Pub Date : 2026-04-01Epub Date: 2026-01-12DOI: 10.1016/j.jocd.2026.101667
Nour Khalil , Rawad El Hage , Emne Hammoud, Elie Maliha, Gisèle El Khoury, Zaher El Hage, Christophe Jacob
{"title":"Sarcopenic obesity negatively affects composite indices of femoral neck strength in premenopausal women","authors":"Nour Khalil , Rawad El Hage , Emne Hammoud, Elie Maliha, Gisèle El Khoury, Zaher El Hage, Christophe Jacob","doi":"10.1016/j.jocd.2026.101667","DOIUrl":"10.1016/j.jocd.2026.101667","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 2","pages":"Article 101667"},"PeriodicalIF":1.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-06DOI: 10.1016/j.jocd.2026.101689
Rachel Shingaki-Wells, Pauline Du, Nicholas Batt, Hannah Youn, Anouk Dev, Sally Bell, Suong Le, Frances Milat, Anne Trinh
Introduction: Chronic liver disease (CLD) is a known risk factor for osteoporosis and minimal trauma fracture through multiple mechanisms including cholestasis, alcohol, malnutrition, sarcopenia and hypogonadism. The evidence for bisphosphonates is mostly seen in primary biliary cholangitis and liver transplantation.
Methods: This is a retrospective observational study of adult CLD patients, examining changes in bone mineral density (BMD) and bone turnover markers in the 12 months following zoledronic acid (ZA) compared to an age- and sex-matched population of CLD patients.
Results: 20 adults with CLD who received ZA were matched to 20 adults who had not received bone-specific treatment. Mean age of all participants was 59.7 ± 1.5 years and 55% were female. Baseline mean T-scores at the lumbar spine (LS) was -1.8 ± 1.3, left femoral neck (LFN) was -2.0 ± 0.9 and the left total hip (LTH) was -1.7 ± 1.0. There was a 3.61% difference in change in BMD per year at the LS (p=0.001) and 1.73% difference at the LTH between those who received ZA and those who did not (p=0.037). There was no difference at the LFN. In those who received ZA, mean change in procollagen type 1 N-propeptide was 3.0% p=0.051 and mean change in C-telopeptide was -10.4%, p= 0.032.
Conclusion: Zoledronic acid increases bone mineral density in a chronic liver disease population with reduction in bone resorption markers. This requires confirmation in a randomised setting.
慢性肝病（CLD）是骨质疏松症和轻度创伤性骨折的已知危险因素，其机制包括胆汁淤积、酒精、营养不良、肌肉减少症和性腺功能减退。双膦酸盐的证据主要见于原发性胆管炎和肝移植。方法：这是一项对成年CLD患者的回顾性观察研究，研究了在服用唑来膦酸（ZA）后12个月内骨密度（BMD）和骨转换标志物的变化，并与年龄和性别匹配的CLD患者进行了比较。结果：20名接受骨特异性治疗的成人CLD患者与20名未接受骨特异性治疗的成人相匹配。所有参与者的平均年龄为59.7±1.5岁，其中55%为女性。腰椎（LS）基线平均t评分为-1.8±1.3，左股骨颈（LFN）为-2.0±0.9，左全髋（LTH）为-1.7±1.0。接受ZA治疗的患者与未接受ZA治疗的患者在LS和LTH的年骨密度变化差异分别为3.61%和1.73% （p=0.037）。在LFN上没有区别。ZA组1型前胶原n -前肽平均变化3.0% p=0.051， c -末端肽平均变化-10.4% p= 0.032。结论：唑来膦酸增加慢性肝病患者骨密度，降低骨吸收标志物。这需要在随机设置中进行确认。
{"title":"Zoledronic acid improves bone mineral density at the lumbar spine and total hip in adults with chronic liver disease.","authors":"Rachel Shingaki-Wells, Pauline Du, Nicholas Batt, Hannah Youn, Anouk Dev, Sally Bell, Suong Le, Frances Milat, Anne Trinh","doi":"10.1016/j.jocd.2026.101689","DOIUrl":"https://doi.org/10.1016/j.jocd.2026.101689","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic liver disease (CLD) is a known risk factor for osteoporosis and minimal trauma fracture through multiple mechanisms including cholestasis, alcohol, malnutrition, sarcopenia and hypogonadism. The evidence for bisphosphonates is mostly seen in primary biliary cholangitis and liver transplantation.</p><p><strong>Methods: </strong>This is a retrospective observational study of adult CLD patients, examining changes in bone mineral density (BMD) and bone turnover markers in the 12 months following zoledronic acid (ZA) compared to an age- and sex-matched population of CLD patients.</p><p><strong>Results: </strong>20 adults with CLD who received ZA were matched to 20 adults who had not received bone-specific treatment. Mean age of all participants was 59.7 ± 1.5 years and 55% were female. Baseline mean T-scores at the lumbar spine (LS) was -1.8 ± 1.3, left femoral neck (LFN) was -2.0 ± 0.9 and the left total hip (LTH) was -1.7 ± 1.0. There was a 3.61% difference in change in BMD per year at the LS (p=0.001) and 1.73% difference at the LTH between those who received ZA and those who did not (p=0.037). There was no difference at the LFN. In those who received ZA, mean change in procollagen type 1 N-propeptide was 3.0% p=0.051 and mean change in C-telopeptide was -10.4%, p= 0.032.</p><p><strong>Conclusion: </strong>Zoledronic acid increases bone mineral density in a chronic liver disease population with reduction in bone resorption markers. This requires confirmation in a randomised setting.</p>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 2","pages":"101689"},"PeriodicalIF":1.6,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-29DOI: 10.1016/j.jocd.2025.101664
