResultsTwo 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).ConclusionBone 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 Dual-energy X-ray absorptiometry (DXA) represents the gold standard for measuring bone mineral density (BMD). However, its size and bulkiness limit its use in mass screening. Portable and easily accessible instruments are more suitable for this purpose. We conducted a study to assess the repeatability, sensitivity, accuracy, and validation of a new ultrasound densitometer for the calcaneus (OsteoSys BeeTLe) compared to standard DXA. BMD (g/cm2) was measured at the femoral and lumbar spine levels using DXA (Discovery Acclaim (Hologic, Waltham, MA, USA) or Lunar Prodigy (GE Healthcare, Madison, WI, USA) devices). Bone Quality Index (BQI, a dimensionless measure of bone quality derived from measures of SOS [Speed Of Sound] and BUA [broadband ultrasound attenuation]) was measured with OsteoSys BeeTLe. The Bland–Altman test and simple linear regression were used to evaluate the association between values measured with the two instruments. Additionally, the ability of the T-score calculated with BeeTLe to identify patients with previous osteoporotic fractures was tested using ROC curves. A total of 201 patients (94.5% females) with a mean age of 62.1 ± 10.2 were included in the study. The BeeTLe instrument showed a coefficient of variation (CV, in 75 repeated measurements) of 1.21%, which was not statistically different from the CV of DXA (1.20%). We found a significant association between BQI and BMD at the femoral neck (r2 = 0.500, p

Objectives: This research delves into the application of texture analysis in spine computed tomography (CT) scans and its correlation with bone mineral density (BMD), as determined by dual-energy X-ray absorptiometry (DXA). It specifically addresses the discordance between the 2 measurements, suggesting that certain spinal-specific factors may contribute to this discrepancy. Methods: The study involved 405 cases from a single institution collected between May 6, 2012 and June 30, 2021. Each case underwent a spinal CT scan and a DXA scan. BMD values at the lumbar region (T12 to S1) and total hip were recorded. Texture features from axial cuts of T12 to S1 vertebrae were extracted using gray-level co-occurrence matrices, and a regression model was constructed to predict the BMD values. Results: The correlation between CT texture analysis results and BMD from DXA was moderate, with a correlation coefficient ranging between 0.4 and 0.5. This discordance was examined in light of factors unique to the spine region, such as abdominal obesity, aortic calcification, and lumbar degenerative changes, which could potentially affect BMD measurements. Conclusions: Emerging from this study is a novel insight into the discordance between spinal CT texture analysis and DXA-derived BMD measurements, highlighting the unique influence of spinal attributes. This revelation calls into question the exclusive reliance on DXA scans for BMD assessment, particularly in scenarios where DXA scanning may not be feasible or accurate.

Summary: This study investigated bone mineral density assessment for patients with DISH. DXA-based T-scores overestimated bone quality, while MRI-based VBQ scores and CT-based HU values provided accurate assessments, particularly for advanced degenerative cases. This enhances accurate evaluation of BMD, crucial for clinical decision-making. Purpose: To investigate the diagnostic effectiveness of DXA, MRI, and CT in assessing bone mineral density (BMD) for diffuse idiopathic skeletal hyperostosis (DISH) patients. Methods: Retrospective analysis of 105 DISH patients and 116 age-matched controls with lumbar spinal stenosis was conducted. BMD was evaluated using DXA-based T-scores, MRI-based vertebral bone quality (VBQ) scores, and CT-based Hounsfield unit (HU) values. Patients were categorized into three BMD subgroups. Lumbar osteophyte categories were determined by Mata score. Demographics, clinical data, T-scores, VBQ scores, and HU values were collected. Receiver operating characteristic (ROC) analysis identified VBQ and HU thresholds for diagnosing normal BMD using DXA in controls. Correlations between VBQ, HU, and lumbar T-score were analyzed. Results: Age, gender, and BMI showed no significant differences between DISH and control groups. DISH patients had higher T-score (L1–4), the lowest T-score, and Mata scores. VBQ and HU did not significantly differ between groups. In controls, VBQ and HU effectively diagnosed normal BMD (AUC = 0.857 and 0.910, respectively) with cutoffs of 3.0 for VBQ and 104.3 for HU. DISH had higher normal BMD prevalence using T-scores (69.5% vs. 58.6%, P < 0.05), but no significant differences using VBQ (57.1% vs. 56.2%, P > 0.05) and HU (58.1% vs. 57.8%, P > 0.05). Correlations revealed moderate correlations between HU and T-scores (L1–4) in DISH (r = 0.642, P < 0.001) and strong in controls (r = 0.846, P < 0.001). Moderate negative correlations were observed between VBQ and T-scores (L1–4) in DISH (r = − 0.450, P < 0.001) and strong in controls (r = − 0.813, P < 0.001). Conclusion: DXA-based T-scores may overestimate BMD in DISH. VBQ scores and HU values could effectively complement BMD assessment, particularly in DISH patients or those with advanced lumbar degeneration. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) in the lumbar spine can potentially lead to an overestimation of bone mineral density (BMD), and this can be a challenge in accurately diagnosing conditions like osteoporosis, where precise measurement of BMD is crucial. Radiofrequency Echographic Multi Spectrometry (REMS) is being recognized as an innovative diagnostic tool for assessing bone status. The purpose of this study was to evaluate whether the use of REMS may enhance the identification of osteoporosis in patients with osteoarthritis. Methods: A cohort of 500 patients (mean age: 63.9 ± 11.2 years) diagnosed with osteoarthritis and having a medical prescription for dual-energy X-ray absorptiometry (DXA) were recruited for the study. All patients underwent BMD measurements at lumbar spine and femoral sites by both DXA and REMS techniques. Results: The T-score values for BMD at the lumbar spine (BMD-LS) by DXA were significantly higher with respect to BMD-LS by REMS across all OA severity scores, and the differences were more pronounced in patients with a higher degree of OA severity (p < 0.001). Furthermore, the percentage of subjects classified as "osteoporotic", on the basis of BMD by REMS was markedly higher than those classified by DXA, both when considering all skeletal sites (39.4% vs. 15.1%, respectively) and the lumbar spine alone (30.5% vs. 6.0%, respectively). A similar pattern was observed when OA patients were grouped according to the Kellgren–Lawrence grading score. Conclusions: The findings from our study indicate that, in a population with varying severity levels of osteoarthritis, REMS demonstrated a higher capability to diagnose osteoporosis compared to DXA, and this could lead to earlier intervention and improved outcomes for patients with bone fragility, reducing the likelihood of fractures and associated complications. [ABSTRACT FROM AUTHOR]

