Sub-millimetre resolution magnetic resonance imaging (MRI) reveal detailed patterns of inter- and intra-muscular fat (IMF) enabled by recent segmentation algorithms. However, clinical relevance of finer IMF streaks, beyond definite deposits, remains unclear. T1-weighted spin-echo MRI was acquired in the AMBERS (Appendicular Muscle and Bone Extension Research Study; calves from community-based females) and OAI (Osteoarthritis Initiative; thighs from disease-focused males and females) cohorts, including adults 45–85 years old. Thigh and calf MR images were segmented using the iterative threshold-seeking algorithm to quantify definite versus thinner streaks, with 3D connectivity verification, and partial volume correction. Absolute and relative IMF volumes were derived. Lower-extremity physical function and activities of daily living (ADL) were assessed contemporaneously. Clinical sensitivity was evaluated using multivariable linear regression relating IMF volumes to demographics, physical function, and ADLs. Among 385 adults (89

Fracture risk is commonly assessed by FRAX, a tool that estimates 10-yr risk for major osteoporotic fracture (MOF) and hip fracture. FRAX scores are often refined by including FN BMD measured by DXA as an input. Rho, a novel AI-powered software, estimates FN BMD T-Scores from conventional X-rays, even when FN is not in the image. Whether a FRAX score using this estimate (FRAX-Rho) can improve a FRAX score without a T-Score input (FRAX-NoT) has not been studied. We conducted a retrospective analysis of Canadian Multicentre Osteoporosis Study participants who had X-rays of the lumbar and/or thoracic spine, FRAX risk factors, and DXA T-Scores acquired at the same time point, and follow-up fracture outcomes over 9 yr. In 1361 participants with lumbar X-rays, FRAX-Rho and FRAX with DXA FN T-Scores (FRAX-DXA) had very good agreement in categorizing participants by MOF risk (Cohen's weighted kappa κ = 0.80 [0.77-0.82]), which tended to be better than that between FRAX-NoT and FRAX-DXA (0.76 [0.73-0.79]). Agreement in categorizing participants by hip fracture risk was significantly greater between FRAX-Rho and FRAX-DXA (0.67 [0.63-0.71]) than FRAX-NoT and FRAX-DXA (0.52 [0.48-0.56]). In predicting true incident MOF, FRAX-Rho and FRAX-DXA did not differ in their discriminative power (c-index) (0.76 and 0.77; p = .36); both were significantly greater than that of FRAX-NoT (0.73; p < .004). The accuracy of FRAX-Rho for predicting MOF (Brier Score) was better than FRAX-NoT (p < .05) but not as good as FRAX-DXA. Similar results were observed in participants with thoracic X-rays. In conclusion, FN T-Scores estimated by Rho from lumbar and thoracic X-rays add value to FRAX-NoT estimates and may be useful for risk assessment when DXA is not available.

The FRAX model defines fractures occurring at the hip, vertebrae, humerus, and forearm as major osteoporotic fractures (MOF), leading to the misconception that fractures at other sites (NonMOF) are unimportant. We aimed to compare MOF and NonMOF to 1) assess their contribution to subsequent fracture and mortality risks and 2) the differences in subsequent fracture and mortality risks between MOF and NonMOF as well as 3) assess these contributions using an anatomical classification of hip, vertebral, proximal and distal fractures. Data from 7568 women and 3366 men aged 60+ were utilised from two Longitudinal cohorts (the Canadian Multicentre Osteoporosis Study and Dubbo Osteoporosis Epidemiology Study) to assess subsequent fracture and mortality following initial fractures. Initial fractures were classified as MOF or NonMOF for aim 1 and 2, and as hip, vertebral, proximal, or distal for aim 3. There were 1998 initial fractures (38% NonMOF) in women and 484 (48% NonMOF) in men. During 9551 person-years (py), women experienced 605 subsequent fractures (38% post-NonMOF) and during 2230 py, men had 97 subsequent fractures (48% post-NonMOF). Following the initial fracture, 556 women died (29% post-NonMOF) over 12065 py and 196 men died (38% post-NonMOF) over 2773 py. NonMOF were associated with 69% higher subsequent fracture risk in women (HR: 1.69; 95% CI: 1.47-1.95) and two-fold in men (2.06; 1.52-2.80), compared to initial fracture, comparable to MOF (women: 1.76; 1.56-1.98 and men: 2.09; 1.53-2.85. NonMOF imparted >30% excess mortality (women: 1.37; 1.16-1.60 and men: 1.33; 1.03-1.72), compared to fracture-free population, lower than MOF (women: 1.75; 1.54-1.99 and men: 2.26; 1.81-2.81) but still substantial. All anatomical fracture sites were associated with subsequent fracture risk, and the risk of mortality increased incrementally from distal to proximal, vertebral and hip. MOF and NonMOF showed comparable risks of subsequent fracture and mortality. All sites are associated with adverse outcomes and should be addressed in clinical care guidelines.

