Pub Date : 2023-07-01DOI: 10.1016/j.jocd.2023.101409
Devon Cataldi PhD.c (Primary Autho) , John Shepherd PhD (Contributing Author) , Struan Grant PhD (Contributing Author) , Heidi Kalkwarf PhD (Contributing Author) , Leila Kazemi MSc, CMRI/CBDT (Contributing Author) , Brandon Quon MS (Contributing Author) , Jonathan Mitchell PhD (Contributing Author) , Andrea Kelly PhD (Contributing Author) , Shana McCormack PhD (Contributing Author) , Babette Zemel PhD (Contributing Author)
Purpose/Aims
To determine the precision, accuracy, and unique analysis challenges of HSA in children.
Rationale/Background
Hip structural analysis (HSA) variables, a collection of 10 measures including cross-sectional area (CSA), cross-sectional inertia (CSI), and buckling ratio (BR), have been shown to be independent risk factors in determining fracture risk in adults, but there have been few studies reporting the utility and accuracy of HSA in children. Previous work has described the precision of HSA in adults, but the precision and unique challenges of the HSA protocol in children is unexplored. Here we describe the unique challenges, precision, and quality assurance protocol of pediatric HSA measures in a large cohort of over 2,500 children.
Methods
This is a retrospective analysis of prospectively collected DXA scans acquired as part of two studies, the Bone Mineral Density in Childhood Study (BMDCS) and the Genome-wide Analysis Study (GWAS). The combined sample consisted of 2,514 children (10,787 scans, 1,271 girls) aged from 5 to 21 years. The proximal femur DXA scans were acquired on five Hologic systems (Hologic, Inc., Marlborough, MA) of similar models (A and W) with up to eight years of annual follow-up between 2002 and 2009. All scans were analyzed centrally by the authors using one technologist using APEX 3.4 software. A unique and comprehensive quality assurance check was completed for all scans including a review of the acquisition criteria set by ISCD and a review of the automatically placed HSA region's narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS) region of interests. During processing, regions were either repositioned or eliminated on DXA imaging. Duplicate scans were performed on 150 children (71 girls) for precision assessment. Specific HSA quality control (QC) codes were generated for this particular analysis in accordance with the author's criteria. Short-term precision estimates were calculated as the RMSE and %CV. QA codes were assigned to the NN, IT, and FS boxes that were either incorrectly positioned or invalidated.
Results
Of the entire dataset under 10% of NN and FS boxes needed to be repositioned and none were invalidated. Figure 1 provides an example of proper placement of the IT box (at a 45-degree angle) in between the greater and lesser trochanter. If the angle of the IT box is either < 10 or >25 degrees, the IT box was invalidated. In this study, 100% of the IT boxes needed to be repositioned and 54% remained invalid. Multiple reasons were identified for an invalid scan region including the unavoidable presence of a growth plate in the hip scans for participants less than 15 years old, as shown in Figure 1. All HSA precision over all age groups ranged was less than 6% CV except for the NN Buckling ratio and Cross-sectional Inertia. In general, the precision error was lower in t
{"title":"Advanced Analysis Protocol Improves Quality of Pediatric Hip Structural Analysis","authors":"Devon Cataldi PhD.c (Primary Autho) , John Shepherd PhD (Contributing Author) , Struan Grant PhD (Contributing Author) , Heidi Kalkwarf PhD (Contributing Author) , Leila Kazemi MSc, CMRI/CBDT (Contributing Author) , Brandon Quon MS (Contributing Author) , Jonathan Mitchell PhD (Contributing Author) , Andrea Kelly PhD (Contributing Author) , Shana McCormack PhD (Contributing Author) , Babette Zemel PhD (Contributing Author)","doi":"10.1016/j.jocd.2023.101409","DOIUrl":"10.1016/j.jocd.2023.101409","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To determine the precision, accuracy, and unique analysis challenges of HSA in children.</p></div><div><h3>Rationale/Background</h3><p>Hip structural analysis (HSA) variables, a collection of 10 measures including cross-sectional area (CSA), cross-sectional inertia (CSI), and buckling ratio (BR), have been shown to be independent risk factors in determining fracture risk in adults, but there have been few studies reporting the utility and accuracy of HSA in children. Previous work has described the precision of HSA in adults, but the precision and unique challenges of the HSA protocol in children is unexplored. Here we describe the unique challenges, precision, and quality assurance protocol of pediatric HSA measures in a large cohort of over 2,500 children.</p></div><div><h3>Methods</h3><p>This is a retrospective analysis of prospectively collected DXA scans acquired as part of two studies, the Bone Mineral Density in Childhood Study (BMDCS) and the Genome-wide Analysis Study (GWAS). The combined sample consisted of 2,514 children (10,787 scans, 1,271 girls) aged from 5 to 21 years. The proximal femur<span> DXA scans were acquired on five Hologic systems (Hologic, Inc., Marlborough, MA) of similar models (A and W) with up to eight years of annual follow-up between 2002 and 2009. All scans were analyzed centrally by the authors using one technologist using APEX 3.4 software. A unique and comprehensive quality assurance check was completed for all scans including a review of the acquisition criteria set by ISCD and a review of the automatically placed HSA region's narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS) region of interests. During processing, regions were either repositioned or eliminated on DXA imaging. Duplicate scans were performed on 150 children (71 girls) for precision assessment. Specific HSA quality control (QC) codes were generated for this particular analysis in accordance with the author's criteria. Short-term precision estimates were calculated as the RMSE and %CV. QA codes were assigned to the NN, IT, and FS boxes that were either incorrectly positioned or invalidated.</span></p></div><div><h3>Results</h3><p>Of the entire dataset under 10% of NN and FS boxes needed to be repositioned and none were invalidated. Figure 1 provides an example of proper placement of the IT box (at a 45-degree angle) in between the greater and lesser trochanter<span>. If the angle of the IT box is either < 10 or >25 degrees, the IT box was invalidated. In this study, 100% of the IT boxes needed to be repositioned and 54% remained invalid. Multiple reasons were identified for an invalid scan region including the unavoidable presence of a growth plate in the hip scans for participants less than 15 years old, as shown in Figure 1. All HSA precision over all age groups ranged was less than 6% CV except for the NN Buckling ratio and Cross-sectional Inertia. In general, the precision error was lower in t","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44604818","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101414
Dr. MEI DONG (Primary Author)
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.
