Pub Date : 2025-12-13DOI: 10.1016/j.jocd.2025.101659
Amit Kumar Gupta, Anusha Putcha, Varshini Vadhithala, Sachin Kumar
{"title":"Reframing the BMI–BMD–TBS triad in type 2 diabetes: Clinical and policy implications","authors":"Amit Kumar Gupta, Anusha Putcha, Varshini Vadhithala, Sachin Kumar","doi":"10.1016/j.jocd.2025.101659","DOIUrl":"10.1016/j.jocd.2025.101659","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101659"},"PeriodicalIF":1.6,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835104","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 : 2025-12-11DOI: 10.1016/j.jocd.2025.101658
Liqa A Rousan , Naser Obeidat , Nour Abdo , Tarek Ajam , Hamzeh Al-Zoubi , Leena Alshira’h , Hamad Saif , Abdulla Albaqshi , Khaled J Zaitoun
Background: Osteoporosis is the most common metabolic bone disease in the elderly. This study aimed to assess whether routine T1-weighted MR images can visually indicate the presence of osteoporosis by estimating vertebral bone marrow fat content.
Methods: Lumbar spine MRI and DEXA scans from 320 patients (performed within a 6-month interval) were retrospectively reviewed. Two radiologists independently graded the percentage of high T1 signal within the L4 vertebral body into <50 % or ≥50 %, representing marrow fat content. Visual fat scores were compared with T-scores from DEXA scans. Inter-reader agreement was assessed using Cohen's and Fleiss' kappa statistics. Spearman’s correlation was used to evaluate the association between MRI grading and DEXA scores.
Results: Of the 320 patients (mean age 56.8 years; 80.3 % female), 48.4 % had osteopenia or osteoporosis. Visual MRI grading yielded 141 patients with <50 % and 179 with ≥50 % marrow fat. A weak but statistically significant correlation was observed between MRI visual fat scores and DEXA T-scores (ρ = 0.139, p = 0.013). Inter-reader agreement was moderate (Cohen’s kappa = 0.509, 95 % CI: 0.415 to 0.603).
Conclusion: Routine T1-weighted lumbar spine MRI may serve as an opportunistic screening tool for osteoporosis. Visual estimation of vertebral marrow fat content shows potential to identify patients who may benefit from further DEXA evaluation.
{"title":"Visual estimation of vertebral marrow fat on lumbar MRI as a screening tool for osteoporosis: A retrospective study","authors":"Liqa A Rousan , Naser Obeidat , Nour Abdo , Tarek Ajam , Hamzeh Al-Zoubi , Leena Alshira’h , Hamad Saif , Abdulla Albaqshi , Khaled J Zaitoun","doi":"10.1016/j.jocd.2025.101658","DOIUrl":"10.1016/j.jocd.2025.101658","url":null,"abstract":"<div><div><em>Background:</em> Osteoporosis is the most common metabolic bone disease in the elderly. This study aimed to assess whether routine T1-weighted MR images can visually indicate the presence of osteoporosis by estimating vertebral bone marrow fat content.</div><div><em>Methods:</em> Lumbar spine MRI and DEXA scans from 320 patients (performed within a 6-month interval) were retrospectively reviewed. Two radiologists independently graded the percentage of high T1 signal within the L4 vertebral body into <50 % or ≥50 %, representing marrow fat content. Visual fat scores were compared with T-scores from DEXA scans. Inter-reader agreement was assessed using Cohen's and Fleiss' kappa statistics. Spearman’s correlation was used to evaluate the association between MRI grading and DEXA scores.