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Background: Osteoporosis is commonly seen affecting the bones in post-menopausal females, especially in India. Dual energy X-ray absorptiometry (DEXA) is the gold standard for identifying osteoporosis in female patients. Digital panoramic radiography (OPG) is a common imaging modality used frequently in routine dental practice. Mandibular cortical index (MCI) on OPG can be used to diagnose osteoporosis. Therefore, this study evaluated the efficacy of MCI on OPG to help detect osteoporosis in postmenopausal Indian females. Aim: To evaluate the accuracy of OPG versus DEXA in predicting bone mineral density (BMD). Materials and Methods: The research involved forty-two women with a postmenopausal history for a minimum of a year. The BMD was measured using DEXA. OPG was taken, and analysis of the mandible on OPG was done by two observers using the MCI given by Klemetti et al. Results: OPG had an overall sensitivity and specificity of 71% in the normal group, sensitivity of 50%, specificity of 68% in the osteopenia group, and sensitivity of 36%, specificity of 89% in the osteoporotic group in predicting the BMD using MCI. A positive correlation was seen in the efficacy of OPG in predicting BMD in the normal (P = 0.031*) and osteoporotic groups (P = 0.000*). Conclusion: MCI on OPG helped diagnose normal and osteoporotic patients efficiently, but osteopenia was misdiagnosed as normal or osteoporotic. Hence, MCI alone should not be used to predict BMD.

Background: The measurement of bone mineral density (BMD) is important for determining osteoporosis. The novel bioelectrical impedance analysis (BIA) presented herein provides a new body composition measurement function: bone density measurement. The purpose of this studywas to evaluate the accuracy of a novel bioimpedance method for whole-body BMD measurement in postmenopausal women in Taiwan. Methods: Menopausal women in Taiwan were recruited as subjects. The standing foot-to-foot bioimpedance analyzer StarBIA201 (Starbia meditek Co., Taichung City, Taiwan) was used to measure whole-body bone density, and the results were compared with dual energy X-ray absorptiometry (DXA) measurements. The consistency of the 2 methods was evaluated through Pearson correlation, linear regression, and Bland-Altman analysis. Differences in whole-body BMD between groups with different obesity levels were analyzed using univariate Bonferroni-corrected analysis. A total of 74 postmenopausal women with a mean age of 66.5 ± 8.6 years, men height of 156.3 ± 4.7 cm, and mean weight of 58.6 ± 9.2 kg were included in the study. Results: The mean whole body BMD measured by BIA (1.05 ± 0.06 g/cm²) was significantly higher than by DXA (0.99 ± 0.13 g/cm²). The correlation coefficient between the 2 devices for total body BMD in all subjects was 0.609. When the body mass index (BMI) was < 25 kg/m², BIA overestimated BMD by 0.06 g/cm². When the BMI was > 25 kg/m², BIA overestimated BMD by 0.05 g/cm². The limit of agreement in the Bland-Altman plots was -0.170 to 0.248 g/cm². Conclusion: For postmenopausal women, BIA provides a rapid, convenient, and safe method for preliminary screening of whole-body BMD. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effects of feeding homozygous β-CN A1 or A2 milk on the body composition, milk intake, and growth of German Holstein (GH), German Simmental (GS), and crossbred (CR) dairy calves of both sexes during the first 2 wk of life. A total of 104 calves (n = 54 female, f; and n = 50 male, m) from the breed groups GH (n = 23), GS (n = 61), and crossbred GH × GS (n = 20) were evaluated. Calves were weighed after birth and received colostrum ad libitum. On the second day, calves were alternately housed in pairs in double-igloo systems according to their random birth order and received either A1 milk (n = 52; 27 female and 25 male) or A2 milk (n = 52; 27 female and 25 male). They were offered 7.5 L/d, and the individual actual total milk intake was recorded. Daily energy-corrected milk intake was also calculated based on the milk composition (fat and protein). Fecal scores were recorded daily. On d 15, visceral adipose tissue (VAT) volume was assessed by open magnetic resonance imaging and dual-energy X-ray absorptiometry (DXA). In addition, fat and lean mass (g), as well as bone mineral content (g) and bone mineral density (g/cm2), were determined by DXA. The body composition, milk intake, and growth were similar between the 2 types of milk in the first 2 wk of life. Female calves had more VAT and fat mass, but less lean mass than male calves. GH and CR calves had more VAT and less lean mass than GS calves. Male calves were heavier than female calves after birth and on d 15. The average days with diarrhea and diarrhea occurrence were similar between calves fed A1 and A2 milk and between both sex groups. GS calves presented slightly more days with diarrhea and increased odds of having diarrhea compared with GH calves, not differing from CR. [ABSTRACT FROM AUTHOR]

Abstract Background Diabetes is a chronic condition that can result in many long-term physiological, metabolic, and neurological complications. Therefore, early detection of diabetes would help to determine a proper diagnosis and treatment plan. Methods In this study, we employed machine learning (ML) based case-control study on a diabetic cohort size of 1000 participants form Qatar Biobank to predict diabetes using clinical and bone health indicators from Dual Energy X-ray Absorptiometry (DXA) machines. ML models were utilized to distinguish diabetes groups from non-diabetes controls. Recursive feature elimination (RFE) was leveraged to identify a subset of features to improve the performance of model. SHAP based analysis was used for the importance of features and support the explainability of the proposed model. Results Ensemble based models XGboost and RF achieved over 84% accuracy for detecting diabetes. After applying RFE, we selected only 20 features which improved the model accuracy to 87.2%. From a clinical standpoint, higher HDL-Cholesterol and Neutrophil levels were observed in the diabetic group, along with lower vitamin B12 and testosterone levels. Lower sodium levels were found in diabetics, potentially stemming from clinical factors including specific medications, hormonal imbalances, unmanaged diabetes. We believe Dapagliflozin prescriptions in Qatar were associated with decreased Gamma Glutamyltransferase and Aspartate Aminotransferase enzyme levels, confirming prior research. We observed that bone area, bone mineral content, and bone mineral density were slightly lower in the Diabetes group across almost all body parts, but the difference against the control group was not statistically significant except in T12, troch and trunk area. No significant negative impact of diabetes progression on bone health was observed over a period of 5-15 yrs in the cohort. Conclusion This study recommends the inclusion of ML model which combines both DXA and clinical data for the early diagnosis of diabetes.

Aims: This study was designed to develop a model for predicting bone mineral density (BMD) loss of the femur after total hip arthroplasty (THA) using artificial intelligence (AI), and to identify factors that influence the prediction. Additionally, we virtually examined the efficacy of administration of bisphosphonate for cases with severe BMD loss based on the predictive model. Methods: The study included 538 joints that underwent primary THA. The patients were divided into groups using unsupervised time series clustering for five-year BMD loss of Gruen zone 7 postoperatively, and a machine-learning model to predict the BMD loss was developed. Additionally, the predictor for BMD loss was extracted using SHapley Additive exPlanations (SHAP). The patient-specific efficacy of bisphosphonate, which is the most important categorical predictor for BMD loss, was examined by calculating the change in predictive probability when hypothetically switching between the inclusion and exclusion of bisphosphonate. Results: Time series clustering allowed us to divide the patients into two groups, and the predictive factors were identified including patient- and operation-related factors. The area under the receiver operating characteristic (ROC) curve (AUC) for the BMD loss prediction averaged 0.734. Virtual administration of bisphosphonate showed on average 14% efficacy in preventing BMD loss of zone 7. Additionally, stem types and preoperative triglyceride (TG), creatinine (Cr), estimated glomerular filtration rate (eGFR), and creatine kinase (CK) showed significant association with the estimated patient-specific efficacy of bisphosphonate. Conclusion: Periprosthetic BMD loss after THA is predictable based on patient- and operation-related factors, and optimal prescription of bisphosphonate based on the prediction may prevent BMD loss. Cite this article: Bone Joint Res 2024;13(4):184–192.