{"title":"Association of bone mineral density and muscle mass with fracture risk assessed by FRAX for postmenopausal women in Inner Mongolia","authors":"Dr. MEI DONG (Primary Author)","doi":"10.1016/j.jocd.2023.101414","DOIUrl":"10.1016/j.jocd.2023.101414","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>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.</p></div><div><h3>Rationale/Background</h3><p>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.</p></div><div><h3>Brief Description of the Undertaking/Best</h3><p>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.</p></div><div><h3>Outcomes achieved/documented</h3><p>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.</p></div><div><h3>Conclusions Conclusion</h3><p>The results of this study suggest that the appendicular lean mass index correlates with an increased risk of a major fracture or hip fracture.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45893324","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101385
Tyler Prout MD (Primary Author) , Casey E. Pelzl MPH (Contributing Author) , Eric W. Christensen PhD (Contributing Author) , Neil Binkley MD (Contributing Author) , John Schousboe MD (Contributing Author) , Diane Krueger BS, CBDT (Contributing Author)
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.
{"title":"Dual-energy X-ray Performance Among Medicare Beneficiaries: 2005-2019","authors":"Tyler Prout MD (Primary Author) , Casey E. Pelzl MPH (Contributing Author) , Eric W. Christensen PhD (Contributing Author) , Neil Binkley MD (Contributing Author) , John Schousboe MD (Contributing Author) , Diane Krueger BS, CBDT (Contributing Author)","doi":"10.1016/j.jocd.2023.101385","DOIUrl":"10.1016/j.jocd.2023.101385","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To provide updated trends in DXA number, utilization rates, place of service and interpreter specialty based on a Medicare population dataset.</p></div><div><h3>Rationale/Background</h3><p>DXA exam utilization rate, place of service and interpreters have changed since 2005.</p></div><div><h3>Methods</h3><p>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<span><span><span><span> [OH], Other), provider type (Radiologist, Non-Radiologist, Advanced Practice Practitioner [APP]), and interpreter specialty (Radiology, Primary Care, Ob/Gyn, </span>Rheumatology, </span>Endocrinology, Other) were described. </span>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.</span></p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Implications</h3><p>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.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42760735","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101383
Virginia A. Kaperick MD (Primary Author)
Case Description
6 year old with Duchenne's Muscular Dystrophy (DMD), on chronic daily glucocorticoids, presented for his scheduled DXA screening, as per 2018 DMD Care Considerations Guidelines. He fell on his bottom the night before his appointment resulting in acute severe midline low back pain. GE Lunar iDXA densitometer was unable to automatically detect bone edges requiring manual ROI placement to complete the study. The Lumbar Spine L1-L4 BMD Z-score was - 7.5, with very low BMC of 0.93 grams. On Whole Body scan the Total Body Less Head (TBLH) Z-score= -2.0. No prior x- ray or DXA imaging available. Spine X-rays had subtle changes concerning for possible early vertebral compression. His pain remained moderate to severe over following 8 days, and had slow improvement with supportive care over subsequent weeks. Vertebral fracture was confirmed on repeat spine x-ray eight weeks after original study when noted to have 25% ht loss of L5, as well as compressive changes to L2, L3. Repeat DXA at this time showed L1-L4 BMD Z-score = -2.2 with BMC= 8.67g and TBLH Z-score remained -2.0. Acute injury, with its associated inflammation, edema, and possibly local hemorrhage, led to difficulties in edge detection and discrimination of bone versus soft tissue. This is not commonly reported in the manufacture or scientific literature as a source of error. Provider knowledge of this potential source of internal artifact should lead to either delay of imaging, or to repeat the study at an appropriate time if findings are inconsistent with expected outcomes in the setting of acute injury.
