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BACKGROUND: Guidelines recommend dual-energy x-ray absorptiometry (DXA) screening to assess fracture risk and benefit from antiresorptive therapy in men with metastatic hormone-sensitive prostate cancer (mHSPC) on androgen deprivation therapy (ADT). However,

Introduction: Osteoporosis is a skeletal disease characterized by low bone mass, which increases the risk of fractures and can arise from primary or secondary causes. The aim of this study is to evaluate the frequency and causes of secondary osteoporosis diagnosis in patients presenting to our clinic, as well as to assess the clinical characteristics and treatment responses of these patients. Materials and Methods: Seventy patients with secondary osteoporosis, who were followed and treated for at least two years due to chronic disease, were included in the study. The clinical characteristics, comorbidities, medications used, laboratory tests, Dual X-ray Absorptiometry (DXA) scans, magnetic resonance imaging results, and treatment protocols of the patients were evaluated. Results: The mean age of the patients was 10.37±3.81 years. The mean age at diagnosis of the primary disease (chronic illness) was 4.47±3.54 years. The mean duration for the development of osteoporosis was 5.76±4.31 years. Among the cases, 21 (30%) had oncological, 15 (21.5%) had rheumatological, 11 (15.7%) had nephrological, 11 (15.7%) had hematological, 4 (5.7%) had neurological diseases, and 8 (11.4%) had other diseases. Of the patients, 35 (50%) had a history of steroid use, 16 (22.9%) used both steroids and methotrexate (MTX), 10 (14.3%) used MTX, and 9 (12.9%) used antiepileptic drugs. The mean vertebral DXA Z-score before treatment was -3.06±1.05, while the DXA Z-scores at the 1st and 2nd years of treatment were -2.51±1.09 and -2.16±1.15, respectively. A significant difference was found between the pre-treatment and 1st and 2nd year DXA Z-scores (p<0.001). Conclusion: In our study, patients with secondary osteoporosis caused by various chronic diseases and their treatments were evaluated. With treatment, significant positive changes in bone mineral density and clinical findings were observed. There is a need for the development of guidelines for the diagnosis, treatment, and follow-up of secondary osteoporosis patients and for the creation of larger databases through prospective studies to guide clinical practices. [ABSTRACT FROM AUTHOR]

Background: There is limited research on body composition in persons with haemophilia (PwH). The literature describes an increased body fat distribution and decreased lean mass in PwH compared to healthy controls using bioimpedance analysis. Using dual x‐ray absorptiometry (DXA), which is known to be the most accurate method, this investigation aims to postulate reference data for body composition parameters within haemophilia severity phenotypes and age groups. Methods: Persons underwent whole body DXA screening using Horizon. Body fat percentage, estimated visceral adipose tissue (VAT), appendicular fat and lean mass, and lean and fat mass in relation to body height were assessed. Haemophilia severity and five age groups were distinguished. Results: Two hundred and one persons with mild (n = 44), moderate (n = 41), or severe (n = 116) haemophilia A/B (median age 40 [28–55; 1.IQ–3.IQ] years) were analysed. The median body fat percentage was 28.7% [25.5%–33.9%] and median estimated VAT was 657 g [403–954 g] with no significant difference between severity phenotypes (p =.474; p =.781). Persons with severe haemophilia had less lean mass compared to moderate and mild haemophilia (p =.013; p =.034). Total and appendicular fat is increased in older PwH (aged ≥40 years) compared to younger PwH (aged ≤29 years; p <.05). Lean mass did not differ between age groups. Conclusion: This study provides valuable reference data for body composition parameters in PwH. Persons with severe haemophilia show significantly less lean mass compared to persons with moderate or mild haemophilia. Body fat percentage and VAT did not differ between severity phenotypes, but increased with age. [ABSTRACT FROM AUTHOR]

Introduction: Osteoporosis is a skeletal disease characterized by low bone mass, which increases the risk of fractures and can arise from primary or secondary causes. The aim of this study is to evaluate the frequency and causes of secondary osteoporosis diagnosis in patients presenting to our clinic, as well as to assess the clinical characteristics and treatment responses of these patients. Materials and Methods: Seventy patients with secondary osteoporosis, who were followed and treated for at least two years due to chronic disease, were included in the study. The clinical characteristics, comorbidities, medications used, laboratory tests, Dual X-ray Absorptiometry (DXA) scans, magnetic resonance imaging results, and treatment protocols of the patients were evaluated. Results: The mean age of the patients was 10.37±3.81 years. The mean age at diagnosis of the primary disease (chronic illness) was 4.47±3.54 years. The mean duration for the development of osteoporosis was 5.76±4.31 years. Among the cases, 21 (30%) had oncological, 15 (21.5%) had rheumatological, 11 (15.7%) had nephrological, 11 (15.7%) had hematological, 4 (5.7%) had neurological diseases, and 8 (11.4%) had other diseases. Of the patients, 35 (50%) had a history of steroid use, 16 (22.9%) used both steroids and methotrexate (MTX), 10 (14.3%) used MTX, and 9 (12.9%) used antiepileptic drugs. The mean vertebral DXA Z-score before treatment was -3.06±1.05, while the DXA Z-scores at the 1st and 2nd years of treatment were -2.51±1.09 and -2.16±1.15, respectively. A significant difference was found between the pre-treatment and 1st and 2nd year DXA Z-scores (p

The purpose of this study was to compare the muscle-to-bone ratio (MBR) in National Collegiate Athletic Association Division I football players (collegiate football players [CFP]) to healthy, age-matched controls. In addition, we examined MBR in CFP by position. A total of 553 CFP and 261 controls had their total and regional lean mass (LM), fat mass (FM), and bone mineral content (BMC) determined by dual x-ray absorptiometry (DXA). College football players were categorized by positions defined as offensive linemen (OL), defensive linemen (DL), tight end, linebacker (LB), running back (RB), punter or kicker, quarterback (QB), defensive back (DB), and wide receiver (WR). There were significant differences between CFP and controls for total LM (80.1 ± 10.0 vs. 56.9 ± 7.8 kg), FM (22.2 ± 12.5 vs. 15.2 ± 7.1 kg), and BMC (4.3 ± 0.5 vs. 3.1 ± 0.5 kg). Although there were significant differences in body composition between CFP and controls, there was no significant differences in total MBR between CFP and controls (18.6 ± 1.4 vs. 18.8 ± 1.7). Regionally, CFP had significantly lower trunk MBR than controls (26.7 ± 2.7 vs. 28.7 ± 4.2), but no difference was seen in leg or arm MBR. Positional differences in CFP were noted as total MBR being significantly higher in DL (19.0 ± 1.4) than in DB (18.1 ± 1.3), WR (18.1 ± 1.3), and LB (18.2 ± 1.3). OL had a significantly higher total MBR (19.2 ± 1.3) than DB(18.1 ± 1.3), LB (18.2 ± 1.3), QB (18.1 ± 1.0), and WR (18.1 ± 1.3). In addition, RB had significantly higher total MBR (18.8 ± 1.3) than DB (18.1 ± 1.3) and WR (18.1 ± 1.3). This study may provide athletes and training staff with normative values when evaluating total and regional MBR with DXA. [ABSTRACT FROM AUTHOR]

Summary: In this study of postmenopausal women in Malaysia, total adiposity was inversely associated with total BMD, while regional associations varied. No differences were detected across Malay, Chinese, and Indian ethnicities. Low BMD contributes substantially to morbidity and mortality, and increasing adiposity levels globally may be contributing to this. Purpose: To investigate associations of total and regional adiposity with bone mineral density (BMD) among a multi-ethnic cohort of postmenopausal women. Methods: Dual X-ray absorptiometry (DXA) imaging was undertaken for 1990 postmenopausal women without prior chronic diseases (30% Malay, 53% Chinese, and 17% Indian) from The Malaysian Cohort (TMC). The strength of the associations between standardized total and regional body fat percentages with total and regional BMD was examined using linear regression models adjusted for age, height, lean mass, ethnicity, education, and diabetes. Effect modification was assessed for ethnicity. Results: Women with a higher total body fat percentage were more likely to be Indian or Malay. Mean (SD) BMD for the whole-body total, lumbar spine, leg, and arm were 1.08 (0.11), 0.96 (0.15), 2.21 (0.22), and 1.36 (0.12) g/cm2, respectively. Total body and visceral fat percentage were inversely associated with total BMD (− 0.02 [95% CI − 0.03, − 0.01] and − 0.01 [− 0.02, − 0.006] g/cm2 per 1 SD, respectively). In contrast, subcutaneous and gynoid fat percentages were positively associated with BMD (0.007 [0.002, 0.01] and 0.01 [0.006, 0.02] g/cm2, respectively). Total body fat percentage showed a weak positive association with lumbar BMD (0.01 [0.004, 0.02]) and inverse associations with leg (− 0.04 [− 0.06, − 0.03]) and arm (− 0.02 [− 0.03, − 0.02]) BMD in the highest four quintiles. There was no effect modification by ethnicity (phetero > 0.05). Conclusion: Total adiposity was inversely associated with total BMD, although regional associations varied. There was no heterogeneity across ethnic groups suggesting adiposity may be a risk factor for low BMD across diverse populations. [ABSTRACT FROM AUTHOR]

