scholarly journals MDCT-Based Finite Element Analyses: Are Measurements at the Lumbar Spine Associated with the Biomechanical Strength of Functional Spinal Units of Incidental Osteoporotic Fractures along the Thoracolumbar Spine?

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 455
Author(s):  
Nico Sollmann ◽  
Nithin Manohar Rayudu ◽  
Long Yu Yeung ◽  
Anjany Sekuboyina ◽  
Egon Burian ◽  
...  
Keyword(s):  
Finite Element ◽  
Lumbar Spine ◽  
Fracture Risk ◽  
Thoracolumbar Spine ◽  
Areal Bone Mineral Density ◽  
Mineral Density ◽  
Osteoporotic Vertebral Fractures ◽  
The Mean ◽  
Biomechanical Strength

Assessment of osteoporosis-associated fracture risk during clinical routine is based on the evaluation of clinical risk factors and T-scores, as derived from measurements of areal bone mineral density (aBMD). However, these parameters are limited in their ability to identify patients at high fracture risk. Finite element models (FEMs) have shown to improve bone strength prediction beyond aBMD. This study aims to investigate whether FEM measurements at the lumbar spine can predict the biomechanical strength of functional spinal units (FSUs) with incidental osteoporotic vertebral fractures (VFs) along the thoracolumbar spine. Multi-detector computed tomography (MDCT) data of 11 patients (5 females and 6 males, median age: 67 years) who underwent MDCT twice (median interval between baseline and follow-up MDCT: 18 months) and sustained an incidental osteoporotic VF between baseline and follow-up scanning were used. Based on baseline MDCT data, two FSUs consisting of vertebral bodies and intervertebral discs (IVDs) were modeled: one standardly capturing L1-IVD–L2-IVD–L3 (FSU_L1–L3) and one modeling the incidentally fractured vertebral body at the center of the FSU (FSU_F). Furthermore, volumetric BMD (vBMD) derived from MDCT, FEM-based displacement, and FEM-based load of the single vertebrae L1 to L3 were determined. Statistically significant correlations (adjusted for a BMD ratio of fracture/L1–L3 segments) were revealed between the FSU_F and mean load of L1 to L3 (r = 0.814, p = 0.004) and the mean vBMD of L1 to L3 (r = 0.745, p = 0.013), whereas there was no statistically significant association between the FSU_F and FSU_L1–L3 or between FSU_F and the mean displacement of L1 to L3 (p > 0.05). In conclusion, FEM measurements of single vertebrae at the lumbar spine may be able to predict the biomechanical strength of incidentally fractured vertebral segments along the thoracolumbar spine, while FSUs seem to predict only segment-specific fracture risk.

scholarly journals The influence of snuff and smoking on bone accretion in late adolescence. The Tromsø study, Fit Futures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ole Andreas Nilsen ◽  
Nina Emaus ◽  
Tore Christoffersen ◽  
Anne Winther ◽  
Elin Evensen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Late Adolescence ◽  
Areal Bone Mineral Density ◽  
Childhood And Adolescence ◽  
Preventive Strategy ◽  
Mineral Density ◽  
Future Fracture

