RESUMEN
Thalassemia major is a genetic haemoglobinopathy manifesting as severe anaemia, jaundice and hepatosplenomegaly. Due to altered iron metabolism and increased bone resorption it is associated with secondary osteoporosis manifested as decreased bone mineral density (BMD). Dual energy X-ray absorptiometry (DXA) is frequently performed for the diagnosis of secondary osteoporosis. Soft tissues are rarely visualized on DXA unless there is calcification involving those structures like nephro-, cholelithiasis or iatrogenic e.g. surgical clips. Hepatic iron deposition occurs in thalassemia due to repeated blood transfusions which leads to increased density of the liver resulting in visualization of liver on DXA scan. We present an interesting image of hepatic visualization on DXA performed for bone mineral density assessment in a patient with thalassemia major.
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Absorciometría de Fotón , Densidad Ósea , Hígado , Humanos , Absorciometría de Fotón/métodos , Hígado/diagnóstico por imagen , Talasemia beta/complicaciones , Talasemia beta/diagnóstico por imagen , Osteoporosis/diagnóstico por imagen , Femenino , Adulto , MasculinoRESUMEN
OBJECTIVE: We developed a few-shot learning (FSL) framework for the diagnosis of osteopenia and osteoporosis in knee X-ray images. METHODS: Computer vision models containing deep convolutional neural networks were fine-tuned to enable generalization from natural images (ImageNet) to chest X-ray images (normal vs. pneumonia, base images). Then, a series of automated machine learning classifiers based on the Euclidean distances of base images were developed to make predictions for novel images (normal vs. osteopenia vs. osteoporosis). The performance of the FSL framework was compared with that of junior and senior radiologists. In addition, the gradient-weighted class activation mapping algorithm was used for visual interpretation. RESULTS: In Cohort #1, the mean accuracy (0.728) and sensitivity (0.774) of the FSL models were higher than those of the radiologists (0.512 and 0.448). A diagnostic pipeline of FSL model (first)-radiologists (second) achieved better performance (0.653 accuracy, 0.582 sensitivity, and 0.816 specificity) than radiologists alone. In Cohort #2, the diagnostic pipeline also showed improved performance. CONCLUSIONS: The FSL framework yielded practical performance with respect to the diagnosis of osteopenia and osteoporosis in comparison with radiologists. This retrospective study supports the use of promising FSL methods in computer-aided diagnosis tasks involving limited samples.
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Enfermedades Óseas Metabólicas , Osteoporosis , Humanos , Osteoporosis/diagnóstico por imagen , Osteoporosis/diagnóstico , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Anciano , Rodilla/diagnóstico por imagen , Rodilla/patología , Algoritmos , Redes Neurales de la Computación , Aprendizaje Automático , Radiografía/métodos , Adulto , Estudios Retrospectivos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Diagnóstico por Computador/métodosRESUMEN
BACKGROUND: Patients with osteoporosis demonstrate increased vascular calcification but the effect of osteoporosis treatments on vascular calcification remains unclear. The present study aimed to examine whether coronary or aortic calcification are influenced by denosumab and alendronic acid treatment. METHODS AND RESULTS: In a double-blind randomized controlled SALTIRE2 (Study Investigating the Effect of Drugs Used to Treat Osteoporosis on the Progression of Calcific Aortic Stenosis) trial, patients with aortic stenosis were randomized 2:1:2:1 to denosumab, placebo injection, alendronic acid, or placebo capsule. Participants underwent serial imaging with computed tomography and 18F-sodium fluoride positron emission tomography for the assessment of vascular calcium burden and calcification activity, respectively. We report the prespecified secondary analyses of 24-month change in coronary calcium score, and 12-month changes in thoracic aorta calcium score, coronary and aortic 18F-sodium fluoride activity. One hundred fifty patients with aortic stenosis (72±8 years; 21% female) were randomized to denosumab (n=49), alendronic acid (n=51), and placebo (injection n=25, capsule n=25). There were no differences in change in coronary calcium scores between placebo (16 [-64 to 148] Agatston units) and either denosumab (94 [0-212] Agatston units, P=0.24) or alendronic acid (34 [-62 to 134], P=0.99). There were no differences in change in thoracic aorta calcium scores between placebo (132 [22-512] Agatston units) and either denosumab (118 [11-340], P=0.75) or alendronic acid (116 [26-498] Agatston units, P=0.62). There were no differences in changes in coronary or aortic 18F-sodium fluoride activity between treatment groups. CONCLUSIONS: Neither alendronic acid nor denosumab are associated with changes in the activity or progression of coronary or aortic calcification. Osteoporosis treatments do not appear to have major impact on vascular calcification of atherosclerosis. REGISTRATION: https://www.clinicaltrials.gov; Unique identifier: NCT02132026.
