Journal of Clinical Densitometry最新文献

Trabecular bone score (TBS) is a bone mineral density (BMD)-independent risk factor for fracture. During DXA analysis and BMD reporting, it is standard practice to exclude lumbar vertebral levels affected by structural artifact. Although TBS is relatively insensitive to degenerative artifact, it is uncertain whether TBS is still useful in the presence extreme structural artifact that precludes reliable spine BMD measurement even after vertebral exclusions. Among individuals aged 40 years and older undergoing baseline DXA assessment from September 2012 to March 2018 we identified three mutually exclusive groups: spine BMD reporting performed without exclusions (Group 1, N=12,865), spine BMD reporting performed with vertebral exclusions (Group 2, N=4867), and spine BMD reporting not performed due to severe structural artifact (Group 3, N=1541). No significant TBS difference was seen for Group 2 versus Group 1 (referent), whereas TBS was significantly greater in Group 3 (+0.041 partially adjusted, +0.043 fully adjusted). When analyzed by the reason for vertebral exclusion, multilevel degenerative changes significantly increased TBS (+0.041 partially adjusted, +0.042 fully adjusted), while instrumentation significantly reduced TBS (-0.059 partially adjusted, -0.051 fully adjusted). Similar results were seen when analyses were restricted to those in Group 3 with a single reason for vertebral exclusions, and when follow up scans were also included. During mean follow-up of 2.5 years there were 802 (4.2 %) individuals with one or more incident fractures. L1-L4 TBS showed significant fracture risk stratification in all groups including Group 3 (P-interaction >0.4). In conclusion, lumbar spine TBS can be reliably measured in the majority of lumbar spine DXA scans, including those with artifact affecting up to two vertebral levels. However, TBS is significantly affected by the presence of extreme structural artifact in the lumbar spine, especially those with multilevel degenerative disc changes and/or instrumentation that precludes reliable BMD reporting.

Introduction/Background: The monocyte-to-high-density lipoprotein (HDL) ratio (MHR) and carotid intima media thickness may be used as a marker of inflammation and oxidative stres. This study is aimed to investigate the role of MHR in etiopathogenesis and to determine the association between MHR and carotid intima media thickness, fracture risk, and quality of life (QoL) in postmenopausal osteoporosis patients without comorbidities. Methodology: Sixty osteoporosis, sixty osteopenia and sixty control groups were included in the prospective study evaluating postmenapausal women. The monocyte, HDL, and MHR values of all patients were evaluated. The bone mineral density of the participants was determined using the dual energy X-ray absorptiometry device. The fracture risk was assessed using the Turkish model of the Fracture Risk Assessment Tool. The QoL was determined using the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) scale, and carotid intima media thickness ultrasonography was used. Results: The age, body mass index, duration of menopause, monocyte, HDL, and MHR were similar in all three groups. carotid intima media thickness was higher in the osteoporosis group than in the normal group (p=0.015). A positive correlation was found between L1-4 total T score and monocytes, major osteoporotic fracture risk and physical function from QUALEFFO-41 sub-headings, MHR and QUALEFFO-41 total score (p<0.05). When all participants were evaluated, a positive correlation was found between femoral neck T score and MHR, L1-4 total T score and monocytes, while a negative correlation was found between L1-4 total T score and CIMT (p<0.05). Conclusion: Among postmenopausal women without comorbidities, MHR in the osteoporosis group was similar to that of the osteopenia and normal groups. Monocyte and MHR correlate with femoral neck T score and L1-4 total T score. CIMT was associated with a decreased L1–4 total T-score and an increased fracture risk, but not with MHR.

