Application of a Magnetic Resonance Imaging-Based Lumbar Vertebral Bone Quality Scoring System in Patients with Degenerative Lumbar Scoliosis.

BACKGROUND: Although dual-energy X-ray absorptiometry is still the gold standard for diagnosing osteoporosis, it can lead to inaccurate bone mineral density measurements due to lumbar degeneration and scoliosis. Many researchers have investigated diagnostic methods for osteoporosis in patients with degenerative lumbar scoliosis (DLS). This study aimed to investigate the differences between conventional vertebral bone quality (VBQ) scores and modified VBQ scores in patients with DLS and the influence of lumbar scoliosis on VBQ scores. METHODS: We retrospectively collected the clinical and radiological data of 68 patients with DLS admitted to Sun Yat-sen Memorial Hospital from July 2018 to April 2023. The patients were classified into one of 2 groups based on the T score of the left femoral neck. VBQ scores relative to cerebrospinal fluid at different levels, VBQ scores on different planes and single-level VBQ scores were compared. Receiver operating characteristic analysis was also performed. Different modified VBQ scores were compared between the moderate scoliosis group (10°

Analyzing the factors associated with efficacy among teriparatide treatment in postmenopausal women with osteoporosis.

BACKGROUND: Teriparatide (TPTD) is a widely used anabolic agent for the treatment of osteoporosis. Several factors have been identified to be related to bone mineral density (BMD) increase in anti-osteoporosis treatment with other agents; however, there has been no systematic analysis to summarize the associated determinants of BMD reaction to daily teriparatide treatment. METHODS: In this retrospective study, we performed a comprehensive investigation involving not only clinical data but also several relevant lifestyle factors to be examined for their potential contribution to BMD response. This post-hoc analysis included 258 post-menopaused patients with osteoporosis who received TPTD at 20 µg/day for 12 months. Univariate and multivariate analyses were conducted to distinguish the response variables of lumbar spine (LS) BMD transformation, the principal outcome measure of efficacy, from the baseline at 12 months. RESULTS: Twelve months of TPTD treatment resulted in an absolute 0.39 ± 0.37 increase in T-score of LS BMD. Gastrointestinal disease, prior bisphosphonate or glucocorticoid treatment, no vitamin K2 supplementation, low levels of serum 25(OH)D and PINP, weak increment of PINP and ß-CTX at 3 months, unhealthy lifestyle (excessive smoking, tea, coffee, and drinking), vegetarian diet pattern, low ALT level, and high BMD at baseline were determined by univariate analyses to be related to the weak reaction of TPTD treatment (P < 0.10). In the multiple regression model, postmenopausal women with vitamin K2 supplementation, higher baseline serum 25(OH)D level, and higher PINP concentration at 3 months indicated a good reaction of LS BMD at 12 months (P < 0.05). Patients with gastrointestinal disease, prior bisphosphonate and glucocorticoid treatment, vegetarian diet pattern, and higher baseline BMD were significantly more likely to have a lower absolute LS BMD response compared to patients without these characteristics (P < 0.05). Further analysis confirmed the negative effect of unhealthy lifestyle on TPTD treatment. CONCLUSION: Our results emphasize the significance of a comprehensive assessment of clinical or lifestyle-related characteristics of postmenopausal women with osteoporosis in the management of TPTD therapy in routine care.

Diagnostic Value of Quantitative Ultrasound for Osteoporosis in Elderly Women: A Meta-Analysis.

Objective: To assess the reliability of quantitative ultrasound (QUS) in diagnosing and screening osteoporosis in elder women. Methods: We conducted a systematic search of the online databases, including PubMed, Embase, Web of Science, and China National Knowledge, and screened the studies according to the inclusion criteria. We directly extract or calculate the value of true positive (TP), false positive (FP), false negative (FN), and true negative (TN) from eligible studies. We sought to evaluate the diagnostic parameters of QUS, containing the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC). Results: Twelve studies were included in this study with a total of 2260 women. QUS showed a pooled diagnostic odds ratio of 5.07 (95% CI 3.28-7.84), sensitivity of 0.69 (95% CI 0.65-0.72), specificity of 0.67 (95% CI 0.64-0.69), and an AUC of 0.7523 (Q*=0.6953). There was no obvious heterogeneity and threshold effect according to the Spearman correlation coefficient (P = 0.059). No significant publication bias was found through the Deek's funnel. Conclusion: Our study suggested that the diagnostic value of QUS for osteoporosis in elder women was acceptable, but the accuracy still needed to be improved, QUS can be recommended as a pre-screening tool for osteoporosis to determine whether DXA measurement was needed.

Follow-up Bone Mineral Density Testing: 2023 Official Positions of the International Society for Clinical Densitometry.

