| 1. Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 2014;25:1439-43. |
Review/Other-Dx |
N/A |
To make the case and encourage clinicians to use the term osteoporosis when they identify an older patient with an elevated fracture risk determined by any one of these criteria: T-scores as one means for diagnosis but recommend that, alternatively, hip fracture; osteopenia-associated vertebral, proximal humerus, pelvis, or some wrist fractures; or FRAX scores with =3 % (hip) or 20 % (major) 10-year fracture risk. |
No results stated in abstract. |
4 |
| 2. Gillespie CW, Morin PE. Trends and Disparities in Osteoporosis Screening Among Women in the United States, 2008-2014. Am J Med 2017;130:306-16. |
Observational-Dx |
N/A |
To describe contemporary patterns of osteoporosis screening. |
verall screening rates were low: 21.1%, 26.5%, and 12.8% among women ages 50-64, 65-79, and 80+ years, respectively. Secular trends differed significantly by age (P <.001). Between 2008 and 2014, utilization among women ages 50-64 years declined 31.4%, changed little among women 65-79, and increased 37.7% among women 80+ years. Even after accounting for socioeconomic status, health status, and health care utilization patterns, non-Hispanic black women were least likely to be screened, whereas non-Hispanic Asian and Hispanic women were most likely to undergo screening. Marked socioeconomic gradients in screening probabilities narrowed substantially over time, decreasing by 44.5%, 71.9%, and 59.7% among women ages 50-64, 65-79 and 80+ years, respectively. |
4 |
| 3. Wright NC, Looker AC, Saag KG, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014;29:2520-6. |
Observational-Dx |
99 million adults |
To estimate the prevalence of osteoporosis and low bone mass based on bone mineral density (BMD) at the femoral neck and the lumbar spine in adults 50 years and older in the United States (US). |
There were over 99 million adults 50 years and older in the US in 2010. Based on an overall 10.3% prevalence of osteoporosis, we estimated that in 2010 10.2 million older adults had osteoporosis. The overall low bone mass prevalence was 43.9%, from which we estimated that 43.4 million older adults had low bone mass. We estimated that 7.7 million non-Hispanic White, 0.5 million non-Hispanic Black, and 0.6 million Mexican American adults had osteoporosis and another 33.8, 2.9, and 2.0 million had low bone mass, respectively. When combined, osteoporosis and low bone mass at the femoral neck or lumbar spine affected an estimated 53.6 million older US adults in 2010. Although most of the individuals with osteoporosis or low bone mass were non-Hispanic White women, a substantial number of men and women from other racial/ethnic groups also had osteoporotic BMD or low bone mass. |
4 |
| 4. Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res 2007;22:781-8. |
Review/Other-Dx |
1358 women and 858 men |
To estimate the residual lifetime risk of fracture (RLRF) in elderly men and women. |
After adjusting for competing risk of death, the RLRF for women and men from age 60 was 44% (95% CI, 40-48) and 25% (95% CI, 19-31), respectively. For individuals with osteoporosis (BMD T-scores < or = -2.5), the mortality-adjusted lifetime risk of any fracture was 65% (95% CI, 58-73) for women and 42% (95% CI, 24-71) for men. For the entire cohort, the lifetime risk of hip fracture was 8.5% (95% CI, 6-11%) for women and 4% (95% CI, 1.3-5.4%) for men; risk of symptomatic vertebral fracture was 18% (95% CI, 15-21%) for women and 11% (95% CI, 7-14%) for men. |
4 |
| 5. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465-475. |
Review/Other-Dx |
N/A |
To evaluate osteoporosis-related fractures and associated costs across race/ethnicity, age groups, sex, and fracture types in the United States during 2005 and projects costs and fracture incidence to the year 2025. |
More than 2 million incident fractures at a cost of $17 billion are predicted for 2005. Total costs including prevalent fractures are more than $19 billion. Men account for 29% of fractures and 25% of costs. Total incident fractures by skeletal site were vertebral (27%), wrist (19%), hip (14%), pelvic (7%), and other (33%). Total costs by fracture type were vertebral (6%), hip (72%), wrist (3%), pelvic (5%), and other (14%). By 2025, annual fractures and costs are projected to rise by almost 50%. The most rapid growth is estimated for people 65–74 years of age, with an increase >87%. An increase of nearly 175% is projected for Hispanic and other subpopulations. |
4 |
| 6. Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J, et al. Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States. JBMR Plus 2019;3:e10192. |
Review/Other-Dx |
N/A |
To project the future burden of osteoporotic fractures in women age 65 years and older (i.e., those likely to be at high risk of fractures) and evaluate the impact of increasing efforts to prevent such fractures to inform future healthcare policy for this vulnerable population to improve outcomes. |
We projected the fracture burden in US women by modeling the expected demographic shift as well as potential policy changes. With the anticipated population aging and growth, annual fractures are projected to increase from 1.9 million to 3.2 million (68%), from 2018 to 2040, with related costs rising from $57 billion to over $95 billion. Policy-driven expansion of case finding and treatment of at-risk women could lower this burden, preventing 6.1 million fractures over the next 22 years while reducing payer costs by $29 billion and societal costs by $55 billion. |
4 |
| 7. Balasubramanian A, Zhang J, Chen L, et al. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 2019;30:79-92. |
Review/Other-Dx |
377,561 women |
To assess the risk of subsequent fractures among postmenopausal women who have already sustained a fracture. |
Among 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65-74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women = 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1 year depending on initial fracture site; risk rose to 15-26% within 2 years and 28-42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture. |
4 |
| 8. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009;301:513-21. |
Review/Other-Dx |
2245 women and 1760 men |
To examine long-term mortality risk in women and men following all osteoporotic fractures and to assess the association of subsequent fracture with that risk. |
In women, there were 952 low-trauma fractures followed by 461 deaths, and in men, 343 fractures were followed by 197 deaths. Age-adjusted SMRs were increased following hip fractures (SMRs, 2.43 [95% confidence interval [CI], 2.02-2.93] and 3.51 [95% CI, 2.65-4.66]), vertebral fractures (SMRs, 1.82 [95% CI, 1.52-2.17] and 2.12 [95% CI, 1.66-2.72]), major fractures (SMRs, 1.65 [95% CI, 1.31-2.08] and 1.70 [95% CI, 1.23-2.36]), and minor fractures (SMRs, 1.42 [95% CI, 1.19-1.70] and 1.33 [95% CI, 0.99-1.80]) for both women and men, respectively. Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years. Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures. Increases in absolute mortality that were above expected, for 5 years after fracture, ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men, depending on fracture type. Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 (95% CI, 1.54-2.37) in women and 2.99 (95% CI, 2.11-4.24) in men. Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population (SMR, 1.41 [95% CI, 1.01-1.97] and SMR, 1.78 [95% CI, 0.96-3.31] for women and men, respectively). |
4 |
| 9. Haentjens P, Magaziner J, Colon-Emeric CS, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 2010;152:380-90. |
Meta-analysis |
24 articles |
To determine the magnitude and duration of excess mortality after hip fracture in older men and women. |
Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively. |
Good |
| 10. Fischer S, Kapinos KA, Mulcahy A, Pinto L, Hayden O, Barron R. Estimating the long-term functional burden of osteoporosis-related fractures. Osteoporos Int 2017;28:2843-51. |
Review/Other-Dx |
743 fracture cases |
To document evidence of an association between fractures and significant declines and functional health and activities that persist but attenuate beyond two years. |
Fracture cases reported increases in limitations to ADLs, difficulties with mobility, difficulties with gross motor skills, and difficulties with fine motor skills in each HRS collection period (the survey is administered every 2 years) following the fracture or index date (thus up to two years later) than matched controls (all p values < 0.05). The magnitude of these effects diminished in the second post-fracture wave (two to four years after fracture/index date), but they were still statistically significant. |
4 |
| 11. Morgan SL, Prater GL. Quality in dual-energy X-ray absorptiometry scans. Bone 2017;104:13-28. |
Review/Other-Dx |
N/A |
To review errors in DXA scanning that affect trueness and precision related to the machine, the patient, and the technologist and reviews articles which document problems with DXA quality in clinical and research settings. |
No results stated in abstract. |
4 |
| 12. American College of Radiology. ACR–SPR–SSR Practice Parameter for the Performance of Dual-Energy X-Ray Absorptiometry (DXA) . Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/DXA.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 13. Damilakis J, Adams JE, Guglielmi G, Link TM. Radiation exposure in X-ray-based imaging techniques used in osteoporosis. Eur Radiol. 2010;20(11):2707-2714. |
Review/Other-Dx |
N/A |
The article provides (a) a brief review of the current X-ray methods used for quantitative assessment of the skeleton, (b) data on the levels of radiation exposure associated with these methods and (c) information about radiation safety issues. |
No results stated. |
4 |
| 14. Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM. Opportunistic Use of CT Imaging for Osteoporosis Screening and Bone Density Assessment: A Qualitative Systematic Review. J Bone Joint Surg Am 2017;99:1580-90. |
Review/Other-Dx |
37 studies including 9,109 patients |
To determine the clinical opportunities for the use of computed tomography (CT) imaging for inferring bone quality and to critically analyze the correlation between dual x-ray absorptiometry (DXA) and diagnostic CT as reported in the literature. |
Of these, 10 studies correlated HU measurements of trabecular bone with DXA-based bone assessment. Reported correlation coefficients ranged between 0.399 and 0.891, and 5 of the studies reported appropriate threshold HU levels for diagnosing osteoporosis or osteopenia. |
4 |
| 15. Kim YW, Kim JH, Yoon SH, et al. Vertebral bone attenuation on low-dose chest CT: quantitative volumetric analysis for bone fragility assessment. Osteoporos Int. 28(1):329-338, 2017 01. |
Observational-Dx |
232 subjects (78 men and 154 women) |
To evaluate the use of low-dose chest computed tomography (LDCT) for detecting bone fragility. |
The average attenuation of the four vertebrae showed strong correlation with DXA-measured BMD of the lumbar spine (r = 0.726, p < 0.05). In receiver-operating characteristic (ROC) analyses, the area under the curve (AUC) across LDCT-measured thresholds of the average attenuation to distinguish compression fractures was 0.827, and a threshold of 129.5 HU yielded 90.9 % sensitivity and 64.4 % specificity. Similarly, average attenuation showed high AUCs and good diagnostic performance for detecting osteoporosis and low BMD in both men and women. Among 44 subjects with compression fractures, the average bone attenuation showed strong negative correlation with both the worst fracture grade (r = -0.525, p < 0.05) and cumulative fracture grade score (r = -0.633, p < 0.05). |
3 |
| 16. Lee SJ, Binkley N, Lubner MG, Bruce RJ, Ziemlewicz TJ, Pickhardt PJ. Opportunistic screening for osteoporosis using the sagittal reconstruction from routine abdominal CT for combined assessment of vertebral fractures and density. Osteoporos Int. 27(3):1131-1136, 2016 Mar. |
Observational-Dx |
571 adults |
To combine the tasks of density measurement and vertebral fracture assessment on the sagittal view. |