Abstract Summary Areal bone mineral density (aBMD) predicts future fracture risk. This study explores associations between use of tobacco and bone accretion in Norwegian adolescents. Our results indicate that use of snuff is negatively associated with accretion of aBMD in adolescence and may be a signal of increased future fracture risk. Purpose Bone mineral accrual in childhood and adolescence is a long-term primary preventive strategy of osteoporosis. Areal bone mineral density (aBMD) is a surrogate measure of bone strength and a predictor of fracture risk. The aim of this population-based 2-year follow-up cohort study was to explore associations between use of snuff and smoking and changes (∆) in aBMD in Norwegian girls and boys aged 15–17 years at baseline. Methods The first wave of the Tromsø study, Fit Futures was conducted from 2010 to 2011. Femoral neck (FN), total hip (TH), and total body (TB) bone mineral content (BMC) and aBMD were measured by dual-energy X-ray absorptiometry. Information on use of snuff, smoking habits, and other lifestyle related variables were collected through self-administered questionnaires. Two years later, during 2012–2013, the measurements were repeated in the second wave. The present study included 349 girls and 281 boys and compared “non-users” (n = 243 girls, 184 boys) with “users” (n = 105 girls, 96 boys) of snuff and “non-smokers” (n = 327 girls, 249 boys) with “smokers” (n = 21 girls, 31 boys) using linear regression adjusted for age, baseline height and weight, change in height and weight, pubertal maturation, physical activity, ethnicity, alcohol consumption, diagnosis known to affect bone, and medication known to affect bone. The influence of “double use” on bone accretion was also explored. Results In girls, no associations between use of snuff and ∆aBMD were found. In boys, use of snuff was associated with reduced bone accretion in all ∆aBMD models. Sensitivity analysis with exclusion of “sometimes” users of snuff strengthened associations at femoral sites in girls and attenuated all associations in boys. In girls, no associations between smoking and ∆aBMD were found. In boys, only the association with TB ∆aBMD was significant in the fully adjusted models. In girls, “double users” analyses showed similar association to smoking. In boys, nearly all models showed statistically significant associations with a difference of ~ 1–2% in ∆aBMD between “non-users” and “double users” during 2 years of follow-up. Conclusions Our results indicate that tobacco use in late adolescence could be detrimental to bone accretion and may be a signal of increased fracture risk in adult life.

scholarly journals Texture Analysis Using CT and Chemical Shift Encoding-Based Water-Fat MRI Can Improve Differentiation Between Patients With and Without Osteoporotic Vertebral Fractures

2022 ◽  
Vol 12 ◽  
Author(s):  
Nico Sollmann ◽  
Edoardo A. Becherucci ◽  
Christof Boehm ◽  
Malek El Husseini ◽  
Stefan Ruschke ◽  
...  
Keyword(s):  
Chemical Shift ◽  
Texture Analysis ◽  
Vertebral Fractures ◽  
Thoracolumbar Spine ◽  
Texture Features ◽  
Areal Bone Mineral Density ◽  
Proton Density ◽  
Mineral Density ◽  
Osteoporotic Vertebral Fractures ◽  
Vertebral Bodies

PurposeOsteoporosis is a highly prevalent skeletal disease that frequently entails vertebral fractures. Areal bone mineral density (BMD) derived from dual-energy X-ray absorptiometry (DXA) is the reference standard, but has well-known limitations. Texture analysis can provide surrogate markers of tissue microstructure based on computed tomography (CT) or magnetic resonance imaging (MRI) data of the spine, thus potentially improving fracture risk estimation beyond areal BMD. However, it is largely unknown whether MRI-derived texture analysis can predict volumetric BMD (vBMD), or whether a model incorporating texture analysis based on CT and MRI may be capable of differentiating between patients with and without osteoporotic vertebral fractures.Materials and MethodsTwenty-six patients (15 females, median age: 73 years, 11 patients showing at least one osteoporotic vertebral fracture) who had CT and 3-Tesla chemical shift encoding-based water-fat MRI (CSE-MRI) available were analyzed. In total, 171 vertebral bodies of the thoracolumbar spine were segmented using an automatic convolutional neural network (CNN)-based framework, followed by extraction of integral and trabecular vBMD using CT data. For CSE-MRI, manual segmentation of vertebral bodies and consecutive extraction of the mean proton density fat fraction (PDFF) and T2* was performed. First-order, second-order, and higher-order texture features were derived from texture analysis using CT and CSE-MRI data. Stepwise multivariate linear regression models were computed using integral vBMD and fracture status as dependent variables.ResultsPatients with osteoporotic vertebral fractures showed significantly lower integral and trabecular vBMD when compared to patients without fractures (p<0.001). For the model with integral vBMD as the dependent variable, T2* combined with three PDFF-based texture features explained 40% of the variance (adjusted R2[Ra2] = 0.40; p<0.001). Furthermore, regarding the differentiation between patients with and without osteoporotic vertebral fractures, a model including texture features from CT and CSE-MRI data showed better performance than a model based on integral vBMD and PDFF only (Ra2 = 0.47 vs. Ra2 = 0.81; included texture features in the final model: integral vBMD, CT_Short-run_emphasis, CT_Varianceglobal, and PDFF_Variance).ConclusionUsing texture analysis for spine CT and CSE-MRI can facilitate the differentiation between patients with and without osteoporotic vertebral fractures, implicating that future fracture prediction in osteoporosis may be improved.

