Abstract Background: Women aged 65+ account for nearly half of new ovarian cancer diagnoses. This patient group faces a substantial risk of declining functional status, i.e., the capability to carry out essential daily activities necessary for basic needs and health, such as dressing, bathing, toilet use, and eating. For this patient group, maintaining functional independence is a top priority. However, factors influencing functional status in older women with ovarian cancer remain poorly understood. This study aimed to identify demographic and clinical factors associated with functional status in this vulnerable population. Methods: We utilized data from the Minimum Data Set (MDS), which provides standardized functional assessments for U.S. nursing home residents. MDS data were linked with SEER-Medicare to capture cancer diagnoses and medical histories. The cohort included 6,257 women with primary invasive epithelial ovarian cancer diagnosed at age 65+ between 2000-2019. Functional status was quantified using a validated Activities of Daily Living (ADL) scale ranging from 0-28, with higher scores indicating greater dependency. A linear mixed-effect model was fit to identify factors associated with functional status during the first year after diagnosis, while accounting for repeated measures. Variables included age at diagnosis, Charlson Comorbidity Index, tumor stage, histotype, race/ethnicity, and Medicaid enrollment (as a proxy for socioeconomic status). Results: Median age at diagnosis was 79 years (interquartile range 74-84 years) with most diagnosed at distant stage (74%). Older age was associated with higher ADL scores (mean difference [MD]=0.07 per one year increase in age, 95% confidence interval [CI] 0.05-0.09, p<0.01). Other factors associated with higher ADL scores included: higher comorbidity (MD=0.41 per unit increase in Charlson Comorbidity Index, 95% CI 0.33-0.50, p<0.01), later tumor stage (distant vs. localized stages: MD=1.38, 95% CI 0.80-1.95, p<0.01) and non-serous histotype (non-serous vs. serous: MD=0.90, 95% CI 0.63-1.18, p<0.01). Higher ADL scores were also observed for non-White vs. White women (MD=1.95, 1.45, 1.14 for Black, Hispanic, and Asian/Pacific Islander, respectively, all p<0.01) and Medicaid-enrolled patients vs. non-enrolled (MD=0.65, 95% CI 0.11-1.18, p=0.02). Conclusions: Older age, higher comorbidity, later tumor stage, non-serous histotype, non-White race/ethnicity, and Medicaid enrollment are independently associated with increased functional dependency in older women with ovarian cancer. These findings suggest both biological and socioeconomic drivers of functional decline. Targeted supportive care is needed to mitigate functional decline, particularly for women with advanced disease, comorbidities, minority backgrounds, and low socioeconomic status. Citation Format: Minh Tung Phung, Lisa M. Barroilhet, Neil Binkley, Ronald E. Gangnon, Janelle Sobecki, Britton Trabert, Amy Trentham-Dietz. Factors associated with functional status among older women with ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 873.

BACKGROUND:Sagittal abdominal diameter (SAD), a measure of visceral adiposity, has been linked to major adverse cardiovascular events (MACE). However, the relationship between SAD and abdominal aortic calcification (AAC), a marker of subclinical vascular disease, and whether they independently and jointly predict MACE remains unclear. OBJECTIVE:To investigate whether weight-normalized SAD and AAC scored using a validated machine learning algorithm (ML-AAC24) are independently and jointly associated with incident MACE. METHODS:SAD and ML-AAC24 were measured from dual-energy X-ray absorptiometry (DXA) posteroanterior and lateral spine images, respectively, from the Manitoba Bone Density registry. RESULTS:Among 8806 individuals (mean age 75.1 ± 6.6 years, 93.9% women), 11.3% experienced MACE during a mean follow-up of 3.8 years. SAD/weight and ML-AAC24 were positively correlated (Spearman r = 0.11, P < 0.001). Individuals with moderate and high ML-AAC24 had 1.1% and 3.0% higher mean SAD/weight, respectively, than those with low ML-AAC24. Both ML-AAC24 and SAD/weight were independently associated with higher risk of MACE. Adjusted hazard ratios [HRs] for MACE were 1.45, 95%CI 1.24-1.71 and 1.99, 95%CI 1.67-2.35 for moderate and high ML-AAC24, respectively, vs. low. The HR for the highest vs. lowest tertile of SAD/weight was 1.37, 95%CI 1.16-1.61. Individuals who had both high ML-AAC24 and were in the highest SAD/weight tertile had the highest MACE risk (HR 2.63, 95% CI 2.02-3.44). CONCLUSION:Higher baseline SAD/weight was associated with higher ML-AAC24 scores. Both measures independently and jointly associated with MACE. Their combined use may potentially help identify individuals at high risk for cardiovascular disease during routine bone density testing.