</div><div><em>Results:</em> Of the 320 patients (mean age 56.8 years; 80.3 % female), 48.4 % had osteopenia or osteoporosis. Visual MRI grading yielded 141 patients with <50 % and 179 with ≥50 % marrow fat. A weak but statistically significant correlation was observed between MRI visual fat scores and DEXA T-scores (ρ = 0.139, <em>p</em> = 0.013). Inter-reader agreement was moderate (Cohen’s kappa = 0.509, 95 % CI: 0.415 to 0.603).</div><div><em>Conclusion:</em> Routine T1-weighted lumbar spine MRI may serve as an opportunistic screening tool for osteoporosis. Visual estimation of vertebral marrow fat content shows potential to identify patients who may benefit from further DEXA evaluation.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101658"},"PeriodicalIF":1.6,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839786","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 : 2025-11-28DOI: 10.1016/j.jocd.2025.101655
Parth Aphale, Himanshu Shekhar, Shashank Dokania
{"title":"Corrigendum to “Radiation therapy–Associated bone attenuation loss in anorectal cancer: Need for standardized imaging and clinical correlation” [Journal of Clinical Densitometry Volume 28 (2025) 101629]","authors":"Parth Aphale, Himanshu Shekhar, Shashank Dokania","doi":"10.1016/j.jocd.2025.101655","DOIUrl":"10.1016/j.jocd.2025.101655","url":null,"abstract":"","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101655"},"PeriodicalIF":1.6,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624780","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 : 2025-11-22DOI: 10.1016/j.jocd.2025.101657
Keith A. Knurr , James P. Lyon , Neil C. Binkley , Tamara A. Scerpella , Bryan C. Heiderscheit
Following anterior cruciate ligament reconstruction (ACLR), athletes demonstrate reduced bone mineral density (BMD) surrounding the knee that persists for years. These changes have been identified using total-body and site-specific dual-energy X-ray absorptiometry (DXA) scans. It is unknown whether these two scan types provide comparable measures of BMD. This study assessed the agreement between total-body and knee-specific DXA scans for measuring BMD of the distal femur and proximal tibia in Division I collegiate athletes with and without an ACLR. We further assessed the influence of surgical hardware on BMD with and without the use of the manual artifact correction tool in athletes post-ACLR. Collegiate athletes (healthy: 46; post-ACLR: 20) were included. Regions of interest (ROI) were placed at the 5 % and 15 % lengths of the distal femur and the proximal tibia to assess BMD of each limb on total-body and knee-specific scans. BMD values for each limb and between-limb asymmetry were compared between scan types at each ROI using Bland-Altman analyses. Mean differences are reported as total-body minus knee-specific values. Total-body scans provided significantly lower BMD than knee-specific scans for all ROIs (-0.102 to -0.038 g/cm2, all p-values < 0.01) except for the tibia 5 % (0.047 g/cm2, p < 0.01) in healthy athletes. No differences in between-limb asymmetry were detected between scan types in healthy athletes (-0.78 % to 0.56 %; all p-values > 0.11). Athletes post-ACLR had more pronounced differences in BMD between scan types (-0.245 to -0.064 g/cm2, all p-values < 0.02) and wider limits of agreement when surgical hardware was present, but this effect was mitigated when the manual artifact correction tool was used to exclude hardware (-0.122 to -0.008 g/cm2, p-values from <0.01 to 0.57). Despite differences in absolute BMD, this study supports the use of total-body scans for assessing between-limb asymmetry in knee-specific regions in healthy athletes and in athletes post-ACLR when excluding hardware.
