Figeno: multi-region genomic figures with long-read support.

SUMMARY: The vast amount of publicly available genomic data requires analysis and visualization tools. Here, we present figeno, an application for generating publication-quality FIgures for GENOmics. Figeno particularly focuses on multi-region views across genomic breakpoints and on long reads with base modifications. In addition, we support epigenomic data including ATAC-seq, ChIP-seq or HiC, as well as whole genome sequencing data with copy numbers and structural variants. AVAILABILITY AND IMPLEMENTATION: Figeno is available as a python package with both a command line and graphical user interface. It can be installed via PyPI and the source code is available at https://github.com/CompEpigen/figeno.

Late-onset NPM1 mutation in a MYC-amplified relapsed / refractory acute myeloid leukemia patient treated with gemtuzumab ozogamicin and glasdegib.

Not available.

Georg Schmorl prize of the German spine society (DWG) 2022: current treatment for inpatients with osteoporotic thoracolumbar fractures-results of the EOFTT study.

AIM: Osteoporotic thoracolumbar fractures are of increasing importance. To identify the optimal treatment strategy this multicentre prospective cohort study was performed. PURPOSE: Patients suffering from osteoporotic thoracolumbar fractures were included. Excluded were tumour diseases, infections and limb fractures. Age, sex, trauma mechanism, OF classification, OF-score, treatment strategy, pain condition and mobilization were analysed. METHODS: A total of 518 patients' aged 75 ± 10 (41-97) years were included in 17 centre. A total of 174 patients were treated conservatively, and 344 were treated surgically, of whom 310 (90%) received minimally invasive treatment. An increase in the OF classification was associated with an increase in both the likelihood of surgery and the surgical invasiveness. RESULTS: Five (3%) complications occurred during conservative treatment, and 46 (13%) occurred in the surgically treated patients. 4 surgical site infections and 2 mechanical failures requested revision surgery. At discharge pain improved significantly from a visual analogue scale score of 7.7 (surgical) and 6.0 (conservative) to a score of 4 in both groups (p < 0.001). Over the course of treatment, mobility improved significantly (p = 0.001), with a significantly stronger (p = 0.007) improvement in the surgically treated patients. CONCLUSION: Fracture severity according to the OF classification is significantly correlated with higher surgery rates and higher invasiveness of surgery. The most commonly used surgical strategy was minimally invasive short-segmental hybrid stabilization followed by kyphoplasty/vertebroplasty. Despite the worse clinical conditions of the surgically treated patients both conservative and surgical treatment led to an improved pain situation and mobility during the inpatient stay to nearly the same level for both treatments.

Influence of the layer thickness on the flexural strength of aged and nonaged additively manufactured interim dental material.

PURPOSE: To measure the flexural strength and Weibull characteristics of aged and nonaged printed interim dental material fabricated with different layer thickness. MATERIAL AND METHODS: Bars (25×2×2 mm) were additively fabricated by using a polymer printer (Asiga Max) and an interim resin (Nexdent C&B MFH). Specimens were fabricated with the same printing parameters and postprocessing procedures, but with 7 different layer thickness: 50 (control or 50-G group), 10 (10-G group), 25 (25-G group), 75 (75-G group), 100 (100-G group), 125 (125-G group), and 150 µm (150-G group). Two subgroups were created: nonaged and aged subgroups (n = 10). A universal testing machine was selected to measure flexural strength. Two-parameter Weibull distribution values were computed. Two-way ANOVA and Tukey tests were selected for statistical evaluation of the data (α = 0.05). RESULTS: Artificial aging methods (p < 0.001) were a significant predictor of the flexural strength computed. Aged specimens acquired less flexural strength than nonaged specimens. The Weibull distribution obtained the highest shape for nonaged 50-G and 75-G group specimens compared with those of other nonaged groups, while the Weibull distribution showed the highest shape for aged 125-G specimens. CONCLUSIONS: The flexural strength of the additively fabricated interim material examined was not influenced by the layer thickness at which the specimens were fabricated; however, artificial aging techniques reduced its flexural strength. Aged specimens presented lower Weibull distribution values compared with nonaged specimens, except for the 125-G specimens.

