Development of a shape-based algorithm for identification of asymptomatic vertebral compression fractures: A proof-of-principle study

Objectives@#Vertebral fracture is both common and serious among adults, yet it often goes undiagnosed. This study aimed to develop a shape-based algorithm (SBA) for the automatic identification of vertebral fractures. @*Methods@#The study included 144 participants (50 individuals with a fracture and 94 without a fracture) whose plain thoracolumbar spine X-rays were taken. Clinical diagnosis of vertebral fracture (grade 0 to 3) was made by rheumatologists using Genant’s semiquantitative method. The SBA algorithm was developed to determine the ratio of vertebral body height loss. Based on the ratio, SBA classifies a vertebra into 4 classes: 0 = normal, 1 = mild fracture, 2 = moderate fracture, 3 = severe fracture). The concordance between clinical diagnosis and SBAbased classification was assessed at both person and vertebra levels. @*Results@#At the person level, the SBA achieved a sensitivity of 100% and specificity of 62% (95% CI, 51%–72%). At the vertebra level, the SBA achieved a sensitivity of 84% (95% CI, 72%–93%), and a specificity of 88% (95% CI, 85%–90%). On average, the SBA took 0.3 s to assess each X-ray. @*Conclusions@#The SBA developed here is a fast and efficient tool that can be used to systematically screen for asymptomatic vertebral fractures and reduce the workload of healthcare professionals.

Asia-Pacific consensus on long-term and sequential therapy for osteoporosis

Objectives@#This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. @*Methods@#A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. @*Results@#The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. @*Conclusions@#This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.

Discordance between quantitative ultrasound and dual-energy X-ray absorptiometry in bone mineral density: The Vietnam Osteoporosis Study

Objectives@#Calcaneal quantitative ultrasound measurement (QUS) has been considered an alternative to dual-energy X-ray absorptiometry (DXA) based bone mineral density (BMD) for assessing bone health. This study sought to examine the utility of QUS as an osteoporosis screening tool by evaluating the correlation between QUS and DXA. @*Methods@#The study was a part of the Vietnam Osteoporosis Study that involved 1270 women and 773 men aged 18 years and older. BMD at the femoral neck, total hip and lumbar spine was measured using DXA. Osteoporosis was diagnosed based on the femoral neck T-score using World Health Organization criteria. Broadband ultrasound attenuation (BUA) at the calcaneus was measured by QUS. The concordance between BUA and BMD was analyzed by the linear regression model. @*Results@#In all individuals, BUA modestly correlated with femoral neck BMD (r = 0.35; P < 0.0001) and lumbar spine BMD (r = 0.34; P < 0.0001) in both men and women. In individuals aged 50 years and older, approximately 16% (n = 92/575) of women and 3.2% (n = 10/314) of men were diagnosed to have osteoporosis. Only 0.9% (n = 5/575) women and 1.0% (n = 3/314) men were classified as “Low BUA”. The kappa coefficient of concordance between BMD and BUA classification was 0.09 (95% CI, 0.04 to 0.15) for women and 0.12 (95% CI, 0.03 to 0.22) for men. @*Conclusions@#In this population-based study, QUS BUA modestly correlated with DXA BMD, suggesting that BUA is not a reliable method for screening of osteoporosis.

Discordance between quantitative ultrasound and dual-energy X-ray absorptiometry in bone mineral density: The Vietnam Osteoporosis Study

Objectives@#Calcaneal quantitative ultrasound measurement (QUS) has been considered an alternative to dual-energy X-ray absorptiometry (DXA) based bone mineral density (BMD) for assessing bone health. This study sought to examine the utility of QUS as an osteoporosis screening tool by evaluating the correlation between QUS and DXA. @*Methods@#The study was a part of the Vietnam Osteoporosis Study that involved 1270 women and 773 men aged 18 years and older. BMD at the femoral neck, total hip and lumbar spine was measured using DXA. Osteoporosis was diagnosed based on the femoral neck T-score using World Health Organization criteria. Broadband ultrasound attenuation (BUA) at the calcaneus was measured by QUS. The concordance between BUA and BMD was analyzed by the linear regression model. @*Results@#In all individuals, BUA modestly correlated with femoral neck BMD (r = 0.35; P < 0.0001) and lumbar spine BMD (r = 0.34; P < 0.0001) in both men and women. In individuals aged 50 years and older, approximately 16% (n = 92/575) of women and 3.2% (n = 10/314) of men were diagnosed to have osteoporosis. Only 0.9% (n = 5/575) women and 1.0% (n = 3/314) men were classified as “Low BUA”. The kappa coefficient of concordance between BMD and BUA classification was 0.09 (95% CI, 0.04 to 0.15) for women and 0.12 (95% CI, 0.03 to 0.22) for men. @*Conclusions@#In this population-based study, QUS BUA modestly correlated with DXA BMD, suggesting that BUA is not a reliable method for screening of osteoporosis.