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Alendronato , Conservadores de la Densidad Ósea , Denosumab , Calcificación Vascular , Humanos , Femenino , Masculino , Denosumab/uso terapéutico , Anciano , Método Doble Ciego , Calcificación Vascular/diagnóstico por imagen , Alendronato/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Resultado del Tratamiento , Estenosis de la Válvula Aórtica/tratamiento farmacológico , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Osteoporosis/tratamiento farmacológico , Osteoporosis/diagnóstico por imagen , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico , Tomografía de Emisión de Positrones , Factores de TiempoRESUMEN
BACKGROUND: Bisphosphonate (BP) can treat osteoporosis and prevent osteoporotic fractures in clinical. However, the effect of BP on microstructure and mechanical properties of cortical and trabecular bone has been taken little attention, separately. METHODS: In this study, BP was used to intervene in ovariectomized female SD rats. The femoral micro-CT images were used to measure the structural parameters and reconstruct the 3D models in volume of interest. The structural parameters of cortical and trabecular bone were measured, and the mechanical properties were predicted using micro-finite element analysis. RESULTS: There was almost no significant difference in the morphological structure parameters and mechanical properties of cortical bone between normal, ovariectomized (sham-OVX) and BP intervention groups. However, BP could significantly improve bone volume fraction (BV/TV) and trabecular separation (Tb.SP) in inter-femoral condyles (IT) (sham-OVX vs. BP, p < 0.001), and had no significant effect on BV/TV in medial and lateral femoral condyles (MT, LT). Similarly, BPs could significantly affect the effective modulus in IT (sham-OVX vs. BP, p < 0.001), and had no significant difference in MT and LT. In addition, the structural parameters and effective modulus showed a good linear correlation. CONCLUSION: In a short time, the effects of BP intervention and osteoporosis on cortical bone were not obvious. The effects of BP on trabecular bone in non-main weight-bearing area (IT) were valuable, while for osteoporosis, the main weight-bearing area (MT, LT) may improve the structural quality and mechanical strength of trabecular bone through exercise compensation.
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Difosfonatos , Osteoporosis , Ovariectomía , Ratas Sprague-Dawley , Microtomografía por Rayos X , Animales , Femenino , Osteoporosis/tratamiento farmacológico , Osteoporosis/diagnóstico por imagen , Difosfonatos/farmacología , Difosfonatos/uso terapéutico , Ratas , Conservadores de la Densidad Ósea/farmacología , Conservadores de la Densidad Ósea/uso terapéutico , Fémur/efectos de los fármacos , Fémur/diagnóstico por imagen , Fémur/patología , Fémur/fisiopatología , Hueso Esponjoso/efectos de los fármacos , Hueso Esponjoso/diagnóstico por imagen , Hueso Esponjoso/patología , Fenómenos Biomecánicos , Modelos Animales de Enfermedad , Densidad Ósea/efectos de los fármacos , Análisis de Elementos FinitosRESUMEN
BACKGROUND: Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA). METHODS: Data used in the present study was drawn from a large multicentre study including 228 children aged 4-16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested. RESULTS: One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0-5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 - 0.5. For cone-beam CT, based on a 1-3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1). CONCLUSIONS: Categorizing DXA LS and automated radiographic Z-scores on a 0-5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.