Although previous studies indicated that chronic alcohol abuse (CAA) and alcoholic liver cirrhosis (ALC) are associated with increased bone fragility, understanding bone fragility determinants is still modest in these individuals. We used a comprehensive individualized clinical fracture risk assessment approach (vertebral osteodensitometry, femoral osteodensitometry and geometry, and serum bone turnover biomarkers) to compare adult male patients with ALC who have not previously had femoral or vertebral fractures (n = 39), patients with CAA (without liver cirrhosis, n = 78) who have not previously had femoral or vertebral fractures and healthy age- and sex-matched controls (n = 43). Our data suggested that intertrochanteric bone mineral density was significantly lower in ALC and CAA patients than in controls. Also, the trabecular bone score was considerably lower in ALC patients compared with CAA and control individuals. The most significant inter-group differences in femoral geometry were noted on the femoral shaft. Patients with ALC and CAA have a higher 10-year risk of major osteoporotic fractures compared to the controls. Analysis of bone turnover biomarkers showed increased osteoprotegerin and beta-C-terminal telopeptide serum concentrations and decreased insulin growth factor-1 concentrations in patients with ALC compared to CAA and control groups. Our data revealed that bone alterations are present in patients with ALC and CAA even if they did not sustain a nontraumatic bone fracture, but it is also indicative that current bone-assessing clinical methods are not entirely reliable. Thus, future studies should focus on developing a reliable integrative clinical tool that can be used to accurately predict and prevent bone fracture occurrences in patients with ALC and CAA. [ABSTRACT FROM AUTHOR]

BackgroundWhile several methodologies are available to measure adiposity, few have been validated in sub-Saharan African (SSA) and none in postpartum African women living with HIV (WLHIV). We compared bioelectrical impendence analysis (BIA) and air displacement plethysmography (ADP) against dual x-ray absorptiometry (DXA) in South African women and examined differences by HIV and body mass index (BMI) status.MethodsLin’s concordance correlation coefficient (CCC) test was used to examine fat mass (FM), fat free mass (FFM), and total body fat percent (%BF) difference between BIA vs. DXA, and ADP vs. DXA in women living with HIV (n = 57) and without HIV (n = 25). The Bland Altman test was used to assess mean differences and the direction of bias.ResultsThe median age was 31 years (IQR, 26–35) and months postpartum were 11 (IQR, 7–16), 44% of the women had obesity. Lin’s CCC for BIA and ADP vs. DXA were both 0.80 for %BF and 0.97 for FM, and 0.86 and 0.80 for FFM, respectively. Mean differences (DXA-BIA and ADP estimates) were 0.22 ± 4.54% (p = 0.54) and 3.35 ± 3.27% (p