Lean mass and peak bone mineral density

Objectives@#The association between body composition parameters and peak bone mineral density is not well documented. The aim of this study is to assess the relative contributions of lean mass and fat mass on peak bone mineral density (BMD). @*Methods@#The study involved 416 women and 334 men aged between 20 and 30 years who were participants in the population-based Vietnam Osteoporosis Study. Whole body composition parameters (eg, fat mass and lean mass) and BMD at the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. The association between lean mass and fat mass and BMD was analyzed by the linear regression model using the Least Absolute Shrinkage and Selection Operator (LASSO). @*Results@#Peak BMD in men was higher than women, and the difference was more pronounced at the femoral neck (average difference: 0.123 g/㎠; 95% confidence interval [CI] 0.105–0.141 g/㎠) than at the lumbar spine (average difference 0.019 g/㎠; 95% CI, 0.005–0.036 g/㎠). Results of LASSO regression indicated that lean mass was the only predictor of BMD for either men or women. Each kilogram increase in lean mass was associated with ∼0.01 g/㎠ increase in BMD. Lean mass alone explained 16% and 36% of variation in lumbar spine and femoral neck BMD, respectively. @*Conclusions@#Lean mass, not fat mass, is the main determinant of peak bone mineral density. This finding implies that good physical activity during adulthood can contribute to the maximization of peak bone mass during adulthood.

Lean mass and peak bone mineral density

Objectives@#The association between body composition parameters and peak bone mineral density is not well documented. The aim of this study is to assess the relative contributions of lean mass and fat mass on peak bone mineral density (BMD). @*Methods@#The study involved 416 women and 334 men aged between 20 and 30 years who were participants in the population-based Vietnam Osteoporosis Study. Whole body composition parameters (eg, fat mass and lean mass) and BMD at the lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. The association between lean mass and fat mass and BMD was analyzed by the linear regression model using the Least Absolute Shrinkage and Selection Operator (LASSO). @*Results@#Peak BMD in men was higher than women, and the difference was more pronounced at the femoral neck (average difference: 0.123 g/㎠; 95% confidence interval [CI] 0.105–0.141 g/㎠) than at the lumbar spine (average difference 0.019 g/㎠; 95% CI, 0.005–0.036 g/㎠). Results of LASSO regression indicated that lean mass was the only predictor of BMD for either men or women. Each kilogram increase in lean mass was associated with ∼0.01 g/㎠ increase in BMD. Lean mass alone explained 16% and 36% of variation in lumbar spine and femoral neck BMD, respectively. @*Conclusions@#Lean mass, not fat mass, is the main determinant of peak bone mineral density. This finding implies that good physical activity during adulthood can contribute to the maximization of peak bone mass during adulthood.

The Vietnam Osteoporosis Study: Rationale and design

OBJECTIVES: Osteoporosis and fracture impose a significant health care burden on the contemporary populations in developing countries. The Vietnam Osteoporosis Study (VOS) sought to assess the burden of osteoporosis and its comorbidities in men and women. METHODS: The study was designed as a population-based family investigation in which families were randomly recruited from Ho Chi Minh City, Vietnam. Individuals were assessed for bone health, including bone mineral density (BMD) and body composition and trabecular and cortical bone properties by pQCT (peripheral quantitative computed tomography). Fasting blood samples were obtained for the analysis of plasma glucose, glycosylated hemoglobin, and bone turnover markers. Genomic DNA extraction from whole blood samples for further genetic and genomic analyses. RESULTS: We have recruited more than 4157 individuals from 817 families. The average age of participants was 51, with approximately 45% of the individuals aged 50 years and older. Approximately 3% of participants were obese (body mass index ≥ 30 kg/m²), and 21% were overweight. Notably, 11% of participants aged 40 years and older were diabetic. Among those aged 50 years and older, approximately 14% of women and 5% of men had osteoporosis (i.e., femoral neck BMD T-scores ≤−2.5). There were modest correlations between volumetric BMD and areal BMD. CONCLUSIONS: VOS is a major bone research project in Vietnam aimed at comprehensively documenting the burden osteoporosis, its co-occurrence of chronic diseases, and their underlying etiologies. The Study will make important contributions to the literature of bone health worldwide.

