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Radiology Jun 2024Background Diagnosing osteoporosis is challenging due to its often asymptomatic presentation, which highlights the importance of providing screening for high-risk... (Randomized Controlled Trial)
Randomized Controlled Trial
Background Diagnosing osteoporosis is challenging due to its often asymptomatic presentation, which highlights the importance of providing screening for high-risk populations. Purpose To evaluate the effectiveness of dual-energy x-ray absorptiometry (DXA) screening in high-risk patients with osteoporosis identified by an artificial intelligence (AI) model using chest radiographs. Materials and Methods This randomized controlled trial conducted at an academic medical center included participants 40 years of age or older who had undergone chest radiography between January and December 2022 without a history of DXA examination. High-risk participants identified with the AI-enabled chest radiographs were randomly allocated to either a screening group, which was offered fully reimbursed DXA examinations between January and June 2023, or a control group, which received usual care, defined as DXA examination by a physician or patient on their own initiative without AI intervention. A logistic regression was used to test the difference in the primary outcome, new-onset osteoporosis, between the screening and control groups. Results Of the 40 658 enrolled participants, 4912 (12.1%) were identified by the AI model as high risk, with 2456 assigned to the screening group (mean age, 71.8 years ± 11.5 [SD]; 1909 female) and 2456 assigned to the control group (mean age, 72.1 years ± 11.8; 1872 female). A total of 315 of 2456 (12.8%) participants in the screening group underwent fully reimbursed DXA, and 237 of 315 (75.2%) were identified with new-onset osteoporosis. After including DXA results by means of usual care in both screening and control groups, the screening group exhibited higher rates of osteoporosis detection (272 of 2456 [11.1%] vs 27 of 2456 [1.1%]; odds ratio [OR], 11.2 [95% CI: 7.5, 16.7]; < .001) compared with the control group. The ORs of osteoporosis diagnosis were increased in screening group participants who did not meet formalized criteria for DXA compared with those who did (OR, 23.2 [95% CI: 10.2, 53.1] vs OR, 8.0 [95% CI: 5.0, 12.6]; interactive = .03). Conclusion Providing DXA screening to a high-risk group identified with AI-enabled chest radiographs can effectively diagnose more patients with osteoporosis. Clinical trial registration no. NCT05721157 © RSNA, 2024 See also the editorial by Smith and Rothenberg in this issue.
Topics: Humans; Female; Osteoporosis; Male; Radiography, Thoracic; Absorptiometry, Photon; Aged; Neural Networks, Computer; Mass Screening; Middle Aged
PubMed: 38916510
DOI: 10.1148/radiol.231937 -
PeerJ 2024Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence...
BACKGROUND
Low energy availability (LEA) causes pathophysiology of the female athlete's body affecting the bone and reproductive health and was observed to have a high prevalence in recreational female athletes previously. The aim of this study was to analyse the relationship between low energy availability in females questionnaire (LEAF-Q), bone mineral density (BMD), and postural stability in recreational athletes.
METHODS
Recreational female athletes ( = 24, age: 23.71 ± 2.94, Tier I) completed LEAF-Q, postural stability measurement during quiet stance (Zebris platform FDM; GmbH) and their BMD was measured using DXA (Hologic QDR Horizon A). Non-parametric statistical tests were used to analyse the relationships between LEAF-Q, BMD, and postural stability and to compare differences between participants divided by the LEAF-Q score and its subscales.
RESULTS
Risk of LEA was observed in 50% of recreational athletes participating in this study. Up to 46% of participants perceived menstrual bleeding changes related to training and 37.50% experienced menstrual dysfunction. Body composition and body weight fluctuations were observed to affect postural stability and BMD. With the risk score for LEA, the BMD and postural stability were not negatively affected in recreational athletes. However, the high number of recreational athletes in the risk score for LEA and menstrual dysfunctions highlights the need for public health programs aimed to increase awareness of LEA and its health consequences and for open communication about the menstrual cycle. Future longitudinal studies observing LEA, BMD, menstrual function, postural stability, and their interrelationship in female athletes are needed to increase the knowledge of this topic.
Topics: Humans; Female; Bone Density; Athletes; Young Adult; Adult; Postural Balance; Surveys and Questionnaires; Athletic Injuries; Relative Energy Deficiency in Sport; Body Composition; Absorptiometry, Photon
PubMed: 38915384
DOI: 10.7717/peerj.17533 -
Clinical & Experimental Optometry Jun 2024Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment...
CLINICAL RELEVANCE
Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment involvement of the eye in patients treated with isotretinoin.
BACKGROUND
This study aimed to evaluate lens clarity with the densitometry software of Scheimpflug tomography in patients treated with isotretinoin and to compare with healthy control subjects.