BackgroundNew recommendations for the assessment of malnutrition and sarcopenia include body composition, specifically reduced muscle mass. Three-dimensional optical imaging (3DO) is a validated, accessible, and affordable alternative to dual X-ray absorptiometry (DXA).ObjectiveIdentify strengths and weaknesses of 3DO for identification of malnutrition in participants with low body mass index (BMI) and eating disorders.DesignParticipants were enrolled in the cross-sectional Shape Up! Adults and Kids studies of body shape, metabolic risk, and functional assessment and had BMI of

Low bone mineral density (BMD) is common in adults with coeliac disease (CD), even in individuals adhering to a gluten-free diet (GFD). Women are more likely to have low BMD and have an increased risk of osteoporosis, so women with pre-existing low BMD related to CD are at an even higher risk. BMD assessed by dual X-ray absorptiometry (DXA) and bone quality assessed through quantitative ultrasound (QUS) were investigated in 31 premenopausal women with CD consuming a GFD, and 39 matched healthy controls from the Lower North Island, New Zealand. In addition, bone metabolism and nutrient status were assessed, and four-day diet diaries were used to estimate nutrient intake. No statistically significant differences were found in BMD assessed by DXA between the two groups at the hip, lumbar spine or forearm. However, the parameters measured by the QUS were significantly lower in CD participants. Dietary data indicated significantly lower intakes of energy, dietary fibre, magnesium and phosphorus in women with CD, likely as a result of a reduced intake of wholegrain foods, and suggested that both groups had inadequate intake of calcium. No significant differences were demonstrated in biochemical parameters. BMD and bone biomarkers indicated no differences between coeliac and healthy women in New Zealand. However, these findings suggest that QUS may be more sensitive for the coeliac population, due to the disease's affect on the trabecular bone, and warrant further research. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is the most common cancer worldwide and a leading cause of cancer-related deaths in women. Mammographic breast density, the relative amount of fibroglandular tissue as seen on a mammogram, is one of the strongest predictors of breast cancer risk, with higher breast density associated with greater risk. Breasts undergo extensive fibroglandular tissue proliferation in early life, making this a potential window of vulnerability for carcinogen exposures. Early-life growth (e.g., height and weight) is also associated with breast cancer risk. Research into the 'developmental origins of health and disease' paradigms investigate the pathways of risk for disease in later life from early-life exposures across developmental phases. However, little is known about the association between early-life growth and breast density. Further investigation into these risk pathways could increase knowledge of disease etiology and help identify women at increased risk at an earlier age and inform potential mediation of breast cancer risk. Breast density is a strong intermediate endpoint to investigate the association between early-life exposures and breast cancer risk. This study investigates the association between early-life growth and breast density in young adult women measured using Optical Breast Spectroscopy (OBS) and Dual X-ray Absorptiometry (DXA). OBS measurements were obtained for 536 female Raine Cohort Study participants at ages 27–28, with 268 completing DXA measurements. Participants with three or more height and weight measurements from ages 8 to 22 were used to generate linear growth curves for height, weight and body mass index (BMI) using SITAR modelling. Three growth parameters (size, velocity and timing) were examined for association with breast density measures, adjusting for potential confounders. Women who reached their peak height rapidly (velocity) and later in adolescence (timing) had lower OBS-breast density. Overall, women who were taller (size) had higher OBS-breast density. For weight, women who grew quickly (velocity) and later in adolescence (timing) had higher absolute DXA-breast density. Overall, weight (size) was also inversely associated with absolute DXA-breast density, as was BMI. These findings provide new evidence that adolescent growth is associated with breast density measures in young adult women, suggesting potential mediation pathways for breast cancer risk in later life. [ABSTRACT FROM AUTHOR]

Preterm infants have increased body adiposity at term-equivalent age and risk of adverse metabolic outcomes. The aim of the study was to define how nutrient intake may impact body composition (BC) of very low-birth weight infants fed with early progressive enteral feeding and standard fortification. Eighty-six infants with <1500 g birth weight were included in the BC study and stratified into extremely preterm (EP) and very preterm (VP) groups. Nutrient intake was calculated during the first 28 days and BC assessed by dual X-ray absorptiometry at discharge and by skinfold thickness at 12 months of corrected age (CA). Total nutrient intake did not differ between the groups. EP infants had a higher fat mass percentage at discharge than VP infants (24.8% vs. 19.4%, p < 0.001); lean mass did not differ. None of the nutrients had any impact on BC of EP infants. Protein intake did not result in a higher lean mass in either group; fat intake was a significant predictor of increased fat mass percentage in VP infants at discharge (p = 0.007) and body adiposity at 12 months of CA (p = 0.021). Nutritional needs may depend on gestational age and routine fortification should be used with caution in more mature infants. [ABSTRACT FROM AUTHOR]

Nutritional compromise, low levels of vitamin D, chronic inflammation, abnormal growth, and physical inactivity affect bone metabolism and compromise long‐term bone health in individuals with epidermolysis bullosa (EB). The result is a high risk for osteopenia, osteoporosis, and pathologic fractures, but this important consequence of EB has been the focus of few investigations. Our scoping review found 21 publications that assessed the current understanding and clinical practices for monitoring of osteoporosis and its treatment in EB. Recommendations summarized from 13 of these publications include early nutritional and weight assessments before 2 years of age; bloodwork every 6–12 months starting at birth; Tanner stage assessments every 6 months to detect any pubertal delay; DEXA scans starting at age 6 years with repeated scans every 1–2 years, except in mild cases; and vitamin D supplementation of 80–320 IU daily for children 0–7 years and 720 IU for patients >8 years. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many predictors of morbidity caused by metabolic disease are associated with body shape. 3D optical (3DO) scanning captures body shape and has been shown to accurately and precisely predict body composition variables associated with mortality risk. 3DO is safer, less expensive, and more accessible than criterion body composition assessment methods such as dual-energy X-ray absorptiometry (DXA). However, 3DO scanning has not been standardized across manufacturers for pose, mesh resolution, and post processing methods. PURPOSE: We introduce a scanner-agnostic algorithm that automatically fits a topologically consistent human mesh to 3DO scanned point clouds and predicts clinically important body metrics using a standardized body shape model. Our models transform raw scans captured by any 3DO scanner into fixed topology meshes with anatomical consistency, standardizing the outputs of 3DO scans across manufacturers and allowing for the use of common prediction models across scanning devices. METHODS: A fixed-topology body mesh template was automatically registered to 848 training scans from three different 3DO systems. Participants were between 18 and 89 years old with body mass index ranging from 14 to 52 kg/m2 . Scans were registered by first performing a coarse nearest neighbor alignment between the template and the input scan with an anatomically constrained principal component analysis (PCA) domain deformation using a device and gender specific bootstrap basis trained on 70 seed scans each. The template mesh was then optimized to fit the target with a smooth per-vertex surface-to-surface deformation. A combined unified PCA model was created from the superset of all automatically fit training scans including all three devices. Body composition predictions to DXA measurements were learned from the training mesh PCA coefficients using linear regression. Using this final unified model, we tested the accuracy of our body composition models on a withheld sample of 562 scans by fitting a PCA parameterized template mesh to each raw scan and predicting the expected body composition metrics from the principal components using the learned regression model. RESULTS: We achieved coefficients of determination (R2 ) above 0.8 on all nine fat and lean predictions except female visceral fat (0.77). R2 was as high as 0.94 (total fat and lean, trunk fat), and all root-mean-squared errors were below 3.0 kg. All predicted body composition variables were not significantly different from reference DXA measurements except for visceral fat and female trunk fat. Repeatability precision as measured by the coefficient of variation (%CV) was around 2-3x worse than DXA precision, with visceral fat %CV below 2x DXA %CV and female total fat mass at 5x. CONCLUSIONS: Our method provides an accurate, automated, and scanner agnostic framework for standardizing 3DO scans and a low cost, radiation-free alternative to criterion radiology imaging for body composition analysis. We published a web-app version of this work at https://shapeup.shepherdresearchlab.org/3do-bodycomp-analyzer/ that accepts mesh file uploads and returns templated meshes with body composition predictions for demo purposes.