Objective: The objective of this study was to examine the impact of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma. Methods: We conducted a cross-sectional study in children aged 7-17 years with asthma, who received long-term (≥2 years), medium to high-dose inhaled budesonide (≥400μg/day in 6-11 years old; ≥800 μg/day in >11 years old). We measured bone mineral density (BMD) using dual-energy X-ray absorptiometry and compared it with reference Indian normative values. Results: Thirty-five children with moderate to severe asthma receiving long-term medium to high-dose inhaled budesonide, were included in the study. We found a significantly low lumbar-spine BMD in the study population compared to reference Indian values (p-value 0.002). Eight cases had short stature. Despite the adjustment for height-age in these short-stature cases, lumbar-spine BMD remained significantly low in the study population (p-value 0.020). No significant difference was found in 25-hydroxy vitamin D levels between subjects with "low BMD" and "BMD z-score > -2". Conclusions: The findings of this study suggest that long-term medium to high-dose inhaled budesonide treatment in children with asthma is associated with decreased BMD. However, further investigation with a larger sample size is necessary to confirm this relationship. [ABSTRACT FROM AUTHOR]

Background: This research explores the application of morphometric texture analysis in chest Computed Tomography (CT) scans for determining Bone Mineral Content (BMC) and its temporal changes, both crucial in diagnosing osteoporosis. The study establishes an innovative approach to osteoporosis screening by leveraging Hounsfield Units (HUs) in CT scans to evaluate BMC, offering a comparison with dual-energy X-ray absorptiometry (DXA)-based BMC. Methods: A total of 806 instances (encompassing 379 individuals) were meticulously compiled from a sole institution, during the period stretching from 6 May 2012 to 30 June 2020. In this detailed analysis, each participant was subjected to a pair of chest CT scans, sequentially pursued by a DXA scan, spread over two years. Focused records of BMC values at the inaugural lumbar vertebra (L1) were secured from both the DXA and CT axial slices across all instances. A meticulous selection process pinpointed the largest trabecular section from the L1 vertebral body, whereupon 45 distinctive texture attributes were harvested utilizing gray-level co-occurrence matrix methodologies. Utilizing these amassed 45 attributes, a regression architecture was devised, aiming to forecast the precise BMC values individually. Moreover, an alternative regression framework was engaged, leveraging 90 distinct features, to gauge the BMC fluctuations observed between the duo of scans administered to each participant. Results: The precision of the cultivated regression frameworks was scrupulously assessed, benchmarking against the correlation coefficient (CC) and the mean absolute deviation (MAE) in comparison to the DXA-established references. The regression apparatus employed for estimating BMC unveiled a CC of 0.754 and an MAE of 1.641 (g), respectively. Conversely, the regression mechanism devoted to discerning the variations in BMC manifested a CC of 0.680, coupled with an MAE of 0.528 (g), respectively. Conclusion: The innovative methodology utilizing morphometric texture analysis in CT HUs offers an indirect, yet promising, approach for osteoporosis screening by providing estimations of BMC and its temporal changes. The estimations demonstrate moderate positive correlations with DXA measures, suggesting a potential alternative in circumstances where DXA scanning is limited. [ABSTRACT FROM AUTHOR]

Background: Recent research underscores the clinical relevance of muscle conditions such as sarcopenia and their links to bone mineral density (BMD), yet notable gaps persist in the understanding of their interconnections. Our study addresses this by introducing a novel approach to decipher the correlation between BMD and the texture of the multifidus muscle, utilizing spinal computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) to evaluate muscle texture, BMD, and bone mineral content (BMC) at the total lumbar vertebra and total hip. Methods: Our single-institution study examined 395 cases collected from 6 May 2012 to 30 November 2021. Each patient underwent a spinal CT scan and a DXA scan within a one-month interval. BMD and BMC at the total lumbar vertebra and total hip were measured. The texture features of the multifidus muscle from the axial cuts of T12 to S1 vertebrae were assessed via gray-level co-occurrence matrices. CT texture analysis values at angles of 45 + 45 and 90 degrees were calculated and correlated with BMD and BMC. A regression model was then constructed to predict BMD values, and the precision of these correlations was evaluated using mean square error (MSE) analysis. Results: Total lumbar BMC showed a correlation of 0.583–0.721 (MSE 1.568–1.842) and lumbar BMD of 0.632–0.756 (MSE 0.068–0.097). Total hip BMC had a correlation of 0.556–0.690 (MSE 0.448–0.495), while hip BMD ranged from 0.585 to 0.746 (MSE 0.072–0.092). Conclusions: The analysis of spinal CT texture alongside BMD and BMC measures provides a new approach to understanding the relationship between bone and muscle health. The strong correlations expected from our research affirm the importance of integrating bone and muscle measures in the prevention, diagnosis, and management of conditions such as sarcopenia and osteoporosis. [ABSTRACT FROM AUTHOR]

