BACKGROUND:Systemic sclerosis (SSc) is associated with multifactorial bone loss and elevated vertebral fracture risk. Dual-energy X-ray absorptiometry (DXA) measures areal bone mineral density (aBMD), which reflects bone mass rather than bone strength and provides no information on trabecular microarchitecture. The trabecular bone score (TBS) provides complementary, indirect information on trabecular microarchitecture that may be independently impaired in SSc. The clinical determinants of low TBS and its relationship to vertebral fractures in SSc remain incompletely characterized. OBJECTIVES:To compare TBS and BMD between SSc patients and age- and sex-matched healthy controls, overall and separately in women and men; to identify clinical factors independently associated with low TBS in SSc; and to describe vertebral fracture prevalence at 5-year radiographic follow-up. METHODS:A case-control study enrolled 130 adult SSc patients and 390 age- and sex-matched healthy controls at Srinagarind Hospital, Khon Kaen University, Thailand. All participants underwent lumbar spine DXA with TBS analysis on the same densitometer. Matched comparisons of continuous outcomes used generalized estimating equations with exchangeable working correlation within matched set; matched comparisons of binary outcomes used conditional logistic regression stratified on matched set. Effect modification by sex was assessed with formal SSc-by-sex interaction terms. Factors associated with low TBS (TBS <1.350) were examined by univariate and multivariable logistic regression, with odds ratios, confidence intervals and p-values derived from the same model. Vertebral fractures were graded by Genant's semiquantitative method at 5-year follow-up in 80 patients with radiographs; after pre-analysis exclusion of two patients with tuberculous vertebral destruction, 78 patients contributed to the fracture analysis. RESULTS:Low TBS was significantly more prevalent in SSc patients than controls (53.1% vs. 34.1%, p < 0.001). Mean BMD was significantly lower at all skeletal sites in SSc patients (all p < 0.001). The excess of low TBS in SSc was significant in women (63.2%vs. 37.9% of controls; OR 3.77, 95% CI 2.13-6.69) but not in men (25.7%vs. 23.8%; OR 1.12, 95% CI 0.45-2.78), and the SSc-by-sex interaction was statistically significant, albeit marginally (p=0.047 for continuous TBS; interaction OR 3.38, 95% CI 1.15-9.95, p=0.027 for low TBS). Deficits persisted after BMI adjustment. Within SSc patients, age ≥60 years (adjusted OR 3.99, 95% CI 1.63-9.72; p = 0.002) and female sex (adjusted OR 5.29, 95% CI 2.12-13.18; p < 0.001) were each independently associated with low TBS, and both remained so under Firth penalized-likelihood estimation. Among the 78 evaluable patients, vertebral fracture prevalence at 5-year follow-up was 42.3% (95% CI 32.0-53.4%); fractures occurred across all BMD and TBS categories, including in 8 of 20 patients (40%) with both normal BMD and normal TBS. Of 35 patients meeting the T-score criterion for osteoporosis, 11 (31.4%) received no anti-osteoporotic treatment. CONCLUSIONS:SSc patients exhibit significantly impaired bone microarchitecture compared with matched controls. Age and female sex were each independently associated with low TBS, and the microarchitectural deficit relative to controls was more marked in women, though the male subgroup was small and the interaction evidence marginal. TBS may provide information complementary to BMD in SSc, and its role in fracture risk stratification warrants prospective evaluation. The high vertebral fracture prevalence and the substantial treatment gap identify priorities for bone health care in SSc.
