Journal of Clinical Densitometry最新文献_第3页

Predicting bone mineral content from smartphone digital anthropometrics: evaluation of an existing application and the development of new prediction models 从智能手机数字人体测量学预测骨矿物质含量：评估现有应用并开发新的预测模型

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-24 DOI: 10.1016/j.jocd.2024.101537

Austin J. Graybeal , Sydney H. Swafford , Abby T. Compton , Megan E. Renna , Tanner Thorsen , Jon Stavres

Introduction/Background: Bone mineral content (BMC) is most commonly evaluated using dual-energy X-ray absorptiometry (DXA), but there are several challenges that limit use of DXA during routine care. Breakthroughs in digital imaging now allow smartphone applications to automate important anthropometrics that can predict several body composition components. However, it is unknown whether the anthropometrics automated using smartphone applications can predict DXA-derived BMC.

Methodology: A total of 214 participants (129 F, 85 M) had BMC measurements collected from an existing proprietary prediction equation, embedded within a smartphone application (MeThreeSixty), and evaluated against DXA. LASSO regression was then used to develop a new BMC prediction equation using the anthropometric estimates produced by the smartphone application in a portion of the participants (n = 174), which was subsequently evaluated against DXA in the remaining sample (n = 40). BMC z-scores were calculated and used to identify the prevalence of low BMC for the existing and newly developed smartphone prediction equations and evaluated against DXA-derived z-scores.

Results: Neither BMC estimates (R²: 0.72; RMSE: 376 g) nor BMC z-scores (R²: 0.55; RMSE: 1.09 SD) produced from the existing propriety prediction equation demonstrated equivalence with DXA in the combined sample. Moreover, the existing prediction equation had a 69.6 % accuracy of identifying low BMC. LASSO regression for the newly developed smartphone prediction model produced the following equation:

BMC (g) = -2020.769 + 60.902(Black=1, 0=all other races) – 180.364(Asian=1, 0=all other races) + 24.433(height) + 1.702(weight) + 2.92(shoulder circumference) + 0.258(arm surface area) – 715.29(waist circumference/(BMI^2/3 x height^1/2)).

BMC (R²: 0.91; RMSE: 209 g) and BMC z-scores (R²: 0.85; RMSE: 0.61) produced from the newly developed equation in the testing sample demonstrated equivalence with DXA and had a 92.5 % accuracy of identifying low BMC.

Conclusions: Smartphone anthropometrics provide accurate and clinically relevant BMC measurements outside of an advanced setting through the use of our newly-developed smartphone prediction model.

简介/背景：骨矿物质含量（BMC）最常用双能 X 射线吸收测量法（DXA）进行评估，但在日常护理过程中，DXA 的使用受到一些挑战的限制。现在，数字成像技术取得了突破性进展，智能手机应用程序可以自动进行重要的人体测量，预测身体成分的几个组成部分。然而，使用智能手机应用程序自动进行的人体测量是否能预测从 DXA 导出的 BMC 还不得而知：方法：共 214 名参与者（129 名女性，85 名男性）通过现有的专有预测方程收集了 BMC 测量值，将其嵌入智能手机应用程序（MeThreeSixty）中，并根据 DXA 进行评估。然后，利用智能手机应用程序对部分参与者（n = 174）进行的人体测量估算结果，采用 LASSO 回归方法建立了一个新的 BMC 预测方程，并随后根据 DXA 对其余样本（n = 40）进行了评估。对现有的和新开发的智能手机预测方程计算了BMC z-scores，用于确定低BMC的流行率，并与DXA得出的z-scores进行了对比评估：在综合样本中，现有专有预测方程得出的 BMC 估计值（R2：0.72；RMSE：376 g）和 BMC z-scores（R2：0.55；RMSE：1.09 SD）均未显示出与 DXA 的等效性。此外，现有预测方程识别低 BMC 的准确率为 69.6%。对新开发的智能手机预测模型进行 LASSO 回归得出以下公式：BMC（克）= -2020.769 + 60.902（黑人=1，0=所有其他种族）- 180.364（亚洲人=1，0=所有其他种族）+ 24.433（身高）+ 1.702（体重）+ 2.92（肩围）+ 0.在测试样本中，根据新开发的方程得出的 BMC（R2：0.91；RMSE：209 g）和 BMC z 分数（R2：0.85；RMSE：0.61）与 DXA 相当，识别低 BMC 的准确率为 92.5%：结论：通过使用我们新开发的智能手机预测模型，智能手机人体测量学可在高级环境之外提供准确且与临床相关的 BMC 测量值。