scholarly journals POS1106 FRAX AND THE EFFECT OF TERIPARATIDE ON BONE MINERAL DENSITY IN SECONDARY OSTEOPOROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 833.2-834
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
M. Rato ◽  
F. Oliveira Pinheiro ◽  
D. Fonseca ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fracture Probability ◽  
Mineral Density ◽  
T Score

Background:Teriparatide has been shown to increase spine and hip bone mineral density (BMD) and to reduce vertebral and non-vertebral fractures. (1) It is currently not clear whether the effect of teriparatide is dependent on the baseline risk of fracture or osteoporosis (OP) type, a finding that could have an impact on our therapeutic decision.Objectives:Investigate if there is a relationship between teriparatide effect in BMD and baseline 10-year fracture probability, assessed using FRAX®, in primary and secondary OP patients.Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of OP treated with teriparatide for 24 months, with a ten-year follow-up period, at our rheumatology department. Demographic, clinical, laboratorial, BMD and occurrence of fracture data were collected. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v 4.1 with the Portuguese population reference. Statistical analysis was performed using the software SPSS 23.0. Correlations between continuous variables were evaluated with spearman coefficient. p<0.05 was considered statistically significant.Results:Eighty patients (88.8% female, median age 65.00 (59; 75)) were included. Forty-nine patients (61.3%) has secondary OP, mainly of cortisonic etiology (61.2%, n=30). Before treatment, median lumbar spine BMD was 0.870 [0.767, 0.964] g/cm2, median T-score of -2.60 (-3.30, -1.90); median total femur BMD was 0.742 [0.667, 0.863] g/cm2, median T-score of -2.10 (-2.80, -1.30); median femoral neck BMD was 0.671 [0.611, 0.787] g/cm2, median T-score of -2.50 [-3.20, -1.85]. Regarding fracture risk, median FRAX-based 10-year major fracture risk (with BMD) at baseline was 16% [10.0; 23], and median hip fracture risk was 7.2% [3.4; 13.8].The median variation of BMD, after finishing teriparatide treatment, in the spine was 0.107 [0.029; 0.228]; median BMD variation in total femur was 0.013 [-0.013; 0.068] and median BMD femoral neck was 0.046 [-0.002; 0.109]. We observed a numerically superior effect, albeit without any statistical significance, of teriparatide on bone mineral density gain in secondary OP (versus primary OP) at lumbar spine, total femur and femoral neck.Most patients continued anti-osteoporotic treatment with a bisphosphonate (81.2%, n=65) and, during follow-up, 17 patients had an incident fracture (8 hip fractures and 6 vertebral fractures), median of 5 [1.75, 8.25] years after ending teriparatide.We found a discrete correlation between FRAX-based hip fracture probability and the variation of bone mineral density in total femur (Spearman’s coefficient 0.248, p = 0.04). There was no correlation between FRAX-based major fracture probability and and the variation of bone mineral density in the spine or femur. When we separately analyze the relationship between the variation in total hip BMD and the FRAX-based fracture risk, depending on whether it is a secondary or primary OP, we find that the correlation is stronger and only remains in secondary OP (Spearman’s coefficient 0.348, p = 0.03).Conclusion:Our data suggest that teriparatide could be an important weapon in the treatment of secondary cause OP, particularly cortisonic, and in patients at high fracture risk, although further larger studies are needed to confirm these findings.References:[1]Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2.Disclosure of Interests:None declared.

scholarly journals Changes in bone mineral density over 10 years in patients with early rheumatoid arthritis