Background: Diabetes is a chronic condition that can result in many long-term physiological, metabolic, and neurological complications. Therefore, early detection of diabetes would help to determine a proper diagnosis and treatment plan. Methods: In this study, we employed machine learning (ML) based case-control study on a diabetic cohort size of 1000 participants form Qatar Biobank to predict diabetes using clinical and bone health indicators from Dual Energy X-ray Absorptiometry (DXA) machines. ML models were utilized to distinguish diabetes groups from non-diabetes controls. Recursive feature elimination (RFE) was leveraged to identify a subset of features to improve the performance of model. SHAP based analysis was used for the importance of features and support the explainability of the proposed model. Results: Ensemble based models XGboost and RF achieved over 84% accuracy for detecting diabetes. After applying RFE, we selected only 20 features which improved the model accuracy to 87.2%. From a clinical standpoint, higher HDL-Cholesterol and Neutrophil levels were observed in the diabetic group, along with lower vitamin B12 and testosterone levels. Lower sodium levels were found in diabetics, potentially stemming from clinical factors including specific medications, hormonal imbalances, unmanaged diabetes. We believe Dapagliflozin prescriptions in Qatar were associated with decreased Gamma Glutamyltransferase and Aspartate Aminotransferase enzyme levels, confirming prior research. We observed that bone area, bone mineral content, and bone mineral density were slightly lower in the Diabetes group across almost all body parts, but the difference against the control group was not statistically significant except in T12, troch and trunk area. No significant negative impact of diabetes progression on bone health was observed over a period of 5-15 yrs in the cohort. Conclusion: This study recommends the inclusion of ML model which combines both DXA and clinical data for the early diagnosis of diabetes. [ABSTRACT FROM AUTHOR]

Context Patients with active acromegaly present a decreased adipose tissue (AT) mass, and short-term studies show that treatment leads to AT depot-specific gain. However, it remains unclear if the increase is persistent in the long-term perspective and/or is sex-dependent. Design To characterize the depot-specific changes of AT after treatment of acromegaly and identify contributing factors. Methods Adipose tissue, including visceral (VAT), subcutaneous (SAT), and total (TAT), and android to gynoid ratio (A/G ratio) were measured by dual energy X-ray absorptiometry at diagnosis (n = 62), and after treatment at short-term (median (IQR) 1.9 (1.5-2.3)) and long-term 5.5 (3.9-9.5) years, and correlated to clinical and biochemical measurements. Growth hormone (GH), insulin-like growth factor 1 (IGF-1), glucose and HbA1c levels, gonadal status, and the presence of diabetes mellitus were recorded. Remission status was assessed at the long-term visit (IGF-1/ULN ≤ 1.3). Differences in the temporal course of AT from baseline to short- and long-term follow-up according to sex, diabetes, gonadal, and remission status were evaluated by mixed model analysis, adjusted for age. Results Despite a stable body mass index, VAT and A/G ratio increased at both time points, whereas SAT mainly increased at short-term, plateauing afterwards (P <.05 for all). Visceral adipose tissue and A/G ratio were higher in men (P =.035 and P <.001), and the A/G ratio increased more than in women (P =.003). Glucose and HbA1c decreased short-term (P <.05) and remained stable at long-term. The increase in AT depots correlated with the decrease of disease activity at long-term. Remission status had no effect on changes in AT mass during follow-up. Conclusion Treatment of acromegaly leads to an increase in AT mass in a depot- and sex-specific manner both at short-term and long-term follow-up. Glucose metabolism improves rapidly after disease control and persists. [ABSTRACT FROM AUTHOR]

SignificanceGrowing levels of obesity and metabolic syndrome have driven demand for more advanced forms of body composition assessment. While various techniques exist to measure body composition, devices are typically expensive and not portable, involve radiation [in the case of dual-energy x-ray absorptiometry (DXA)], and are limited to analysis of adiposity while metabolic information from blood supply and oxygenation are not considered.AimWe evaluate whether diffuse optical spectroscopic imaging (DOSI) can be used to predict site-specific adiposity and percent fat (whole body) while simultaneously providing information about local tissue hemoglobin levels and oxygenation.ApproachDOSI measures of tissue composition in gastrocnemius, quadriceps, abdomen, and biceps, DXA whole-body composition, and ultrasound-derived skin and adipose tissue thickness (SATT) in the quadriceps were obtained from 99 individuals aged 7 to 34 years old.ResultsVarious DOSI-derived parameters were correlated with SATT and an optical method is proposed for estimating SATT using a newly defined parameter, the optical fat fraction (OFF), which considers all parameters that correlate with SATT. Broadband absorption and scattering spectra from study participants with the thinnest (SATT  ≈  0.25  ±  0.02  cm) and thickest SATT (SATT  ≈  1.55  ±  0.14  cm), representing best estimates for pure in vivo lean and fatty tissue, respectively, are reported. Finally, a trained prediction model is developed which allows DOSI assessment of OFF to predict DXA body-fat percentage, demonstrating that DOSI can be used to quantify body composition.ConclusionsThis study shows that DOSI can be used to assess the adiposity of specific tissues or the entire human body, and the OFF parameter is defined for corroboration and further evaluation in future research.

Background We evaluated the effects of 12 months of exercise training on bone mineral density (BMD) in patients with chronic kidney disease (CKD) stages 3–5 not on kidney replacement therapy (KRT). Methods A total of 151 patients were randomized to 12 months of either balance or strength training, both together with endurance training. Some 112 patients completed and 107 (69 men, 38 women) were analysed, with a mean age 66 ± 13.5 years and 31% having diabetes. The exercise training was self-administered, prescribed and monitored by a physiotherapist. Total body, hip and lumbar BMD, T score and Z score were measured at baseline and after 12 months using dual energy X-ray absorptiometry. Results Both groups showed increased physical performance. The prevalence of osteoporosis and osteopenia was unchanged. The strength group (SG) decreased total body BMD (P  < .001), the balance group (BG) increased total body T score (P  < .05) and total body Z score (P  < .005). Total body ΔT score was negative in the SG and unchanged in the BG (P  < .005). Total body ΔZ score was negative in the SG and positive in the BG (P  < .001). The proportion of progressors measured by ΔT (P  < .05) and ΔZ scores (P  < .05) was significantly lower in the BG compared with the SG. In multivariate logistic regression analysis, belonging to the BG was the only factor with a lower risk of deterioration of total body BMD, T and Z scores. Conclusions Twelve months of balance training together with endurance training seemed to be superior to strength training in maintaining and improving BMD in patients with CKD not on KRT. [ABSTRACT FROM AUTHOR]

Abstract Aims To examine the association between body fat and muscle parameters and FLD in individuals of Chinese descent. Methods A total of 515 participants who underwent routine check-ups between November 2019 and August 2021 were reviewed. Based on ultrasound performance, the subjects were categorized into the non-FLD group and the FLD group. The prevalence of FLD in sex subgroups was analyzed using logistic regression to calculate the odds ratios (ORs) of body composition parameters with adjustment for confounders. Results A total of 262 males and 253 females aged 20–84 years were reviewed. In both males and females, higher fat mass index (FMI) (OR: 1.989 for males vs. 1.389 for females), fat mass percent (FM%) (OR: 1.253 for males vs. 1.149 for females), visceral adipose tissue (VAT) (OR: 1.002 for males vs. 1.002 for females), and body mass index (BMI) (OR: 1.530 for males vs. 1.247 for females)were associated with increased ORs of FLD while higher lean mass percent (LM%) (OR: 0.839 for males vs. 0.856 for females)was associated with decreased ORs of FLD. Despite accounting for confounding factors, the associations remained present. Logistic regression of the quartiles of the indices showed associations with the prevalence of FLD. The trends still existed even after adjusting for confounders. Conclusion Independently of age, lipid profiles and other confounders, lower VAT, FM, FMI, FM% and BMI tended to be associated with a lower prevalence of FLD, while lower LM% trended to be associated with a higher prevalence of FLD in both sexes of the general population.

To investigate whether there is an influence on the results of lumbar spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) under three different hip flexion angles (90°, 45°, 0° of hip flexion). We collected a total of 60 outpatients, including 44 females (56.4 ± 5.7 years) and 16 males (50.2 ± 13.7 years). The DXA results of the lumbar spine were scanned and analyzed in three different positions with hip flexion of 90°, 45°, and 0°. We found that there was no significant difference in the area of interest, bone mineral content, BMD, and vertebral body height of the lumbar vertebral body measured by DXA in three hip flexion positions of 90°, 45°, and 0°; Pearson’s correlation analysis showed that lumbar BMD in hip flexion 90° was correlated with it in hip flexion 45° (r = 0.998, P＜0.01) and in hip flexion 0° (r = 0.996, P＜0.01) respectively. There was no statistically significant difference in the diagnosis of BMD between 90° and 45° hip flexion (P = 0.903), which was the same as 90° and 0° hip flexion (P = 0.822). Therefore, we conclude that different hip flexion angles can be used in lumbar BMD detection by DXA, which is beneficial to patients who have difficulty in hip flexion, especially for elderly patients with osteoporosis.

Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder that leads to heterotopic ossification (HO), resulting in progressive restriction of physical function. In this study, low-dose, whole-body computed tomography (WBCT) and dual energy X-ray absorptiometry (DXA) were evaluated to determine the preferred method for assessing total body burden of HO in patients with FOP. This was a non-interventional, two-part natural history study in patients with FOP (NCT02322255; date of registration: December 2014). In Part A (described here), WBCT and DXA scans were individually assessed for HO presence and severity across 15 anatomical regions. All images were independently reviewed by an expert imaging panel. Ten adult patients were enrolled across four sites. The sensitivity to HO presence and severity varied considerably between the two imaging modalities, with WBCT demonstrating HO in more body regions than DXA (76/138 [55%] versus 47/113 [42%]) evaluable regions). Inability to evaluate HO presence, due to overlapping body regions (positional ambiguity), occurred less frequently by WBCT than by DXA (mean number of non-evaluable regions per scan 1.2 [standard deviation: 1.5] versus 2.4 [1.4]). Based on the increased sensitivity and decreased positional ambiguity of low-dose WBCT versus DXA in measuring HO in patients with FOP, low-dose WBCT was chosen as the preferred imaging for measuring HO. Therefore, low-dose WBCT was carried forward to Part B of the natural history study, which evaluated disease progression over 36 months in a larger population of patients with FOP.

Abstract Background Osteoporosis is a chronic, multifactorial skeletal disease that occurs especially in women following a decrease in estrogen levels and decrease in bone mineral density. The aim of this study was to evaluate the relationship between qualitative and quantitative indexes in panoramic radiographs and quantitative indexes in CBCT images with femoral and vertebral BMD in postmenopausal women. Methods This comparative cross-sectional study was performed on postmenopausal women aging 40 to 80 years attending for obtaining either panoramic radiograph or mandibular CBCT scan. Dual energy X-ray absorptiometry (DEXA) was performed from the femur and lumbar vertebra. Quantitative parameters of mental index (MI), panoramic mandibular index (PMI), antegonial index (AI) as well as qualitative parameters of mandibular cortical index (MCI) and trabecular bone pattern (TP) were evaluated in panoramic radiographs. Quantitative parameters computed tomography mandibular index (CTMI), computed tomography index (inferior) [CTI(I)] and computed tomography index (superior) [CTI(S)] were analyzed in CBCT images. Kolmogorov-Smirnov tests and Pearson correlation coefficient were used (α = 0.05). Results In individuals with panoramic radiography, statistically significant correlations were observed between MI with vertebral and femoral T-score, AI with vertebral and femoral T-score (except for the right AI with femoral T-score), and TP with vertebral and femoral T-score (p

It is unknown whether the relative contribution to energy imbalance in amyotrophic lateral sclerosis (ALS) is due to decreased energy intake, or increased energy expenditure from hyper-metabolism and/or physical activity, or both. We studied 10 free-living sporadic ALS subjects with mild to moderate disease and 10 matched healthy controls to address this question. We estimated energy intake by 24-h recall in ALS subjects and three-day food diary in all. We estimated body composition by dual energy X-ray absorptiometry and resting metabolic rate by indirect calorimetry; and measured total daily energy expenditure (TEE) and physical activity-energy expenditure using doubly labeled water. Daily energy intake was no different between ALS subjects and controls. Despite lower fat-free mass, unadjusted TEE was higher in ALS subjects than controls (2844 ± 319 vs. 2505 ± 261 kcal/d, p = 0.005 by paired t-test). Compared to controls, hyper-metabolism occurred in 80% of ALS subjects. Physical activity-energy expenditure was higher in ALS subjects than controls (718 ± 262 kcal/d vs. 487 ± 196 kcal/d, p = 0.04). In controls, energy intake matched TEE; in ALS subjects TEE was higher than energy intake. We found higher TEE in ALS subjects than controls, with larger contribution to difference from physical activity-energy expenditure than hyper-metabolism. Although daily energy intake in ALS subjects was similar to that in controls, they were unable to compensate for increased energy needs. To accurately determine energy balance and optimize nutrition in ALS, future studies should consider measuring energy intake, energy expenditure, and physical activity. [ABSTRACT FROM AUTHOR]

Summary: This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and osteoporosis without fracture. It has been proved that the volumetric bone mineral density (vBMD) measured by QCT exhibits a stronger correlation with fracture risk than areal bone mineral density (aBMD) measured by DXA. Purpose: This study aims to systematically evaluate the ability of QCT and DXA to distinguish between osteoporosis with vertebral fracture and osteoporosis without fracture according to vBMD and aBMD. Methods: We conducted a primary literature search of the online databases up to 3 July, 2022, in both English and Chinese publications, combining synonyms for "QCT", "DXA" and "osteoporosis". The Newcastle–Ottawa scale (NOS) was employed to evaluate the quality of the selected articles. vBMD obtained through QCT and aBMD obtained through DXA were extracted, and were analyzed by Review Manager 5.4 and RStudio. Results: Six studies with 610 individuals aged 45 to 90, of which 179 had vertebral fractures, were included in the final analysis. The weighted mean difference (WMD) between osteoporosis with vertebral fracture and osteoporosis without fracture for vBMD was − 27.08 (95% CI − 31.24 to − 22.92), while for aBMD was − 0.05 (95% CI − 0.08 to − 0.03). Conclusions: Both vBMD detected by QCT and aBMD detected by DXA could discriminate fracture status in the spine, and vBMD performed a stronger correlation with fracture risk. Trial registration: PROSPERO 2022 CRD42022349185. [ABSTRACT FROM AUTHOR]

Aims: To examine the association between body fat and muscle parameters and FLD in individuals of Chinese descent. Methods: A total of 515 participants who underwent routine check-ups between November 2019 and August 2021 were reviewed. Based on ultrasound performance, the subjects were categorized into the non-FLD group and the FLD group. The prevalence of FLD in sex subgroups was analyzed using logistic regression to calculate the odds ratios (ORs) of body composition parameters with adjustment for confounders. Results: A total of 262 males and 253 females aged 20–84 years were reviewed. In both males and females, higher fat mass index (FMI) (OR: 1.989 for males vs. 1.389 for females), fat mass percent (FM%) (OR: 1.253 for males vs. 1.149 for females), visceral adipose tissue (VAT) (OR: 1.002 for males vs. 1.002 for females), and body mass index (BMI) (OR: 1.530 for males vs. 1.247 for females)were associated with increased ORs of FLD while higher lean mass percent (LM%) (OR: 0.839 for males vs. 0.856 for females)was associated with decreased ORs of FLD. Despite accounting for confounding factors, the associations remained present. Logistic regression of the quartiles of the indices showed associations with the prevalence of FLD. The trends still existed even after adjusting for confounders. Conclusion: Independently of age, lipid profiles and other confounders, lower VAT, FM, FMI, FM% and BMI tended to be associated with a lower prevalence of FLD, while lower LM% trended to be associated with a higher prevalence of FLD in both sexes of the general population. [ABSTRACT FROM AUTHOR]

The aim of this study was to use geometric features and texture analysis to discriminate between healthy and unhealthy femurs and to identify the most influential features. We scanned proximal femoral bone (PFB) of 284 Iranian cases (21 to 83 years old) using different dual-energy X-ray absorptiometry (DEXA) scanners and magnetic resonance imaging (MRI) machines. Subjects were labeled as "healthy" (T-score > −0.9) and "unhealthy" based on the results of DEXA scans. Based on the geometry and texture of the PFB in MRI, 204 features were retrieved. We used support vector machine (SVM) with different kernels, decision tree, and logistic regression algorithms as classifiers and the Genetic algorithm (GA) to select the best set of features and to maximize accuracy. There were 185 participants classified as healthy and 99 as unhealthy. The SVM with radial basis function kernels had the best performance (89.08%) and the most influential features were geometrical ones. Even though our findings show the high performance of this model, further investigation with more subjects is suggested. To our knowledge, this is the first study that investigates qualitative classification of PFBs based on MRI with reference to DEXA scans using machine learning methods and the GA. [ABSTRACT FROM AUTHOR]