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引用次数: 0

Opportunistic Screening for Low Bone Mineral Density in Routine Computed Tomography Scans: A Brazilian Validation Study 常规计算机断层扫描中的低骨密度机会性筛查：巴西验证研究

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-22 DOI: 10.1016/j.jocd.2024.101539

Felipe Welter Langer , Giovanni Brondani Torri , Fernando Schaffazick , Guilherme Maia , Camila Piovesan Wiethan , Carlos Jesus Haygert , Marcos Cordeiro d'Ornellas

Introduction/background: Osteoporotic fractures are a major health concern worldwide due to high mortality rates, deterioration in quality of life, and elevated healthcare costs related to hospital treatment. However, most patients who sustain an osteoporotic fracture have never been formally screened for osteoporosis. Opportunistic screening of osteoporosis through conventional computed tomography (CT) scans performed for unrelated reasons could help identify patients with low bone mass. There are currently no studies validating the opportunistic screening of low bone mass through CT in South America. The aim of our study is to assess whether conventional CT scans could be used for the opportunistic screening of osteopenia and osteoporosis in Brazilian patients.

Methodology: Patients who underwent unenhanced CT and dual-energy X-ray absorptiometry (DXA) scans within a six-month interval were assessed retrospectively. Mean CT attenuation was measured in the first lumbar vertebra (L1) in axial, coronal, and sagittal planes and compared to their respective DXA T-scores; vertebral fractures were assessed in the sagittal plane. Potential thresholds suggestive of low bone mass density (BMD) were established using receiver operating characteristics analysis.

Results: 491 patients were included (93.2 % female; mean age of 64.1 ± 9.8 years; mean interval of 63.5 days between scans). Mean L1 CT attenuation was significantly lower in osteopenic and osteoporotic patients in all CT planes (p < 0.001). Positive linear correlations were found between DXA T-scores and the average L1 attenuations in all CT planes (p < 0.001). An average L1 attenuation equal or below 100 Hounsfield Units (HU) in the sagittal plane identified low BMD (osteopenia or osteoporosis) with a specificity of 96.3 % and a positive predictive value of 96 %. In contrast, an average L1 attenuation above 180 HU demonstrated a sensitivity of 97.6 % and a negative predictive value of 94.9 % for detecting osteoporosis. Patients with L1 sagittal attenuation at or below 100 HU exhibited a significantly higher prevalence of vertebral fractures (prevalence ratio: 8.67; p < 0.001). An online calculator based on the results of this study is freely available at www.osteotc.com.br.

Conclusions: Routine CT scans can identify probable low bone density (osteopenia or osteoporosis) in Brazilian patients without additional costs or radiation exposure. Opportunistic CT screening does not substitute formal bone mineral density assessment; instead, it assists in identifying patients who may benefit from it.

导言/背景：骨质疏松性骨折是全球关注的主要健康问题，因为其死亡率高、生活质量下降以及与医院治疗相关的医疗费用增加。然而，大多数骨质疏松性骨折患者从未接受过正规的骨质疏松症筛查。通过与此无关的常规计算机断层扫描（CT）对骨质疏松症进行机会性筛查，有助于发现低骨量患者。目前，南美洲还没有研究验证通过 CT 对低骨量患者进行机会性筛查。我们的研究旨在评估常规 CT 扫描是否可用于巴西患者骨质疏松症和骨质疏松症的机会性筛查：我们对在六个月内接受过非增强 CT 和双能 X 射线吸收测量（DXA）扫描的患者进行了回顾性评估。在轴向、冠状面和矢状面测量第一腰椎（L1）的平均CT衰减，并与各自的DXA T-scores进行比较；在矢状面评估椎体骨折。通过接收器操作特性分析确定了提示低骨质密度（BMD）的潜在阈值：共纳入 491 名患者（93.2% 为女性；平均年龄为 64.1 ± 9.8 岁；平均扫描间隔为 63.5 天）。在所有 CT 平面上，骨质疏松和骨质疏松症患者的 L1 CT 平均衰减量都明显较低（p 结论：常规 CT 扫描可识别可能的骨质疏松症：常规 CT 扫描可发现巴西患者可能存在的低骨密度（骨质疏松症或骨质疏松症），且无需额外费用或辐射暴露。机会性 CT 筛查并不能取代正规的骨矿密度评估，相反，它有助于识别可能从中受益的患者。