This survey of 116 patients aged ≥ 50 years with ≥ 1 confirmed symptomatic vertebral fracture within 36 weeks prior to enrollment showed that pain related to fracture persisted after 24 weeks for a subset of patients and affected activities of daily living. These data emphasize the importance of vertebral fracture prevention. To describe pain persistence, severity, and effect on ADLs after symptomatic vertebral fracture. This was an observational cross-sectional survey of patients recruited from 7 United States clinical sites aged ≥ 50 years with ≥ 1 symptomatic osteoporotic vertebral fracture diagnosed within the prior 36 weeks. Patients’ experience of pain and its impact on ADLs during the past 7 days before the patient survey were evaluated. Data were collected through one-time patient surveys and retrospective medical chart review and analyzed descriptively. Of 116 patients enrolled, most were postmenopausal women (83

Background:Artificial Intelligence (AI)-based opportunistic risk stratification solutions can help to counter rising fragility fracture rates. Existing tools estimate bone mineral density (BMD) alone, while the present study incorporates trabecular bone score (TBS), a surrogate of bone microarchitecture, more closely mirroring fracture pathophysiology. We aimed to evaluate the performance of an AI tool that estimates bone fragility directly from standard radiographs to identify individuals at highest risk of fracture. Methods:This retrospective, multinational cohort study included 18,858 paired radiographs and lumbar spine dual-energy X-ray absorptiometry (DXA) scans from adult patients (aged at least 20 years) from three clinical sites in Europe and two sites in the United States. Routine clinical radiographs of the spine, abdomen, chest, or pelvis acquired in the anteroposterior or posteroanterior view and including visualisation of the lumbar spine were included. Eligible radiographs had an in-plane spatial resolution of ≤0.2 mm per pixel, independent of vendor, and had a corresponding DXA examination within 6 months, and included at least two lumbar vertebrae (L1-L4). The AI model training used a composite Bone Fragility Index, combining TBS and BMD. Training, internal validation and testing was performed on two European sites (n = 10,692; Italy and Austria); and external validation involved three sites with ethnically diverse populations (n = 7079): Slovakia, US site 1 (Wisconsin) and US site 2 (New York). Model performance for identifying very high bone fragility (characterised by degraded TBS and osteoporosis) prioritised specificity (as per the intended clinical use to prioritise low false-positive rates) and was evaluated with accuracy, sensitivity, specificity, AUC and precision. Findings:Between Jan 1, 2010 and Dec 31, 2023, 18,858 paired radiographs and lumbar spine dual-energy X-ray absorptiometry (DXA) scans from 11,138 participants across five international sites were retrospectively aggregated. Internal testing on two European sites demonstrated an accuracy of 0.86 (95% CI: 0.78, 0.92), specificity of 0.93 (0.85, 0.99), and sensitivity of 0.53 (0.41, 0.67). External testing on three sites demonstrated consistently high specificity of 0.88 (0.77, 0.99) in the European cohort, 0.94 (0.91, 0.97) in the American White dataset, and 0.96 (0.81, 0.99) in the American Non-White. External sensitivity ranged from 0.53 (0.41, 0.67) to 0.64 (0.50, 0.88). Interpretation:The proposed approach provides rapid identification of individuals with very high bone fragility from routine radiographs. Its specificity across diverse populations supports clinical use for opportunistic osteoporosis screening in real-world settings. Future work should assess the model's performance in more sex-balanced cohorts without prior DXA assessment, and evaluate its ability to predict incident fractures. Funding:The Swiss National Science Foundation, the Foundation of the Orthopaedic Hospital of the Vaudois University Hospital (Lausanne, Switzerland), and Medimaps Group SA, Switzerland.