Nami Safai Haeri , Subashan Perera , Susan L. Greenspan
Background: Osteoporosis and sarcopenia are prevalent in older adults, particularly in long-term care (LTC) settings, where logistical barriers often impede timely musculoskeletal assessments. Traditional mobile DXA services are limited and typically lack integrated evaluations of muscle health and functional performance. The present report shares our experience with an all-in-one mobile assessment unit designed to provide comprehensive musculoskeletal evaluations directly at LTC facilities.
Methods: The mobile unit was deployed across five randomized controlled trials in over 30 LTC facilities from 2007 to 2025. It integrates multiple modalities to evaluate bone and muscle health. We report on feasibility, resource utilization, acceptability, and safety.
Results: A total of 876 individuals were enrolled in the trials and underwent 3,623 assessments in the mobile unit, including screenings of non-enrolled individuals and repeated visits during 2–3 years of follow-up among enrolled participants. The mobile unit effectively conducted comprehensive assessments within 45 to 60 min per participant. No device-related adverse events occurred.
Conclusion: This mobile assessment model offers a scalable solution to enhance musculoskeletal care access for older adults in LTC settings. Future directions include expanding its use to underserved populations and integrating telehealth capabilities to further improve care delivery.
{"title":"Bridging diagnostic gaps in osteoporosis and sarcopenia in long-term care: Leveraging a mobile assessment unit for clinical trials and comprehensive musculoskeletal evaluations","authors":"Nami Safai Haeri , Subashan Perera , Susan L. Greenspan","doi":"10.1016/j.jocd.2025.101664","DOIUrl":"10.1016/j.jocd.2025.101664","url":null,"abstract":"<div><div><em>Background:</em> Osteoporosis and sarcopenia are prevalent in older adults, particularly in long-term care (LTC) settings, where logistical barriers often impede timely musculoskeletal assessments. Traditional mobile DXA services are limited and typically lack integrated evaluations of muscle health and functional performance. The present report shares our experience with an all-in-one mobile assessment unit designed to provide comprehensive musculoskeletal evaluations directly at LTC facilities.</div><div><em>Methods:</em> The mobile unit was deployed across five randomized controlled trials in over 30 LTC facilities from 2007 to 2025. It integrates multiple modalities to evaluate bone and muscle health. We report on feasibility, resource utilization, acceptability, and safety.</div><div><em>Results:</em> A total of 876 individuals were enrolled in the trials and underwent 3,623 assessments in the mobile unit, including screenings of non-enrolled individuals and repeated visits during 2–3 years of follow-up among enrolled participants. The mobile unit effectively conducted comprehensive assessments within 45 to 60 min per participant. No device-related adverse events occurred.</div><div><em>Conclusion:</em> This mobile assessment model offers a scalable solution to enhance musculoskeletal care access for older adults in LTC settings. Future directions include expanding its use to underserved populations and integrating telehealth capabilities to further improve care delivery.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101664"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-22DOI: 10.1016/j.jocd.2025.101640
Lili Zhuang , Song Zou
Objective: To investigate the relationship between body mass index (BMI) and areal bone mineral density (BMD) as well as trabecular bone score (TBS) in adults with type 2 diabetes mellitus (T2DM) and to determine whether age or sex modifies these relationships.