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Absorciometría de Fotón , Artritis Juvenil , Densidad Ósea , Tomografía Computarizada de Haz Cónico , Humanos , Artritis Juvenil/diagnóstico por imagen , Artritis Juvenil/fisiopatología , Niño , Femenino , Masculino , Densidad Ósea/fisiología , Absorciometría de Fotón/métodos , Adolescente , Preescolar , Tomografía Computarizada de Haz Cónico/métodos , Osteoporosis/diagnóstico por imagen , Osteoporosis/etiología , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiopatologíaRESUMEN
In addition to human donor bones, bone models made of synthetic materials are the gold standard substitutes for biomechanical testing of osteosyntheses. However, commercially available artificial bone models are not able to adequately reproduce the mechanical properties of human bone, especially not human osteoporotic bone. To overcome this issue, new types of polyurethane-based synthetic osteoporotic bone models have been developed. Its base materials for the cancellous bone portion and for the cortical portion have already been morphologically and mechanically validated against human bone. Thus, the aim of this study was to combine the two validated base materials for the two bone components to produce femur models with real human geometry, one with a hollow intramedullary canal and one with an intramedullary canal filled with synthetic cancellous bone, and mechanically validate them in comparison to fresh frozen human bone. These custom-made synthetic bone models were fabricated from a computer-tomography data set in a 2-step casting process to achieve not only the real geometry but also realistic cortical thicknesses of the femur. The synthetic bones were tested for axial compression, four-point bending in two planes, and torsion and validated against human osteoporotic bone. The results showed that the mechanical properties of the polyurethane-based synthetic bone models with hollow intramedullary canals are in the range of those of the human osteoporotic femur. Both, the femur models with the hollow and spongy-bone-filled intramedullary canal, showed no substantial differences in bending stiffness and axial compression stiffness compared to human osteoporotic bone. Torsional stiffnesses were slightly higher but within the range of human osteoporotic femurs. Concluding, this study shows that the innovative polyurethane-based femur models are comparable to human bones in terms of bending, axial compression, and torsional stiffness.
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Fuerza Compresiva , Fémur , Ensayo de Materiales , Osteoporosis , Poliuretanos , Poliuretanos/química , Humanos , Fémur/diagnóstico por imagen , Fémur/fisiopatología , Fenómenos Biomecánicos , Osteoporosis/diagnóstico por imagen , Osteoporosis/fisiopatología , Pruebas MecánicasRESUMEN
Within the scope of this investigation, we carried out experiments to investigate the potential of the Vision Transformer (ViT) in the field of medical image analysis. The diagnosis of osteoporosis through inspection of X-ray radio-images is a substantial classification problem that we were able to address with the assistance of Vision Transformer models. In order to provide a basis for comparison, we conducted a parallel analysis in which we sought to solve the same problem by employing traditional convolutional neural networks (CNNs), which are well-known and commonly used techniques for the solution of image categorization issues. The findings of our research led us to conclude that ViT is capable of achieving superior outcomes compared to CNN. Furthermore, provided that methods have access to a sufficient quantity of training data, the probability increases that both methods arrive at more appropriate solutions to critical issues.
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Redes Neurales de la Computación , Osteoporosis , Osteoporosis/diagnóstico por imagen , Humanos , Rayos X , Procesamiento de Imagen Asistido por Computador/métodos , AlgoritmosRESUMEN
The primary aim of this study was to evaluate computed tomography (CT)-based bone density analysis at the level of thoracic vertebra 12 (Th12) as a screening method for decreased bone density in patients admitted to the intensive care unit (ICU). Interobserver variability was analyzed. Secondary aims were to assess the prevalence of CT-based low bone density upon ICU admission in a cohort of COVID-19 patients and to assess the potential effect of long-term ICU stay on bone density in these patients. Retrospective single-center cohort study. ICU of the Leiden University Medical Center (LUMC), the Netherlands. Patients admitted to the ICU of the LUMC between March 1st, 2020 and February 1st, 2022 with a diagnosis of COVID-19, and a length of ICU stay of ≥ 21 days. In the included patients both baseline chest CT scans (obtained upon ICU admission) and follow-up chest CT scans (obtained ≥ 21 days after ICU admission) were available for analysis. A total of 118 CT scans in 38 patients were analyzed. There was a good interobserver variability, with an overall mean absolute difference (between measurements of three observers) of 9.7 Hounsfield Units (HU) and an intraclass correlation coefficient (ICC) of 0.93 (95% CI 0.88-0.96). The effect of intravenous contrast administration on bone density measurements was small (+ 7.5 HU (95% CI 3.4-11.5 HU)) higher in contrast enhanced CT images compared to non contrast enhanced CT images). Thirty-seven percent of patients had a bone density < 140 HU, suggestive of osteoporosis. No significant difference was found between bone density upon ICU admission and bone density at follow-up (≥ 21 days after ICU admission). Vertebral CT-based bone density analysis using routine CT scans is an easily applicable method to identify ICU patients with decreased bone density, which could enable enrollment in osteoporosis prevention programs. A high prevalence of low bone density was found in our cohort of ICU patients. There were no changes observed in bone density between baseline and follow-up measurements.