Background: To examine substrate oxidation in prepubertal and early pubertal children as a function of body weight, body composition, and sex during an exhaustive cycling test. Methods: This study included 320 children in prepubertal and early puberty (Tanner stage 1 or 2; n = 188 males) who completed a minimum of 4 stages (2–5 min/stage) of an adapted version of the McMaster exhaustive exercise protocol on an upright cycle ergometer. Substrate utilization, relative to individual VO2peak, was determined using VO2 and VCO2 data, obtained with breath-by-breath gas analysis during exercise. Results: Both peak (mg/kg lean body mass·min) and submaximal lipid oxidation (mg/kg lean body mass·min) were highest (P <.01) in children with healthy weight (HW), then overweight, and lowest in obese (OB). Both females with HW (compared with males with HW) and females with OB (compared with males with OB) had higher (P <.01) peak and submaximal lipid oxidation. In children with OB, fat-free mass correlated positively (P <.01) with submaximal lipid oxidation (r =.50). In contrast, in children with HW and overweight, fat-free mass correlated positively (P <.01) with carbohydrate oxidation (r =.52 and r =.47, respectively). Conclusion: Obesity during childhood may alter substrate oxidation during exercise. These results may have implications in the implementation of exercise programs in prepubertal or early puberty to control adiposity. [ABSTRACT FROM AUTHOR]

Aims: The Exeter short stem was designed for patients with Dorr type A femora and short-term results are promising. The aim of this study was to evaluate the minimum five-year stem migration pattern of Exeter short stems in comparison with Exeter standard stems. Methods: In this case-control study, 25 patients (22 female) at mean age of 78 years (70 to 89) received cemented Exeter short stem (case group). Cases were selected based on Dorr type A femora and matched first by Dorr type A and then age to a control cohort of 21 patients (11 female) at mean age of 74 years (70 to 89) who received with cemented Exeter standard stems (control group). Preoperatively, all patients had primary hip osteoarthritis and no osteoporosis as confirmed by dual X-ray absorptiometry scanning. Patients were followed with radiostereometry for evaluation of stem migration (primary endpoint), evaluation of cement quality, and Oxford Hip Score. Measurements were taken preoperatively, and at three, 12, and 24 months and a minimum five-year follow-up. Results: At three months, subsidence of the short stem -0.87 mm (95% confidence interval (CI) -1.07 to -0.67) was lower compared to the standard stem -1.59 mm (95% CI -1.82 to -1.36; p < 0.001). Both stems continued a similar pattern of subsidence until five-year follow-up. At five-year follow-up, the short stem had subsided mean -1.67 mm (95% CI -1.98 to -1.36) compared to mean -2.67 mm (95% CI -3.03 to -2.32) for the standard stem (p < 0.001). Subsidence was not influenced by preoperative bone quality (osteopenia vs normal) or cement mantle thickness. Conclusion: The standard Exeter stem had more early subsidence compared with the short Exeter stem in patients with Dorr type A femora, but thereafter a similar migration pattern of subsidence until minimum five years follow-up. Both the standard and the short Exeter stems subside. The standard stem subsides more compared to the short stem in Dorr type A femurs. Subsidence of the Exeter stems was not affected by cement mantle thickness. Cite this article: Bone Jt Open 2023;4(7):507–515.

Relative Energy Deficiency in Sport (REDs) is a syndrome describing the relationship between prolonged and/or severe low energy availability and negative health and performance outcomes. The high energy expenditures incurred during training and competition put endurance athletes at risk of REDs. The objective of this study was to investigate differences in bone quality in winter endurance athletes classified as either low-risk versus at-risk for REDs. Forty-four participants were recruited (M = 18; F = 26). Bone quality was assessed at the distal radius and tibia using high resolution peripheral quantitative computed tomography (HR-pQCT), and at the hip and spine using dual X-ray absorptiometry (DXA). Finite element analysis was used to estimate bone strength. Participants were grouped using modified criteria from the REDs Clinical Assessment Tool Version 1. Fourteen participants (M = 3; F = 11), were classified as at-risk of REDs (≥ 3 risk factors). Measured with HR-pQCT, cortical bone area (radius) and bone strength (radius and tibia) were 6.8%, 13.1% and 10.3% lower (p = 0.025, p = 0.033, p = 0.027) respectively, in at-risk compared with low-risk participants. Using DXA, femoral neck areal bone density was 9.4% lower in at-risk compared with low-risk participants (p = 0.005). At-risk male participants had 21.9% lower femoral neck areal bone density (via DXA) than low-risk males (p = 0.020) with no significant differences in females. Overall, 33.3% of athletes were at-risk for REDs and had lower bone quality than those at low-risk. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to examine the muscle-to-bone ratio (MBR) in National Football League (NFL) players. Three hundred and forty-six NFL players had their total body lean, fat and bone masses determined using dual X-ray absorptiometry and were compared to 228 age-matched, healthy male controls. Compared to the control group, NFL players had a significantly lower percent total body fat (17.90±6.92 vs. 22.93±8.96%, p=0.053), but significantly greater total fat mass (19.76±11.29 vs. 17.84±12.11 kg, p<0.0001), lean mass (84.55±8.75 vs. 55.3±11.79 kg, p<0.0001), bone mineral content (4.58±0.45 vs. 2.91±0.67 kg, p<0.0001), and bone mineral density (1.61±0.11 vs. 1.26±0.21 g/cm2 , p<0.0001). NFL players had greater arm MBR (17.70±1.47 vs. 16.48±1.88, p<0.0001) than controls; however, both trunk (26.62±2.55 vs. 31.56±4.19, p<0.0001) and total (18.50±1.31 vs. 19.12±1.88, p<0.001) MBR were lower in NFL players. Leg MBR was not significantly different between NFL players and controls (16.72±1.53 vs. 16.85±1.87, p=0.34). When NFL players were categorized by their offensive or defensive position for comparison, no differences in total MBR were observed. However, leg MBR varied greatly among NFL players by position. It is possible that regional differences in MBR in the NFL players may be related to the demands of that position. [ABSTRACT FROM AUTHOR]

Several techniques exist to measure fat-free mass (FFM). Accordingly, this study is based on data from our recent trial comparing the sensitivity of the main field methods available with that of dual-energy X-ray absorptiometry (DXA) as reference and analyzing the cross-sectional accuracy of these field methods in recreationally resistance-trained males. We hypothesized that the use of these techniques would lead to varying estimates of FFM compared with DXA. Participants (N = 23; 21.4 ± 3.3 years) completed a 10-week resistance training plus diet intervention designed to optimize hypertrophy. FFM was determined by bioelectrical impedance analysis (BIA), 23 anthropometric equations, and DXA. After the intervention, FFM increased significantly according to BIA and most anthropometric estimates, but this increase was not detected by 2 anthropometric equations or by DXA. Only 1 of these 2 equations showed significant correlation with DXA and no standardized or significant differences to this reference method, although it did display significant heteroscedasticity. In our cross-sectional analysis, only 1 anthropometric equation gave rise to good accuracy as confirmed by DXA. Our findings indicate that the use of different techniques to assess FFM gains in response to a hypertrophic intervention yields different results. BIA with general embedded equations should not be used to monitor a young male adult's body composition. To monitor FFM over time, we would recommend the Dunne et al. equation (2) as the most sensitive field method, and to assess FFM cross-sectionally, equation (1) of these authors is the most accurate field method. This study compares the sensitivity and the cross-sectional accuracy of BIA and anthropometry using DXA as a reference in resistance-trained males. Fat-free mass was significantly increased according to BIA and to most anthropometric estimates, but not according to 2 anthropometric equations or to DXA. Anthropometric equations (1) and (2) of Dunne et al. [20] reported the best sensitivity and the best accuracy, respectively. BIA, bioimpedance analysis; DXA, dual-energy X-ray absorptiometry [Display omitted] [ABSTRACT FROM AUTHOR]