Methods: We retrospectively identified 762 community-dwelling adults aged ≥ 50 years (257 with T2DM and 505 non-diabetic controls) who underwent dual-energy X-ray absorptiometry at our centre between August 2023 and May 2024. Lumbar-spine and femoral-neck BMD as well as TBS were extracted. Associations were evaluated with Spearman’s ρ and multiple linear regression, adjusting for age and sex.
Results: In men, BMI, BMD and TBS did not differ between diabetic and non-diabetic participants in any age stratum (all P > 0.05). Women aged 50–60 y with T2DM exhibited higher LS-BMD but lower TBS than non-diabetic peers (both P < 0.05), indicating early dissociation between density and micro-architecture. Correlation analysis shows a positive association between BMI and LS-BMD (ρ=0.286, P= 0.002). Multivariate linear regression confirmed that BMI was an independent positive predictor of LS-BMD (β = 0.276, P < 0.001) and an independent negative predictor of TBS (β = −0.069, P = 0.043).
Conclusion: In T2DM, higher BMI is independently associated with greater BMD but poorer trabecular micro-architecture. This paradox is most evident in post-menopausal women, underscoring TBS as an early warning tool when BMD remains normal.
目的：探讨成人2型糖尿病（T2DM）患者身体质量指数（BMI）与骨密度（BMD）及骨小梁评分（TBS）的关系，并探讨年龄和性别是否会改变这种关系。方法：我们回顾性地确定了762名年龄≥50岁的社区居民（257名T2DM患者，505名非糖尿病对照组），他们于2023年8月至2024年5月在我们的中心接受了双能x线吸收仪检查。提取腰椎、股骨颈骨密度及TBS。采用Spearman ρ和多元线性回归评估相关性，调整年龄和性别。结果：在男性中，糖尿病和非糖尿病参与者在任何年龄段的BMI、BMD和TBS均无差异（均P >； 0.05）。50-60岁的女性T2DM患者的LS-BMD高于非糖尿病患者，但TBS低于非糖尿病患者（P < 0.05），表明密度与微结构之间的早期分离。相关分析显示BMI与LS-BMD呈正相关（ρ=0.286， P= 0.002）。多元线性回归证实BMI是LS-BMD的独立阳性预测因子（β = 0.276, P < 0.001），是TBS的独立阴性预测因子（β = - 0.069, P = 0.043）。结论：在T2DM中，较高的BMI与较高的BMD和较差的小梁微结构独立相关。这种矛盾在绝经后妇女中最为明显，强调TBS是骨密度保持正常的早期预警工具。
{"title":"Correlation between body mass index, bone mineral density and trabecular bone score in patients with Type 2 diabetes","authors":"Lili Zhuang , Song Zou","doi":"10.1016/j.jocd.2025.101640","DOIUrl":"10.1016/j.jocd.2025.101640","url":null,"abstract":"<div><div><em>Objective:</em> To investigate the relationship between body mass index (BMI) and areal bone mineral density (BMD) as well as trabecular bone score (TBS) in adults with type 2 diabetes mellitus (T2DM) and to determine whether age or sex modifies these relationships.</div><div><em>Methods:</em> We retrospectively identified 762 community-dwelling adults aged ≥ 50 years (257 with T2DM and 505 non-diabetic controls) who underwent dual-energy X-ray absorptiometry at our centre between August 2023 and May 2024. Lumbar-spine and femoral-neck BMD as well as TBS were extracted. Associations were evaluated with Spearman’s ρ and multiple linear regression, adjusting for age and sex.</div><div><em>Results:</em> In men, BMI, BMD and TBS did not differ between diabetic and non-diabetic participants in any age stratum (all P > 0.05). Women aged 50–60 y with T2DM exhibited higher LS-BMD but lower TBS than non-diabetic peers (both P < 0.05), indicating early dissociation between density and micro-architecture. Correlation analysis shows a positive association between BMI and LS-BMD (ρ=0.286, <em>P</em>= 0.002). Multivariate linear regression confirmed that BMI was an independent positive predictor of LS-BMD (β = 0.276, <em>P</em> < 0.001) and an independent negative predictor of TBS (β = −0.069, <em>P</em> = 0.043).</div><div><em>Conclusion:</em> In T2DM, higher BMI is independently associated with greater BMD but poorer trabecular micro-architecture. This paradox is most evident in post-menopausal women, underscoring TBS as an early warning tool when BMD remains normal.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101640"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-12-31DOI: 10.1016/j.jocd.2025.101661
Hannah E. Westerberg , Madeline A. Czeck , Donald R. Dengel , Lisa S. Chow
Introduction: Muscle and bone are impacted by adiposity and metabolic dysfunction. To investigate their relationship, we assessed total and regional muscle-to-bone (MBR) and soft tissue-to-bone (SBR) ratios and their association with cardiometabolic risk factors in adults across body mass indexes (BMIs).