Objectives Immune checkpoint inhibitors (ICIs) have revolutionized prognoses in oncology but their efficacy is often associated with immune toxicity. Few studies have investigated potential effects of immunotherapy on bones. We aimed to evaluate the bone status of patients undergoing ICI therapy. Methods In this retrospective monocentric descriptive study, we included all adult patients treated with ICIs with at least one thoracic or abdominal computed tomography scan as part of their oncological follow-up. The opportunistic diagnosis of osteoporosis was performed by determining the estimated bone mineral density (eBMD) by measuring regions of interest in the trabecular bone in T7 and L1 vertebrae in Hounsfield units (HUs). Results Between January 2014 and December 2021, 87 patients (56.3% male) were included. The main cancers were lung cancer (66.7%) and skin cancer (20.8%), with 77 patients (88.5%) at the metastatic stage, mainly treated with the PD1 inhibitors. Two measurements were for 79 patients with no significant of BMD change upon treatment after a follow-up of 16.3 ± 14.1 months. If we focused on the association between UH<110 and/or vertebral fracture, or UH<90 and/or vertebral fracture, 43 patients and 27 patients were identified using these criteria respectively. Conclusion Nearly half of the patients treated with ICIs were osteoporotic without specific treatment, despite significant risk factors for bone loss and fractures. During follow-up, BMD was stable under ICI therapy..
Forearm dual-energy X-ray absorptiometry (DXA) is frequently employed for fracture risk assessment in patients with certain chronic conditions such as end-stage renal disease (ESRD), in whom the lumbar spine and hip measurements may be confounded. We report a case of a 72-year-old postmenopausal woman with ESRD maintained on hemodialysis through a stented left forearm arteriovenous fistula (AVF) and type 2 diabetes mellitus, referred for forearm DXA. Bone mineral density measurement of the access-bearing left forearm yielded a T-score of -4.8, consistent with osteoporosis. The acquired image incidentally demonstrated sclerosis of the carpal lunate concerning for Kienböck's disease, in addition to a partially visualized AVF stent. This case underscores the rationale for imaging the non-access forearm in patients with vascular access undergoing DXA evaluation, while illustrating the importance of scrutinizing the full DXA image set rather than the numerical output alone.
PURPOSE:Bone mineral density (BMD) alone is insufficient to fully capture fracture risk. This study investigated the association between lumbar spine BMD (LS-BMD) and trabecular bone score (TBS) and constructed age- and sex-specific centile reference curves for both measures in a Taiwanese population. METHODS:This cross-sectional study included 1,196 participants. LS-BMD was measured at L1-L4 by dual-energy X-ray absorptiometry (DXA), and TBS was derived from the same images using TBS iNsight software (Med-Imaps). Pearson correlation and multiple linear regression were performed to examine BMD-TBS associations and identify predictors of TBS variation. Generalized Additive Models for Location, Scale and Shape (GAMLSS) with cubic spline smoothing was applied separately by sex to generate continuous age-specific centile curves (5th-95th percentiles) for ages 20-90 years. RESULTS:The cohort comprised 530 (44.3%) participants with normal BMD, 493 (41.2%) with osteopenia, and 173 (14.5%) with osteoporosis. LS-BMD and TBS were positively correlated (r = 0.68). LS-BMD, BMI, and age were significant independent predictors of TBS (adjusted R² = 0.672); menopausal status was not. GAMLSS centile curves revealed that female LS-BMD peaked at ages 30-40 years and declined sharply after age 50, while male upper BMD centiles remained stable despite concurrent TBS decline, a BMD-TBS dissociation undetectable by mean-based analyses. CONCLUSION:LS-BMD and TBS provide complementary information on bone quantity and microarchitectural integrity. The sex-specific GAMLSS-derived centile curves constitute the first full-distribution normative reference standards for LS-BMD and TBS in a Taiwanese population, extending beyond conventional T-score classification.