Dual-energy X-ray absorptiometry (DXA) is the gold standard method for measuring bone mineral density (BMD) which is most strongly associated with fracture risk. BMD is therefore the basis for the World Health Organization's densitometric definition of osteoporosis. The International Society for Clinical Densitometry (ISCD) promotes best densitometry practices and its official positions reflect critical review of current evidence by domain experts. This document reports new official positions regarding follow-up DXA examinations based on a systematic review of literature published through December 2022. Adoption of official positions requires consensus agreement from an expert panel following a modified RAND protocol. Unless explicitly altered by the new position statements, prior ISCD official positions remain in force. This update reflects increased consideration of the clinical context prompting repeat examination. Follow-up DXA should be performed with pre-defined objectives when the results would have an impact on patient management. Testing intervals should be individualized according to the patient's age, sex, fracture risk and treatment history. Incident fractures and therapeutic approach are key considerations. Appropriately ordered and interpreted follow-up DXA examinations support diagnostic and therapeutic decision making, thereby contributing to excellent clinical care. Future research should address the complementary roles of clinical findings, imaging and laboratory testing to guide management.

Quantitative 31P magnetic resonance imaging on pathologic rat bones by ZTE at 7T.

BACKGROUND: Osteoporosis is characterized by low bone mineral density (BMD), which predisposes individuals to frequent fragility fractures. Quantitative BMD measurements can potentially help distinguish bone pathologies and allow clinicians to provide disease-relieving therapies. Our group has developed non-invasive and non-ionizing magnetic resonance imaging (MRI) techniques to measure bone mineral density quantitatively. Dual-energy X-ray Absorptiometry (DXA) is a clinically approved non-invasive modality to diagnose osteoporosis but has associated disadvantages and limitations. PURPOSE: Evaluate the clinical feasibility of phosphorus (31P) MRI as a non-invasive and non-ionizing medical diagnostic tool to compute bone mineral density to help differentiate between different metabolic bone diseases. MATERIALS AND METHODS: Fifteen ex-vivo rat bones in three groups [control, ovariectomized (osteoporosis), and vitamin-D deficient (osteomalacia - hypo-mineralized) were scanned to compute BMD. A double-tuned (1H/31P) transmit-receive single RF coil was custom-designed and in-house-built with a better filling factor and strong radiofrequency (B1) field to acquire solid-state 31P MR images from rat femurs with an optimum signal-to-noise ratio (SNR). Micro-computed tomography (µCT) and gold-standard gravimetric analyses were performed to compare and validate MRI-derived bone mineral densities. RESULTS: Three-dimensional 31P MR images of rat bones were obtained with a zero-echo-time (ZTE) sequence with 468 µm spatial resolution and 12-17 SNR on a Bruker 7 T Biospec having multinuclear capability. BMD was measured quantitatively on cortical and trabecular bones with a known standard reference. A strong positive correlation (R = 0.99) and a slope close to 1 in phantom measurements indicate that the densities measured by 31P ZTE MRI are close to the physical densities in computing quantitative BMD. The 31P NMR properties (resonance linewidth of 4 kHz and T1 of 67 s) of ex-vivo rat bones were measured, and 31P ZTE imaging parameters were optimized. The BMD results obtained from MRI are in good agreement with µCT and gravimetry results. CONCLUSION: Quantitative measurements of BMD on ex-vivo rat femurs were successfully conducted on a 7 T preclinical scanner. This study suggests that quantitative measurements of BMD are feasible on humans in clinical MRI with suitable hardware, RF coils, and pulse sequences with optimized parameters within an acceptable scan time since human femurs are approximately ten times larger than rat femurs. As MRI provides quantitative in-vivo data, various systemic musculoskeletal conditions can be diagnosed potentially in humans.

Quantitative analysis of vertebral fat fraction and R2* in osteoporosis using IDEAL-IQ sequence.

OBJECTIVE: To investigate the correlation between FF, R2* value of IDEAL-IQ sequence and bone mineral density, and to explore their application value in the osteoporosis. METHODS: We recruited 105 women and 69 men aged over 30 years who voluntarily underwent DXA and MRI examination of lumbar spine at the same day. Participants were divided into normal, osteopenia and osteoporosis group based on T-score and BMD value of DXA examination. One-way ANOVA was adopted to compare the quantitative parameters among the three groups. Independent samples t-test was utilized to compare FF and R2* value between men and women.Pearson correlation analysis was used to research the correlation between FF, R2* value and BMD. RESULTS: Age, height, weight, BMD and FF value were significantly different among three groups (p < 0.05). No significant difference was found in FF value between male and female group, while R2* value were significantly different. Vertebral FF was moderately negatively correlated with aBMD, especially in women (r = -0.638, p < 0.001). R2* was mildly to moderately positively correlated with aBMD in men (r = 0.350, p = 0.003), but not in women. Moreover, FF was positively correlated with age, R2* was negatively correlated with age in men, and BMD was negatively correlated with age. CONCLUSIONS: The vertebral FF value of IDEAL-IQ sequence has the potential to be a new biological marker for the assessment of osteoporosis. Vertebral FF is moderately negatively correlated with aBMD, especially in women, allowing accuratly quantify the bone marrow fat. R2* value is mildly to moderately correlated with BMD in men and can be served as a complementary tool in the assessment of osteoporosis.