Methodology: This study included 152 males (n=58; age 28.8±6.4 yrs) and females (n=94; age 28.1±6.8 yrs) with different BMIs. Dual X-ray absorptiometry provided lean mass, fat mass, and bone mineral content. ANCOVA with Bonferroni correction assessed ratio differences between BMIs while controlling for age. Linear regression assessed associations between the ratios with insulin, glucose, homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC:HDL ratio, and blood pressure while controlling for BMI and self-reported exercise status.
Results: Males with obesity (OM) had higher arm and leg, but not total MBR than males with healthy weight (HWM). OM had higher total, arm, and leg SBRs (all p<0.001) than HWM. Females with obesity (OF) had higher total, arm, and leg MBRs and SBRs than healthy weight (HWF) (all p<0.01). Controlling for BMI and exercise status in females, total MBR and SBR positively associated with insulin (MBR: adjusted r2=0.24, p=0.02; SBR: adjusted r2=0.25, p=0.01) and HOMA-IR (MBR: adjusted r2=0.28, p=0.04; SBR: adjusted r2=0.30, p=0.01) while SBR associated with TC:HDL ratio (adjusted r2=0.19, p=0.03). No associations were found between the ratios with cardiometabolic outcomes in males.
Conclusions: OF had higher total and regional MBRs and SBRs than HWF. OM had higher regional MBRs and all SBRs than HWM, but not total MBR. Total MBR and SBR associated positively with insulin and HOMA-IR in females, but not males. In females, SBR also positively associated with TC:HDL ratio. Although higher MBRs and SBRs may relate to higher cardiometabolic risk in females, further research is needed.
{"title":"Exploring body composition ratios and their relation to cardiometabolic disease risk factors in adults with varying body mass index categories","authors":"Hannah E. Westerberg , Madeline A. Czeck , Donald R. Dengel , Lisa S. Chow","doi":"10.1016/j.jocd.2025.101661","DOIUrl":"10.1016/j.jocd.2025.101661","url":null,"abstract":"<div><div><em>Introduction:</em> Muscle and bone are impacted by adiposity and metabolic dysfunction. To investigate their relationship, we assessed total and regional muscle-to-bone (MBR) and soft tissue-to-bone (SBR) ratios and their association with cardiometabolic risk factors in adults across body mass indexes (BMIs).</div><div><em>Methodology:</em> This study included 152 males (n=58; age 28.8±6.4 yrs) and females (n=94; age 28.1±6.8 yrs) with different BMIs. Dual X-ray absorptiometry provided lean mass, fat mass, and bone mineral content. ANCOVA with Bonferroni correction assessed ratio differences between BMIs while controlling for age. Linear regression assessed associations between the ratios with insulin, glucose, homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC:HDL ratio, and blood pressure while controlling for BMI and self-reported exercise status.</div><div><em>Results:</em> Males with obesity (O<sub>M</sub>) had higher arm and leg, but not total MBR than males with healthy weight (HW<sub>M</sub>). O<sub>M</sub> had higher total, arm, and leg SBRs (all p<0.001) than HW<sub>M</sub>. Females with obesity (O<sub>F</sub>) had higher total, arm, and leg MBRs and SBRs than healthy weight (HW<sub>F</sub>) (all p<0.01). Controlling for BMI and exercise status in females, total MBR and SBR positively associated with insulin (MBR: adjusted r<sup>2</sup>=0.24, p=0.02; SBR: adjusted r<sup>2</sup>=0.25, p=0.01) and HOMA-IR (MBR: adjusted r<sup>2</sup>=0.28, p=0.04; SBR: adjusted r<sup>2</sup>=0.30, p=0.01) while SBR associated with TC:HDL ratio (adjusted r<sup>2</sup>=0.19, p=0.03). No associations were found between the ratios with cardiometabolic outcomes in males.</div><div><em>Conclusions:</em> O<sub>F</sub> had higher total and regional MBRs and SBRs than HW<sub>F</sub>. O<sub>M</sub> had higher regional MBRs and all SBRs than HW<sub>M</sub>, but not total MBR. Total MBR and SBR associated positively with insulin and HOMA-IR in females, but not males. In females, SBR also positively associated with TC:HDL ratio. Although higher MBRs and SBRs may relate to higher cardiometabolic risk in females, further research is needed.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101661"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-11-20DOI: 10.1016/j.jocd.2025.101656
Ashley McKenzie , Alvin Lee Day
Introduction: Osteoporosis is the most common metabolic bone disease in the United States. It is often underdiagnosed and undertreated resulting in additional fragility fractures. Hip fractures specifically can lead to 8-36 % excess mortality at 1 year. It has been found that 80-95 % of patients in certain practice settings are discharged with insufficient antifracture treatment. We were interested in determining the frequency of transition from oral bisphosphonate to parenteral osteoporosis therapy following hospitalization for a hip fracture in veterans aged 65 and older.