{"title":"Total-body versus knee-specific dual-energy X-ray absorptiometry scans for assessing bone mineral density surrounding the knee joint in collegiate athletes with and without an anterior cruciate ligament reconstruction","authors":"Keith A. Knurr , James P. Lyon , Neil C. Binkley , Tamara A. Scerpella , Bryan C. Heiderscheit","doi":"10.1016/j.jocd.2025.101657","DOIUrl":"10.1016/j.jocd.2025.101657","url":null,"abstract":"<div><div>Following anterior cruciate ligament reconstruction (ACLR), athletes demonstrate reduced bone mineral density (BMD) surrounding the knee that persists for years. These changes have been identified using total-body and site-specific dual-energy X-ray absorptiometry (DXA) scans. It is unknown whether these two scan types provide comparable measures of BMD. This study assessed the agreement between total-body and knee-specific DXA scans for measuring BMD of the distal femur and proximal tibia in Division I collegiate athletes with and without an ACLR. We further assessed the influence of surgical hardware on BMD with and without the use of the manual artifact correction tool in athletes post-ACLR. Collegiate athletes (healthy: 46; post-ACLR: 20) were included. Regions of interest (ROI) were placed at the 5 % and 15 % lengths of the distal femur and the proximal tibia to assess BMD of each limb on total-body and knee-specific scans. BMD values for each limb and between-limb asymmetry were compared between scan types at each ROI using Bland-Altman analyses. Mean differences are reported as total-body minus knee-specific values. Total-body scans provided significantly lower BMD than knee-specific scans for all ROIs (-0.102 to -0.038 g/cm<sup>2</sup>, all p-values < 0.01) except for the tibia 5 % (0.047 g/cm<sup>2</sup>, <em>p</em> < 0.01) in healthy athletes. No differences in between-limb asymmetry were detected between scan types in healthy athletes (-0.78 % to 0.56 %; all p-values > 0.11). Athletes post-ACLR had more pronounced differences in BMD between scan types (-0.245 to -0.064 g/cm<sup>2</sup>, all p-values < 0.02) and wider limits of agreement when surgical hardware was present, but this effect was mitigated when the manual artifact correction tool was used to exclude hardware (-0.122 to -0.008 g/cm<sup>2</sup>, p-values from <0.01 to 0.57). Despite differences in absolute BMD, this study supports the use of total-body scans for assessing between-limb asymmetry in knee-specific regions in healthy athletes and in athletes post-ACLR when excluding hardware.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101657"},"PeriodicalIF":1.6,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684165","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 : 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":"2025-11-20","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 : 2025-11-12DOI: 10.1016/j.jocd.2025.101653
Benjamin Bakke Hansen , Bryan Haddock , Niklas Rye Jørgensen , Peter Vestergaard , Uffe Kock Wiil , Lars Folkestad , Sören Möller , Nicholas Fuggle , Bente Langdahl , Katrine Hass Rubin , Bo Abrahamsen
Background: Osteoporosis is a common, underdiagnosed condition causing increased risk of fracture. While dual-energy X-ray absorptiometry (DXA) is the diagnostic standard, this may not be successfully targeted to individuals at the highest risk. This study presents an extensive nationwide dataset characterizing DXA-scanning practices in Denmark.
Methodology: In this study, we identified all Danish residents from the birth cohort 1900-1960, with a first DXA scan between 2010-2022 to form the Nationwide Osteoporosis Cohort Trials Environment (NOCTE) dataset. These individuals were matched 1:5 to a non-scanned reference population by birth year, sex, and region of residence. Individual data were linked to national registers for comprehensive sociodemographic and clinical information.
Results: The final cohort included 263,651 individuals who underwent DXA scanning. At their first scan, 33% of women and 17% of men had osteoporosis. Compared to the matched reference, the scanned cohort had similar socioeconomic profiles but substantially different clinical profiles. Scanned individuals had a much higher prevalence of prior major osteoporotic fractures, prior systemic glucocorticoid exposure, and overall comorbidity burden.
Conclusion: Referral for DXA in Denmark is driven by clinical risk rather than socioeconomic status, reflecting an equitable resource allocation. However, a significant diagnostic gap persists, as many high-risk individuals with prior fractures did not receive a DXA. The NOCTE cohort is a new, powerful resource for developing strategies to help close this gap.