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001142
Author(s):  
Lisa Theander ◽  
Minna Willim ◽  
Jan Åke Nilsson ◽  
Magnus Karlsson ◽  
Kristina E Åkesson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Z Score ◽  
Mineral Density ◽  
Early Ra ◽  
Z Scores ◽  
The Mean

ObjectivesTo investigate changes in bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) over a 10-year period.MethodsConsecutive patients with early RA (symptom duration <12 months) were followed according to a structured programme and examined with dual-energy X-ray absorptiometry (DXA) at inclusion and after 2, 5 and 10 years. Mean Z-scores over the study period were estimated using mixed linear effect models. Changes in Z-scores between follow-up visits were analysed using paired T-tests.ResultsAt inclusion, 220 patients were examined with DXA. At the femoral neck, the mean Z-score over 10 years was −0.33 (95 % CI −0.57 to −0.08) in men and −0.07 (−0.22 to 0.08) in women. Men had significantly lower BMD at the femoral neck than expected by age at inclusion (intercept Z-score value −0.35; 95 % CI −0.61 to −0.09), whereas there was no such difference in women. At the lumbar spine, the mean Z-score over the study period for men was −0.05 (−0.29 to 0.19) and for women 0.06 (−0.10 to 0.21). In paired comparisons of BMD at different follow-up visits, femoral neck Z-scores for men decreased significantly from inclusion to the 5-year follow-up. After 5 years, no further reduction was seen.ConclusionsIn this observational study of a limited sample, men with early RA had reduced femoral neck BMD at diagnosis, with a further significant but marginal decline during the first 5 years. Lumbar spine BMD Z-scores were not reduced in men or women with early RA. Data on 10-year follow-up were limited.

scholarly journals Bone Mineral Density Utilization in Patients with Newly Diagnosed Multiple Myeloma: A Single Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5386-5386
Author(s):  
Eli Muchtar ◽  
Adi Zelig ◽  
Eyal Robenshtok ◽  
Tzippy Shochat ◽  
Nino Oniashvili ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Advisory Board ◽  
Time Interval ◽  
Mineral Density ◽  
T Score ◽  
The Mean

