Toe grip strength (TGS) measures foot muscle strength and evaluates stability maintenance, as well as the risk of falls. Handgrip strength (HGS) is considered a simple and effective method for assessing overall strength, and it correlates with bone variables. The aim of this study was: first, to investigate the relationship between TGS and overall strength and bone variables; and second, to compare the relationships between TGS and HGS with overall strength and bone variables. This cross-sectional study included 59 Caucasian men aged 60 to 84 years. Participants underwent muscle strength testing using exercises such as the bench press, leg extension, leg curl, and biceps curl, along with assessments of HGS and TGS. Body composition and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry (DXA). TGS was positively correlated with bench press performance (r = 0.68; p < 0.001), leg extension strength (r = 0.72; p < 0.001), leg curl strength (r = 0.83; p < 0.001), and biceps curl strength (r = 0.74; p < 0.001). A strong positive correlation was also observed between TGS and HGS (r = 0.88; p < 0.001). Finally, both TGS and HGS showed significant positive correlations with bone mass (r = 0.62; p < 0.001 and r = 0.68; p < 0.001, for toe grip and handgrip respectively). In conclusion, this study suggests that TGS is as good as HGS as a positive determinant of muscle strength and bone mass in older men.
{"title":"Toe Grip Strength is Another Indicator of Muscle Strength and Bone Mass in Older Men","authors":"Elie Maliha , Christophe Jacob , Nour Khalil , Abdel-Jalil Berro , Rami Abboud , Rawad ElHage","doi":"10.1016/j.jocd.2025.101603","DOIUrl":"10.1016/j.jocd.2025.101603","url":null,"abstract":"<div><div>Toe grip strength (TGS) measures foot muscle strength and evaluates stability maintenance, as well as the risk of falls. Handgrip strength (HGS) is considered a simple and effective method for assessing overall strength, and it correlates with bone variables. The aim of this study was: first, to investigate the relationship between TGS and overall strength and bone variables; and second, to compare the relationships between TGS and HGS with overall strength and bone variables. This cross-sectional study included 59 Caucasian men aged 60 to 84 years. Participants underwent muscle strength testing using exercises such as the bench press, leg extension, leg curl, and biceps curl, along with assessments of HGS and TGS. Body composition and bone mineral density (BMD) were assessed using dual-energy X-ray absorptiometry (DXA). TGS was positively correlated with bench press performance (<em>r</em> = 0.68; <em>p</em> < 0.001), leg extension strength (<em>r</em> = 0.72; <em>p</em> < 0.001), leg curl strength (<em>r</em> = 0.83; <em>p</em> < 0.001), and biceps curl strength (<em>r</em> = 0.74; <em>p</em> < 0.001). A strong positive correlation was also observed between TGS and HGS (<em>r</em> = 0.88; <em>p</em> < 0.001). Finally, both TGS and HGS showed significant positive correlations with bone mass (<em>r</em> = 0.62; <em>p</em> < 0.001 and <em>r</em> = 0.68; <em>p</em> < 0.001, for toe grip and handgrip respectively). In conclusion, this study suggests that TGS is as good as HGS as a positive determinant of muscle strength and bone mass in older men.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 4","pages":"Article 101603"},"PeriodicalIF":1.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144588525","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 : 2025-06-16DOI: 10.1016/j.jocd.2025.101600
Danielle D’Annibale , E. Michael Lewiecki , Gina Woods
Primary hyperparathyroidism can be divided into three clinical phenotypes: classical primary hyperparathyroidism with hypercalcemia and target organ involvement, asymptomatic primary hyperparathyroidism with hypercalcemia, and normocalcemic primary hyperparathyroidism. The latter phenotype is being increasingly recognized in patients having serum parathyroid hormone levels measured as part of the initial evaluation of osteoporosis. The diagnosis of normocalcemic primary hyperparathyroidism requires exclusion of secondary causes of parathyroid hormone elevation, such an vitamin D deficiency and calcium malabsorption. There is no consensus on the management of patients with normocalcemic primary hyperparathyroidism, particularly with regard to consideration of parathyroid surgery versus clinical observation. This is a case report of a patient with persistently normal calcium levels, high parathyroid hormone, and no recognized cause of secondary hyperparathyroidism. This case was presented and discussed at Bone Health Extension for Community Healthcare Outcomes, a virtual community of practice that has been meeting online weekly since 2015.