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引用次数: 0

Comparison of the Effect of Selective Serotonin and Norepinephrine Reuptake Inhibitors on Bone Mineral Density with Selective Serotonin Reuptake Inhibitors and Healthy Controls 选择性羟色胺和去甲肾上腺素再摄取抑制剂对骨矿密度的影响与选择性羟色胺再摄取抑制剂和健康对照组的比较。

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-22 DOI: 10.1016/j.jocd.2024.101538

Süheyla Doğan Bulut , Gamze Zengin İspir , Serdar Bulut , Emine AK Aygün

Purpose: This study investigated the association between selective serotonin reuptake inhibitor (SSRI) and selective serotonin and norepinephrine reuptake inhibitor (SNRI) use and the risk of decreased bone mineral density in postmenopausal women.

Methods: Sixty-three patients diagnosed with GAD (Generalized Anxiety Disorder) were treated with venlafaxine or duloxetine from the SNRI group, and sixty patients treated with SSRIs were enrolled. Social demographic features, the Hamilton Anxiety Scale (HAS) results, and the Hamilton Depression Scale (HDS) scores of all the patients were assessed. The BMD (bone mineral density) of the patients was measured by dual-energy X-ray absorptiometry (DXA) at the femoral and lumbar regions. The BMD of the patients was compared with that of 40 healthy controls.

Results: Bone measurements in the SNRI and SSRI users were similar to those of the healthy controls. However, osteopenic values were observed in the SSRI users, while normal bone density was found in the SNRI users. Also, the bone mineral densities were compared between patients using duloxetine and venlafaxine with healthy controls, showing similar T-score and Z-score values with no significant differences compared to the control group. However, while the lumbar region T-scores of those using duloxetine were within normal values, they were within the osteopenia range of venlafaxine and healthy controls.

Conclusion: SNRIs may have a lower risk of developing osteoporosis than SSRIs. Of the SNRIs, duloxetine appears to be safer than venlafaxine. Further randomized controlled studies are warranted to determine whether SNRI use is risky.

目的：本研究调查了绝经后妇女使用选择性5-羟色胺再摄取抑制剂（SSRI）和选择性5-羟色胺及去甲肾上腺素再摄取抑制剂（SNRI）与骨矿物质密度下降风险之间的关系：63名被诊断为GAD（广泛性焦虑症）的患者接受了SNRI组的文拉法辛或度洛西汀治疗，60名患者接受了SSRIs治疗。对所有患者的社会人口学特征、汉密尔顿焦虑量表（HAS）结果和汉密尔顿抑郁量表（HDS）评分进行了评估。通过双能 X 射线吸收仪（DXA）测量了患者股骨和腰椎部位的骨密度（BMD）。将患者的骨密度与 40 名健康对照者的骨密度进行了比较：结果：SNRI 和 SSRI 使用者的骨骼测量值与健康对照组相似。然而，SSRI 使用者出现骨质疏松，而 SNRI 使用者的骨密度正常。此外，使用度洛西汀和文拉法辛的患者与健康对照组的骨矿物质密度也进行了比较，结果显示两者的 T 值和 Z 值相似，与对照组相比无显著差异。然而，虽然使用度洛西汀的患者腰椎部位的T值在正常值范围内，但文拉法辛和健康对照组的腰椎部位的T值却在骨质疏松范围内：结论：与 SSRI 相比，SNRI 类药物患骨质疏松症的风险较低。在 SNRIs 中，度洛西汀似乎比文拉法辛更安全。需要进一步开展随机对照研究，以确定服用 SNRI 是否有风险。

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引用次数: 0

Canadian adult reference data for body composition, trabecular bone score and advanced hip analysis using DXA 使用 DXA 进行身体成分、骨小梁评分和高级髋关节分析的加拿大成人参考数据。

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-16 DOI: 10.1016/j.jocd.2024.101535

Lauren A. Burt , Liam T. Pond , Annabel R. Bugbird , David A. Hanley , Steven K. Boyd

DXA-derived reference data for visceral adipose tissue (VAT) and advanced hip analysis (AHA) parameters spanning the entire adult lifespan are limited. The purpose of this study was to develop age-, site- and sex-specific reference data for dual X-ray absorptiometry (DXA) -derived body composition, trabecular bone score (TBS) and advanced hip analysis (AHA) parameters across the adult lifespan. Adults (N = 908; female: 561 and male: 347) from Calgary and the surrounding area over the age of 20 years participated in this study. Participants received DXA scans of their hip (total hip [TH] and femoral neck [FN]), lumbar spine [LS], forearm [33 % site] and total body (iDXA, GE Lunar, GE Healthcare). Areal bone mineral density (aBMD, g/cm²) was captured at all sites, and body composition variables, including lean mass, fat mass and percent fat, were analyzed from the total body scan. VAT mass was assessed from total body DXA scans. Advanced hip analysis (AHA) was performed on hip scans and trabecular bone score (TBS) on the LS scans to assess bone quality. Site- and sex-specific centile curves and tables were generated using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Clinicians and researchers can use these Canadian reference data as a tool to assess body composition, TBS and AHA parameters across the adult lifespan.