Dual‐energy x‐ray absorptiometry (DXA) scanning is used for objective determination of body composition, but instrumentation is expensive and not generally available in customary clinical practice. Anthropometric surrogates are often substituted as anticipated correlates of absolute and relative body fat content in the clinical management of obesity and its associated medical risks. DXA and anthropometric data from a cohort of 9230 randomly selected American subjects, available through the ongoing National Health and Nutrition Examination Survey, was used to evaluate combinations of surrogates (age, height, total weight, waist circumference) as predictors of DXA‐determined absolute and relative body fat content. Multiple regression analysis yielded linear combinations of the 4 surrogates that were closely predictive of DXA‐determined absolute fat content (R2 = 0.93 and 0.96 for male and female subjects). Accuracy of the new algorithm was improved over customary surrogate‐based predictors such as body mass index. However prediction of relative body fat was less robust (R2 less than 0.75), probably due to the nonlinear relation between degree of obesity (based on body mass index) and relative body fat. The paradigm was validated using an independent cohort from the National Health and Nutrition Examination Survey, as well as two independent external subject groups. The described regression‐based algorithm is likely to be a sufficiently accurate predictor of absolute body fat (but not relative body fat) to substitute for DXA scanning in many clinical situations. Further work is needed to assess algorithm validity for subgroups of individuals with "atypical" body construction. [ABSTRACT FROM AUTHOR]

Introduction: Gender affirming hormone therapy (GAHT) is the mainstay treatment in transitioning individuals and has positive physical and psychological effects. Among the things to monitor in transgender patients on long-term hormones, bone health is an essential consideration. As the calcium intake in the Indian population is less, and many gender-incongruent individuals may not take adequate calcium in their diet, we needed data on the bone health of Indians with gender dysphoria as the information available globally may not apply to our population. Materials and Methods: The study was performed to assess bone mineral density in individuals with gender dysphoria who were on gender-affirming hormonal therapy for at least 6 months. It was a hospital-based cross-sectional study of bone mineral density measured at two sites - hip and spine in individuals with gender dysphoria on GAHT for at least six months. Results: A total of 30 individuals were included in this study. The mean age of individuals with Gender dysphoria was found to be 28.17 ± 6.15 years, and the age range was 19-42 years. Out of the 30 individuals, 14 were transgender males, and the remaining 16 were transgender females. Bone mineral density at the hip and spine in transgender males was 1.047 ± 0.124 g/cm2 and 1.065 ± 0.115 g/cm2, which was better compared to transgender females in whom the bone mineral density at hip and spine was 0.899 ± 0.873 g/cm2 and 0.854 ± 0.099 g/cm2 (P = 0.001 for hip; P = 0.000 for spine). The Z score at hip and spine were better in transgender males as compared to transgender females (P < 0.001 for hip; P < 0.001 for spine) when compared to genetic sex and at the spine (P = 0.001) when compared to affirmed sex. In this study, we observed that the transgender females who underwent orchidectomy had a lower mean Z score at spine compared to individuals who did not undergo the procedure. Conclusions: The current study results indicate that GAHT does have positive effects on bone health in transmen. [ABSTRACT FROM AUTHOR]

Background and Objective: Segmentation of the femur in Dual-Energy X-ray (DXA) images poses challenges due to reduced contrast, noise, bone shape variations, and inconsistent X-ray beam penetration. In this study, we investigate the relationship between noise and certain deep learning (DL) techniques for semantic segmentation of the femur to enhance segmentation and bone mineral density (BMD) accuracy by incorporating noise reduction methods into DL models. Methods: Convolutional neural network (CNN)-based models were employed to segment femurs in DXA images and evaluate the effects of noise reduction filters on segmentation accuracy and their effect on BMD calculation. Various noise reduction techniques were integrated into DL-based models to enhance image quality before training. We assessed the performance of the fully convolutional neural network (FCNN) in comparison to noise reduction algorithms and manual segmentation methods. Results: Our study demonstrated that the FCNN outperformed noise reduction algorithms in enhancing segmentation accuracy and enabling precise calculation of BMD. The FCNN-based segmentation approach achieved a segmentation accuracy of 98.84% and a correlation coefficient of 0.9928 for BMD measurements, indicating its effectiveness in the clinical diagnosis of osteoporosis. Conclusions: In conclusion, integrating noise reduction techniques into DL-based models significantly improves femur segmentation accuracy in DXA images. The FCNN model, in particular, shows promising results in enhancing BMD calculation and clinical diagnosis of osteoporosis. These findings highlight the potential of DL techniques in addressing segmentation challenges and improving diagnostic accuracy in medical imaging.

Hip fractures contribute significantly to mortality in older adults. New methods to identify those at risk use dual-energy X-ray absorptiometry (DXA) images and advanced image processing. However, DXA images have an overlapping femur and pelvis and may contain boundary lines, making automation challenging. Herein, a 5-layer U-net convolutional neural network (CNN) was developed to segment the femur from hip DXA images. Images were used from the Canadian Longitudinal Study on Aging (CLSA, N=104) and Canadian Multicentre Osteoporosis Study (CaMos, N=105) databases for training, with manual contour drawing defining the ‘true output’ of each image. An algorithm was then developed to mask each hip image, and trained to predict subsequent masks. The CNN was tested with 44 additional CLSA images and 42 CaMos images. This proposed approach had an accuracy and intersection over union (IoU) of 97% and 0.57, and 93% and 0.51, for CaMos and CLSA scans, respectively. Furthermore, a series of augmentation techniques was applied to increase the data size, with accuracies of 96% and 94%, and IoU of 0.53 and 0.50. Overall, our strategy automatically determined the contour of the proximal femur using various clinical DXA images, a key step to automate fracture risk assessment in clinical practice.