{"title":"Bone health ECHO case report: Normocalcemic hyperparathyroidism in a patient with osteoporosis referred for pre-operative bone health evaluation before spine surgery","authors":"Danielle D’Annibale , E. Michael Lewiecki , Gina Woods","doi":"10.1016/j.jocd.2025.101600","DOIUrl":"10.1016/j.jocd.2025.101600","url":null,"abstract":"<div><div>Primary hyperparathyroidism can be divided into three clinical phenotypes: classical primary hyperparathyroidism with hypercalcemia and target organ involvement, asymptomatic primary hyperparathyroidism with hypercalcemia, and normocalcemic primary hyperparathyroidism. The latter phenotype is being increasingly recognized in patients having serum parathyroid hormone levels measured as part of the initial evaluation of osteoporosis. The diagnosis of normocalcemic primary hyperparathyroidism requires exclusion of secondary causes of parathyroid hormone elevation, such an vitamin D deficiency and calcium malabsorption. There is no consensus on the management of patients with normocalcemic primary hyperparathyroidism, particularly with regard to consideration of parathyroid surgery versus clinical observation. This is a case report of a patient with persistently normal calcium levels, high parathyroid hormone, and no recognized cause of secondary hyperparathyroidism. This case was presented and discussed at Bone Health Extension for Community Healthcare Outcomes, a virtual community of practice that has been meeting online weekly since 2015.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 4","pages":"Article 101600"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518919","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 : 2025-06-10DOI: 10.1016/j.jocd.2025.101602
A.B.M. Kamrul-Hasan , Saptarshi Bhattacharya , Vanishri Ganakumar , Lakshmi Nagendra , Deep Dutta , Fatema Tuz Zahura Aalpona , Joseph M. Pappachan
Background: Trabecular bone score (TBS) independently predicts diabetic bone disease. Many studies have compared TBS in those with and without diabetes, showing inconsistent results. We conducted a systematic review and meta-analysis to evaluate TBS in type 2 diabetes mellitus (T2DM) and clarify its role, considering gender and other confounders.
Methodology: Relevant studies were systematically searched until October 2024 using related terms across multiple databases. RevMan Web and R software were employed to conduct statistical analyses. Meta-analyses utilized random-effects models and the inverse variance statistical method; results were expressed as mean differences (MD) with 95 % confidence intervals. The primary outcome of interest was the MD in TBS (unadjusted or adjusted) between the T2DM and non-diabetes groups.
Results: Data from 27 studies with 16,354 subjects were analyzed. Compared to controls without diabetes, subjects with T2DM exhibited lower unadjusted TBS in the combined sex group (MD -0.10 [-0.18, -0.02], P = 0.01), as well as in men (MD -0.02 [-0.04, -0.00], P = 0.02) and women (MD -0.05 [-0.07, -0.03], P < 0.0001). Individuals with T2DM also had a lower adjusted TBS in the combined sex group (MD -0.16 [-0.24, -0.08], P < 0.0001), men (MD -0.02 [-0.04, -0.00], P = 0.02), and women (MD -0.04 [-0.06, -0.02], P = 0.0005). While lumbar spine bone mineral density (BMD) was higher in individuals with T2DM than in those without across all three groups, total hip BMD was higher in women and the combined sex group; femoral neck BMD was higher only in the combined sex group.
Conclusion: According to the data analyzed in this updated meta-analysis, T2DM appears to adversely affect TBS, despite having a positive effect on BMD; however, the evidence level is very low. Larger and longer-term studies are necessary to explore the implicated factors and potential remedial strategies.