INTRODUCTION:Osteoporosis is usually diagnosed by evaluating Bone Mineral Density (BMD) at hip and spine in central DXA (cDXA). In certain cases, cDXA alone may miss patients with BMD loss in cortical bones such as distal radius resulting in underdiagnoses and treatment. We evaluated the incremental role of 33% distal radius BMD/peripheral DXA (pDXA) in correctly classifying the WHO category of BMD which may otherwise be mislabeled on routine cDXA. METHODS:Retrospective analysis of 454 DXA scans acquired between January 2018 and July 2024. Patients over 18 years with both cDXA and pDXA, regardless of gender or cancer history, were included. Exclusions included pediatric patients, those on antiresorptive therapy and osseous metastases. BMD at scanned sites, demographics and FRAX risk factors were noted. Descriptive statistics included means and standard deviations for quantitative data, and frequencies with percentages for categorical variables. McNemar's test and logistic regression were used to assess BMD discordance and its predictors. FRAX 10-year major osteoporotic and hip fracture probabilities were calculated using online FRAX tool with pDXA-derived BMD values and compared with cDXA-derived BMD values. Differences in the proportion of patients meeting treatment thresholds were assessed, with statistical significance defined as p < 0.05. RESULTS:Most patients were females (85%) with mean age of 62 years. Addition of pDXA increased the proportion of patients classified as having osteoporosis from 32% to 46%. Overall, 26% of patients were reclassified to a lower BMD category, most commonly from osteopenia to osteoporosis (73%), followed by normal to osteopenia (10.9%) and normal to osteoporosis (7.6%). Low distal radius BMD was particularly frequent among patients with rheumatoid arthritis and those with multiple osteoporosis risk factors. Comparing routine FRAX risk calculation on cDXA with 33% distal radius (pDXA) BMD, in >50% of patients, there was a statistically significant increase in those qualifying for initiation of bone strengthening treatment (p-value = 0.04). CONCLUSION:The addition of pDXA to existing cDXA protocols led to worsening of WHO BMD category in one in four of our population, highlighting the value of including 33% distal radius in bone health evaluation especially in women, elderly, patients with rheumatoid arthritis, and those with multiple FRAX risk factors. Using pDXA BMD value in FRAX calculation increases the predicted likelihood of major osteoporotic and/or hip fracture and therefore would have a significant impact on treatment.
BACKGROUND:The accuracy of four-electrode bioelectrical impedance analysis (BIA) and eight-electrode BIA in estimating body fat percentage (BF%), fat mass (FM), and skeletal muscle mass (SMM) remains a matter of debate. Moreover, systematic and quantitative comparisons between four- and eight-electrode BIA across these indices are limited. OBJECTIVE:This study aimed to evaluate the agreement of four-electrode BIA and eight-electrode BIA against dual-energy X-ray absorptiometry (DXA) in the assessment of BF%, FM, and SMM in adults. By directly comparing these two BIA modalities with DXA, we sought to clarify their measurement accuracy and to quantify the magnitude of inter-method differences. METHODS:Healthy adults aged 18-60 years were enrolled. BF%, FM, and SMM were measured using four-electrode BIA, eight-electrode BIA, and DXA, and the results were compared across methods. RESULTS:Analysis of variance revealed no statistically significant differences among the three methods in the measurement of BF%, FM, or SMM. Intraclass correlation coefficient (ICC) analysis demonstrated strong agreement between both four-electrode and eight-electrode BIA and DXA (P < 0.001), with higher ICC values observed for eight-electrode BIA. Bland-Altman analyses further indicated that, for BF%, FM, and SMM, the proportion of observations falling within the 95% limits of agreement was consistently greater for eight-electrode BIA than for four-electrode BIA when compared with DXA. CONCLUSION:Both four-electrode and eight-electrode BIA demonstrated high reliability in measuring body fat percentage, fat mass, and muscle mass. Moreover, the eight-electrode BIA showed better agreement with DXA compared with the four-electrode system. These findings provide empirical evidence supporting the application of BIA in body composition assessment and may offer practical guidance for device selection in both research and clinical settings.
OBJECTIVE:To evaluate the relationship between MRI-derived proximal humeral cortical bone thickness and dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) parameters in patients with acromegaly. METHODS:This retrospective study included 22 patients with acromegaly and 20 age- and sex-matched controls. Proximal humeral cortical bone thickness (CBTavg) was measured on coronal T1-weighted MRI images as the mean of four standardized cortical measurements. Lumbar spine DXA T-scores were recorded in the acromegaly cohort. Group comparisons, Spearman correlation analyses, and exploratory receiver operating characteristic (ROC) analysis were performed. RESULTS:Mean CBTavg did not differ significantly between patients with acromegaly and controls (5.86 ± 1.83 mm vs 6.38 ± 1.33 mm, P = 0.294). Within the acromegaly cohort, CBTavg demonstrated a strong positive correlation with lumbar DXA T-scores (ρ = 0.906, p < 0.001). No significant associations were observed between CBTavg and disease duration or body mass index. Patients with active disease demonstrated lower mean CBTavg values compared with those in remission; however, this difference was not statistically significant. Exploratory ROC analysis demonstrated discriminative performance of CBTavg for identifying low BMD (AUC = 0.946). CONCLUSION:MRI-derived proximal humeral cortical thickness is associated with DXA-derived BMD parameters in acromegaly and may provide opportunistic structural information from routine MRI examinations that include the proximal humerus. However, CBTavg did not significantly differ between patients with acromegaly and healthy controls and therefore should not be interpreted as a disease-specific skeletal biomarker.