A provider-based water planning and management model--WaterSim 4.0--for the Phoenix Metropolitan Area.

Uncertainty in future water supplies for the Phoenix Metropolitan Area (Phoenix) are exacerbated by the near certainty of increased, future water demands; water demand may increase eightfold or more by 2030 for some communities. We developed a provider-based water management and planning model for Phoenix termed WaterSim 4.0. The model combines a FORTRAN library with Microsoft C# to simulate the spatial and temporal dynamics of current and projected future water supply and demand as influenced by population demographics, climatic uncertainty, and groundwater availability. This paper describes model development and rationale. Water providers receive surface water, groundwater, or both depending on their portfolio. Runoff from two riverine systems supplies surface water to Phoenix while three alluvial layers that underlie the area provide groundwater. Water demand was estimated using two approaches. One approach used residential density, population projections, water duties, and acreage. A second approach used per capita water consumption and separate population growth estimates. Simulated estimates of initial groundwater for each provider were obtained as outputs from the Arizona Department of Water Resources (ADWR) Salt River Valley groundwater flow model (GFM). We compared simulated estimates of water storage with empirical estimates for modeled reservoirs as a test of model performance. In simulations we modified runoff by 80%-110% of the historical estimates, in 5% intervals, to examine provider-specific responses to altered surface water availability for 33 large water providers over a 25-year period (2010-2035). Two metrics were used to differentiate their response: (1) we examined groundwater reliance (GWR; that proportion of a providers' portfolio dependent upon groundwater) from the runoff sensitivity analysis, and (2) we used 100% of the historical runoff simulations to examine the cumulative groundwater withdrawals for each provider. Four groups of water providers were identified, and discussed. Water portfolios most reliant on Colorado River water may be most sensitive to potential reductions in surface water supplies. Groundwater depletions were greatest for communities who were either 100% dependent upon groundwater (urban periphery), or nearly so, coupled with high water demand projections. On-going model development includes linking WaterSim 4.0 to the GFM in order to more precisely model provider-specific estimates of groundwater, and provider-based policy options that will enable "what-if" scenarios to examine policy trade-offs and long-term sustainability of water portfolios.

A simulation model for policy decision analysis: a case of pandemic influenza on a university campus.

Pandemic influenza preparedness plans strongly focus on efficient mitigation strategies including social distancing, logistics and medical response. These strategies are formed by multiple decision makers before a pandemic outbreak and during the pandemic in local communities, states and nation-wide. In this paper, we model the spread of pandemic influenza in a local community, a university, and evaluate the mitigation policies. Since the development of an appropriate vaccine requires a significant amount of time and available antiviral quantities can only cover a relatively small proportion of the population, university decision makers will first focus on non-pharmaceutical interventions. These interventions include social distancing and isolation. The disease spread is modelled as differential equations-based compartmental model. The system is simulated for multiple non-pharmaceutical interventions such as social distancing including suspending university operations, evacuating dorms and isolation of infected individuals on campus. Although the model is built based on the preparedness plan of one of the biggest universities in the world, Arizona State University, it can easily be generalized for other colleges and universities. The policies and the decisions are tested by several simulation runs and evaluations of the mitigation strategies are presented in the paper.

Building partnerships with physicians: moving outside the walls of the hospital.

Fostering open dialogue, listening, and promoting healthy lifestyles will build solid relationships between physician staff and management. Solid relationships will reduce physician burnout and ultimately, keep a safe and happy productive environment that provides quality health care delivery during ever increasing demands for workplace change.