PROSPERO registration number: CRD42024608004
背景：骨小梁评分（TBS）可独立预测糖尿病骨病。许多研究比较了糖尿病患者和非糖尿病患者的TBS，结果不一致。在考虑性别和其他混杂因素的情况下，我们进行了一项系统回顾和荟萃分析，以评估2型糖尿病（T2DM）患者的TBS，并阐明其作用。方法：系统检索相关研究，直到2024年10月，使用多个数据库的相关术语。采用RevMan Web和R软件进行统计分析。meta分析采用随机效应模型和反方差统计方法；结果表示为平均差异（MD），置信区间为95% %。研究的主要终点是T2DM组和非糖尿病组之间TBS的MD（未调整或调整）。结果：分析了27项研究的16,354名受试者的数据。与未患糖尿病的对照组相比，T2DM患者在性别组合组中表现出较低的未调整TBS (MD -0.10 [-0.18, -0.02], P = 0.01)，男性（MD -0.02 [-0.04, -0.00], P = 0.02）和女性（MD -0.05 [-0.07, -0.03], P <； 0.0001）。T2DM患者的调整TBS在性别组合组中也较低（MD -0.16 [-0.24, -0.08], P <； 0.0001），男性（MD -0.02 [-0.04, -0.00], P = 0.02），女性（MD -0.04 [-0.06, -0.02], P = 0.0005）。在所有三组中，T2DM患者的腰椎骨密度（BMD）均高于非T2DM患者，但女性和两性混合组的髋部骨密度（BMD）较高；股骨颈骨密度仅在性别混合组较高。结论：根据这项最新荟萃分析分析的数据，T2DM似乎对TBS有不利影响，尽管对BMD有积极影响；然而，证据水平非常低。有必要进行更大规模和更长期的研究，以探索涉及的因素和潜在的补救策略。普洛斯彼罗注册号：CRD42024608004
{"title":"Trabecular Bone Score in Type 2 Diabetes Mellitus: An Updated Systematic Review and Meta-Analysis","authors":"A.B.M. Kamrul-Hasan , Saptarshi Bhattacharya , Vanishri Ganakumar , Lakshmi Nagendra , Deep Dutta , Fatema Tuz Zahura Aalpona , Joseph M. Pappachan","doi":"10.1016/j.jocd.2025.101602","DOIUrl":"10.1016/j.jocd.2025.101602","url":null,"abstract":"<div><div><em>Background:</em> Trabecular bone score (TBS) independently predicts diabetic bone disease. Many studies have compared TBS in those with and without diabetes, showing inconsistent results. We conducted a systematic review and meta-analysis to evaluate TBS in type 2 diabetes mellitus (T2DM) and clarify its role, considering gender and other confounders.</div><div><em>Methodology:</em> Relevant studies were systematically searched until October 2024 using related terms across multiple databases. RevMan Web and R software were employed to conduct statistical analyses. Meta-analyses utilized random-effects models and the inverse variance statistical method; results were expressed as mean differences (MD) with 95 % confidence intervals. The primary outcome of interest was the MD in TBS (unadjusted or adjusted) between the T2DM and non-diabetes groups.</div><div><em>Results:</em> Data from 27 studies with 16,354 subjects were analyzed. Compared to controls without diabetes, subjects with T2DM exhibited lower unadjusted TBS in the combined sex group (MD -0.10 [-0.18, -0.02], <em>P</em> = 0.01), as well as in men (MD -0.02 [-0.04, -0.00], <em>P</em> = 0.02) and women (MD -0.05 [-0.07, -0.03], <em>P</em> < 0.0001). Individuals with T2DM also had a lower adjusted TBS in the combined sex group (MD -0.16 [-0.24, -0.08], <em>P</em> < 0.0001), men (MD -0.02 [-0.04, -0.00], <em>P</em> = 0.02), and women (MD -0.04 [-0.06, -0.02], <em>P</em> = 0.0005). While lumbar spine bone mineral density (BMD) was higher in individuals with T2DM than in those without across all three groups, total hip BMD was higher in women and the combined sex group; femoral neck BMD was higher only in the combined sex group.</div><div><em>Conclusion:</em> According to the data analyzed in this updated meta-analysis, T2DM appears to adversely affect TBS, despite having a positive effect on BMD; however, the evidence level is very low. Larger and longer-term studies are necessary to explore the implicated factors and potential remedial strategies.</div><div><em>PROSPERO registration number:</em> CRD42024608004</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 4","pages":"Article 101602"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518921","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 : 2025-06-10DOI: 10.1016/j.jocd.2025.101599
Kun Zhu , Michael Hunter , Chrianna Bharat , Kevin Murray , Jennie Hui , John P. Walsh , Joseph Hung
Background: DXA-measured visceral adipose tissue (VAT) is associated with development of metabolic syndrome in middle-aged adults, but its association with incident cardiovascular disease (CVD) has not been studied. We evaluated the longitudinal association of baseline VATDXA with incident CVD events within the Busselton Healthy Ageing study.
Methods: Participants (n = 4866, 54 % female, aged 46-70 years, ∼99 % white) were assessed for VATDXA and were followed up longitudinally for a median of 7.9 years. Outcome measures were time to incident CVD or coronary heart disease (CHD) events (defined as non-fatal hospitalisations or death). Sex-stratified associations were examined using Cox proportional hazards models adjusting for baseline age, lifestyle factors and prior CVD.