由 DXA 得出的内脏脂肪组织（VAT）和高级髋关节分析（AHA）参数的参考数据在整个成人生命周期中都很有限。本研究的目的是为双 X 射线吸收测定法（DXA）得出的身体成分、骨小梁评分（TBS）和高级髋关节分析（AHA）参数开发针对不同年龄、部位和性别的参考数据。卡尔加里及周边地区 20 岁以上的成年人（N = 908；女性：561；男性：347）参加了这项研究。参与者接受了髋部（全髋[TH]和股骨颈[FN]）、腰椎[LS]、前臂[33%部位]和全身（iDXA，GE Lunar，GE Healthcare）的 DXA 扫描。在所有部位采集骨矿物质密度（aBMD，克/平方厘米），并通过全身扫描分析身体成分变量，包括瘦体重、脂肪量和脂肪百分比。全身 DXA 扫描评估了增值肌肉质量。对髋部扫描进行高级髋部分析（AHA），对LS扫描进行骨小梁评分（TBS），以评估骨质情况。使用位置、尺度和形状的广义相加模型（GAMLSS）方法生成了特定部位和性别的百分位曲线和表格。临床医生和研究人员可以使用这些加拿大参考数据作为工具，评估成年人整个生命周期的身体成分、TBS 和 AHA 参数。

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引用次数: 0

Comprehensive evaluation of bone health among kidney transplant recipients – A prospective, single center, observational cohort study from India 全面评估肾移植受者的骨骼健康状况--印度一项前瞻性、单中心、观察性队列研究。

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-09 DOI: 10.1016/j.jocd.2024.101534

Selvin Sundar Raj Mani , Kripa Elizabeth Cherian , Nitin Kapoor , Athul Thomas , Jeethu Joseph Eapen , Elenjickal Elias John , Sabina Yusuf , Mercy Deborah , Grace Rebekah , Anjali Mohapatra , Suceena Alexander , Vinoi George David , Santosh Varughese , Thomas V. Paul , Anna T. Valson

Background: There is a paucity of studies describing trabecular bone score (TBS) and bone mineral density (BMD) in kidney transplant (KT) recipients from developing countries. Study setting: This prospective observational study, from a tertiary teaching hospital in India assessed clinical, biochemical parameters including bone turnover markers and dual-energy X-ray absorptiometry (DXA) for BMD/TBS, hip structural analysis (HSA) and vertebral fracture assessment (VFA) at pre-KT, 3 months and 12 months post-KT. Results: A total of 53 KT recipients (90.6% living related) were recruited from August 2019 to March 2020 and followed till 1-year post-KT. The mean age was 33.9±10.4 years, 71.7% were males, and 11.5% had a history of pre-KT steroid use. Baseline fractures pre-KT as assessed by VFA were seen in 4 patients (7.5%). Mean BMD at spine and femoral neck and HSA variables at narrow neck and femoral shaft continued to decline till 3 months, but stabilised and reached pre-KT values 12 months post-KT. However, TBS and bone turn over markers continued to decline till 12 months post-KT (p value <0.001). New onset vertebral fractures were seen in 2(3.7%) and 1 patient (2.3%) at 3- and 12-months post-KT respectively. Pre-KT BMD significantly influenced bone health at 12 months post-KT, with patients in each quartile maintaining a similar trajectory over the follow up period (p < 0.001). Conclusion: Despite significant improvement in kidney function following transplant, TBS and BMD of the spine significantly decreased mainly in the early post-KT period suggesting the effect of immunosuppressants on the bone. Strategies to improve bone health in KT patients are warranted.

