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Metabolic tumor volume is a volume defined as the total metabolically active tumor volume of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) exams. Calculating the metabolic tumor volume (MTV) is often time consuming requiring a high degree of manual input. A comparison of MTV calculations obtained by a board-certified Nuclear Radiologist and two Nuclear Medicine Technologist Students (NMTS) was performed in this study. A 30-minute training session with a Nuclear Radiologist was performed with the NMTS after their classroom time as part of their educational program. The NMTS calculated MTV within 7.5% of the Radiologist in a set of DLBCL patients undergoing initial staging FDG PET/CT. These findings suggest NM Technologists may help accelerate implementation of MTV into clinical practice with favorable accuracy, possibly as an initial step followed by interpreting physician validation. The aim of this study is to explore improved efficiency of calculating total MTV by integrating Nuclear Medicine (NM) Technologists with a semi-automated workflow.

Objectives Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. Methods A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. Results There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant’s medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. Discussion When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.

Background: Peptide receptor radionuclide therapy with 177Lu-dotatate is a novel therapy for metastatic neuroendocrine cancers. It undergoes reabsorption at the proximal tubule; after the breakdown of the peptide fragment, 177Lu is retained and continues its decay process exposing the nephron to continuous low dose radiation. Pivotal NETTER-1 trial did not include patients with eGFR Methods: We performed a retrospective chart review of all consecutive adult patients that received 177Lu-dotatate over 1 year at Mayo Clinic, Rochester. We analyzed renal and hematological laboratory data obtained prior to each of four treatment cycles and at 3- and 6-month post completion of all treatment. We defined CKD as eGFR Results: Overall 86 patients were included in the study with 39 (45%) with known CKD. About three patients had CKD, four with eGFR of 20–30 ml/min. About 4 (4.6%) patients had AKI and the predominant cause being hypotension. Among the CKD patients the average eGFR improved after the first cycle of PRRT therapy from baseline of 49 (13) to 53.5 (17) ml/min ( p = 0.01) with no significant decline of renal function noted at 3- and 6-months post treatment follow up. Rate of thrombocytopenia and leukopenia were significantly more in the CKD patients starting even after single treatment. No drug dose correlation was noted. Conclusion: Patients with CKD are at a higher risk of hematological toxicity especially with thrombocytopenia and require close monitoring and ongoing dose adjustment. Ongoing safety studies to assess the long-term impact of 177Lu-dotatate on the kidney are needed.

Radium-223 (Ra-223) has been recommended for bone-dominant metastatic castration-resistant prostate cancer (mCRPC). Second-generation hormone therapy in combination with Ra-223 in mCRPC has been utilized, yet its benefit has not been well elucidated. We investigated the potential survival benefit of concomitant enzalutamide with Ra-223 in the third-line setting and predictors of improved overall survival (OS).We retrospectively identified 51 patients with bone-dominant mCRPC that were treated with Ra-223 in the postchemotherapy and post-hormone therapy setting, either alone (group A; n = 32) or with concomitant enzalutamide (group B; n = 19). The primary endpoint was to study the OS difference between groups A and B. The secondary endpoint was to identify predictors of improved OS with Ra-223 in the third-line setting.Mean age was 70.9 years, median baseline prostatic-specific antigen (PSA) was 23.1 ng/mL, alkaline phosphatase was 91 IU/L, and hemoglobin was 12.5 g/dL. There was no difference in median OS between groups A and B, at 20.4 versus 17.5 months, respectively (P = .5186). In univariate and multivariate analyses, only pre-Ra-223 PSA 30 ng/mL and Eastern Cooperative Oncology Group performance status 2 were associated with improved OS.In our study cohort, concomitant use of enzalutamide with Ra-223 in the mCRPC setting was not associated with improved OS. Only pretreatment PSA 30 ng/mL and pretreatment Eastern Cooperative Oncology Group performance status 2 were associated with improved OS. Further prospective studies are warranted.

Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs. In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies. We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.

We report a case of smoldering multiple myeloma patient who developed signs and symptoms consistent with polyarthritis. A PET-CT demonstrated marked FDG activity in multiple joints, concerning for inflammatory arthritis. Arthrocentesis from the glenohumeral joint was consistent with inflammatory synovial fluid with no evidence for infection or crystals. Congo-red stain of the synovial fluid was positive, and mass-spectrometry based amyloid typing was consistent with wild-type transthyretin type. The patient responded instantly to glucocorticoids. This case reports highlights the feasibility of non-tissue diagnosis of amyloidosis using body fluids and underscores the importance of accurate typing to avoid erroneous treatment.