Credit
Michelle Clausen, Lead Nuclear Medicine/PET Technologist Children's Wisconsin
{"title":"6 year old with Duchenne's Muscular Dystrophy with extremely low BMD and BMC calculations secondary to local edema from acute vertebral fracture","authors":"Virginia A. Kaperick MD (Primary Author)","doi":"10.1016/j.jocd.2023.101383","DOIUrl":"10.1016/j.jocd.2023.101383","url":null,"abstract":"<div><h3>Case Description</h3><p><span>6 year old with Duchenne's Muscular Dystrophy (DMD), on chronic daily </span>glucocorticoids<span>, presented for his scheduled DXA<span> screening, as per 2018 DMD Care Considerations Guidelines. He fell on his bottom the night before his appointment resulting in acute severe midline low back pain. GE Lunar iDXA densitometer was unable to automatically detect bone edges requiring manual ROI placement to complete the study. The Lumbar Spine<span> L1-L4 BMD Z-score was - 7.5, with very low BMC of 0.93 grams. On Whole Body scan<span> the Total Body Less Head (TBLH) Z-score= -2.0. No prior x- ray or DXA imaging available. Spine X-rays had subtle changes concerning for possible early vertebral compression. His pain remained moderate to severe over following 8 days, and had slow improvement with supportive care over subsequent weeks. Vertebral fracture was confirmed on repeat spine x-ray eight weeks after original study when noted to have 25% ht loss of L5, as well as compressive changes to L2, L3. Repeat DXA at this time showed L1-L4 BMD Z-score = -2.2 with BMC= 8.67g and TBLH Z-score remained -2.0. Acute injury, with its associated inflammation, edema, and possibly local hemorrhage, led to difficulties in edge detection and discrimination of bone versus soft tissue. This is not commonly reported in the manufacture or scientific literature as a source of error. Provider knowledge of this potential source of internal artifact should lead to either delay of imaging, or to repeat the study at an appropriate time if findings are inconsistent with expected outcomes in the setting of acute injury.</span></span></span></span></p></div><div><h3>Credit</h3><p>Michelle Clausen, Lead Nuclear Medicine/PET Technologist Children's Wisconsin</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45363303","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101393
David P. Martin II MD (Primary Author) , Samuel S. Lake MD Physician (Contributing Author) , Michael A. Behun MD (Contributing Author) , Diane Krueger BS, CBDT (Contributing Author) , Radius Neil Binkley MD (Contributing Author) , David Hennessy MD (Contributing Author) , Brian Nickel MD (Contributing Author)
Purpose/Aims
To evaluate Intraoperative Physician Assessment (IPA) during total hip arthroplasty (THA) as a quantitative measure of bone status based on tactile assessment. IPA was compared to DXA-measured bone mineral density (BMD), 3D-Shaper parameters, and radiographic indices to assess its validity for evaluating bone status.
Rationale/Background
The International Society for Clinical Densitometry (ISCD) Official Positions acknowledge the orthopedic surgeons’ ability to assess bone intraoperatively and recommend bone assessment for patients with poor bone quality. Currently, there is no validated method to quantify bone status intraoperatively and correlate it with DXA-parameters. This study sought to fill that void.
Methods
A retrospective analysis identified patients undergoing primary THA who had IPA recorded in the operative report and a DXA within 2 years prior to surgery. Patients were excluded if they had prior surgery on the involved hip. 60 patients (64 hips) operated on by 2 fellowship-trained arthroplasty surgeons were included. Intraoperatively, surgeons subjectively assessed bone quality on a 5-point scale based on tactile feedback. This scale defined 1 as excellent and 5 as poor, as noted in Table 1. IPA score was compared to DXA BMD and T-score, 3D Shaper measurements, WHO classification, FRAX scores, radiographic Dorr classification and Cortical Index. IPA was correlated with bone parameters using the Pearson method for continuous variables and Spearman method for ordinal variables.
Results
Mean (SD) patient age and BMI were 69.1 (8.5) years and 27.7 (5.9) kg/m2 respectively; 54 (84%) were female. Patient demographic data and bone parameters were similar between surgeons. Mean IPA was 2.95 ± 0.98 with no difference between surgeons (p = 0.121). There was a moderate correlation between IPA score and total hip BMD (r = 0.386, p = 0.002) and 3D shaper measurements, including trabecular volumetric BMD (r = -0.326, p = 0.010), cortical surface BMD (r = -0.347, p = 0.006), and cortical thickness (r = -0.381, p = 0.002). There was a strong correlation (all p < 0.001) between IPA score and lowest T-score (r = -0.485), WHO classification (r = 0.528), and FRAX major and hip fracture scores (r = 0.501, 0.622). All patients with below average or poor IPA score had osteopenia or osteoporosis by DXA.
Implications
IPA during THA is a simple, valuable tool for quantifying bone status based on tactile feedback. This information can be used to identify patients with poor bone quality that may benefit from bone health evaluation and treatment.
{"title":"Intraoperative Physician Assessment during total hip arthroplasty correlates with DXA parameters","authors":"David P. Martin II MD (Primary Author) , Samuel S. Lake MD Physician (Contributing Author) , Michael A. Behun MD (Contributing Author) , Diane Krueger BS, CBDT (Contributing Author) , Radius Neil Binkley MD (Contributing Author) , David Hennessy MD (Contributing Author) , Brian Nickel MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101393","DOIUrl":"10.1016/j.jocd.2023.101393","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To evaluate Intraoperative Physician Assessment (IPA) during total hip arthroplasty (THA) as a quantitative measure of bone status based on tactile assessment. IPA was compared to DXA-measured bone mineral density (BMD), 3D-Shaper parameters, and radiographic indices to assess its validity for evaluating bone status.</p></div><div><h3>Rationale/Background</h3><p>The International Society for Clinical Densitometry (ISCD) Official Positions acknowledge the orthopedic surgeons’ ability to assess bone intraoperatively and recommend bone assessment for patients with poor bone quality. Currently, there is no validated method to quantify bone status intraoperatively and correlate it with DXA-parameters. This study sought to fill that void.</p></div><div><h3>Methods</h3><p>A retrospective analysis identified patients undergoing primary THA who had IPA recorded in the operative report<span> and a DXA within 2 years prior to surgery. Patients were excluded if they had prior surgery on the involved hip. 60 patients (64 hips) operated on by 2 fellowship-trained arthroplasty surgeons were included. Intraoperatively, surgeons subjectively assessed bone quality on a 5-point scale based on tactile feedback. This scale defined 1 as excellent and 5 as poor, as noted in Table 1. IPA score was compared to DXA BMD and T-score, 3D Shaper measurements, WHO classification, FRAX scores, radiographic Dorr classification and Cortical Index. IPA was correlated with bone parameters using the Pearson method for continuous variables and Spearman method for ordinal variables.</span></p></div><div><h3>Results</h3><p><span>Mean (SD) patient age and BMI were 69.1 (8.5) years and 27.7 (5.9) kg/m2 respectively; 54 (84%) were female. Patient demographic data and bone parameters were similar between surgeons. Mean IPA was 2.95 ± 0.98 with no difference between surgeons (p = 0.121). There was a moderate correlation between IPA score and total hip BMD (r = 0.386, p = 0.002) and 3D shaper measurements, including trabecular volumetric BMD (r = -0.326, p = 0.010), cortical surface BMD (r = -0.347, p = 0.006), and cortical thickness (r = -0.381, p = 0.002). There was a strong correlation (all p < 0.001) between IPA score and lowest T-score (r = -0.485), WHO classification (r = 0.528), and FRAX major and hip fracture scores (r = 0.501, 0.622). All patients with below average or poor IPA score had </span>osteopenia<span> or osteoporosis by DXA.</span></p></div><div><h3>Implications</h3><p>IPA during THA is a simple, valuable tool for quantifying bone status based on tactile feedback. This information can be used to identify patients with poor bone quality that may benefit from bone health evaluation and treatment.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41311216","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101404
Gary K. Schneider DO (Primary Author Fellow Physician)
Purpose/Aims
To assess reliability of lumbar vertebral body computed tomography (CT) attenuation measurement between different observers.