Results: Mean baseline VATDXA mass was 1678±877 g and 882±600 g in males and females respectively. Incident CVD and CHD events were recorded for 332 (6.8 %) and 245 (5.0 %) study participants. There was a near-linear increase in risk for CVD and CHD events with VATDXA in both sexes. After covariate adjustment each standard deviation (SD) increment in VATDXA was associated with a hazard ratio [95 % confidence interval] for incident CVD in males and females of 1.26 [1.11-1.44] and 1.30 [1.10-1.55] respectively, and a hazard ratio for CHD of 1.28 [1.11-1.49] and 1.40 [1.14-1.72] respectively. However, VATDXA was no longer independently associated with CVD events once adjusted for BMI and waist circumference.
Conclusion: VATDXA has utility for identifying middle-aged adults at greater risk for incident CVD and CHD but further studies are needed to determine if VATDXA can improve risk discrimination beyond anthropometric measures.
{"title":"DXA-Measured Visceral Adipose Tissue and Incident Cardiovascular Disease Events in Middle-Aged Adults: Busselton Healthy Ageing Study","authors":"Kun Zhu , Michael Hunter , Chrianna Bharat , Kevin Murray , Jennie Hui , John P. Walsh , Joseph Hung","doi":"10.1016/j.jocd.2025.101599","DOIUrl":"10.1016/j.jocd.2025.101599","url":null,"abstract":"<div><div><em>Background:</em> DXA-measured visceral adipose tissue (VAT) is associated with development of metabolic syndrome in middle-aged adults, but its association with incident cardiovascular disease (CVD) has not been studied. We evaluated the longitudinal association of baseline VAT<sub>DXA</sub> with incident CVD events within the Busselton Healthy Ageing study.</div><div><em>Methods:</em> Participants (<em>n</em> = 4866, 54 % female, aged 46-70 years, ∼99 % white) were assessed for VAT<sub>DXA</sub> and were followed up longitudinally for a median of 7.9 years. Outcome measures were time to incident CVD or coronary heart disease (CHD) events (defined as non-fatal hospitalisations or death). Sex-stratified associations were examined using Cox proportional hazards models adjusting for baseline age, lifestyle factors and prior CVD.</div><div><em>Results:</em> Mean baseline VAT<sub>DXA</sub> mass was 1678±877 g and 882±600 g in males and females respectively. Incident CVD and CHD events were recorded for 332 (6.8 %) and 245 (5.0 %) study participants. There was a near-linear increase in risk for CVD and CHD events with VAT<sub>DXA</sub> in both sexes. After covariate adjustment each standard deviation (SD) increment in VAT<sub>DXA</sub> was associated with a hazard ratio [95 % confidence interval] for incident CVD in males and females of 1.26 [1.11-1.44] and 1.30 [1.10-1.55] respectively, and a hazard ratio for CHD of 1.28 [1.11-1.49] and 1.40 [1.14-1.72] respectively. However, VAT<sub>DXA</sub> was no longer independently associated with CVD events once adjusted for BMI and waist circumference.</div><div><em>Conclusion:</em> VAT<sub>DXA</sub> has utility for identifying middle-aged adults at greater risk for incident CVD and CHD but further studies are needed to determine if VAT<sub>DXA</sub> can improve risk discrimination beyond anthropometric measures.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 3","pages":"Article 101599"},"PeriodicalIF":1.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144472455","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}
Introduction/background: Lower extremity amputations, particularly at more proximal levels such as transfemoral amputations (TFA)s, negatively affect bone mineral density (BMD). The aim of this study was to determine the relationship between muscle strength, residual limb length (RLL), and BMD on the amputated side in individuals with traumatic unilateral TFA and to investigate other potentially related factors.
Methodology: This is a retrospective, cross-sectional study. The study included 39 individuals with TFA. Demographic and clinical data of the individuals were recorded. RLL was determined by measuring the distance from the trochanter major to the most distal end point of the stump. Hip flexor and extensor muscle strengths were assessed by determining peak torque at an angular velocity of 60°/s using an isokinetic system. Dual-energy X-ray absorptiometry (DXA) imaging T-scores of the femoral neck and lumbar spine on the amputee side were evaluated.