Mean absolute difference in L1 trabecular attenuation between transverse and sagittal reconstructions was 6.7 HU (±5.7) or 6.2%. The transverse and sagittal HU measurements were in agreement (i.e., both measurements above or below this threshold) in 94.5% of cases at the 110-HU cutoff. A total of 243 (42.3%) patients had likely osteoporosis by CT criteria, of which only 48 (19.8%) had previous DXA screening. |
3 |
| 17. Burrows M, Liu D, McKay H. High-resolution peripheral QCT imaging of bone micro-structure in adolescents. Osteoporos Int 2010;21:515-20. |
Observational-Dx |
278 participants (15-20 years old) |
To examine the feasibility of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microstructure in adolescents. |
The 2.8-min scan resulted in a relatively low radiation dose (<3 microSv) while producing artifact clear images in all participants. An 8% scan site was equivalent to 33 +/- 2 mm of total tibial length (400 +/- 30 mm). We observed active growth plates in 33 participants. The growth plate was located at 13 +/- 2 mm of total tibial length and was not included in the ROI for any participant. |
3 |
| 18. Shuhart CR, Yeap SS, Anderson PA, et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019;22:453-71. |
Review/Other-Dx |
N/A |
To summarize the ISCD Adult and Pediatric Official Positions, with the new 2019 positions highlighted in bold. |
No results stated in abstract. |
4 |
| 19. Curry SJ, Krist AH, Owens DK, et al. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA 2018;319:2521-31. |
Review/Other-Dx |
N/A |
To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis. |
No results stated in abstract. |
4 |
| 20. Kanis JA, Borgstrom F, De Laet C, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581-589. |
Review/Other-Dx |
N/A |
To review the assessment of fracture risk. |
No results stated in abstract. |
4 |
| 21. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35(2):375-382. |
Meta-analysis |
15259 men and 44902 women |
To quantify this risk on an international basis and to explore the relationship of this risk with age, sex, and bone mineral density (BMD). |
The results of the different studies were merged by using the weighted beta-coefficients. A previous fracture history was associated with a significantly increased risk of any fracture compared with individuals without a prior fracture (RR = 1.86; 95% CI = 1.75-1.98). The risk ratio was similar for the outcome of osteoporotic fracture or for hip fracture. There was no significant difference in risk ratio between men and women. Risk ratio (RR) was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any fracture (8%) and for hip fracture (22%). The risk ratio was stable with age except in the case of hip fracture outcome where the risk ratio decreased significantly with age. |
M |
| 22. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001;12:989-95. |
Review/Other-Dx |
N/A |
To estimate 10 year probabilities of osteoporotic fractures in men and women according to age and bone mineral density (BMD) at the femoral neck. |
The 10-year probability of any fracture was determined from the proportion of individuals fracture-free from the age of 45 years. With the exception of forearm fractures in men, 10 year probabilities increased with age and T-score. In the case of hip and spine fractures, fracture probabilities for any age with low BMD were similar between men and women. The effect of age on risk independently of BMD suggests that intervention thresholds should not be at a fixed T-score but vary according to absolute probabilities. Intervention thresholds based on hip BMD T-scores are similar between sexes. |
4 |
| 23. Shepherd JA, Schousboe JT, Broy SB, Engelke K, Leslie WD. Executive Summary of the 2015 ISCD Position Development Conference on Advanced Measures From DXA and QCT: Fracture Prediction Beyond BMD. J Clin Densitom 2015;18:274-86. |
Review/Other-Dx |
N/A |
To describe the methodology of the 2015 ISCD Position Development Conference and the results from the topics regarding advanced measures from DXA and QCT for fracture prediction beyond BMD. |
N/A |
4 |
| 24. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis- 2020 Update Executive Summary. Endocr Pract 2020;26:564-70. |
Review/Other-Dx |
N/A |
To develop clinical practice guidelines for the diagnosis and treatment of post-menopausal osteoporosis. |
No results stated in abstract. |
4 |
| 25. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 25(10):2359-81, 2014 Oct. |
Review/Other-Dx |
N/A |
A clinician's guide to prevention and treatment of osteoporosis. This guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men age 50 and older. |
N/A |
4 |
| 26. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis : report of a WHO study group [meeting held in Rome from 22 to 25 June 1992]. 1994; Available at: https://apps.who.int/iris/handle/10665/39142. |
Review/Other-Dx |
N/A |
To resolve several controversies concerning the usefulness of screening programmes, the appropriate target populations, the most effective methods for predicting fracture risk, techniques for assessment, and the comparative effectiveness of currently available preventive and therapeutic interventions. |
No results stated in abstract. |
4 |
| 27. Reid IR, Horne AM, Mihov B, et al. Fracture Prevention with Zoledronate in Older Women with Osteopenia. N Engl J Med 2018;379:2407-16. |
Experimental-Tx |
2000 women |
To assesses the effects of zoledronate on fracture in postmenopausal women with hip bone mineral density that is characterized as osteopenia. |
At baseline, the mean (±SD) age was 71±5 years, the T score at the femoral neck was -1.6±0.5, and the median 10-year risk of hip fracture was 2.3%. A fragility fracture occurred in 190 women in the placebo group and in 122 women in the zoledronate group (hazard ratio with zoledronate, 0.63; 95% confidence interval, 0.50 to 0.79; P<0.001). The number of women that would need to be treated to prevent the occurrence of a fracture in 1 woman was 15. As compared with the placebo group, women who received zoledronate had a lower risk of nonvertebral fragility fractures (hazard ratio, 0.66; P=0.001), symptomatic fractures (hazard ratio, 0.73; P=0.003), vertebral fractures (odds ratio, 0.45; P=0.002), and height loss (P<0.001). |
1 |
| 28. Kanis JA, McCloskey EV, Johansson H, Oden A, Strom O, Borgstrom F. Development and use of FRAX in osteoporosis. Osteoporos Int 2010;21 Suppl 2:S407-13. |
Review/Other-Dx |
N/A |
To review briefly the development and clinical use of FRAX in the development of assessment guidelines for osteoporosis. |
The FRAX tool integrates information on fracture risk from clinical risk factors with or without the use of BMD and can be used to improve the targeting of individuals at high fracture risk. |
4 |
| 29. Kanis JA, Hans D, Cooper C, et al. Interpretation and use of FRAX in clinical practice. Osteoporos Int. 2011;22(9):2395-2411. |
Review/Other-Dx |
N/A |
The introduction of the WHO FRAX(R) algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. Its use in fracture risk prediction has strengths, but also limitations of which the clinician should be aware and are the focus of this review. |
Details on the clinical risk factors currently used in FRAX are provided, and the reasons for the exclusion of others are provided. Recommendations are made for the development of surrogate models where country-specific FRAX models are not available. The wish list of clinicians for the modulation of FRAX is large, but in many instances, these wishes cannot presently be fulfilled; however, an explanation and understanding of the reasons may be helpful in translating the information provided by FRAX into clinical practice. |
4 |
| 30. Barton DW, Behrend CJ, Carmouche JJ. Rates of osteoporosis screening and treatment following vertebral fracture. Spine J. 19(3):411-417, 2019 03. |
Review/Other-Dx |
2,933 unique patients |
To demonstrate the current state of post vertebral fracture osteoporosis management at a large tertiary care center with no established secondary fracture prevention program. |
Between 2008 and 2014, 2,933 unique patients were seen at an included emergency department for one or more vertebral fracture encounters. Ninety-eight percent did not receive a DXA scan within the preceding 2 years or 1 year following fracture. Seven percent of patients were started on antiresorptive therapy after their fracture, with 341 (5%) starting within 1 year of fracture and 211 (2%) starting thereafter. Twenty-one percent (n=616) had taken an antiresorptive medication before their fracture. Seventy three percent (n=2,128) were never prescribed antiresorptive therapy. Treatment rates slightly decreased over time. Thirty eight percent of patients presenting with a vertebral fracture (n=1,115) went on to develop a second fragility fracture within 2 years. |
4 |
| 31. Trijau S, de Lamotte G, Pradel V, et al. Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database. RMD Open 2016;2:e000249. |
Observational-Dx |
32,812 patients |
To evaluate the rate of screening and treatment of GIOP. |
Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9-18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. |
4 |
| 32. Engelke K, Lang T, Khosla S, et al. Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part I. J Clin Densitom 2015;18:338-58. |
Review/Other-Dx |
N/A |
To discuss the ISCD official positions for the clinical use of quantitative computed tomography of the hip with supporting medical evidence, rationale, controversy, and suggestions for further study. |
No results stated in abstract. |
4 |
| 33. Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom 2014;17:438-48. |
Review/Other-Dx |
N/A |
A review on the clinical applications and new developments of axial quantitative CT (QCT). |
Compared with dual-energy X-ray absorptiometry, the current standard bone mineral density technique, QCT has a number of pertinent advantages, including volumetric measurements, less susceptibility to degenerative spine changes, and higher sensitivity to changes in bone mass. Disadvantages include the higher radiation doses and less experience with fracture prediction and therapy monitoring. Over the last 10 yr, a number of novel applications have been described allowing assessment of bone mineral density and bone quality in larger patient populations, developments that may substantially improve patient care. |
4 |
| 34. Cann CE, Adams JE, Brown JK, Brett AD. CTXA hip--an extension of classical DXA measurements using quantitative CT. PLoS One 2014;9:e91904. |
Observational-Dx |
69 patient and 22 controls |
To compare CTXA Hip and DXA areal BMD measures at both the femoral neck and total hip regions in a cohort of women between the ages of 20–80 years. |
Long-term reproducibility calculated as root-mean-square averages of SDs in vivo was 0.012 g/cm2 (CV?=?1.8%) for CTXA Total Hip and 0.011 g/cm2 (CV?=?2.0%) for CTXA Femoral Neck compared to 0.014 g/cm2 (CV?=?2.0%) and 0.016 g/cm2 (CV?=?2.7%), respectively, for DXA. The correlation of Total Hip BMD CTXA vs. DXA was R?=?0.97 and for Femoral Neck was R?=?0.95 (SEE 0.044 g/cm2 in both cases). Cortical bone comprised 62±5% (mean ± SD) of total hipbone mass in osteoporotic women. |
3 |
| 35. American College of Radiology. ACR–SPR–SSR Practice Parameter for the Performance of Quantitative Computed Tomography (QCT) Bone Densitometry. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/QCT.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 36. Loffler MT, Jacob A, Valentinitsch A, et al. Improved prediction of incident vertebral fractures using opportunistic QCT compared to DXA. Eur Radiol. 29(9):4980-4989, 2019 Sep. |
Observational-Dx |
84 patients |
To compare opportunistic quantitative CT (QCT) with dual energy X-ray absorptiometry (DXA) in their ability to predict incident vertebral fractures. |
Sixteen patients had incident vertebral fractures showing lower mean BMDQCT than patients without fracture (p = 0.001). For the risk of incident vertebral fractures, the hazard ratio increased per SD in BMDQCT (4.07; 95% CI, 1.98-8.38), as well as after adjusting for age, sex, and prevalent fractures (2.54; 95% CI, 1.09-5.90). For DXA, a statistically significant increase in relative hazard per SD decrease in T-score was only observed after age and sex adjustment (1.57; 95% CI, 1.04-2.38). The predictability of incident vertebral fractures was good by BMDQCT (AUC = 0.76; 95% CI, 0.64-0.89) and non-significant by T-scores. Asynchronously calibrated CT scanners showed good long-term stability (linear drift ranging from - 0.55 to - 2.29 HU per year). |