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Densidad Ósea , COVID-19 , Osteoporosis , Tomografía Computarizada por Rayos X , Humanos , Osteoporosis/diagnóstico por imagen , Osteoporosis/diagnóstico , Femenino , Tomografía Computarizada por Rayos X/métodos , Masculino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Unidades de Cuidados Intensivos , Países Bajos/epidemiología , Tamizaje Masivo/métodos , Vértebras Torácicas/diagnóstico por imagen , SARS-CoV-2/aislamiento & purificación , Anciano de 80 o más AñosRESUMEN
BACKGROUND: There is a corresponding increase in the prevalence of osteoporosis and related fractures with the aging population on the rise. Furthermore, osteoporotic vertebral compression fractures (OVCF) may contribute to higher patient mortality rates. It is essential to conduct research on risk factors for OVCF and provide a theoretical basis for preventing such fractures. METHODS: We retrospectively recruited patients who had spine CT for OVCF or back pain. Demographic and CT data were collected. Quantitative computed tomography (QCT) software analyzed the CT data, using subcutaneous fat and paraspinal muscles as reference standards for BMD processing. BMD of cortical and cancellous bones in each patient's vertebral body was determined. RESULTS: In this study, 144 patients were divided into non-OVCF (96) and OVCF (48) groups. Non-OVCF patients had higher cortical BMD of 382.5 ± 52.4 to 444.6 ± 70.1 mg/cm3, with T12 having the lowest BMD (p < 0.001, T12 vs. L2). Cancellous BMD ranged from 128.5 ± 58.4 to 140.9 ± 58.9 mg/cm3, with L3 having the lowest BMD. OVCF patients had lower cortical BMD of 365.0 ± 78.9 to 429.3 ± 156.7 mg/cm3, with a further decrease in T12 BMD. Cancellous BMD ranged from 71.68 ± 52.07 to 123.9 ± 126.2 mg/cm3, with L3 still having the lowest BMD. Fractured vertebrae in OVCF patients (T12, L1, and L2) had lower cortical bone density compared to their corresponding vertebrae without fractures (p < 0.05). CONCLUSIONS: T12 had the lowest cortical BMD and L3 had the lowest cancellous BMD in OVCF patients, with T12 also having the highest incidence of osteoporotic fractures. These findings suggest that reduction in cortical BMD has a greater impact on OVCF than reduction in cancellous BMD, along with biomechanical factors.
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Densidad Ósea , Hueso Cortical , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Tomografía Computarizada por Rayos X , Humanos , Femenino , Anciano , Masculino , Fracturas Osteoporóticas/diagnóstico por imagen , Fracturas Osteoporóticas/etiología , Estudios Retrospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Hueso Cortical/diagnóstico por imagen , Factores de Riesgo , Anciano de 80 o más Años , Cuerpo Vertebral/diagnóstico por imagen , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/etiología , Osteoporosis/diagnóstico por imagenRESUMEN
Osteoporosis is under-diagnosed while detectable by measuring bone mineral density (BMD) using quantitative computer tomography (QCT). Opportunistic screening for low BMD has previously been suggested using lumbar QCT. However, thoracic QCT also possesses this potential to develop upper and lower cut-off values for low thoracic BMD, corresponding to the current cut-offs for lumbar BMD. In participants referred with chest pain, lumbar and thoracic BMD were measured using non-contrast lumbar- and cardiac CT scans. Lumbar BMD cut-off values for very low (< 80 mg/cm3), low (80-120 mg/cm3), and normal BMD (> 120 mg/cm3) were used to assess the corresponding thoracic values. A linear regression enabled identification of new diagnostic thoracic BMD cut-off values. The 177 participants (mean age 61 [range 31-74] years, 51% women) had a lumbar BMD of 121.6 mg/cm3 (95% CI 115.9-127.3) and a thoracic BMD of 137.0 mg/cm3 (95% CI: 131.5-142.5), p < 0.001. Categorization of lumbar BMD revealed 14%, 35%, and 45% in each BMD category. When applied for the thoracic BMD measurements, 25% of participants were reclassified into a lower group. Linear regression predicted a relationship of Thoracic BMD = 0.85 * Lumbar BMD + 33.5, yielding adjusted thoracic cut-off values of < 102 and > 136 mg/cm3. Significant differences in BMD between lumbar and thoracic regions were found, but a linear relationship enabled the development of thoracic upper and lower cut-off values for low BMD in the thoracic spine. As Thoracic CT scans are frequent, these findings will strengthen the utilization of CT images for opportunistic detection of osteoporosis.