Rationale/Background
The International Society for Clinical Densitometry (ISCD) guidelines for DXA interpretation include assessment of “opportunistic CT” as a surrogate for DXA scan using L1 vertebral body attenuation, with threshold >150 and < 100 Hounsfield units (HU) estimating the likelihood of normal bone density and osteoporosis, respectively. ISCD guidelines include precision analysis of DXA, but there are no formal guidelines for assessing precision error when assessing bone mineral density (BMD) by CT attenuation of lumbar vertebral body. Measurement of precision have been published and we sought to determine inter-rater reliability and to assess precision by test-retest of the same patient.
Methods
Utilizing Visage PACS to view CT images, six observers each measured CT attenuation of L1 and L5 vertebral bodies of the same set of 31 separate CT scans. Measurements were performed as previously described.3 Average HU within an elliptical region of interest (ROI) of the L1 and L5 vertebral bodies were recorded for each measurement, as well as L1 and L5 ROI area. Intra-class correlation (ICC) was calculated for each of these variables, with >0.9 indicating excellent agreement, 0.75-0.9 indicating good agreement, 0.5-0.75 indicating moderate agreement, and < 0.5 indicating poor agreement. ICC was calculated of L1 attenuation measured by a single observer on a separate set of 12 patients with CT scans done within 30 days of each other. Additionally we calculated root mean square–coefficient of variation (RMS-CV) of L1 vertebral body attenuation on this set of 12 patients.
Results
ICC of L1 attenuation and L5 attenuation were 0.94 and 0.92, respectively, indicating excellent agreement between observers. ICC of ROI areas at L1 and L5 ROI were 0.04 and 0.03, respectively, indicating poor agreement (Table 1). ICC of L1 CT attenuation on repeat scans within 30 days by a single observer was 0.97, indicating excellent agreement between two readings . Root mean square-SD was 14.6 HU. Least significant change was 40.4 HU. Percent coefficient of variation was 34.6.
Implications
This study demonstrates that measurement of CT attenuation at L1 and L5 between different observers is reliable while area of region of interest at L1 and L5 between observers showed poor agreement. In test-retest of scans performed within 30 days on the same patient, a short time period in which little change is expected, measurement of CT attenuation also showed excellent agreement.
{"title":"Inter-observer Reliability of CT Attenuation Measurement of Lumbar Vertebral Bodies","authors":"Gary K. Schneider DO (Primary Author Fellow Physician)","doi":"10.1016/j.jocd.2023.101404","DOIUrl":"10.1016/j.jocd.2023.101404","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To assess reliability of lumbar vertebral body computed tomography (CT) attenuation measurement between different observers.</p></div><div><h3>Rationale/Background</h3><p>The International Society for Clinical Densitometry<span><span> (ISCD) guidelines for DXA interpretation include assessment of “opportunistic CT” as a surrogate for DXA scan using L1 vertebral body attenuation, with threshold >150 and < 100 Hounsfield units (HU) estimating the likelihood of normal bone density and osteoporosis, respectively. ISCD guidelines include precision analysis of DXA, but there are no formal guidelines for assessing precision error when assessing bone mineral density (BMD) by </span>CT attenuation of lumbar vertebral body. Measurement of precision have been published and we sought to determine inter-rater reliability and to assess precision by test-retest of the same patient.</span></p></div><div><h3>Methods</h3><p>Utilizing Visage PACS to view CT images, six observers each measured CT attenuation of L1 and L5 vertebral bodies of the same set of 31 separate CT scans. Measurements were performed as previously described.3 Average HU within an elliptical region of interest (ROI) of the L1 and L5 vertebral bodies were recorded for each measurement, as well as L1 and L5 ROI area. Intra-class correlation (ICC) was calculated for each of these variables, with >0.9 indicating excellent agreement, 0.75-0.9 indicating good agreement, 0.5-0.75 indicating moderate agreement, and < 0.5 indicating poor agreement. ICC was calculated of L1 attenuation measured by a single observer on a separate set of 12 patients with CT scans done within 30 days of each other. Additionally we calculated root mean square–coefficient of variation (RMS-CV) of L1 vertebral body attenuation on this set of 12 patients.</p></div><div><h3>Results</h3><p>ICC of L1 attenuation and L5 attenuation were 0.94 and 0.92, respectively, indicating excellent agreement between observers. ICC of ROI areas at L1 and L5 ROI were 0.04 and 0.03, respectively, indicating poor agreement (Table 1). ICC of L1 CT attenuation on repeat scans within 30 days by a single observer was 0.97, indicating excellent agreement between two readings . Root mean square-SD was 14.6 HU. Least significant change was 40.4 HU. Percent coefficient of variation was 34.6.</p></div><div><h3>Implications</h3><p>This study demonstrates that measurement of CT attenuation at L1 and L5 between different observers is reliable while area of region of interest at L1 and L5 between observers showed poor agreement. In test-retest of scans performed within 30 days on the same patient, a short time period in which little change is expected, measurement of CT attenuation also showed excellent agreement.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49593436","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 : 2023-07-01DOI: 10.1016/j.jocd.2023.101395
Lucas Andersen BS (Primary Author) , Diane Krueger BS, CBDT (Contributing Author) , Gretta Borchardt BS (Contributing Author) , Brian Nickel MD (Contributing Author) , Paul A. Anderson MD (Contributing Author) , Neil Binkley MD (Contributing Author)
Purpose/Aims
To compare bone mineral density (BMD) precision of knee custom regions of interest (ROI) with and without total knee arthroplasty (TKA).