OBJECTIVE:to examine regional tibial marrow density as measured by peripheral quantitative computed tomography (pQCT) and determine its association with incident fragility fractures among postmenopausal females. METHODS:The Appendicular Muscle and Bone Extension Research Study (AMBERS) is a longitudinal cohort study that recruited postmenopausal females 60-85 yr of age. pQCT distal tibia scans were acquired at baseline (22.5 & 27.5 mm proximal from tibial endplate). Marrow was segmented from trabeculae using the Iterative Threshold-Seeking Algorithm. Central versus peripheral regions were delineated using edge detection and threshold-based concentric peeling, and marrow density was calculated. Self-reported incident fragility fractures across 7 follow-up years were ascertained by X-ray confirmation. Cox proportional hazards models, competing risk (against mortality), and conditional Cox models assessed the relationship between marrow density and time to first fracture. Models were adjusted for age, body mass index, diabetes/hypertension, hypo/hyperthyroidism, antiresorptive usage, diagnosis of osteoarthritis, physical activity, lumbar spine bone mineral density, and trabecular tissue mineral density at the same distal tibia site. RESULTS:Among 312 postmenopausal females, 41(13.1%) experienced an incident fracture over a median follow-up of 83.9(24.8) months. Lower central marrow density at the distal (hazard ratio (HR) per SD: 1.81(1.21, 2.71)) and proximal slice (HR:1.58(1.06, 2.36)) each associated with increased fracture risk. Peripheral marrow density only associated with increased fracture risk (2.65(1.19, 5.92) when comparing intermediate to highest levels. These trends held true after accounting for competing mortality, and time-dependent effects. CONCLUSION:Our findings suggested that central tibia marrow density as quantified by pQCT is a proxy for marrow composition that reveals important 4 to 7-yr risk of fragility fractures among postmenopausal females. These results highlight the potential of marrow density as a separate risk factor for fractures from bone density, warranting further investigation as a potential contributor to fracture risk pending external validation.

Osteoporosis is a skeletal disease that significantly increases fracture risk and imposes a growing public health and economic burden. Notably, hip fractures are associated with high mortality, long-term disability, and loss of independence. When evaluating osteoporosis and estimating fracture risk, DXA is commonly used to determine the BMD. To capture geometrical morphology from these DXA scans as factors in fracture risk prediction, landmarking around the femur is conducted manually around the ROI. However, this process is labor-intensive and prone to variability. This study presents the development of a fully automated femoral landmarking tool that integrates a U-Net convolutional neural network for femur contour segmentation with a geometric algorithm for consistent landmark placement. A heterogeneous dataset of 555 DXA scans was used to train and evaluate the U-Net model, achieving a pixel-wise accuracy of 97.55%, an Intersection over Union of 91.55%, and a Dice coefficient of 95.56% on the test set. When incorporated into a statistical shape and appearance modeling (SSAM) framework for fracture risk prediction, predictions using the automatically generated landmarks achieved a test AUC of 0.831 (95% CI: 0.698-0.965), compared with 0.780 (95% CI: 0.635-0.925) for manual landmarks; a paired DeLong test showed no significant difference (p = .53), indicating a comparable performance. The proposed pipeline produces anatomically relevant, reproducible landmarks, and supports fracture prediction performance similar to manual methods. It presents a scalable and objective solution for morphometric analysis in DXA imaging.