Implicit bias is common and is thought to drive discriminatory behaviour. Having previously demonstrated discrimination against specific applicant demographics by academic radiology departments in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation.A total of 51 faculty reviewers at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race or ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self-awareness of bias.A total of 31 out of 51 faculty reviewers (61%) completed and submitted results of race and weight Implicit Association Tests. A total of 74% (23/31) reported implicit anti-obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations (SDs) lower than non-obese applicants (P .001). A total of 71% (22/31) reported implicit anti-Black bias, discordant with application ratings, which were 0.47 SDs higher for Black than for White applicants (P .001). A total of 84% (26/31) of participants reported feeling self-aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self-awareness of potential anti-obese bias (P .001). Participation in formal diversity training was not associated with implicit anti-Black or anti-fat bias, nor with self-reported awareness of potential racial or weight-based bias (all P .2).These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation.

This retrospective analysis identifies predictors of survival in a cohort of patients with meta-iodobenzylguanidine (MIBG)-positive stage IV pulmonary and gastroenteropancreatic neuroendocrine tumor (P/GEP-NET) treated with 131I-MIBG therapy, to inform treatment selection and posttreatment monitoring. Methods: Survival, symptoms, imaging, and biochemical response were extracted via chart review from 211 P/GEP-NET patients treated with 131I-MIBG between 1991 and 2014. For patients with CT follow-up (n = 125), imaging response was assessed by RECIST 1.1 if images were available (n = 76) or by chart review of the radiology report if images could not be reviewed (n = 49). Kaplan-Meier analysis and Cox multivariate regression estimated survival and progression-free survival benefits predicted by initial imaging, biochemical response, and symptomatic response. Results: All patients had stage IV disease at the time of treatment. Median survival was 29 mo from the time of treatment. Symptomatic response was seen in 71% of patients, with the median duration of symptomatic relief being 12 mo. Symptomatic response at the first follow-up predicted a survival benefit of 30 mo (P < 0.001). Biochemical response at the first clinical follow-up was seen in 34% of patients, with stability of laboratory values in 48%; response/stability versus progression extended survival by 40 mo (P < 0.03). Imaging response (20% of patients) or stability (60%) at the initial 3-mo follow-up imaging extended survival by 32 mo (P < 0.001). Additionally, multiple 131I-MIBG treatments were associated with 24 mo of additional survival (P < 0.05). Conclusion: Therapeutic 131I-MIBG for metastatic P/GEP-NETs appears to be an effective means of symptom palliation. Imaging, biochemical, and symptomatic follow-up help prognosticate expected survival after 131I-MIBG therapy. Multiple rounds of 131I-MIBG are associated with prolonged survival.

Fibroinflammatory disorders are rare disorders characterized by chronic inflammation in combination with fibrosis that affect multiple organs. Among the fibroinflammatory disorders, 2 present with specific cardiovascular involvement, the immunoglobulin G4–related disease, which presents with

To determine whether the recently introduced Bayesian penalized likelihood PET reconstruction (Q.Clear) increases the visual conspicuity and SUVmax of small pulmonary nodules near the PET resolution limit, relative to ordered subset expectation maximization (OS-EM). In this institutional review board-approved and HIPAA-compliant study, 29 FDG PET/CT scans performed on a five-ring GE Discovery IQ were retrospectively selected for pulmonary nodules described in the radiologist’s report as “too small to characterize”, or small lung nodules in patients at high risk for lung cancer. Thirty-two pulmonary nodules were assessed, with mean CT diameter of 8 mm (range 2–18). PET images were reconstructed with OS-EM and Q.Clear with noise penalty strength β values of 150, 250, and 350. Lesion visual conspicuity was scored by three readers on a 3-point scale, and lesion SUVmax and background liver and blood pool SUVmean and SUVstdev were recorded. Comparison was made by linear mixed model with modified Bonferroni post hoc testing; significance cutoff was p