3 |
| 37. Njeh CF, Hans D, Li J, et al. Comparison of six calcaneal quantitative ultrasound devices: precision and hip fracture discrimination. Osteoporos Int 2000;11:1051-62. |
Observational-Dx |
35 subject and 35 controls |
To evaluate the abilities of six calcaneal QUS devices to discriminate between normal and hip-fractured subjects compared with the established method of dual-energy X-ray absorptiometry (DXA). |
Discrimination of fracture patients versus controls was assessed using logistic regression analysis (expressed as age- and BMI-adjusted odds ratios per standard deviation decrease with 95% confidence interval) and receiver operating characteristics (ROC) curve analysis. Measurement precision was standardized to the biological range (sCV). The sCV ranged from 3.14% to 5.5% for speed of sound (SOS) and from 2.45% to 6.01% for broadband ultrasound attenuation (BUA). The standardized medium-term precision ranged from 4.33% to 8.43% for SOS and from 2.77% to 6.91% for BUA. The pairwise Pearson correlation coefficients between different devices was highly significant (SOS, r = 0.79-0.93; BUA, r = 0.71-0.92). QUS variables correlated weakly, though significantly, with femoral BMD (SOS, r = 0.30-0.55; BUA, r = 0.35-0.61). The absolute BUA and SOS values varied among devices. The gel-coupled devices generally had a higher SOS than water-coupled devices. Bone mineral density (BMD) and BUA were weakly correlated with weight (r = 0.48-0.57 for BMD and r = 0.18-0.54 for BUA), whereas SOS was independent of weight. All the QUS devices gave similar, statistically significant hip fracture discrimination for both SOS and BUA measures. The odds ratios for SOS (2.1-2.8) and BUA (2.4-3.4) were comparable to those for femoral BMD (2.6-3.5), as were the area under the curve (SOS, 0.65-0.71; BUA, 0.62-0.71; BMD, 0.65-0.74) from ROC analysis. |
3 |
| 38. Krieg MA, Barkmann R, Gonnelli S, et al. Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11(1):163-187. |
Review/Other-Dx |
N/A |
The International Society for Clinical Densitometry (ISCD) 2007 Position Development Conference (PDC) addressed clinical applications of quantitative ultrasound for fracture risk assessment, diagnosis of osteoporosis, treatment initiation, monitoring of treatment, and quality assurance/quality control. The ISCD Official Positions on QUS resulting from this PDC, the rationale for their establishment, and recommendations for further study are presented in the document. |
N/A |
4 |
| 39. Oo WM, Naganathan V, Bo MT, Hunter DJ. Clinical utilities of quantitative ultrasound in osteoporosis associated with inflammatory rheumatic diseases. Quant Imaging Med Surg 2018;8:100-13. |
Review/Other-Dx |
N/A |
To address the potential utilities of QUS in secondary osteoporosis of inflammatory rheumatic diseases, focusing on the clinical aspects of QUS in these diseases, based on the conformity of QUS with dual emission X-ray absorptiometry (DXA), the relationship with disease characteristics, and its capability of fracture prediction. |
No results stated in abstract. |
4 |
| 40. Adami S, Gatti D, Rossini M, et al. The radiological assessment of vertebral osteoporosis. Bone 1992;13 Suppl 2:S33-6. |
Observational-Dx |
36 women |
To compare the lateral radiographs of lumbar and thoracic spine to similar X-ray pictures taken by chance at least five years before menopause. |
By defining a fracture as any decrease in vertical height above 1 mm, we found 77 deforming events in 29 out of 36 patients. We then applied some of the methods to identify objectively fractures in our postmenopausal radiographs: the sensitivity of the various systems ranged from 50 to 100%; however there was a large overlap between false positives and false negatives and the methods with the highest sensitivity lack specificity and vice versa. |
3 |
| 41. Haara M, Heliovaara M, Impivaara O, et al. Low metacarpal index predicts hip fracture: a prospective population study of 3,561 subjects with 15 years of follow-up. Acta Orthop 2006;77:9-14. |
Observational-Dx |
7,217 participants |
To study metacarpal index (MCI) for its ability to predict hip fractures. |
High age, low body mass index, tall stature and smoking at baseline showed, independently of each other, significant associations with low MCI. Low MCI was a strong predictor of hip fracture. When adjusted for all potential confounding factors, the relative risk of hip fracture per decrement of MCI by one standard deviation (0.1) was 1.5 (95% CI 1.2-1.8). |
3 |
| 42. Tecle N, Teitel J, Morris MR, Sani N, Mitten D, Hammert WC. Convolutional Neural Network for Second Metacarpal Radiographic Osteoporosis Screening. J Hand Surg Am 2020;45:175-81. |
Observational-Dx |
4,000 unique digital posteroanterior (PA) hand radiographs |
To determine whether a computer learning system could classify whether a hand radiograph demonstrated osteoporosis based on the second metacarpal cortical percentage. |
Laterality classification accuracy was 99.62%, with a specificity of 100% and sensitivity of 99.3%. Rotation of the hand within 10° of vertical was accurate in 93.2% of films. Segmentation was 94.8% accurate. Proxy osteoporosis predictor was 88.4% accurate. Full pipeline accuracy was 93.9%. In the testing data set, the CNN had a sensitivity of 82.4% and specificity of 95.7%. In the balanced data set, 6 of 39 osteoporotic films were classified as nonosteoporotic; sensitivity was 82.4% and specificity, 94.3%. |
3 |
| 43. Martineau P, Leslie WD, Johansson H, et al. Clinical Utility of Using Lumbar Spine Trabecular Bone Score to Adjust Fracture Probability: The Manitoba BMD Cohort. J Bone Miner Res 2017;32:1568-74. |
Observational-Dx |
34,316 women |
To determine how often applying the TBS adjustment to fracture probability altered treatment qualification. |
Overall, proportions of women reclassified with the TBS adjustment to FRAX were small (less than 5%) with more than 90% of the reclassification occurring close to the intervention threshold. For women close to an intervention cut-off reclassification, rates ranged from 9.0% to 17.9% and were <1% otherwise. There was a small but significant improvement in overall NRI for all individual FRAX-based intervention criteria (range 0.007 to 0.018) and all three national CPGs (range 0.008 to 0.011). NRI was larger in women below age 65 years (up to 0.056 for hip fracture). |
4 |
| 44. Winzenrieth R, Michelet F, Hans D. Three-dimensional (3D) microarchitecture correlations with 2D projection image gray-level variations assessed by trabecular bone score using high-resolution computed tomographic acquisitions: effects of resolution and noise. J Clin Densitom 2013;16:287-96. |
Observational-Dx |
Thirty human cadaveric vertebrae |
To determine the level of correlation between the 3-dimensional (3D) characteristics of trabecular bone microarchitecture, as evaluated using microcomputed tomography (µCT) reconstruction, and trabecular bone score (TBS), as evaluated using 2D projection images directly derived from 3D µCT reconstruction (TBSµCT). |
Correlations were detected that were strongly to intermediately positive for connectivity density (0.711 = r2 = 0.752) and trabecular number (0.584 = r2 = 0.648) and negative for trabecular space (-0.407 = r2 = -0.491), up to a pixel size of 1023 µm. In addition, TBSµCT values were strongly correlated between each other (0.77 = r2 = 0.96). |
3 |
| 45. Silva BC, Leslie WD, Resch H, et al. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res. 2014;29(3):518-530. |
Review/Other-Dx |
N/A |
A review on trabecular bone score. |
The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment. |
4 |
| 46. Padlina I, Gonzalez-Rodriguez E, Hans D, et al. The lumbar spine age-related degenerative disease influences the BMD not the TBS: the Osteolaus cohort. Osteoporos Int. 28(3):909-915, 2017 03. |
Observational-Dx |
1443 women |
To evaluate the influence of degenerative disease and fractured vertebra on lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) |
1443 women were enrolled: mean age 66.7 ± 11.7 years, BMI 25.7 ± 4.4. LS BMD and TBS were weakly correlated (r2 = 0.16). The correlation (Vex excluded) between age and BMD was +0.03, between age and TBS -0.34. According to age group, LS BMD was 1.2 to 3.2% higher before excluding Vex (p < 0.001). TBS had an insignificant change of <1% after excluding Vex. LS BMD (Vex) decreased by 4.6% between 52.5 and 62.5 years, and increased by 2.6% between 62.5 and 77.5 years. TBS (Vex excluded) values decreased steadily with age with an overall loss of 8.99% between 52.5 and 77.5 years. |
4 |
| 47. Florez H, Hernandez-Rodriguez J, Muxi A, et al. Trabecular bone score improves fracture risk assessment in glucocorticoid-induced osteoporosis. Rheumatology (Oxford). 59(7):1574-1580, 2020 07 01. |
Observational-Dx |
127 patients |
To analyze the clinical utility of trabecular bone score (TBS) evaluation for fracture risk assessment in glucocorticoid (GC)-treated patients compared with BMD assessment. |
All patients were receiving GC treatment for autoimmune diseases during 47.7 (68.9) months at a mean daily dose of 14.5 mg; 17% had VF, 28% any type of fragility fracture (VF + non-VF), 29% OP and 52% degraded microarchitecture. Degraded microarchitecture was significantly more frequent than densitometric OP in patients with VF (76% vs 38%) and with any fragility fracture (69% vs 36%). For VF, TBS and BMD sensitivity, specificity, PPV, and NPV were 0.76, 0.53, 0.25 and 0.92, and 0.38, 0.72, 0.22 and 0.85, respectively. Specificity increased to 0.89 for VF and 0.9 for any fragility fracture on combining BMD+TBS. TBS had better ability than BMD to discriminate between patients with fracture, especially VF (area under the curve = 0.73). |
3 |
| 48. Hans D, Stenova E, Lamy O. The Trabecular Bone Score (TBS) Complements DXA and the FRAX as a Fracture Risk Assessment Tool in Routine Clinical Practice. [Review]. Curr. osteoporos. rep.. 15(6):521-531, 2017 12. |
Review/Other-Dx |
N/A |
To review the scientific literature on TBS and answers the most relevant clinical questions. |
No results stated in abstract. |
4 |
| 49. Leslie W, Kanis JA, Lamy O, Johansson H, McCloskey EV, Hans D. Adjustment of FRAX probability according to lumbar spine Trabecular Bone Score (TBS): The Manitoba BMD Cohort. Journal of Clinical Densitometry 2013;16:267-68. |
Observational-Dx |
42,170 women |
We assessed the value of combining FRAX probability with lumbar spine TBS. |
During mean 5.6 y, incident MOFs were identified in 2661 women (674 hip fractures). Lower lumbar spine TBS and higher FRAX probabilities were found in fracture vs non fracture women (all P<0.001). TBS modulated fracture risk after adjustment for treatment and individual FRAX risk factors (hazard ratio [HR] per SD reduction in TBS: MOF 1.21 [95% CI 1.16-1.250, P<0.001; hip fracture 1.14 [95% CI 1.05-1.23), P=0.001). Results were largely unaffected by including lumbar spine BMD or spine-hip Tscore “offset” in the model. A preliminary method to adjust FRAX probability based upon lumbar spine TBS tertile is shown in the Table. When used to reclassify fracture risk, this gave a significant increase in integrated discrimination index for MOF (+1.3%, P<0.001) and hip fracture (+1.3%, P<0.001), with net reclassification improvement +4.6% for MOF (P<0.001). There was an age interaction with larger TBS effects in younger than older women age for MOF (P<0.001) and hip fracture (P=0.002). |
3 |
| 50. McCloskey EV, Oden A, Harvey NC, et al. A Meta-Analysis of Trabecular Bone Score in Fracture Risk Prediction and Its Relationship to FRAX. J Bone Miner Res 2016;31:940-8. |
Meta-analysis |
17,809 men and women in 14 prospective population-based cohorts |
To determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. |
FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% confidence interval [CI] 1.35–1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR?=?1.32, 95% CI 1.24–1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95% CI 1.65–1.87 versus 1.70, 95% CI 1.60–1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). |