METHODS
Thirty-seven acnepatients treated with isotretinoin who met the inclusion criteria (24 males and 13 females, mean age 22.94 ± 4.21 years) and 39 healthy control subjects were included in the study. Clinical characteristics of the isotretinoin and control subjects were recorded. Lens density was evaluated with the densitometry software of the Scheimpflug tomography device (PentacamHR, Oculus, Wetzlar, Germany).
RESULTS
There was no statistically significant difference between the groups in age, gender distribution, spherical equivalent, or anterior segment parameters measured by the Pentacam system ( > 0.05 for all). Lens density values in zones 2 and 3 were significantly higher in the isotretinoin group ( = 0.042, < 0.001) and positively correlated with cumulative isotretinoin dose (zone 2: = 0.384, = 0.032; zone 3: = 0.384, = 0.005).
CONCLUSION
Zone 2 and zone 3 lens density are higher in patients treated with isotretinoin when compared to healthy controls.
PubMed: 38914426
DOI: 10.1080/08164622.2024.2371360 -
Revista Espanola de Cirugia Ortopedica... Jun 2024Osteoporosis is a highly prevalent and multifactorial disease whose main manifestation is the appearance of fragility or low-impact fractures. The most frequent...
Osteoporosis is a highly prevalent and multifactorial disease whose main manifestation is the appearance of fragility or low-impact fractures. The most frequent locations of osteoporotic fractures occur at the vertebrae, femoral, distal end of the radius and humerus. Osteoporotic vertebral fracture deserves special mention among them due to its prevalence, importance as it often goes unnoticed and medium-long term consequences are: pain, deformity, disability and deterioration in quality of life. In this review we will focus on the classification and initial evaluation of the patient with osteoporosis, estimation of risk factors, laboratory and imaging studies for an adequate assessment using simple radiography, dual densitometry and magnetic resonance imaging. We will also address the main aspects of the differential diagnosis, treatment and prevention of vertebral fragility fracture, briefly reviewing the main therapeutic agents currently used for its prevention and treatment.
PubMed: 38914200
DOI: 10.1016/j.recot.2024.06.011 -
Aging Clinical and Experimental Research Jun 2024Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the... (Review)
Review
Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).There is a growing literature demonstrating a strong correlation between DXA and REMS measures of BMD and further work supporting 5-year prediction of fracture using the REMS Fragility Score, which provides a measure of bone quality (in addition to the quantitative measure of BMD).The non-ionising radiation emitted by REMS allows it to be used in previously underserved populations including pregnant women and children and may facilitate more frequent measurement of BMD.The portability of the device means that it can be deployed to measure BMD for frail patients at the bedside (avoiding the complications in transfer and positioning which can occur with DXA), in primary care, the emergency department, low-resource settings and even at home.The current evidence base supports the technology as a useful tool in the management of osteoporosis as an alternative to DXA.
Topics: Humans; Osteoporosis; Absorptiometry, Photon; Bone Density; Lumbar Vertebrae; Femur Neck; Female; Ultrasonography
PubMed: 38904870
DOI: 10.1007/s40520-024-02784-w -
BMC Medical Imaging Jun 2024Osteoporosis (OP) is a common chronic metabolic bone disease characterized by decreased bone mineral content and microstructural damage, leading to increased fracture...
BACKGROUND
Osteoporosis (OP) is a common chronic metabolic bone disease characterized by decreased bone mineral content and microstructural damage, leading to increased fracture risk. Traditional methods for measuring bone density have limitations in accurately distinguishing vertebral bodies and are influenced by vertebral degeneration and surrounding tissues. Therefore, novel methods are needed to quantitatively assess changes in bone density and improve the accurate diagnosis of OP.
METHODS
This study aimed to explore the applicative value of the iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron (IDEAL-IQ) sequence combined with intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) for the diagnosis of osteoporosis. Data from 135 patients undergoing dual-energy X-ray absorptiometry (DXA), IDEAL-IQ, and IVIM-DWI were prospectively collected and analyzed. Various parameters obtained from IVIM-DWI and IDEAL-IQ sequences were compared, and their diagnostic efficacy was evaluated.
RESULTS
Statistically significant differences were observed among the three groups for FF, R2*, f, D, DDC values, and BMD values. FF and f values exhibited negative correlations with BMD values, with r=-0.313 and - 0.274, respectively, while R2*, D, and DDC values showed positive correlations with BMD values, with r = 0.327, 0.532, and 0.390, respectively. Among these parameters, D demonstrated the highest diagnostic efficacy for osteoporosis (AUC = 0.826), followed by FF (AUC = 0.713). D* exhibited the lowest diagnostic performance for distinguishing the osteoporosis group from the other two groups. Only D showed a significant difference between genders. The AUCs for IDEAL-IQ, IVIM-DWI, and their combination were 0.74, 0.89, and 0.90, respectively.