Rationale/Background
TKA is a common procedure that results in 10 to 15% BMD loss at the distal femur. This could contribute to complications such as periprosthetic fracture, especially if osteoporosis is present at the time of TKA. Prior work supports measuring BMD around the knee using custom ROIs, this study investigates precision error of such an approach.
Methods
Thirty participants from a study evaluating BMD pre- and post-TKA had duplicate posteroanterior (PA) and lateral (LAT) scans in TKA and non-TKA knees with repositioning between. Scans were acquired on a Lunar iDXA with the orthopedic knee feature (GE enCORE software v18). Custom ROIs were manually placed on PA and LAT scans at the distal femur condyle (ROI 1), metaphysis (ROI 2) and shaft (ROI 3), and the proximal tibia (ROI 4) and tibial shaft (ROI 5) (Figure 1). The prosthesis was identified as artifact by the software. Precision error was calculated using the ISCD Advanced Precision Calculator and differences between TKA vs non-TKA legs were assessed by F-test.
Results
Study participants (n = 30; 6M, 24F) with mean (SD) age and BMI of 69.2 (6.5) years and 31.6 ± 4.9 kg/m2 respectively were included. Precision at various ROIs (Table 1) on non-TKA legs ranged from 1.2 - 3.8% on PA and 2.5 – 5.6% on LAT projections. Similarly, TKA leg ROI %CV ranged from 1.5 - 5.4% and 1.0 – 4.1% on PA and LAT respectively. PA precision differed (p < 0.001) between TKA and non-TKA legs at the distal femur condyle and tibia shaft. LAT precision differed between legs (p < 0.05) at the femur metaphysis, shaft, and tibia shaft. In the non-TKA leg, lateral positioning precision was numerically poorer at all ROIs; a generally similar pattern was observed in the TKA leg. The bone area post-TKA was small in the most distal femur and proximal tibia ROIs due to implant artifact. Tibial PA shaft reproducibility was confounded by fibular overlap in 23% of non-TKA scans but none post-TKA. However, fibula overlap was present on LAT view in 30% and 43% of non-TKA and TKA legs respectively.
Implications
Distal femur and proximal tibia BMD measurement may have utility for surgical planning and is best assessed in the PA projection. Based on precision, monitoring is best at the PA femur shaft and postoperatively at the tibial shaft. It is reasonable to expect precision improvement with automated ROI placement.
{"title":"Custom Femur and Tibia BMD Precision in Elective Total Knee Arthroplasty Patients","authors":"Lucas Andersen BS (Primary Author) , Diane Krueger BS, CBDT (Contributing Author) , Gretta Borchardt BS (Contributing Author) , Brian Nickel MD (Contributing Author) , Paul A. Anderson MD (Contributing Author) , Neil Binkley MD (Contributing Author)","doi":"10.1016/j.jocd.2023.101395","DOIUrl":"10.1016/j.jocd.2023.101395","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To compare bone mineral density (BMD) precision of knee custom regions of interest (ROI) with and without total knee arthroplasty (TKA).</p></div><div><h3>Rationale/Background</h3><p>TKA is a common procedure that results in 10 to 15% BMD loss at the distal femur<span>. This could contribute to complications such as periprosthetic fracture<span>, especially if osteoporosis is present at the time of TKA. Prior work supports measuring BMD around the knee using custom ROIs, this study investigates precision error of such an approach.</span></span></p></div><div><h3>Methods</h3><p><span>Thirty participants from a study evaluating BMD pre- and post-TKA had duplicate posteroanterior (PA) and lateral (LAT) scans in TKA and non-TKA knees with repositioning between. Scans were acquired on a Lunar iDXA with the orthopedic<span> knee feature (GE enCORE software v18). Custom ROIs were manually placed on PA and LAT scans at the distal femur condyle (ROI 1), metaphysis (ROI 2) and shaft (ROI 3), and the </span></span>proximal tibia<span> (ROI 4) and tibial shaft (ROI 5) (Figure 1). The prosthesis was identified as artifact by the software. Precision error was calculated using the ISCD Advanced Precision Calculator and differences between TKA vs non-TKA legs were assessed by F-test.</span></p></div><div><h3>Results</h3><p><span>Study participants (n = 30; 6M, 24F) with mean (SD) age and BMI of 69.2 (6.5) years and 31.6 ± 4.9 kg/m2 respectively were included. Precision at various ROIs (Table 1) on non-TKA legs ranged from 1.2 - 3.8% on PA and 2.5 – 5.6% on LAT projections. Similarly, TKA leg ROI %CV ranged from 1.5 - 5.4% and 1.0 – 4.1% on PA and LAT respectively. PA precision differed (p < 0.001) between TKA and non-TKA legs at the distal femur condyle and tibia shaft. LAT precision differed between legs (p < 0.05) at the femur metaphysis, shaft, and tibia shaft. In the non-TKA leg, lateral positioning precision was numerically poorer at all ROIs; a generally similar pattern was observed in the TKA leg. The bone area post-TKA was small in the most distal femur and proximal tibia ROIs due to implant artifact. Tibial PA shaft reproducibility was confounded by fibular overlap in 23% of non-TKA scans but none post-TKA. However, </span>fibula overlap was present on LAT view in 30% and 43% of non-TKA and TKA legs respectively.