How long to delay orthopedic surgery for preoperative BHO using ABL remains unclear. Main finding: ABL results in significant BMD gains by three months in both men and postmenopausal women with osteoporosis. ABL shows promise for preoperative BHO in elective orthopedic surgery patients, but further research is required. This study aims to assess the early response to abaloparatide (ABL) in men and postmenopausal women with osteoporosis at high risk for fracture to inform its potential role in preoperative bone health optimization (BHO). We aim to assess changes in bone mineral density (BMD) by three months and early changes in bone turnover markers (BTMs). A post-hoc analysis of two randomized ABL trials in men and postmenopausal women with osteoporosis was performed. BMD and BTM data from 149 men and 250 postmenopausal treated with ABL for 12 months were assessed. The primary endpoint was mean percent BMD change at 3-months in the femoral neck, total hip, and lumbar spine. BTMs P1NP and CTX were also assessed. At 3 months, mean (SD) BMD percent increases in men were 1.79 (0.35), 1.26 (0.26), and 4.14 (0.43), at the femoral neck, total hip, and lumbar spine, respectively. In women, mean BMD percent increases at the same sites were 1.55 (0.28), 1.78 (0.21), and 4.42 (0.34) respectively. Compared with baseline, serum P1NP increased over threefold at 1 month in women and men. Subcutaneous ABL (80 µg/day) results in significant BMD gains by three months in both men and postmenopausal women with osteoporosis at levels associated with decreased fracture risk. Bone formation is increased at 1 month and sustained for 12 months. Further research is required to investigate the effectiveness of a three-month ABL treatment period on bone strength and osteoporosis-related surgical complications in elective orthopedic surgery patients.

OBJECTIVE:Leading oncology societies recommend assessing pre-treatment frailty to guide care for older adults with cancer. However, frailty may change post-diagnosis. This study characterized post-diagnosis frailty and its association with overall survival among older women with ovarian cancer. METHODS:We included 24,725 women aged 65+ diagnosed with ovarian cancer between 2000 and 2019 from Surveillance, Epidemiology, and End Results (SEER)-Medicare. Frailty was quantified at diagnosis and 1-3 years post-diagnosis using a validated claims-based index. We compared patients' frailty at the beginning and end of each year. At 1, 2, and 3 years post-diagnosis, we fit a Cox proportional hazards model including frailty at diagnosis and current frailty to assess associations with survival. RESULTS:Frailty distribution at diagnosis was: 7.1% non-frail, 71% pre-frail, 18% mildly frail, 3.4% moderately frail, and 0.9% severely frail. During year 1, 38% of women maintained frailty status, 4% improved, 26% worsened, and 32% died. In years 2-3, some women remained stable while others improved or worsened. There were 21,309 deaths during a median follow-up of 25 months (interquartile range 7-58). Frailty at diagnosis was not associated with survival after adjusting for current frailty (hazard ratios [HRs] for severely frail versus non-frail =0.98, 1.00, 0.76 at 1, 2, 3 years, respectively, all p-values>0.20). Current frailty was strongly associated with survival, and the association increased over time (HRs =2.26, 2.77, 3.70, respectively; all p-values<0.001). CONCLUSIONS:Post-diagnosis frailty is dynamic. Current frailty has a stronger association with overall survival compared to frailty at diagnosis. Repeated frailty assessments should be incorporated into clinical practice.

Osteoporosis treatment does not normalize BMD. We hypothesized cyclic romosozumab dosing might provide greater BMD increases. Cyclic therapy (six romosozumab monthly doses then one denosumab dose) produced broadly similar BMD increases as previously reported for 12 romosozumab doses. A second cycle further increased spine and hip BMD but with a blunted response. Evaluating novel osteoporosis medication approaches to maximize BMD is reasonable. A bone remodeling-based cyclic approach, i.e., activate, depress, free and repeat (ADFR), has been proposed. We hypothesized that short course romosozumab followed by denosumab represents an appropriate cycle. This exploratory retrospective case series reports six months of romosozumab treatment then one denosumab dose, followed by a second identical cycle. Women at very high fracture risk were offered cyclic therapy. DXA was obtained at baseline, 1 and 2 years. Data from 41 women treated for 1, and 18 for 2 years are reported. Percent BMD change from baseline was evaluated by ANOVA. Patient mean (SD) age and BMI were 68.8 (6.6) years and 25.6 (5.0) kg/m2 respectively. Mean total hip T-score was -2.5, FRAX estimated hip fracture risk was 6.9