The Santa Fe Bone Symposium (SFBS) held its 23rd annual event on August 5-6, 2023, in Santa Fe, New Mexico, USA. Attendees participated in-person and remotely, representing many states and countries. The program included plenary presentations, panel discussions, satellite symposia, a Project ECHO workshop, and a session on healthcare policy and reimbursement for fracture liaison programs. A broad range of topics were addressed, including transitions of osteoporosis treatments over a lifetime; controversies in vitamin D; update on Official Positions of the International Society for Clinical Densitometry; spine surgery and bone health; clinical applications of bone turnover markers; basic bone biology for clinicians; premenopausal-, pregnancy-, and lactation-associated osteoporosis; cancer treatment induced bone loss in patients with breast cancer and prostate cancer; genetic testing for skeletal diseases; and an update on nutrition and bone health. There were also sessions on rare bone diseases, including managing patients with hypophosphatasia; treatment of X-linked hypophosphatemia; and assessment and treatment of patients with hypoparathyroidism. There were oral presentations of abstracts by endocrinology fellows selected from those who participated in the Santa Fe Fellows Workshop on Metabolic Bone Diseases, held the 2 days prior to the SFBS. These proceedings of the 2023 SFBS present the clinical highlights and insights generated from many formal and informal discussions in Santa Fe.

Aim: To evaluate the prognostic value of vertebral bone mineral density (BMD) and its relationship with mortality using the computed tomography (CT) scans of sepsis patients admitted to the intensive care unit. Methods: In this retrospective study, patients diagnosed with sepsis at the intensive care unit between January and December 2022 were evaluated. Bone density was manually measured from the vertebral body using axial CT images. The relationship of clinical variables and patient outcomes with vertebral BMD, mortality, and mechanical ventilation was investigated. A lower BMD (osteoporosis) was defined as ≤100 HU. Results: The study included 213 patients (95 females, 44.6%). The mean age of all patients was 60.1±18.7 years. At least one comorbidity was present in 64.7% (n=138) of the patients, and the most common comorbidity was hypertension (n=73, 34.2%). The mortality rate was 21.1% (n=45), and the mechanical ventilation rate was 17.4% (n=37), both being statistically significantly higher among the patients with a lower BMD (36.4 vs. 12.9%; p<0.001 and 29.7 vs. 10.8%; p=0.001, respectively). The rate of a lower BMD was significantly higher in the mortality group (59.5 vs. 29.5%; p=0.001). In the regression analysis, a lower BMD [odds ratio (OR), 2.785; 95% confidence interval (CI): 1.231–6.346, p=0.014] was a significant independent predictor of mortality. Interobserver agreement for BMD measurement was excellent, with an intraclass correlation coefficient of 0.919 (95% CI: 0.904−0.951). Conclusion: Vertebral BMD is a strong independent predictor of mortality and can be easily and reproducible evaluated on the thoracoabdominal CT images of patients admitted to the intensive care unit with a diagnosis of sepsis.

Purpose/Aims

To evaluate a potential DXA approach to sacral BMD measurement using extended field and standard L1-4 scans in women with gynecologic cancer.

Rationale/Background

Few data exist regarding bone status in women with gynecologic cancer despite known bone toxic effects of treatment-induced menopause, chemotherapy, and pelvic radiation. Cancer treatment-induced bone loss almost certainly increases subsequent fracture risk. Pelvic insufficiency fracture is a potentially catastrophic complication occurring in up to 7.8% of women. It is plausible that sacral BMD measurement could identify women at higher risk for this complication. Whether sacral BMD can be measured as part of routine DXA scanning has not been explored.

Methods

Subjects were from a study evaluating BMD change in women treated for gynecologic cancers. Standard clinical spine, hip, forearm and VFA scans, along with an extended length spine scan to include the sacrum, were acquired. Using a GE Lunar iDXA, sacral scans were obtained from the pubic tubercle cranially to the standard spine termination at T12. Sacral regions of interest (ROIs) were placed by outlining the sacrum (ROI 1) then this ROI was divided in half horizontally (ROIs 2 and 3; Figure 1). L1-L4 BMD from standard and extended scans were compared by Pearsons correlation and Bland-Altman analyses. Sacral ROI BMD was correlated by Pearsons with mean total hip, L1-4 and 0.3 radius BMD.

