Osteoporosis International最新文献

This study investigated simulated tube current reduction and sparse sampling for low-dose computed tomography (CT) regarding volumetric bone mineral density (vBMD) and cortical bone thickness (Ct.Th) of the proximal femur. Sparse sampling with dose reductions of up to 90% may still allow extraction of bone strength parameters with clinically acceptable accuracy.

Introduction: We aimed to investigate effects of CT with simulated lowered tube current and sparse sampling on trabecular and cortical vBMD as well as Ct.Th of the entire proximal femur, its subregions, and with detailed spatial assessments.

Methods: Clinical routine multi-detector CT (MDCT) scans covering the hips from 40 patients were used for simulations of low-dose imaging with 50% and 10% of the original tube current (D50, D10) or projections (P50, P10) combined with statistical iterative reconstruction (SIR), which were then compared against original data with full dose (D100 P100) regarding trabecular vBMD, cortical vBMD, and Ct.Th. An automated framework for multi-parametric assessments was used. Relative errors by comparing measures from original data and simulated low-dose data, regression analyses, Bland-Altman analyses, and statistical parametric mapping (SPM, to assess the spatial distribution of accuracy) were computed.

Results: Sparse sampling enabled drastic reductions of radiation exposure (down to 10% of original imaging) while still producing determinants of bone strength with clinically acceptable relative changes. Lower biases according to Bland-Altman analyses were observed for sparse sampling compared to imaging with virtually lowered tube currents (D10 P100 versus D100 P10) regarding trabecular vBMD, cortical vBMD, as well as Ct.Th. Better accuracy across the whole proximal femur for D100 P50 than for D50 P100 and for D100 P10 than for D10 P100 was observed.

Conclusions: Sparse sampling with SIR may enable drastic reductions of radiation exposure (up to 90% of original doses) for opportunistically measuring image-based surrogate parameters of bone strength.

Investigating vertebral fractures and brain structure, we found significant gray matter volume reductions in the right hippocampus, amygdala, and parahippocampal gyrus, especially in males. These findings emphasize the importance of integrating skeletal and neural health in osteoporosis management.

Purpose: Vertebral fractures (VF) due to osteoporosis impact morbidity and quality of life in the elderly. The relationship between VF and changes in brain structure remains underexplored. This study aimed to investigate the association between VF and gray matter volume (GMV) reductions in specific brain regions and to explore potential sex differences.

Methods: Data from 1,751 participants (571 males, 1,180 females; mean age 64.9, range 18-97) in the fourth survey of the population-based Research on Osteoarthritis/Osteoporosis Against Disability study (2015-2016) were used. Participants were classified into those with and without VF (VF + and VF - groups) based on Genant's semiquantitative method, assessed by spine radiographs. Voxel-based morphometry was applied to MRI images to measure GMV, and a general linear model analysis was performed to compare GMV between groups, adjusting for age, sex, total brain volume, and Mini-Mental State Examination scores as covariates. Additionally, a two-way analysis of variance was conducted on the significant GMV cluster, with sex and VF presence as independent variables, to explore interaction effects.

Results: The VF+ group consisted of 113 participants, while the VF- group included 1,638 participants. The analysis identified a significant cluster with reduced GMV in the VF + group compared to the VF - group. This cluster included the right hippocampus, right amygdala, and right parahippocampal gyrus. Further analysis revealed that males in the VF + group exhibited more pronounced GMV reductions in the significant cluster compared to females.

Conclusion: These findings suggest that VF is associated with significant reductions in brain regions critical for memory, emotional processing, and visuospatial memory, with more severe effects observed in males.

This study examined the link between baseline CTX levels and zoledronic acid's effectiveness in boosting bone density in osteoporosis patients. Among 472 Chinese patients, higher initial CTX levels correlated with greater lumbar spine bone density improvement after treatment. However, no such correlation was found for hip or femoral neck bones. This suggests CTX levels may aid in treatment selection for lumbar spine, though further research is needed. The findings have clinical implications for optimizing osteoporosis treatment.

Purpose: To elucidate the correlation between baseline CTX levels and the therapeutic efficacy of zoledronic acid in augmenting bone mineral density (BMD) among individuals with osteoporosis.

Methods: This study studied patients diagnosed with primary osteoporosis who were hospitalized at least twice and received annual zoledronic acid therapy. Patients were stratified into three groups based on their initial CTX levels prior to zoledronic acid administration. ANOVA was employed to compare BMD alterations across the groups. Generalized estimating equations (GEE) were utilized to analyze the relationship between baseline CTX levels and subsequent BMD changes post-zoledronic acid treatment. Statistical analyses were conducted using SPSS version 26.0.