Profiles of trauma histories as predictors of depression among women living with HIV.

This study examined co-occurring psychosocial problems among 120 women living with HIV (WLWH) in Washington, DC, USA. Participants completed a demographic survey, PHQ-9 (depressive symptoms), the Life Stressor Checklist (stressful events) and the PCL-C (PTSD symptoms in civilian populations). We calculated descriptive statistics and chi-square solutions for participant demographics. Classes of trauma history were established using latent class analysis (LCA). Latent indicators were extracted from participant self-reported traumatic histories on the LSC-R. Traumatic events have been found to be predictive of both depression. Latent class solution selection was guided by utility in evaluating and discriminating between classes as predictors of scales measuring depression or trauma exposure. Three distinct classes of trauma histories were identified: a high trauma (HT) class, an abuse/neglect (AN) class and a childhood trauma (CT) class. Binary logistic regression analyses determined whether trauma profiles predicted depression or PTSD after controlling for age, marital status, race and education. Participants in both the AN and CT class were over five times more likely than those in the HT class to endorse depressive symptoms. Classes differed significantly on whether they endorse depressive symptoms (p = .008) and marital status (p = .009), while PTSD appeared to trend toward significance (p = .085).

Quantitative comparison of within-sample heterogeneity scores for DNA methylation data.

DNA methylation is an epigenetic mark with important regulatory roles in cellular identity and can be quantified at base resolution using bisulfite sequencing. Most studies are limited to the average DNA methylation levels of individual CpGs and thus neglect heterogeneity within the profiled cell populations. To assess this within-sample heterogeneity (WSH) several window-based scores that quantify variability in DNA methylation in sequencing reads have been proposed. We performed the first systematic comparison of four published WSH scores based on simulated and publicly available datasets. Moreover, we propose two new scores and provide guidelines for selecting appropriate scores to address cell-type heterogeneity, cellular contamination and allele-specific methylation. Most of the measures were sensitive in detecting DNA methylation heterogeneity in these scenarios, while we detected differences in susceptibility to technical bias. Using recently published DNA methylation profiles of Ewing sarcoma samples, we show that DNA methylation heterogeneity provides information complementary to the DNA methylation level. WSH scores are powerful tools for estimating variance in DNA methylation patterns and have the potential for detecting novel disease-associated genomic loci not captured by established statistics. We provide an R-package implementing the WSH scores for integration into analysis workflows.

Influence of postpolymerization methods and artificial aging procedures on the fracture resistance and flexural strength of a vat-polymerized interim dental material.