Abstract Introduction: Bone disease is a major cause for morbidity in multiple myeloma (MM), mainly manifested by osteolytic lesions. Bone mineral loss is another aspect of bone involvement, although osteoporosis (with or without compression fractures) in the absence of osteolytic lesions is no more a criterion for treatment initiation in MM. Methods: We performed a retrospective study to evaluate the use of bone mineral density (BMD) exams by dual-energy X-ray absorptiometry (DXA) among MM patients in a tertiary medical care facility. We included 173 patients with symptomatic MM diagnosed between January 2007 and September 2014 who underwent BMD exam at diagnosis. The T-scores of lumbar spine (LS), left femur neck (FN) and left total hip (TH) were obtained and analyzed. In addition, we have specified the lowest T-score at each site. In patients with follow-up exam, we calculated the relative difference between the baseline and follow-up exams as the percentage change in absolute BMD value expressed in g/cm2 as follows: [(BMD at follow-up) - (BMD at baseline)/(BMD at baseline)]*100. Results: The mean lumbar spine T-score was (-1.3), while the low lumbar spine T-score was (-2.0). At the femur level, the mean FN T-score was (-1.5), while the mean TH T-score was (-1.1) and the mean low femur T-score was (-2.2). There was a strong correlation between spine and femur T-scores (r=0.56-0.61, p<0.0001). Nevertheless, on a multivariate regression analysis, different parameters correlated with the T-scores of the LS and the femur sites. The following variables were encountered as significantly associated with the mean T-score value at the lumbar spine: sex (β coefficient= (-0.17), p=0.05), BMI (β coefficient=0.21, p=0.02) and vertebral fracture(s) (β coefficient= (-0.23), p=0.01). Conversely, the following variables were found to be independent predictors of the FN T-score: age (β coefficient= (-0.37), p<0.0001) and vertebral fracture (s) (β coefficient= (-0.25), p=0.005), whereas vitamin D showed a strong trend towards significance (β coefficient= (-0.15), p=0.08). Patients with light chain only disease had lower T-score values compared with patients with IgG myeloma, reaching significance at the femur sites [FN T-score (-1.7) vs. (-1.3), p=0.06; TH T-score (-1.3) vs. (-0.9), p=0.02; femur low T-score (-2.4) vs. (-1.8), p=0.008]. Patients with vertebral fracture(s) had significantly lower T-scores of the spine compared to patients without vertebral fractures. Sixty-three patients (36.4% of all patients) had a follow-up DXA exam at a median of 25 months from the baseline test (range, 12-82 months). Basically, LS T-scores increased, while femur sites' T-scores decreased during follow-up. This did not include patients who achieved complete response (CR) and/or retained it during follow-up, who had improved BMD results at the femur sites as well (Table). Conclusion: DXA-based BMD assessment of myeloma bone disease is a valuable tool that illustrates a differential myeloma-induced bone mineral loss regarding the lumbar spine and femur. Table.Variables associated with change of bone mineral density values at follow-up DXA exam in relation to exam at diagnosisVariable mean [range]Mean change at lumbar spine (LS)Mean change at femur neck (FN)Mean change at total hip (TH)Time interval between tests12-24 months (n=31)4.1% [(-10%) - 25.2%]-4.3% [(-24.8%) - 10.6%]-0.1% [(-17.4%) - 10.4%]Time interval >24 months (n=32)4.8% [(-3.8) - 16.4%]-1.7%[(-19.5%) - 27.2%]-0.1%[(-18.8%) - 14.9%]P value0.500.220.96Autologous stem cell transplantationYes (n=35)4.5% [(-7.6%) - 25.2%]-3.4%[(-24.8%) - 27.2%]-1.1%[(-18.8%) - 14.9%]No (n=28)4.3% [(-10.8) - 19.4%]-2.7%[(-18.3%) - 11.1%]-0.1%[(-17.9%) - 10.4%]P value0.890.760.77Response to first line treatmentCR/sCR (n=22)4.3%[(-10.8%) - 18.1%]0.1%[(-12%) - 18.1%]2.1%[(-10.6%) - 10.4%]Less than CR (n=41)4.5%[(-5.5) - 25.2%]-5%[(-24.8%) - 8.6%]-2.5%[(-18.8%) - 14.9%]P value0.910.010.01Disease status at FU testCR/sCR (n=15)3.9% [(-10.8%) - 19.4%]-1.2%[(-24.8%) - 27.2%]2.4%[(-10%) - 10.4%]Less than CR* (n=48)4.6% [(-5.5%) - 19.4%]-3.6%[(-10%) - 10.9%]-1.9%[(-18.8%) - 14.9%]P value0.80.350.03* All patients with partial response or very good partial response Disclosures Raanani: Pfizer: Other: Advisory Board; Novartis: Other: Advisory Board, Research Funding; BMS: Other: Advisory Board; Ariad: Other: Advisory Board.

Fracture risk among men, in relation to osteopenia and osteoporosis defined by areal bone mineral density

2013 ◽  
Author(s):  
Julie Pasco ◽  
Stephen Lane ◽  
Sharon Brennan ◽  
Elizabeth Timney ◽  
Gosia Bucki-Smith ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Areal Bone Mineral Density ◽  
Mineral Density

scholarly journals AB1082 INFLUENCE OF THE VARIATION OF THE OPERATOR, PATIENT POSITION AND DEVICE ON THE MEASUREMENT PERFORMANCE OF RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1830.1-1830
Author(s):  
C. Caffarelli ◽  
G. Adami ◽  
G. Arioli ◽  
G. Bianchi ◽  
M. L. Brandi ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
High Performance ◽  
Mineral Density ◽  
Research Support ◽  
Short Term ◽  
Alphabetical Order ◽  
Patient Position ◽  
Term Monitoring