• BMI >50th percentile is positively associated with FEV1pp, but body composition may be a better measure. • Children with CF had a lower FMI-z, FFMI-z , BMIz than healthy reference populations. • From 8–10 years old, BMI-z, FFMI-z and FMI-z were predominantly <0 in children with CF. • The relationship between FMI-z and FEV1pp is not statistically significant. • Both FFMI-z and BMI-z have a positive, but limited strength of association with FEV1pp. Historically, body mass index (BMI) >50th percentile has represented optimal nutritional status in children with cystic fibrosis (CF) due to its positive association with lung function. Body composition parameters including fat-free mass index (FFMI) have been suggested as a more physiological nutrition benchmark. Aims: (1) describe changes in body composition with age and gender; (2) assess the correlation between measures of nutritional status (FFMI-z, FMI-z, BMI-z) and lung function (forced expiratory volume in one second predicted; FEV1pp). This retrospective, mixed cross-sectional and serial measures study consisted of children with CF (8 to 18 years) attending Sydney Children's Hospital (2007–2020). FFMI and fat mass index (FMI) were taken from biennial dual energy x-ray absorptiometry (DXA) scans. Z-scores were derived using Well's reference population [1]. Repeated measures correlation analyses assessed correlations between FFMI-z, FMI-z, and BMI-z with FEV1pp. 339 DXA reports were analysed from 137 patients. There were slight downwards trends in BMI-z and FMI-z, and an upwards trend in FFMI-z with increasing age and across both genders. Females had higher FMI-z and FFMI-z than males from 12.5 years. There was a weak, positive correlation between FEV1pp and BMI-z (r = 0.14, p = 0.04), and FFMI-z (r = 0.25, p <0.001). FMI-z had no correlation with FEV1pp (r =-0.06, p = 0.41). Deficits in FFMI exist despite increasing trends with age. FFMI-z and BMI-z had a weak, positive correlation with FEV1pp. In contemporary cohorts, nutritional status (reflected by surrogate markers such as FFMI and BMI) may be less influential upon lung function than in previous decades. [1]: Wells, J.C. , et al. Body-composition reference data for simple and reference techniques and a 4-component model: a new UK reference child. Am. J. Clin. Nutr. 96 , 1316–1326 (2012). [ABSTRACT FROM AUTHOR]

Early screening and timely treatment can effectively reduce the morbidity and mortality of the osteoporotic fractures, and hence efficient and accurate non-invasive radiological method is crucial. Non-invasive imaging methods of radiology frequently encounter less resistance in the promotion of therapeutic activities than invasive procedures like bone biopsy and perfusion imaging. Although dual-energy X-ray absorption has been established as the primary diagnostic method for osteoporosis, its efficacy is relatively constrained due to various parameters, and it is challenging to accurately depict the true status of bone structure. In recent years, radiological techniques have developed rapidly. Computed tomography, magnetic resonance imaging, quantitative ultrasound and other imaging techniques have been widely used in the diagnosis of osteoporosis in the research and clinical practices, which provides more comprehensive and detailed information about bone mineral density and bone structure for early diagnosis, treatment design and prognosis monitoring. As clinic and computer science crosstalk closely, it will become possible for artificial intelligence to assist or even independently perform imaging analysis and disease screening in image data base. This article reviews the individual characteristics and latest research progress of the non-invasive radiological techniques for the osteoporosis.

BACKGROUND: Bone mineral content (BMC) and areal-bone mineral density (aBMD) measurements of the lumbar spine (LS) and whole body less head (WBLH) by dual energy X-ray absorptiometry (DXA) are recommended for bone health assessment in children. Intermachine differences were not considered previously in formulating these recommendations. METHODOLOGY: DXA measurements of the LS, WBLH, total hip, femoral neck and distal 1/3 radius from the Bone Mineral Density in Childhood Study were examined. Healthy children, ages 6 to 16 years, from five clinical centers participated. The same spine, whole body, and femur phantoms were measured on each Centers DXA machine. Percentage of individuals with low BMC or aBMD (Z-score

Purpose of Review: Osteoporosis ranks high among morbidities in the elderly as it is a natural process to lose bone, making them susceptible to fractures from minor falls. The cost of managing these patients is staggering. The fractures can be prevented with better care of the elderly, and by treating the major predisposing factor, osteoporosis. Clinicians and scientists, in general, constantly look for early diagnostic and prognostic indicators for osteopenia and osteoporosis to proactively prevent fractures. Dental panoramic radiography (DPR) is a rotational pantomography used for identifying dental pathology in patients. Early signs of osteopenia and osteoporosis can be identified in DPR. The usefulness of notable jaw changes in DPR to predict osteopenia and osteoporosis is still evolving as more studies continue to delve into this concept. The purpose of this review is to present advances made in the practical application of DPR for predicting early onset of osteopenia and osteoporosis. Recent Findings: Dental panoramic radiography, a form of tomography commonly used by dental practitioners, has been the standard of care for decades for detecting dento-alveolar pathology. Several technological advancements have taken place with respect to the use of DPR. These include conversion from plain film to digital radiography, advancements in the manufacture of flat panel detectors, and accurate imaging of the layers of mandible and maxilla that has become possible with appropriate patient positioning within the focal trough of the machine. Improvements in the software infrastructure make it easier to view, enhance, and save the radiographic images. The radiographic appearance of the trabecular bone within the mandible and indices measured from the dental panoramic radiographs focusing on the inferior cortex of the mandible are considered useful tools for identifying asymptomatic individuals with osteoporosis or at risk for developing osteoporosis. These indices apparently correlate with risks of fragility fractures of osteoporosis in other parts of the body. Summary: Dental panoramic radiography (DPR) is a commonly used radiographic procedure in dentistry for evaluation of teeth and associated maxillofacial structures. The evaluation of the inferior border of the mandible for reduction or loss of cortical thickness and evaluation of the trabecular bone within the mandible are helpful markers for early signs of osteopenia to identify patients at risk for osteoporosis. This review focused on research advancements on practical application of DPR in early identification of osteopenia and osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is an autoimmune disorder associated with a chronic inflammation, which can cause joint damage and extra-articular complications. Anti-citrullinated protein antibody (ACPA) positivity is accompanied by poor prognosis in RA, and testing for ACPA has become traditional practice in the context of RA diagnosis. Objective: The aim of the study was to estimate the prevalence of low bone mineral density (BMD) among female patients with RA using dual energy x-ray absorptiometry (DEXA), and to study the correlation between BMD & levels of anti-cyclic citrullinated peptide (anti-CCP) and RF in the studied cases. Patients and methods: The present study was a cross-section descriptive study that was conducted on eighty female patients with RA. All patients were subjected to assessment to the levels of anti-CCP and RF using ELISA. BMD was measured by DEXA. Results: Osteopenia and Osteoporosis at lumbar spine, femoral neck and distal end of radius showed statistically significant increase in +ve anti-CCP patients when compared to -ve anti-CCP patients. BMD at the lumbar spine, femoral neck and lower end of radius showed statistically significant decrease in +ve anti-CCP patients when compared to -ve anti-CCP patients. History of fragility fracture showed statistically significant increase in RA patients with +ve RF when compared to -ve RF patients. Conclusion: Bone loss and fragility fracture are common in RA and increased in seropositive RA, post-menopausal state and corticosteroids use. The presence of ACPA and RF are strongly predictive for the development of osteoporosis and erosions in RA patients. It would be a more appropriate approach to carefully monitor osteoporosis in seropositive RA. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a chronic, multifactorial skeletal disease that occurs especially in women following a decrease in estrogen levels and decrease in bone mineral density. The aim of this study was to evaluate the relationship between qualitative and quantitative indexes in panoramic radiographs and quantitative indexes in CBCT images with femoral and vertebral BMD in postmenopausal women. Methods: This comparative cross-sectional study was performed on postmenopausal women aging 40 to 80 years attending for obtaining either panoramic radiograph or mandibular CBCT scan. Dual energy X-ray absorptiometry (DEXA) was performed from the femur and lumbar vertebra. Quantitative parameters of mental index (MI), panoramic mandibular index (PMI), antegonial index (AI) as well as qualitative parameters of mandibular cortical index (MCI) and trabecular bone pattern (TP) were evaluated in panoramic radiographs. Quantitative parameters computed tomography mandibular index (CTMI), computed tomography index (inferior) [CTI(I)] and computed tomography index (superior) [CTI(S)] were analyzed in CBCT images. Kolmogorov-Smirnov tests and Pearson correlation coefficient were used (α = 0.05). Results: In individuals with panoramic radiography, statistically significant correlations were observed between MI with vertebral and femoral T-score, AI with vertebral and femoral T-score (except for the right AI with femoral T-score), and TP with vertebral and femoral T-score (p < 0.05). In the group with CBCT scans, the correlations between CTMI with vertebral and femoral T-score, CTI(I) with vertebral and femoral T-score, and CTI(S) with vertebral and femoral T-score were statistically significant (p < 0.05). Conclusions: in CBCT images, quantitative indexes of CTMI, CTI(I), and CTI(S), and in panoramic images, quantitative indexes of MI and AI and qualitative index of TP can be used to predict the possibility of osteoporosis in postmenopausal women. [ABSTRACT FROM AUTHOR]