STATEMENT OF PROBLEM: The influence of postpolymerization methods and artificial aging procedures on the fracture resistance and flexural strength of additively manufactured interim polymers remains unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the conditions (dry and water- and glycerin-submerged) and time (25, 30, 35, 40, and 45 minutes) of postpolymerization methods with and without artificial aging procedures on the fracture resistance and flexural strength of an additively manufactured interim material. MATERIAL AND METHODS: Bar specimens (25×2×2 mm) were manufactured from an interim resin (NexDent C&B MFH N1) with a 3-dimensional printer (NexDent 5100) as per the manufacturer's recommendations. Three groups were created based on the postpolymerization condition: dry (D group) and submerged in a container with water (W group) or glycerin (G group) inside the ultraviolet polymerization machine (LC-3DPrint Box). Each group was divided into 5 subgroups (D1 to D5, W1 to W5, and G1 to G5) depending on the polymerizing time (25, 30, 35, 40, and 45 minutes) (n=20). Each subgroup was divided into nonaged and aged subgroups. The aged groups were treated in a mastication simulator. Fracture strength was measured on a universal testing machine. The flexural strength was calculated as per International Organization for Standardization (ISO) 10477-2018. The Kolmogorov-Smirnov test demonstrated that data were normally distributed. The 3-way ANOVA test was used to analyze the data (α=.05). RESULTS: A significant main effect was found on the fracture strength analysis for each of the 3 factors: postpolymerization condition (F[2, 449]=81.00, P<.001), treatment duration (F[4, 449]=2.84, P=.024), and aging procedure (F [1, 449] =7.62, P=.006). The only significant 2-way interaction was between postpolymerization condition and treatment duration (F[8, 449]=3.12, P=.002). Furthermore, a significant main effect was found on the flexural strength for each of the 3 factors including postpolymerization condition (F[2, 449]=82.55, P<.001), treatment duration (F[4, 449]=2.85, P=.024), and artificial aging procedure (F[1, 449]=6.72, P=.010). The only significant 2-way interaction was between postpolymerization condition and treatment duration (F[8, 449]=3.33, P=.001). Dry postconditions at 25 minutes and nonaged procedures obtained the significantly highest fracture resistance and flexural strength values. CONCLUSIONS: Postpolymerization conditions and duration time affected the fracture resistance and flexural strength of the additively manufactured interim material assessed. Artificial aging procedures significantly decreased the fracture resistance and flexural strength of the additively manufactured interim dental material.

Influence of postprocessing rinsing solutions and duration on flexural strength of aged and nonaged additively manufactured interim dental material.

STATEMENT OF PROBLEM: Additive manufacturing procedures for fabricating interim restorations include rinsing postprocessing procedures. However, the impact of different rinsing solutions and times on flexural strength is unknown. PURPOSE: The purpose of this in vitro study was to assess the influence of the rinsing solutions and duration, as well as accelerated aging (thermocycling) procedures, on the flexural strength and Weibull characteristics of an additively manufactured interim dental material. MATERIAL AND METHODS: A bar design (25×2×2 mm) file was used to fabricate all the specimens with 3D printing and an interim material (Nextdent C&B MFH). Five groups were created based on the rinsing solution used during the postprocessing procedures: 91% isopropyl alcohol (IPA) (control or IPA-91), 99% IPA (IPA-99 group), bio-ethyl alcohol 100% (BE group), tripropylene glycol monomethyl ether (TPM) 100% (TPM group), and water miscible formula (Resinaway) (RA group). Each group was divided into 4 subgroups depending on the total rinsing time: 5, 6, 7, and 8 minutes (5, 6, 7, and 8 subgroups). Additionally, each subgroup was distributed between nonaged and aged thermocycling procedures (n=10). Flexural strength measurements were made by using a universal testing machine. Two-parameter Weibull distribution values, including the Weibull modulus, scale (m), and shape (0), were calculated. Three-way ANOVA and pairwise multiple comparison Tukey tests were used to analyze the data (α=.05). RESULTS: Three-way ANOVA showed that the rinsing solution (P<.001), rinsing time (P=.004), and thermocycling procedures (P<.001) were significant predictors of the flexural strength values obtained. The IPA-91 and IPA-99 groups obtained the highest flexural strength, while the RA, TPM, and BE groups obtained the lowest flexural strength. The 7- and 8-minute subgroups obtained the highest flexural strength, while the 5-minute subgroup obtained the lowest flexural strength. The nonaged specimens obtained significantly higher mean flexural strength values than the aged specimens. CONCLUSIONS: The vat-polymerized additively manufactured interim dental material tested with differing rinsing solutions and times demonstrated significant differences in the flexural strength values measured. Accelerated artificial aging procedures significantly decreased the flexural strength of the vat-polymerized interim dental material tested.

Expedited Digital-Analog Hybrid Method to Fabricate a 3D-Printed Implant Overdenture.