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Densidad Ósea , Vértebras Lumbares , Osteoporosis , Vértebras Torácicas , Tomografía Computarizada por Rayos X , Humanos , Densidad Ósea/fisiología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Vértebras Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Osteoporosis/diagnóstico por imagen , Osteoporosis/diagnóstico , Vértebras Lumbares/diagnóstico por imagenRESUMEN
Bone health is crucial at all stages of life. Several medical conditions and changes in lifestyle affect the growth, structure, and functions of bones. This may lead to the development of bone degenerative disorders, such as osteoporosis, osteoarthritis, rheumatoid arthritis, etc., which are major public health concerns worldwide. Accurate and reliable measurement and monitoring of bone health are important aspects for early diagnosis and interventions to prevent such disorders. Significant progress has recently been made in developing new sensing technologies that offer non-invasive, low-cost, and accurate measurements of bone health. In this review, we have described bone remodeling processes and common bone disorders. We have also compiled information on the bone turnover markers for their use as biomarkers in biosensing devices to monitor bone health. Second, this review details biosensing technology for bone health assessment, including the latest developments in various non-invasive techniques, including dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and biosensors. Further, we have also discussed the potential of emerging technologies, such as biosensors based on nano- and micro-electromechanical systems and application of artificial intelligence in non-invasive techniques for improving bone health assessment. Finally, we have summarized the advantages and limitations of each technology and described clinical applications for detecting bone disorders and monitoring treatment outcomes. Overall, this review highlights the potential of emerging technologies for improving bone health assessment with the potential to revolutionize clinical practice and improve patient outcomes. The review highlights key challenges and future directions for biosensor research that pave the way for continued innovations to improve diagnosis, monitoring, and treatment of bone-related diseases.
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Absorciometría de Fotón , Técnicas Biosensibles , Huesos , Humanos , Técnicas Biosensibles/instrumentación , Técnicas Biosensibles/métodos , Huesos/diagnóstico por imagen , Absorciometría de Fotón/métodos , Enfermedades Óseas/diagnóstico , Remodelación Ósea/fisiología , Biomarcadores/análisis , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Osteoporosis/diagnóstico , Osteoporosis/diagnóstico por imagen , AnimalesRESUMEN
Osteoporosis is a systemic disease with a high incidence in the elderly and seriously affects the quality of life of patients. Photoacoustic (PA) technology, which combines the advantages of light and ultrasound, can provide information about the physiological structure and chemical information of biological tissues in a non-invasive and non-radiative way. Due to the complex structural characteristics of bone tissue, PA signals generated by bone tissue are non-stationary and nonlinear. However, conventional PA signal processing methods are not effective for non-stationary signal processing. In this study, an empirical mode decomposition (EMD)-based Hilbert-Huang transform (HHT) PA signal analysis method, called HHT PA signal analysis (HPSA), was developed to assess the microstructure information of bone tissue, which is closely related to bone health. The feasibility of the HPSA method in bone health assessment was proven by numerical simulation and experimental studies on animal samples with different bone volume/total volume (BV/TV) and bone mineral densities. First, based on adaptive EMD, the different modes correlated with multi-scale information were mined from the PA signal, the correlations between different intrinsic mode function (IMF) modes and BV/TVs were analyzed, and the optimal mode for more efficient PA time-frequency analysis was selected. Second, multi-wavelength HPSA was used to assess the changes in the chemical components of the bone tissue. The results demonstrate that the HPSA method can distinguish bones with different BV/TVs and microstructure conditions adaptively with high efficiency. They further emphasize the potential of PA techniques in characterizing biological tissues in bones for early and rapid detection of bone diseases.