Trabecular microarchitecture contributes to bone strength, but its role in bone stress injury (BSI) risk in young healthy adults is unclear. Tibial volumetric BMD (vBMD), geometry, and microarchitecture, whole-body areal BMD, lean and fat mass, biochemical markers of bone metabolism, aerobic fitness, and muscle strength and power were measured in 201 British Army male infantry recruits (age 20.7 [4.3] years, BMI 24.0 ± 2.7 kg·m2) in week one of basic training. Tibial scans were performed at the ultra-distal site, 22.5 mm from the distal endplate of the non-dominant leg using High Resolution Peripheral Quantitative Computed Tomography (XtremeCT, Scanco Medical AG, Switzerland). Binary logistic regression analysis was performed to identify associations with lower body BSI confirmed by MRI. 20 recruits (10.0%) were diagnosed with a lower body BSI. Pre-injured participants had lower cortical area, stiffness and estimated failure load (p = 0.029, 0.012 and 0.011 respectively) but tibial vBMD, geometry, and microarchitecture were not associated with BSI incidence when controlling for age, total body mass, lean body mass, height, total 25(OH)D, 2.4-km run time, peak power output and maximum dynamic lift strength. Infantry Regiment (OR 9.3 [95%CI, 2.6, 33.4]) Parachute versus Line Infantry, (p ≤ 0.001) and 2.4-km best effort run time (1.06 [95%CI, 1.02, 1.10], p < 0.033) were significant predictors. Intrinsic risk factors, including ultradistal tibial density, geometry, and microarchitecture, were not associated with lower body BSI during arduous infantry training. The ninefold increased risk of BSI in the Parachute Regiment compared with Line Infantry suggests that injury propensity is primarily a function of training load and risk factors are population-specific. [ABSTRACT FROM AUTHOR]

Aim: Evaluate the impact of Tenofovir Disoproxil Fumarate (TDF) treatment on bone mineral density (BMD) for patients with chronic hepatitis B (CHB) with Dual X-ray absorptiometry (DEXA) and the Fracture Risk Assessment Tool (FRAX) score. Materials and Methods: A total of 38 CHB patients treated with TDF were included in this retrospective study. To estimate BMD, DEXA, demographic details, and laboratory values were examined in patients. The BMD measurements were compared after dividing the patients into 3 groups as normal BMD, osteopenic, and osteoporotic. FRAX scores (before and after DEXA) were calculated. Results: Twenty-one of the 38 (55.3%) cases of CHB infection were male, the median age was 51 (min-max: 29-71) years, and seven patients (18.4%) were over 60 years of age. The median TDF duration was median 6 (min-max: 3-13) years. Osteopenia, defined by DEXA results, was found in 17 patients (44.7%) at the lumbar spine site, 11 (28.9%) at the femoral neck, and 10 (26.3%) at the total hip. Osteoporosis was detected in six patients (15.8%) at the lumbar spine site. Pre-DEXA FRAX score and post-DEXA FRAX score were calculated. Only one patient (1/33, 3%) had a score over the intervention threshold, by post-DEXA FRAX score. None of the patients classified as low risk based on the pre-DEXA FRAX score had a post-DEXA FRAX score above the intervention threshold. When the TDF duration, serum phosphorus level, vitamin D levels, and ALP levels were compared, no significant differences were found between the groups. Conclusion: There are concerns about the negative effects of TDF used in CHB infection on BMD. However, BMD loss may not increase as the duration of TDF use increases. FRAX score is useful in identifying to risk of osteoporotic fracture. FRAX score can also eliminate the need for DEXA in most CHB cases. The FRAX score should be used in clinical practice to determine cases at risk. [ABSTRACT FROM AUTHOR]

Abstract Background Robust evidence on whether diagnostic discordance exists between lumbar osteoporosis detected by quantitative computed tomography (QCT) vs. dual-energy X-ray absorptiometry (DXA) is still lacking. In this study involving a relatively large prospective cohort of older men (aged > 60 years) and postmenopausal women, we assessed lumbar QCT-derived volumetric bone mineral density (vBMD) and DXA-derived area BMD and evaluated their predictive performance for prevalent vertebral fracture (VF). Methods A total of 501 patients who underwent spinal surgery from September 2020 to September 2022 were enrolled. The criteria recommended by the American College of Radiology and the World Health Organization were used for lumbar osteoporosis diagnosis. The osteoporosis detection rates between QCT and DXA were compared. QCT-vBMD was plotted against the DXA T score, and the line of best fit was calculated based on linear regression. Multivariate logistic regression was used to analyze the associations between risk factors and VF. Receiver operating characteristic curve analysis was performed, and the corresponding area under the curve (AUC) was calculated. Results QCT screening showed that 60.7% of patients had osteoporosis, whereas DXA screening showed that 50.7% of patients had osteoporosis. Diagnoses were concordant for 325 (64.9%) patients. In all, 205 patients suffered a VF of at least one anatomic level. Of these, 84.4% (173/205) were diagnosed with osteoporosis by QCT, while only 73.2% (150/205) were diagnosed by DXA. Multivariate logistic regression showed that osteoporosis detected by QCT exhibited a stronger relationship with VF than that detected by DXA (unadjusted OR, 6.81 vs. 5.04; adjusted OR, 3.44 vs. 2.66). For discrimination between patients with and without VF, QCT-vBMD (AUC = 0.802) showed better performance than DXA T score (AUC = 0.76). Conclusion In older patients undergoing spinal surgery, QCT-vBMD is more helpful than DXA in terms of osteoporosis detection rate and prediction of patients with prevalent VFs.

Background: Osteoporosis is a systemic skeletal disease that weakens bones by lowering mineral density and causing micro-architectural degradation of bony tissue. Aim: This study was conducted to examine the use of vitamin D, calcium, and estrogen levels in saliva as biomarkers for early detection of osteoporosis. Materials and Methods: Ninety postmenopausal women were divided into three groups based on T-scores from dual-energy X-ray absorptiometry scans. The groups consist of 30 women with osteoporosis, 30 women with osteopenia, and 30 women serving as controls. The enzyme-linked immunosorbent assay was used to look for vitamin D and estrogen in the saliva by specific vitamin D3 and estradiol kits. Calcium concentrations were measured by a colorimetric method. Results: The level of salivary biomarkers (vitamin D, calcium, and estrogen) showed a clear distinction between the groups analyzed. Salivary estrogen and vitamin D levels were significantly lower in patients with osteoporosis compared to those with osteopenia and controls. The highest concentration of calcium was found in the osteoporosis group's saliva compared to the other groups. Conclusion: The results highlight the significance of vitamin D, calcium, and estrogen in saliva as a simple, noninvasive biomarker in diagnosing postmenopausal osteoporosis.

Background: Children spend increasing amounts of time on recreational screen media, which may lead to an obesogenic environment. Objectives: We investigated the association of trajectories of screen time across ages 3, 5 and 7 years with body composition at age 7 in the Odense Child Cohort. Methods: Data were collected in the Municipality of Odense, Denmark, between 2010 and 2019. Group‐based trajectory modelling was applied to group participants into four trajectories of prospective parent‐reported screen time. Body composition was assessed using dual‐energy x‐ray absorptiometry with calculated fat‐mass index (FMI) as the primary outcome. Primary models were linear multivariable regression models adjusted for participants' sex, age, birthweight, maternal origin, maternal education, maternal body‐mass‐index, and maternal age. Further models were adjusted for additional possible confounders. Selection bias was addressed by inverse probability weighting. Results: In total, 803 children (48.2% female) were included in the primary analysis. Participants with screen time at all time points were assigned to four trajectory groups [constant low screen time (12.7%), low increase (36.3%), high increase between ages 3 and 5 (33.5%) and high increase in screen time (17.5%)]. Sample characteristics differed across missing data status and trajectories. Mean FMI (kg/m2) and standard deviation (SD) were 3.7 (SD 1.3) and 3.9 (SD 1.6) for the constant low versus high screen time, respectively. No differences in FMI were found between screen time trajectory groups at age 7 (adjusted mean difference 0.1 kg/m2, 95% confidence interval −0.3, 0.5 for constant low versus high screen time). No consistent associations between screen time groups and secondary body composition outcomes were found. Conclusions: Results from this study do not suggest that recreational screen time from age 3 to 7 years is associated with adiposity or other measures of body composition. [ABSTRACT FROM AUTHOR]