Results: There was a statistically significant relationship between peak hip flexion torque and RLL with the femoral neck BMD T-score (r = 0.327*, p = 0.045; r = 0.432*, p = 0.006, respectively). RLL and peak hip flexion torque were identified as determinants of femoral neck BMD T-score (p = 0.004, p = 0.031, respectively). It was found that for every 1 cm increase in RLL, the femoral neck BMD T-score increased by approximately 0.09. A one-unit increase in peak hip flexion torque was associated with an approximate increase of 0.04 in the ipsilateral femoral neck BMD T-score.
Conclusions: In the rehabilitation program of individuals with unilateral TFA, it may be important to plan hip flexor muscle strengthening interventions that may affect BMD. Performing amputation surgeries while preserving RLL at the longest possible length may be beneficial in terms of BMD results on the amputated side.
{"title":"Bone Mineral Density and Associated Factors in Individuals with Traumatic Unilateral Transfemoral Amputation","authors":"Gizem Kılınç Kamacı, Merve Örücü Atar, Elif Tekin, Fatma Özcan, Yasin Demir, Koray Aydemir","doi":"10.1016/j.jocd.2025.101598","DOIUrl":"10.1016/j.jocd.2025.101598","url":null,"abstract":"<div><div><em>Introduction/background:</em> Lower extremity amputations, particularly at more proximal levels such as transfemoral amputations (TFA)s, negatively affect bone mineral density (BMD). The aim of this study was to determine the relationship between muscle strength, residual limb length (RLL), and BMD on the amputated side in individuals with traumatic unilateral TFA and to investigate other potentially related factors.</div><div><em>Methodology:</em> This is a retrospective, cross-sectional study. The study included 39 individuals with TFA. Demographic and clinical data of the individuals were recorded. RLL was determined by measuring the distance from the trochanter major to the most distal end point of the stump. Hip flexor and extensor muscle strengths were assessed by determining peak torque at an angular velocity of 60°/s using an isokinetic system. Dual-energy X-ray absorptiometry (DXA) imaging T-scores of the femoral neck and lumbar spine on the amputee side were evaluated.</div><div><em>Results:</em> There was a statistically significant relationship between peak hip flexion torque and RLL with the femoral neck BMD T-score (<em>r = </em>0.327*, <em>p = </em>0.045; <em>r = </em>0.432*, <em>p = </em>0.006, respectively). RLL and peak hip flexion torque were identified as determinants of femoral neck BMD T-score (<em>p = </em>0.004, <em>p = </em>0.031, respectively). It was found that for every 1 cm increase in RLL, the femoral neck BMD T-score increased by approximately 0.09. A one-unit increase in peak hip flexion torque was associated with an approximate increase of 0.04 in the ipsilateral femoral neck BMD T-score.</div><div><em>Conclusions:</em> In the rehabilitation program of individuals with unilateral TFA, it may be important to plan hip flexor muscle strengthening interventions that may affect BMD. Performing amputation surgeries while preserving RLL at the longest possible length may be beneficial in terms of BMD results on the amputated side.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 3","pages":"Article 101598"},"PeriodicalIF":1.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279885","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 : 2025-06-02DOI: 10.1016/j.jocd.2025.101596
Sevde Nur Emir, Ahmet Kürşat Soydan, Safiye Sanem Dereli Bulut
Background: This study aims to assess the diagnostic accuracy of axial and sagittal CT-derived Hounsfield Unit (HU) values in identifying osteopenia and osteoporosis. Additionally, it investigates whether the combination of multiple vertebral levels enhances predictive performance compared to single-level assessments.
Methodology: This retrospective study included 346 patients from who underwent both dual-energy X-ray absorptiometry (DXA) and non-contrast thoracic computed tomography (CT) scans within a 6-month interval. Axial and sagittal HU measurements were obtained from key vertebral levels, including T4, T7, T10, T12, and L1. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the diagnostic performance of individual and combined vertebral models. Patients with vertebral metastases, hemangiomas, compression fractures, or severe deformities were excluded.
Results: The sagittal T4 vertebra measurement achieved the highest individual AUC (0.810), indicating strong diagnostic potential. Combining T4 and L1 measurements improved the AUC to 0.828, while a six-vertebra model yielded a slightly higher AUC of 0.844. Despite this marginal improvement, simpler two-vertebra models offer practical advantages in clinical settings. Optimal cut-off values were determined using Youden’s Index, with T4S at 164 HU and L1S at 133 HU, both showing high specificity but moderate sensitivity.