{"title":"The Danish Nationwide osteoporosis cohort trials environment (NOCTE) – a DXA dataset for the 1900-1960 birth cohort","authors":"Benjamin Bakke Hansen , Bryan Haddock , Niklas Rye Jørgensen , Peter Vestergaard , Uffe Kock Wiil , Lars Folkestad , Sören Möller , Nicholas Fuggle , Bente Langdahl , Katrine Hass Rubin , Bo Abrahamsen","doi":"10.1016/j.jocd.2025.101653","DOIUrl":"10.1016/j.jocd.2025.101653","url":null,"abstract":"<div><div><em>Background:</em> Osteoporosis is a common, underdiagnosed condition causing increased risk of fracture. While dual-energy X-ray absorptiometry (DXA) is the diagnostic standard, this may not be successfully targeted to individuals at the highest risk. This study presents an extensive nationwide dataset characterizing DXA-scanning practices in Denmark.</div><div><em>Methodology:</em> In this study, we identified all Danish residents from the birth cohort 1900-1960, with a first DXA scan between 2010-2022 to form the Nationwide Osteoporosis Cohort Trials Environment (NOCTE) dataset. These individuals were matched 1:5 to a non-scanned reference population by birth year, sex, and region of residence. Individual data were linked to national registers for comprehensive sociodemographic and clinical information.</div><div><em>Results:</em> The final cohort included 263,651 individuals who underwent DXA scanning. At their first scan, 33% of women and 17% of men had osteoporosis. Compared to the matched reference, the scanned cohort had similar socioeconomic profiles but substantially different clinical profiles. Scanned individuals had a much higher prevalence of prior major osteoporotic fractures, prior systemic glucocorticoid exposure, and overall comorbidity burden.</div><div><em>Conclusion:</em> Referral for DXA in Denmark is driven by clinical risk rather than socioeconomic status, reflecting an equitable resource allocation. However, a significant diagnostic gap persists, as many high-risk individuals with prior fractures did not receive a DXA. The NOCTE cohort is a new, powerful resource for developing strategies to help close this gap.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101653"},"PeriodicalIF":1.6,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624782","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}
Background: Hypocalcemia after initiating antiresorptive therapy is well documented, but the association between early changes in serum-corrected calcium (Ca) concentration and long-term bone mineral density (BMD) response in osteoporosis remains unclear. This study compared early Ca changes and BMD outcomes in patients treated with zoledronic acid or denosumab.
Methodology: In this retrospective study, 67 outpatients with osteoporosis received either zoledronic acid (n = 25) or denosumab (n = 42). Baseline BMD, serum-corrected Ca concentration, bone turnover markers, estimated glomerular filtration rate (eGFR), and 25-hydroxyvitamin D [25(OH)D] were recorded. Serum-corrected Ca concentration and eGFR were reassessed at 1 week, 6 months, and 12 months and BMD was measured at baseline, 6 months, and 12 months. To prevent hypocalcemia, patients received different vitamin D regimens according to standard practice (active vitamin D3 for zoledronic acid and combined natural and active vitamin D for denosumab). Multivariate regression has been adjusted for age, baseline BMD, 25(OH)D, eGFR, and TRACP-5b.
Results: A significant decrease in serum-corrected Ca at 1 week was observed in both groups. The magnitude of this decrease was negatively associated with lumbar spine BMD change at 12 months (zoledronic acid: r = −0.59, p = 0.0077; denosumab: r = −0.52, p = 0.0067). This association remained significant after multivariate adjustment. ROC analysis showed that Ca decrease predicted greater BMD gains (AUC 0.909 for zoledronic acid and AUC 0.81 for denosumab), but these results should be interpreted with caution due to the small sample size and different vitamin D regimens.
Conclusions: Early decreases in serum-corrected Ca concentration after antiresorptive therapy were associated with greater BMD gains at 12 months, independent of baseline vitamin D, renal function, and bone turnover markers. This study is exploratory and preliminary in nature, and its findings should be interpreted with caution.