BACKGROUND:Parathyroid gland adenomas or hyperplasia can cause primary hyperparathyroidism where increased levels of parathyroid hormone (PTH) lead to increased bone resorption. Parathyroidectomy can attenuate or reverse this bone loss. This study compares the difference in gland histology on Bone Mineral Density (BMD) following parathyroidectomy. METHODS:A retrospective cohort study of patients with primary hyperparathyroidism comparing BMD before and after parathyroidectomy between patients with single-gland adenomas and hyperplasia on histological examination. BMD was measured using Dual-Energy X-Ray Absorptiometry (DXA) at the lumbar spine, total hip, femoral neck, total forearm, distal one-third radius and ultra-distal radius. T-Scores and Z-Scores were calculated and compared. RESULTS:A total of 118 patients were included (Adenoma Group n = 82; Hyperplasia Group n = 36). On presentation, a lower proportion of patients with adenomas were symptomatic with renal calculi (14.5% versus 35.3%, p = 0.013). The Hyperplasia Group had lower pre-operative BMD in their lumbar spine (p = 0.031), femoral neck (p = 0.002), total forearm (p = 0.022), and distal one-third radius (p = 0.009) and higher rates of osteoporosis (p = 0.023). The Adenoma Group had higher post-operative BMD gains in the femoral neck (3.3% versus 0.4%, p = 0.029). CONCLUSION:Primary hyperparathyroidism caused by hyperplasia presents with worse BMD loss than that of adenoma. Following parathyroidectomy, adenoma demonstrates greater BMD recovery compared to hyperplasia. BMD gain is primarily within mixed cortical/trabecular bone of the hip whilst no relative gain was observed in the spine or forearm, reflecting different manifestations of bone resorption between these histological variants.
INTRODUCTION:The postmenopausal bone health reflects the influence of various factors that have been in effect throughout life and hormonal regulation is among them. The aim of the current study is to investigate the effect of pregnancies and other factors related to female reproductive health on bone mineral density and the incidence of fractures in the postmenopausal period. MATERIAL AND METHODS:We performed a case-control retrospective analysis in a group of 977 postmenopausal women from the RACOST-POL cohort. RESULTS:In the study group, there were 894 (91.5%) women who had at least one delivery and breastfeeding was reported by 845 (86.5%) women. Bone mineral density (FN T-score) was not related to pregnancies and history of lactation, but correlated positively with age at menopause and with time of reproductive period. Low-energy fractures were reported by 286 women, which consists 29.3% of the study group. There was no difference in fracture prevalence between women who delivered (29.4%) or not (27.7%). Also the breastfeeding status was not related to fracture prevalence (28.9% in the subgroup declaring lactation and 31.8% in the others). Women with fractures had earlier age of menopause and shorter time of reproductive period in comparison to subjects without fractures (48.3 ± 5.2 vs. 49.5 ± 4.7 ys.; p < 0.001; OR 0.95 (95% CI: 0.93 - 0.98), and 34.1 ± 5.5 vs. 35.5 ± 4.9 ys.; p < 0.001; OR 0.95 (95% CI: 0.93 - 0.98), respectively). Additionally, fracture prevalence in the 'early menopause' (below 45 ys) subgroup was significantly higher (39.1%) than in all the others (27.8%) with OR 1.66 (95% CI: 1.13 - 2.42). CONCLUSIONS:Our study did not show a significant association between history of pregnancies or lactation and the skeletal status in the postmenopausal period. However, a shortened period between menarche and menopause and an earlier age at menopause may have a negative impact on bone health in later life. Presented results complement the knowledge on a wide and diverse spectrum of factors modifying bone health in postmenopausal women.