This study aimed to estimate the utility of the Radiofrequency Echographic Multispectrometry (REMS) approach in the assessment of bone mineral density (BMD) in subjects with osteogenesis imperfecta (OI). In 41 subjects (40.5 ± 18.7 years) with OI and in 36 healthy controls, we measured BMD at the lumbar spine (LS-BMD), femoral neck (FN-BMD) and total hip (TH-BMD), employing a dual-energy X-ray absorptiometry tool. Additionally, REMS scans were also performed at the lumbar and femoral sites. The presence and number of reported fractures were assessed in the study population. Patients characterized by a history of fragility fractures represented 84.5% of the study population. OI subjects showed significantly reduced BMD values both at the level of the lumbar spine and the femoral subregions (p < 0.01) compared to healthy controls when performed using both the DXA and the REMS method. Dividing OI patients on the basis of the Sillence classification, no differences were found between the LS-BMD values carried out using the DXA technique between the OI type I group and OI Type III and IV groups. On the contrary, the OI Type III and IV groups presented significantly lower values of both Trabecular Bone Score (TBS) and LS-BMD through REMS with respect to OI type I patients (p < 0.05). Based on the data of this study, it is possible to conclude that even the new REMS assessment, which does not use ionizing radiation, represents an excellent method for studying the bone status in subjects affected by OI. [ABSTRACT FROM AUTHOR]

Background: This study aimed to validate the application of CT texture analysis in estimating Bone Mineral Density (BMD) in patients with Type 2 Diabetes (T2D) and comparing it with the results of dual-energy X-ray absorptiometry (DXA) in a normative cohort. Methods: We analyzed a total of 510 cases (145 T2D patients and 365 normal patients) from a single institution. DXA-derived BMD and CT texture analysis-estimated BMD were compared for each participant. Additionally, we investigated the correlation among 45 different texture features within each group. Results: The correlation between CT texture analysis-estimated BMD and DXA-derived BMD in T2D patients was consistently high (0.94 or above), whether measured at L1 BMD, L1 BMC, total hip BMD, or total hip BMC. In contrast, the normative cohort showed a modest correlation, ranging from 0.66 to 0.75. Among the 45 texture features, significant differences were found in the Contrast V 64 and Contrast V 128 features in the normal group. Conclusion: In essence, our study emphasizes that the clinical assessment of bone health, particularly in T2D patients, should not merely rely on traditional measures, such as DXA BMD. Rather, it may be beneficial to incorporate other diagnostic tools, such as CT texture analysis, to better comprehend the complex interplay between various factors impacting bone health. [ABSTRACT FROM AUTHOR]

Abstract Background Bone mineral content (BMC) values in certain bones and changes in BMC over time are key features for diagnosing osteoporosis. This study examined those features using morphometric texture analysis in chest computational tomography (CT) by comparing a dual-energy X-ray absorptiometry (DXA)-based BMC. An accessible approach for screening osteoporosis was suggested by accessing BMC using only Hounsfield units (HU). Methodology The study included a total of 510 cases (255 patients) acquired between May 6, 2012, and June 30, 2020, at a single institution. Two cases were associated with two chest CT scans from one patient with a scan interval of over two years, and each scan was followed soon after by a DXA scan. Axial cuts of the first lumbar vertebra in CT and DXA-based L1 BMC values were corrected for each case. The maximum trabecular area was selected from the L1 spine body, and 45 texture features were extracted from the region using gray-level co-occurrence matrices. A regression model was employed to estimate the absolute BMC value in each case using 45 features. Also, an additional regression model was used to estimate the change in BMC between two scans for each patient using 90 features from the corresponding cases. Results The correlation coefficient (CC) and mean absolute error (MAE) between estimates and DXA references were obtained for the evaluation of regressors. In the case of the BMC estimation, CC and MAE were 0.754 and 1.641 (g). In the case of the estimation of change in BMC, CC and MAE were 0.680 and 0.528 (g). Conclusion The modality using morphometric texture analysis with CT HUs can indirectly help screening osteoporosis because it provides estimates of BMC and BMC change that show moderate positive correlations with DXA measures.

