Journal of Clinical Densitometry最新文献

Introduction: The aim of this study was to evaluate whether degenerative bone changes in the mandibular condyle on cone beam computed tomography images are associated with the Eichner index.

Methodology: 336 cone beam computed tomography images condyle images of 168 patients were analyzed for degenerative bone changes. These changes were named as condyle flattening, osteophytes, erosions, subchondral sclerosis, generalized sclerosis and subchondral cysts. The edentulous status of the patients was classified as group A-B-C and subtypes according to the Eichner index. Categorical variables were evaluated with chi-square test and p < 0.05 was considered statistically significant.

Results: According to the results of the study, the most common degenerative condyle change was flattening of the condyle. Among the Eichner index groups, the most common group was A and the least common group was C. Condyle changes on the right and left sides were most commonly observed in group A patients. The statistically significant majority of patients with right-sided condyle flattening and erosion were in group C. No significant difference was found between all other condyle changes and Eichner index groups. There was no significant relationship between Eichner index and gender.

Conclusion: Degenerative bone changes (flattening and erosion of the condyle) in the condyle region were more common in group C patients with more tooth loss. There is a significant relationship between condyle changes and posterior toothlessness.

Introduction/Background: Gender-affirming care for gender diverse and transgender (GDTG) youth includes puberty suppression with gonadotropin-releasing hormone agonists (GnRHa). Puberty is a critical period of bone mass accrual, and pubertal suppression may impact bone health. Previous studies have shown a decrease in areal bone mineral density (aBMD) Z-score while on puberty suppression. However, the rate of bone mass accrual and its determinants during GnRHa therapy are not known.

Methodology: This is a retrospective chart review of GDTG youth with aBMD assessment within six months of starting GnRHa monotherapy at Cincinnati Children's Hospital Medical Center between 01/2011 and 12/2022. In individuals with follow-up aBMD assessment, we calculated their aBMD velocity and generated Z-scores using reference data from the Bone Mineral Density in Childhood Study. The determinants of baseline height-adjusted aBMD and aBMD velocity Z-scores were assessed with multiple linear regression models.

Results: Thirty-six participants (36% assigned female at birth (AFAB), mean age at first aBMD assessment 12 ± 1.1 years) had baseline height-adjusted aBMD Z-score of -0.053 ± 0.79. Among 16 participants with follow-up aBMD assessment, the mean aBMD velocity Z-score was -0.42 ± 1.13 (-0.27 ± 0.79 in AFAB vs -0.52 ± 1.32 in assigned male at birth, p = 0.965). Baseline aBMD Z-scores significantly correlated with age at the first aBMD assessment (adjusted R² 0.124, p = 0.02) with combined modeling including age at first aBMD assessment and BMI Z-score being most significant (adjusted R² 0.21, p = 0.008). Only BMI Z-scores were positively associated with the aBMD-velocity Z-scores (adjusted R² 0.255, p = 0.046).

Conclusions: GDTG youth undergoing GnRHa therapy appeared to have below-average aBMD velocity Z-scores. A lower BMI Z-score was a determinant of lower baseline height-adjusted aBMD and aBMD velocity Z-scores. Building on previous studies, our study highlights aBMD velocity as a novel technique for bone health surveillance in GDTG youth.

Background: Weight bearing computed tomography (WBCT) utilizes cone beam CT technology to provide assessments of lower limb joint structures while they are functionally loaded. Grey-scale values indicative of X-ray attenuation that are output from cone beam CT are challenging to calibrate, and their use for bone mineral density (BMD) measurement remains debatable. To determine whether WBCT can be reliably used for cortical and trabecular BMD assessment, we sought to establish the accuracy of BMD measurements at the knee using modern WBCT by comparing them to measurements from conventional CT.

Methods: A hydroxyapatite phantom with three inserts of varying densities was used to systematically quantify signal uniformity and BMD accuracy across the acquisition volume. We evaluated BMD in vivo (n = 5, female) using synchronous and asynchronous calibration techniques in WBCT and CT. To account for variation in attenuation along the height (z-axis) of acquisition volumes, we tested a height-dependent calibration approach for both WBCT and CT images.