Methods: Utilizing the national Department of Veterans Affairs database, VA Informatics and Computing Infrastructure or VINCI, a cohort of patients aged 65 and older with a prior diagnosis of osteoporosis taking bisphosphonates who subsequently had a hip fracture was collected and analyzed. This created a cohort of 46,004 patients. This cohort was divided by gender and included 42,876 males and 3,128 females. The deidentified cohort records were reviewed to determine who received parenteral medications after the hip fracture.
Results: Based on the analysis, there were 1,459 patients on parenteral medications in the cohort of 46,004 after hip fracture. This resulted in a percentage of 3.17 % overall. The percentage of women placed on a parenteral medication was 1.66 % and for men was 3.28 %. The most used medication was zoledronic acid (Zoledronic Acid) with 1,190 uses of the 1,459 (81.6 %).
Conclusion: Hip fractures have a large impact on morbidity and mortality in the older population. Our study shows opportunity for increased utilization of parenteral therapies in patients who fractured on a background of oral bisphosphonate therapy. Delays may be the result of several issues including cost, recognition of fracture risk change, lack of communication, and comfort with therapies. The low percentage of parenteral medication use indicates some opportunity for more potent treatment. Future research directions could analyze civilian databases to get a more generalizable data set.
{"title":"Treatment trends after hip fracture of veterans with osteoporosis","authors":"Ashley McKenzie , Alvin Lee Day","doi":"10.1016/j.jocd.2025.101656","DOIUrl":"10.1016/j.jocd.2025.101656","url":null,"abstract":"<div><div><em>Introduction:</em> Osteoporosis is the most common metabolic bone disease in the United States. It is often underdiagnosed and undertreated resulting in additional fragility fractures. Hip fractures specifically can lead to 8-36 % excess mortality at 1 year. It has been found that 80-95 % of patients in certain practice settings are discharged with insufficient antifracture treatment. We were interested in determining the frequency of transition from oral bisphosphonate to parenteral osteoporosis therapy following hospitalization for a hip fracture in veterans aged 65 and older.</div><div><em>Methods:</em> Utilizing the national Department of Veterans Affairs database, VA Informatics and Computing Infrastructure or VINCI, a cohort of patients aged 65 and older with a prior diagnosis of osteoporosis taking bisphosphonates who subsequently had a hip fracture was collected and analyzed. This created a cohort of 46,004 patients. This cohort was divided by gender and included 42,876 males and 3,128 females. The deidentified cohort records were reviewed to determine who received parenteral medications after the hip fracture.</div><div><em>Results:</em> Based on the analysis, there were 1,459 patients on parenteral medications in the cohort of 46,004 after hip fracture. This resulted in a percentage of 3.17 % overall. The percentage of women placed on a parenteral medication was 1.66 % and for men was 3.28 %. The most used medication was zoledronic acid (Zoledronic Acid) with 1,190 uses of the 1,459 (81.6 %).</div><div><em>Conclusion:</em> Hip fractures have a large impact on morbidity and mortality in the older population. Our study shows opportunity for increased utilization of parenteral therapies in patients who fractured on a background of oral bisphosphonate therapy. Delays may be the result of several issues including cost, recognition of fracture risk change, lack of communication, and comfort with therapies. The low percentage of parenteral medication use indicates some opportunity for more potent treatment. Future research directions could analyze civilian databases to get a more generalizable data set.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101656"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-10-15DOI: 10.1016/j.jocd.2025.101635
Carla Antoniana Ferreira de Almeida Vieira , Eveline Gadelha Pereira Fontenele , Danielle de Souza Bessa , Fábia Karine de Moura Lopes , Larissa Luna Queiroz , Carlos Henrique Paiva Grangeiro , Catarina Brasil D´alva , Renan Magalhães Montenegro Junior , Maria Elisabete Amaral de Moraes
Introduction: Turner syndrome is a rare chromosomal abnormality in females who typically present with short stature, hypogonadism and increased risk of osteoporosis. Areal bone densitometry (aBMD) usually underestimates bone mass in people with short stature and the bone mineral apparent density (BMAD) can be used as an adjustment for height. The study aimed to assess the frequency of low bone mass and associated factors in Brazilian women with TS at a referral center.