Results: A total of 472 patients were evaluated and categorized into three cohorts according to their initial CTX levels, arranged in ascending order. Notably, group 3, characterized by the highest initial CTX levels, demonstrated a significantly more pronounced increase in lumbar spine BMD compared to the other two groups. Specifically, when group 1 served as the reference, group 3 exhibited a 0.4-unit elevation in lumbar spine T-score. Conversely, no discernible relationship was observed between baseline CTX levels and BMD changes in the hip or femoral neck following zoledronic acid treatment.

Conclusions: Our findings among a Chinese population indicate that elevated CTX levels, particularly exceeding 0.480 ng/ml, are notably associated with enhanced therapeutic efficacy of zoledronic acid in boosting lumbar spine BMD. However, this correlation appears less robust with respect to improvements in hip and femoral neck BMD.

In this study, we show that combining register and radiological visit data enables more accurate automated identification of proximal humerus fractures compared to traditional register analysis. In a cohort of 11,863 post-menopausal women, our proposed approach improved the coverage of identified fractures from 74 to 81%.

Purpose: The aim of this study was to investigate how reliably proximal humerus fractures can be identified from different administrative datasets without manual review.

Method: Using the national medical registers, namely the Care Register for Health Care and the Register for Primary Health Care Visits, as well as the regional radiological image archive PACS, we developed algorithms for automated identification of proximal humerus fractures. In addition to these sources, we used data from patient records as well as from the self-reports gathered by the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) to establish a gold standard of fractures for validating the algorithms. This gold standard included proximal humerus fractures for a cohort of 11,863 post-menopausal women living in the Kuopio region between 2004 and 2022.

Results: We report the national registers' yearly accuracy in identifying proximal humerus fractures. During the studied 19-year period, the registers' coverage initially improved but then settled at 75%. We show that the image archive provides almost complete coverage of radiographs for the fracture cases, but excluding false positives poses a challenge. In addition, we propose a simple approach that combines register and radiography visit data to improve the accuracy of automated fracture identification. Our algorithm improves the coverage from 74 to 81% and reduces the false discovery rate from 8 to 7% compared to the traditional register analysis.

Conclusion: The proposed approach enables a more reliable way of identifying proximal humerus fractures from administrative data. This study contributes to the objective of automatically tracking all types of fragility fractures in large datasets.

This study compared TBS v4.0, which uses DXA-derived tissue thickness corrections, with TBS v3, which adjusts using BMI. TBS v4.0 improved soft tissue adjustments and maintained fracture risk prediction equivalence with TBS v3, enhancing applicability across diverse body compositions/phenotypes. Direct tissue thickness adjustment increases TBS's utility in osteoporosis assessment and management.

Purpose: This study aimed to compare trabecular bone score (TBS) version 4.0, which uses direct tissue thickness correction via DXA measurements, with TBS version 3, which adjusts for soft tissues using body mass index (BMI). The objective was to assess the performance of TBS v4.0 compared to v3, for bone health evaluation and fracture risk assessment across diverse body compositions.

Methods: Data from the OsteoLaus cohort were analyzed. Associations between TBS, BMI, DXA-measured tissue thickness, visceral fat (VFAT), and android fat were examined using regression and correlation analyses. Machine learning, including Random Forest (RF) and SHapley Additive exPlanations (SHAP), explored TBS changes between versions. Five-year fracture risk was assessed using FRAX adjustment, and logistic regression.

Results: TBS v3 correlated with BMI (r = 0.110, p < 0 .001), VFAT mass (r =  - 0.162, p < 0 .001), and soft tissue thickness (r =  - 0.165, p < 0.001). TBS v4.0 demonstrated weaker correlations with BMI (r =  - 0.057, p > 0.999), VFAT Mass (r =  - 0.067, p > 0.779), and soft tissue thickness (r =  - 0.114, p = 0.019). Differences between TBS versions were investigated with SHapley Additive exPlanations (SHAP) and explained by BMI, tissue thickness, VFAT, and gynoid fat. Logistic regression and Delong's test revealed no significant differences in vertebral fracture prediction between the two TBS versions (p = 0.564). FRAX adjustments were highly consistent between versions (r = 0.994, p < 0.001), with no evidence of calibration bias (p = 0.241).

Conclusion: TBS v4.0 enhances the adjustment for regional soft tissue effects and results suggest comparable vertebral fracture risk prediction to TBS v3. Explainable AI provided insights into the contributions of BMI, tissue thickness, visceral fat, and gynoid fat to the observed changes between TBS versions. Incorporating direct tissue thickness adjustment improves TBS applicability across diverse body sizes and compositions.

The relationship between rheumatoid arthritis (RA) and fracture risk was estimated in an international meta-analysis of individual-level data from 29 prospective cohorts. RA was associated with an increased fracture risk in men and women, and these data will be used to update FRAX®.

Introduction: RA is a well-documented risk factor for subsequent fracture that is incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between rheumatoid arthritis and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD) with a view to updating FRAX.