Good |
| 51. Ripamonti C, Lisi L, Buffa A, Gnudi S, Caudarella R. The Trabecular Bone Score Predicts Spine Fragility Fractures in Postmenopausal Caucasian Women Without Osteoporosis Independently of Bone Mineral Density. Med Arh. 72(1):46-50, 2018 Feb. |
Observational-Dx |
699 white postmenopausal women |
To assess the ability of the TBS to predict spine fragility fractures (SFF) in postmenopausal women with or without osteoporosis (diagnosed by T-score=-2.5). |
At the unpaired t-test, both the TBS and the LS-BMD (p=0.001) were lower in women with SFF (n.62) in the entire-group. In the non-osteoporosis subgroup, the TBS (p=0.009) was lower in women with SFF (n.29). In the osteoporosis subgroup, the LS-BMD (p=0.003) was lower in women with SFF (n.33). Considering the TBS and LS-BMD separately in a block logistic regression, the TBS was associated with SFF in the entire-group (odds ratio (OR): 1.599, 95% confidence interval (CI): 1.021-2.128) and in the non-osteoporosis-subgroup (OR: 1.725, 95% CI:1.118-2.660) whereas LS-BMD was associated with SFF in the entire-group (OR: 1.611, 95% CI: 1.187-2.187) and in the osteoporosis-subgroup (OR: 2.383, 95% CI: 1.135-5.003). According to forward logistic regression, entering the TBS, LS-BMD and confounders as predictors, the LS-BMD in the entire-group (OR: 1.620, 95% CI: 1.229-2.135) and in the osteoporosis subgroup (OR: 2.344, 95% CI: 1.194-4.600), and the TBS in the non-osteoporosis subgroup (OR: 1.685, 95% CI: 1.131-2.511) were the only predictors of SFFs. |
3 |
| 52. Leslie WD, Aubry-Rozier B, Lamy O, Hans D. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab. 2013;98(2):602-609. |
Observational-Dx |
29,407 women |
To evaluate the ability of lumbar spine TBS to account for increased fracture risk in diabetes. |
Diabetes was associated with higher BMD at all sites but lower lumbar spine TBS in unadjusted and adjusted models (all P < .001). The adjusted odds ratio (aOR) for a measurement in the lowest vs the highest tertile was less than 1 for BMD (all P < .001) but was increased for lumbar spine TBS [aOR 2.61, 95% confidence interval (CI) 2.30-2.97]. Major osteoporotic fractures were identified in 175 women (7.4%) with and 1493 (5.5%) without diabetes (P < .001). Lumbar spine TBS was a BMD-independent predictor of fracture and predicted fractures in those with diabetes (adjusted hazard ratio 1.27, 95% CI 1.10-1.46) and without diabetes (hazard ratio 1.31, 95% CI 1.24-1.38). The effect of diabetes on fracture was reduced when lumbar spine TBS was added to a prediction model but was paradoxically increased from adding BMD measurements. |
4 |
| 53. Yamamoto M, Yamauchi M, Sugimoto T. Prevalent vertebral fracture is dominantly associated with spinal microstructural deterioration rather than bone mineral density in patients with type 2 diabetes mellitus. PLoS ONE. 14(9):e0222571, 2019. |
Observational-Dx |
548 patients |
To determine which bone properties predominantly contributed to increased bone fragility. |
Vertebral fractures (VFs) were identified in 74 (28.8%) women and 115 (39.5%) men. A relationship between BMD and VFs was observed in the limited subgroup of women with a BMD T-score =-1.0. According to multivariate logistic regression analysis, low TBS was significantly correlated with prevalent VFs, independent of BMD in both genders, except for men with a BMD T-score > -1.0. |
3 |
| 54. Munoz-Torres M, Manzanares Cordova R, Garcia-Martin A, et al. Usefulness of Trabecular Bone Score (TBS) to Identify Bone Fragility in Patients with Primary Hyperparathyroidism. J Clin Densitom. 22(2):162-170, 2019 Apr - Jun. |
Observational-Dx |
72 patients with primary hyperparathyroidism |
To evaluate the usefulness of TBS in patients with primary hyperparathyroidism in clinical practice. |
A total of 51.4% of the patients showed degraded microarchitecture while only 37.5% of them were diagnosed of osteoporosis by DXA. No significant correlation was found between TBS values and BMD parameters. However, TBS values were lower in osteoporotic patients compared to those classified as normal by BMD (1.16 ± 0.12vs 1.26 ± 0.17; p = 0.043) and in patients with fragility fractures compared to nonfractured patients (1.19 ± 0.03vs 1.24 ± 0.02, p < 0.001). The area under the curve for TBS performed better than the combination of femoral, hip and spine-BMD for prevalent fractures (0.714vs 0.679). TBS-adjusted FRAX was higher than nonadjusted model for both major osteoporotic and hip fracture (4.5% vs 3%; 0.9% vs 0.7%; p < 0.001). At follow-up, an improvement in TBS values was observed in treated patients (medical or surgical) vs nontreated close to significance (1.27 ± 0.10vs 1.24 ± 0.11, p = 0.074). |
3 |
| 55. Carey JJ, Delaney MF. Utility of DXA for monitoring, technical aspects of DXA BMD measurement and precision testing. Bone 2017;104:44-53. |
Review/Other-Dx |
N/A |
To describe some of the technical aspects of measurement and discuss the utility of DXA for monitoring patients in clinical practice. |
no results stated in abstract. |
4 |
| 56. Gourlay ML, Fine JP, Preisser JS, et al. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 2012;366:225-33. |
Observational-Dx |
4,957 women |
To determine how the BMD testing interval relates to the timing of the transition from normal BMD or osteopenia to the development of osteoporosis before a hip or clinical vertebral fracture occurs. |
The estimated BMD testing interval was 16.8 years (95% confidence interval [CI], 11.5 to 24.6) for women with normal BMD, 17.3 years (95% CI, 13.9 to 21.5) for women with mild osteopenia, 4.7 years (95% CI, 4.2 to 5.2) for women with moderate osteopenia, and 1.1 years (95% CI, 1.0 to 1.3) for women with advanced osteopenia. |
4 |
| 57. Lewiecki EM, Watts NB, McClung MR, et al. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004;89(8):3651-3655. |
Review/Other-Dx |
N/A |
Official positions of the international society for clinical densitometry. The report summarizes the methodology of the ISCD Position Development Conferences and presents selected Official Positions of general interest. |
N/A |
4 |
| 58. Kendler DL, Compston J, Carey JJ, Wu CH, Ibrahim A, Lewiecki EM. Repeating Measurement of Bone Mineral Density when Monitoring with Dual-energy X-ray Absorptiometry: 2019 ISCD Official Position. J Clin Densitom 2019;22:489-500. |
Review/Other-Dx |
N/A |
To clarify if and when BMD should be repeated. |
No results stated in abstract. |
4 |
| 59. Bezerra de Carvalho KS, Vasco RFV, Custodio MR, Jorgetti V, Moyses RMA, Elias RM. Chronic kidney disease is associated with low BMD at the hip but not at the spine. Osteoporosis International. 30(5):1015-1023, 2019 May. |
Review/Other-Dx |
1172 patients were included in this study (81.3% women, 79.9% white, and 8.1% diabetic) |
To investigate the features of bone mineral density (BMD) in patients with assorted kidney diseases and determine if low BMD, as measured by dual-energy X-ray absorptiometry (DXA), would be more prevalent as kidney function decreased and would correlate with biomarkers of mineral and bone disease. |
Osteopenia and osteoporosis in at least one site (total hip or spine) were found in 32.7% and 20.0% of patients, respectively. As CKD progressed, the percentage of patients with normal BMD decreased, whereas the percentage of osteopenia and osteoporosis increased, which was mostly due to the total hip involvement, particularly in patients with estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Older age and hyperparathyroidism were independent risk factors for osteopenia/osteoporosis at the total hip; female gender, older age, and higher iCa were independently associated with the risk of osteopenia/osteoporosis at the spine. With eGFR > 90 ml/min as reference, the odds ratios for osteoporosis/osteopenia at the hip were 1.51 (95% CI 1.01-2.24) and 1.91 (95% CI 1.13-3.20) for patients with eGFR 30-60 and 15-30 ml/min/1.73 m2, respectively. |
4 |
| 60. Bilezikian JP, Khan AA, Potts JT, Jr. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab. 2009;94(2):335-339. |
Review/Other-Dx |
N/A |
Guidelines for the management of asymptomatic primary hyperparathyroidism. |
N/A |
4 |
| 61. Engelke K, Fuerst T, Dardzinski B, et al. Odanacatib treatment affects trabecular and cortical bone in the femur of postmenopausal women: results of a two-year placebo-controlled trial. J Bone Miner Res 2015;30:30-8. |
Observational-Tx |
158 women |
To analyze quantitative computed tomography (QCT) data of postmenopausal women treated with odanacatib using Medical Image Analysis Framework. |
There were consistent and significant differential treatment effects (ODN-PBO) for total hip integral (5.4%), trabecular volumetric BMD (vBMD) (12.2%), and cortical vBMD (2.5%) at 24 months. There was no significant differential treatment effect on integral bone volume. Results for bone mineral content (BMC) closely matched those for vBMD for integral and trabecular compartments. However, with small but mostly significant differential increases in cortical volume (1.0% to 1.3%) and thickness (1.4% to 1.9%), the percentage cortical BMC increases were numerically larger than those of vBMD. With a total hip BMC differential treatment effect (ODN-PBO) of nearly 1000?mg, the proportions of BMC attributed to cortical gain were 45%, 44%, 52%, and 40% for the total, neck, trochanter, and intertrochanter subregions, respectively. |
2 |
| 62. Engelke K, Nagase S, Fuerst T, et al. The effect of the cathepsin K inhibitor ONO-5334 on trabecular and cortical bone in postmenopausal osteoporosis: the OCEAN study. J Bone Miner Res 2014;29:629-38. |
Experimental-Tx |
147 subjects |
To report the first QCT results from the OCEAN study. |
After 24 months ONO-5334 showed statistically significant increases versus placebo for integral, trabecular, and cortical BMD at the spine and the hip (for ONO-5334 300?mg QD, BMD increases were 10.5%, 7.1%, and 13.4% for integral, cortical, and trabecular BMD at the spine, respectively, and 6.2%, 3.4%, and 14.6% for integral, cortical, and trabecular total femur BMD, respectively). Changes in cortical and trabecular BMD in the spine and hip were similar for alendronate as for ONO-5334. Integral volume did not demonstrate statistically significant changes under ONO-5334 treatment, thus there was no evidence of periosteal apposition, neither at the spine nor at the femur. Cortical thickness changes were not statistically significant for ONO-5334 in the spine and hip, with exception of a 2.1% increase after month 24 in the intertrochanter for ONO-5334 300?mg QD. |
1 |
| 63. Genant HK, Libanati C, Engelke K, et al. Improvements in hip trabecular, subcortical, and cortical density and mass in postmenopausal women with osteoporosis treated with denosumab. Bone 2013;56:482-8. |
Observational-Tx |
62 postmenopausal women |
To report changes in BMD and bone mineral content (BMC) from baseline and compared placebo with denosumab over 36 months of treatment (placebo N=26; denosumab N=36). |
Denosumab treatment resulted in significant improvements in total hip integral volumetric BMD (vBMD) and BMC from baseline at each time point. At month 36, the mean percentage increase from baseline in total hip integral vBMD and BMC was 6.4% and 4.8%, respectively (both p<0.0001). These gains were accounted for by significant increases in vBMD and BMC in the trabecular, subcortical, and cortical compartments. In the placebo group, total hip integral vBMD and BMC decreased at month 36 from baseline by -1.5% and -2.6%, respectively (both p<0.05). The differences between denosumab and placebo were also significant at months 12, 24, and 36 for integral, trabecular, subcortical, and cortical vBMD and BMC (all p<0.05 to <0.0001). |
1 |
| 64. Hans D, Goertzen AL, Krieg MA, Leslie WD. Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study. J Bone Miner Res 2011;26:2762-9. |
Observational-Dx |
29,407 women |
To evaluate the ability of lumbar spine TBS to predict future clinical osteoporotic fractures. |