Results

Ten women, mean (SD) age and BMI of 53.7 (11.0) years and 32.9 (9.5) kg/m2 were studied. All subjects underwent hysterectomy with bilateral oophorectomy within 35 (14.9) days of baseline DXA scan. Mean L1-4 BMD was 1.146 (0.177) g/cm2 and lowest T-score -0.3 (1.5). Sacral BMD at ROIs 1, 2 & 3 was 0.808 (0.192), 0.897 (0.170) and 0.771 (0.210) g/cm2 respectively. Extended spine scan L1-4 BMD was highly correlated (r = 0.996) with standard L1-4 spine BMD and demonstrated a low bias, -0.006 g/cm2. Sacral BMD of all ROIs correlated with L1-4 (r = 0.88 – 0.93; p < 0.001) and mean total hip BMD (r = 0.79 – 0.84; p < 0.05), but not 0.3 radius (r = -0.23 to -0.12).

Implications

These data suggest that lumbar spine BMD can be measured using longer scan length DXA, equivalent to standard L1-4 measurements. That sacral BMD corelates with trabecular (spine and hip) but not a cortical sites (0.3 radius) could be expected and may suggest potential utility to monitor BMD change following gyn cancer therapy. Future research will focus on sacral BMD reproducibility and change post treatment.

Purpose/Aims

Adults with CMT have increased fracture risk, but data in children is lacking. We examine current bone health data in CMT at Lurie Children's Hospital (LCH) to inform clinical care, optimize bone health, and improve long- term morbidity and fracture risk.

Rationale/Background

Poor pediatric bone health increases lifelong risk of osteoporosis, with associated morbidity and mortality. CMT, the most common chronic peripheral neuropathy in childhood, is genetically and clinically heterogeneous, with milder, demyelinating (CMT-D), and more severe, axonal (CMT-A) subtypes.

Presentation includes distal leg weakness or deformity, mobility or balance issues, and muscle cramping. There are no disease-modifying therapies in children; early recognition, symptomatic care, and rehabilitation are critical.

Brief Description of the Undertaking/Best Practice

Retrospective chart review of 38 patients (pts) with CMT seen at LCH from 2012-22 revealed 21 pts (age 7-24 years(y)) who had Dual-energy X-ray Absorptiometry (DXA). Lumbar (LS) and total body less head (TBLH) bone mineral density (BMD, g/cm2) were measured (GE/Lunar iDXA). DXA Z-scores, ambulatory status, scoliosis, fracture, vitamin D supplementation, and 25OH vitamin D (25OHD) levels were assessed.

Outcomes achieved/documented

Seventeen pts had CMT-D; 4 had CMT-A. 18 pts were weight bearing (WB). The 2 non-WB (NWB), and 1 WB with assistance pts all had CMT-A. 3 pts had scoliosis (1 was NWB; 2 had CMT-D). 2 pts had a history of 1 fracture (not vertebral). 16 took supplemental vitamin D; 13 had 25OHD results, 1 was < 20 ng/ml. Pts were 5- 17y at initial DXA and had 1-7 DXA's completed. At initial DXA, 3 had low BMD (TBLH) (9, 12, 15y). One NWB pt later developed low LS BMD, and another with initial normal BMD had low BMD at 9y (NWB). Three pts with low BMD had CMT-A. Patients with fracture and low 25OHD had normal BMD, and 1 pt with scoliosis had low BMD.

Conclusions

Patients with CMT-A had a more severe phenotype and associated bone health measures in this cohort (3 NWB, and 3 with low BMD). Guidelines for pediatric CMT recommend improving muscle strength to slow progression of weakness, without specific bone health recommendations. Given the peripheral nature of CMT, DXA of lateral distal femur or distal 1/3 radius, or peripheral quantitative computed tomography (pQCT) may more accurately characterize bone health status. This study was limited by small sample size and 17/38 pts did not have DXA data. The LCH Neuromuscular program (neurologists, dietitians, physical and occupational therapists, and bone health specialists), seeks to monitor pts with CMT longitudinally, assessing 25OHD, calcium status, and BMD serially, to optimize bone health and prevent fractures and long-term morbidity.

Purpose/Aims

The purpose of the study is to identify the relationship between the risk of osteoporotic fracture in postmenopausal women with reduced bone mineral density and appendicular lean mass.