Conclusions: Axial and sagittal CT measurements, particularly at T4 and L1 levels, demonstrate strong potential for diagnosing osteopenia and osteoporosis. Combining multiple vertebral levels offers improved predictive accuracy, although simpler models remain effective. Opportunistic CT screening, utilizing scans performed for other clinical purposes, provides a practical and cost-effective alternative to DXA, enabling early intervention and comprehensive osteoporosis management.
背景：本研究旨在评估轴向和矢状位ct衍生的Hounsfield Unit （HU）值在识别骨质减少和骨质疏松症中的诊断准确性。此外，它还研究了与单水平评估相比，多个椎体水平的组合是否能提高预测性能。方法：这项回顾性研究包括346名患者，他们在6个月内接受了双能x线吸收仪（DXA）和胸部非对比计算机断层扫描（CT）扫描。轴向和矢状面HU测量来自关键椎体水平，包括T4、T7、T10、T12和L1。采用Logistic回归和受试者工作特征（ROC）分析来评估单个和联合椎体模型的诊断性能。排除有椎体转移、血管瘤、压缩性骨折或严重畸形的患者。结果：矢状面T4椎体测量个体AUC最高（0.810），具有较强的诊断潜力。结合T4和L1测量使AUC提高到0.828，而六椎体模型的AUC略高，为0.844。尽管有这种微小的改进，但更简单的双椎体模型在临床环境中具有实际优势。使用约登指数确定最佳临界值，T4S为164 HU， L1S为133 HU，均具有高特异性，但敏感性中等。结论：轴位和矢状位CT测量，特别是T4和L1水平，显示出诊断骨质减少和骨质疏松症的强大潜力。虽然简单的模型仍然有效，但结合多个椎体水平可以提高预测准确性。机会性CT筛查，利用其他临床目的的扫描，为DXA提供了实用和经济的替代方案，实现了早期干预和全面的骨质疏松症管理。
{"title":"Diagnostic accuracy of axial and sagittal CT measurements for osteoporosis: A multi-vertebra evaluation","authors":"Sevde Nur Emir, Ahmet Kürşat Soydan, Safiye Sanem Dereli Bulut","doi":"10.1016/j.jocd.2025.101596","DOIUrl":"10.1016/j.jocd.2025.101596","url":null,"abstract":"<div><div><em>Background:</em> This study aims to assess the diagnostic accuracy of axial and sagittal CT-derived Hounsfield Unit (HU) values in identifying osteopenia and osteoporosis. Additionally, it investigates whether the combination of multiple vertebral levels enhances predictive performance compared to single-level assessments.</div><div><em>Methodology:</em> This retrospective study included 346 patients from who underwent both dual-energy X-ray absorptiometry (DXA) and non-contrast thoracic computed tomography (CT) scans within a 6-month interval. Axial and sagittal HU measurements were obtained from key vertebral levels, including T4, T7, T10, T12, and L1. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the diagnostic performance of individual and combined vertebral models. Patients with vertebral metastases, hemangiomas, compression fractures, or severe deformities were excluded.</div><div><em>Results:</em> The sagittal T4 vertebra measurement achieved the highest individual AUC (0.810), indicating strong diagnostic potential. Combining T4 and L1 measurements improved the AUC to 0.828, while a six-vertebra model yielded a slightly higher AUC of 0.844. Despite this marginal improvement, simpler two-vertebra models offer practical advantages in clinical settings. Optimal cut-off values were determined using Youden’s Index, with T4S at 164 HU and L1S at 133 HU, both showing high specificity but moderate sensitivity.</div><div><em>Conclusions:</em> Axial and sagittal CT measurements, particularly at T4 and L1 levels, demonstrate strong potential for diagnosing osteopenia and osteoporosis. Combining multiple vertebral levels offers improved predictive accuracy, although simpler models remain effective. Opportunistic CT screening, utilizing scans performed for other clinical purposes, provides a practical and cost-effective alternative to DXA, enabling early intervention and comprehensive osteoporosis management.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 4","pages":"Article 101596"},"PeriodicalIF":1.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563107","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 : 2025-05-13DOI: 10.1016/j.jocd.2025.101595
Sarah E. Deemer , Diana E. Kolb , Nicole L. Cipriano , Daniel L. Smith , George A. King
Introduction: Accurate assessment of body composition is critical for understanding health risks and developing appropriate interventions, particularly in underrepresented populations. The purpose of this study was to compare the body composition estimate (% body fat [%BF]) between dual-energy x-ray absorptiometry (DXA) and hydrodensitometry via hydrostatic weighing (HW) in a group of Hispanic pre-menopausal women.