</p></div><div><h3>Implications</h3><p>Distal femur and proximal tibia BMD measurement may have utility for surgical planning and is best assessed in the PA projection. Based on precision, monitoring is best at the PA femur shaft and postoperatively at the tibial shaft. It is reasonable to expect precision improvement with automated ROI placement.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46930638","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: Low bone mineral density (BMD) is prevalent in individuals with β-thalassemia and is associated with increased circulating dickkopf-1 concentration. These data are limited in α-thalassemia. Therefore, we aimed to determine the prevalence of low BMD and the association between BMD and serum dickkopf-1 in adolescents with non-deletional hemoglobin H disease, a form of α-thalassemia whose severity is comparable to β-thalassemia intermedia. Methodology: The lumbar spine and total body BMD were measured and converted into height-adjusted z-scores. Low BMD was defined as BMD z-score ≤ -2. Participant blood was drawn for measurement of dickkopf-1 and bone turnover marker concentrations. Results: Thirty-seven participants with non-deletional hemoglobin H disease (59% female, mean age 14.6 ± 3.2 years, 86% Tanner stage ≥2, 95% regularly transfused, 16% taking prednisolone) were included. Over one year prior to the study, mean average pretransfusion hemoglobin, ferritin and 25-hydroxyvitamin D concentrations were 8.8 ± 1.0 g/dL, and 958 ± 513 and 26 ± 6 ng/mL, respectively. When participants taking prednisolone were excluded, the prevalence of low BMD at the lumbar spine and total body was 42% and 17%, respectively. BMD at both sites was correlated positively with body mass index z-score, and negatively with dickkopf-1 (all p-values <0.05). There were no correlations among dickkopf-1, 25-hydroxyvitamin D, osteocalcin and C-telopeptide of type-I collagen. Multiple regression analysis showed dickkopf-1 inversely associated with total body BMD z-score adjusting for sex, bone age, body mass index, pre-transfusion hemoglobin, 25-hydroxyvitamin D, history of delayed puberty, type of iron chelator and prednisolone use (p-value = 0.009). Conclusions: We demonstrated a high prevalence of low BMD in adolescents with non-deletional hemoglobin H disease. Moreover, dickkopf-1 inversely associated with total body BMD suggesting it may serve as a bone biomarker in this patient population.
{"title":"Bone Mineral Density and Dickkopf-1 in Adolescents with Non-Deletional Hemoglobin H Disease","authors":"Pattara Wiromrat , Aree Rattanathongkom , Napat Laoaroon , Kunanya Suwannaying , Patcharee Komwilaisak , Ouyporn Panamonta , Nantaporn Wongsurawat , Nat Nasomyont","doi":"10.1016/j.jocd.2023.101379","DOIUrl":"10.1016/j.jocd.2023.101379","url":null,"abstract":"<div><p><em>Background:</em><span> Low bone mineral density (BMD) is prevalent in individuals with β-thalassemia and is associated with increased circulating dickkopf-1 concentration. These data are limited in α-thalassemia. Therefore, we aimed to determine the prevalence of low BMD and the association between BMD and serum dickkopf-1 in adolescents with non-deletional hemoglobin H disease, a form of α-thalassemia whose severity is comparable to β-thalassemia intermedia. </span><em>Methodology:</em><span><span> The lumbar spine and total body BMD were measured and converted into height-adjusted z-scores. Low BMD was defined as BMD z-score ≤ -2. Participant blood was drawn for measurement of dickkopf-1 and </span>bone turnover marker concentrations. </span><em>Results:</em><span><span><span> Thirty-seven participants with non-deletional hemoglobin H disease (59% female, mean age 14.6 ± 3.2 years, 86% Tanner stage ≥2, 95% regularly transfused, 16% taking prednisolone) were included. Over one year prior to the study, mean average pretransfusion hemoglobin, ferritin<span> and 25-hydroxyvitamin D concentrations were 8.8 ± 1.0 g/dL, and 958 ± 513 and 26 ± 6 ng/mL, respectively. When participants taking prednisolone were excluded, the prevalence of low BMD at the lumbar spine and total body was 42% and 17%, respectively. BMD at both sites was correlated positively with </span></span>body mass index z-score, and negatively with dickkopf-1 (all p-values <0.05). There were no correlations among dickkopf-1, 25-hydroxyvitamin D, </span>osteocalcin<span><span> and C-telopeptide of type-I collagen. Multiple regression analysis showed dickkopf-1 inversely associated with total body BMD z-score adjusting for sex, bone age, body mass index, pre-transfusion hemoglobin, 25-hydroxyvitamin D, history of delayed puberty, type of </span>iron chelator and prednisolone use (p-value = 0.009). </span></span><em>Conclusions:</em> We demonstrated a high prevalence of low BMD in adolescents with non-deletional hemoglobin H disease. Moreover, dickkopf-1 inversely associated with total body BMD suggesting it may serve as a bone biomarker in this patient population.</p></div>","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10287357","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}
To construct a nude mouse model of aromatase inhibitor-associated bone loss (AIBL) after premenopausal breast cancer surgery, and to explore the possible mechanism of letrozole-induced bone loss.