Background:The monitoring of bone mineral density (BMD) is a key aspect for patients undergoing pharmacological treatments that might cause BMD changes at non-physiological rates. At present, the short-term follow-up of patients under treatment in terms of BMD change with time remains an unmet clinical need, since the current techniques, including the gold standard dual X-ray absorptiometry (DXA), require at least 1 year between two consecutive measurements [1]. Therefore, an effective strategy for the assessment of BMD should guarantee high accuracy, precision and repeatability of the measurements.Objectives:The aim is to assess the influence of the variation 1) in patient position, 2) operator (both intra- and inter-) and 3) device on the REMS performance at lumbar spine and femoral neck.Methods:210 women were enrolled, divided in 7 groups of 30-patient each for the assessment of the parameters of interest, i.e. inter-device, intra- and inter-operator repeatability for lumbar spine scans and inter-patient position, inter-device, intra- and inter-operator repeatability for femoral neck scans.All patients underwent 2 REMS scans at lumbar spine or femoral neck, performed by the same operator or by 2 different operators or by the same operator using 2 different devices or in different patient position (i.e. supine without constraints or with a constrained 25°-rotation of the leg). The percentage coefficient of variation (CV%) with 95% confidence interval and least significant change for a 95% confidence level (LSC) have been calculated.Results:For lumbar spine, intra-operator repeatability resulted in CV%=0.37% (95%CI: 0.26%-0.48%), with LSC=1.02%, inter-operator repeatability resulted in CV%=0.55% (95% CI: 0.42%-0.68%), with LSC=1.52%, inter-device repeatability resulted in CV%=0.53% (95% CI: 0.40%-0.66%), with LSC=1.47%.For femoral neck, intra-operator repeatability resulted in CV%=0.33% (95%CI: 0.23%-0.43%), with LSC=0.91%, inter-operator repeatability resulted in CV%=0.47% (95% CI: 0.35%-0.59%), with LSC=1.30%, inter-device repeatability resulted in CV%=0.42% (95% CI: 0.30%-0.51%), with LSC=1.16%, inter-patient position repeatability resulted in CV%=0.24% (95% CI: 0.18%-0.30%), with LSC=0.66%.Conclusion:REMS densitometry is highly precise for both anatomical sites, showing high performance in repeatability. These results suggest that REMS might be a suitable technology for short-term monitoring. Moreover, thanks to its ionizing radiation-free approach, it might be applied for population mass investigations and prevention programs also in paediatric patients and pregnant women.References:Note:Carla Caffarelli, Giovanni Adami§, Giovanni Arioli§, Gerolamo Bianchi§, Maria Luisa Brandi§, Sergio Casciaro§, Luisella Cianferotti§, Delia Ciardo§, Francesco Conversano§, Davide Gatti§, Giuseppe Girasole§, Monica Manfredini§, Maurizio Muratore§, Paola Pisani§, Eugenio Quarta§, Laura Quarta§, Stefano Gonnelli§Equal contributors listed in alphabetical orderDisclosure of Interests:Carla Caffarelli: None declared, Giovanni Adami: None declared, Giovanni Arioli *: None declared, Gerolamo Bianchi Grant/research support from: Celgene, Consultant of: Amgen, Janssen, Merck Sharp & Dohme, Novartis, UCB, Speakers bureau: Abbvie, Abiogen, Alfa-Sigma, Amgen, BMS, Celgene, Chiesi, Eli Lilly, GSK, Janssen, Medac, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Sanofi Genzyme, Servier, UCB, Maria Luisa Brandi: None declared, Sergio Casciaro: None declared, Luisella Cianferotti: None declared, Delia Ciardo: None declared, Francesco Conversano: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Giuseppe Girasole: None declared, Monica Manfedini: None declared, Maurizio Muratore: None declared, Paola Pisani: None declared, Eugenio Quarta: None declared, Laura Quarta: None declared, Stefano Gonnelli: None declared

scholarly journals POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 294.2-294
Author(s):  
D. Ciardo ◽  
P. Pisani ◽  
F. A. Lombardi ◽  
R. Franchini ◽  
F. Conversano ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
P Value ◽  
T Score ◽  
Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

scholarly journals POS1112 COMPARISON OF TWO APPROACHES IN FRACTURES RISK ASSESSMENT IN WOMEN WITH RHEUMATOID ARTHRITIS AND GLUCOCORTICOID USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 836.1-836
Author(s):  
N. Grygorieva ◽  
V. Povoroznyuk
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Assessment ◽  
Clinical Practice ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Fracture Risk Assessment ◽  
Lifestyle Modifications ◽  
Mineral Density ◽  
Dxa Scan