To critically evaluate the current evidence on the role of vitamin D in inflammatory rheumatic diseases, including its association with disease activity, potential immunomodulatory effects, and the clinical impact of supplementation. A narrative review was conducted based on a comprehensive search of MEDLINE, Cochrane Library, and Epistemonikos databases up to October 2025. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating vitamin D status and/or supplementation in adult patients with inflammatory rheumatic diseases. Evidence was synthesized qualitatively, prioritizing study design and level of evidence. Vitamin D deficiency is highly prevalent across inflammatory rheumatic diseases and is associated with higher disease activity, fatigue, and poorer musculoskeletal outcomes. Experimental data support immunomodulatory effects; however, clinical evidence remains heterogeneous. Randomized controlled trials demonstrate that supplementation effectively corrects deficiency and is safe, with modest improvements in disease activity and fatigue mainly in patients with low baseline 25(OH)D levels. In contrast, large trials and Mendelian randomization studies do not support a causal role of vitamin D in disease onset or sustained remission. Meta-analyses show small and inconsistent benefits, limited by heterogeneity in study design, dosing regimens, and populations. Vitamin D deficiency is a common and clinically relevant finding in inflammatory rheumatic diseases. While supplementation reliably restores adequate levels and may provide modest clinical benefits in deficient patients, current evidence does not support a causal or disease-modifying role. Maintaining serum 25(OH)D ≥30 ng/mL remains advisable for skeletal health, whereas its immunological benefits require further investigation through well-designed randomized trials.

This expert position statement reframes arthroplasty and spinal fusion complications under the unified endpoint of implant fixation failure, defined as loss of mechanical integrity of the bone–implant unit over time. It synthesizes mechanistic and clinical evidence and provides evidence-informed recommendations for peri-operative bone health optimization. Osteoporosis is traditionally conceptualized as causing fragility fractures. However, compromised bone quality also affects the integrity of bone–implant constructs, influencing whether implants maintain fixation, interfaces remain stable, and fusion constructs consolidate. To synthesize mechanistic, translational, and clinical evidence on how osteoporosis and osteoporosis pharmacotherapies influence implant fixation failure across arthroplasty and spinal fusion, and to provide evidence-informed clinical recommendations for peri-operative bone health assessment and optimization within a unified construct-level framework. A position statement was developed following a structured literature search. Evidence was synthesized narratively by defining implant fixation failure as a construct-level outcome encompassing periprosthetic fracture, loosening, subsidence, pseudarthrosis, and junctional failure. Recommendations were categorized by strength (strong or conditional) and certainty of evidence (high, moderate, or low). Low bone mineral density (BMD) is associated with implant fixation failure across arthroplasty and spinal fusion. In arthroplasty, randomized trials demonstrate preservation of periprosthetic BMD with bisphosphonates, while registry analyses suggest improved implant survival. In spinal fusion, antiresorptive and anabolic therapies influence fixation-related parameters, with anabolic agents showing the most consistent evidence for enhanced fusion mass and earlier union. Much of the literature relies on radiographic or biomechanical endpoints rather than definitive outcomes. Viewing arthroplasty and spinal fusion complications through a shared construct-level perspective provides a coherent link between osteoporosis and reconstructive durability. Systematic peri-operative bone health optimization may improve construct longevity, although more definitive outcome-driven trials are needed. Closer integration between orthopedic surgeons and osteoporosis specialists will be central to advancing peri-operative bone health care.