Rationale/Background
At present, clinical and experimental research on AIBL mainly focuses on postmenopausal breast cancer patients, ignoring the premenopausal population of AIs combined with Ovarian Function Suppression. The mechanism of AIBL is not only the well-known sharp decline of estrogen, but also the lack of exploration of the cellular mechanism and factors related to bone metabolism. H-type blood vessels contribute to angiogenesis and bone formation in the bone microenvironment. It is a sensitive indicator for evaluating bone mass andSlit guided ligand 3 (SLIT3) is a type of angiogenic factor secreted by osteoblasts. Knocking out SLIT3 will lead to the reduction of H-type vascular endothelial cells in bone and resulting in a decrease in bone mass. Based on this, it will be helpful to establish AIBL animal model and explore the mechanism of bone loss, which will help optimize the endocrine therapy regimen.
Methods
The postoperative AIBL model of premenopausal breast cancer was established by inoculation and resection of breast cancer xenografts, bilateral ovariectomy and letrozole gavage. BALB/c nude mice were randomly divided into 5 groups: Control group (Control group), postoperative group (MX group), castration group (MX+OVX group), model group A (MX+OVX+Le group), model group B (OVX+Le group). The eyeball blood of mice was collected to detect the related bone metabolism and bone-related hormones by ELISA. The bone mineral density and trabecular microstructure of the femur and tibia were evaluated by mirco-CT, the bone tissue was evaluated by HE staining, the activity of osteoblasts was evaluated by OCN immunohistochemistry, and the activity of osteoclasts was evaluated by TRAP immunohistochemistry. Immunofluorescence staining of type H blood vessel (CD31hiEmcnhi) was used to explore the potential mechanism and related targets of AIBL.
Results
Compared with the control group, there were significant differences in serum E2, P1NP, CTX-1, GH and SLIT3 in model A and model B groups (P< 0.05). Bone mineral density was significantly reduced by mirco-CT (P< 0.05), and the decrease in model group A was more significant. In HE staining, the number of bone trabeculae in the model A group was significantly reduced. In addition, TRAP and OCN immunohistochemical staining showed that the trabeculae of model A group were surrounded by more osteoclasts and fewer osteoblasts. Compared to the control group, H-type blood vessels in model A group were smaller under immunofluorescence.
Implications
Model group A is more suitable as an AIBL animal model after premenopausal breast cancer surgery. Mirco- CT combined with pathological
{"title":"Experimental study on the establishment of Aromatase inhibitor associated bone loss model after premenopausal breast cancer and the mechanism of bone loss","authors":"Meiling Chu (Primary Author), Yulian Yin (Contributing Author), Hongfeng Chen (Contributing Author)","doi":"10.1016/j.jocd.2023.101405","DOIUrl":"10.1016/j.jocd.2023.101405","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To construct a nude mouse model of aromatase inhibitor-associated bone loss (AIBL) after premenopausal breast cancer surgery, and to explore the possible mechanism of letrozole-induced bone loss.</p></div><div><h3>Rationale/Background</h3><p>At present, clinical and experimental research on AIBL mainly focuses on postmenopausal breast cancer patients, ignoring the premenopausal population of AIs combined with Ovarian Function Suppression. The mechanism of AIBL is not only the well-known sharp decline of estrogen, but also the lack of exploration of the cellular mechanism and factors related to bone metabolism. H-type blood vessels contribute to angiogenesis and bone formation in the bone microenvironment. It is a sensitive indicator for evaluating bone mass andSlit guided ligand 3 (SLIT3) is a type of angiogenic factor secreted by osteoblasts. Knocking out SLIT3 will lead to the reduction of H-type vascular endothelial cells in bone and resulting in a decrease in bone mass. Based on this, it will be helpful to establish AIBL animal model and explore the mechanism of bone loss, which will help optimize the endocrine therapy regimen.</p></div><div><h3>Methods</h3><p>The postoperative AIBL model of premenopausal breast cancer was established by inoculation and resection of breast cancer xenografts, bilateral ovariectomy and letrozole gavage. BALB/c nude mice were randomly divided into 5 groups: Control group (Control group), postoperative group (MX group), castration group (MX+OVX group), model group A (MX+OVX+Le group), model group B (OVX+Le group). The eyeball blood of mice was collected to detect the related bone metabolism and bone-related hormones by ELISA. The bone mineral density and trabecular microstructure of the femur and tibia were evaluated by mirco-CT, the bone tissue was evaluated by HE staining, the activity of osteoblasts was evaluated by OCN immunohistochemistry, and the activity of osteoclasts was evaluated by TRAP immunohistochemistry. Immunofluorescence staining of type H blood vessel (CD31hiEmcnhi) was used to explore the potential mechanism and related targets of AIBL.</p></div><div><h3>Results</h3><p>Compared with the control group, there were significant differences in serum E2, P1NP, CTX-1, GH and SLIT3 in model A and model B groups (P< 0.05). Bone mineral density was significantly reduced by mirco-CT (P< 0.05), and the decrease in model group A was more significant. In HE staining, the number of bone trabeculae in the model A group was significantly reduced. In addition, TRAP and OCN immunohistochemical staining showed that the trabeculae of model A group were surrounded by more osteoclasts and fewer osteoblasts. Compared to the control group, H-type blood vessels in model A group were smaller under immunofluorescence.</p></div><div><h3>Implications</h3><p>Model group A is more suitable as an AIBL animal model after premenopausal breast cancer surgery. Mirco- CT combined with pathological","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42515886","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}
To evaluate the incidence of patients declining osteoporotic pharmacologic treatment and to identify factors affecting patient refusal or deferment of treatment options.