Introduction Prehabilitation is the process of enhancing an individual’s functional capacity to better tolerate upcoming stressors such as total hip arthroplasty (THA) or total knee arthroplasty (TKA). Its clinical implementation, however, depends on complete intervention reporting. This review evaluated the completeness of reporting of THA and TKA prehabilitation interventions using the Template for Intervention Description and Replication (TIDieR) checklist and examined changes in reporting quality over time. Methods MEDLINE, EMBASE, CENTRAL, and Google Scholar were searched from inception to May 3, 2024, to identify randomized controlled trials or trial protocols reporting prehabilitation interventions for adults undergoing THA or TKA. Results From 1278 unique search results, 191 full-text studies were assessed for eligibility, and 84 studies met inclusion criteria (n = 54 TKA, n = 15 THA, n = 15 TKA/THA). Prehabilitation intervention modalities reported across studies included exercise (n = 51), multimodal programs (n = 14), behavioural (n = 6), nutritional supplementation or weight loss (n = 3), and other (n = 10). The mean (standard deviation) TIDieR score was 8.1 (1.6), indicating moderate reporting quality. The proportion of studies reporting each item completely were as follows: name (100%), rationale (100%), materials (67%), procedures (90%), providers (25%), mode of delivery (82%), location (74%), dose and duration (88%), tailoring (35%), modifications (5%), planned adherence (37%), and actual adherence (38%). Reporting quality was similar before and after publication of TIDieR in 2014. Discussion By systematically evaluating reporting quality using the TIDieR checklist, this review identifies the intervention components most often underreported and provides a benchmark to guide future trial design and reporting.

Promoting and maintaining intrinsic capacity, the composite of an individual’s physical and mental abilities, is central to the World Health Organization’s Integrated Care for Older People (ICOPE) framework. Intrinsic capacity reflects a person’s overall functional ability and resilience. Strengthening intrinsic capacity through community-based, person-centered interventions is key to enabling older adults to live independently and maintain well-being. Dance-based rehabilitation represents a promising, holistic approach that supports multiple domains of intrinsic capacity, including locomotor, cognitive, and psychological function, within a single, engaging program. This two-arm, parallel-group, single-blind trial compares Cognitive Groove to wait-listed control. Participants will attend 1-h group classes twice weekly for 3 months at YMCA sites. Eligibility includes a FRAIL Scale score ≥ 2, ability to walk 25 m (with or without assistive devices), and follow two-step instructions. The target sample is 250 older adults (125 per arm). The primary outcome is physical performance, measured by the Short Physical Performance Battery (SPPB), representing locomotor capacity within the ICOPE framework. Secondary outcomes align with other ICOPE domains and include measures of cognitive, psychological, sensory, and vitality capacities. Outcomes will be analyzed using generalized linear model (GLM) analysis to assess between-group differences over time. This protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. By evaluating Cognitive Groove in real-world settings, the study will generate critical evidence to support the implementation of scalable, non-pharmacological strategies for frailty management in community-dwelling older adults. This trial is registered on ClinicalTrials.gov (NCT06870149).

[This corrects the article DOI: 10.1016/j.bonr.2025.101857.].

Patients are concerned about which activities increase fracture risk and which are considered safe. Our study describes where, when, and how fractures occurred in Canadian adults followed over ten years. Falls are a leading cause of all fracture types in Canadian adults and should be prioritized in fracture prevention guidelines. Our study characterized the type and circumstances of fractures which occurred over 10 years during the Canadian Multicentre Osteoporosis Study. Details of incident fractures were recorded annually using questionnaires, and fractures were confirmed by X-ray. Medical and lifestyle history, including self-reported physical activity, was obtained by interview at baseline, year 5 and year 10. 9423 community-dwelling females and males aged ≥ 25 years were included. 1533 fractures were reported and confirmed (13

Osteoporosis, a common bone disease in older adults, is associated with low bone mineral density (BMD) and an increased risk of fractures. While fracture risk is often assessed using T-scores derived from dual-energy X-ray absorptiometry (DXA) scans, these measures are not fully effective in identifying individuals at greatest risk. To address this, a Statistical Shape and Appearance Modeling (SSAM) tool was previously developed to analyze femur shape and BMD distribution and demonstrated superior fracture risk prediction compared to T-scores using hip DXA scans exported in JPG format. The present study aimed to evaluate whether changes in DXA-imaging protocol (hip protocol vs. High-Definition Instant Vertebral Assessment (IVA-HD)) may influence the image and the SSAM tool's fracture risk predictions. The effect of image file type (JPG vs. PNG) was also explored, as native formats such as Digital Imaging and Communications in Medicine (DICOM) cannot be readily exported or saved in large databases. DXA scans from 36 subjects and seven cadaveric femurs were analyzed across four imaging conditions (file types and imaging protocols). Structural Similarity Index Measures (SSIM) quantified image differences, and Bland-Altman plots assessed agreement in fracture risk predictions. Minimal differences were found in SSAM tool outputs across protocols and file types. Higher-resolution scans (IVA-HD) and lossless file types (PNG) did not improve the accuracy of risk predictions compared to the standard hip protocol in JPG format. These findings suggest that the SSAM tool is robust to variations in imaging conditions, supporting its use with standard DXA imaging protocols and file formats.