Purpose Primary hyperparathyroidism (PHPT) is a common endocrine disorder that affects bone structure. Several methods are available to evaluate bone microarchitecture, and among these, the Trabecular Bone Score (TBS) provides an indirect assessment through textural analysis of lumbar spine Dual-energy X-ray absorptiometry (DXA) images. Our study aimed to assess the effects of PHPT on bone in postmenopausal women using bone mineral density (BMD) and TBS, and to evaluate the relationship between TBS, BMD, clinical characteristics, and biochemical parameters. Method The clinical characteristics, laboratory findings, and DXA imaging results of 118 postmenopausal women with PHPT were retrospectively analyzed, and TBS analyses were performed. Results A total of 118 patients were included in this study. Among them, 92 (77.9%) had TBS≤1.35, with a mean TBS value of 1.23±0.12, indicating an impaired bone microarchitecture. Additionally, 55 patients (46.6%) met the diagnostic criteria for osteoporosis, and 77.1% of the overall cohort were asymptomatic at presentation. Patients with TBS≤1.35 had lower BMD at the lumbar spine, femur, and radius and were more frequently diagnosed with osteoporosis (p<0.05). A positive correlation was observed between TBS and BMD in all measured skeletal areas (p<0.05). BMD values were significantly lower in symptomatic patients than in asymptomatic patients (p<0.05), whereas no statistically significant difference was found in TBS between the two groups (p>0.05). TBS values were also significantly lower in patients recommended for surgical treatment than in those under follow-up (p=0.005). Conclusion Bone microarchitecture is affected in patients with asymptomatic PHPT. To accurately assess the effects of PHPT on bone, bone microarchitecture should also be evaluated.
INTRODUCTION:Type 2 diabetes (T2D) is characterised by low bone turnover. Diabetes is considered to be a risk factor for osteoporosis and vertebral fractures (VF). Sclerostin, a molecule found at high levels in diabetic patients, inhibits osteoblastogenesis and bone formation. Our study aims to investigate the relationship between sclerostin, osteoporosis and VFs in patients with T2D. METHODS:The study included 101 postmenopausal women with T2D and 30 nondiabetic, postmenopausal controls. The levels of parathyroid hormone (PTH), C-terminal telopeptide (CTX), 25-hydroxyvitamin D and sclerostin were measured in all participants. Dual-energy X-ray absorptiometry (DXA) and thoracolumbar radiography were performed on all patients, with the results being evaluated separately by two clinicians using the Genant method to assess VF in a blinded manner. The FRAX scoring system was used to calculate the patients' risk of fracture. RESULTS:Postmenopausal diabetic patients were divided into three groups according to their T-scores: osteoporotic, osteopenic and normal. The group of diabetics with normal T-scores had the highest levels of sclerostin. Sclerostin was an independent factor associated with osteoporosis (p = 0.003, OR = 1.24, CI = 1.15-1.3). The prevalence of VF was similar in both diabetic and non-diabetic groups, and no relationship was found between VF and sclerostin levels. CONCLUSION:Sclerostin may be a potential marker for osteoporosis in diabetic patients, but further research is needed for VF. Anti-sclerostin therapies could be a treatment option for diabetic osteoporosis.
BACKGROUND:Accurate assessment of body composition is fundamental for evaluating obesity or bone health. While Dual-energy X-ray absorptiometry (DXA) is a method with high and reliable accuracy for measuring body composition, bioelectrical impedance analysis (BIA) provides a rapid, non-invasive, and more accessible alternative. This study aimed to determine the correlation and agreement between multi-frequency BIA and DXA measurements among healthy Vietnamese adults. METHODS:A cross-sectional study was conducted on 456 adults (222 males, 234 females; mean age 37.0 ± 13.7 years). Body composition parameters including fat mass, body fat percentage, lean body mass, fat-free mass, and bone mineral content were measured using DXA (Hologic Horizon W) and BIA (Tanita MC-980MA PLUS). Bland-Altman plots were used to further assess the agreement between BIA and DXA results. RESULTS:Compared with DXA, BIA consistently underestimated body fat percentage (-6.19% for whole body, -4.88% for trunk; p < 0.001) and overestimated fat-free mass (+4.26 kg) and lean mass (+3.94 kg; p < 0.001). Correlations between BIA and DXA were strong (r = 0.95-0.97 for lean and fat-free mass; lowest for BMC, r = 0.81). Bland-Altman analyses revealed proportional bias by region - greater discrepancies in trunk and arms, while the legs showed more stable agreement. CONCLUSION:Overall, the two methods demonstrated strong correlation but region-specific bias, indicating that agreement between BIA and DXA depends on body site.