Hounsfield units on abdominal computed tomography: a new tool for predicting osteoporosis.

BACKGROUND: Osteoporosis can cause bone fractures and disability, but early diagnosis faces challenges. Our proposed diagnostic indicators offer a new approach for early detection, which benefits early identification. PURPOSE: To determine the most appropriate threshold for predicting osteoporosis in patients with each section of vertebral body. MATERIAL AND METHODS: A retrospective analysis of 210 patients, including 646 vertebrae, who had both abdominal computed tomography (CT) and dual-energy X-ray absorptiometry (DXA) within six months. The correlation between DXA T-score and CT Hounsfield units (HU) values was tested by Pearson. The area under the curve (AUC) was calculated using the threshold obtained from the regression equation. RESULTS: The thresholds matching the T-score of -2.5 were 85, 95, 85, and 90 HU for the upper axial plane of the vertebral body (Lau), the middle axial plane of the vertebral body (Lam), the lower axial plane of the vertebral body (Lad), and the mid-sagittal plane of the vertebral body (Lsm), respectively. Defining osteoporosis using CT as Lau ≤ 85, Lam ≤ 95, Lad ≤ 85, or Lsm ≤ 90 HU had a specificity of 88.1% (116/134) and sensitivity of 90.8% (69/76) for distinguishing DXA osteoporosis of the lumbar spine in 210 patients. T-score ≤-2.5 defined as Lau ≤85 or Lam ≤95 or Lad ≤85 or Lsm ≤90 HU had a specificity of 85.9% (275/320) and sensitivity of 82.8% (270/326) for DXA T-score ≤-2.5 in 646 lumbar vertebrae. CONCLUSION: CT HU values obtained based on different sections of the vertebral body in abdominal CT can be used as a supplementary measure to assess osteoporosis.

Metabolomics analysis of the potential mechanism of Yi-Guan-Jian decoction to reverse bone loss in glucocorticoid-induced osteoporosis.

BACKGROUND: Glucocorticoid-induced osteoporosis (GIOP) is a disease in which long-term use of glucocorticoid causes bone loss, deterioration of bone microstructure and fracture. Currently, clinical drugs targeting this disease have certain side effects. There is still a need to find effective drugs with fewer side effects. The theory of traditional Chinese medicine suggests that YGJ has therapeutic effect on GIOP, but it has not been explained. Therefore, this study aims to explore the protective effect of YGJ on GIOP mouse models and elucidate the underlying mechanism through LC-MS-based metabolomics analysis. METHODS: The general condition of 8 week age male C57BL/6J mice was recorded after 8 weeks of treatment with dexamethasone (DEX) and YGJ. Bone-related parameters and bone morphology were determined by Micro-CT. HE staining was used to observe the pathological changes of bone tissue. Serum levels of bone metabolism markers were detected by ELISA. Liver metabolomics analysis was conducted to search for the significant markers of anti-GIOP of YGJ and the metabolic pathway affecting it. RESULTS: After treatment, YGJ significantly reversed the weight loss caused by DEX; increase the number of bone trabecular in ROI region, significantly improve the bone-related parameters of GIOP mice, and increase the levels of alkaline phosphatase and osteocalcin. In the study of metabolic mechanism, YGJ reversed 24 potential markers in GIOP mice. These included cortisol, 3-hydroxybutyric acid, taurine, esculin and uric acid, which are closely associated with osteoporosis. Topological analysis results showed that YGJ had the most significant effect on taurine and hypotaurine metabolism, with - log10 (P) > 2.0 and Impact > 0.4. CONCLUSIONS: Yi-Guan-Jian decoction can increase bone density and improve bone microstructure by regulating the levels of alkaline phosphatase and osteocalcin and reverse bone loss in GIOP mouse model. The underlying metabolic mechanism may be related to taurine and hypotaurine metabolic pathway.

Psoralen prevents the inactivation of estradiol and treats osteoporosis via covalently targeting HSD17B2.