Introduction: Left ventricular global longitudinal strain (GLS) is considered to be the first marker of diabetes mellitus-related subclinical cardiac dysfunction, but whether it is attributable to fat mass and distribution remains uncertain. In this study, we explored whether fat mass, especially fat mass in the android area, is associated with subclinical systolic dysfunction before the onset of cardiac disease. Methods: We conducted a single-center prospective cross-sectional study between November 2021 and August 2022 on inpatients of the Department of Endocrinology, Nanjing Drum Tower Hospital. We included 150 patients aged 18–70 years with no signs, symptoms, or history of clinical cardiac disease. Patients were evaluated with speckle tracking echocardiography and dual energy X-ray absorptiometry. The cutoff values for subclinical systolic dysfunction were set at a global longitudinal strain (GLS) < 18%. Results: After adjusting for sex and age, patients with GLS < 18% had a higher mean (± standard deviation) fat mass index (8.06 ± 2.39 vs. 7.10 ± 2.09 kg/m2, p = 0.02), higher mean trunk fat mass (14.9 ± 4.9 vs. 12.8 ± 4.3 kg, p = 0.01), and higher android fat mass (2.57 ± 1.02 vs. 2.18 ± 0.86 kg, p = 0.02) than those in the GLS ≥ 18%. Partial correlation analysis showed that the fat mass index, truck fat mass, and android fat mass were negatively correlated with GLS after adjusting for sex and age (all p < 0.05). Adjusted for traditional cardiovascular metabolic factors, fat mass index (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.05–1.55, p = 0.02), trunk fat mass (OR 1.13, 95% CI 1.03–1.24, p = 0.01), and android fat mass (OR 1.77, 95% CI 1.16–2.82, p = 0.01) were independent risk factors for GLS < 18%. Conclusion: Among patients with type 2 diabetes mellitus without established clinical cardiac disease, fat mass, especially android fat mass, was associated with subclinical systolic dysfunction independently of age and sex. [ABSTRACT FROM AUTHOR]

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Background: Spinal cord injury (SCI) is accompanied by loss of bone mass caused by accelerated bone remodeling, with bone resorption exceeding bone formation which causes net bone loss. The significance of osteoporosis after SCI is that it results in skeletal fragility and an increased risk of fractures. Complications from fractures lead to an increase not only in the associated morbidity and mortality, but also in the health-care costs that they generate. Aims and Objectives: The objective of the study was to evaluate bone mineral density (BMD) in patients with SCI in Indian population and to determine the effects of the neurological level, severity of injury, and mobility status on BMD. Materials and Methods: This study was a prospective and observational study conducted on 52 chronic SCI patients. After detailed history and examination, patients were assessed using American spinal injury association impairment scale following which BMD was assessed by Dual Energy X-ray Absorptiometry Scan. Correlation between the T score and neurological level, severity of injury and mobility status was assessed. P

Abstract Background The primary aim of the study was to assess the nutritional status of pediatric liver transplant outpatients in nutrition clinic, particularly the nutritional status of their bones. Methods One hundred thirty-eight pediatric liver transplant outpatients, who had visited the nutrition clinic in Shanghai Children’s Medical Center between January 2017 and December 2019, were recruited. The bone mineral density (BMD) z-scores were determined by dual energy X-ray absorptiometry (DXA). Nutritional assessment was performed, and their corresponding height-for-age z-scores (HAZs)/weight-for-age z-scores (WAZs)/BMI-for-age z-scores (BMIZs) were obtained. Results A total of 138 patients came to our nutrition outpatient clinic, including 68 boys (49.3%) and 70 girls (50.7%). The median age was 0.87y (0.68y, 1.71y). Among these patients, 44 (31.9%) had acute malnutrition with WAZ/BMIZ value -1.14 (-2.38, -0.18), 55 (38.4%) had chronic malnutrition with HAZ value -1.51 (-2.39, -0.38), and 96 (69.6%) had a BMD lower than normal. The BMD z-score was significantly correlated with the WAZ/BMIZ value (Spearman’s correlation coefficient = 0.334, p

The purpose of this analysis was to determine if acute, localized resistance exercise (RE) artificially influences total and regional estimates of body composition from dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Recreationally active male (n = 14) and female (n = 18) subjects completed 3 testing visits: rest (R), upper-extremity RE (U), and lower-extremity RE (L). Dual-energy X-ray absorptiometry scans were completed before exercise and 60 minutes after exercise. Bioelectrical impedance analysis was completed immediately before and after exercise and at 15, 30, and 60 minutes after exercise. Subjects were not allowed to intake fluid during the exercise session or during the postexercise assessment period. The effects of the acute RE session on DXA and BIA estimates were analyzed using linear mixed-effects models with a random intercept for subject. Condition by time interactions were observed for most BIA outcomes. Relative to the reference model (i.e., R condition at baseline), total body water and fat-free mass estimates were, on average, approximately 1 and approximately 1.2 kg higher, in the U condition. In contrast, lower-extremity RE exerted little or no impact on most BIA variables. Some DXA estimates exhibited time main effects, but the magnitude of changes was negligible. An acute bout of localized RE, particularly upperextremity RE, can artificially influence BIA body fluid and composition estimates, whereas DXA may be robust to the acute biological error introduced by RE. Although body composition assessments should ideally be conducted under standardized conditions, DXA may be suitable in less standardized situations. In addition, BIA is differentially influenced by upper-extremity and lower-extremity resistance exercise. [ABSTRACT FROM AUTHOR]

Bone accrual in childhood determines bone health in later life. Loss of bone strength in early life can lead to increased morbidity and reduced quality of life in childhood and adolescence. Increased availability of assessment tools and bisphosphonate therapy, together with increased awareness on the significance of fracture history and risk factors, have led to greater opportunities, to improve detection and optimize management of children and adolescents with bone fragility globally, including those in lower resource settings. Bone mineral density z-scores and bone mineral content are surrogate measures of bone strength, which can be measured by dual-energy X-ray absorptiometry (DXA), in growing individuals. DXA can aid in the diagnosis and management of primary and secondary bone fragility disorders in childhood. DXA helps evaluate children with clinically significant fractures, and monitor those with bone fragility disorders, or at high risk for compromised bone strength. Obtaining DXA images can however be challenging, especially in younger children, due to difficulty in positioning and movement artefacts, while paediatric DXA interpretation can be confounded by effects of growth and puberty. Furthermore, access to DXA facilities as well as appropriate paediatric reference norms and expertise for interpretation, may not be easily available especially in lower resource settings. Pediatric bone experts are now placing increasing emphasis on the fracture phenotype and clinical context to diagnose osteoporosis over bone mineral density (BMD) by DXA. Low trauma vertebral fractures are now recognized as a hallmark of bone fragility, and spinal fracture surveillance by either conventional lateral thoracolumbar radiographs or vertebral fracture assessment by DXA is gaining increasing importance in diagnosing childhood osteoporosis, and initiating bone protective therapy. Furthermore, it is now understood that even a single, low-trauma long bone fracture can signal osteoporosis in those with risk factors for bone fragility. Intravenous bisphosphonate therapy is the mainstay of treatment for childhood bone fragility disorders. Other supportive measures to improve bone strength include optimizing nutrition, encouraging weight bearing physical activity within the limits of the underlying condition, and treating any associated endocrinopathies. With this paradigm shift in childhood osteoporosis evaluation and management, lack of DXA facilities to assess BMD at baseline and/or provide serial monitoring is not a major barrier for initiating IV bisphosphonate therapy in children in whom it is clinically indicated and would benefit from its use. DXA is useful, however, to monitor treatment response and optimal timing for treatment discontinuation in children with transient risk factors for osteoporosis. Overall, there is lack of awareness and paucity of guidelines on utilizing and adopting available resources to manage paediatric bone disorders optimally in lower-resource settings. We provide an evidence-based approach to the assessment and management of bone fragility disorders in children and adolescents, with appropriate considerations for lower resource settings including LMIC countries. [ABSTRACT FROM AUTHOR]