BACKGROUND:Side-to-side discordance in hip bone mineral density (BMD) is common. We evaluated the associations of discordance in hip BMD with hip osteoarthritis (OA) severity and the risk of progression to total hip replacement (THR) in middle-aged adults. METHODOLOGY:In 568 participants (aged 47-69 years, 40.3% females) from the Busselton Healthy Ageing Study, including 145 who progressed to THR during a median follow-up of 7.9 years, bilateral hip BMD was measured using dual-energy x-ray absorptiometry (DXA), and Kellgren-Lawrence hip OA grading (0-normal to 4-severe OA) was performed on DXA images of both hips at baseline. Associations were examined using general linear and logistic regression models, accounting for sex, baseline age and BMI. RESULTS:Mean absolute side-to-side difference in total hip BMD was 0.036±0.031 g/cm2. The discordance in total hip BMD was significantly greater in participants with grade 4 hip OA (n = 9) compared with those with grade 0 (n = 206), 1 (n = 212) or 2 (n = 88) OA at the worst hip (0.068 vs 0.035, 0.036 and 0.031 g/cm2, respectively, all P < 0.05), and in participants who progressed to THR during follow-up (0.045 vs 0.033 g/cm2, P < 0.001). Per 0.010 g/cm2 greater discordance in total hip BMD was associated with 9.2% higher odds of having high OA grades (3 or 4) and 13.0% higher odds of post-baseline THR. CONCLUSION:Our data show that greater side-to-side discordance in hip BMD is associated with higher hip OA grades and greater risk of progression to total hip replacement, and thus could be of clinical utility in identifying high-risk patients.
This study aimed to examine the association between vertical jump performance and hip bone strength, specifically the composite indices of the femoral neck: compression strength index (CSI), bending strength index (BSI), and impact strength index (ISI), in post-menopausal women. A total of 51 participants volunteered. Body composition and bone mineral density (BMD) were measured using DXA, and the strength indices (CSI, BSI, ISI) were calculated accordingly. Jumping performance was assessed via the Sargent test. Results showed positive correlations between jumping performance and all three strength indices, which remained significant even after adjusting for age. In summary, the findings indicate a positive relationship between vertical jump ability and femoral neck strength in this population.
OBJECTIVE:The aim of this study is to compare bone mineral density (BMD), trabecular bone score (TBS), and prevalence of osteoporosis between women with breast cancer and controls across different age groups. METHODS:Dual-energy X-ray absorptiometry data (lumbar spine BMD, hip region BMD, and lumbar spine TBS) from 578 women with breast cancer and 2,312 controls (October 2022-May 2024) were retrospectively analyzed. Differences in BMD, TBS, and osteoporosis prevalence between women with breast cancer and controls across different age groups were compared. The correlations of TBS and BMD with age and body mass index (BMI) were calculated. Multivariate logistic regression analysis was performed to identify factors independently associated with degraded microarchitecture. RESULTS:Compared with controls, women with breast cancer aged < 60 years had lower lumbar spine BMD, whereas those ≥ 60 years had higher lumbar spine BMD. In the hip region, women aged < 50 years had lower BMD compared with controls, whereas those ≥ 50 years had higher hip BMD. The prevalence of osteoporosis in women with breast cancer increased progressively with age. Across all age strata, the prevalence of degraded microarchitecture increased with age and was consistently higher in women with breast cancer (P < 0.05). Among the subgroups categorized by BMD status (osteoporosis, osteopenia, and normal), the proportion of degraded microarchitecture was significantly higher in women with breast cancer than in controls. BMI correlated positively with BMD and TBS, whereas age correlated negatively. Multivariate logistic regression analysis identified age and lumbar spine BMD as the independent predictors of degraded microarchitecture (P < 0.001). CONCLUSIONS:Relying solely on BMD may underestimate the osteoporosis risk in women with breast cancer. Concurrent assessment of TBS provides complementary information on bone microarchitecture, which is particularly valuable for refining fracture risk stratification in younger patients and may help guide early bone-protective interventions.