Rationale/Background
Patient consumption of recent literature on the side effects of osteoporosis treatment protocols has dropped the usage of medications such as bisphosphonates by as much as half. This has posed a considerable obstacle in the proactive treatment of osteoporosis and the prevention of fractures.
Methods
Researchers studied data from 412 patients from a community-based primary care clinic who had undergone screening for osteoporosis utilizing a bone density or DEXA scan. The criteria for identifying individuals as having osteoporosis was based on International Osteoporosis Foundation criteria, which states that the threshold for qualification is a T-Score of less than or equal to -2.5 in one or more regions or the occurrence of a fragility fracture of the hip or vertebra. Of the 412 patients, 134 patients were confirmed to have had osteoporosis based on this criteria. Patient consent to treatment, side effects, reasons for refusal, and incidence of fractures were recorded for those 134 patients.
Results
Of the 412 patients screened for osteoporosis, 83.9% were female (346/412), and 16% (66/412) were male. The average age for the sample group was 68.5 (68 for females and 73 for males), which is in line with expectations given that post-menopausal women are thought to be the population that requires the screening the most. There were 134 patients who were diagnosed with osteoporosis, and the average age of a person in that group was 71 (70 for females and 81 for males). The average T-Score on a bone density scan for those individuals was -2.8. There was no preference for which region (lumbar vs. hip) was most affected within the group studied. Of the 134 patients diagnosed with osteoporosis based on bone density scan results, 67.9% (91/134) agreed to start and continue a treatment plan for osteoporosis. While 28.4% (38/134) refused treatment for osteoporosis, 97% of that group(34/38) said the reason was lack of insurance or a high deductible on their plan. Only four people out of the group that refused treatment ended up stating that they preferred natural remedies for their condition. There was no evidence based on records that any of the patients experienced any side effects due to the treatment regimen. However, there were 5 cases where patients had fractures before the start of their respective treatments. Among the patients, there was a striking preference for Prolia (denosumab) as the treatment plan, with 68.1% (62/91) electing for that exclusively, whereas only 29.7% (27/91) elected to receive Reclast (zolendronate) exclusively. Only five people (5/91) elected for oral bisphosphonates.
{"title":"Factors affecting Patient Compliance in the Treatment of Osteoporosis.","authors":"Madhu Pamganamamula M.D., BC-ADM, CDCES, CCD, CPI (Contributing Author Program Director), Srinidhi Manchiraju MBBS (Contributing Author), Harshavardhini Kommavarapu MBBS (Primary Author), Gowtham Dronavalli MPA, MBA, MBBS (Contributing Author Clinical Administrator), Tejasvi Pamg MBA (Contributing Author Practice Administrator)","doi":"10.1016/j.jocd.2023.101400","DOIUrl":"10.1016/j.jocd.2023.101400","url":null,"abstract":"<div><h3>Purpose/Aims</h3><p>To evaluate the incidence of patients declining osteoporotic pharmacologic treatment and to identify factors affecting patient refusal or deferment of treatment options.</p></div><div><h3>Rationale/Background</h3><p>Patient consumption of recent literature on the side effects of osteoporosis treatment protocols has dropped the usage of medications such as bisphosphonates by as much as half. This has posed a considerable obstacle in the proactive treatment of osteoporosis and the prevention of fractures.</p></div><div><h3>Methods</h3><p>Researchers studied data from 412 patients from a community-based primary care clinic who had undergone screening for osteoporosis utilizing a bone density or DEXA scan. The criteria for identifying individuals as having osteoporosis was based on International Osteoporosis Foundation criteria, which states that the threshold for qualification is a T-Score of less than or equal to -2.5 in one or more regions or the occurrence of a fragility fracture of the hip or vertebra. Of the 412 patients, 134 patients were confirmed to have had osteoporosis based on this criteria. Patient consent to treatment, side effects, reasons for refusal, and incidence of fractures were recorded for those 134 patients.</p></div><div><h3>Results</h3><p>Of the 412 patients screened for osteoporosis, 83.9% were female (346/412), and 16% (66/412) were male. The average age for the sample group was 68.5 (68 for females and 73 for males), which is in line with expectations given that post-menopausal women are thought to be the population that requires the screening the most. There were 134 patients who were diagnosed with osteoporosis, and the average age of a person in that group was 71 (70 for females and 81 for males). The average T-Score on a bone density scan for those individuals was -2.8. There was no preference for which region (lumbar vs. hip) was most affected within the group studied. Of the 134 patients diagnosed with osteoporosis based on bone density scan results, 67.9% (91/134) agreed to start and continue a treatment plan for osteoporosis. While 28.4% (38/134) refused treatment for osteoporosis, 97% of that group(34/38) said the reason was lack of insurance or a high deductible on their plan. Only four people out of the group that refused treatment ended up stating that they preferred natural remedies for their condition. There was no evidence based on records that any of the patients experienced any side effects due to the treatment regimen. However, there were 5 cases where patients had fractures before the start of their respective treatments. Among the patients, there was a striking preference for Prolia (denosumab) as the treatment plan, with 68.1% (62/91) electing for that exclusively, whereas only 29.7% (27/91) elected to receive Reclast (zolendronate) exclusively. Only five people (5/91) elected for oral bisphosphonates.</p></div><div><h3>Implications</h3><p>A strong patient advocacy team app","PeriodicalId":50240,"journal":{"name":"Journal of Clinical Densitometry","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43860755","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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