ETHNOPHARMACOLOGICAL RELEVANCE: Psoralea corylifolia L. seeds (P. corylifolia), popularly known as Buguzhi in traditional Chinese medicine, are often used to treat osteoporosis in China. Psoralen (Pso) is the key anti-osteoporosis constituent in P. corylifolia, however, its targets and mechanism of action are still unclear. AIM OF THE STUDY: The purpose of this study was to explore the interaction between Pso and 17-ß hydroxysteroid dehydrogenase type 2 (HSD17B2), an estrogen synthesis-related protein that inhibits the inactivation of estradiol (E2) to treat osteoporosis. MATERIALS AND METHODS: Tissue distribution of Pso was analyzed by in-gel imaging after oral administration of an alkynyl-modified Pso probe (aPso) in mice. The target of Pso in the liver was identified and analyzed using chemical proteomics. Co-localization and cellular thermal shift assays (CETSA) were used to verify the key action targets. To detect the key pharmacophore of Pso, the interaction of Pso and its structural analogs with HSD17B2 was investigated by CETSA, HSD17B2 activity assay, and in-gel imaging determination. Target competitive test, virtual docking, mutated HSD17B2 activity, and CETSA assay were used to identify the binding site of Pso with HSD17B2. A mouse model of osteoporosis was established by ovariectomies, and the efficacy of Pso in vivo was confirmed by micro-CT, H&E staining, HSD17B2 activity, and bone-related biochemical assays. RESULTS: Pso regulated estrogen metabolism by targeting HSD17B2 in the liver, with the α, ß-unsaturated ester in Pso being the key pharmacophore. Pso significantly suppressed HSD17B2 activity by irreversibly binding to Lys236 of HSD17B2 and preventing NAD+ from entering the binding pocket. In vivo studies in ovariectomized mice revealed that Pso could inhibit HSD17B2 activity, prevent the inactivation of E2, increase levels of endogenous estrogen, improve bone metabolism-related indices, and play a role in anti-osteoporosis. CONCLUSIONS: Pso covalently binds to Lys236 of HSD17B2 in hepatocytes to prevent the inactivation of E2, thereby aiding in the treatment of osteoporosis.

Prevalence of osteoporosis in older male veterans receiving hip-containing computed tomography scans: opportunistic use of biomechanical computed tomography analysis (BCT).

Osteoporosis care in men is suboptimal due to low rates of testing and treatment. Applying biomechanical computed tomography (BCT) analysis to existing CT scans, we found a high proportion of men with osteoporosis have never been diagnosed or treated. BCT may improve identification of patients at high risk of fracture. PURPOSE: Osteoporosis care in men is suboptimal due to low rates of DXA testing and treatment. Biomechanical computed tomography analysis (BCT) can be applied "opportunistically" to prior hip-containing CT scans to measure femoral bone strength and hip BMD. METHODS: In this retrospective, cross-sectional study, we used BCT in male veterans with existing CT scans to investigate the prevalence of osteoporosis, defined by hip BMD (T-score ≤ - 2.5) or fragile bone strength (≤ 3500 N). 577 men, age ≥ 65 with abdominal/pelvic CTs performed in 2017-2019, were randomly selected for BCT analysis. Clinical data were collected via electronic health records and used with the femoral neck BMD T-score from BCT to estimate 10-year hip fracture risks by FRAX. RESULTS: Prevalence of osteoporosis by BCT increased with age (13.5% age 65-74; 18.2% age 75-84; 34.3% age ≥ 85), with an estimated overall prevalence of 18.3% for men age ≥ 65. In those with osteoporosis (n = 108/577), only 38.0% (41/108) had a prior DXA and 18.6% (7/108) had received osteoporosis pharmacotherapy. Elevated hip fracture risk by FRAX (≥ 3%) did not fully capture those with fragile bone strength. In a multivariate logistic regression model adjusted for age, BMI, race, and CT location, end stage renal disease (odds ratio 7.4; 95% confidence interval 2.3-23.9), COPD (2.2; 1.2-4.0), and high-dose inhaled corticosteroid use (3.7; 1.2-11.8) were associated with increased odds of having osteoporosis by BCT. CONCLUSION: Opportunistic BCT in male veterans provides an additional avenue to identify patients who are at high risk of fractures.

Trabecular bone score in the hip: a new method to examine hip bone microarchitecture-a feasibility study.