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Hueso Esponjoso , Técnicas Fotoacústicas , Técnicas Fotoacústicas/métodos , Animales , Hueso Esponjoso/diagnóstico por imagen , Procesamiento de Señales Asistido por Computador , Densidad Ósea , Algoritmos , Procesamiento de Imagen Asistido por Computador/métodos , Osteoporosis/diagnóstico por imagen , Estudios de FactibilidadRESUMEN
BACKGROUND: T-score measurement via dual-energy X-ray absorptiometry (DXA) is the gold standard for assessing and classifying the bone mineral density status of patients as normal, osteopenic, or osteoporotic according to the World Health Organization criteria. However, the diagnostic accuracy may be affected by the skeletal site selected for DXA. OBJECTIVES: Estimate the prevalence of femoral and lumbar BMD discordance in a community-based setting in Riyadh, Saudi Arabia. DESIGN: Cross-sectional. SETTING: Polyclinics at a tertiary care center. PATIENTS AND METHODS: This study included all patients aged ≥60 years who visited the Department of Family Medicine and underwent DXA screening between 2016 and 2022. MAIN OUTCOME MEASURES: Discordance was defined as a difference in BMD status between two skeletal sites. Minor discordance occurs when adjacent sites have different diagnoses; i.e., one site exhibits osteoporosis and the other exhibits osteopenia. In contrast, major discordance occurs when one site exhibits osteoporosis and the other exhibits normal BMD. SAMPLE SIZE: 1429 older adults. RESULTS: The study patients had a median age of 66 years (60-99, minimum-maximum). The prevalence of discordance was 41.6%, with major discordance present in 2.2% of patients and minor discordance in 39.4%. The distribution of discordance did not differ significantly among the sociodemographic factors. CONCLUSION: Discordance is prevalent among the Saudi geriatric population. During the analysis of DXA results, physicians should account for discordance when diagnosing and ruling out osteoporosis in high-risk patients. LIMITATIONS: All factors influencing discordance were not explored thoroughly; this study mainly focused on older adults. Furthermore, diverse age groups need to be investigated for a more comprehensive understanding of the analyzed factors.
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Absorciometría de Fotón , Densidad Ósea , Enfermedades Óseas Metabólicas , Fémur , Vértebras Lumbares , Osteoporosis , Humanos , Femenino , Anciano , Masculino , Estudios Transversales , Arabia Saudita/epidemiología , Absorciometría de Fotón/métodos , Osteoporosis/epidemiología , Osteoporosis/diagnóstico , Osteoporosis/diagnóstico por imagen , Persona de Mediana Edad , Prevalencia , Vértebras Lumbares/diagnóstico por imagen , Anciano de 80 o más Años , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Fémur/diagnóstico por imagenRESUMEN
Patients with low bone mineral density (BMD) face an increased risk of fractures, yet are frequently undiagnosed. Consequently, it is imperative to have opportunistically screen for low BMD in patients undergoing other medical evaluations. This retrospective study encompassed 422 patients aged ≥ 50 who underwent both dual-energy X-ray absorptiometry (DXA) and hand radiographs (modality of digital X-ray) from three different vendors within a 12-month period. The dataset was randomly divided into training/validation (n=338) and test (n=84) datasets. we sought to predict osteoporosis/osteopenia and establish correlations between bone textural analysis and DXA measurements. Our results demonstrate that the deep learning model achieved an accuracy of 77.38%, sensitivity of 77.38%, specificity of 73.63%, and an area under the curve (AUC) of 83% in detecting osteoporosis/osteopenia. These findings suggest that hand radiographs can serve as a viable screening tool for identifying individuals warranting formal DXA assessment for osteoporosis/osteopenia.
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Absorciometría de Fotón , Osteoporosis , Humanos , Osteoporosis/diagnóstico por imagen , Persona de Mediana Edad , Femenino , Anciano , Masculino , Estudios Retrospectivos , Tamizaje Masivo , Sensibilidad y Especificidad , Densidad Ósea , Mano/diagnóstico por imagen , Aprendizaje Profundo , Enfermedades Óseas Metabólicas/diagnóstico por imagenRESUMEN
BACKGROUND: Older subjects have a higher risk for vertebral compression fracture. Maintaining a higher bone mineral density (BMD) at this age can protect individuals from osteoporosis-related events. Body mass index (BMI) has been found to have a robust association with BMD. However, excessive BMI is detrimental to bone health and may cause systemic disorders. Therefore, the present study aimed to determine the association between BMI and BMD, and identify a reasonable BMI range. METHODS: A total of 961 participants were recruited from community-dwelling residents between August 2021 and May 2022. A weighted multivariate linear regression model was applied to identify the relationship between BMI and BMD. Meanwhile, subgroup stratified analysis by BMI quartile and gender was also performed. A non-linear relationship and threshold value were determined based on the smooth curve fittings and threshold effects analysis model. RESULTS: A robust relationship was found between BMI and BMD, which remained significant in subgroups stratified by gender and BMI quartile. The BMI inflection point values in lumbar BMD and femoral neck BMD were 25.2 kg/m2 and 27.3 kg/m2, respectively. For individuals with BMI < 25.2 kg/m2, an increase in BMI was related to an increase in lumbar BMD. For BMI > 25.2 kg/m2, an increase in BMI was associated with a decrease in lumbar BMD. For subjects with BMI < 27.3 kg/m2, the femoral neck BMD rose by 0.008 kg/m2 for each unit rise in BMI. However, when BMI exceeded 27.3 kg/m2, the femoral neck BMD increased only by 0.005 kg/m2. Fracture risk assessment based on the spinal deformity index (SDI) failed to determine the optimal BMI range. CONCLUSIONS: This study found an inflection point between BMI and lumbar/ femoral neck BMD in older community-dwelling subjects. An appropriate BMI but not an excessive BMI may allow older adults to have a better BMD.