The present case report describes a technique to convert an interim mandibular complete dental prosthesis into a digitally designed and additively manufactured implant overdenture prosthesis. A patient had two dental implants placed, an interim complete denture, and a soft reline procedure completed. After implant osseointegration, existing healing abutments were removed, a functionally generated reline impression with polyvinyl siloxane impression material was made. Using an intraoral scanner, a 360-degree optical scan was obtained of the relined interim prosthesis. A new prosthesis was digitally designed using the optical scan, additively manufactured, and housings picked-up intraorally to create an implant-retained overdenture.

Changes in Alcohol Use and Drinking and Driving Outcomes From Before Arrest for Driving Under the Influence to After Interlock Removal.

BACKGROUND: Half of the offenders convicted of impaired driving in the United States are sentenced to install alcohol ignition interlock devices (IIDs), which prevent them from starting their vehicles if they have been drinking. No research has yet explored offenders' patterns of alcohol consumption and driving under the influence of alcohol (DUI) from the time before the arrest to the time period after the IID is installed. This study aims to fill that gap in knowledge. METHODS: Using the Timeline Follow-back interview procedure, we assessed the daily drinking of 153 convicted DUI offenders' self-reported total alcohol consumption and rates of self-reported driving after drinking over 4 phases: before DUI arrest, between arrest and IID installation, during the phase on the interlock, and after the interlock is removed. Because information about behaviors in each period was not available for every participant, comparisons were made using paired-sample contrasts. RESULTS: Compared with before the arrest, total alcohol use decreased by 50% in the 4-month phase following arrest and before IID installation, though it did not change much afterward. The frequency of drinking and driving decreased sharply after the arrest (-82%), with further decrease upon installation of the interlock (-58%, p = 0.05). The frequency of drinking and driving after the IID was removed returned to preinstallation drinking and driving status (+58%, p = 0.01). CONCLUSIONS: Participants made significant adjustments to their drinking behavior by adhering to the traditional DUI driving restrictions in the postarrest phase. Although installation of an IID was not associated with a significant change in drinking, it further reduced the frequency of drinking and driving. Evaluations of the IID experience should take into account information on an individual's drinking and DUI behaviors not only before the IID was installed, but before the individual was arrested.

Convicted drinking and driving offenders: Comparing alcohol use before and after the pandemic outbreak.

BACKGROUND: Before the COVID-19 pandemic, very little was known about the impact of social isolation on individuals' alcohol use and misuse. This study examines how socially isolated individuals with a history of heavy drinking used alcohol during the pandemic. METHODS: Data for this study came from an add-on to the Managing Heavy Drinking (MHD) longitudinal study of drivers convicted of DWI that was conducted in Erie County, New York. Pre-COVID information (October 2019-March 2020) was augmented with a COVID-19 questionnaire collected between July and August 2020. A total of 92 participants completed the COVID-19 survey. RESULTS: The sample of problem drinkers showed a significant increase after the pandemic outbreak in the average number of drinking days from 1.99 to 2.49 per week (p = 0.047), but a significant decrease in the average number of drinks per drinking day, from 3.74 to 2.74 (p = 0.003). The proportion of individuals who drank more frequently was greater among those who, before the outbreak had an Alcohol Use Disorders Identification Test (AUDIT) score <8 (26% increase) compared with those with an AUDIT score of >8 (13%). Alcohol treatment was also associated with the frequency of drinking, with individuals who were not in alcohol treatment showing a 16% increase in frequency compared with a 10% increase among those in treatment. Further, individuals who, after the outbreak worried about their health (30%) or finances (37%) reported greater increases in the frequency of drinking than those who did not worry about their health (17%) or finances (10%). CONCLUSIONS: Overall, the individuals in our sample showed small changes in the frequency andheaviness of drinking after the outbreak of COVID-19, effects that opposite in direction from one another and thus resulted in no overall change in drinks consumed. Nonetheless, we identified factors that influenced the effects of the pandemic on drinking behavior among individuals convicted of DWI, which emphasizes the need to individualize these individuals' treatment, particularly in the context of dramatic environmental change.