Our study found, in older adults who are residents of long-term care facilities, assessing hip microarchitecture with DXA-derived bone texture score may serve as a supplement to bone mineral density to improve fracture prediction and to facilitate decision-making for pharmacological management. PURPOSE: Many patients with high fragility fracture risk do not have a sufficiently low bone mineral density (BMD) to become eligible for osteoporosis treatment. They often have deteriorated bone microarchitecture despite a normal or only mildly abnormal BMD. We sought to examine the beta version of the trabecular bone score (TBS) algorithm for the hip: TBS Hip, an indirect index of bone microarchitecture, and assess if TBS Hip brings complementary information to other bone quality indices such as BMD and bone turnover markers (BTMs) to further improve identifying individuals who are at high risk for fractures. METHODS: In this analysis, we considered baseline TBS Hip at total hip, femoral neck, and greater trochanter, TBS at lumbar spine, BMD at all of these skeletal sites, and BTMs in 132 postmenopausal women who were residents of long-term care (LTC) facilities enrolled in a randomized placebo-controlled osteoporosis clinical trial. RESULTS: On average, participants were 85.2 years old and had a BMI of 26.9 kg/m2. The correlation coefficient between BMD and TBS Hip at total hip, femoral neck, and greater trochanter was 0.50, 0.32, and 0.39 respectively (all p < 0.0001). The correlation coefficient between BMD and lumbar spine TBS was 0.52 (p < 0.0001). There was no statistically significant correlation between BTMs with TBS at lumbar spine or TBS Hip at total hip, femoral neck, and greater trochanter. CONCLUSION: Among older women residing in LTC facilities, there was a moderate correlation between measures of BMD and TBS Hip at total hip, femoral neck, and greater trochanter, suggesting TBS Hip may provide complementary information to BMD .

Behavior during aging of bone-marrow fatty-acids profile in women's calcaneus to search for early potential osteoporotic biomarkers: a 1H-MR Spectroscopy study.

AIM: Identify new potential biomarkers of osteoporosis at an early stage, by magnetic resonance spectroscopy (MRS), studying early changes in the metabolic profile of bone-marrow fatty acids in women's calcanei during healthy aging and osteoporosis status. METHODS: Single voxel MRS was performed by using a point resolved spectroscopy (PRESS) sequence at 3T. Thirty-four Caucasian women (age range: 22-59 years) were recruited to investigate calcaneus bone marrow. The cohort was constituted of four groups according to age, menopausal status, and T-score evaluated after a DXA examination on the femoral neck. Women were classified in young control (n = 11, mean age = 26.5 ± 3.8 y, age range: 22-34 years), perimenopausal groups (n = 11, mean age = 42.0 ± 3.6 y, age range: 37-47 years), postmenopausal group (n = 9, mean age = 55.4 ± 2.9 y, age range: 50-59 years, mean T-score = -1.70 ± 0.50) and osteoporotic group (n = 6, mean age = 53.0 ± 2.8 y, age range: 50-58 years, mean T-score = -2.54 ± 0.10). The total lipid content (TL), the Unsaturation Index (UI), and the fraction of unsaturated/polyunsaturated fatty acid (fUFA and fPUFA) were calculated. RESULTS: TL was significantly correlated with age (r = 0.73, p < 0.001). TL increases linearly with age in the young + perimenopausal population (r = 0.92, p < 0.001) but this trend is not significant in the postmenopausal subject (r = 0.48, p = 0.07). No significant correlation was found between T-Score and TL in postmenopausal and osteoporotic women, whereas a significant correlation was found between TL and time interval (tp) between the age at menopause and the age of the subject at the MRS examination. Conversely, no correlation was found between T-score and tp. The unsaturation index (UI) does not significantly discriminate between osteoporotic, peri- and postmenopausal women. On the other hand, fUFA is significantly different in peri-menopausal and osteoporotic subjects (p = 0.02), while fPUFA is significantly different both between peri- and postmenopausal women (p = 0.05) and postmenopausal and osteoporotic subjects (p = 0.03). Both fUFA and fPUFA did not correlate with subjects' age. CONCLUSION: In the female calcaneus, fUFA and fPUFA are promising measurable quantities for the characterization of bone marrow's composition potentially correlated with the development of osteoporosis, whereas UI does not differentiate between subjects of varying osteoporotic status. The fact that the TL in the calcaneus is correlated with tp, indicates that active metabolic changes are still occurring in these subjects, giving complementary information to the DXA about the changes in bone marrow's composition which may affect the whole bone health.

Trends in osteoporosis diagnosis and management in Australia.