Summary: Twelve months following discontinuation of denosumab, the percent decrease in mean bone mineral density (BMD) values at the hip and knee regions were similar between both the denosumab and placebo groups. These findings emphasize the need for additional trials to understand the effect of continued administration of denosumab after subacute spinal cord injury (SCI) to avoid this demineralization. Objective: To determine changes in BMD 1 year after denosumab was discontinued in participants with subacute SCI who had drug treatment initiated within 90 days post SCI and continued for 1 year. Methods: Fourteen participants who completed a randomized, double-blinded, placebo-controlled drug trial (parent study: denosumab 60 mg (Prolia, Amgen Inc., n = 8) or placebo (n = 6); administered at baseline, 6, and 12 months) were followed 12 months after the 18 months from baseline primary end point was completed. The BMD of skeletal regions below the SCI at higher risk of fracture was measured [total hip, distal femur epiphysis (DFE), distal femur metaphysis (DFM), and proximal tibia epiphysis (PTE)] by dual energy X-ray absorptiometry. Results: The percent decreases in mean BMD values at all regions of the hip and knee from 18 to 30 months were similar in both the denosumab and placebo groups. However, at 30 months, the absolute values for mean BMD remained significantly higher in the drug treatment than that of the placebo group at the DFM (p = 0.03), DFE (p = 0.04), and PTE (p = 0.05). Conclusions: In persons with SCI who initiated denosumab treatment during the subacute injury phase and maintained treatment for 1 year, the discontinuation of drug resulted in percent loss of mean BMD similar to that of the placebo group, with absolute mean BMD values at the knee regions at the 12-month follow-up visit significantly higher in the drug treatment than those in the placebo group. These data underscore the need to study continued administration of denosumab after subacute SCI to avoid marked demineralization in the sublesional skeleton upon discontinuation of this agent. [ABSTRACT FROM AUTHOR]

This literature review was conducted to analyze the capability of cone-beam computed tomography (CBCT) to accurately identify low bone mass density in women. A systematic search of MEDLINE, Embase, Scopus, Google Scholar, the Cochrane Library, and Science Direct was performed to identify relevant articles, and the Cochrane risk of bias criterion was used to determine the methodological quality of the included studies. All ten included studies assessed primary research on the capacity of CBCT to accurately diagnose insufficient bone mineral density. All relevant data were extracted, and the results were summarized narratively. The results indicated that the CBCT has good sensitivity and specificity and high accuracy in predicting osteoporosis. Four of the included studies measured qualitative values, while the others concentrated on quantitative values and found lower values in osteoporosis patients compared to those of osteopenic and healthy patients. All the studies compared CBCT grayscale values with dual energy X-ray absorptiometry scores, which strengthened our confidence in the accuracy of CBCT's diagnostic capability. CBCT is considered a feasible predictive tool for detecting patients who are at risk of osteoporosis, although further research is needed to confirm the evidence and enhance its common use among health care professionals. [ABSTRACT FROM AUTHOR]

Early screening and timely treatment can effectively reduce the morbidity and mortality of the osteoporotic fractures, and hence efficient and accurate non-invasive radiological method is crucial. Non-invasive imaging methods of radiology frequently encounter less resistance in the promotion of therapeutic activities than invasive procedures like bone biopsy and perfusion imaging. Although dual-energy X-ray absorption has been established as the primary diagnostic method for osteoporosis, its efficacy is relatively constrained due to various parameters, and it is challenging to accurately depict the true status of bone structure. In recent years, radiological techniques have developed rapidly. Computed tomography, magnetic resonance imaging, quantitative ultrasound and other imaging techniques have been widely used in the diagnosis of osteoporosis in the research and clinical practices, which provides more comprehensive and detailed information about bone mineral density and bone structure for early diagnosis, treatment design and prognosis monitoring. As clinic and computer science crosstalk closely, it will become possible for artificial intelligence to assist or even independently perform imaging analysis and disease screening in image data base. This article reviews the individual characteristics and latest research progress of the non-invasive radiological techniques for the osteoporosis. [ABSTRACT FROM AUTHOR]

Bone accrual in childhood determines bone health in later life. Loss of bone strength in early life can lead to increased morbidity and reduced quality of life in childhood and adolescence. Increased availability of assessment tools and bisphosphonate therapy, together with increased awareness on the significance of fracture history and risk factors, have led to greater opportunities, to improve detection and optimize management of children and adolescents with bone fragility globally, including those in lower resource settings. Bone mineral density z-scores and bone mineral content are surrogate measures of bone strength, which can be measured by dual-energy X-ray absorptiometry (DXA), in growing individuals. DXA can aid in the diagnosis and management of primary and secondary bone fragility disorders in childhood. DXA helps evaluate children with clinically significant fractures, and monitor those with bone fragility disorders, or at high risk for compromised bone strength. Obtaining DXA images can however be challenging, especially in younger children, due to difficulty in positioning and movement artefacts, while paediatric DXA interpretation can be confounded by effects of growth and puberty. Furthermore, access to DXA facilities as well as appropriate paediatric reference norms and expertise for interpretation, may not be easily available especially in lower resource settings. Pediatric bone experts are now placing increasing emphasis on the fracture phenotype and clinical context to diagnose osteoporosis over bone mineral density (BMD) by DXA. Low trauma vertebral fractures are now recognized as a hallmark of bone fragility, and spinal fracture surveillance by either conventional lateral thoracolumbar radiographs or vertebral fracture assessment by DXA is gaining increasing importance in diagnosing childhood osteoporosis, and initiating bone protective therapy. Furthermore, it is now understood that even a single, low-trauma long bone fracture can signal osteoporosis in those with risk factors for bone fragility. Intravenous bisphosphonate therapy is the mainstay of treatment for childhood bone fragility disorders. Other supportive measures to improve bone strength include optimizing nutrition, encouraging weight bearing physical activity within the limits of the underlying condition, and treating any associated endocrinopathies. With this paradigm shift in childhood osteoporosis evaluation and management, lack of DXA facilities to assess BMD at baseline and/or provide serial monitoring is not a major barrier for initiating IV bisphosphonate therapy in children in whom it is clinically indicated and would benefit from its use. DXA is useful, however, to monitor treatment response and optimal timing for treatment discontinuation in children with transient risk factors for osteoporosis. Overall, there is lack of awareness and paucity of guidelines on utilizing and adopting available resources to manage paediatric bone disorders optimally in lower-resource settings. We provide an evidence-based approach to the assessment and management of bone fragility disorders in children and adolescents, with appropriate considerations for lower resource settings including LMIC countries.

Background: Spinal cord injury (SCI) is accompanied by loss of bone mass caused by accelerated bone remodeling, with bone resorption exceeding bone formation which causes net bone loss. The significance of osteoporosis after SCI is that it results in skeletal fragility and an increased risk of fractures. Complications from fractures lead to an increase not only in the associated morbidity and mortality, but also in the health-care costs that they generate. Aims and Objectives: The objective of the study was to evaluate bone mineral density (BMD) in patients with SCI in Indian population and to determine the effects of the neurological level, severity of injury, and mobility status on BMD. Materials and Methods: This study was a prospective and observational study conducted on 52 chronic SCI patients. After detailed history and examination, patients were assessed using American spinal injury association impairment scale following which BMD was assessed by Dual Energy X-ray Absorptiometry Scan. Correlation between the T score and neurological level, severity of injury and mobility status was assessed. P<0.05 was considered statistically significant. Results: Out of 52 patients included, 41 were having complete SCI and 35 were non-ambulatory. T score was significantly (P<0.001) lower in lumbar spine and both femur in complete SCI patients. The T score was indicative of increased osteoporosis in non-ambulatory patients. BMD did not differ significantly (P<0.059) in patients with relation to various neurological levels. Conclusion: From this study, we conclude that osteoporosis is commonly present in patients with complete SCI and non-ambulatory was more affected. Early mobilization of these patients reduces the development of osteoporosis. [ABSTRACT FROM AUTHOR]

Bone mineral density (BMD) is a key feature in diagnosing bone diseases. Although computational tomography (CT) is a common imaging modality, it seldom provides bone mineral density information in a clinic owing to technical difficulties. Thus, a dual-energy X-ray absorptiometry (DXA) is required to measure bone mineral density at the expense of additional radiation exposure. In this study, a deep learning framework was developed to estimate the bone mineral density from an axial cut of the L1 bone on computational tomography. As a result, the correlation coefficient between bone mineral density estimates and dual-energy X-ray absorptiometry bone mineral density was .90. When the samples were categorized into abnormal and normal groups using a standard (T-score = -1.0), the maximum F1 score in the diagnostic test was .875. In addition, it was identified using explainable artificial intelligence techniques that the network intensively sees a local area spanning tissues around the vertebral foramen. This method is well suited as an auxiliary tool in clinical practice and as an automatic screener for identifying latent patients in computational tomography databases. [ABSTRACT FROM AUTHOR]