背景：开始抗吸收治疗后的低钙血症有充分的文献记载，但骨质疏松症患者血清校正钙（Ca）浓度的早期变化与长期骨密度（BMD）反应之间的关系尚不清楚。该研究比较了接受唑来膦酸或地诺单抗治疗的患者的早期钙变化和BMD结果。方法：在这项回顾性研究中，67例骨质疏松症门诊患者接受唑来膦酸（n = 25）或地诺单抗（n = 42）治疗。记录基线骨密度、血清校正钙浓度、骨转换标志物、估计肾小球滤过率（eGFR）和25-羟基维生素D [25(OH)D]。在1周、6个月和12个月时重新评估血清校正Ca浓度和eGFR，在基线、6个月和12个月时测量BMD。为了预防低钙血症，患者根据标准惯例接受不同的维生素D方案（唑来膦酸治疗活性维生素D3，地诺单抗治疗天然和活性维生素D联合治疗）。对年龄、基线BMD、25(OH)D、eGFR和TRACP-5b进行了多因素回归校正。结果：两组患者1周时血清校正钙均显著降低。这种下降的幅度与12个月时腰椎骨密度变化呈负相关（唑来膦酸：r = -0.59, p = 0.0077；地诺单抗：r = -0.52, p = 0.0067）。在多变量调整后，这种关联仍然显著。ROC分析显示，钙降低预示着更大的骨密度增加（唑来膦酸的AUC为0.909，地诺单抗的AUC为0.81），但由于样本量小和不同的维生素D方案，这些结果应谨慎解释。结论：抗吸收治疗后血清校正钙浓度的早期降低与12个月时更高的骨密度增加相关，与基线维生素D、肾功能和骨转换标志物无关。本研究是探索性的、初步的，研究结果应谨慎解读。
{"title":"The relationship between changes in calcium concentration and bone mineral density by anti-bone resorptive therapy","authors":"Akira Horikawa , Yuji Kasukawa , Michio Hongo , Akihisa Sano , Naohisa Miyakoshi","doi":"10.1016/j.jocd.2025.101642","DOIUrl":"10.1016/j.jocd.2025.101642","url":null,"abstract":"<div><div><em>Background:</em> Hypocalcemia after initiating antiresorptive therapy is well documented, but the association between early changes in serum-corrected calcium (Ca) concentration and long-term bone mineral density (BMD) response in osteoporosis remains unclear. This study compared early Ca changes and BMD outcomes in patients treated with zoledronic acid or denosumab.</div><div><em>Methodology:</em> In this retrospective study, 67 outpatients with osteoporosis received either zoledronic acid (n = 25) or denosumab (n = 42). Baseline BMD, serum-corrected Ca concentration, bone turnover markers, estimated glomerular filtration rate (eGFR), and 25-hydroxyvitamin D [25(OH)D] were recorded. Serum-corrected Ca concentration and eGFR were reassessed at 1 week, 6 months, and 12 months and BMD was measured at baseline, 6 months, and 12 months. To prevent hypocalcemia, patients received different vitamin D regimens according to standard practice (active vitamin D3 for zoledronic acid and combined natural and active vitamin D for denosumab). Multivariate regression has been adjusted for age, baseline BMD, 25(OH)D, eGFR, and TRACP-5b.</div><div><em>Results:</em> A significant decrease in serum-corrected Ca at 1 week was observed in both groups. The magnitude of this decrease was negatively associated with lumbar spine BMD change at 12 months (zoledronic acid: r = −0.59, p = 0.0077; denosumab: r = −0.52, p = 0.0067). This association remained significant after multivariate adjustment. ROC analysis showed that Ca decrease predicted greater BMD gains (AUC 0.909 for zoledronic acid and AUC 0.81 for denosumab), but these results should be interpreted with caution due to the small sample size and different vitamin D regimens.</div><div><em>Conclusions:</em> Early decreases in serum-corrected Ca concentration after antiresorptive therapy were associated with greater BMD gains at 12 months, independent of baseline vitamin D, renal function, and bone turnover markers. This study is exploratory and preliminary in nature, and its findings should be interpreted with caution.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101642"},"PeriodicalIF":1.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145551600","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":"2025-10-26","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 : 2025-10-26DOI: 10.1016/j.jocd.2025.101637
Siraj Fahad Wally , Muwaffaq F. Wali , Osama Adnan Hariri , Rasha E. Alotiabi , Badr K Waked , Najla M. Almudayni , Faisal M. Khashab , Batool A. Alshahrani , Khalid M. Aljaaly , Abdulrahman O. Alzahrani
A serious worldwide health issue, osteoporosis is characterized by weakened bones and a higher risk of fracture. Though alternative imaging modalities like quantitative ultrasound (QUS), radiographic absorptiometry (RA), quantitative computed tomography (QCT), and radiofrequency echographic multispectrometry (REMS) have emerged as viable diagnostic or screening tools, dual-energy X-ray absorptiometry (DEXA) is still the gold standard for measuring bone mineral density (BMD). The purpose of this systematic review was to evaluate the clinical usefulness, diagnostic accuracy, and dependability of different radiographic modalities for osteoporosis detection. In order to find papers published between 2001 and 2023 comparing DEXA with other radiographic modalities for osteoporosis diagnosis, a thorough search of the PubMed, Scopus, and