Rationale/Background

We hypothesized that limb muscle mass could be used as an independent risk predictor for FRAX. In the present study, we explored the correlation between BMD, limb muscle mass and FRAX in postmenopausal women in Inner Mongolia, adjusting for potential confounders.

Brief Description of the Undertaking/Best

Practice Methods A cross-sectional study was conducted on 1032 postmenopausal women who were treated at the Second Affiliated Hospital of Inner Mongolia Medical University. The whole body, spine, and hip bone mineral density and body composition were measured by dual-energy x-ray absorptiometry, and the fracture risk assessment was calculated using WHO FRAX risk assessment for the risk of major fractures and hip fracture.

Outcomes achieved/documented

Results There were 1032 women with a mean age of 64 years (range, 40 to 90 years). Mean values of lumbar spine BMD, femoral neck BMD, total hip BMD, and ALM were found to be 0.78±0.16g/cm2, 0.64±0.14g/cm2, 0.76±0.15g/cm2, and 15.9±2.4 kg, respectively. The fracture risk calculated in 10 years by using the FRAX for hip fracture and the major fracture was 4.2%(2.8,6.9) and 1%(0.3,2.4), respectively. The appendicular lean mass index showed a significantly higher association with major fracture and hip fracture risk.

Conclusions Conclusion

The results of this study suggest that the appendicular lean mass index correlates with an increased risk of a major fracture or hip fracture.

Purpose/Aims

To provide updated trends in DXA number, utilization rates, place of service and interpreter specialty based on a Medicare population dataset.

Rationale/Background

DXA exam utilization rate, place of service and interpreters have changed since 2005.

Methods

The Medicare Physician/Supplier Procedure Summary Limited Data Set between 2005-2019 was used. All claims with CPT DXA codes 76075, 76076, 77080, 77081 were retained. Annual counts of DXA scans and rates per 10,000 Medicare beneficiaries were calculated. Annual distributions (%) of DXA scans performed by place of service (Office, Outpatient hospital [OH], Other), provider type (Radiologist, Non-Radiologist, Advanced Practice Practitioner [APP]), and interpreter specialty (Radiology, Primary Care, Ob/Gyn, Rheumatology, Endocrinology, Other) were described. Linear regression was used to identify significant trends (significance assigned at p < 0.05) of the mean annual share of DXA utilization by place of service, provider type, and specialty.

Results

Annual DXA use/10,000 beneficiaries peaked in 2008 at 832, declined to 656 in 2015 and subsequently increased (p < 0.001) by a mean of ∼38 to 807 in 2019 (Figure 1). In 2005, 70.7% of DXAs were performed in office settings with 28.6% acquired in OH. Since 2005, number of DXAs performed in OH increased 1.8%/yr, reaching 51.7% in 2019, and decreased (p < 0.001) 1.8% at office sites. In 2005, 53.7% were interpreted by non-Radiologists and 43.5% by Radiologists. Across the study period the mean proportion interpreted by Radiologists increased (p-values for trend < 0.001) in both office (0.3%/yr) and OH (2.0%/yr) settings, such that by 2019, Radiologists read 73.5% of DXA exams and non-Radiologists 22.8% (Figure 2). A decline in interpretation (p < 0.001) was observed for Primary Care (mean 1.5%/yr), Rheumatology (mean 0.3%/yr) and Ob/Gyn (mean 0.2%/yr) with no significant change for Endocrinology. The share of DXA interpreted by APPs increased by a mean of 0.1%/yr (p < 0.001) from 2005-2019.

Implications

DXA number and utilization rate among Medicare beneficiaries has increased since 2015 and returned to 2005 levels. Office DXA rates have declined since 2005 with 51.7% of all scans now occurring in an outpatient hospital setting. DXA interpretation by Radiologists and APPs increased while most other specialties declined. Radiologist DXA interpretation has increased in both settings such that Radiology interpreted 73.5% of all DXAs submitted to Covered Medical Services for reimbursement in 2019.