To investigate whether there is an influence on the results of lumbar spine bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) under three different hip flexion angles (90°, 45°, 0° of hip flexion). We collected a total of 60 outpatients, including 44 females (56.4 ± 5.7 years) and 16 males (50.2 ± 13.7 years). The DXA results of the lumbar spine were scanned and analyzed in three different positions with hip flexion of 90°, 45°, and 0°. We found that there was no significant difference in the area of interest, bone mineral content, BMD, and vertebral body height of the lumbar vertebral body measured by DXA in three hip flexion positions of 90°, 45°, and 0°; Pearson’s correlation analysis showed that lumbar BMD in hip flexion 90° was correlated with it in hip flexion 45° (r = 0.998, P＜ 0.01) and in hip flexion 0° (r = 0.996, P＜0.01) respectively. There was no statistically significant difference in the diagnosis of BMD between 90° and 45° hip flexion (P = 0.903), which was the same as 90° and 0° hip flexion (P = 0.822). Therefore, we conclude that different hip flexion angles can be used in lumbar BMD detection by DXA, which is beneficial to patients who have difficulty in hip flexion, especially for elderly patients with osteoporosis. [ABSTRACT FROM AUTHOR]

Commercial extruded cat foods deviate noticeably from the natural diet of wild cats and contain greater carbohydrate and less protein. This alteration in macronutrient distribution is postulated as a potential factor in feline obesity, yet the precise role of carbohydrates in either predisposing to, or treating, obesity in cats remains inconclusive. This study explored the effects of diets differing in protein, fat, and carbohydrates (NFE) on physical activity and body composition when fed to adult male cats to maintain body weight (BW). Three extruded diets were formulated for adult maintenance according to AAFCO in an isoenergetic approach using the same ingredients in varying proportions: low-protein (LP; protein 28% of metabolizable energy [ME], fat 40% ME, NFE 32% ME), low-fat (LF; protein 42% ME, fat 30% ME, NFE 30% ME), or low-carbohydrate (LC; protein 36% ME, fat 41%ME, NFE 23% ME). Lean (n = 9) and obese (n = 9) adult male neutered cats were fed each diet for 4-wk in a 3 x 3 Latin square design. Physical activity was measured via actigraphy on d 15 to 21 of each period. On d 23 total tissue mass (TTM), body fat mass (BFM), lean soft tissue mass (LSTM), and bone mineral content (BMC) were assessed by dual energy x-ray absorptiometry. Daily food intake and weekly BW were recorded. Data were statistically analyzed in SAS Studio via the GLIMMIX procedure with diet and body condition (bc) as fixed effects and cat as subject. A Tukey post-hoc analysis was performed to assess multiple comparisons when significant (P < 0.05). Body weight (Pbc < 0.0001), TTM (Pbc < 0.0001), BFM (Pbc < 0.0001), LSTM (Pbc < 0.0001), and BMC (Pbc = 0.004) were greater in obese compared with lean cats. Regardless of body condition, LSTM was greater in cats consuming the LF diet (P = 0.010). Daily physical activity was similar between lean and obese cats; however, activity as a ratio of light:dark activity was greater for lean cats compared with obese (Pbc = 0.027). Additionally, cats were more active during dark hours when fed LC and LF (Pdiet = 0.016), though no difference was observed for activity during light hours (P = 0.452). These findings support previous observations regarding body composition disparities between lean and obese cats. Contrary to previous reports, no discernible distinctions in voluntary physical activity were noted between lean and obese cats. In previous studies, both high-carbohydrate and high-fat diets reduced voluntary physical activity when fed to maintain BW which was attributed to a potential alteration in mood and energy levels seen in other species. An increase in physical activity in cats consuming the LF diet could suggest a similar pattern. Future research should explore the metabolic implications of varied macronutrient distributions to expand upon the physiological insights presented herein. Funding for this study was provided by Champion Petfoods, Mitacs Accelerate, and the Natural Sciences and Engineering Council of Canada. [ABSTRACT FROM AUTHOR]

The aim of this study was to use geometric features and texture analysis to discriminate between healthy and unhealthy femurs and to identify the most influential features. We scanned proximal femoral bone (PFB) of 284 Iranian cases (21 to 83 years old) using different dual-energy X-ray absorptiometry (DEXA) scanners and magnetic resonance imaging (MRI) machines. Subjects were labeled as “healthy” (T-score > −0.9) and “unhealthy” based on the results of DEXA scans. Based on the geometry and texture of the PFB in MRI, 204 features were retrieved. We used support vector machine (SVM) with different kernels, decision tree, and logistic regression algorithms as classifiers and the Genetic algorithm (GA) to select the best set of features and to maximize accuracy. There were 185 participants classified as healthy and 99 as unhealthy. The SVM with radial basis function kernels had the best performance (89.08%) and the most influential features were geometrical ones. Even though our findings show the high performance of this model, further investigation with more subjects is suggested. To our knowledge, this is the first study that investigates qualitative classification of PFBs based on MRI with reference to DEXA scans using machine learning methods and the GA.

Abstract Background Literature is scarce on primary sarcopenia among Indian older adults. This study was aimed to estimate the prevalence of primary sarcopenia among older persons in India using the European Working Group on Sarcopenia in the Older People 2010 (EWGSOP) diagnostic criteria and to elucidate the factors leading to its development. Methodology Two hundred twenty‐seven subjects over 60 years of age attending the geriatric outpatient clinic were recruited for the study. Sarcopenia was diagnosed based on set criteria for gait speed, handgrip, and skeletal muscle mass assessment by dual‐energy x‐ray absorptiometry. Result The prevalence of primary sarcopenia in the study population was 39.2% (n = 89). Male patients were more sarcopenic than women, 47% (n = 72) vs 23% (n = 17). Obese subjects (body mass index > 25 kg/m2) had a lower prevalence of sarcopenia (odds ratio = 0.10; 95% confidence interval = 0.05–0.19). There was no association between sarcopenia and other postulated risk factors like low vitamin D levels, dietary protein or carbohydrate intake, or sedentary lifestyle. Conclusion Contrary to published data, primary sarcopenia appears to be higher among older Indians using presently available guidelines. Community studies with validated cutoffs suited for the Indian subcontinent may yield a lower prevalence of primary sarcopenia.

Background Novel advancements in wearable technologies include continuous measurement of body composition via smart watches. The accuracy and stability of these devices are unknown. Objectives This study evaluated smart watches with integrated bioelectrical impedance analysis (BIA) sensors for their ability to measure and monitor changes in body composition. Methods Participants recruited across BMIs received duplicate body composition measures using 2 wearable bioelectrical impedance analysis (W-BIA) model smart watches in sitting and standing positions, and multiple versions of each watch were used to evaluate inter- and intramodel precision. Duplicate laboratory-grade octapolar bioelectrical impedance analysis (8-BIA) and criterion DXA scans were acquired to compare estimates between the watches and laboratory methods. Test-retest precision and least significant changes assessed the ability to monitor changes in body composition. Results Of 109 participants recruited, 75 subjects completed the full manufacturer-recommended protocol. No significant differences were observed between W-BIA watches in position or between watch models. Significant fat-free mass (FFM) differences (P  < 0.05) were observed between both W-BIA and 8-BIA when compared to DXA, though the systematic biases to the criterion were correctable. No significant difference was observed between the W-BIA and the laboratory-grade BIA technology for FFM (55.3 ± 14.5 kg for W-BIA versus 56.0 ± 13.8 kg for 8-BIA; P  > 0.05; Lin's concordance correlation coefficient = 0.97). FFM was less precise on the watches than DXA {CV, 0.7% [root mean square error (RMSE) = 0.4 kg] versus 1.3% (RMSE = 0.7 kg) for W-BIA}, requiring more repeat measures to equal the same confidence in body composition changes over time as DXA. Conclusions After systematic correction, smart-watch BIA devices are capable of stable, reliable, and accurate body composition measurements, with precision comparable to but lower than that of laboratory measures. These devices allow for measurement in environments not accessible to laboratory systems, such as homes, training centers, and geographically remote locations. [ABSTRACT FROM AUTHOR]