Introduction: Gender affirming hormone therapy (GAHT) is the mainstay treatment in transitioning individuals and has positive physical and psychological effects. Among the things to monitor in transgender patients on long-term hormones, bone health is an essential consideration. As the calcium intake in the Indian population is less, and many gender-incongruent individuals may not take adequate calcium in their diet, we needed data on the bone health of Indians with gender dysphoria as the information available globally may not apply to our population. Materials and Methods: The study was performed to assess bone mineral density in individuals with gender dysphoria who were on gender-affirming hormonal therapy for at least 6 months. It was a hospital-based cross-sectional study of bone mineral density measured at two sites – hip and spine in individuals with gender dysphoria on GAHT for at least six months. Results: A total of 30 individuals were included in this study. The mean age of individuals with Gender dysphoria was found to be 28.17 ± 6.15 years, and the age range was 19-42 years. Out of the 30 individuals, 14 were transgender males, and the remaining 16 were transgender females. Bone mineral density at the hip and spine in transgender males was 1.047 ± 0.124 g/cm2 and 1.065 ± 0.115 g/cm2, which was better compared to transgender females in whom the bone mineral density at hip and spine was 0.899 ± 0.873 g/cm2 and 0.854 ± 0.099 g/cm2 (P = 0.001 for hip; P = 0.000 for spine). The Z score at hip and spine were better in transgender males as compared to transgender females (P < 0.001 for hip; P < 0.001 for spine) when compared to genetic sex and at the spine (P = 0.001) when compared to affirmed sex. In this study, we observed that the transgender females who underwent orchidectomy had a lower mean Z score at spine compared to individuals who did not undergo the procedure. Conclusions: The current study results indicate that GAHT does have positive effects on bone health in transmen.

Abstract Introduction As the radiomics technique using texture features in CT is adopted for accessing DXA-equivalent bone mineral density (BMD), this study aims to compare BMD by DXA and predicted BMD to investigate the impact of obesity and central obesity in general patients. Materials and methods A total of 710 cases (621 patients) obtained from May 6, 2012, to June 30, 2021, were used in the study. We focused both their abdomen & pelvis CT’s first lumbar vertebrae axial cuts to predict estimated BMD and bone mineral content (BMC). In each patient’s CT, we extracted the largest trabecular region of the L1 vertebral body as a region of interest (ROI) using the gray-level co-occurrence matrices (GLCM) technique, and linear regression was applied to predict the indices. Cases were divided by central obesity/overall obesity and normal group by body mass index (BMI), waist circumference (WC), or index of central obesity (ICO) standard. Results The coefficients were all above 0.73, respectively. P-values from ICO were over 0.05 when the measures were Hip BMD and Hip BMC. In contrast, those from ICO were 0.0131 and 0.0351 when the measures were L1 BMD and L1 BMC, respectively, which show a difference between the two groups. Conclusions The CT HU texture analysis method was an effective and economical method for measuring estimated BMD and BMC and evaluating the impact of obesity. We found that central obesity especially exerted an effect on the disturbance of the clinical BMD measurements since groups were significantly different under the ICO standard.

The trabecular bone score (TBS) can be determined in addition to the Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement to diagnose, evaluate, and stratify bone loss and decide on appropriate treatment in patients at risk. Especially in patients with secondary osteoporosis, TBS detects restricted bone quality. To investigate the influence of an additional evaluation of TBS on patients' treatment strategy decisions, we enrolled 292 patients, with a high proportion of patients with secondary osteoporosis, from one outpatient unit over one year. Patients eligible for BMD measurement had the option to opt-in for TBS measurement. We analyzed demographic data, leading diagnoses, bone metabolism parameters, and results of BMD and TBS measurements. More than 90% of patients consented to TBS measurement. TBS measurement influenced the decision in approximately 40% of patients with a treatment indication for anti-osteoporotic drugs. We demonstrate that depending on the underlying disease/risk spectrum, 21–25.5% of patients had an unremarkable BMD measurement with poor bone quality shown in the TBS measurement. In patients with secondary osteoporosis, the use of TBS supplementary to DXA seems useful to better assess fracture risk and, thus, to initiate therapy for osteoporosis in these patients in time. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis (OA) in the lumbar spine can potentially lead to an overestimation of bone mineral density (BMD), and this can be a challenge in accurately diagnosing conditions like osteoporosis, where precise measurement of BMD is crucial. Radiofrequency Echographic Multi Spectrometry (REMS) is being recognized as an innovative diagnostic tool for assessing bone status. The purpose of this study was to evaluate whether the use of REMS may enhance the identification of osteoporosis in patients with osteoarthritis. Methods: A cohort of 500 patients (mean age: 63.9 ± 11.2 years) diagnosed with osteoarthritis and having a medical prescription for dual-energy X-ray absorptiometry (DXA) were recruited for the study. All patients underwent BMD measurements at lumbar spine and femoral sites by both DXA and REMS techniques. Results: The T-score values for BMD at the lumbar spine (BMD-LS) by DXA were significantly higher with respect to BMD-LS by REMS across all OA severity scores, and the differences were more pronounced in patients with a higher degree of OA severity (p < 0.001). Furthermore, the percentage of subjects classified as “osteoporotic”, on the basis of BMD by REMS was markedly higher than those classified by DXA, both when considering all skeletal sites (39.4% vs. 15.1%, respectively) and the lumbar spine alone (30.5% vs. 6.0%, respectively). A similar pattern was observed when OA patients were grouped according to the Kellgren–Lawrence grading score. Conclusions: The findings from our study indicate that, in a population with varying severity levels of osteoarthritis, REMS demonstrated a higher capability to diagnose osteoporosis compared to DXA, and this could lead to earlier intervention and improved outcomes for patients with bone fragility, reducing the likelihood of fractures and associated complications.