Methodology: Healthy Hispanic women (n=78, age: 22–51 years, BMI: 18.5–42.5) were measured for body composition by DXA and HW at a single lab visit. %BF from HW was calculated from body density using three commonly used adult-specific equations (2-component [2-C] Siri, 2-C Brozek, 3-component [3-C] Lohman) and a 2-C Hispanic-specific equation. Comparisons between the two methods (DXA and HW) were analyzed using paired t-tests, and linear regression and Bland-Altman plots were used to assess agreement between the two methods.
Results: %BF was significantly higher by DXA compared to all four HW equations (P < 0.01). Based on regression analyses the mean difference scores were not different from zero for all estimates of %BF.
Conclusions: While DXA and HW are both common laboratory measures for determining %BF, given the time-efficiency, minimal participant effort, and high precision, %BF estimation by DXA appears to be an adequate and sufficient method of measurement of body composition in Hispanic women.
{"title":"Comparison of Body Composition Estimates in Hispanic Women by Dual-Energy X-ray Absorptiometry and Hydrostatic Densitometry","authors":"Sarah E. Deemer , Diana E. Kolb , Nicole L. Cipriano , Daniel L. Smith , George A. King","doi":"10.1016/j.jocd.2025.101595","DOIUrl":"10.1016/j.jocd.2025.101595","url":null,"abstract":"<div><div><em>Introduction:</em> Accurate assessment of body composition is critical for understanding health risks and developing appropriate interventions, particularly in underrepresented populations. The purpose of this study was to compare the body composition estimate (% body fat [%BF]) between dual-energy x-ray absorptiometry (DXA) and hydrodensitometry via hydrostatic weighing (HW) in a group of Hispanic pre-menopausal women.</div><div><em>Methodology:</em> Healthy Hispanic women (n=78, age: 22–51 years, BMI: 18.5–42.5) were measured for body composition by DXA and HW at a single lab visit. %BF from HW was calculated from body density using three commonly used adult-specific equations (2-component [2-C] Siri, 2-C Brozek, 3-component [3-C] Lohman) and a 2-C Hispanic-specific equation. Comparisons between the two methods (DXA and HW) were analyzed using paired t-tests, and linear regression and Bland-Altman plots were used to assess agreement between the two methods.</div><div><em>Results:</em> %BF was significantly higher by DXA compared to all four HW equations (<em>P</em> < 0.01). Based on regression analyses the mean difference scores were not different from zero for all estimates of %BF.</div><div><em>Conclusions:</em> While DXA and HW are both common laboratory measures for determining %BF, given the time-efficiency, minimal participant effort, and high precision, %BF estimation by DXA appears to be an adequate and sufficient method of measurement of body composition in Hispanic women.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 3","pages":"Article 101595"},"PeriodicalIF":1.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137884","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 : 2025-05-07DOI: 10.1016/j.jocd.2025.101594
Babette S. Zemel , John A. Shepherd , Laila Kazemi , Andrea Kelly , Virginia A. Stallings , Heidi Kecskemethy , David R. Weber , Halley Wasserman , Heidi J. Kalkwarf
Introduction: Many children with musculoskeletal disorders are at high risk of fracture, and the lateral distal femur (LDF) may be the only feasible site to measure bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). Pediatric reference ranges and adjustment for linear growth are needed to interpret BMD results.
Methods: Lateral distal femur scans by DXA were obtained on children, ages 1 to 18 y, from two clinical centers. Precision in young children was estimated from duplicate scans. Smoothed reference ranges for three regions of the LDF were generated. Prediction equations were developed to account for the effects of short or tall stature on BMD.
Results: We obtained >2400 measurements on 1,245 children and generated reference ranges for three LDF BMD regions. Precision of BMD was similar (% CV of 1.33 to 2.42 %) to estimates reported at other skeletal sites. Modest sex differences were observed, with females having greater BMD than males at older ages. Children identified as Black had greater BMD than children identified as Non-Black. Height-for-age Z-scores were associated with BMD-for-age Z-scores in pre- and peri-pubertal children, and adjustment equations were generated.
Conclusions: This study fills substantial gaps in pediatric bone health assessment for children with musculoskeletal disorders who are at high-risk of fracture by providing smoothed reference ranges for ages 1 to 18 y and equations to estimate the impact of small body size on BMD-for-age Z-scores.