Background/Aim: Denosumab is a human monoclonal antibody that binds to the receptor-activated nuclear factor kappa beta ligand (RANKL). Densosumab leads to a reduction in bone resorption by inhibiting RANKL and has been approved for treating postmenopausal osteoporosis (OP). The present study investigated real life data by evaluating the demographic data of postmenopausal patients with OP who received denosumab treatment and the changes in dual energy x-ray absorptiometry (DEXA) parameters before and after denosumab treatment. Methods: This retrospective cohort study included 49 postmenopausal female patients followed in our OP outpatient clinic who were treated with 60 mg subcutaneous denosumab every six months for at least 12 months. The study retrospectively analyzed and recorded patient age, body mass index, age of menopause, fracture history, antiresorptive and/or anabolic drug treatment history, and pre- and post-denosumab Tscores in addition to L1-4, femoral neck, and total hip bone mineral densities (BMDs) on DEXA scans. The changes that occurred before and after the treatment in addition to those that occurred after the treatment based on whether previous anabolic or antiresorptive agents had been used were statistically compared. Results: The L1-4 and total hip T-scores and L1-4 and total hip BMD values measured prior to denosumab treatment showed a statistically significant increase after denosumab treatment (P < 0.001, P = 0.002, P = 0.028, and P = 0.002, respectively). No statistically significant changes in the femoral neck Tscore and BMD after denosumab treatment compared to that before denosumab use (P = 0.056 and P = 0.138, respectively) were found. Furthermore, no statistically significant difference between the pre- and post-denosumab DEXA parameters in the patients who used antiresorptive agents and those who did not (P > 0.05) was found. Additionally, pre- and post-denosumab parameters were not statistically significantly different between those who received and did not receive anabolic therapy before denosumab (P > 0.05). Conclusion: Denosumab treatment for postmenopausal OP leads to a significant increase in lumbar and total hip T-scores and BMDs. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop appropriate correction equations for dual energy X-ray absorptiometry (DXA) for total carcass composition of live meat- and egg-type chickens. Linear (bivariate linear and multivariate linear) and nonlinear (polynomial, multivariate polynomial, broken-line and Gompertz) equations were used to estimate carcass composition of DXA-scanned birds based on chemical proximate analysis. A total of 288 laying females (10-30 wk of age) and 305 broiler breeder females (4-32 wk of age) were used. The same birds scanned by DXA were dissected and utilized for whole-body proximate chemical analysis for body lean, fat, and mineral content (ash). As indicators of carcass fat and lean, abdominal fat pad and breast muscle weights were also recorded. Models were evaluated using root mean square error (RMSE), Bayesian Information Criterion (BIC), coefficient of determination (R 2 ), Durbin Watson test for autocorrelation (DW), and residuals observation (RES). Model estimations were done separately by strain or combined. Estimations of composition responses fit at least 1 of each linear and nonlinear models for the egg- and meat-type chickens on all parameters estimated (P < 0.05). In the egg-type chickens, multivariate linear regression was the best fit for body lean with the lowest RMSE and BIC, and highest R 2 whereas body fat, body ash, and breast muscle were best predicted by the multivariate polynomial model. In the meat-type chickens, body lean was best predicted by the multivariate linear model with the lowest RMSE and BIC, and the highest R 2 whereas the multivariate polynomial was the most parsimonious model for body fat, body ash, and abdominal fat. Positive autocorrelations were observed in several models tested for body fat, body ash, breast muscle, and abdominal fat pad when both strains were analyzed combined (P < 0.05). In summary, a strain-based correction is recommended to all the parameters, with exception of the BW estimation. Correction equations developed in this study demonstrated that the DXA technique is a reliable alternative to proximate chemical analysis in egg- and meat-type chickens., Competing Interests: DISCLOSURES The authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract Background Body mass index (BMI) increases while cardiometabolic risk factors decrease in individuals in high‐income countries. This paradoxical observation raises the question of whether current measures of overweight and obesity properly identify cardiometabolic risk. Methods A total of 3675 participants (59% women) aged 40–84 years with whole‐body dual‐energy x‐ray absorptiometry scans from the seventh survey of the Tromsø Study were included to examine the association between visceral adipose tissue (VAT) in grams and BMI, waist circumference (WC), waist‐to‐hip ratio (WHR), and waist‐to‐height ratio (WHtR). Further, their association with single cardiometabolic risk factors (blood pressure, triglycerides, total cholesterol, high‐density lipoprotein [HDL] cholesterol, glycated hemoglobin, high‐sensitivity C‐reactive protein), modified single components from the ATP Ⅲ criteria for metabolic syndrome (hypertension, diabetes, high triglycerides, and low HDL cholesterol), and metabolic syndrome were examined. Results VAT mass was strongly correlated with BMI (r ≥ 0.77), WC (r ≥ 0.80), WHR (r ≥ 0.58), and WHtR (r ≥ 0.78). WC was the strongest predictor for VAT (area under the curve: 0.90). Compared to anthropometric measures, the associations between VAT and metabolic syndrome as well as single components of metabolic syndrome were statistically significantly stronger, but the clinical differences were likely minor. Conclusion Although VAT mass showed statistically stronger associations with cardiometabolic risk compared to traditional anthropometrics, the clinical importance was likely small. Simple, clinically available tools seem to satisfactory substitute for VAT to identify cardiometabolic risk.

Introduction: Sarcopenia, loss of muscle mass and strength, leads to functional dependence and disability. To date, no study reported the postoperative change of sarcopenia prevalence after hip fractures. Thus, we assessed postoperative changes in the prevalence of osteoporosis and sarcopenia in hip fracture patients. Materials and methods: Among 1159 patients, who underwent surgery for low-energy hip fractures between May 2012 and December 2019, 224 patients (38 men and 186 women with a mean age of 76.8 ± 8.7 years) were studied with preoperative and follow-up dual-energy X-ray absorptiometry (DXA). Bone mineral density (BMD) and skeletal muscle mass were measured on DXA scans. The postoperative changes in the prevalence of osteoporosis and that of the sarcopenia were evaluated as well as Koval grade of the hip fracture patients. Results: While there was no significant change in BMD, SMI significantly decreased postoperatively. Mean decrease of the SMI was 0.53 kg/m2 in men and 0.38 kg/m2 in women. Prevalence of sarcopenia increased from 63 to 89% (p = 0.014) in men and from 45 to 57% (p = 0.006) in women. Lower BMI (Odds ratio (OR) 0.85 (95% confidence interval (CI) 0.76–0.96), p = 0.008) and prior sarcopenia (OR 14.47 (95% CI 5.29–35.39), p < 0.001) were the risk factors for the decrease of SMI after hip fracture. Conclusions: After hip fracture, osteoporosis seemed to be well managed and the prevalence of osteoporosis did not increase. However, SMI decreased and the prevalence of sarcopenia increased. More active measures are warranted to prevent sarcopenia in elderly hip fracture patients. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) is a worldwide problem that could affect children. Aim of the work: to evaluate bone mineral density (BMD) and assess risk factors of OP in children. Patients and methods: This study was carried out on 960 children (410 male and 550 female). All children were subjected to full medical, nutritional history, clinical examination; laboratory investigations, dorsolumbar plain x-ray and dual energy X-ray absorptiometry (DEXA) scan. Results: The children were 57.3% females and 42.7% males (F: M 1.3:1) with a mean age of 9.3 ± 2.7 years. The frequency of low BMD was 28.3% (n = 272), while 11.2% (n = 107) were osteoporotic. OP was idiopathic in 4.7% and secondary in 95.3%. In OP children there was history of vertebral fracture in 91, 2 long bone fractures in 13 and 3 long bone fractures in 3 following low impact traumas. The risk factors of OP were unhealthy nutrition (89.7%), anemia (87.9%), underweight (81.3%), bronchial asthma (68.2%), diabetes mellitus (58.9%), epilepsy (12.2%), delayed puberty (8.4%), chronic kidney disease (4.3%), rheumatic diseases (4.3%) and hypothyroidism (1.9%). There was a significant difference between those with and without OP as regards serum calcium, phosphorous, alkaline phosphatase (p < 0.001) and most common risk factors of OP among studied children (p ≤ 0.05). Conclusions : Osteoporosis is frequent in children and unhealthy nutrition is the most common risk factor. OP is frequent among chronic disease as anemia, diabetes mellitus, bronchial asthma and epilepsy. Raising awareness among rheumatologists, pediatricians and family medicine physicians about this alarming condition is warranted to early detect and treat cases. [ABSTRACT FROM AUTHOR]