Methodology: Cross-sectional dual-energy X-ray absorptiometry scans at the lumbar spine and femur were performed to assess bone mass. The association of aBMD, BMAD, age, height, history of fractures, karyotype, use of somatropin (rhGH) and estrogen replacement therapy (ERT) with low bone mass was tested and p-value < 0.05 was considered statistically significant.
Results: Forty-six patients with a mean age of 32 years and height (SDS) 145 cm (-2.89) were evaluated. Five (11%) had a history of fracture. Thirty-five (83%) patients had delayed puberty (> 13 years), 4 (9%) had spontaneous menarche, 19 (41%) were treated with rhGH. Lumbar aBMD was positively correlated to height (p = 0.010). Low bone mass was more frequently detected with aBMD (49% lumbar spine and 48% femoral neck) than with BMAD (31% lumbar spine and 13% femoral neck) and was associated with estrogen status (p=0,002). All patients with delayed puberty and without ERT at the time of the study had low bone mass at the lumbar spine. In contrast, all patients with spontaneous menarche had normal bone mass at both sites. No significant correlation between treatment with rhGH or karyotype with low bone mass was observed.
Conclusions: Low bone mass is a common finding in a cohort of Brazilian women with TS and is associated with delayed puberal induction or start of ERT. Our results highlight the importance of early diagnosis and prompt initiation of ERT to optimise bone mass acquisition.
{"title":"Low Bone Mass is Common and Associated with Delayed Estrogen Replacement Therapy in Adult Brazilian Women with Turner Syndrome","authors":"Carla Antoniana Ferreira de Almeida Vieira , Eveline Gadelha Pereira Fontenele , Danielle de Souza Bessa , Fábia Karine de Moura Lopes , Larissa Luna Queiroz , Carlos Henrique Paiva Grangeiro , Catarina Brasil D´alva , Renan Magalhães Montenegro Junior , Maria Elisabete Amaral de Moraes","doi":"10.1016/j.jocd.2025.101635","DOIUrl":"10.1016/j.jocd.2025.101635","url":null,"abstract":"<div><div><em>Introduction:</em> Turner syndrome is a rare chromosomal abnormality in females who typically present with short stature, hypogonadism and increased risk of osteoporosis. Areal bone densitometry (aBMD) usually underestimates bone mass in people with short stature and the bone mineral apparent density (BMAD) can be used as an adjustment for height. The study aimed to assess the frequency of low bone mass and associated factors in Brazilian women with TS at a referral center.</div><div><em>Methodology:</em> Cross-sectional dual-energy X-ray absorptiometry scans at the lumbar spine and femur were performed to assess bone mass. The association of aBMD, BMAD, age, height, history of fractures, karyotype, use of somatropin (rhGH) and estrogen replacement therapy (ERT) with low bone mass was tested and p-value < 0.05 was considered statistically significant.</div><div><em>Results:</em> Forty-six patients with a mean age of 32 years and height (SDS) 145 cm (-2.89) were evaluated. Five (11%) had a history of fracture. Thirty-five (83%) patients had delayed puberty (> 13 years), 4 (9%) had spontaneous menarche, 19 (41%) were treated with rhGH. Lumbar aBMD was positively correlated to height (p = 0.010). Low bone mass was more frequently detected with aBMD (49% lumbar spine and 48% femoral neck) than with BMAD (31% lumbar spine and 13% femoral neck) and was associated with estrogen status (p=0,002). All patients with delayed puberty and without ERT at the time of the study had low bone mass at the lumbar spine. In contrast, all patients with spontaneous menarche had normal bone mass at both sites. No significant correlation between treatment with rhGH or karyotype with low bone mass was observed.</div><div><em>Conclusions:</em> Low bone mass is a common finding in a cohort of Brazilian women with TS and is associated with delayed puberal induction or start of ERT. Our results highlight the importance of early diagnosis and prompt initiation of ERT to optimise bone mass acquisition.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101635"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145469077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Osteoporosis is a prevalent and growing public health issue, particularly in aging populations, due to its association with fragility fractures, reduced mobility, and increased healthcare burden. Dual-energy X-ray absorptiometry (DXA) remains the clinical gold standard for assessing bone mineral density (BMD), but it requires dedicated equipment. DXA is separately required from the radiography system for fracture diagnosis, making DXA difficult to access depending on the facility and region.