背景：有关发展中国家肾移植（KT）受者骨小梁评分（TBS）和骨矿物质密度（BMD）的研究很少：这项前瞻性观察研究在印度的一家三级教学医院进行，评估了肾移植前、肾移植后3个月和12个月的临床、生化指标（包括骨转换标志物）以及双能X射线吸收测定法（DXA）的骨密度/骨小梁评分、髋关节结构分析（HSA）和椎体骨折评估（VFA）：从2019年8月至2020年3月，共招募了53名KT受者（90.6%为生活相关者），并随访至KT术后1年。平均年龄为（33.9±10.4）岁，71.7%为男性，11.5%在KT前有类固醇使用史。根据 VFA 评估，4 名患者（7.5%）在 KT 前出现基线骨折。脊柱和股骨颈的平均 BMD 以及窄颈和股骨轴的 HSA 变量在 3 个月前持续下降，但在 KT 后 12 个月趋于稳定并达到 KT 前的值。然而，TBS 和骨转换标志物在 KT 术后 12 个月前持续下降（P 值结论）：尽管移植后肾功能明显改善，但 TBS 和脊柱 BMD 主要在 KT 后早期明显下降，这表明免疫抑制剂对骨骼有影响。因此有必要制定改善 KT 患者骨骼健康的策略。

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引用次数: 0

Fractal Analysis of Mandible in Panoramic Radiographs of Patients Received Radiotherapy for Nasopharyngeal Carcinoma 鼻咽癌放疗患者全景照片中下颌骨的分形分析

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-05 DOI: 10.1016/j.jocd.2024.101531

Rabia Duman Tepe , Kubra Ozkaya Toraman , Kivanc Bektas Kayhan , Ilknur Ozcan , Hulya Cakir Karabas

Purpose: This study aimed to assess the impact of radiotherapy on the internal structure complexity of mandibular cortical and trabecular bone and to determine the duration required for a return to healthy values post-radiotherapy.

Materials and Methods: Panoramic radiographs from patients undergoing radiotherapy for nasopharyngeal carcinoma were analyzed before and after treatment. Four groups were formed based on post-radiotherapy radiography timing (0-6 months, 6-12 months, 12-24 months, and 24-36 months), comprising a total of 59 cases and 118 radiographs. Fractal analysis was conducted on four bilateral regions (ROI) in both trabecular and cortical bone on each radiograph. Additionally, measurements of inferior alveolar canal width and mandibular cortical width were performed. Mean and maximum radiation dose values to the mandible were measured, and their correlation with changes in fractal dimension, inferior alveolar canal width, and mandibular cortical width values was assessed.

Results: Fractal dimension values in regions over trabecular bone showed a statistically significant decrease in all groups, although no significant difference was observed among the four groups. In ROI-4 from cortical bone, a significant fractal dimension decrease was noted in all groups except the 0-6 month group. The magnitude of fractal dimension decrease was higher in the 12-24 and 24-36 month groups compared to the 0-6 month group. inferior alveolar canal width and mandibular cortical width values significantly decreased post-radiotherapy in all groups, with a consistent decrease across the groups.

Conclusions: Radiotherapy induces a reduction in the internal complexity of trabecular and cortical bone structures in the mandible. Osteoradionecrosis risk persists even three years post-radiotherapy, suggesting a cautious approach to interventional procedures on the bone.

目的：本研究旨在评估放疗对下颌骨皮质和骨小梁内部结构复杂性的影响，并确定放疗后恢复到健康值所需的时间：对鼻咽癌患者接受放疗前后的全景X光片进行分析。根据放疗后拍片时间分为四组（0-6 个月、6-12 个月、12-24 个月和 24-36 个月），共 59 例，118 张照片。对每张照片上骨小梁和皮质骨的四个双侧区域（ROI）进行了分形分析。此外，还对下牙槽宽度和下颌骨皮质宽度进行了测量。测量了下颌骨的平均和最大辐射剂量值，并评估了它们与分形维度、下牙槽宽度和下颌骨皮质宽度值变化的相关性：结果：所有组别骨小梁上区域的分形维度值都出现了统计学意义上的显著下降，但四个组别之间并无明显差异。在皮质骨的 ROI-4 中，除 0-6 个月组外，其他各组的骨折维度均显著下降。与 0-6 个月组相比，12-24 个月组和 24-36 个月组的骨折维度下降幅度更大。所有组的下牙槽宽度和下颌骨皮质宽度值在放疗后均显著下降，且各组的下降幅度一致：结论：放疗会降低下颌骨小梁和皮质骨结构的内部复杂性。放疗后三年仍存在骨坏死的风险，建议对骨进行介入治疗时要慎重。

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引用次数: 0

Effects of Lumbar Spine Vertebral Fractures on Trabecular Bone Score (TBS): The Manitoba BMD Registry 腰椎椎体骨折对骨小梁评分 (TBS) 的影响：马尼托巴省 BMD 登记