Abstract Background Cage subsidence may occur following transforaminal lumbar interbody fusion (TLIF) and lead to nonunion, foraminal height loss and other complications. Low bone quality may be a risk factor for cage subsidence. Assessing bone quality through Hounsfield units (HU) from computed tomography has been proposed in recent years. However, there is a lack of literature evaluating the correlation between HU and cage subsidence after TLIF. Methods Two hundred and seventy-nine patients suffering from lumbar degenerative diseases from April, 2016 to August, 2018 were enrolled. All underwent one-level TLIF with a minimum of 1-year follow-up. Cage subsidence was defined as > 2 mm loss of disc height at the fusion level. The participants were divided into 2 groups: cage subsidence group (CS) and non-cage subsidence group (non-CS). Bone quality was determined by HU, bone mineral density of lumbar (BMD-l) and femoral (BMD-f) from dual-emission X-ray absorptiometry (DXA). HU of each vertebra from L1 to L4 (e.g., HU1 for HU of L1) and mean value of the four vertebrae (HUm) were calculated. Visual analog scale (VAS) of back/leg pain and Oswestry disability index (ODI) were used to report clinical outcomes. Results Cage subsidence occurred in 82 (29.4%) cases at follow-ups. Mean age was 50.8 ± 9.0 years with a median follow-up of 18 months (range from 12 to 40 months). A total of 90.3% patients presented fusion with similar fusion rate between the two groups. ODI and VAS in leg were better in non-CS group at last follow-ups. Using receiver operating characteristic curves (ROCs) to predict cage subsidence, HUm provided a larger area under the curve (AUC) than BMD-l (Z = 3.83, P

Background: Robust evidence on whether diagnostic discordance exists between lumbar osteoporosis detected by quantitative computed tomography (QCT) vs. dual-energy X-ray absorptiometry (DXA) is still lacking. In this study involving a relatively large prospective cohort of older men (aged > 60 years) and postmenopausal women, we assessed lumbar QCT-derived volumetric bone mineral density (vBMD) and DXA-derived area BMD and evaluated their predictive performance for prevalent vertebral fracture (VF). Methods: A total of 501 patients who underwent spinal surgery from September 2020 to September 2022 were enrolled. The criteria recommended by the American College of Radiology and the World Health Organization were used for lumbar osteoporosis diagnosis. The osteoporosis detection rates between QCT and DXA were compared. QCT-vBMD was plotted against the DXA T score, and the line of best fit was calculated based on linear regression. Multivariate logistic regression was used to analyze the associations between risk factors and VF. Receiver operating characteristic curve analysis was performed, and the corresponding area under the curve (AUC) was calculated. Results: QCT screening showed that 60.7% of patients had osteoporosis, whereas DXA screening showed that 50.7% of patients had osteoporosis. Diagnoses were concordant for 325 (64.9%) patients. In all, 205 patients suffered a VF of at least one anatomic level. Of these, 84.4% (173/205) were diagnosed with osteoporosis by QCT, while only 73.2% (150/205) were diagnosed by DXA. Multivariate logistic regression showed that osteoporosis detected by QCT exhibited a stronger relationship with VF than that detected by DXA (unadjusted OR, 6.81 vs. 5.04; adjusted OR, 3.44 vs. 2.66). For discrimination between patients with and without VF, QCT-vBMD (AUC = 0.802) showed better performance than DXA T score (AUC = 0.76). Conclusion: In older patients undergoing spinal surgery, QCT-vBMD is more helpful than DXA in terms of osteoporosis detection rate and prediction of patients with prevalent VFs. [ABSTRACT FROM AUTHOR]

Purpose: Electrocardiogram (ECG) QRS voltages correlate poorly with left ventricular mass (LVM). Body composition explains some of the QRS voltage variability. The relation between QRS voltages, LVM and body composition in endurance athletes is unknown. Methods: Elite endurance athletes from the Pro@Heart trial were evaluated with 12-lead ECG for Cornell and Sokolow-Lyon voltage and product. Cardiac magnetic resonance imaging assessed LVM. Dual energy x-ray absorptiometry assessed fat mass (FM) and lean mass of the trunk and whole body (LBM). The determinants of QRS voltages and LVM were identified by multivariable linear regression. Models combining ECG, demographics, DEXA and exercise capacity to predict LVM were developed. Results: In 122 athletes (19 years, 71.3% male) LVM was a determinant of the Sokolow-Lyon voltage and product (β = 0.334 and 0.477, p < 0.001) but not of the Cornell criteria. FM of the trunk (β = − 0.186 and − 0.180, p < 0.05) negatively influenced the Cornell voltage and product but not the Sokolow-Lyon criteria. DEXA marginally improved the prediction of LVM by ECG (r = 0.773 vs 0.510, p < 0.001; RMSE = 18.9 ± 13.8 vs 25.5 ± 18.7 g, p > 0.05) with LBM as the strongest predictor (β = 0.664, p < 0.001). DEXA did not improve the prediction of LVM by ECG and demographics combined and LVM was best predicted by including VO2max (r = 0.845, RMSE = 15.9 ± 11.6 g). Conclusion: LVM correlates poorly with QRS voltages with adipose tissue as a minor determinant in elite endurance athletes. LBM is the strongest single predictor of LVM but only marginally improves LVM prediction beyond ECG variables. In endurance athletes, LVM is best predicted by combining ECG, demographics and VO2max. [ABSTRACT FROM AUTHOR]

Background Context: Level-specific lumbar bone mineral density (BMD) evaluation of a single vertebral body can provide useful surgical planning and osteoporosis management information. Previous comparative studies have primarily focused on detecting spinal osteoporosis but not at specific levels.Purpose: To compare the detection rate of lumbar osteoporosis between quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA); to explore and analyze the distribution models of QCT-derived BMD and DXA T-score at the specific levels; and to evaluate the diagnostic accuracy of level-specific BMD thresholds for the prediction of osteoporotic vertebral compression fracture (OVCF) in postmenopausal women.Study Design/setting: A comparative analysis of prospectively collected data comparing QCT-derived BMD with DXA T-score.Patient Sample: A total of 296 postmenopausal women who were referred to the spine service of a single academic institution were enrolled.Outcome Measures: QCT-derived BMD and DXA T-score at specific levels, with or without osteoporotic vertebral compression fracture.Methods: Postmenopausal women who underwent QCT and DXA within a week of admission from May 2019 to June 2022 were enrolled. The diagnostic criteria for osteoporosis recommended by the World Health Organization and the American College of Radiology were used for lumbar osteoporotic diagnosis. To evaluate differences in lumbar BMD measurements at specific levels, a threshold of T score=-2.5 and QCT-derived BMD = 80 mg/cm3 were used to categorize level-specific lumbar BMD into low and high BMD. Disagreements in BMD categorization between DXA and QCT were classified as a minor or major discordance based on the definition by Woodson. Data between QCT and DXA were visualized in a stacked bar plot and analyzed. Correlations between DXA and QCT at the specific levels were evaluated using Pearson's linear correlation and scatter plots. Curve fitting of BMD distribution, receiver operating characteristic (ROC) and area under the curve (AUC) for each single vertebral level was performed.Results: Of the 296 patients, QCT diagnosed 61.1% as osteoporosis, 30.4% as osteopenia and 8.4% as normal. For those screened with DXA, 54.1% of the patients had osteoporosis, 29.4% had osteopenia and 16.6% had normal BMD. Diagnoses were concordant for 194 (65.5%) patients. Of the other 102 discordant patients, 5 (1.7%) were major and 97 (32.8%) were minor. Significant correlations in level-specific BMD between DXA and QCT were observed (p<.001), with Pearson's correlation coefficients ranging from 0.662 to 0.728. The correlation strength was in the order of L1 > L2 > L3 > L4. The low BMD detection rate for QCT was significantly higher than that for DXA at the L3 and L4 levels (65% vs. 47.9% and 68.1% vs 43.7, respectively, p<.001). Patients with OVCF showed significantly lower QCT-derived BMD (47.2 mg/cm3 vs. 83.2 mg/cm3, p<.001) and T-score (-3.39 vs. -1.98, p<.001) than those without OVCF. Among these patients, 82.8% (101/122) were diagnosed with osteoporosis by QCT measurement, while only 74.6% (91/122) were diagnosed by DXA. For discrimination between patients with and without OVCF, QCT-derived BMD showed better diagnosed performance (AUC range from 0.769 to 0.801) than DXA T-score (AUC range from 0.696 to 0.753).Conclusion: QCT provided a more accurate evaluation of lumbar osteoporosis than DXA. The QCT-derived BMD measurements at a specific lumbar level have a high diagnostic performance for OVCF. [ABSTRACT FROM AUTHOR]