Methods: The resource comprised 1,909,896 men and women, aged 20-116 years, from 29 prospective cohorts in which the prevalence of RA was 3% or less (primary analysis) and an additional 17 cohorts with a prevalence greater than 3% (supplementary analysis). The association between RA and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture (MOF), and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients.

Results: In the primary analysis, RA was reported in 1.3% of individuals. During 15,683,133 person-years of follow-up, 139,002 fractures occurred, of which 27,518 were hip fractures. RA was associated with an increased risk of any clinical fracture (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.35-1.65). The HRs were of similar magnitude for osteoporotic fracture and MOF but higher for hip fracture (HR = 2.23; 95% CI 1.85-2.69). For hip fracture, there was a significant interaction with age with higher HRs at younger ages. HRs did not differ between men and women and were independent of exposure to glucocorticoids and femoral neck BMD. Lower HRs were observed in the supplementary analysis cohorts, particularly in those with a high apparent prevalence of RA, possibly from conflation of RA with osteoarthritis.

Conclusions: A diagnosis of RA confers an increased risk of fracture that is largely independent of BMD, sex, and corticosteroids. RA should be retained as a risk factor in future iterations of FRAX with updated risk functions to improve fracture risk prediction.

This study explored the association between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in Chinese males. Results show that elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders.

Purpose: This study investigates the relationship between the hypersensitive C-reactive protein to albumin ratio (CAR) and fragility fractures in a Chinese male population.

Methods: A total of 48,186 male participants (age range 18-98 years old, average age 53.92 years) at baseline were recruited from the Kailuan Study and followed up for outcomes until 2022. The Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident fragility fractures. The dose response between CAR and fracture risk was analyzed using restricted cubic splines. Additionally, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were utilized to assess the incremental predictive value of various indicators for the discrimination of fragility fractures.

Results: During an average follow-up of 11.17 years, 728 incident fragility fractures occurred among the 48,186 participants. Compared to participants in the second quartile of CAR, those in the highest quartile had a 49% increased risk of fragility fractures (HR = 1.49, 95% CI = 1.21-1.84) after adjusting for risk factors. Restricted cubic spline analysis showed a nonlinear relationship between CAR and the risk of fragility fractures. The C-index, continuous NRI, and IDI for predicting the risk of fragility fractures were 61.142%, 0.089 (p < 0.05), and 0.00009 (p < 0.05), respectively, which were higher than those of hs-CRP (C-index 0.6137, NRI 0.086, IDI 0.000074) and albumin (C- index 0.6116, NRI 0.068, IDI - 0.000004).

Conclusion: Elevated levels of CAR were associated with an increased risk of fragility fractures and that this association was robust to adjustment for multiple potential confounders.

Screening initiatives for osteoporosis must facilitate treatment of those at elevated fracture risk. In a randomized controlled trial of 24,229 women, those in the screening group with FRAX ≥ 15% were invited for DXA with AOM treatment offered as per national guidelines. Treatment initiation in the following year was 9.5 times higher compared with controls.

Purpose: To determine if screened individuals have lower adherence to anti-osteoporotic medication (AOM) than unscreened and to examine determinants for low treatment adherence.

Method: In 2010/2011, women aged 65-80 (N = 34,229) in the Region of Southern Denmark were invited to the risk-stratified osteoporosis strategy evaluation (ROSE) randomized study. Women in the screening group with moderate to high 10-year fracture risk (FRAX® ≥ 15%) were invited for dual-energy x-ray absorptiometry with AOM treatment as per national guidelines. Screened, controls, and an age-matched general population sample were compared for adherence to AOM using 10-year follow-up data on prescription and hospital records.

Results: Among ROSE participants with FRAX ≥ 15%, 5864 screened and 5790 controls were eligible for analysis, along with an equal number from the general population. AOM initiation in the first year was 9.5 times higher in screened compared to controls (HR 9.50, 7.16; 12.61). There was no difference in implementation assessed as medication possession ratio. The 5-year persistence rates were similar in screened and controls (51-52%), but lower in the general population (44%). FRAX risk factors partly influenced AOM initiation in the screened, with different patterns in other groups. Immobilization, comorbidities, and co-medications were key determinants of discontinuation in both the short and long term.

Conclusion: The ROSE screening programme significantly increased treatment initiation in postmenopausal women. Screened women showed similar treatment adherence levels to non-screened once they started medication. However, frail women were more prone to treatment discontinuation, highlighting the need for targeted support in this subgroup.

Trial registration: The original ROSE trial is registered at ClinicalTrials.gov (NCT01388244). The study protocol has been published in Rubin et al. The risk-stratified osteoporosis strategy evaluation study (ROSE): a randomized prospective population-based study. Design and baseline characteristics. Calcif Tissue Int. 2015;96(2):167-79.