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-10-01 DOI: 10.1016/j.jocd.2024.101533

William D. Leslie , Neil Binkley , Didier Hans

Trabecular bone score (TBS) is a BMD-independent risk factor for fracture. During BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. It is uncertain whether TBS is affected by lumbar spine fractures. The current study examined the effect of lumbar spine compression fractures on TBS measurements. We identified 656 individuals with vertebral fractures (mean age 75.8 ± 7.9 years, 90.9% female) who had lumbar spine DXA, TBS measurements from L1-L4 and vertebral fracture assessment (VFA) for identifying vertebral fractures. There were 272 cases with lumbar spine fractures and 384 controls with only thoracic spine fractures. L1 TBS and BMD were significantly greater in those with than without lumbar fractures (p< 0.001) but did not significantly differ for other vertebral levels or for L1-L4 combined. TBS and BMD measurements were then renormalized to remove level-specific differences (denoted rTBS and rBMD). The mean difference (all fractured minus all non-fractured vertebrae) was +0.040 (+3.3%) for rTBS and +0.088 g/cm² (+9.5%) for rBMD (both p <0.001). The largest effect was for L1 with mean difference +0.058 (+4.9%) for rTBS and +0.098 g/cm² (+10.6%) for rBMD (both p <0.001). The mean difference between fractured and non-fractured levels for rTBS was +0.028 (+2.4%) for grade 1, +0.036 (+3.0%) for grade 2 and +0.059 (+5.0%) for grade 3 fractures; for rBMD +0.051 (+5.5%), +0.076 (+8.2%) and +0.151 (+16.4%) g/cm², respectively. The impact of excluding lumbar vertebral levels with fracture from the L1-L4 TBS measurement overall was small (-0.011 [-1.0%]; p<0.001) and was also small for grade 3 fractures (-0.020 [-1.7%]; p<0.001). In summary, TBS is mildly increased by VFA-confirmed lumbar vertebral fractures, but the percentage effect is much smaller (less than half) than seen for BMD and minimally affects TBS measured from L1-L4. This would support the use of L1-L4 without exclusions in individuals with lumbar vertebral fractures.

骨小梁评分（TBS）是与 BMD 无关的骨折风险因素。在 BMD 报告中，标准做法是排除受结构假象影响的腰椎水平。目前还不确定 TBS 是否受腰椎骨折的影响。本研究考察了腰椎压缩性骨折对 TBS 测量的影响。我们确定了 656 名椎体骨折患者（平均年龄为 75.8 ± 7.9 岁，90.9% 为女性），这些患者接受了腰椎 DXA、L1-L4 的 TBS 测量以及用于识别椎体骨折的椎体骨折评估（VFA）。其中有 272 例腰椎骨折，384 例对照组仅有胸椎骨折。腰椎骨折患者的 L1 TBS 和 BMD 均明显高于非腰椎骨折患者（p< 0.001），但其他椎体水平或 L1-L4 组合无明显差异。然后对 TBS 和 BMD 测量值进行再归一化，以消除特定水平的差异（表示为 rTBS 和 rBMD）。rTBS和rBMD的平均差异（所有骨折椎体减去所有未骨折椎体）分别为+0.040（+3.3%）和+0.088 g/cm2（+9.5%）（均为p <0.001）。对 L1 的影响最大，rTBS 的平均差异为 +0.058 (+4.9%) ，rBMD 的平均差异为 +0.098 g/cm2 (+10.6%) （均为 p <0.001）。骨折与非骨折水平之间的平均差异为：rTBS 1级为+0.028（+2.4%），2级为+0.036（+3.0%），3级为+0.059（+5.0%）；rBMD分别为+0.051（+5.5%）、+0.076（+8.2%）和+0.151（+16.4%）g/cm2。从 L1-L4 TBS 测量中排除有骨折的腰椎水平的影响很小（-0.011 [-1.0%]; p<0.001），对 3 级骨折的影响也很小（-0.020 [-1.7%]; p<0.001）。总之，经 VFA 证实的腰椎骨折会轻度增加 TBS，但影响的百分比比 BMD 的影响要小得多（不到一半），而且对 L1-L4 测量的 TBS 影响很小。这将支持在腰椎骨折患者中使用 L1-L4 而不排除其他因素。

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引用次数: 0

Technical and biological reliability of pQCT measured bone and muscle tissue quality across the age-span pQCT 测量各年龄段骨骼和肌肉组织质量的技术和生物学可靠性

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-08-24 DOI: 10.1016/j.jocd.2024.101522

Grace L. Rose , Alex N. Boytar , Isabel N. King , Morgan J. Farley , Michelle Maugham-Macan , Tina L. Skinner , Kate A. Bolam , Mia A. Schaumberg

Introduction: Reliable peripheral quantitative computed tomography (pQCT) assessment is essential to the accurate longitudinal reporting of bone and muscle quality. However, the between-day reliability of pQCT and the influence of age on outcome reliability is currently unknown.