CONCLUSIONS
IDEAL-IQ combined with IVIM-DWI provides valuable information for the diagnosis of osteoporosis and offers evidence for clinical decisions. The superior diagnostic performance of IVIM-DWI, particularly the D value, suggests its potential as a more sensitive and accurate method for diagnosing osteoporosis compared to IDEAL-IQ. These findings underscore the importance of integrating advanced imaging techniques into clinical practice for improved osteoporosis management and highlight the need for further research to explore the full clinical implications of these imaging modalities.
Topics: Humans; Female; Osteoporosis; Male; Diffusion Magnetic Resonance Imaging; Middle Aged; Aged; Bone Density; Absorptiometry, Photon; Prospective Studies; Least-Squares Analysis; Adult; Aged, 80 and over
PubMed: 38902641
DOI: 10.1186/s12880-024-01326-0 -
Annals of Biomedical Engineering Jun 2024In order to improve the ability of clinical diagnosis to differentiate articular cartilage (AC) injury of different origins, this study explores the sensitivity of...
In order to improve the ability of clinical diagnosis to differentiate articular cartilage (AC) injury of different origins, this study explores the sensitivity of mid-infrared (MIR) spectroscopy for detecting structural, compositional, and functional changes in AC resulting from two injury types. Three grooves (two in parallel in the palmar-dorsal direction and one in the mediolateral direction) were made via arthrotomy in the AC of the radial facet of the third carpal bone (middle carpal joint) and of the intermediate carpal bone (the radiocarpal joint) of nine healthy adult female Shetland ponies (age = 6.8 ± 2.6 years; range 4-13 years) using blunt and sharp tools. The defects were randomly assigned to each of the two joints. Ponies underwent a 3-week box rest followed by 8 weeks of treadmill training and 26 weeks of free pasture exercise before being euthanized for osteochondral sample collection. The osteochondral samples underwent biomechanical indentation testing, followed by MIR spectroscopic assessment. Digital densitometry was conducted afterward to estimate the tissue's proteoglycan (PG) content. Subsequently, machine learning models were developed to classify the samples to estimate their biomechanical properties and PG content based on the MIR spectra according to injury type. Results show that MIR is able to discriminate healthy from injured AC (91%) and between injury types (88%). The method can also estimate AC properties with relatively low error (thickness = 12.7% mm, equilibrium modulus = 10.7% MPa, instantaneous modulus = 11.8% MPa). These findings demonstrate the potential of MIR spectroscopy as a tool for assessment of AC integrity changes that result from injury.
PubMed: 38902468
DOI: 10.1007/s10439-024-03540-x -
The British Journal of General Practice... Jun 2024Prostate Cancer (PCa) is the commonest cancer in the UK. Androgen deprivation therapy (ADT) is a mainstay of treatment. It increases fragility fractures causing a huge... (Observational Study)
Observational Study
BACKGROUND
Prostate Cancer (PCa) is the commonest cancer in the UK. Androgen deprivation therapy (ADT) is a mainstay of treatment. It increases fragility fractures causing a huge burden to patients and the NHS. As men live longer with PCa, many require prolonged ADT. Reducing fracture risks and improving cancer survivorship is becoming increasingly important. Primary care plays an important role.
AIM
To evaluate how fracture risk of PCa patients taking ADT (PCa-ADT) was assessed and managed in primary care.
METHOD
A retrospective multi-practice database study. PCa patients were identified using SNOMED codes from five sociodemographically diverse practices (registered population 49 400). Data were extracted by hand-searching records, including hospital letters, and included: demographics; a 10-year fragility fracture score (FRAX); NOGG intervention threshold; DEXA requests; and use of bisphosphonates.
RESULTS
Of the 261 PCa patients identified, 6% were Black African/Caribbean and 89% White British. Half had been prescribed ADT, 28% being current users. No fracture risk assessment was documented for any patients. ADT current users had significantly increased FRAX scores for both major osteoporotic fractures (MOF) (9.61%±1.12%) and hip fracture (HF) (5.30%±1.02%) compared with PCa patients without ADT (7.08%±0.57% [MOF] and 3.06%±0.46% [HF], <0.001). For ADT current users, 39% showed intermediate fracture risk (NOGG amber), warranting a DEXA scan, with only 30% performed. Patients in more affluent areas received more DEXA scans and bisphosphonate treatment.
CONCLUSION
Osteoporosis is underdiagnosed and undertreated in men with PCa-ADT, especially in those with deprived backgrounds. There is an unmet need to manage the fracture prevention in this population.