Purpose
To address these limitations, we developed the quantitative bone (Q-BONE) system, a novel diagnostic tool that updates existing radiography system to utilize dual energy in a single X-ray irradiation to produce BMD (Q-BONE score) and high-resolution X-ray images (Q-BONE images).
Methods
We evaluated the correlation between the Q-BONE score of Q-BONE system and the BMD of the DXA for the DXA measurement phantom and the 200 people, and the degree of agreement among them by Bland-Altman analysis. Further, fracture detectability was compared between Q-BONE images and radiographs using predefined radiological criteria.
Results
The correlation between bone mineral density and Q-BONE score for 200 individuals was as high as 0.91 with good linearity; however, these two values were statistically inconsistent mainly because of body fat percentage (P < 0.05). Q-BONE images significantly improved visualization of cortical and trabecular bone structures (P < 0.01) and improved detection of fractures and structural abnormalities compared with conventional radiographs.
Conclusions
The Q-BONE system has the potential that achieves comprehensive osteoporosis assessment by combining BMD measurement and fracture evaluation in a single efficient procedure. Its implementation could improve diagnostic efficiency and accessibility, particularly in settings where DXA is unavailable. Further technical improvement on body fat issues, and studies are warranted to assess its clinical utility across broader populations and skeletal sites.
{"title":"The Q-BONE system: A novel dual-energy X-ray diagnostic method for osteoporosis","authors":"Takahiro Kawamura , Tomoyuki Takahashi , Kayo Okano , Masahiko Yamada , Toshiko Iidaka , Sakae Tanaka , Noriko Yoshimura","doi":"10.1016/j.jocd.2025.101638","DOIUrl":"10.1016/j.jocd.2025.101638","url":null,"abstract":"<div><h3>Background</h3><div>Osteoporosis is a prevalent and growing public health issue, particularly in aging populations, due to its association with fragility fractures, reduced mobility, and increased healthcare burden. Dual-energy X-ray absorptiometry (DXA) remains the clinical gold standard for assessing bone mineral density (BMD), but it requires dedicated equipment. DXA is separately required from the radiography system for fracture diagnosis, making DXA difficult to access depending on the facility and region.</div></div><div><h3>Purpose</h3><div>To address these limitations, we developed the quantitative bone (Q-BONE) system, a novel diagnostic tool that updates existing radiography system to utilize dual energy in a single X-ray irradiation to produce BMD (Q-BONE score) and high-resolution X-ray images (Q-BONE images).</div></div><div><h3>Methods</h3><div>We evaluated the correlation between the Q-BONE score of Q-BONE system and the BMD of the DXA for the DXA measurement phantom and the 200 people, and the degree of agreement among them by Bland-Altman analysis. Further, fracture detectability was compared between Q-BONE images and radiographs using predefined radiological criteria.</div></div><div><h3>Results</h3><div>The correlation between bone mineral density and Q-BONE score for 200 individuals was as high as 0.91 with good linearity; however, these two values were statistically inconsistent mainly because of body fat percentage (<em>P</em> < 0.05). Q-BONE images significantly improved visualization of cortical and trabecular bone structures (<em>P</em> < 0.01) and improved detection of fractures and structural abnormalities compared with conventional radiographs.</div></div><div><h3>Conclusions</h3><div>The Q-BONE system has the potential that achieves comprehensive osteoporosis assessment by combining BMD measurement and fracture evaluation in a single efficient procedure. Its implementation could improve diagnostic efficiency and accessibility, particularly in settings where DXA is unavailable. Further technical improvement on body fat issues, and studies are warranted to assess its clinical utility across broader populations and skeletal sites.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101638"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2025-09-08DOI: 10.1016/j.jocd.2025.101625
Daniel G. Whitney , Michelle S. Caird , Edward A. Hurvitz , Karl J. Jepsen
Introduction/background: Multi-trait vs. single trait approaches, such as dis-integration patterns of key size-mass traits, may better capture the heterogeneity of bone strength profiles for skeletally complex populations like adults with cerebral palsy (CP). The objective was to assess if dis-integration of dual-energy x-ray absorptiometry (DXA)-derived bone traits predict fracture incidence among adults with CP.
Methodology: This was a retrospective cohort study including n=75 adults with CP with a hip DXA from 01/01/2012-03/05/2021 from a single Medical Center; individuals were followed through 9/12/2023 for fracture incidence. Logistic regression estimated the odds ratio (OR) of fracture by the exposure, an interaction between (1) the residual of the BMC-area linear regression and (2) bone area, after adjusting for confounders. Discrimination (c-statistic) was assessed to compare whether the primary exposure or BMD better predicted incident fracture.