The aim – to determine the possibility of identifying individuals with osteoporosis using asynchronous computed quantitative tomography (CT) of the proximal femur by comparison with dual-energy X-ray absorptiometry (DХA).Materials and methods. The study included 40 postmenopausal women and 6 men over 50 years old (Me of age – 72.5 [65.3; 77.7] years) referred by the attending physician for densitometric examination. The patients signed an informed consent. The measurements were performed on a DXA with a narrow fan beam (Lunar Prodigy Advance, GE Healthcare, USA), and QCT on the Aquilion 64 (Canon Medical Systems, Japan). Correlation analysis and comparison of projected bone mineral density (BMD), bone mineral content (BMC), measurement area and T-score using the Blend – Altman method were carried out.Results. A statistically significant correlations were revealed between the indicators of DXA and asynchronous QCT: for femoral neck BMD r=0.93; for the T-score r=0.93; for the total hip – r=0.91 and r=0.91 respectively. When conducting the analysis using the Blend – Altman method, it was found that the QCT underestimated the value of the femoral neck BMC (bias –0.923 g), covered a smaller area of interest (bias 0.376 cm2 ), and therefore there was a shift in the values of BMD by –0.224 g/cm2 . The value of the T-score for the femoral neck had bias –0.29 standard deviations (SD), and for the total hip –0.72 SD, which were statistically significant.Conclusions. There was a high correlation between quantitative indicators of bone tissue of the proximal hip, assessed using QCT and DXA. The BMD and T-score values for the femoral neck and the total hip at QCT were lower compared to the values of the DXA results. Considering the conducted research, it is recommended that when introducing asynchronous QCT into clinical practice to identify people with osteoporosis, a synchronous phantom should be pre-scanned to compare the QCT and DXA results, followed by adjusting the BMD and T-score values for QCT by the average difference between them.

BackgroundThere is evidence that human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are independent risk factors for osteoporosis and fracture which is not solely explained by changes in bone mineral density. Thus, we hypothesized that the assessment of trabecular microstructure might play an important role for bone quality in this population and might explain the increased fracture risk. In this study, we have assessed bone microstructure in the proximal femur using high-resolution magnetic resonance imaging (MRI) as well as in the extremities using high resolution peripheral quantitative computed tomography (HR-pQCT) in HIV-infected men and healthy controls and compared these findings to those based on areal bone mineral density (aBMD) derived from dual X-ray absorptiometry (DXA) which is the standard clinical parameter for the diagnosis of osteoporosis.MethodsEight HIV-infected men and 11 healthy age-matched controls were recruited and informed consent was obtained before each scan. High-resolution MRI of the proximal femur was performed using fully balanced steady state free precession (bSSFP) on a 3T system. Three volumes of interest at corresponding anatomic locations across all subjects were defined based on registrations of a common template. Four MR-based trabecular microstructural parameters were analyzed at each region: fuzzy bone volume fraction (f-BVF), trabecular number (Tb.N), thickness (Tb.Th), and spacing (Tb.Sp). In addition, the distal radius and distal tibia were imaged with HR-pQCT. Four HR-pQCT-based microstructural parameters were analyzed: trabecular bone volume fraction (BV/TV), Tb.N, Tb.Th, and Tb.Sp. Total hip and spine aBMD were determined from DXA.ResultsMicrostructural bone parameters derived from MRI at the proximal femur and from HR-pQCT at the distal tibia showed significantly lower bone quality in HIV-infected patients compared to healthy controls. In contrast, DXA aBMD data showed no significant differences between HIV-infected patients and healthy controls.ConclusionsOur results suggest that high-resolution imaging is a powerful tool to assess trabecular bone microstructure and can be used to assess bone health in HIV-infected men who show no differences to healthy males by DXA aBMD. Advances in MRI technology have made microstructural imaging at the proximal femur possible. Further studies in larger patient cohorts are clearly warranted.

The efficacy of opportunistic osteoporosis screening with computed tomography (CT) scans obtained for other indications has not yet been implemented by the current guidelines. We aimed to compile available evidence on the efficacy of osteoporosis screening with CT scans obtained for other indications compared with dual X-ray absorptiometry (DXA). Studies comparing the diagnostic performance of the CT scan with the DXA published before 2023 were retrieved. We conducted a bias assessment using the Newcastle-Ottawa Scale for cross-sectional studies. Correlation coefficients (CC), area under the curve (AUC), sensitivity, and specificity of the CT scans compared with the DXA were meta-analyzed with random effects modeling. 41 studies fulfilled the inclusion/exclusion criteria. The included studies reported weak to very strong CC (0.35 to 0.95) and low to high accuracy for opportunistic osteoporosis screening with CT scans. The meta-analysis showed a moderate pooled CC of 0.59 (95 % CI: 0.53-0.64, P-value<0.001), and a relatively high AUC of 0.81 (95 % CI: 0.78-0.84, P-value<0.001). Subgroup analysis based on age and menopausal status did not show significant between-group differences. Significantly higher accuracy measures were estimated for CT scans of the proximal femur compared to other anatomic regions (CC: 0.70, 95 % CI: 0.57-0.82; AUC: 0.79, 95 % CI: 0.72-0.87), North American cases (CC: 0.66, 95 % CI: 0.52-0.80; AUC: 0.82, 95 % CI: 0.82-0.83), and populations with a higher percentage of women (CC: 0.60, 95 % CI: 0.52-0.69; AUC: 0.86, 95 % CI: 0.83-0.89). We observed a moderate performance of opportunistic osteoporosis screening with CT scans obtained for other indications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Our study's purpose was to determine the most reliable Hounsfield unit (HU) measurement method to reflect bone mineral density (BMD) on cervical spine computed tomography (CT) and to identify any factors that influence these results.Materials and Methods: We retrospectively analyzed 439 consecutive patients with mild head and neck injuries. Mean HU values of the C2-C7 vertebra were determined on each sagittal, coronal, and axial CT image. Correlation patterns were analyzed between the HU value and corresponding dual-energy X-ray absorptiometry (DXA) in the lumbar vertebra (T-score) and femoral neck (T-score). A sub-group analysis was performed according to patient age, sex, and degree of spinal degeneration.Results: The correlation coefficients for HU and DXA ranged from 0.52 to 0.65 in all cervical segments. A simple linear regression analysis revealed the following formula: T-score = 0.01 × (HU) - 4.55. The mean HU values for osteopenia and osteoporosis were 284.0 ± 63.3 and 231.5 ± 52.8, respectively. The ROC curve indicated that the HU method has a sensitivity of 89.2% and specificity of 88.7% to diagnose osteoporosis. The HU measurement showed a high correlation value (range: r = 0.64-0.70) with spine DXA score regardless of the degree of degeneration or patient age or sex.Conclusion: HU values using the upper two cervical vertebrae (C2 and C3) reflected a more reliable BMD level than other segments. Additionally, the HU of cervical CT provided reliable information regardless of measurement plane, age or sex, and degree of degeneration. [ABSTRACT FROM AUTHOR]