Chronic senescent human mesenchymal stem cells as possible contributor to the wound healing disorder after exposure to the alkylating agent sulfur mustard.

Wound healing is a complex process, and disturbance of even a single mechanism can result in chronic ulcers developing after exposure to the alkylating agent sulfur mustard (SM). A possible contributor may be SM-induced chronic senescent mesenchymal stem cells (MSCs), unable to fulfil their regenerative role, by persisting over long time periods and creating a proinflammatory microenvironment. Here we show that senescence induction in human bone marrow derived MSCs was time- and concentration-dependent, and chronic senescence could be verified 3 weeks after exposure to between 10 and 40 µM SM. Morphological changes, reduced clonogenic and migration potential, longer scratch closure times, differences in senescence, motility and DNA damage response associated genes as well as increased levels of proinflammatory cytokines were revealed. Selective removal of these cells by senolytic drugs, in which ABT-263 showed initial potential in vitro, opens the possibility for an innovative treatment strategy for chronic wounds, but also tumors and age-related diseases.

Workflow for a metal-resin-zirconia fixed complete denture: A dental technique.

The hard- and soft-tissue replacement materials in the traditional workflow for an implant fixed complete denture are acrylic resin and conventional resin denture teeth supported by a rigid substructure. A novel technique is described combining a modified digital complete denture workflow with analog components and systems, allowing the use of multicolored zirconia and 3D-printed resin. In combination with an appropriate metal substructure, a high-quality prosthesis can be fabricated with reduced effort and cost.

A Latent Class Analysis of DUI Offender Motivation and Awareness as Predictors of Performance While on Alcohol Ignition Interlocks.

INTRODUCTION: Alcohol ignition interlock devices (IID) reduce rates of drinking and driving. The interlock offers an opportune time for tailoring targeted interventions to develop habits to separate drinking from driving among this high-risk population. This study identified different types of IID users upon whom targeted interventions could be developed. METHODS: Participants (N = 114) were assessed at IID installation and again six months later. Latent class analysis (LCA) was conducted using drinking environment, drinking motivation, social support, drug use, and problem drinking behaviors as indicators. Multivariate regression analyses were conducted comparing latent class assignment with impaired driving attempts. RESULTS: LCA supported a 4-class model where 14.8% of participants fell into the low use/high awareness class; 30.6% fell into the heavy use/high awareness class; 30.6% fell into the mixed use/high awareness class; and 24.0% fell into the moderate use/low awareness class. Drivers in the moderate use/low awareness condition had increased early morning BAC lockouts. CONCLUSIONS: These typologies demonstrate important differences within high risk drivers. Indeed, drivers who fell into the moderate use/low awareness class may not have considered their alcohol-related behaviors problematic. This information could lend itself to the development of targeted interventions to address subgroups of drinking drivers.

Guidelines for cell-type heterogeneity quantification based on a comparative analysis of reference-free DNA methylation deconvolution software.

BACKGROUND: Cell-type heterogeneity of tumors is a key factor in tumor progression and response to chemotherapy. Tumor cell-type heterogeneity, defined as the proportion of the various cell-types in a tumor, can be inferred from DNA methylation of surgical specimens. However, confounding factors known to associate with methylation values, such as age and sex, complicate accurate inference of cell-type proportions. While reference-free algorithms have been developed to infer cell-type proportions from DNA methylation, a comparative evaluation of the performance of these methods is still lacking. RESULTS: Here we use simulations to evaluate several computational pipelines based on the software packages MeDeCom, EDec, and RefFreeEWAS. We identify that accounting for confounders, feature selection, and the choice of the number of estimated cell types are critical steps for inferring cell-type proportions. We find that removal of methylation probes which are correlated with confounder variables reduces the error of inference by 30-35%, and that selection of cell-type informative probes has similar effect. We show that Cattell's rule based on the scree plot is a powerful tool to determine the number of cell-types. Once the pre-processing steps are achieved, the three deconvolution methods provide comparable results. We observe that all the algorithms' performance improves when inter-sample variation of cell-type proportions is large or when the number of available samples is large. We find that under specific circumstances the methods are sensitive to the initialization method, suggesting that averaging different solutions or optimizing initialization is an avenue for future research. CONCLUSION: Based on the lessons learned, to facilitate pipeline validation and catalyze further pipeline improvement by the community, we develop a benchmark pipeline for inference of cell-type proportions and implement it in the R package medepir.