Results: Femoral neck BMC-area residual was associated fracture incidence (n=19 fractures) but was conditional on bone area (P-for-interaction, 0.026-0.067). A lower residual was associated with increased OR for smaller areas (e.g., at 10th percentile of area, OR = 1.18; 95 %CI = 0.96-1.45), but a lower OR for larger areas (e.g., at 90th percentile of area, OR = 0.88; 95 %CI = 0.77-1.02). The primary exposure had higher discrimination of incident fracture compared to BMD across all unadjusted and adjusted models (c-statistic range 0.69-0.84 vs. 0.49-0.79, respectively).
Conclusions: Dis-integration of key size-mass bone traits was associated with incident fracture and was a stronger predictor of fracture compared to BMD in this clinical cohort of adults with CP.
介绍/背景：多性状与单性状方法，如关键尺寸-质量性状的分解模式，可能更好地捕捉骨骼复杂人群（如脑瘫（CP）成人）骨强度谱的异质性。目的是评估双能x线吸收仪（DXA）衍生的骨骼特征的瓦解是否能预测成年CP患者的骨折发生率。方法：这是一项回顾性队列研究，包括n=75名患有髋关节DXA的成年CP患者，时间为2012年1月1日至2021年3月5日，来自单一医疗中心；随访至2023年9月12日，观察骨折发生率。在调整混杂因素后，Logistic回归通过暴露估计骨折的优势比（OR），这是(1)BMC-area线性回归的残差和(2)骨面积之间的相互作用。判别性（c-statistic）被评估来比较初次暴露或骨密度是否能更好地预测骨折。结果：股骨颈BMC-area残差与骨折发生率相关（n=19例骨折），但与骨面积有关（相互作用p值为0.026-0.067）。较低的残留与增加或较小的地区(例如,在第十百分位的区域,或 = 1.18;95 CI % = 0.96 - -1.45),但较低的或更大的区域(例如,在第90个百分位的区域,或 = 0.88;95 CI % = 0.77 - -1.02)。在所有未调整和调整的模型中，与骨密度相比，初次暴露对意外骨折的辨别能力更高（c-统计范围分别为0.69-0.84比0.49-0.79）。结论：在成年CP患者的临床队列中，关键尺寸-质量骨特征的解体与偶发性骨折有关，与骨密度相比，它是骨折的更强预测因子。
{"title":"Fracture prediction by bone trait dis-integration using DXA among a clinical cohort of adults with cerebral palsy","authors":"Daniel G. Whitney , Michelle S. Caird , Edward A. Hurvitz , Karl J. Jepsen","doi":"10.1016/j.jocd.2025.101625","DOIUrl":"10.1016/j.jocd.2025.101625","url":null,"abstract":"<div><div><em>Introduction/background:</em> Multi-trait vs. single trait approaches, such as dis-integration patterns of key size-mass traits, may better capture the heterogeneity of bone strength profiles for skeletally complex populations like adults with cerebral palsy (CP). The objective was to assess if dis-integration of dual-energy x-ray absorptiometry (DXA)-derived bone traits predict fracture incidence among adults with CP.</div><div><em>Methodology:</em> This was a retrospective cohort study including n=75 adults with CP with a hip DXA from 01/01/2012-03/05/2021 from a single Medical Center; individuals were followed through 9/12/2023 for fracture incidence. Logistic regression estimated the odds ratio (OR) of fracture by the exposure, an interaction between (1) the residual of the BMC-area linear regression and (2) bone area, after adjusting for confounders. Discrimination (c-statistic) was assessed to compare whether the primary exposure or BMD better predicted incident fracture.</div><div><em>Results:</em> Femoral neck BMC-area residual was associated fracture incidence (n=19 fractures) but was conditional on bone area (<em>P-</em>for-interaction, 0.026-0.067). A lower residual was associated with increased OR for smaller areas (e.g., at 10<sup>th</sup> percentile of area, OR = 1.18; 95 %CI = 0.96-1.45), but a lower OR for larger areas (e.g., at 90<sup>th</sup> percentile of area, OR = 0.88; 95 %CI = 0.77-1.02). The primary exposure had higher discrimination of incident fracture compared to BMD across all unadjusted and adjusted models (c-statistic range 0.69-0.84 vs. 0.49-0.79, respectively).</div><div><em>Conclusions:</em> Dis-integration of key size-mass bone traits was associated with incident fracture and was a stronger predictor of fracture compared to BMD in this clinical cohort of adults with CP.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101625"},"PeriodicalIF":1.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145468408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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