Trends in bone mineral density monitoring, and drug treatment for osteoporosis, in Australia were examined. Rates of DEXA scanning have increased in response to changes to government policy affecting reimbursement. The drug denosumab is being utilised at an increasing rate, while bisphosphonate use has declined. Osteoporosis prevalence remained stable over the same timeframe, while rate of hip fractures declined, suggesting that introduction of osteoporosis screening was associated with a reduction in adverse osteoporosis outcomes, but may also have been associated with overutilisation. INTRODUCTION: Radiology interventions to diagnose and medications to manage osteoporosis in Australia are reimbursed under the Medicare benefits schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Monitoring of these databases enables changes in utilisation of these practices to be monitored over time. METHODS: This study examined rates of utilisation for bone mineral density (BMD) measurement and osteoporosis pharmacotherapy subsidised under the MBS. Rates of osteoporosis and hip fracture were estimated using data reported by the Australian Bureau of Statistics (ABS) and Australian Institute for Health and Welfare (AIHW). RESULTS: Rates of BMD measurement increased since the technology was first reimbursed, with changes to policy regarding reimbursement for screening for individuals over 70 leading to an increase in BMD measurement after 2007. Prescribing rates also increased over time, initially with the introduction of oral bisphosphonates and subsequently for denosumab, which has subsequently become the most commonly prescribed agent for osteoporosis management in Australia, while bisphosphonate use has declined. Osteoporosis prevalence in Australia has remained relatively static at 3-4% of the population since 2001 to 2017, while rates of minimal trauma hip fracture hospitalisations have declined from 195 per 100,000 to 174 per 100,000 in the same timeframe. CONCLUSION: Available data indicates that osteoporosis screening rates changed over time from 2001 to 2018 and that changes to government policy had a significant effect on the rates at which screening was performed. Over the same timeframe, there was a sustained reduction in hip fracture hospitalisation rates, with no change to reported osteoporosis prevalence. This suggests that policy changes permitting unlimited access to BMD measurement were associated with a reduction in osteoporotic fractures, but may also have been associated with overutilisation. Prospective studies to assess the efficacy of specific policies to ensure screening is performed in accordance with best-practice guidelines may be desirable.

Osteoporosis Imaging.

Osteoporosis is the most common disease affecting bones worldwide. Dual x-ray absorptiometry (DXA) is the current reference standard for assessing bone health and, combined with other clinical parameters, provides a good estimation of fracture risk. DXA-based Trabecular Bone Score (TBS) can provide complementary indirect information about bone microarchitecture, which also deteriorates osteoporosis. QCT can provide a 3-D volumetric assessment of bone mineral density (BMD), and FEA of computed tomography (CT) images of bone can provide estimates of bone strength, which have the potential to add value, beyond BMD, for fracture risk assessment. Magnetic resonance imaging (MRI) of bone microarchitecture is an additional promising alternative to the assessment of BMD, and there is evidence that microarchitectural parameters could 1 day have benefits for diagnosing osteoporosis beyond BMD and/or FRAX. Assessment of bone via MRI also provides insight into other bone tissue properties (cortical porosity, marrow fat) that are altered in osteoporosis and that DXA cannot assess. Overall, bone health cannot be characterized solely by one parameter. Current imaging techniques/modalities in combination with advanced image processing hold the potential to provide a comprehensive understanding of the pathologic changes that occur in bone tissue in the setting of osteoporosis and pave the way for new imaging methods to diagnose, monitor, and predict osteoporosis.

Bone quality in patients with osteoporosis undergoing lumbar fusion surgery: analysis of the MRI-based vertebral bone quality score and the bone microstructure derived from microcomputed tomography.