BACKGROUND:Trabecular bone score (TBS) is a textural analysis of lumbar spine dual-energy X-ray absorptiometry (DXA) data that reflects bone microstructure and predicts fracture risk independent of DXA. This study evaluated TBS in distal radius fractures (DRF) patients, an initial manifestation of osteoporotic fractures. METHODOLOGY:Fifty-eight female DRF patients (mean age, 73) who underwent DXA and TBS were included. Low-TBS was defined as ≤1.230 based on Japanese reference data. TBS data from 47 female knee osteoarthritis patients (mean age, 77) undergoing total knee arthroplasty (TKA) served as controls. Osteoporosis was defined as ≤-2.5 SD of T-score on DXA. Correlations between TBS and clinical parameters (age, BMI, and medical history), blood markers (calcium, magnesium, TRACP-5b, osteocalcin, PTH-intact, tP1NP, and 25OHD), and DXA were analyzed. RESULTS:The mean TBS in DRF patients was 1.285±0.077, significantly lower than in TKA patients (1.325±0.084, p < 0.05). The prevalence of low-TBS in DRF patients (20.7%) was lower than DXA-defined osteoporosis (lumbar spine=44.8%; femoral neck=77.2%; total hip=43.9%, p < 0.05). TBS value correlated positively with DXA but negatively with age. Low-TBS patients with exhibited reduced calcium levels, elevated PTH-intact, increased renal dysfunction, and more fragility fractures (p < 0.05). Notably, 50% of low-TBS patients showed no osteoporosis on lumbar spine DXA, a finding associated with lower TRACP-5b, osteocalcin, and tP1NP levels. CONCLUSIONS:TBS in DRF was associated with age, DXA, renal dysfunction, fragility fractures, and serum calcium and PTH-intact levels. However, low-TBS was less prevalent than DXA-defined osteoporosis. Discrepancies between TBS and DXA may reflect low bone-turnover osteoporosis.
INTRODUCTION:This study aimed to evaluate the factors associated with the initiation and maintenance of osteoporosis evaluation and management in postmenopausal women following distal radius fracture (DRF). MATERIALS AND METHODS:We retrospectively reviewed 341 consecutive postmenopausal women who sustained a DRF after minor trauma between January 2018 and August 2021. Data on baseline characteristics, general medical condition (assessed using the American Society of Anesthesiologists classification system), dual-energy X-ray absorptiometry (DXA) results, and osteoporosis treatments before and up to two years following DRF were collected. RESULTS:After excluding 36 patients who were receiving anti-osteoporosis medication at the time of DRF, 305 patients were recommended for DXA evaluation after DRF. Sixteen patients (5.2%) with normal DXA results were not prescribed medication. Fifty patients (16.4%) either declined DXA evaluation or refused to initiate anti-osteoporosis medications (refusal group), while 239 patients initiated anti-osteoporosis medication (initiation group). A significantly higher portion of patients in the initiation group underwent surgery for DRF compared with the refusal group (82.0% vs. 68.0%, p = 0.03). Among the 239 patients who initiated anti-osteoporosis treatment, 164 (68.6%) maintained medication for two years. In multivariable analysis, only a diagnosis of osteoporosis rather than osteopenia was significantly associated with medication maintenance (odds ratio 1.960; 95% confidence interval, 1.117-3.440, p = 0.02). CONCLUSIONS:This study found that postmenopausal women who received non-operative treatment or had osteopenia on DXA are less likely to initiate or maintain osteoporosis evaluation and management following DRF. Clinicians need to emphasize osteoporosis evaluation and treatment adherence, particularly in these patients following DRF.