Context Prognosis of metastatic pheochromocytoma/paraganglioma following 131-Iodine metaiodobenzylguanidine (MIBG) is incompletely characterized due to small samples and shorter follow-up in these rare, often indolent tumors. Objective To describe long-term survival, frequency, and prognostic impact of imaging, biochemical, and symptomatic response to 131-I MIBG. Design Retrospective chart and imaging review at a tertiary referral center. Patients Six hundred sixty-eight person-years of follow-up in 125 patients with metastatic pheochromocytoma/paraganglioma with progression through prior multimodal treatment. Intervention Median 18 800 MBq 131-I MIBG. Main Outcome Measures Overall survival, Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST) imaging response, symptomatic response per chart review, and biochemical response (20% change over 2 consecutive assays of catecholamines, vanillylmandelic acid, metanephrines, or chromogranin A). Results Median survival standard deviation [SD] from diagnosis was 11.5 years [2.4]; following metastasis, 6.5 years [0.8]; post treatment, 4.3 years [0.7]. Among 88 participants with follow-up imaging, 1% experienced complete response, 33% partial response, 53% stability, and 13% progression. Fifty-one percent showed subsequent progression, median progression-free survival [SD] of 2.0 years [0.6]. Stability/response vs progression at first imaging follow-up (3–6 months) predicted improved survival, 6.3 vs 2.4 years (P = 0.021). Fifty-nine percent of 54 patients demonstrated biochemical response. Fifty percent of these relapsed, with median time to laboratory progression [SD] of 2.8 years [0.7]. Biochemical response did not predict extended survival. Seventy-five percent of 83 patients reported improvement in pretreatment symptoms, consisting primarily of pain (42%), fatigue (27%), and hypertension (14%). Sixty-one percent of these patients experienced subsequent symptomatic progression at median [SD] 1.8 years [0.4]. Symptomatic response did not predict extended survival. Conclusions Imaging, symptomatic, and laboratory response to multimodal treatment including high-dose 131-I MIBG were achieved on long-term follow-up in metastatic pheochromocytoma or paraganglioma. Imaging response at 3 to 6 months was prognostic.

To evaluate for appearance-based discrimination in the selection of radiology residents.A deception study simulating the resident selection process examined the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from 5 academic radiology departments reviewed mock residency applications in September and October 2017. Each application included demographic information and a photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed- and random-effects models.Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive vs unattractive, B = 0.30 [SE = 0.056]; neutral vs unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (vs not obese) (B = -0.14 [SE = 0.024]).Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

To objectively and subjectively evaluate a large, academic radiology department's transition to electronic health record (EHR) centered workflow.Multiple metrics were compared from before and after the move to EHR-driven workflow. Examination ordering and reading priority data were obtained for 30 days both before and after the transition. Sixteen radiologists were observed opening a computed tomography (CT) examination, and time to open, mouse clicks, and keystrokes were recorded. Information available to the radiologist during interpretation was also compared. Additionally, a 12 question survey was sent out to the residents and faculty both before and after the transition.Implementation of an eight-level reading priority system increased worklist granularity and improved identification of more urgent studies to read. Radiologists opened CT studies in picture archiving and communications system-driven workflow in 52.4 ± 16.9 seconds using 9.5 ± 3.9 clicks and 6.3 ± 2.9 keystrokes, compared to 17.3 ± 9.5 seconds, 4.8 ± 1.5 clicks, and 0.1 ± 0.3 keystrokes in EHR-driven workflow (p0.001 for each measure). More information was available to the radiologist during examination interpretation, and 54.7% of radiologists rated the ease of use of the new system as good or very good (compared to 4.2% for the old system, p0.001).Transitioning to an EHR-driven workflow at a large academic medical center improved efficiency, was favorable to radiologists, and enhanced examination prioritization.

This retrospective analysis identifies predictors of survival in a cohort of patients with meta-iodobenzylguanidine (MIBG)-positive stage IV pulmonary and gastroenteropancreatic neuroendocrine tumor (P/GEP-NET) treated with

Background: 5-Aminosalicylate (5-ASA) formulations are approved for the treatment of ulcerative colitis (UC). Determination of the colonic pharmacokinetics of 5-ASA is challenging. A dynamic model of 5-ASA colonic amounts after oral delayed-release 5-ASA (Asacol), oral extended delayed-release 5-ASA (Lialda), 5-ASA enema (Rowasa), foam and suppositories (Canasa) was developed to determine the colonic kinetics of these agents. Methods: We created a model with Stella software. Colonic 5-ASA in the right, transverse, descending, sigmoid colon, and rectum were estimated for adults after recommended doses of the above formulations. Simulations of active mild/moderate UC and in remission were performed and compared using Student's t-test for differences in means. Results: For UC in remission, the highest amounts of 5-ASA were from Asacol in the right and transverse colon (P < 0.01), Lialda in the descending and sigmoid colon (P < 0.01), and Rowasa in the rectum (P < 0.01). For active UC, sigmoid amounts were highest with foam (P < 0.01), and rectal amounts highest with Rowasa (P < 0.01). Differences in rectosigmoid amounts of 5-ASA from enemas and suppositories for UC in remission occurred based on the relationship between the timing of administration relative to the daily bowel movement (P < 0.01). Conclusions: Compared to Asacol, Lialda results in higher 5-ASA amounts in the left colon. Asacol with Rowasa provides highest 5-ASA amounts across the entire colon. Higher 5-ASA amounts from topical formulations occur when the insertion occurs soon after the daily bowel movement. This model provides a rationale for further investigation. (Inflamm Bowel Dis 2012)