Results: Phantom BMD measurement error in WBCT was as high as 15.3% and consistently larger than CT (up to 5.6%). Phantom BMD measures made under synchronous conditions in WBCT improved measurement accuracy by up to 3% but introduced more variability in measured BMD. We found strong correlations (R = 0.96) as well as wide limits of agreement (-324 mgHA/cm³ to 183 mgHA/cm³) from Bland-Altman analysis between WBCT and CT measures in vivo that were not improved by height-dependent calibration.

Conclusion: Whilst BMD accuracy from WBCT was found to be dependent on apparent density, accuracy was independent of the calibration technique (synchronous or asynchronous) and the location of the measurement site within the field of view. Overall, we found strong correlations between BMD measures from WBCT and CT and in vivo measures to be more accurate in trabecular bone regions. Importantly, WBCT can be used to distinguish between anatomically relevant differences in BMD, however future work is necessary to determine the repeatability and sensitivity of BMD measures in WBCT.

Background Perimenopause is associated with a decline in estrogen levels, leading to decreased bone mineral density (BMD) and altered bone metabolism, increasing the risk of osteoporosis. Tai Chi Rouli Ball, a traditional Chinese sport, is thought to have beneficial effects on physical health, but its impact on bone health in perimenopausal women is not well understood.

Methods This study involved a randomized controlled trial with 52 perimenopausal women aged 45–55 years from community senior centers. Participants were divided into two groups: the Tai Chi Rouli Ball group and the control group. Baseline assessments of bone density, bone mineral content (BMC), and bone metabolism markers, including estrogen levels, were conducted. The Tai Chi Rouli Ball group underwent regular training for a specific period, while the control group did not receive any intervention. Post-experiment assessments were then compared to the baseline.

Results Post-intervention, the Tai Chi Rouli Ball group showed a significant increase in spine bone density and BMC in various body parts, including the whole body, trunk/torso, and spine, compared to the control group. Bone metabolism indicators also improved, with increased levels of estrogen and a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Calcium levels showed a significant increase, while other markers like alkaline phosphatase (ALP), phosphorus (P), and magnesium (Mg) had non-significant changes.

Conclusions Tai Chi Rouli Ball exercise may positively influence bone health by improving bone density, BMC, and altering bone metabolism markers in perimenopausal women. These findings suggest that Tai Chi Rouli Ball could be a viable non-pharmacological approach to prevent osteoporosis in this demographic.

Introduction: Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap.

Methods: Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP).

Results: Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05–-0.03); p < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08–0.17); p < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30–2.64); p = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02–0.07); p < 0.0001]. A decrease in CTx has been documented post-surgery.

Conclusion: Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis is essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted

Introduction: In the previous report, we noted a significant increase in hip fracture incidence in the local study area. The aim of the study was the continuous observation of hip fracture incidence in the local community over the last 20 years and to estimate their projection for the next 30 years.

Methods: Medical records of the patients aged 50 years and older in the period 2002 – 2021 (local data – area of the district Tarnowskie Góry and the city of Piekary Śląskie) with diagnosis ICD-10: S72.0; S72.1; and S72.2 (only the fragility fractures) were taken into analysis.

Results: 2,723 fragility hip fractures in the local area were registered (72 % in women). The increase in the rate was constantly observed, even during the COVID – 19 pandemic. The incidence rate ratio for the local population increased to 1.41. The incidence rate in 2021 was for the total population 230.2 (men 151.3; women 294.2). For comparison in 2002, it was 129.0 (men 48.8; women 192.4). In 2050 the number of fractures according to our new estimation will increase.

Conclusions: The number of fragility hip fractures in Polish men and women aged over 50 years in the local population increased. The epidemiological situation is still worsening. Therefore, especially due to the reduction of orthopedic beds and the aging population phenomenon the situation will be tragic to our patients.