Although previous studies indicated that chronic alcohol abuse (CAA) and alcoholic liver cirrhosis (ALC) are associated with increased bone fragility, understanding bone fragility determinants is still modest in these individuals. We used a comprehensive individualized clinical fracture risk assessment approach (vertebral osteodensitometry, femoral osteodensitometry and geometry, and serum bone turnover biomarkers) to compare adult male patients with ALC who have not previously had femoral or vertebral fractures (n = 39), patients with CAA (without liver cirrhosis, n = 78) who have not previously had femoral or vertebral fractures and healthy age- and sex-matched controls (n = 43). Our data suggested that intertrochanteric bone mineral density was significantly lower in ALC and CAA patients than in controls. Also, the trabecular bone score was considerably lower in ALC patients compared with CAA and control individuals. The most significant inter-group differences in femoral geometry were noted on the femoral shaft. Patients with ALC and CAA have a higher 10-year risk of major osteoporotic fractures compared to the controls. Analysis of bone turnover biomarkers showed increased osteoprotegerin and beta-C-terminal telopeptide serum concentrations and decreased insulin growth factor-1 concentrations in patients with ALC compared to CAA and control groups. Our data revealed that bone alterations are present in patients with ALC and CAA even if they did not sustain a nontraumatic bone fracture, but it is also indicative that current bone-assessing clinical methods are not entirely reliable. Thus, future studies should focus on developing a reliable integrative clinical tool that can be used to accurately predict and prevent bone fracture occurrences in patients with ALC and CAA.

Non-metastatic prostate cancer (PCa) patients are at increased risk for osteoporosis and fractures mainly due to androgen deprivation therapy (ADT)-associated hypogonadism, but this remains largely underdiagnosed and untreated. In this study, we examine the value of pre-screening calcaneal QUS in identifying patients who should be referred for screening for osteoporosis using dual-energy X-Ray absorptiometry (DXA). In a single-center retrospective cross-sectional cohort study, we analysed data on DXA and calcaneal QUS measurements systematically collected between 2011 and 2013 in all non-metastatic PCa patients attending our Uro-Oncological Clinic at the Leiden University Medical Center. Receiver operating characteristic curves were used to assess the positive (PPV) and negative (NPV) predictive values of QUS T-scores of 0, −1.0, and − 1.8 in identifying DXA-diagnosed osteoporosis (T-scores ≤ − 2.5 and ≤ −2) at lumbar spine and/or femoral neck. Complete sets of data were available in 256 patients, median age 70.9 (53.6–89.5) years; 93.0 % had received local treatment, 84.4 % with additional ADT. Prevalence of osteoporosis and osteopenia was respectively 10.5 % and 53 %. Mean QUS T-score was −0.54 ± 1.58. Whereas PPV at any QUS T-score was

Sarcopenia and osteoporosis are highly prevalent syndromes in older people, characterized by loss of muscle and bone tissue, and related to adverse outcomes. Previous reports indicate mid‐thigh dual‐energy X‐ray absorptiometry (DXA) is well suited for the simultaneous assessment of bone, muscle, and fat mass in a single scan. Using cross‐sectional clinical data and whole‐body DXA images of 1322 community‐dwelling adults from the Geelong Osteoporosis Study (57% women, median age 59 years), bone and lean mass were quantified in three unconventional regions of interest (ROIs): (i) a 2.6‐cm‐thick slice of mid‐thigh, (ii) a 13‐cm‐thick slice of mid‐thigh, and (iii) the whole thigh. Conventional indices of tissue mass were also calculated (appendicular lean mass [ALM] and bone mineral density [BMD] of lumbar spine, hip, and femoral neck). The performance of thigh ROIs in identifying osteoporosis, osteopenia, low lean mass and strength, past falls, and fractures was evaluated. All thigh regions (especially whole thigh) performed well in identifying osteoporosis (area under the receiver‐operating characteristic [ROC] curve [AUC] > 0.8) and low lean mass (AUC >0.95), but they performed worse in the diagnosis of osteopenia (AUC 0.7–0.8). All thigh regions were equivalent to ALM in discrimination of poor handgrip strength, gait speed, past falls, and fractures. BMD in conventional regions was more strongly associated with past fractures than thigh ROIs. In addition to being faster and easier to quantify, mid‐thigh tissue masses can be used for identifying osteoporosis and low lean mass. They are also equivalent to conventional ROIs in their associations with muscle performance, past falls, and fractures; however, further validation is required for the prediction of fractures. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. [ABSTRACT FROM AUTHOR]