BACKGROUND CONTEXT: Osteoporosis is a risk factor for instrumentation failure in spine surgery. Bone strength is commonly assessed by bone mineral density (BMD) as a surrogate marker. However, BMD represents only a portion of bone strength and does not capture the qualitative dimensions of bone. Recently, the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score was introduced as a novel marker of bone quality. However, it is still unclear if the VBQ score correlates with in-vivo bone microstructure. PURPOSE: The aims of the study were (1) to demonstrate differences in MRI-based (VBQ) and in-vivo (microcomputed tomography; µCT) bone quality between osteopenic/osteoporotic and normal bone, (2) to show the correlation between VBQ, bone microstructure and volumetric BMD (vBMD), and (3) to determine the predictive value of the VBQ score for the prevalence of osteopenia/osteoporosis. STUDY DESIGN/SETTING: Retrospective cross-sectional study. PATIENT SAMPLE: 267 patients who underwent posterior lumbar fusion surgery from 2014 to 2021 at a single academic institution. Bone biopsies were harvested intraoperatively in 118 patients. OUTCOME MEASURES: VBMD, VBQ score, and bone microstructure parameters derived from µCT. METHODS: Quantitative computed tomography (QCT) measurements were performed at the lumbar spine and the L1/L2 average was used to categorize patients with a vBMD ≤120mg/cm3 as osteopenic/osteoporotic. The VBQ score was determined by dividing the median signal intensity of the L1-L4 vertebrae by the signal intensity of the cerebrospinal fluid using sagittal T1-weighted MRI scans. Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with µCT. VBQ scores and µCT parameters were compared between the normal and the osteopenic/osteoporotic group. Correlations between VBQ score, µCT parameters and vBMD were assessed with Spearman's correlation (ρ). Receiver operating characteristic (ROC) analysis was performed to determine the VBQ score as a predictor for osteopenia/osteoporosis. Multiple linear regression analysis with vBMD L1/L2 as outcome was used to identify independent predictors from VBQ, µCT parameters and demographics. RESULTS: 267 patients (55.8% female, age 63.3 years, BMI 29.7 kg/m2; n=118 with bone biopsy) with a prevalence of osteopenia/osteoporosis of 65.2% were analyzed. In the osteopenic/osteoporotic group the VBQ score, structured model index (SMI), and trabecular separation (Tb.Sp) were significantly higher, whereas bone volume fraction (BV/TV), connectivity density (Conn.D) and trabecular number (Tb.N) were significantly lower. There were significant correlations between VBQ and µCT parameters ranging from ρ=-.387 to ρ=0.314 as well as between vBMD and µCT parameters ranging from ρ=-.425 to ρ=.421, and vBMD and VBQ (ρ=-.300, p<.001). ROC analysis discriminated osteopenia/osteoporosis with a sensitivity of 84.7% and a specificity of 40.6% at a VBQ score threshold value of 2.18. Age, BV/TV and trabecular thickness (Tb.Th), but not VBQ, were significant independent predictors for vBMD (corrected R2=0.434). CONCLUSIONS: This study demonstrated for the first time that the VBQ score is associated with trabecular microstructure determined by µCT. The bone microstructure and VBQ score were significantly different in patients with impaired vBMD. However, the ability to predict osteopenia/osteoporosis with the VBQ score was moderate. The VBQ score appears to reflect additional bone quality characteristics and might have a complementary role to vBMD. This enhances our understanding of the biological background of the radiographic VBQ score and might be a take-off point to evaluate the clinical utility of it as non-invasive screening tool for bone quality.

Effect of a Screening and Education Programme on Knowledge, Beliefs, and Practices Regarding Osteoporosis among Malaysians.

Background: Osteoporosis is an emerging geriatric condition with high morbidity and healthcare cost in developing nations experiencing rapid population ageing. Thus, identifying strategies to prevent osteoporosis is critical in safeguarding skeletal health. This study aimed to evaluate the effects of a bone health screening and education programme on knowledge, beliefs, and practice regarding osteoporosis among Malaysians aged 40 years and above. Methods: A longitudinal study was conducted from April 2018 to August 2019. During the first phase of the study, 400 Malaysians (190 men, 210 women) aged ≥ 40 years were recruited in Klang Valley, Malaysia. Information on subjects' demography, medical history, knowledge, and beliefs regarding osteoporosis, physical activity status, and dietary and lifestyle practices were obtained. Subjects also underwent body anthropometry measurement and bone mineral density scan (hip and lumbar spine) using a dual-energy X-ray absorptiometry device. Six months after the first screening, similar investigations were carried out on the subjects. Results: During the follow-up session, 72 subjects were lost to follow up. Most of them were younger subjects with a lower awareness of healthy practices. A significant increase in knowledge, beliefs (p < 0.05), calcium supplement intake (p < 0.001), and dietary calcium intake (p = 0.036) and a reduction in coffee intake (p < 0.001) were found among subjects who attended the follow-up. In this study, the percentage of successful referrals was 41.86%. Subjects with osteoporosis were mostly prescribed alendronate plus vitamin D3 by medical doctors, and they followed the prescribed treatment accordingly. Conclusions: The bone health screening and education programmes in this study are effective in changing knowledge, beliefs, and practice regarding osteoporosis. The information is pertinent to policymakers in planning strategies to prevent osteoporosis and its associated problems among the middle-aged and elderly population in Malaysia. Nevertheless, a more comprehensive bone health education program that includes long-term monitoring and consultation is needed to halt the progression of bone loss.

Studying the Effects of Cold Plasma Phosphorus Using Physiological and Digital Image Processing Techniques.

The goal of this study is to see how cold plasma affects rabbit bone tissue infected with osteoporosis. The search is divided into three categories: control, infected, and treated. The rabbits were subjected to cold plasma for five minutes in a room with a microwave plasma voltage of "175 V" and a gas flow of "2." A histopathological photograph of infected bone cells is obtained to demonstrate the influence of plasma on infected bone cells, as well as the extent of destruction and effect of plasma therapy before and after exposure. The findings of the search show that plasma has a clear impact on Ca and vitamin D levels. In the cold plasma, the levels of osteocalcin and alkali phosphates (ALP) respond as well. Image processing techniques (second-order gray level matrix) with textural elements are employed as an extra proof. The outcome gives good treatment indicators, and the image processing result corresponds to the biological result.