INTRODUCTION:Procollagen type 1 N-propeptide (P1NP) and carboxy-terminal telopeptide of type 1 collagen (CTX) are bone turnover markers for diagnosing and monitoring metabolic bone diseases and growth disorders. This study aimed to establish representative reference ranges for CTX and P1NP, as measured with an IDS-iSYS system, in Canadian children and adolescents. METHODS:Serum levels of CTX and P1NP were measured in participants of the Canadian Health Measures Survey, a nationally representative study. The LMSP method, using Box-Cox power exponential distribution to accommodate kurtosis in the distribution, was employed to estimate age- and sex-specific reference curves and parameters for Z-score calculation. In addition, non-parametric analysis was utilized to establish 95 % reference intervals for two-year age brackets. Reference curves were generated based on the cohort aged 6 to 27 years, and reference intervals were calculated based on the age range 6 to 20 years. RESULTS:The cohort included 1840 participants for CTX (51.6 % males) and 4069 for P1NP (50.5 % males). Reference ranges for age and sex showed the expected patterns with peaks at the age of puberty (earlier in females than males). As the aim of the study was to present representative reference data, results were provided based on the entire study population regardless of ethnicity and health status. Results obtained in the most common ethnicity ('white') and in the subgroup of 'healthy white' study participants were similar. CONCLUSION:This study establishes age- and sex-specific reference values for serum concentrations of CTX and P1NP in Canadian individuals from 6 to 20 years of age. These results have the potential to enhance diagnostic accuracy and inform bone health clinical decision-making for this population.

Jumping mechanography is a tool for dynamic assessment of muscle function. We present the largest available reference data set to date for jumping mechanography in children and adolescents. Jumping mechanography reference data serve as a crucial benchmark for evaluating muscle and bone health outcomes in children and adolescents. We aimed to develop age- and sex-specific reference data for jumping mechanography measures in Canadian children and adolescents. Data from over 3000 children and adolescents (50.0

Family mapping is a useful tool for tracking the inheritance of rare inherited diseases, including hypophosphatasia (HPP), through generations. We show the inheritance of HPP in 6 affected families, describing genetic variants, biochemical hallmarks, and clinical manifestations among family members. Mapping families with HPP is warranted in clinical practice to better understand monitoring needs for potentially affected individuals over time, since manifestations of HPP can arise throughout a patient's lifespan.

Postfracture survival rates provide prognostic information but are rarely reported along with other mortality outcomes in adults aged >= 50 yr. The timing of survival change following a fracture also needs to be further elucidated. This population-based, matched-cohort, retrospective database study examined 98 474 patients (73% women) aged >= 66 yr with an index fracture occurring at an osteoporotic site (hip, clinical vertebral, proximal non-hip non-vertebral [pNHNV], and distal non-hip non-vertebral [dNHNV]) from 2011 to 2015, who were matched (1:1) to nonfracture individuals based on sex, age, and comorbidities. All-cause 1- and 5-yr overall survival and relative survival ratios (RSRs) were assessed, and time trends in survival changes were characterized starting immediately after a fracture. In both sexes, overall survival was markedly decreased over 6 yr of follow-up after hip, vertebral, and pNHNV fractures, and as expected, worse survival rates were observed in older patients and males. The lowest 5-yr RSRs were observed after hip fractures in males (66-85 yr, 51.9%-63.9%; >= 86 yr, 34.5%), followed by vertebral fractures in males (66-85 yr, 53.2%-69.4%; >= 86 yr, 35.5%), and hip fractures in females (66-85 yr, 69.8%-79.0%; >= 86 yr, 52.8%). Although RSRs did not decrease as markedly after dNHNV fractures in younger patients, relatively low 5-yr RSRs were observed in females (75.9%) and males (69.5%) aged >= 86 yr. The greatest reduction in survival occurred within the initial month after hip, vertebral, and pNHNV fractures, indicating a high relative impact of short-term factors, with survival-reduction effects persisting over time. Therefore, the most critical period for implementing interventions aimed at improving post-fracture prognosis appears to be immediately after a fracture; however, considering the immediate need for introducing such interventions, primary fracture prevention is also crucial to prevent the occurrence of the initial fracture in high-risk patients. Graphical Abstract