A prior study conducted in high-income countries demonstrated that specific sedentary behavior, such as TV viewing, is prospectively associated with adiposity in both active and inactive adolescents. The aim of this study was to examine the joint associations of sedentary behaviors and moderate- and vigorous-intensity physical activity (MVPA) with adiposity among Brazilian adolescents. This prospective cohort study included 377 participants of the 1993 Pelotas (Brazil) Study who completed an accelerometry assessment at age 13 years and a dual-energy X-ray absorptiometry (DXA) assessment at age 18 years. Accelerometer-measured MVPA was dichotomized into high (≥60 min/day) and low (<60 min/day). Accelerometer-measured sedentary time (SED) was dichotomized into low (<49 min/h) and high (≥49 min/h) based on the median. Self-reported TV viewing time was also dichotomized into low (<3 h/day) and high (≥3 h/day) based on the median. We combined the two MVPA groups (high and low) and two SED groups (low and high) to form the four MVPA&SED groups: high&low, high&high, low&low, and low&high. We also created four MVPA&TV groups in the same manner. Fat mass index (FMI; kg/m2) was calculated using DXA-derived fat mass. Multivariable linear regression analyses compared FMI at 18 years among the four MVPA&SED groups and among the four MVPA&TV groups, adjusting for socioeconomic status, energy intake, and baseline adiposity. The analysis results showed that SED or TV viewing time was not prospectively associated with adiposity in both active and inactive Brazilian adolescents. This study suggests that the association between specific sedentary behaviors, such as TV viewing, and adiposity may differ across societal settings—in this case, high-income vs. middle-income countries. [ABSTRACT FROM AUTHOR]

Abstract Background Osteoarthritis (OA) and vertebral fractures at the lumbar spine lead to an overestimation of bone mineral density (BMD). Recently, a new approach for osteoporosis diagnosis, defined as radiofrequency echographic multi-spectrometry (REMS), represents an innovative diagnostic tool that seems to be able to investigate bone quality and provide an estimation of fracture risk independent of BMD. The aim of this paper was to evaluate whether the use of REMS technology can favor the diagnosis of osteoporosis in subjects with an apparent increase in BMD. Methods In a cohort of 159 postmenopausal (66.2 ± 11.6 yrs) women with overestimated BMD by DXA at the lumbar spine, we performed an echographic scan with the REMS technique. Results The mean values of BMD at different skeletal sites obtained by the DXA and REMS techniques showed that the BMD T-scores by REMS were significantly lower than those obtained by the DXA technique both at the lumbar spine (p

Background: This research explores the application of morphometric texture analysis in chest Computed Tomography (CT) scans for determining Bone Mineral Content (BMC) and its temporal changes, both crucial in diagnosing osteoporosis. The study establishes an innovative approach to osteoporosis screening by leveraging Hounsfield Units (HUs) in CT scans to evaluate BMC, offering a comparison with dual-energy X-ray absorptiometry (DXA)-based BMC. Methods: A total of 806 instances (encompassing 379 individuals) were meticulously compiled from a sole institution, during the period stretching from 6 May 2012 to 30 June 2020. In this detailed analysis, each participant was subjected to a pair of chest CT scans, sequentially pursued by a DXA scan, spread over two years. Focused records of BMC values at the inaugural lumbar vertebra (L1) were secured from both the DXA and CT axial slices across all instances. A meticulous selection process pinpointed the largest trabecular section from the L1 vertebral body, whereupon 45 distinctive texture attributes were harvested utilizing gray-level co-occurrence matrix methodologies. Utilizing these amassed 45 attributes, a regression architecture was devised, aiming to forecast the precise BMC values individually. Moreover, an alternative regression framework was engaged, leveraging 90 distinct features, to gauge the BMC fluctuations observed between the duo of scans administered to each participant. Results: The precision of the cultivated regression frameworks was scrupulously assessed, benchmarking against the correlation coefficient (CC) and the mean absolute deviation (MAE) in comparison to the DXA-established references. The regression apparatus employed for estimating BMC unveiled a CC of 0.754 and an MAE of 1.641 (g), respectively. Conversely, the regression mechanism devoted to discerning the variations in BMC manifested a CC of 0.680, coupled with an MAE of 0.528 (g), respectively. Conclusion: The innovative methodology utilizing morphometric texture analysis in CT HUs offers an indirect, yet promising, approach for osteoporosis screening by providing estimations of BMC and its temporal changes. The estimations demonstrate moderate positive correlations with DXA measures, suggesting a potential alternative in circumstances where DXA scanning is limited.