Analysis of type I osteoporosis animal models using synchrotron radiation.

Preclinical experiments to analyze the trabecular space of spongy bones using small animals are required for the evaluation and treatment of patients with osteoporosis (OP). We performed ovariectomy to create OP models. A total of four mice were used. Ovariectomized group (OVX, n = 2) in which both ovaries were resected at random, and the sham operated group (SHAM, n = 2) performed surgery without resecting the ovaries. We propose a study that enables OP analysis by analyzing tibia microstructures of OVX and SHAM using synchrotron radiation (SR). SR imaging is a technology capable of irradiating an extremely small object in the order of several tens of nanometers using a nondestructive method at the microscopic level. Unlike previous imaging diagnoses (staining, micro-CT [Computed Tomography]) it was possible to preserve the real shape and analyze bone microstructures in real-time and analyze and evaluate spongy bones to secure data and increase the reliability of OP analysis. We were able to confirm the possibility of OP diagnosis through experimental animals for spongy bone damage related to bone mineral density. Therefore, we aimed to provide a rehabilitation and medicine therapy intervention method through basic research on the evaluation of OP diagnosis through human-based segmentation of challenging spongy bones while supplementing the limitations of existing imaging methods. RESEARCH HIGHLIGHTS: We present an analysis of osteoporosis through spongy bone using phase-contrast X-ray source. Unlike existing methods, it is possible to analyze the internal microstructure of the tibia with this method. This is an objective mechanism for OP and a basis for rehabilitation.

Chondroitin Sulfate Alleviates Diabetic Osteoporosis and Repairs Bone Microstructure via Anti-Oxidation, Anti-Inflammation, and Regulating Bone Metabolism.

Diabetic osteoporosis (DOP) belongs to secondary osteoporosis caused by diabetes; it has the characteristics of high morbidity and high disability. In the present study, we constructed a type 1 diabetic rat model and administered chondroitin sulfate (200 mg/kg) for 10 weeks to observe the preventive effect of chondroitin sulfate on the bone loss of diabetic rats. The results showed that chondroitin sulfate can reduce blood glucose and relieve symptoms of diabetic rats; in addition, it can significantly increase the bone mineral density, improve bone microstructure, and reduce bone marrow adipocyte number in diabetic rats; after 10 weeks of chondroitin sulfate administration, the SOD activity level was upregulated, as well as CAT levels, indicating that chondroitin sulfate can alleviate oxidative stress in diabetic rats. Chondroitin sulfate was also found to reduce the level of serum inflammatory cytokines (TNF-α, IL-1, IL-6, and MCP-1) and alleviate the inflammation in diabetic rats; bone metabolism marker detection results showed that chondroitin sulfate can reduce bone turnover in diabetic rats (decreased RANKL, CTX-1, ALP, and TRACP 5b levels were observed after 10 weeks of chondroitin sulfate administration). At the same time, the bone OPG and RUNX 2 expression levels were higher after chondroitin sulfate treatment, the bone RANKL expression was lowered, and the OPG/RANKL ratio was upregulated. All of the above indicated that chondroitin sulfate could prevent STZ-induced DOP and repair bone microstructure; the main mechanism was through anti-oxidation, anti-inflammatory, and regulating bone metabolism. Chondroitin sulfate could be used to develop anti-DOP functional foods and diet interventions for diabetes.

Bone Status in a Mouse Model of Experimental Autoimmune-Orchitis.

Investigations in male patients with fertility disorders revealed a greater risk of osteoporosis. The rodent model of experimental autoimmune-orchitis (EAO) was established to analyze the underlying mechanisms of male infertility and causes of reduced testosterone concentration. Hence, we investigated the impact of testicular dysfunction in EAO on bone status. Male mice were immunized with testicular homogenate in adjuvant to induce EAO (n = 5). Age-matched mice were treated with adjuvant alone (adjuvant, n = 6) or remained untreated (control, n = 7). Fifty days after the first immunization specimens were harvested. Real-time reverse transcription-PCR indicated decreased bone metabolism by alkaline phosphatase and Cathepsin K as well as remodeling of cell-contacts by Connexin-43. Micro computed tomography demonstrated a loss of bone mass and mineralization. These findings were supported by histomorphometric results. Additionally, biomechanical properties of femora in a three-point bending test were significantly altered. In summary, the present study illustrates the induction of osteoporosis in the investigated mouse model. However, results suggest that the major effects on bone status were mainly caused by the complete Freund's adjuvant rather than the autoimmune-orchitis itself. Therefore, the benefit of the EAO model to transfer laboratory findings regarding bone metabolism in context with orchitis into a clinical application is limited.