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Índice de Masa Corporal , Densidad Ósea , Vértebras Lumbares , Osteoporosis , Humanos , Densidad Ósea/fisiología , Masculino , Femenino , Anciano , Estudios Transversales , Beijing/epidemiología , Persona de Mediana Edad , Osteoporosis/epidemiología , Osteoporosis/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Cuello Femoral/diagnóstico por imagen , Anciano de 80 o más Años , Vida Independiente , Absorciometría de Fotón , Factores de RiesgoRESUMEN
BACKGROUND: The use of dual-energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) methods are important for the diagnosis and follow-up of osteoporosis, and are used especially in cases to determine the degree of osteoporosis and the risk of fracture, monitoring the effectiveness of the treatment applied. PURPOSE: To compare the parameters measured using the DEXA method from the lumbar (L1-L4) vertebrae and the Hounsfield unit (HU) values measured with QCT at the same levels among young adults and the elderly. MATERIAL AND METHODS: The study included 155 patients (age range = 26-93 years). A total of 57 (36.8%) patients (age range = 26-64 years) were defined as the first group, and 98 (63.2%) patients (aged ≥65 years) were defined as the second group. T-test and correlation analysis were performed to compare bone mineral density (BMD), T score, and HU values measured using DEXA and QCT. RESULTS: A statistically significant difference was found between T score, lumbar total BMD, and HU values according to age and sex (P < 0.05). When the values measured from lumbar vertebrae were compared using both DEXA and CT, a high correlation was found between them. CONCLUSION: In the study, it was observed that QCT attenuation measurements of the lumbar spine measured between different age groups provided reliable results in terms of BMD scanning, as in DEXA. It should be noted that QCT has a longer imaging time and higher radiation dose compared to DEXA, and unnecessary scans should be avoided.
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Absorciometría de Fotón , Densidad Ósea , Vértebras Lumbares , Tomografía Computarizada por Rayos X , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Femenino , Absorciometría de Fotón/métodos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano , Adulto , Anciano de 80 o más Años , Osteoporosis/diagnóstico por imagenRESUMEN
This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p < 0.001), although regression analyses revealed a strong linear association between these measures (R2 = 0.84). A statistical model for the prediction of TNC-VCa CT attenuation was established (TNC-VCa[HU] = - 6.81 + 0.87 × VP-VCa[HU]-0.55 × body weight[kg]) and yielded good agreement between observed and predicted values. Furthermore, a L1 CT attenuation threshold of 293 HU in VP-VCa showed a sensitivity of 90% and a specificity of 96% for detecting osteoporosis. The application of contrast media leads to an overestimation of L1 CT attenuation in VCa. However, CT attenuation values from VP-VCa can be used within CT-based opportunistic osteoporosis screening eighter by applying a separate threshold of 293 HU or by converting measured data to TNC-VCa CT attenuation with the given regression equation.
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Densidad Ósea , Calcio , Medios de Contraste , Tomografía Computarizada por Rayos X , Humanos , Medios de Contraste/química , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Anciano , Persona de Mediana Edad , Calcio/metabolismo , Densidad Ósea/efectos de los fármacos , Vértebras Lumbares/diagnóstico por imagen , Anciano de 80 o más Años , Columna Vertebral/diagnóstico por imagen , Adulto , Osteoporosis/diagnóstico por imagenRESUMEN
This study explored why some elderly females do not adhere to their bone density tests. It found that factors like age, race, marital status, insurance type, social vulnerability index, and vaccination status influence completion of these tests. Addressing these differences could improve the management of bone health in older adults. PURPOSE: This study investigated factors influencing the cancellation of dual-energy x-ray absorptiometry (DXA) scans among females aged 65 and above during the COVID-19 pandemic. METHODS: Utilizing a dataset of 19,066 females from 2021 to 2023, the research employed chi-squared tests and logistic regression analyses to examine demographic, socio-economic, and health-related determinants of DXA scan adherence. RESULTS: Key findings revealed that younger seniors, White patients, married individuals, those with commercial/private or Medicare insurance, and vaccinated persons were more likely to complete DXA scans. In contrast, Asian and African American females, along with those from higher Social Vulnerability Index areas, showed lower completion rates. CONCLUSION: These results highlight the need for tailored strategies to improve osteoporosis screening adherence, focusing on identified demographic groups to enhance overall healthcare outcomes in osteoporosis management.