BACKGROUND: The purpose of this double-blind randomized clinical trial was to compare the relative effectiveness of a higher protein and conventional carbohydrate intake during weight loss on body composition and physical function in older women. METHODS: Thirty-one overweight or obese, postmenopausal women (mean ± SD: age 65.2 ± 4.6 years, body mass index 33.7 ± 4.9 kg/m(2)) were prescribed a reduced calorie diet (1,400 kcal/day; 15%, 65%, 30% energy from protein, carbohydrate, and fat, respectively) and randomly assigned to 2 × 25 g/day whey protein (PRO n = 15) or maltodextrin (CARB n = 16) supplementation for 6 months. Lean soft tissue (LST) via dual-energy X-ray absorptiometry; thigh muscle, subcutaneous adipose tissue (SAT), and intermuscular adipose tissue with magnetic resonance imaging; knee strength with isokinetic dynamometry; balance and physical function with a battery of performance tests. RESULTS: PRO lost more weight than CARB (-8.0% ± 6.2%, -4.1% ± 3.6%, p = .059; respectively). Changes in LST, %LST, and strength, balance, or physical performance measures did not differ between groups (all p > .05). Weight to leg LST ratio improved more in PRO versus CARB (-4.6 ± 3.6%, -1.8 ± 2.6%, p = .03). PRO lost 4.2% more muscle (p = .01), 10.9% more SAT (p = .02), and 8.2% more intermuscular adipose tissue (p = .03) than CARB. Relative to thigh volume changes, PRO gained 5.8% more muscle (p = .049) and lost 3.8% greater SAT (p = .06) than CARB. Weight to leg LST ratio (r(2) = .189, p = .02) and SAT (r(2) = .163, p = .04) predicted improved up and go, relative muscle (r(2) = .238, p = .01) and SAT (r(2) = .165, p = .04) predicted improved transfer test, and %LST predicted improved balance (r(2) = .179, p = .04). CONCLUSIONS: A higher protein intake during caloric restriction maintains muscle relative to weight lost, which in turn enhances physical function in older women.

A precise understanding of the role of dietary protein in bone health has been evasive despite decades of research. It is known that a dietary acid load is harmful to bone, and sulfur-containing amino acids are metabolized to provide such an acid load. It is also known that protein elevates urine calcium loss. However, recent clinical studies and a meta-analysis have indicated either no effect or a modest benefit associated with higher protein intakes. These contradictory considerations may be explained by the existence of a two-faced relationship between protein and bone, with simultaneous positive and negative pathways. In opposition to the negative effects of dietary acid load, protein may exert positive effects related to improving calcium absorption, increasing insulin-like growth factor 1, or improving lean body mass, which, in turn, improves bone strength. Putative mechanisms behind these pathways are reviewed here, and some limitations in the historical literature as well as suggested measures to counter these in the future are identified. When positive and negative pathways are considered in tandem, protein may offer modest benefits to bone in the presence of adequate dietary calcium and acid-neutralizing fruits and vegetables.

Current theory on the influence of breast cancer on bone describes metastasis of tumor cells to bone tissue, followed by induction of osteoclasts and bone degradation. Tumor influences on bone health in pre- or nonmetastatic models are unknown. Female rats (n = 48, 52 days old) were injected with N-methyl-N-nitrosourea (MNU) to induce breast cancer. Animals were euthanized 10 weeks later, and tumors were weighed and classified histologically. Right femurs were extracted for testing of bone mineral density (BMD) by dual X-ray absorptiometry (DXA), bone mechanical strength by three-point bending and femoral neck bending tests, and structure by micro–computed tomography (µCT). Of 48 rats, 22 developed one or more tumors in response to MNU injection by 10 weeks. Presence of any tumor predicted significantly poorer bone health in 17 of 28 measures. In tumored versus nontumored animals, BMD was adversely affected by 3%, force at failure of the femoral midshaft by 4%, force at failure of the femoral neck by 12%, and various trabecular structural parameters by 6% to 27% (all p