Health service records were assessed for the incidence of nontraumatic osteoporotic fracture codes subsequent to BMD testing (mean follow-up 4.7 years). Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Osteoporotic fractures were identified in 1668 (5.7%) women, including 439 (1.5%) spine and 293 (1.0%) hip fractures. Significantly lower spine TBS and BMD were identified in women with major osteoporotic, spine, and hip fractures (all p?<?0.0001). Spine TBS and BMD predicted fractures equally well, and the combination was superior to either measurement alone (p?<?0.001). |
2 |
| 65. Ho-Pham LT, Hans D, Doan MC, Mai LD, Nguyen TV. Genetic determinant of trabecular bone score (TBS) and bone mineral density: A bivariate analysis. Bone. 92:79-84, 2016 11. |
Observational-Dx |
556 women and 189 men |
To determine the genetic contribution to the variation of TBS in the general population. |
TBS was strongly correlated with lumbar spine BMD (r=0.73; P<0.001). On average TBS in men was higher than women, after adjusting age and height which are significantly associated with both TBS and lumbar spine BMD. The age and height adjusted index of heritability of TBS was 0.46 (95% CI, 0.39-0.54), which was not much different from that of LSBMD (0.44; 95% CI, 0.31-0.55). Moreover, the genetic correlation between TBS and LSBMD was 0.35 (95% CI, 0.21-0.46), between TBS and femoral neck BMD was 0.21 (95% CI, 0.10-0.33). |
4 |
| 66. Krueger D, Fidler E, Libber J, Aubry-Rozier B, Hans D, Binkley N. Spine trabecular bone score subsequent to bone mineral density improves fracture discrimination in women. J Clin Densitom. 2014;17(1):60-65. |
Observational-Dx |
158 women with fracture and 271 age-matched controls |
To evaluate the ability of TBS measurement to discriminate between older women with prior fragility fracture, including unappreciated vertebral fracture, from those without fracture, independent of their BMD. Additionally, the authors investigated whether the combination of TBS and BMD enhances fracture detection compared with either measurement alone. |
The correlation between lumbar spine bone mineral density (LS BMD) and trabecular bone score (TBS) was low (r = 0.28), suggesting these parameters reflect different bone properties. Age- and body mass index-adjusted odds ratios (ORs) ranged from 1.36 to 1.63 for LS or hip BMD in discriminating women with low trauma nonvertebral and vertebral fractures. TBS demonstrated ORs from 2.46 to 2.49 for these respective fractures; these remained significant after lowest BMD T-score adjustment (OR = 2.38 and 2.44). Seventy-three percent of all fractures occurred in women without osteoporosis (BMD T-score > -2.5); 72% of these women had a TBS score below the median, thereby appropriately classified them as being at increased risk. In conclusion, TBS assessment enhances DXA by evaluating trabecular pattern and identifying individuals with vertebral or low trauma fracture. TBS identifies 66-70% of women with fracture who were not classified with osteoporosis by BMD alone. |
3 |
| 67. Muschitz C, Kocijan R, Haschka J, et al. TBS reflects trabecular microarchitecture in premenopausal women and men with idiopathic osteoporosis and low-traumatic fractures. Bone 2015;79:259-66. |
Observational-Dx |
80 female patients and 43 male patients |
To test if TBS may be useful as a surrogate to histomorphometric trabecular parameters of transiliac bone biopsies. |
Micro-computed tomography values of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), structural model index (SMI) as well as serum bone turnover markers (BTMs) sclerostin, intact N-terminal type 1 procollagen propeptide (P1NP) and cross-linked C-telopeptide (CTX) were investigated. TBS values were higher in females (1.282 vs 1.169, p< 0.0001) with no differences in spine aBMD, whereas sclerostin levels (45.5 vs 33.4 pmol/L) and aBMD values at the total hip (0.989 vs 0.971 g/cm(2), p<0.001 for all) were higher in males. Multiple regression models including: gender, aBMD and BTMs revealed TBS as an independent, discriminative variable with adjusted multiple R(2) values of 69.1% for SMI, 79.5% for Tb.N, 68.4% for Tb.Sp, and 83.3% for BV/TV. |
3 |
| 68. Schousboe JT, Vo T, Taylor BC, et al. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men. J Bone Miner Res 2016;31:690-7. |
Review/Other-Dx |
5,979 men |
To use data from the Osteoporotic Fractures in Men (MrOS) study to estimate the associations of TBS with incident major osteoporotic and hip fractures in older men after adjustment for both FRAX 10 year fracture risk scores and prevalent radiographic vertebral fracture. |
Model discrimination was tested with Harrell’s C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% C.I. 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% C.I. 1.05 to 1.39) for hip fracture, adjusted for FRAX with BMD 10 year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared to those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% C.I. 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% C.I. 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. |
4 |
| 69. Bilezikian JP, Hattersley G, Fitzpatrick LA, et al. Abaloparatide-SC improves trabecular microarchitecture as assessed by trabecular bone score (TBS): a 24-week randomized clinical trial. Osteoporos Int 2018;29:323-28. |
Experimental-Tx |
222 postmenopausal women with osteoporosis |
To analyze the extent to which abaloparatide-SC improves skeletal microarchitecture, assessed indirectly by trabecular bone score (TBS). |
After 24 weeks, TBS increased significantly by 2.27, 3.14, and 4.21% versus baseline in participants on 20, 40, and 80 µg abaloparatide-SC daily, respectively, and by 2.21% in those on teriparatide (p < 0.05 for each). The TBS in the placebo group declined by 1.08%. The TBS increase in each treatment group was significantly higher than placebo at 24 weeks (p < 0.0001 for each) after adjustment for age, BMI, and baseline TBS. A dose-response was observed at 24 weeks across the three doses of abaloparatide-SC and placebo (p = 0.02). The increase in TBS in the abaloparatide-SC 80 µg group was significantly greater than TPTD (p < 0.03). |
1 |
| 70. Dhaliwal R, Hans D, Hattersley G, et al. Abaloparatide in Postmenopausal Women With Osteoporosis and Type 2 Diabetes: A Post Hoc Analysis of the ACTIVE Study. JBMR Plus 2020;4:e10346. |
Observational-Tx |
198 women |
To evaluated the efficacy and safety of abaloparatide in patients with T2DM. |
Significant (p?<?0.001) improvements in BMD at total hip (mean change 3.0% versus -0.4%), femoral neck (2.6% versus -0.2%), and lumbar spine (8.9% versus 1.3%) and TBS at lumbar spine (3.72% versus -0.56%) were observed with abaloparatide versus placebo at 18?months. Fracture events were fewer with abaloparatide treatment in patients with T2DM, and differences were not significant between groups except nonvertebral fractures in the abaloparatide versus placebo groups (p = 0.04). |
2 |
| 71. Saag KG, Agnusdei D, Hans D, et al. Trabecular Bone Score in Patients With Chronic Glucocorticoid Therapy-Induced Osteoporosis Treated With Alendronate or Teriparatide. Arthritis Rheumatol 2016;68:2122-8. |
Observational-Tx |
65 subjects |
To assess the effect of combination denosumab and teriparatide, as well as the transition from denosumab-to-teriparatide and teriparatide-to-denosumab, on skeletal microarchitecture of the spine, by measuring TBS in postmenopausal women who completed all 4 years of the DATA and DATA-Switch studies. |
Spine trabecular bone score (TBS, a gray-level textural assessment of bone microarchitecture) was measured blinded from treatment groups using images from 2-dimensional DXA spine scans at 0, 12, 24, 30, 36, and 48 months in 65 women who had PA spine DXA images suitable for TBS analysis. After 24 months, TBS increased by 2.7±4.7% in the teriparatide group (P=0.009 versus baseline), by 1.8±5.0% in the denosumab group (P=0.118 versus baseline), and by 4.5±6.7% in the combination group (P=0.017 versus baseline), with no significant between-group differences. In the 6-months after treatments were switched (months 24–30), TBS continued to increase in the combination-to-denosumab and teriparatide-to-denosumab groups but decreased by -1.1±4.0% in the denosumab-to-teriparatide group (P<0.05 versus other groups). After 48 months, compared to month 0, TBS increased by 5.1±5.8% in the teriparatide-to-denosumab group, by 3.6±4.2% in the denosumab-to-teriparatide group, and by 6.1±4.7% in the combination-to-denosumab group (P<0.001 versus baseline for all groups, P=NS for between group differences). |
2 |
| 72. Tsai JN, Jiang LA, Lee H, Hans D, Leder BZ. Effects of Teriparatide, Denosumab, or Both on Spine Trabecular Microarchitecture in DATA-Switch: a Randomized Controlled Trial. J Clin Densitom 2017;20:507-12. |
Experimental-Tx |
65 subjects |
To assess the effect of combination denosumab and teriparatide, as well as the transition from denosumab-to-teriparatide and teriparatide-to-denosumab, on skeletal microarchitecture of the spine, we measured TBS in postmenopausal women who completed all 4 years of the DATA and DATA-Switch studies. |
After 24 months, TBS increased by 2.7±4.7% in the teriparatide group (P=0.009 versus baseline), by 1.8±5.0% in the denosumab group (P=0.118 versus baseline), and by 4.5±6.7% in the combination group (P=0.017 versus baseline), with no significant between-group differences. In the 6-months after treatments were switched (months 24–30), TBS continued to increase in the combination-to-denosumab and teriparatide-to-denosumab groups but decreased by -1.1±4.0% in the denosumab-to-teriparatide group (P<0.05 versus other groups). After 48 months, compared to month 0, TBS increased by 5.1±5.8% in the teriparatide-to-denosumab group, by 3.6±4.2% in the denosumab-to-teriparatide group, and by 6.1±4.7% in the combination-to-denosumab group (P<0.001 versus baseline for all groups, P=NS for between group differences). |
1 |
| 73. Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D. Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice. J Clin Densitom 2017;20:334-45. |
Review/Other-Dx |
N/A |
To summarize a review of the current scientific literature with focus on fracture risk assessment and to present both its findings and its conclusions regarding how and when TBS should be used. |
No results stated in abstract. |
4 |
| 74. Delmas PD, van de Langerijt L, Watts NB, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res. 2005;20(4):557-563. |
Observational-Dx |
2451 postmenopausal women |
To assess prospectively and globally the accuracy of the spinal radiographic diagnosis of vertebral fractures by comparing results of local radiographic reports with that of subsequent central readings. |
Of 2451 women with an evaluable radiograph both centrally and locally, 789 (32%) had at least one vertebral fracture. Adjudicated discrepancies (n = 350 patients) between local and central readings because of undetected vertebral fracture (68%) or equivocal terminology in the local radiology report (32%) yielded a false-negative rate of 34%. |
3 |
| 75. Kanterewicz E, Puigoriol E, Rodriguez Cros JR, Peris P. Prevalent vertebral fractures and minor vertebral deformities analyzed by vertebral fracture assessment (VFA) increases the risk of incident fractures in postmenopausal women: the FRODOS study. Osteoporos Int. 30(10):2141-2149, 2019 Oct. |
Review/Other-Dx |
2,510 women |
To analyze the incidence of VF, the associated risk factors, and particularly the role of MVD in this cohort of subjects. |
Overall, the incidence of VF was 6.6%, increasing with prevalent VF (24.5%) and in women with prevalent MVD (17.7%). |
4 |
| 76. Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis. Bone 2020;136:115358. |
Meta-analysis |
28 studies |
To systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry. |
A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%). |
Good |
| 77. Van der Klift M, De Laet CE, McCloskey EV, Hofman A, Pols HA. The incidence of vertebral fractures in men and women: the Rotterdam Study. J Bone Miner Res 2002;17:1051-6. |
Review/Other-Dx |
7,983 participants |
To investigate the incidence of vertebral fractures in nearly 3500 subjects aged 55 years and over during more than 6 years of follow-up. |
The incidence increased strongly with age, ranging from 7.8/1000 person years (PY) at ages 55-65 years to 19.6/1000 PY at ages over 75 years for women, and 5.2-9.3/1000 PY for men, respectively. |
4 |
| 78. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148. |