Dual-energy X-ray absorptiometry (DXA) alone is not ideal for fracture risk assessment given its two-dimensional nature. We evaluated the 3D-Shaper software for its potential to detect an unappreciated hip trabecular bone loss in astronauts. DXA-based 3D-Shaper software showed promising results as a screening tool while minimizing radiation exposure. Prolonged spaceflight results in bone loss, as assessed by DXA performed before and after long-duration missions. Hip trabecular loss, detected by QCT but not DXA, persists in some astronauts for up to 2 years after 6-month missions. Since QCT increases radiation exposure, we evaluated a DXA software (3D-Shaper) as a screening method to identify astronauts in whom inadequate recovery of hip trabecular bone would be likely confirmed with QCT. Hip data from 23 ISS astronauts (19 M/4F) with pre- and postflight QCT and DXA were analyzed. These scans were obtained pre-flight (within 4 months of launch), immediately post-flight (within 22 days of return), and 1-year post-flight (within 11–14 months). Left total hip data by DXA, QCT, and 3D-Shaper were expressed as percent change from pre-flight and evaluated by repeated measures ANOVA. A regression analysis of 1-year post-flight data compared the abilities of DXA (total hip areal BMD [aBMD]) and 3D-Shaper (trabecular volumetric BMD [Trab vBMD]) to predict persisting trabecular bone deficits as determined by QCT. Immediate postflight mean (SD) total hip aBMD was reduced by 3.9 (2.4)

Vitamin D, classically linked to calcium-phosphate metabolism and skeletal health, is increasingly recognized as a pleiotropic hormone with effects on gastrointestinal and systemic immune functions. This International Consensus aims to critically evaluate the role of vitamin D in gastrointestinal homeostasis, infection prevention, and immune regulation. A multidisciplinary panel of experts conducted a comprehensive review of the literature, distinguishing between associative evidence from observational studies and causal inferences derived from interventional trials addressing gut barrier integrity, dysbiosis, intestinal cancer prevention, respiratory infections, and autoimmune diseases. While vitamin D deficiency has been consistently associated with alterations in gut microbiota composition, increased intestinal permeability, impaired immune tolerance, and increased susceptibility to infections and autoimmune conditions, evidence from interventional studies remains more variable. Clinical outcomes are influenced by baseline 25(OH)D status, supplementation dose and formulation, timing of intervention, and disease context. Vitamin D supplementation has shown potential benefits in selected settings (i.e., autoimmune diseases and acute respiratory infections), and particularly in cases of documented deficiency. Given its pleiotropic role and favourable safety profile, appropriate screening and optimization of vitamin D represent a low-cost and potentially impactful strategy to support gut barrier function and immune competence. While further research is needed to define these therapeutic applications, maintaining vitamin D concentrations above 20 or 30 ng/mL in individuals at skeletal or immunological risk emerges as a reasonable clinical target. This Consensus Panel supports the integration of vitamin D assessment and correction into routine care for at-risk populations and calls for greater awareness of its extra-skeletal relevance.

This study determined how well DXA and other novel assessments of bone microarchitecture predicted screw pullout strength in the femoral neck. Hip-specific DXA performed as well as the novel approaches at predicting screw pullout. These findings support the use of DXA to evaluate bone quality and aid in surgical decision-making. The primary purpose of our study was to determine how well dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS Ortho), 3D-Shaper, and quantitative computed tomography (qCT) predicted screw pullout of cannulated screws placed in the femoral neck of cadaveric specimens. Our secondary objective was to determine how well insertional torque predicted screw pullout. We conducted a biomechanical study using twenty proximal cadaveric femurs. Each femur underwent imaging with each respective modality to assess bone quality. Screws were placed in a standardized configuration, and insertional torque was measured using a digital torque screwdriver. Screws were then pulled out using a mechanical testing machine to determine peak pullout strength. The relationship between screw pullout force and each bone metric was assessed using Spearman correlation coefficients and univariate linear mixed-effects models. DXA bone mineral density (BMD) and 3D-Shaper volumetric BMD (vBMD) at the femoral neck had the highest correlation coefficients with screw pullout strength (r = 0.95, p < 0.001). However, all of the imaging modalities were found to be strong predictors of screw pullout. Insertional torque was also a strong predictor of screw pullout strength (r = .86, p < 0.001). Our findings highlight the clinical utility of hip-specific DXA as a strong and accessible predictor of screw pullout strength, performing as well as newer imaging modalities such as TBS Ortho and 3D-Shaper. Insertional torque also demonstrated strong predictive value and may serve as a useful intraoperative tool when preoperative bone density data are not available.