Background:Nowadays, FRAX is the most useful tool for osteoporotic fracture risk assessment that is included in many guidelines. Rheumatoid arthritis (RA) and glucocorticoid (CG) use are two crucial factors for osteoporotic fractures included in FRAX algorithm. According to the last ACR guidelines for the treatment of GC-induced osteoporosis [1], it was recommended to divide the patients into three groups of fracture risk (high, medium and low) that have a great impact on treatment decision. Recently, we received own Ukrainian thresholds [2] for the national version of FRAX that are age-dependent and now widely used in clinical practice.Objectives:Our study was aimed to compare two approaches (ACR-2017 and Ukrainian (2019) recommendations) in fracture risk assessment in women with RA and GC use.Methods:We examined 195 females with RA aged 40-89 years old who took GC (at dose ≥5 mg/d for ≥3 months) due to RA. The 10-year probabilities of major osteoporotic (MOFs) and hip fractures (HFs) were calculated with and without bone mineral density (BMD) using the Ukrainian FRAX model [3]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; T and Z scores were calculated (DISCOVERY Wi, Hologic, Inc., USA).Results:FRAX indexes for MOFs and HFs without BMD in patients with RA and GC were (Me [25-75Q]) 12.0 [8.1-18.0] and 4.2 [1.7-7.2] %. The correspondent FRAX indexes with BMD were 13.5 [8.5-20.0] and 5.1 [1.8-8.7] %.50 % of examined women had previous fractures and 20 % had previous vertebral fractures. BMD of the femoral neck consisted of 0.62±0.13 and L1-L4 BMD was 0.85±0.15 g/cm2. 89 % of females had low BMD at the lumbar spine and / or femoral neck (49 % osteoporosis and 40 % osteopenia).61 % of women required antiosteoporotic treatment according to ACR-2017 guideline (17.4 % of them a hadhigh risk of MOF and 43.1 % moderate one) without BMD measurement and 64 % of subjects after DXA scan.According to Ukrainian national guideline, 57 % of patients required antiosteoporotic treatment without BMD measurement and 42 % – after additional DXA examination. After BMD measurement in subjects who required the DXA scan, 78.2 % of females with RA and GC use required antiosteoporotic treatment (additionally to calcium and vitamin D, lifestyle modifications).Conclusion:Approximately 60 % of subjects with RA and GC use required antiosteoporotic treatment without additional DXA measurement according to correspondent FRAX indexes from both guidelines. The proportion of women requiring treatment after DXA scan is slightly higher according to Ukrainian recommendations. It proves that both of them can be used effectively in daily clinical practice for fracture risk assessment in females with RA.References:[1]Buckley L, Guyatt G, Fink HA, Cannon M et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology, 2017;69(8), 1521–1537. DOI:10.1002/art.40137[2]Povoroznyuk V, Grygorieva N, Kanis JA et al. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis. Pain. Joint. Spine. 2019;9(4):7-16. DOI: 10.22141/2224-1507.9.4.2019.191921[3]Povoroznyuk VV, Grygorieva NV, Kanis JA et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos. 2017;12(1):53. DOI: 10.1007/s11657-017-0343-2.Disclosure of Interests:Nataliia Grygorieva Consultant of: Servier, Redis, Vladyslav Povoroznyuk: None declared.

Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

2013 ◽  
Vol 19 (1) ◽  
pp. 90-94 ◽  
Author(s):  
Hironobu Sakaura ◽  
Tomoya Yamashita ◽  
Toshitada Miwa ◽  
Kenji Ohzono ◽  
Tetsuo Ohwada
Keyword(s):  
Lumbar Spine ◽  
Clinical Outcome ◽  
Interbody Fusion ◽  
Sagittal Alignment ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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