Weight loss causes bone mineral loss. Higher protein diets continue to be criticized for further potential harmful bone effects, including elevated urinary calcium, but may promote bone health if protein sources include dairy. Overweight middle-aged subjects (n ¼ 130, 59 males) were randomized to a diet providing 1.4 gkg 21 � d 21 protein and 3 daily servings of dairy (PRO) or 0.8 gkg 21 � d 21 protein and 2 daily servings of dairy (CARB) for 4 mo of weight loss plus 8 mo of weight maintenance. Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males. Bone mineral content and density (BMD) for whole body (WB), lumbar spine (LS) and total hip (TH) were measured using dual X-ray absorptiometry, and dietary intake using 3-d weighed food records. Urinary calcium was measured using 24-h collection at 0 and 8 mo for a subsample (n ¼ 42). Participants lost body weight (mean, 95% CI) of 8.2% (7.5-8.9%) at 4 mo, 10.6% (9.5-11.8%) at 8 mo, and 10.5% (8.9-12.0%) at 12 mo without differences between groups at any time (P ¼ 0.64). At 12 mo, PRO BMD was higher by 1.6% (0.3-3.0%) at WB, 2.1% (0.6-3.7%) at LS, and 1.4% (0.2-2.5%) at TH compared with CARB. PRO calcium intake was higher (PRO: 1140 6 58 mg/d, CARB: 766 6 46; P , 0.01), as was urinary calcium (PRO: 163 6 15 mg/d, CARB: 100 6 9.2; P , 0.01). A reduced-energy diet supplying 1.4 gkg 21 � d 21 protein and 3 dairy servings increased urinary calcium excretion but provided improved calcium intake and attenuated bone loss over 4 mo of weight loss and 8 additional mo of

SUMMARY Backround 5-ASA in a pH sensitive tablet (Asacol) is administered as three doses ⁄ day to treat ulcerative colitis. Once daily dosing may improve patient adherence. Simulation of colonic levels of 5-ASA can be used to compare dosing regimens. Aim To create a dynamic model of colonic concentrations of delayed-release 5-aminosalicylic acid (Asacol). Methods Using published data, we created a computer model with STELLA software to simulate amounts of colonic 5-ASA in the total colon, right, transverse, descending and sigmoid ⁄ rectum after daily and three time ⁄ day Asacol. Results The model predicted similar total and regional amounts of 5-ASA with both regimens. Distribution of 5-ASA was 38% in the right colon, 33% in the transverse colon and 14% each in the descending and sigmoid ⁄ rectal colon. Simulated increases in colonic motility and defecation rate exaggerated this 5-ASA distribution, resulting in negligible amounts of 5-ASA in the sigmoid ⁄ rectal region. Conclusions This computer model suggests that Asacol can be administered as a single daily dose. The model supports experimental and clinical observations that alternate dose or route of administration may be necessary to achieve adequate 5-ASA amounts in the distal colon during acute exacerbations of ulcerative colitis. This simulation cannot account for all sources of variability in the clinical setting, but provides a rationale for further investigation.

Weight loss causes bone mineral loss. Higher protein diets continue to be criticized for further potential harmful bone effects, including elevated urinary calcium, but may promote bone health if protein sources include dairy. Overweight middle-aged subjects (n = 130, 59 males) were randomized to a diet providing 1.4 g.kg(-1).d(-1) protein and 3 daily servings of dairy (PRO) or 0.8 g.kg(-1).d(-1) protein and 2 daily servings of dairy (CARB) for 4 mo of weight loss plus 8 mo of weight maintenance. Diets prescribed 6276 kJ/d for females and 7113 kJ/d for males. Bone mineral content and density (BMD) for whole body (WB), lumbar spine (LS) and total hip (TH) were measured using dual X-ray absorptiometry, and dietary intake using 3-d weighed food records. Urinary calcium was measured using 24-h collection at 0 and 8 mo for a subsample (n = 42). Participants lost body weight (mean, 95% CI) of 8.2% (7.5-8.9%) at 4 mo, 10.6% (9.5-11.8%) at 8 mo, and 10.5% (8.9-12.0%) at 12 mo without differences between groups at any time (P = 0.64). At 12 mo, PRO BMD was higher by 1.6% (0.3-3.0%) at WB, 2.1% (0.6-3.7%) at LS, and 1.4% (0.2-2.5%) at TH compared with CARB. PRO calcium intake was higher (PRO: 1140 +/- 58 mg/d, CARB: 766 +/- 46; P0.01), as was urinary calcium (PRO: 163 +/- 15 mg/d, CARB: 100 +/- 9.2; P0.01). A reduced-energy diet supplying 1.4 g.kg(-1).d(-1) protein and 3 dairy servings increased urinary calcium excretion but provided improved calcium intake and attenuated bone loss over 4 mo of weight loss and 8 additional mo of weight maintenance.