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Absorciometría de Fotón , COVID-19 , Osteoporosis , Humanos , Absorciometría de Fotón/estadística & datos numéricos , COVID-19/epidemiología , Femenino , Anciano , Osteoporosis/diagnóstico por imagen , Osteoporosis/epidemiología , Centros Médicos Académicos/estadística & datos numéricos , Anciano de 80 o más Años , SARS-CoV-2 , Cooperación del Paciente/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Tamizaje Masivo/métodos , Densidad ÓseaRESUMEN
BACKGROUND: Osteoporotic fractures are a major global public health issue, leading to patient suffering and death, and considerable healthcare costs. Bone mineral density (BMD) measurement is important to identify those with osteoporosis and assess their risk of fracture. Both the absolute BMD and the change in BMD over time contribute to fracture risk. Predicting future fracture in individual patients is challenging and impacts clinical decisions such as when to intervene or repeat BMD measurement. Although the importance of BMD change is recognised, an effective way to incorporate this marginal effect into clinical algorithms is lacking. METHODS: We compared two methods using longitudinal DXA data generated from subjects with two or more hip DXA scans on the same machine between 2000 and 2018. A simpler statistical method (ZBM) was used to predict an individual's future BMD based on the mean BMD and the standard deviation of the reference group and their BMD measured in the latest scan. A more complex deep learning (DL)-based method was developed to cope with multidimensional longitudinal data, variables extracted from patients' historical DXA scan(s), as well as features drawn from the ZBM method. Sensitivity analyses of several subgroups was conducted to evaluate the performance of the derived models. RESULTS: 2948 white adults aged 40-90 years met our study inclusion: 2652 (90 %) females and 296 (10 %) males. Our DL-based models performed significantly better than the ZBM models in women, particularly our Hybrid-DL model. In contrast, the ZBM-based models performed as well or better than DL-based models in men. CONCLUSIONS: Deep learning-based and statistical models have potential to forecast future BMD using longitudinal clinical data. These methods have the potential to augment clinical decisions regarding when to repeat BMD testing in the assessment of osteoporosis.
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Densidad Ósea , Humanos , Densidad Ósea/fisiología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Absorciometría de Fotón , Aprendizaje Profundo , Anciano de 80 o más Años , Osteoporosis/diagnóstico por imagenRESUMEN
BACKGRUOUND: Osteoporosis and fragility fractures are crucial musculoskeletal complications in long-term survivors of gastric cancer. However, the relationship between changes in body composition after gastrectomy and bone loss has not been investigated. Therefore, this study aimed to explore whether computed tomography (CT)-derived body composition parameters are associated with bone loss after gastrectomy in patients with gastric cancer. METHODS: We retrospectively reviewed medical records and abdomen CT scans of patients who underwent gastrectomy at Yonsei University Severance Hospital between 2009 and 2018. Patients with non-metastatic gastric adenocarcinoma and preoperative and postoperative non-contrast CT scans were analyzed. Section area of skeletal muscle (SMA), visceral fat (VFA), and subcutaneous fat (SFA) were assessed using semi-automatic segmentation software. Changes in trabecular bone attenuation of L1 mid-vertebra level (L1 Hounsfield units [HU]) were measured. RESULTS: Fifty-seven patients (mean age, 65.5±10.6; 70.2% males) were analyzed, and the median duration was 31 months. Fortyseven patients (82.5%) lost weight after gastrectomy. Baseline SMA and VFA did not differ between the bone loss and preserved groups; however, baseline SFA was significantly higher in the bone preserved group than in the bone loss group (P=0.020). In a multivariable linear regression model adjusted for confounding factors, one standard deviation higher VFA at baseline was associated with greater annualized L1 HU loss (%) (P=0.034). However, higher preoperative SFA was associated with protection against bone loss after gastrectomy (P=0.025). CONCLUSION: Higher preoperative SFA exhibited a protective effect against bone loss after gastrectomy in patients with non-metastatic gastric cancer, whereas VFA exhibited a negative effect.