ScienceDirect databases was undertaken. There were ten studies that qualified. Study design, demographic characteristics, imaging methods, diagnostic thresholds, and performance metrics (sensitivity, specificity, and correlation coefficients) were among the data that were extracted. Across studies, DEXA consistently demonstrated high precision and strong correlation with fracture risk, confirming its role as the reference standard. QUS showed moderate agreement with DEXA, supporting its use as a screening tool but not for diagnostic confirmation. RA provided good reproducibility but lower sensitivity compared with DEXA. QCT exhibited superior sensitivity (up to 91%) and early trabecular bone detection but was limited by higher cost and radiation exposure. Emerging evidence for REMS demonstrated strong correlation with DEXA (r = 0.85–0.90), comparable diagnostic accuracy, and the advantage of being radiation-free and portable. DEXA remains the gold standard for osteoporosis diagnosis; however, QCT and REMS show promising diagnostic accuracy and may complement DEXA for early detection and longitudinal monitoring. QUS and RA can serve as cost-effective screening tools, particularly in settings where DEXA is unavailable. Further large-scale, prospective studies with standardized diagnostic thresholds are needed to validate these findings and optimize imaging strategies for osteoporosis management.
{"title":"Comparative diagnostic performance of dual-energy X-ray absorptiometry and other radiological modalities in osteoporosis detection: a systematic review","authors":"Siraj Fahad Wally , Muwaffaq F. Wali , Osama Adnan Hariri , Rasha E. Alotiabi , Badr K Waked , Najla M. Almudayni , Faisal M. Khashab , Batool A. Alshahrani , Khalid M. Aljaaly , Abdulrahman O. Alzahrani","doi":"10.1016/j.jocd.2025.101637","DOIUrl":"10.1016/j.jocd.2025.101637","url":null,"abstract":"<div><div>A serious worldwide health issue, osteoporosis is characterized by weakened bones and a higher risk of fracture. Though alternative imaging modalities like quantitative ultrasound (QUS), radiographic absorptiometry (RA), quantitative computed tomography (QCT), and radiofrequency echographic multispectrometry (REMS) have emerged as viable diagnostic or screening tools, dual-energy X-ray absorptiometry (DEXA) is still the gold standard for measuring bone mineral density (BMD). The purpose of this systematic review was to evaluate the clinical usefulness, diagnostic accuracy, and dependability of different radiographic modalities for osteoporosis detection. In order to find papers published between 2001 and 2023 comparing DEXA with other radiographic modalities for osteoporosis diagnosis, a thorough search of the PubMed, Scopus, and ScienceDirect databases was undertaken. There were ten studies that qualified. Study design, demographic characteristics, imaging methods, diagnostic thresholds, and performance metrics (sensitivity, specificity, and correlation coefficients) were among the data that were extracted. Across studies, DEXA consistently demonstrated high precision and strong correlation with fracture risk, confirming its role as the reference standard. QUS showed moderate agreement with DEXA, supporting its use as a screening tool but not for diagnostic confirmation. RA provided good reproducibility but lower sensitivity compared with DEXA. QCT exhibited superior sensitivity (up to 91%) and early trabecular bone detection but was limited by higher cost and radiation exposure. Emerging evidence for REMS demonstrated strong correlation with DEXA (r = 0.85–0.90), comparable diagnostic accuracy, and the advantage of being radiation-free and portable. DEXA remains the gold standard for osteoporosis diagnosis; however, QCT and REMS show promising diagnostic accuracy and may complement DEXA for early detection and longitudinal monitoring. QUS and RA can serve as cost-effective screening tools, particularly in settings where DEXA is unavailable. Further large-scale, prospective studies with standardized diagnostic thresholds are needed to validate these findings and optimize imaging strategies for osteoporosis management.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"29 1","pages":"Article 101637"},"PeriodicalIF":1.6,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514708","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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