Objective: To quantify the same- and between-day reliability of morphological pQCT at proximal and distal segments of the forearm, shank, and thigh, and explore the influence of participant body size, age, and sex on outcome reliability.

Methods: Men and women (49 % female, 18-85 years, n=72-86) completed two consecutive-day pQCT testing sessions, where repeat measurements were conducted on day-one for technical error, and between-day for biological error quantification. Testing was undertaken following best practice body composition testing guidance, including standardized presentation and consistent time-of-day.

Results: All measurements of bone were classified as having ‘good’ to ‘excellent’ reliability [intraclass correlation coefficient (r=0.786- 0.999], as were measurements of muscle area (ICC r=0.991-0.999) and total fat (r=0.996-0.999). However, between- and same-day muscle density measurements at the thigh and forearm were classified as ‘poor’ (r=0.476) and ‘moderate’ (r=0.622), respectively. Likewise, intramuscular fat area at the thigh was classified as ‘moderate’ (r=0.737) for between-day measurement. Biological error was inflated compared to technical error by an average of 0.4 % for most measurements. Error values tended to increase proportionally with the amount of tissue quantified and males had significantly greater biological error for measurement of distal tibial bone (p<0.002) and trabecular area (p<0.002). Biological error was inflated among older adults for measurement of forearm muscle density (p<0.002).

Conclusions: Most pQCT outcomes can be implemented with confidence, especially outcomes that assess bone area and density at any of the radial, tibial, and femoral sites investigated herein. However, it is important to account for the influence of biological measurement error in further studies, especially for muscle and intramuscular fat outcomes derived by pQCT.

可靠的外周定量计算机断层扫描（pQCT）评估对于准确纵向报告骨骼和肌肉质量至关重要。然而，目前还不清楚 pQCT 的日间可靠性以及年龄对结果可靠性的影响。

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引用次数: 0

Correlation between body composition and bone mineral density differs by sex and skeletal site in overweight and obese Chinese subjects 超重和肥胖中国受试者的身体成分与骨矿物质密度之间的相关性因性别和骨骼部位而异

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-08-23 DOI: 10.1016/j.jocd.2024.101526

Xiang Chen , Yanhong Guo , Fangli Zhou , Xi Wang , Suyuan Wang , Chenghui Zhang , Mingxia Li , Yunhong Wu

Previous studies have yielded inconsistent results regarding the relationship between obesity and bone mineral density (BMD). The aim of this study was to determine the influence of body composition on BMD and the serum sclerostin level in overweight and obese adults. The study had a cross-sectional design and included 90 men and 118 women with a body mass index ≥25. Fat mass, lean mass, and spinal and pelvic BMD were measured using dual-emission X-ray absorptiometry. Subcutaneous fat, visceral fat, and lean mass were measured between L2 and L3 by 16-slice spiral computed tomography. The serum sclerostin level was determined by enzyme-linked immunosorbent assay. Pearson analysis showed that fat mass and appendicular lean mass were positively correlated with spinal BMD in both sexes. A positive association of both fat mass and lean mass with pelvic BMD, which was stronger in women, was also found. Partial correlation analysis showed the positive association between fat mass and BMD was significantly attenuated but the positive association between lean mass and pelvic BMD remained after adjustment for age and body weight. A negative correlation was observed between visceral fat and spinal and pelvic BMD only in women, and the positive association between lean mass with pelvic BMD was more obvious in women than in men, indicating body composition seemed to have a greater impact on the BMD in women. The serum sclerostin level was positively associated with BMD but not with body composition. These findings suggest that the correlation between body composition and BMD is influenced by sex and skeletal site.