Weighted elastic net for unsupervised domain adaptation with application to age prediction from DNA methylation data.

MOTIVATION: Predictive models are a powerful tool for solving complex problems in computational biology. They are typically designed to predict or classify data coming from the same unknown distribution as the training data. In many real-world settings, however, uncontrolled biological or technical factors can lead to a distribution mismatch between datasets acquired at different times, causing model performance to deteriorate on new data. A common additional obstacle in computational biology is scarce data with many more features than samples. To address these problems, we propose a method for unsupervised domain adaptation that is based on a weighted elastic net. The key idea of our approach is to compare dependencies between inputs in training and test data and to increase the cost of differently behaving features in the elastic net regularization term. In doing so, we encourage the model to assign a higher importance to features that are robust and behave similarly across domains. RESULTS: We evaluate our method both on simulated data with varying degrees of distribution mismatch and on real data, considering the problem of age prediction based on DNA methylation data across multiple tissues. Compared with a non-adaptive standard model, our approach substantially reduces errors on samples with a mismatched distribution. On real data, we achieve far lower errors on cerebellum samples, a tissue which is not part of the training data and poorly predicted by standard models. Our results demonstrate that unsupervised domain adaptation is possible for applications in computational biology, even with many more features than samples. AVAILABILITY AND IMPLEMENTATION: Source code is available at https://github.com/PfeiferLabTue/wenda. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Potential for cannabis adaptation among participants in a drunk driving intervention.

BACKGROUND: Some alcohol interventions have been found to have the adverse outcome of increasing non-alcohol-related substance use. It is unknown, however, how changes in alcohol use over the course of alcohol ignition interlocks - a common DUI intervention - may impact other substance use. METHODS: Alcohol and cannabis use were measured using hair ethylglucuronide and Delta-9-Tetrahydrocannabinol concentrations in blood, respectively. Participants (N = 69) were measured at the interlock installation period and again 6-months later while the interlock was installed. A mixed ANOVA was conducted to examine changes in levels of ethanol and THC over time. RESULTS: On measures of marijuana use, there was a significant interaction effect between the group that increased alcohol use and time F(2, 66) = 7.863, p =.001; partial η 2 =.192; as well as a main effect for time F(2, 66) = 21.106, p <.001; partial η 2 =.242. CONCLUSIONS: Installing interlocks may inadvertently increase cannabis use among those who decrease alcohol use. Crash risk associated with cannabis use is notably less than that of alcohol use, however, continued cannabis use may be problematic when the device is removed and alcohol use is expected to return to the higher pre-interlock levels.

Platelets derived from fresh and cold-stored whole blood participate in clot formation in rats with acute traumatic coagulopathy.

The in vitro haemostatic functions of fresh whole blood (FWB) are well preserved after cold storage. This study aimed to determine whether platelets derived from FWB and stored whole blood (SWB) contribute to clot formation in tissue injury after transfusion into coagulopathic rats with polytrauma/haemorrhage (T/H). The rats were resuscitated 1 h after trauma with FWB or SWB collected from green fluorescence protein (GFP) transgenic rats. After transfusion, a liver incision was made and the tissue was collected 10 min after injury to identify GFP+ platelets by immunohistochemistry. In comparison to FWB, platelet aggregation to adenosine diphosphate and protease-activated receptor-4 was reduced by 35% and 20%, and clotting time was shortened by 25% in SWB. After transfusion, SWB led to a significant increase in platelet activation as measured by an elevation of CD62P and phosphatidylserine expression. The platelets from SWB were in a higher activation state, and showed higher clearance rate and formation of platelet-leucocyte aggregates than those from FWB after transfusion. Platelets from both FWB and SWB were equivalently incorporated into the clot at the incisional site, as determined by co-localization of CD61 and GFP. This study suggests that SWB contributes to haemostatic function and is an effective alternative resource to treat trauma patients.