Background: Cage subsidence may occur following transforaminal lumbar interbody fusion (TLIF) and lead to nonunion, foraminal height loss and other complications. Low bone quality may be a risk factor for cage subsidence. Assessing bone quality through Hounsfield units (HU) from computed tomography has been proposed in recent years. However, there is a lack of literature evaluating the correlation between HU and cage subsidence after TLIF. Methods: Two hundred and seventy-nine patients suffering from lumbar degenerative diseases from April, 2016 to August, 2018 were enrolled. All underwent one-level TLIF with a minimum of 1-year follow-up. Cage subsidence was defined as > 2 mm loss of disc height at the fusion level. The participants were divided into 2 groups: cage subsidence group (CS) and non-cage subsidence group (non-CS). Bone quality was determined by HU, bone mineral density of lumbar (BMD-l) and femoral (BMD-f) from dual-emission X-ray absorptiometry (DXA). HU of each vertebra from L1 to L4 (e.g., HU1 for HU of L1) and mean value of the four vertebrae (HUm) were calculated. Visual analog scale (VAS) of back/leg pain and Oswestry disability index (ODI) were used to report clinical outcomes. Results: Cage subsidence occurred in 82 (29.4%) cases at follow-ups. Mean age was 50.8 ± 9.0 years with a median follow-up of 18 months (range from 12 to 40 months). A total of 90.3% patients presented fusion with similar fusion rate between the two groups. ODI and VAS in leg were better in non-CS group at last follow-ups. Using receiver operating characteristic curves (ROCs) to predict cage subsidence, HUm provided a larger area under the curve (AUC) than BMD-l (Z = 3.83, P < 0.01) and BMD-f (Z = 2.01, P = 0.02). AUC for HU4 was larger than BMD-f and close to HUm (Z = 0.22, P = 0.481). Conclusions: Cage subsidence may indicate worse clinical outcomes. HU value could be a more effective predictor of lumbar cage subsidence compared with T-score of DXA after TLIF. [ABSTRACT FROM AUTHOR]

The accurate age at death assessment of unidentified adult skeletal individuals is a critical research task in forensic anthropology, being a key feature for the determination of biological profiles of individual skeletal remains. We have previously shown that the age-related decrease of bone mineral density (BMD) in the proximal femur could be used to assess age at death in women (Navega et al., J Forensic Sci 63:497–503, 2018). The present study aims to generate models for age estimation in both sexes through bone densitometry of the femur and radiogrammetry of the second metacarpal. The training sample comprised 224 adults (120 females, 104 males) from the "Coimbra Identified Skeletal Collection," and different models were generated through least squares regression and general regression neural networks (GRNN). The models were operationalized in a user-friendly online interface at https://osteomics.com/DXAGE2/. The mean absolute difference between the known and estimated age at death ranges from 9.39 to 13.18 years among women and from 10.33 to 15.76 among men with the least squares regression models. For the GRNN models, the mean absolute difference between documented and projected age ranges from 8.44 to 12.58 years in women and from 10.56 to 16.18 years in men. DXAGE 2.0 enables age estimation in incomplete and/or fragmentary skeletal remains, using alternative skeletal regions, with reliable results. [ABSTRACT FROM AUTHOR]

Pompe disease is a rare autosomal recessive disorder caused by the deficiency of acid α-glycosidase resulting in accumulation of glycogen in the lysosomes. The late-onset form of the disease (LOPD) causes primarily progressive muscle weakness and respiratory insufficiency. Enzyme replacement therapy (ERT) introduced in 2006, showed mild improvement or stabilization of the symptoms although long-term data are limited. Aim of the study was to describe the progression of body composition and walking ability in LOPD patients receiving ERT consistently for 9 years. Lean body mass, bone mineral density, body fat and 6 min walking distance were assessed in three male and three female LOPD patients (height 165.8 ± 11.2 cm, age 42.3 ± 11.8yrs, body mass 71.1 ± 20.8 kg, at study entry), every three years, for 9 years since ERT initiation (T0, T3, T6, T9). Total body and upper extremities' lean mass remained unchanged (p < 0.05), but it was decreased for the lower extremities (T3:13.06 ± 3.848 kg vs. T9:11.63 ± 3.49 kg, p < 0.05). Lean body mass was not significantly different after 9 years of ERT compared to before the ERT initiation (T0 to T9). Bone mineral density remained unchanged. Percent body fat increased (T0:39.1 ± 10.3%, vs. T9:43.1 ± 10.4%, p < 0.05). Six minute walking distance tended to increase after 3 years of ERT and decreased gradually thereafter, with no difference between T0-T9. Lean mass of the lower extremities adjusted for body weight was significantly correlated with 6 min walking distance (r = 0.712, p < 0.05). The current data show that enzyme replacement therapy may preserve lean body mass, bone mineral density and walking capacity in LOPD patients. [ABSTRACT FROM AUTHOR]

• The Endocrine Society Annual Meeting (ENDO), San Francisco, CA, USA, March 28–31, 2020. • The annual meeting of the World Congress on Osteoporosis (WCO) - International Osteoporosis Foundation (IOF) - European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases (ESCEO), Barcelona, Spain, August 20–23, 2020. • The Annual Meeting of the American Society for Bone and Mineral Research (Virtual), September 11–15, 2020. In ACTIVE, abaloparatide increased areal BMD (aBMD) of the hip and femoral neck vs teriparatide and placebo in women with osteoporosis. Previously, 3D-processing of dual X-ray absorptiometry (DXA) scans of a subgroup of ACTIVE subjects showed similar increases in trabecular volumetric BMD (Tb.vBMD) and greater increases in cortical vBMD (Ct.vBMD) of the total hip with abaloparatide vs teriparatide. The current analyses from this subgroup describe 2D- and 3D-DXA data for hip subregions. Randomly selected subjects from ACTIVE (n = 250/treatment group) who received 18 mo of placebo, abaloparatide 80 µg, or open-label teriparatide 20 µg by daily subcutaneous injection underwent hip DXA at baseline, and mo 6 and 18 of treatment. Areal BMD of the femoral neck, trochanter, and femoral shaft was determined using standard 2D-DXA and 3D-SHAPER software to retrospectively evaluate changes from baseline in volumetric parameters of these 3 hip subregions, including trabecular and cortical segmentation. Changes in biomechanical parameters cross-sectional moment of inertia (CSMI), section modulus (Z), and buckling ratio were also evaluated. Femoral neck, trochanter, and shaft aBMD increased in the abaloparatide and teriparatide groups at mo 6 and 18 vs placebo, with greater increases for abaloparatide vs teriparatide at the femoral neck at mo 6 and the shaft at mo 6 and 18. All 3 subregions showed similar significant increases in Tb.vBMD with abaloparatide and teriparatide vs placebo, whereas Ct.vBMD of all 3 subregions showed greater increases after 18 mo of abaloparatide vs teriparatide. Biomechanical parameters improved in all subregions with abaloparatide and teriparatide vs placebo, with greater improvements in CSMI and Z of the femoral neck and lower shaft after 6 and 18 mo of abaloparatide vs teriparatide. Differential femoral neck and shaft Ct.vBMD responses may explain the greater increases in CSMI and Z of those subregions with abaloparatide vs teriparatide. [ABSTRACT FROM AUTHOR]

Czeck, MA, Roelofs, EJ, Evanoff, NG, and Dengel, DR. No Changes in body composition in NCAA Division I Collegiate Football Players due to COVID-19 restrictions. J Strength Cond Res 36(6): 1749–1752, 2022—The purpose of this study was to explore the impact of coronavirus disease 2019 (COVID-19) restrictions on body composition, assessed by dual x-ray absorptiometry (DXA), between the 2020 postseason (pre–COVID-19 restrictions) and the 2021 postseason (post–COVID-19 restrictions) in collegiate football players (n = 50). In addition, a subset of athletes (n = 23) was used to explore body composition variables across 4 postseason time points. Body composition variables assessed were total and regional body fat percent, total mass, lean mass, fat mass, bone mineral content, bone mineral density, and visceral adipose tissue mass. Paired t -tests were used to determine differences between the 2020 postseason and the 2021 postseason in body composition variables. Analysis of variance with Tukey HSD post hoc tests assessed significant differences in total and regional body composition across 4 years while adjusting for multiple comparisons. There were no significant differences (p > 0.05) between postseason 2020 and postseason 2021 for all measures of body composition. In a subset of athletes, body composition was analyzed over a 4-year period of time. There were no significant differences between all 4 time points for all measures of body composition. In conclusion, body composition variables in this study's subjects were not affected because of coronavirus disease 2019 restrictions or over 4 years of their collegiate football career. [ABSTRACT FROM AUTHOR]