Bone mineral density (BMD) is widely used for assessment of fracture risk. For the lumbar spine, BMD is typically measured from L1-L4 as it provides the largest area for assessment with the best measurement precision. Structural artifact often confounds spine BMD in clinical practice, and the International Society for Clinical Densitometry (ISCD) recommends removing vertebrae with artifact when reporting spine BMD. In its most recent position statements, the ISCD recommended against the use of a single vertebra when reporting spine BMD but stated that further studies should be done. The current analysis was performed to compare the performance of BMD from different numbers and combination of vertebral levels on fracture prediction in a large clinical registry of DXA tests for the Province of Manitoba, Canada. The study population comprised 39,727 individuals aged 40 years and older (mean age 62.7 years, 91.0 % female) with baseline DXA after excluding those with evidence of structural artifact. Mean follow-up for ascertaining fracture outcomes was 8.7 years. Area under the curve (AUC) for incident fracture risk stratification was statistically significant regardless of the BMD measurement site or fracture outcome. AUC differences with the various numbers and combinations of vertebral levels including a single vertebral body were small (less than or equal to 0.01). More substantial AUC differences were seen for femoral neck and total hip BMD versus L1-L4 BMD, approaching 0.1 for hip fracture stratification. In summary, we found that using combinations of fewer than 4 vertebrae including individual lumbar vertebrae predicted incident fractures. Importantly, differences between these different combinations were small when compared with L1-L4. Spine BMD was a better predictor of incident spine fracture compared to the hip, whereas the hip was better for hip fracture and overall fracture prediction.

Background: This study aimed to evaluate the mandibular bone structure of patients using oral anticoagulants (OACs) vitamin K antagonist drugs (warfarin) and other OACs including direct oral anticoagulants [(DOACs) apixaban, rivaroxaban, dabigatran, edoxaban]. Analyses were based upon the fractal dimension (FD), the panoramic mandibular index (PMI) and the Klemetti index (KI), which is also known as the mandibular cortical index (MCI).

Methodology: Ninety participants were divided into three groups: group 1: 30 systemically healthy individuals who had not used any anticoagulants before, group 2: 30 individuals using warfarin, and group 3: 30 individuals using DOACs. FD was used to analyze trabecular bone architecture in the condyle, angle, and two sites in the alveolar bone. PMI was used to evaluate the quantity of cortical bone and KI was used to evaluate the cortical bone quality.

Results: There was no difference between the groups regarding FD analysis and KI; however, a difference was found between groups 1, 2, and 3 in the PMI (P≤ 0.001). The PMI in group 1 was higher than in groups 2 and 3.

Conclusion: Mandibular radiomorphometric indices can be used on panoramic radiographs to evaluate the quantity of mandibular cortical bone in patients using oral anticoagulants.

Introduction: Change in bone mineral density (BMD) is considered significant when it exceeds the 95 % least significant change (LSC) derived from that facility's precision study. The lumbar spine is often affected by structural artifact such that not all four lumbar vertebrae are evaluable. Guidelines suggest using a site-matched LSC when omitting vertebrae from the BMD measurement. The current study describes significant BMD change related to intervening anti-osteoporosis treatment for different numbers and combinations of lumbar vertebrae using site-matched LSC values.

Methodology: We identified 10,526 untreated adult women mean age 59.6 years with baseline and repeat spine BMD testing (mean interval 4.7 years) where all 4 lumbar vertebrae were evaluable. Change in spine BMD for different combinations of lumbar vertebrae was assessed in relation to intervening anti-resorptive treatment, contrasting women with high treatment exposure (medication possession ratio, MPR ≥ 0.8) versus women who remained untreated. Site-matched LSC values were derived from 879 test-retest precision measurements.

Results: There was consistent linear trend between increasing MPR and BMD change exceeding the LSC for all lumbar vertebral combinations, positive with BMD increase and negative with BMD decrease (all p-trend <0.001). In the high treatment exposure group, mean percent increases in spine BMD were similar for all vertebral combinations, from L1-4 to a single vertebra. In untreated women, mean percent decreases in spine BMD were also similar for all vertebral combinations. The net treatment response (proportion of women with treatment-concordant changes minus proportion with treatment-discordant changes exceeding the LSC) was 29.7 % for 4 vertebrae, 27.5-30.0 % for 3 vertebrae, 22.4-28.5 % for 2 vertebrae, and 18.1-21.9 % for a single vertebra.

Conclusions: All numbers and combinations of lumbar vertebrae, when used in conjunction with site-matched LSC values, can provide clinically meaningful follow-up in treated and untreated patients, even when spine BMD is based on a single vertebral body.