关于肥胖与骨矿物质密度（BMD）之间的关系，以往的研究结果并不一致。本研究旨在确定身体成分对超重和肥胖成年人骨密度和血清硬骨素水平的影响。研究采用横断面设计，包括体重指数≥25 的 90 名男性和 118 名女性。使用双发射 X 射线吸收测量法测量了脂肪量、瘦肉量、脊柱和骨盆 BMD。通过 16 片螺旋计算机断层扫描测量了 L2 和 L3 之间的皮下脂肪、内脏脂肪和瘦体重。通过酶联免疫吸附试验测定了血清硬骨素水平。皮尔逊分析表明，男性和女性的脂肪量和阑尾瘦肉量与脊柱 BMD 呈正相关。脂肪量和瘦体重与骨盆 BMD 也呈正相关，女性的相关性更强。部分相关分析表明，在调整年龄和体重后，脂肪量与 BMD 之间的正相关性明显减弱，但瘦体重与骨盆 BMD 之间的正相关性依然存在。只有女性的内脏脂肪与脊柱和骨盆 BMD 之间呈负相关，而女性的瘦体重与骨盆 BMD 之间的正相关比男性更明显，这表明身体成分似乎对女性的 BMD 影响更大。血清硬骨生成素水平与 BMD 呈正相关，但与身体成分无关。这些研究结果表明，身体成分与 BMD 之间的相关性受性别和骨骼部位的影响。

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引用次数: 0

Lumbar spine densitometry in people with spinal cord injury: Investigation of potential sources of errors 脊髓损伤患者的腰椎密度测量：潜在误差源调查

IF 1.7 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Clinical Densitometry

Pub Date : 2024-08-22 DOI: 10.1016/j.jocd.2024.101528

Matteo Ponzano , Lora M. Giangregorio , Julio C. Furlan , Sivakumar Gulasingam , Jack P. Callaghan , B. Catharine Craven

Purpose: People with spinal cord injury (SCI) experience a considerable loss of bone after the injury. Lumbar spine (LS) bone mineral density (BMD) has been reported to be within the normal range, or even higher when assessed with DXA, in people with SCI; hence, it has been hypothesized that sources of error may spuriously increase LS BMD. The aim of this study was to describe the frequency of potential sources of error that may alter LS BMD measurement in a cohort of individuals with chronic SCI at baseline and over a 2-year period. Methods: We analyzed baseline and 2-year follow up DXA scans (Hologic Discovery QDR 4500, Hologic Inc., MA, USA) previously performed from a cohort of males and females with chronic SCI. Two physicians independently reviewed each scan, commented on whether the scan was appropriate for BMD analysis, should be re-analyzed, or be removed from the dataset, and reported on the presence of potential sources of error in LS BMD measurement. Results: We reviewed 115 lumbar spine DXA scans from 58 participants, and 107 (93.0 %) scans from 52 participants presented at least one potential source of error. At baseline, the average number of potential sources of error per scan was 5.5 ± 1.7 and 5.7 ± 1.5 according to rater 1 and rater 2, respectively. Follow-up scans presented an average of 5.6 ± 1.6 and 5.7 ± 1.4 potential sources of error according to rater 1 and rater 2, respectively. Facet sclerosis, osteophytes and difficulty in detecting bone edges were the most prevalent sources of error. Conclusion: The high frequency of potential sources of error is consistent with current recommendations against the use of LS BMD for fracture risk assessment in people with SCI.

目的：脊髓损伤（SCI）患者在受伤后骨质会大量流失。据报道，脊髓损伤患者的腰椎骨矿物质密度（BMD）在正常范围内，使用 DXA 评估时甚至更高；因此，有人假设误差源可能会虚假地增加腰椎骨矿物质密度。本研究的目的是描述可能改变慢性 SCI 患者基线和两年内 LS BMD 测量的潜在误差源的频率。方法：我们分析了一组患有慢性 SCI 的男性和女性患者之前进行的基线和两年随访 DXA 扫描（Hologic Discovery QDR 4500，Hologic 公司，美国马萨诸塞州）。两名医生对每份扫描进行独立审查，就扫描是否适合进行 BMD 分析、应重新分析或从数据集中删除发表意见，并报告 LS BMD 测量中是否存在潜在的误差源。结果：我们检查了 58 名参与者的 115 份腰椎 DXA 扫描，其中 52 名参与者的 107 份扫描（93.0%）至少存在一个潜在误差源。基线时，根据评分者 1 和评分者 2，每次扫描的潜在错误源平均数量分别为 5.5 ± 1.7 和 5.7 ± 1.5。根据评分者 1 和评分者 2，后续扫描的潜在误差源平均分别为 5.6 ± 1.6 和 5.7 ± 1.4。面骨硬化、骨质增生和难以检测骨边缘是最常见的误差来源。结论潜在错误源的高频率与目前反对使用 LS BMD 评估 SCI 患者骨折风险的建议一致。

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引用次数: 0