{"title":"Pediatric Lateral Distal Femur Reference Ranges for Ages 1 to 18 years","authors":"Babette S. Zemel , John A. Shepherd , Laila Kazemi , Andrea Kelly , Virginia A. Stallings , Heidi Kecskemethy , David R. Weber , Halley Wasserman , Heidi J. Kalkwarf","doi":"10.1016/j.jocd.2025.101594","DOIUrl":"10.1016/j.jocd.2025.101594","url":null,"abstract":"<div><div><em>Introduction:</em> Many children with musculoskeletal disorders are at high risk of fracture, and the lateral distal femur (LDF) may be the only feasible site to measure bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). Pediatric reference ranges and adjustment for linear growth are needed to interpret BMD results.</div><div><em>Methods:</em> Lateral distal femur scans by DXA were obtained on children, ages 1 to 18 y, from two clinical centers. Precision in young children was estimated from duplicate scans. Smoothed reference ranges for three regions of the LDF were generated. Prediction equations were developed to account for the effects of short or tall stature on BMD.</div><div><em>Results:</em> We obtained >2400 measurements on 1,245 children and generated reference ranges for three LDF BMD regions. Precision of BMD was similar (% CV of 1.33 to 2.42 %) to estimates reported at other skeletal sites. Modest sex differences were observed, with females having greater BMD than males at older ages. Children identified as Black had greater BMD than children identified as Non-Black. Height-for-age Z-scores were associated with BMD-for-age Z-scores in pre- and peri-pubertal children, and adjustment equations were generated.</div><div><em>Conclusions:</em> This study fills substantial gaps in pediatric bone health assessment for children with musculoskeletal disorders who are at high-risk of fracture by providing smoothed reference ranges for ages 1 to 18 y and equations to estimate the impact of small body size on BMD-for-age Z-scores.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 3","pages":"Article 101594"},"PeriodicalIF":1.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124716","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 : 2025-04-04DOI: 10.1016/j.jocd.2025.101586
Ibrahim Fayad , Antonio Pinti , Hassane Zouhal , Rawad El Hage
The aim of the current study was to explore the relationships between 20-meter sprinting time and composite indices of femoral neck strength (compression strength index (CSI), bending strength index (BSI) and impact strength index (ISI)) in a group of middle-aged active men. 50 middle-aged active men voluntarily participated in this study. Their mean age was 45 ± 8.6 years. Body composition, total hip bone mineral density (TH BMD) and femoral neck bone mineral density (FN BMD) were evaluated by DXA. Sprinting time was negatively correlated to CSI (r = −0.52; p < 0.001), BSI (r = −0.43; p < 0.01) and ISI (r = −0.47; p < 0.001). The significant correlations between sprinting time and composite indices of femoral neck strength (CSI, BSI and ISI) remained significant after controlling for body weight, age and maximum oxygen consumption using multiple linear regressions. In conclusion, the current study suggests that sprinting performance (m/sec) is a positive determinant of CSI, BSI and ISI in middle-aged men.
{"title":"Sprinting performance correlates with composite indices of femoral neck strength in middle-aged active men","authors":"Ibrahim Fayad , Antonio Pinti , Hassane Zouhal , Rawad El Hage","doi":"10.1016/j.jocd.2025.101586","DOIUrl":"10.1016/j.jocd.2025.101586","url":null,"abstract":"<div><div>The aim of the current study was to explore the relationships between 20-meter sprinting time and composite indices of femoral neck strength (compression strength index (CSI), bending strength index (BSI) and impact strength index (ISI)) in a group of middle-aged active men. 50 middle-aged active men voluntarily participated in this study. Their mean age was 45 ± 8.6 years. Body composition, total hip bone mineral density (TH BMD) and femoral neck bone mineral density (FN BMD) were evaluated by DXA. Sprinting time was negatively correlated to CSI (<em>r</em> = −0.52; <em>p</em> < 0.001), BSI (<em>r</em> = −0.43; <em>p</em> < 0.01) and ISI (<em>r</em> = −0.47; <em>p</em> < 0.001). The significant correlations between sprinting time and composite indices of femoral neck strength (CSI, BSI and ISI) remained significant after controlling for body weight, age and maximum oxygen consumption using multiple linear regressions. In conclusion, the current study suggests that sprinting performance (m/sec) is a positive determinant of CSI, BSI and ISI in middle-aged men.</div></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":"28 3","pages":"Article 101586"},"PeriodicalIF":1.7,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848582","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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