INTRODUCTION:Traditionally, total body (TB) dual-energy x-ray absorptiometry (DXA) scans to assess body composition include the entire body, however novel abbreviated acquisition methods exist. The purpose of this study was to evaluate comparability of measured and estimated body composition results using three novel acquisition techniques; total body less head (TBLH), neck to knee (NTK) and lower extremity (LE). We hypothesized that body composition mass with these three novel methods would not differ from traditional TB acquisition. METHODS:Each subject had TB, TBLH, NTK and LE scans acquired using a Lunar iDXA. A subset of 30 had repeat NTK and LE scans with repositioning between and a matched historical precision control was compiled from existing data for comparison. TBLH and NTK scans used automated software to limit anatomy scanned; NTK estimated non-scanned lower leg mass. LE scans were acquired from L3 to just beyond the toes. Automated analysis, with manual correction, was used for all but LE scans, which were analyzed manually. Equivalence testing was used to compare regional lean, fat and bone mineral content (BMC) measurements from the novel scanning methods to traditional full TB scans. Precision was determined by the ISCD Precision Calculator and compared to TB historical precision by F-test. RESULTS:The study sample included 82 subjects, 41F/41 M mean (SD) age 51.0 (18.4) years and BMI 25.5 (3.7) kg/m2. Total and regional lean, fat and bone mass were equivalent among all approaches (p < 0.01). There was excellent agreement between sexes and ages with TB and TBLH (p < 0.001). Some clinically irrelevant disagreement was observed in NTK and LE fat and lean measurements while NTK and LE precision was excellent, ranging from 0.45 to 2.31%CV. CONCLUSION:These three novel approaches provide regional body composition data consistent with traditional TB measurement and may be considered as equivalent substitutes when appropriate.

Abaloparatide treatment significantly increased BMD at the LS, TH, and FN compared with placebo in men with osteoporosis in the phase 3 ATOM trial. The current study used 3D-DXA modeling to evaluate the effects of abaloparatide on cortical and trabecular compartments of the proximal femur in ATOM study participants. Proximal femur DXA images were retrospectively analyzed using 3D-DXA (3D-Shaper software v2.12.0, 3D-Shaper Medical, Barcelona, Spain) to evaluate changes in bone parameters from baseline at months 6 and 12 in all randomized men from the ATOM trial. Between-group comparisons were made for percent change from baseline data based on a mixed-effect repeated-measure model with treatment, visit, treatment-by-visit interaction, and type of DXA scanner as fixed effects. Other covariates include BMI, age, and baseline values of bone parameters. Abaloparatide treatment significantly increased integral volumetric BMD (vBMD) (3.7%), trabecular vBMD (7.0%), cortical thickness (1.1%), and cortical surface BMD (1.7%) at 12 mo compared to baseline (p < .0001). Changes were greater for abaloparatide compared to placebo for all 4 parameters (p < .01). Significant increases from baseline compared to placebo in integral vBMD (2.7% vs -0.1%, p < .0001) and trabecular vBMD (6.1% vs -0.6%, p < .0001) were also observed at 6 mo. In conclusion, in men with osteoporosis, abaloparatide improved proximal femur 3D-DXA parameters broadly consistent with results in postmenopausal women in the ACTIVE study, adding to the growing data on abaloparatide bone structure effects at the hip.

Proton pump inhibitors (PPI) are widely prescribed medications. Proton pump inhibitors exposure may be associated with lower trabecular bone score (TBS), but has not shown a consistent effect on BMD. We hypothesized that abdominal obesity, which is associated with both gastroesophageal disease and PPI use, could confound the relationship between PPI use and TBS. We assessed the effect of PPI use on TBS (primary measurement) and BMD (secondary measurements) before and after adjustment for sagittal abdominal diameter (SAD), a DXA-derived measure of abdominal soft-tissue thickness. The study population comprised 60 930 individuals (90.3% women, mean age 65.7 yr) that included 11 340 (18.6%) with PPI use in the preceding 12 mo. PPI exposure was categorized from medication persistence ratio (MPR) as non-use (referent), minimal (MPR 0.01-0.25), mild (MPR 0.26-0.5), moderate (MPR 0.51-0.75), and high use (MPR 0.76-1). When logistic regression models were minimally adjusted for age, sex, and scanner, increasing PPI use versus non-use was associated with progressively increasing odds ratios (ORs) for TBS in the lowest tertile (minimal 1.11 [95% CI 1.02-1.22], mild 1.18 [1.04-1.34], moderate 1.34 [1.17-1.53], high 1.41 [1.31-1.52]) but inversely with osteoporotic BMD (minimal 0.97 [0.89-1.06], mild 0.85 [0.75-0.97], moderate 0.82 [0.72-0.94]), and high 0.76 [0.70-0.82]). Sagittal abdominal diameter was greater in PPI users than non-users. After further adjustment for SAD, PPI use was not associated with lower TBS or BMD. Similar patterns were seen in men and women, and for longer durations of PPI use. Among 4742 with a second DXA (mean interval 3.4 yr), PPI use was not associated with more rapid TBS or BMD loss compared to non-users. In conclusion, PPI use is associated with greater SAD, an indicator of abdominal obesity. SAD and other clinical variables have a confounding effect on TBS and BMD measurements. When fully adjusted, PPI exposure did not significantly decrease TBS or BMD.