Review/Other-Dx |
57 postmenopausal women |
To determine the incidence and prevalence of vertebral fractures postmenopausal women (age 65-75 years) by three independent observers. |
The results show excellent intraobserver agreement and good interobserver agreement for the semiquantitative technique. The authors conclude that the semiquantitative approach can be applied reliably in vertebral fracture assessment when performed using well-defined criteria. |
4 |
| 79. Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH. Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporos Int. 2007;18(6):761-770. |
Review/Other-Dx |
2,651 postmenopausal women |
To quantify the impact of vertebral fracture burden on two year fracture risk across a range of BMD T-scores. |
Femoral neck BMD T-score provided significant information regarding fracture risk. Across the range of T-scores, vertebral fracture status provided additional prognostic information. The risk increased with increasing number and severity of prevalent vertebral fractures and SDI, a summary measure of spine fracture burden. Across a range of BMD values, prevalent spine fracture burden as assessed by SDI increased the risk of incident vertebral fractures by up to 12-fold, nonvertebral fractures by about twofold, and any fractures by up to sevenfold. |
4 |
| 80. Ferrar L, Jiang G, Cawthon PM, et al. Identification of vertebral fracture and non-osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 2007;22:1434-41. |
Review/Other-Dx |
732 men |
To (1) compare the prevalence of osteoporotic vertebral fracture in elderly men comparing the ABQ-modified diagnostic approach and two established diagnostic methods; (2) identify reasons for discordance between the different diagnostic methods; and (3) determine whether men with nonosteoporotic SVH identified by ABQ have lower than expected values for BMD. |
The prevalence of at least one VF was 10% (ABQ); 13% (SQ) and 11% (QM-triage) and of at least one SVH (ABQ) was >50%. Agreement between methods was moderate (? = 0.42–0.62). Discordance between methods related mainly to classification of mild thoracic wedging or possible traumatic VF by ABQ. Mean BMD was lower in men with VF (any diagnostic method) than in those without (two-sample t-test, p < 0.05). For ABQ, BMD was similar in men with SVH (no VF) and men with normal vertebrae (ANOVA, p > 0.05). Mean BMD was significantly lower than expected in 40 men with VF identified by all three methods and average or more than average in those identified by a single method. |
4 |
| 81. Delmas PD, Genant HK, Crans GG, et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 2003;33:522-32. |
Observational-Dx |
7705 women with osteoporosis |
To examine whether baseline vertebral fracture severity can predict new vertebral and nonvertebral fracture risk. |
Baseline vertebral fracture severity predicted vertebral and nonvertebral fracture risk at 3 years. In women without prevalent vertebral fractures, 4.3 and 5.5% had new vertebral and nonvertebral fractures, respectively. In women with mild, moderate, and severe prevalent vertebral fractures, 10.5, 23.6, and 38.1% respectively had new vertebral fractures, whereas 7.2, 7.7, and 13.8% respectively experienced new nonvertebral fractures. Number of prevalent vertebral fractures and baseline BMD also predicted vertebral fracture risk, but the severity of prevalent vertebral fractures was the only predictor of nonvertebral fracture risk and remained a significant predictor after adjustment for baseline characteristics, including baseline BMD. In patients with severe baseline vertebral fractures, raloxifene 60 mg/day decreased the risks of new vertebral [RR 0.74 (95% Cl 0.54, 0.99); P = 0.048] and nonvertebral (clavicle, humerus, wrist, pelvis, hip, and leg) fractures [RH 0.53 (95% CI 0.29, 0.99); P = 0.046] at 3 years. To prevent one new fracture at 3 years in women with severe baseline vertebral fractures with raloxifene 60 mg/day, the number needed to treat (NNT) was 10 for vertebral and 18 for nonvertebral fractures. Similar results were observed in women receiving raloxifene 120 mg/day. |
3 |
| 82. Fink HA, Milavetz DL, Palermo L, et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 2005;20:1216-22. |
Observational-Dx |
330 women |
To evaluate the impact on the relationship between these entities of using alternative radiographic criteria for the identification of new deformities. |
A total of 446 incident radiographic vertebral deformities were identified in 330 women, whereas 121 women experienced one or more confirmed incident clinical vertebral fracture. Of incident radiograpic vertebral deformities, 22.6% were also clinically diagnosed as incident vertebral fractures, with clinical diagnoses made for 28.4% of the deformities that exceeded 30% and 4 mm height loss (severe deformity) compared with 14.3% for deformities that involved > or = 20% and 4 mm but < 30% height loss (milder deformity). Of incident clinical vertebral fractures, 72.7% were morphometrically identified as incident deformities, most of them as severe deformities. More than 20% of incident clinical fractures were not identified as incident deformities by even the most liberal morphometric criterion used in this study. |
3 |
| 83. Clark P, Cons-Molina F, Deleze M, et al. The prevalence of radiographic vertebral fractures in Latin American countries: the Latin American Vertebral Osteoporosis Study (LAVOS). Osteoporos Int 2009;20:275-82. |
Review/Other-Dx |
1,922 women aged 50 years and older |
To report the first study of radiographic vertebral fractures in Latin America. |
A standardized prevalence of 11.18 (95% CI 9.23-13.4) was found. The prevalence was similar in all five countries, increasing from 6.9% (95% CI 4.6-9.1) in women aged 50-59 years to 27.8% (95% CI 23.1-32.4) in those 80 years and older (p for trend < 0.001). Among different risk factors, self-reported height loss OR = 1.63 (95% CI: 1.18-2.25), and previous history of fracture OR = 1.52 (95% CI: 1.14-2.03) were significantly (p < 0.003 and p < 0.04 respectably) associated with the presence of radiographic vertebral fractures in the multivariate analysis. In the bivariate analyses HRT was associated with a 35% lower risk OR = 0.65 (95% CI: 0.46-0.93) and physical activity with a 27% lower risk of having a vertebral fracture OR = 0.73 (95% CI: 0.55-0.98), but were not statistically significant in multivariate analyses |
4 |
| 84. Ferrar L, Roux C, Felsenberg D, Gluer CC, Eastell R. Association between incident and baseline vertebral fractures in European women: vertebral fracture assessment in the Osteoporosis and Ultrasound Study (OPUS). Osteoporos Int 2012;23:59-65. |
Review/Other-Dx |
674 women |
To examine the prevalence and incidence of VF and test the association between prevalent and incident VF identified by ABQ VFA. |
Prevalent VF was identified in one premenopausal woman and 41 postmenopausal women. Incident VF was identified in 18 postmenopausal women. Odds ratios (95% CI) for incident VF in postmenopausal women with prevalent VF were 7.8 (2.8, 22.1) (unadjusted) and 4.3 (1.4, 13.7) (adjusted for age and bone mineral density, BMD). Women with prevalent or incident VF were older (P < 0.01), with lower hip BMD (P < 0.001) compared to women without VF. |
4 |
| 85. Schousboe JT, Rosen HR, Vokes TJ, et al. Prediction models of prevalent radiographic vertebral fractures among older women. J Clin Densitom 2014;17:378-85. |
Review/Other-Dx |
7,233 women |
To compare four regression models for predicting PVFx in women age 68 and older . |
The AUROC for a model with age, femoral neck bone mineral density (BMD), historical height loss (HHL), prior non-spine fracture, body mass index, back pain, and grip strength was only minimally better than that of a more parsimonious model with age, femoral neck BMD, and HHL (AUROC 0.689 vs. 0.679, p-values for difference in five bootstrapped samples <0.001 to 0.35). The prevalence of PVFx among this older population of Caucasian women remained over 20% even when women with low probability of PVFx, as estimated by the prediction models, were included in the screened population. |
4 |
| 86. Amin S, Achenbach SJ, Atkinson EJ, Khosla S, Melton LJ, 3rd. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res 2014;29:581-9. |
Review/Other-Dx |
3,549 residents |
To provide more current information on fracture burden in the community by updating our earlier study to estimate skeletal site-specific and overall fracture incidence in a population-based descriptive study among Olmsted County residents =50 years of age in 2009–11 and to test for secular trends at each fracture site since 1989–91. |
The age- and sex-adjusted (to the 2010 US white population) incidence of any fracture was 2704 per 100,000 person-years (95% confidence interval [CI] 2614 to 2793) and that for all fractures was 4017 per 100,000 (95% CI 3908 to 4127). Fracture incidence increased with age in both sexes, but age-adjusted rates were 49% greater among the women. Overall, comparably adjusted fracture incidence rates increased by 11% (from 3627 to 4017 per 100,000 person-years; p = 0.008) between 1989 to 1991 and 2009 to 2011. This was mainly attributable to a substantial increase in vertebral fractures (+47% for both sexes combined), which was partially offset by a decline in hip fractures (-25%) among the women. There was also a 26% reduction in distal forearm fractures among the women; an increase in distal forearm fractures among men aged 50 years and over was not statistically significant. The dramatic increase in vertebral fractures, seen in both sexes and especially after age 75 years, was attributable in part to incidentally diagnosed vertebral fractures. |
4 |
| 87. Bassgen K, Westphal T, Haar P, Kundt G, Mittlmeier T, Schober HC. Population-based prospective study on the incidence of osteoporosis-associated fractures in a German population of 200,413 inhabitants. J Public Health (Oxf) 2013;35:255-61. |
Review/Other-Dx |
200,413 residents |
To prospectively register four types of fractures in an urban population. |
A total of 979 fractures occurred during the period of investigation. The most common type was the distal radius fracture (395; 197.1 per 100 000). The retrospective detected data of the Statistical Bureau were 31, 56% lower than the actual number of fractures. A retrospective analysis of fractures based on the ICD registers of the hospitals revealed an over-registration rate of 26.67%. |
4 |
| 88. Siggeirsdottir K, Aspelund T, Jonsson BY, et al. Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989-2008. Osteoporos Int 2014;25:211-9. |
Review/Other-Dx |
9,116 men and 9,756 women |
To assess the incidence of all fractures in Iceland, with emphasis on the rate of hip fractures, and compare the incidence with other populations as well as examine the secular changes. |
The ratio of first fracture incidence between the sexes varied considerably by site: 2.65 for hip fractures and the highest for distal forearm fractures at 4.83. By the age of 75, 36.7% of women and 21% of men had sustained a fracture, taking into account competing risk of death. The incidence of hip fractures was similar to results previously published from USA, Sweden, Norway, and Scotland. The incidence of MOS fractures in both sexes decreased over the last decade, except hip fractures in men, which remained unchanged, as reflected in the women/men ratio for the hip, which changed from 2.6 to 1.7. |
4 |
| 89. Angeli A, Guglielmi G, Dovio A, et al. High prevalence of asymptomatic vertebral fractures in post-menopausal women receiving chronic glucocorticoid therapy: a cross-sectional outpatient study. Bone 2006;39:253-9. |
Review/Other-Dx |
551 patients |
To measure the prevalence of asymptomatic vertebral fractures in a large sample of post-menopausal women given GCs for different diseases; to compare prevalence of asymptomatic vertebral fractures according to disease, GC treatment and major risk factors; and to assess the quality of life in GC users with and without asymptomatic vertebral fractures. |