Wichmann, TK, Wolfson, J, Roelofs, EJ, Bosch, TA, Bach, CW, Oliver, JM, Carbuhn, A, Stanforth, PR, and Dengel, DR. Longitudinal assessment of NCAA Division I football body composition by season and player age. J Strength Cond Res 36(6): 1682–1690, 2022—The purpose of this study was to examine longitudinal body composition changes by position, categorized by season and age, using dual X-ray absorptiometry in NCAA Division I football players. Seven hundred nineteen collegiate male football players aged 18–22 years ( X ¯ age ± SE = 19.4 ± 0.05 years) were examined. Percent body fat (%BF), fat mass (FM), lean mass (LM), total body mass (TM), bone mineral density (BMD), and visceral adipose tissue (VAT) were measured. Players were categorized into position groups of Linemen, Big Skill, Skill, or Special Team. One player scan was used per season (preseason, postseason, and spring season). Analysis of variance and Tukey HSD assessed total and regional differences across age, position groups, and seasons (significance of p < 0.05). Linemen had the greatest FM and LM measures compared with other groups for season and age. From preseason to postseason, %BF, FM, LM, and BMD significantly decreased for each position group. From postseason to spring season, %BF, FM, and VAT decreased, whereas LM increased within each position group. FM, VAT, LM, and TM increased with age in all position groups. The findings of this study indicate that body composition significantly worsened from preseason to postseason and improved from the preseason and postseason to the spring season. [ABSTRACT FROM AUTHOR]

BACKGROUND: In vertebrae, the amount of cortical bone has been estimated at 30–60%, but 45–75% of axial load on a vertebral body is borne by cortical bone. OBJECTIVE: To compare the role of L1 CT-attenuation and cortical thickness in predicting osteoporosis by opportunistic CT and explore cortical thickness value in osteoporosis. METHODS: We collected data of 94 patients who underwent DXA and thoracic and/or abdominal CT to demonstrate an entire L1 for other indications in routine practice. Patients were divided into three groups according to T-score: osteoporosis, osteopenia, or normal. CT-attenuation value and cortical thickness of L1 were measured. ANOVA analysis was utilized to analyze CT-attenuation and cortical thickness among the three groups. Sensitivity, specificity, and area under the curve (AUC) predicting low BMD were determined using ROC. Pearson correlations were employed to describe relationship between L1 BMD and CT-attenuation value, BMD, as well as cortical thickness. RESULTS: The mean cortical thickness was 0.83±0.11, 0.72±0.10, and 0.64±0.09 mm for normal, osteopenia, and osteoporotic subgroups, respectively. A statistically significant difference was observed in cortical thickness and CT-attenuation value among these three subgroups. A mean CT-attenuation value threshold of > 148.7 yielded 73.0% sensitivity and 86.0% specificity for distinguishing low BMD from normal with an AUC = 0.83. Pearson correlation analysis indicated that BMD was positively correlated with CT-attenuation (r = 0.666, P < 0.001) and cortical thickness (r = 0.604, P < 0.001). CONCLUSIONS: L1 CT-attenuation and cortical thickness measured on opportunistic CT can help predict osteoporosis. Compared with cortical thickness, CT-attenuation is a more sensitive and accurate index for distinguishing low BMD from normal. [ABSTRACT FROM AUTHOR]

Objectives Glucocorticoids (GCs) increase the risk of fracture through reduction in BMD; they may also reduce bone quality, but recent supporting data are scarce. We aimed to confirm these effects in a large population-based cohort. Methods We used data from patients referred for first hip and lumbar spine BMD estimation by the sole DXA scanner in the north-west of England between June 2004 and September 2016. We compared the history of fractures and BMD between patients currently on GCs and patients never exposed to GC. A logistic model adjusted for possible confounders. Results More than 20 000 subjects were included, 82% female, with mean age 63 (s. d. 13) years; 19% were currently on GCs. The patients on GCs were more often male, with higher BMI, but their age was similar to those not exposed to GC. Surprisingly, patients receiving GCs had ∼2% higher BMD at both sites (P  < 0.001) and lower prevalence of (history of) fractures (22% vs 34%; P  < 0.001). The corresponding odds ratio was 0.53 (95% CI: 0.49, 0.58); adjustment for age, sex, BMI and the number of indications for scanning did not alter the association. Conclusion In this large population-based cohort, current GC use compared with never use was associated with higher bone mass and fewer rather than more fractures after adjusting for confounders. These results might be subject to unmeasured confounding, but for now they do not lend support to a detrimental effect of GCs on bone. [ABSTRACT FROM AUTHOR]

DXA-derived reference data for visceral adipose tissue (VAT) and advanced hip analysis (AHA) parameters spanning the entire adult lifespan are limited. The purpose of this study was to develop age-, site- and sex-specific reference data for dual X-ray absorptiometry (DXA) -derived body composition, trabecular bone score (TBS) and advanced hip analysis (AHA) parameters across the adult lifespan. Adults (N = 908; female: 561 and male: 347) from Calgary and the surrounding area over the age of 20 years participated in this study. Participants received DXA scans of their hip (total hip [TH] and femoral neck [FN]), lumbar spine [LS], forearm [33 % site] and total body (iDXA, GE Lunar, GE Healthcare). Areal bone mineral density (aBMD, g/cm 2 ) was captured at all sites, and body composition variables, including lean mass, fat mass and percent fat, were analyzed from the total body scan. VAT mass was assessed from total body DXA scans. Advanced hip analysis (AHA) was performed on hip scans and trabecular bone score (TBS) on the LS scans to assess bone quality. Site- and sex-specific centile curves and tables were generated using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Clinicians and researchers can use these Canadian reference data as a tool to assess body composition, TBS and AHA parameters across the adult lifespan., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Czeck, MA, Roelofs, EJ, Dietz, C, Bosch, TA, and Dengel, DR. Body composition and on-ice skate times for NCAA Division I collegiate male and female ice hockey athletes. J Strength Cond Res 36(1): 187–192, 2022—This study's purpose was to explore positional differences for an on-ice timed skate test and its relationship to body composition. Male (n = 15) and female (n = 18) collegiate hockey players participated in this study (total n = 33). Each player was categorized by position of forward or defensemen. Dual x-ray absorptiometry assessed total body composition variables of lean, fat, and bone mass as well as regional measures of lean mass, fat mass, and visceral adipose tissue. Total time and section times were determined for the on-ice skating test through a gated automatic timing system at 9, 18, 24, 42, 48, 66, 82, 132, and 148 m. Analysis of variance and Tukey's honest significance difference assessed on-ice skate time differences between positions (p ≤ 0.05). Correlations between body composition variables and skate times were determined for change of direction, skating time, linear skate time, and total skate time. There were no significant differences between positions for skate times (p > 0.05). Body fat percent (p = 0.007; r = 0.55), total fat mass (p = 0.027; r = 0.46), and leg fat mass (p = 0.019; 0.49) were significantly correlated with total skate time in men, whereas only body fat percent was significantly correlated with change of direction (p = 0.022; r = 0.54) and total skate times (p = 0.016; r = 0.56) in women. The total upper-body mass to leg lean mass ratio was significantly correlated with change of direction (p = 0.036; r = 0.50) in women. In conclusion, the results from this study suggest no differences between on-ice skating times between forwards and defensemen. However, body fat percentage was correlated with on-ice skate times in male and female collegiate hockey players. [ABSTRACT FROM AUTHOR]

Elderly ankle fractures in the elderly represent a substantial healthcare burden. Dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosis of osteoporosis. However, there is emerging research regarding secondary imaging techniques to evaluate bone mineral density (BMD). The purpose of this systematic review was to summarize the role of secondary imaging techniques for measuring BMD in elderly ankle fractures. A literature search was undertaken using relevant search terms. Articles were screened for suitability and data extracted where studies met inclusion criteria and were of sufficient quality. Eight studies were included in the systematic review. Computed tomography (CT) may have a role in preoperative surgical planning, provide an explanation for injury patterns in elderly patients, and may be correlated with clinical outcomes. High-resolution peripheral quantitative CT may be better suited than DXA for the assessment of ankle fractures due to the resolution of the image and its ability to distinguish between bone compartments, as well as provide a more accurate estimation of bone quality. Quantitative ultrasound has shown promise as a tool for measuring BMD in patients with osteoporosis, but is not able to detect osteoporosis in patients with ankle fractures. This paper helps define the role of each modality in the spectrum of care in the evaluation of osteoporosis as it pertains to elderly ankle fractures. [ABSTRACT FROM AUTHOR]