Trabecular bone score (TBS), derived from the spine dual-energy x-ray absorptiometry (DXA) image, and hip axis length (HAL), derived from the hip DXA image, are bone mineral density (BMD)–independent risk factors for fracture. To date, no studies have directly compared the additive benefits of using TBS and HAL in combination. We found that TBS and HAL made independent contributions to fracture risk, with TBS having a larger benefit for major osteoporotic fractures (MOF) whereas HAL had a larger benefit for hip fractures. To compare the effects of TBS and HAL on fracture risk, separately and in combination. A total of 55,068 individuals (mean age 63.5 years, 90.9

Early increases in bone turnover markers (BTMs) in response to anabolic therapy correlate with 18-mo BMD increases in postmenopausal women with osteoporosis; however, this relationship has not been assessed in men. In this analysis, the correlation between changes from baseline in fasting intact serum procollagen type I N propeptide (PINP) and serum CTX at 1, 3, 6, and 12 mo and percent increase from baseline in BMD at 12 mo in men from the randomized phase 3 ATOM study (NCT03512262) were evaluated using Pearson's correlation coefficients. The uncoupling index (UI), a measure of the balance between markers of bone formation (PINP) and bone resorption (CTX), with positive UI favoring bone formation, was calculated. Results in men were compared to 12-mo results for women from the ACTIVE study using the z score test after Fisher's Z transformation. In abaloparatide-treated men, PINP increases at 1 mo (r = 0.485), 3 mo (r = 0.614), 6 mo (r = 0.632), and 12 mo (r = 0.521) were highly correlated (p < .0001) with 12-mo LS BMD increases. The mean UI for abaloparatide-treated men was greater than placebo as early as 1 mo (2.26 vs -0.25). At month 3, the mean UI for men was greater (1.32) than for women (0.88) (p < .001). There was a significant correlation between 3-mo UI and LS BMD at 12 mo in both men (r = 0.453; p < .001) and women (r = 0.252; p < .01). UI at months 6 and 12 were also significantly correlated with 12-mo LS BMD in men and women, but the correlation was stronger in men than women. These data support that early changes in BTMs in men treated with abaloparatide are associated with subsequent changes in BMD similar to what has been reported in women.

No formal guidance exists regarding optimal opportunistic computed tomography (CT) region of interest (ROI) size or placement to clinically obtain bone Hounsfield unit (HU) data. Using clinical CT scans, this study evaluated ROI size/placement and assessed HU reproducibility. Three non-radiologists independently identified the L1 and L4 vertebral body centroid and then placed varying size circular ROIs on axial and sagittal images of 30 clinical CT scans. A 200-mm2 ROI location was varied left to right, anterior to posterior, and cranial to caudal. Intra- and inter-observer reliability was determined using intraclass correlation coefficients (ICC). ROI size and axial/sagittal HU comparison was performed by ANOVA and t-test. Precision of 200-mm2 axial and sagittal ROIs was assessed in a second cohort of 30 patients with two scans obtained within 16 days. Vertebral body centroid placement was nearly identical between readers (ICC > 0.99). Intra- and inter-observer reliability was excellent for all ROI sizes on both projections (ICC > 0.95). Statistically, but not clinically, significant differences, less than 8 HU, were present between various sized ROIs at L1, with no difference at L4. Axial HU was generally higher than sagittal for all ROI sizes at L1 and L4 by 5–12 HU. In the precision cohort, L1 and L4 HU