Each patient underwent structured medical interview (including dose and duration of GC therapy, major risk factors for osteoporosis, the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO) and a back function score questionnaire), thoraco-lumbar radiographs and subsequent morphometry; for 253 and 437 patients, respectively, lumbar spine bone mineral density (BMD) assessed by dual energy X-ray absorptiometry and calcaneal bone stiffness assessed by quantitative ultrasonometry were available. The prevalence of asymptomatic vertebral fractures resulted >37%, with >14% of patients having two or more asymptomatic vertebral fractures and was much higher than that found in epidemiological studies on healthy women. Distribution of asymptomatic vertebral fractures along the spine showed a bimodal pattern, with two peaks at T7 and T11. The prevalence of asymptomatic vertebral fractures clearly increased with age. Differences in prevalence among diseases were evidenced. When controlled for age, GC cumulative dose, duration of therapy and personal history of fractures, the adjusted prevalences were 30.77% for systemic lupus erythematosus, 33.78% for rheumatoid arthritis, 37.78% for asthma/chronic obstructive pulmonary disease, 43.20% for polymyalgia rheumatica and 43.36% for diseases grouped as "other vasculitides/connective tissue diseases". |
4 |
| 90. Klaus J, Armbrecht G, Steinkamp M, et al. High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease. Gut 2002;51:654-8. |
Review/Other-Dx |
293 patients |
To evaluate the prevalence of osteoporotic vertebral fractures in these patients. |
In 34 (21.8%; 18 female) of 156 Crohn's disease patients with reduced bone mineral density, 63 osteoporotic vertebral fractures (50 fx. (osteoporotic fracture with visible fracture line running into the vertebral body and/or change of outer shape) and 13 fxd. (osteoporotic fracture with change of outer shape but without visible fracture line)) were found, 50 fx. in 25 (16%, 15 female) patients and 13 fxd. in nine (5.8%, three female) patients. In four patients the fractures were clinically evident and associated with severe back pain. Approximately one third of patients with fractures were younger than 30 years. Lumbar bone mineral density was significantly reduced in patients with fractures compared with those without (T score -2.50 (0.88) v -2.07 (0.66); p<0.025) but not at the hip (-2.0 (1.1) v -1.81 (0.87); p=0.38). In subgroups analyses, no significant differences were observed. |
4 |
| 91. Tsugeno H, Tsugeno H, Fujita T, et al. Vertebral fracture and cortical bone changes in corticosteroid-induced osteoporosis. Osteoporos Int 2002;13:650-6. |
Observational-Dx |
86 women |
To examine in detail the effect of qualitative bone changes assessed by peripheral quantitative computed tomography (pQCT) on the fracture risk in corticosteroid-induced osteoporosis. |
Patients treated with high doses of oral steroid (>10 g cumulative oral prednisolone) were found to have an increased risk of fracture compared with control women receiving no steroid medication (odds ratio, 8.85; 95% CI, 4.21-18.60) after adjustment was made for years since menopause, body mass index and RCV. In both groups, the diagnostic and predictive ability of the pQCT parameters for vertebral fracture was assessed by the areas under their receiver operating characteristic (ROC) curves. All parameters were found to be significant predictors ( p<0.0001) in the control group. In the steroid group, however, the cortical bone mineral density (BMD) ( p = 0.001), RCV ( p<0.0001) and SSI ( p = 0.001) were found to be significant predictors, but not trabecular BMD ( p = 0.176). For comparison between the two groups, thresholds of all parameters for vertebral fracture were also calculated by the point of coincidence of sensitivity with specificity in ROC testing and the 90th percentile value. |
3 |
| 92. Jager PL, Jonkman S, Koolhaas W, Stiekema A, Wolffenbuttel BH, Slart RH. Combined vertebral fracture assessment and bone mineral density measurement: a new standard in the diagnosis of osteoporosis in academic populations. Osteoporos Int. 2011;22(4):1059-1068. |
Review/Other-Dx |
2500 patients |
To prospectively study VFA, which was applied routinely in all patients referred for BDM measurement, to assess the rate of vertebral fracture and used questionnaires to study the impact on management. |
In 2,424 patients (1,573 women), results were evaluable. In 541 patients (22%), VFA detected a prevalent VF that was unknown in 69%. In women, the prevalence was 20% versus 27% found in men (p < 0.0001). The prevalence of VF was 14% in patients with normal BMD (97/678), increased to 21% (229/1,100) in osteopenia and to 26% in those with osteoporosis (215/646) by WHO criteria. After excluding mild fractures VF prevalence was 13% (322/2,424). In 468 of 942 questionnaires (50% response rate), 27% of the referring physicians reported VFA results to impact on patient management. |
4 |
| 93. Kanterewicz E, Puigoriol E, Garcia-Barrionuevo J, del Rio L, Casellas M, Peris P. Prevalence of vertebral fractures and minor vertebral deformities evaluated by DXA-assisted vertebral fracture assessment (VFA) in a population-based study of postmenopausal women: the FRODOS study. Osteoporos Int. 2014;25(5):1455-1464. |
Review/Other-Dx |
2,968 postmenopausal women |
To assess the prevalence of VF and minor deformities in 2,968 postmenopausal women aged 59-70 years from a population-based cohort. |
The prevalence of VF was 4.3%, and 17% of the participants had minor vertebral deformities. Low BMD was frequently observed in women with VF, with 4%, and 42% of participants showing osteoporosis and osteopenia. Minor vertebral deformities were observed in nearly 40% of women with VF. Multivariate logistic regression analysis showed that age, history of previous fracture, osteoporotic BMD, receiving anti-osteoporotic treatment, and current use of glucocorticoids were significantly associated with VF. |
4 |
| 94. Mrgan M, Mohammed A, Gram J. Combined vertebral assessment and bone densitometry increases the prevalence and severity of osteoporosis in patients referred to DXA scanning. J Clin Densitom. 2013;16(4):549-553. |
Review/Other-Dx |
3275 patients |
To assess if vertebral fracture assessment (VFA) after routine bone mineral density (BMD) measurement on a dual-energy X-ray absorptiometry (DXA) machine had increased the number of patients diagnosed with osteoporosis and revealed previous unknown incident vertebral fractures. |
Among the 3275 patients, 85% were females and 15% were males. In total, 68% of the patients had normal BMD, and 32% had osteoporosis. Vertebral fractures diagnosed by VFA were seen in 7.9% patients, of which 3.2% had normal BMD and 4.8% had osteoporosis assessed by BMD. The relative number of patients diagnosed with osteoporosis increased 9.79% and in absolute terms from 32.4% to 35.6% of patients referred to DXA. Addition of VFA to routine BMD measurement increased clinically significant the number of patients diagnosed with osteoporosis as well as the number of patients with fractures and thereby altered the severity and prognosis. |
4 |
| 95. Shetty S, John B, Mohan S, Paul TV. Vertebral fracture assessment by dual-energy X-ray absorptiometry along with bone mineral density in the evaluation of postmenopausal osteoporosis. Arch Osteoporos. 15(1):25, 2020 02 24. |
Observational-Dx |
400 postmenopausal women |
To look at the utility of DXA-VFA in addition to bone mineral density (BMD) in the evaluation of postmenopausal osteoporosis. |
Prevalent VF was seen in 261 (65.2%) subjects, of which 114 (28.5%) subjects, 135 (33.7%) subjects, and 12 (3%) subjects had mild, moderate, and severe VF, respectively. Among subjects with VF, 136 (52.1%) and 90 (34.5%) had BMD-defined osteoporosis at the spine and femur neck, respectively. Overall, 59% with VF had osteoporosis at either the spine or femur neck. Forty-one-percent subjects with VF had BMD in non-osteoporotic range at both sites, of which 20% had moderate-to-severe VF. Addition of DXA-VFA to BMD assessment detected additional 27% with VF whose BMD was in the non-osteoporotic range. |
3 |
| 96. Cai S, Yu H, Li Y, et al. Bone mineral density measurement combined with vertebral fracture assessment increases diagnosis of osteoporosis in postmenopausal women. Skeletal Radiol. 49(2):273-280, 2020 Feb. |
Observational-Dx |
502 postmenopausal women |
To study the impact of VFA on the diagnosis of osteoporosis. |
There were 257 patients with T-score =-2.5, 202 patients with a T-score between -1 and - 2.5, and 43 patients with BMD within the normal range. There were 162 patients with 345 fractured vertebrae identified by VFA, among which 84% of patients were previously unknown. Osteoporosis or severe osteoporosis was presented in 51.2% patients diagnosed by BMD alone, in 55.2% patients diagnosed by BMD plus fracture history, and in 62.4% of patients diagnosed by BMD plus fracture history and VFA. Severe osteoporosis significantly increased by 17.2% in patients receiving VFA. |
3 |
| 97. Borges JLC, Sousa da Silva M, Ward RJ, Diemer KM, Yeap SS, Lewiecki EM. Repeating Vertebral Fracture Assessment: 2019 ISCD Official Position. J Clin Densitom 2019;22:484-88. |
Review/Other-Dx |
N/A |
To address issues and provide recommendations for repeating vertebral fracture assessment. |
No results stated in abstract. |
4 |
| 98. Wang YXJ, Liu WH, Diacinti D, et al. Diagnosis and grading of radiographic osteoporotic vertebral deformity by general radiologists after a brief self-learning period. J Thorac Dis 2020;12:4702-10. |
Observational-Dx |
3 young radiologist from Italy and 3 young radiologist from China; Spine radiographs of 44 elderly women |
To evaluate the performance of grading criterion by radiology readers who did not have former training in OVD assessment. |
The final absolute agreement rate with the reference reading (i.e., exactly the same grading as the reference) ranged between 46.2% to 68.2% for the six readers, and the final relative agreement (with one eSQ grade difference allowed) ranged between 78.5% to 92.5%. The >1 grade disagreement rate was all below 11%, and mostly below 7%. The missed OVD were mostly minimal grade. The rate for missing a = mild OVD was <4.5%, and false positive rate was generally <1.4% among the final reading. If the minimal grade was removed and the remaining gradings were converted to Genant's semi-quantitative (GSQ) grading, the mean kappa values against the reference reading for SQ grades-1,2,3 were 0.813, 0.814, and 0.916 respectively. |
3 |
| 99. Cohen A, Shane E. Evaluation and management of the premenopausal woman with low BMD. Curr Osteoporos Rep 2013;11:276-85. |
Review/Other-Tx |
N/A |
To discuss BMD interpretation in young women, epidemiology of fracture risk in premenopausal women, evaluation of premenopausal women with low BMD, and management issues that pertain to this particular population. |
No results stated in abstract. |
4 |
| 100. Cohen A. Premenopausal Osteoporosis. Endocrinol Metab Clin North Am 2017;46:117-33. |
Review/Other-Dx |
N/A |
To review the definition, epidemiology, and potential etiologies of osteoporosis in premenopausal women and will also address recommendations for evaluation as well as potential treatment strategies. |
No results stated in abstract. |
4 |
| 101. Pepe J, Body JJ, Hadji P, et al. Osteoporosis in Premenopausal Women: A Clinical Narrative Review by the ECTS and the IOF. J Clin Endocrinol Metab 2020;105. |
Review/Other-Tx |
N/A |
To provide an update on literature published after 2017 regarding diagnosis and management of osteoporosis in premenopausal women, excluding children and adolescents. |
No results stated in abstract. |
4 |
| 102. Mori Y, Baba K, Kogure A, et al. Assessment of the risk of low bone mineral density in premenopausal Japanese female patients with systemic lupus erythematosus. J Orthop 2018;15:89-93. |
Review/Other-Dx |
136 SLE patients without menopause |
To assess the relationships between clinical parameters and bone mineral density (BMD) in Japanese female patients with systemic lupus erythematosus (SLE). |
Multivariate linear regression analyses showed that in non-bisphosphonate group disease duration was negatively associated with BMD of AP spine and femoral neck, whereas in bisphosphonate group these negative associations were not present. However, multivariate linear regression analyses showed a significant relationship between BMI and BMD of the AP spine, femoral neck and total hip, regardless of bisphosphonate treatment. |