Topics: Humans; Male; Prostatic Neoplasms; Androgen Antagonists; Retrospective Studies; Aged; Risk Assessment; Osteoporotic Fractures; Primary Health Care; Bone Density Conservation Agents; United Kingdom; Middle Aged; Diphosphonates; Databases, Factual; Absorptiometry, Photon; Osteoporosis; Aged, 80 and over; Risk Factors
PubMed: 38902070
DOI: 10.3399/bjgp24X737637 -
Cadernos de Saude Publica 2024We aimed to verify the prevalence of body composition phenotypes and the association of glycemic, lipidic, and inflammatory biomarkers with such phenotypes. This is a...
We aimed to verify the prevalence of body composition phenotypes and the association of glycemic, lipidic, and inflammatory biomarkers with such phenotypes. This is a cross-sectional, population-based study, with 720 participants aged 20 to 59 years. Body composition was assessed by dual-energy X-ray absorptiometry. Obesity was defined as body fat percentage ≥ 25% in males and ≥ 32% in females and sarcopenia by appendicular muscle mass index < 7.0kg/m2 in males and < 5.5kg/m2 in females. Sarcopenic obesity (SO) was defined as the presence of both sarcopenia and obesity. The prevalence of obesity, sarcopenia, and SO were 62.5%, 4.5%, and 6.2%, respectively. The association between biomarkers and phenotypes was verified using multinomial logistic regression models adjusted for confounding factors. The models showed that increased glycemia (OR = 3.39; 95%CI: 1.83-6.27), total cholesterol (TC) (OR = 2.24; 95%CI: 1.35-3.70), LDL-c (OR = 1.01; 95%CI: 1.00-1.02), VLDL-c (OR = 1.04; 95%CI: 1.02-1.06), non-HDL-c (OR = 1.02; 95%CI: 1.01-1.03), triglycerides (Tg) (OR = 3.66; 95%CI: 2.20-6.06), and decreased HDL-c (OR = 0.97; 95%CI: 0.95-0.98) were significantly associated with the obesity phenotype. Increased HOMA-IR (OR = 3.94; 95%CI: 1.69-9.21), LDL-c (OR = 1.01; 95%CI: 1.00-1.02), non-HDL-c (OR = 1.01; 95%CI: 1.00-1.02), and hs-CRP (OR = 2.42; 95%CI: 1.04-5.66) were independently associated with SO phenotype. Our findings indicate that increased glycemia, TC, Tg, LDL-c, VLDL-c, non-HDL-c, and decreased HDL-c may be indicators of the obesity phenotype and that increased hs-CRP, HOMA-IR, LDL-c, and non-HDL-c appear to be indicators of the SO phenotype. Those parameters may be used as additional markers for screening.
Topics: Humans; Male; Female; Adult; Middle Aged; Cross-Sectional Studies; Biomarkers; Phenotype; Obesity; Prevalence; Body Composition; Young Adult; Blood Glucose; Lipids; Absorptiometry, Photon; Sarcopenia; Brazil; Body Mass Index; Inflammation
PubMed: 38896593
DOI: 10.1590/0102-311XEN109823 -
Arquivos de Gastroenterologia 2024Low bone mass density (BMD) is an extraintestinal finding in celiac disease (CD). This may result in bone fractures leading to loss in quality of life.
BACKGROUND
Low bone mass density (BMD) is an extraintestinal finding in celiac disease (CD). This may result in bone fractures leading to loss in quality of life.
OBJECTIVE
To assess BMD in male CD patients at diagnosis according to the patient's age.
METHODS
Descriptive retrospective carried out during the period between 2013 and 2023 in a single office that studied dual-energy X-ray absorptiometry (DXA) results in 28 male patients with a recent diagnosis of CD, divided into three groups: group 1 (age up to 18 years); group 2 (from 19 to 49 years of age) and group 3 (over 50 years of age). Were studied demographic and anthropometric parameters, time delay between symptoms onset and CD diagnosis and fracture occurrence.
RESULTS
Celiac patients studied had median age 36.0 years (IQR=16.5-50.7). Among them, 39.3% had osteopenia and 14.3% had osteoporosis. Only 36% of the sample had normal DXA values (group 1 with 37.5%; group 2 with 46% and group 3 with 14.2%). No pathological fracture was observed in this sample. CD diagnosis delay observed had median 1.0 year (IQR=1.0-4.7). When the number of individuals with normal and abnormal DXA results were compared, there was no difference in body mass index, time of diagnosis delay or Marsh classification (P=0.18).
CONCLUSION
Male patients at the time of CD diagnosis showed a high prevalence of low BMD, which was particularly evident in individuals over 50 years of age.
Topics: Humans; Male; Celiac Disease; Adult; Middle Aged; Retrospective Studies; Absorptiometry, Photon; Bone Density; Osteoporosis; Young Adult; Adolescent; Bone Diseases, Metabolic; Brazil; Age Factors; Aged
PubMed: 38896576
DOI: 10.1590/S0004-2803.24612024-005