Estimation of the Potential Effectiveness of Lowering the Blood Alcohol Concentration (BAC) Limit for Driving from 0.08 to 0.05 Grams per Deciliter in the United States.

BACKGROUND: In 2013, the National Transportation Safety Board (NTSB) issued a report recommending that states lower the illegal blood alcohol concentration (BAC) limit for driving from 0.08 to 0.05 g/dl. The NTSB concluded that there is a strong evidence-based foundation for a BAC limit of 0.05 or lower. Most industrialized nations have already enacted a 0.05 illegal BAC limit. This study was undertaken to contribute to the scientific evidence as to whether lowering the BAC limit to 0.05 will be an effective alcohol policy in the United States. METHODS: We accomplished our objective by: (i) conducting a meta-analysis of qualifying international studies to estimate the range and distribution of the most likely effect size from a reduction to 0.05 BAC or lower; (ii) translating this synthesis toward estimating the effects of reducing the current 0.08 BAC limit to 0.05 in the United States; and (iii) estimating the life-saving benefits of the proposed 0.03 reduction in the driving limit from 0.08 to 0.05 BAC. RESULTS: In our meta-analysis of studies on lowering the BAC limit in general, we found a 5.0% decline in nonfatal alcohol-related crashes, a 9.2% decline in fatal alcohol-related crashes from lowering the BAC to 0.08, and an 11.1% decline in fatal alcohol-related crashes from lowering the BAC to 0.05 or lower. We estimate that 1,790 lives would be saved each year if all states adopted a 0.05 BAC limit. CONCLUSIONS: This study provides strong evidence of the relationship between lowering the BAC limit for driving and the general deterrent effect on alcohol-related crashes.

Concomitant and previous osteoporotic vertebral fractures.

Background and purpose - Patients with osteoporosis who present with an acute onset of back pain often have multiple fractures on plain radiographs. Differentiation of an acute osteoporotic vertebral fracture (AOVF) from previous fractures is difficult. The aim of this study was to investigate the incidence of concomitant AOVFs and previous OVFs in patients with symptomatic AOVFs, and to identify risk factors for concomitant AOVFs. Patients and methods - This was a prospective epidemiological study based on the Registry of Pathological Osteoporotic Vertebral Fractures (REPAPORA) with 1,005 patients and 2,874 osteoporotic vertebral fractures, which has been running since February 1, 2006. Concomitant fractures are defined as at least 2 acute short-tau inversion recovery (STIR-) positive vertebral fractures that happen concomitantly. A previous fracture is a STIR-negative fracture at the time of initial diagnostics. Logistic regression was used to examine the influence of various variables on the incidence of concomitant fractures. Results - More than 99% of osteoporotic vertebral fractures occurred in the thoracic and lumbar spine. The incidence of concomitant fractures at the time of first patient contact was 26% and that of previous fractures was 60%. The odds ratio (OR) for concomitant fractures decreased with a higher number of previous fractures (OR =0.86; p = 0.03) and higher dual-energy X-ray absorptiometry T-score (OR =0.72; p = 0.003). Interpretation - Concomitant and previous osteoporotic vertebral fractures are common. Risk factors for concomitant fractures are a low T-score and a low number of previous vertebral fractures in cases of osteoporotic vertebral fracture. An MRI scan of the the complete thoracic and lumbar spine with STIR sequence reduces the risk of under-diagnosis and under-treatment.