4 |
| 103. Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis Care Res (Hoboken) 2017;69:1095-110. |
Review/Other-Dx |
N/A |
To develop recommendations for prevention and treatment of glucocorticoid-induced osteoporosis (GIOP). |
No results stated in abstract. |
4 |
| 104. Grossmann M, Ramchand SK, Milat F, et al. Assessment and management of bone health in women with oestrogen receptor-positive breast cancer receiving endocrine therapy: position statement summary. Med J Aust 2019;211:224-29. |
Review/Other-Dx |
N/A |
To provide recommendations on the assessment and management of bone health in women with oestrogen receptor-positive early breast cancer receiving endocrine therapy. |
No results stated in abstract. |
4 |
| 105. Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM. Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 2005;90:6410-7. |
Observational-Tx |
152 men with prostate cancer (30 with acute ADT, <6 months; 50 with chronic ADT, ≥6 months; and 72 with no ADT) and 43 healthy age-matched controls. |
To examine the rate of bone loss in men initiating ADT vs. those who are maintained on chronic ADT. |
After 12 months, men receiving acute ADT had a significant reduction in BMD of 2.5 ± 0.6% at the total hip, 2.4 ± 1.0% at the trochanter, 2.6 ± 0.5% at the total radius, 3.3 ± 0.5% at the total body, and 4.0 ± 1.5% at the posteroanterior spine (all P < 0.05). Men with chronic ADT had a 2.0 ± 0.6% reduction in BMD at the total radius (P < 0.05). Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD. Both use and duration of ADT were associated with change in bone mass at the hip (P < 0.05). Men receiving acute ADT had a 10.4 ± 1.7% increase in total body fat and a 3.5 ± 0.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (P < 0.05). Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (P < 0.05). |
1 |
| 106. Leslie WD, Adler RA, El-Hajj Fuleihan G, et al. Application of the 1994 WHO classification to populations other than postmenopausal Caucasian women: the 2005 ISCD Official Positions. J Clin Densitom 2006;9:22-30. |
Review/Other-Dx |
N/A |
To re-address the applicability of the World Health Organization (WHO) classification of bone mineral density to populations other than postmenopausal women. |
No results stated in abstract. |
4 |
| 107. Cohen A, Lang TF, McMahon DJ, et al. Central QCT reveals lower volumetric BMD and stiffness in premenopausal women with idiopathic osteoporosis, regardless of fracture history. J Clin Endocrinol Metab. 2012;97(11):4244-4252. |
Observational-Dx |
32 premenopausal women with IOP, 12 with idiopathic low BMD, and 34 controls |
To compare three-dimensional volumetric BMD and bone stiffness in premenopausal women with IOP based on fracture history, those with idiopathic low BMD (Z score </= -2.0) and no low trauma fracture, and normal age-matched controls. |
Subjects had comparable decreases in total and trabecular volumetric BMD, cortical thickness, and whole-bone stiffness compared with controls, regardless of fracture history. These differences remained significant after controlling for age, body mass index, and bone size. The positive predictive values of a DXA Z score of -2.0 or less for a cQCT volumetric BMD Z score of -2.0 or less were 95% at the lumbar spine, 90% at the total hip, and 86% at the femoral neck. |
3 |
| 108. Cohen A, Dempster DW, Muller R, et al. Assessment of trabecular and cortical architecture and mechanical competence of bone by high-resolution peripheral computed tomography: comparison with transiliac bone biopsy. Osteoporos Int. 2010;21(2):263-273. |
Observational-Dx |
54 subjects |
To determine the extent to which microarchitectural variables measured by HR-pQCT reflect those measured by the "gold standard," transiliac bone biopsy. |
The strongest correlations observed were between trabecular parameters (bone volume fraction, number, separation) measured by microCT of biopsies and HR-pQCT of the radius (R 0.365-0.522; P < 0.01). Cortical width of biopsies correlated with cortical thickness by HR-pQCT, but only at the tibia (R = 0.360, P < 0.01). Apparent Young's modulus calculated by microFE of biopsies correlated with that calculated for both radius (R = 0.442; P < 0.001) and tibia (R = 0.380; P < 0.001) HR-pQCT scans. |
3 |
| 109. Dane C, Dane B, Cetin A, Erginbas M. The role of quantitative ultrasound in predicting osteoporosis defined by dual-energy X-ray absorptiometry in pre- and postmenopausal women. Climacteric 2008;11:296-303. |
Observational-Dx |
351 pre- and postmenopausal women |
To compare correlations between calcaneal quantitative ultrasound parameters and femoral and spine bone mineral density measured with dual-energy X-ray absorptiometry (DXA) and, second, to analyze the predictive values of quantitative ultrasound (QUS) determinations for the diagnosis of osteoporosis in pre- and postmenopausal women. |
The QUS parameters of the postmenopausal group were significantly lower than those of premenopausal women. Significantly lower correlation coefficients between broadband ultrasound attenuation and DXA at the femoral neck and spine were found in premenopausal women (r = 0.44 and 0.38, respectively) compared to postmenopausal women (r = 0.60 and 0.48). The areas under the ROC curves ranged from 0.54 to 0.62 and QUS parameters were shown to be poor at predicting osteoporosis as defined by DXA. |
3 |
| 110. Paccou J, Javier RM, Henry-Desailly I, et al. The French multicentre elevated bone mass study: prevalence and causes. Osteoporos Int 2021:[E-pub ahead of print]. |
Review/Other-Dx |
909 EBM patients |
To evaluate the prevalence and causes of Elevated Bone Mass (EBM) in patients who underwent DXA scanning over a 10-year period. |
The DXA scan reports and imagery and medical records of the 909 EBM patients were reviewed and 936 causes were found. In 42 patients (4%), no cause could be determined due to unavailability of data. Artefactual causes of EBM were found in 752 patients (80%), in whom the predominant cause was degenerative disease of the spine (613 patients, 65%). Acquired causes of focal EBM-including Paget's disease (n = 7)-were found in 12 patients (1%), and acquired causes of generalized EBM-including renal osteodystrophy (n = 32), haematological disorders (n = 20) and hypoparathyroidism (n = 15)-in 84 patients (9%). Other causes were rare hereditary diseases and unknown EBM in 19 (2%) and 27 (3%) cases respectively. |
4 |
| 111. Magrey MN, Lewis S, Asim Khan M. Utility of DXA scanning and risk factors for osteoporosis in ankylosing spondylitis-A prospective study. Semin Arthritis Rheum. 46(1):88-94, 2016 08. |
Observational-Dx |
101 patients |
To investigate the correlation of hip and spine BMD measurements in patients with AS to determine if hip DXA will prove clinically useful while avoiding the confounding effect of spinal disease. |
Frequency of OP among AS patients =50 years of age was 23%, and that of osteopenia was 41%. Among patients <50 years of age, the frequency of low bone mass for expected age (Z-score =-2.0) was 14.7%. There was moderate correlation (? = 0.59) and a fair agreement (? = 0.26; 95% CI: 0.10-0.42) between the lowest T-values of hip and lumbar spine (AP view). OP was significantly associated with elevated CRP level [OR = 4.2 (95% CI: 1.13-15.9), p < 0.03] and African American race [OR = 7.2 (95% CI: 1.18-44.99), p < 0.03]. |
2 |
| 112. Allard HM, Calvelli L, Weyhmiller MG, Gildengorin G, Fung EB. Vertebral Bone Density Measurements by DXA are Influenced by Hepatic Iron Overload in Patients with Hemoglobinopathies. J Clin Densitom. 22(3):329-337, 2019 Jul - Sep. |
Observational-Dx |
114 patients, 22 controls, and a phantom was designed to mimic the geometry and iron concentration of a heavily iron-overloaded human liver. |
To determine if iron in the liver of heavily iron-loaded patients will artificially raise aBMD in the spine, lead to an error and thereby to a potential misinterpretation of the DXA scan. |
A significant effect was observed in the difference of BMD Z-score of L1 and L 3/ 4 when patients with LIC < 1000 were compared to those with >5000 µg Fe/g wet tissue (p = 0.043). A significant relationship was also observed in the difference in aBMD Z-score of L1 and 3/4 when controls were compared to the high iron group (p = 0.037). These findings were supported by phantom experiments. |
3 |
| 113. Bristow SM, Gamble GD, Horne AM, Reid IR. Longitudinal changes in bone mineral density, bone mineral content and bone area at the lumbar spine and hip in postmenopausal women, and the influence of abdominal aortic calcification. Bone Rep 2019;10:100190. |
Review/Other-Dx |
297 postmenopausal women |
To examine changes in BMD, BMC and bone area at the lumbar spine over 5?years and compare them with changes at the total hip and femoral neck, with a view to determining the comparative contributions of changes in bone area and abdominal aortic calcification (AAC) to the apparent stability of spine BMD in older women. |
BMD declined by -4.4% at the total hip and -3.9% at the femoral neck (p < 0.001), but did not change at the spine (-0.5%, p = 0.12). In contrast, bone mineral content (BMC) declined by -4.0% at the total hip, -2.5% at the femoral neck and -1.7% at the spine (all p < 0.001). Bone area increased by 0.5% at the hip and 1.6% at the femoral neck but declined by -1.2% at the spine (all p < 0.001). 43% of the cohort had abdominal aortic calcification (AAC) present at baseline. The presence of AAC at baseline was not related to changes in BMD or BMC at the total hip or femoral neck, nor to BMD at the spine. However, women with AAC present had a smaller loss of BMC at the spine than those without (-0.8% versus -2.4%, p = 0.03). AAC score increased more over 5 years among those with AAC at baseline than those without (0.28 versus 0.16, p = 0.036). |
4 |
| 114. Guglielmi G, Floriani I, Torri V, et al. Effect of spinal degenerative changes on volumetric bone mineral density of the central skeleton as measured by quantitative computed tomography. Acta Radiol 2005;46:269-75. |
Observational-Dx |
84 women |
To evaluate the impact of degenerative changes due to osteoarthritis (OA) at the spine on volumetric bone mineral density (BMD) as measured by volumetric quantitative computed tomography (vQCT). |
Spinal trabecular BMD did not differ significantly between OA grade 0 and OA grade 1. Spinal cortical and integral BMD measures showed statistically significant differences, as did the lumbar spine DXA BMD measurement (13%, P = 0.02). The QCT measurements at the hip were also higher in OA 1 subjects. Femoral trabecular BMD was 13-15% higher in OA grade 1 subjects than in OA grade 0 subjects. The cortical BMD measures in the CT_TOT_FEM and CT_TROCH ROI's were also higher in the OA 1 subjects. The integral QCT BMD measures in the hip showed difference between grades OA 1 and 0. The DXA measurements in the neck and trochanter ROI's showed smaller differences (9 and 11%, respectively). |
2 |
| 115. Schwaiger BJ, Behr M, Gersing AS, et al. Computed Tomography Findings Associated with Clinical Outcome After Dynamic Posterior Stabilization of the Lumbar Spine. World Neurosurg. 93:306-14, 2016 Sep. |
Observational-Dx |
63 patients |
To evaluate whether preoperative multirow detector computed tomography (MDCT) findings were associated with clinical outcome 24 months after dynamic stabilization for painful degenerative lumbar spine disease. |
Clinical scores improved substantially over 24 months compared with preoperative values (delta Oswestry Disability Index -32.1 ± 17.2, delta Short-Form 36 physical component summary 4.9 ± 2.3). Physical component summary improvement was significantly better in patients with lower grades of disc herniation (P < 0.001) and/or spondylolisthesis (P = 0.011), lower cross-sectional area of the spinal canal (P = 0.043), high intervertebral disc height (P = 0.006), and high grades of vertebral body sclerosis (P = 0.002). Patients with high bone mineral density and initially low diameter of intervertebral foramina showed a significantly better improvement of Oswestry Disability Index (P < 0.05). |
3 |
| 116. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
