Search Results (19)

Background and Objectives: People living with HIV (PLWH) have excess osteoporosis and fractures not fully captured by dual-energy X-ray absorptiometry (DXA). We evaluated whether trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS) and bone turnover markers improve vertebral fracture risk assessment beyond areal bone mineral density (BMD) in PLWH. Methods: In this cross-sectional study, 87 antiretroviral-treated adults undergoing DXA had lumbar spine TBS and calcaneal QUS. Morphometric vertebral fractures were identified, correlates of degraded TBS were analyzed using multivariable regression, and sequential logistic models quantified the incremental contribution of TBS and CTX to discriminate for prevalent morphometric vertebral fractures. Results: Low BMD (osteopenia/osteoporosis) was present in 62% of participants, degraded TBS in 37% and morphometric vertebral fractures in 17%. Degraded versus normal TBS was associated with older age (49.1 vs. 39.7 years), longer HIV duration and lower nadir CD4+ count, as well as more frequent tenofovir disoproxil fumarate exposure (66% vs. 52%; all p ≤ 0.04). In multivariable analysis, age (per 10-year increase; adjusted odds ratio [aOR] 1.78; 95% CI 1.13–2.83) and nadir CD4+ < 200 cells/mm³ (aOR 2.29; 95% CI 1.06–4.97) independently predicted degraded TBS. In sequential cross-sectional models for prevalent morphometric vertebral fractures, the area under the curve increased from 0.71 (clinical variables) to 0.79 after adding lumbar spine T-score and to 0.85 after adding TBS; adding CTX yielded 0.87 without a statistically significant incremental gain. Conclusions: In PLWH, TBS captures bone quality deficits and improves vertebral fracture risk discrimination beyond BMD, supporting its integration alongside DXA in routine HIV care. Full article

Background/Objectives: Individuals living with human immunodeficiency virus (HIV) receiving tenofovir-based antiretroviral therapy (ART) are at increased risk of bone loss. Dual-energy X-ray absorptiometry (DXA), the gold standard for determining bone mineral density (BMD), has limited accessibility. Calcaneal quantitative ultrasound (QUS) is an alternative screening tool for bone health, but its performance needs validation. The study aims to compare the performance of QUS between men with HIV on tenofovir-based ART and uninfected men. Methods: A cross-sectional study involving 52 men with HIV on tenofovir-based ART and 42 uninfected men was performed. Their bone health status was determined using DXA (lumbar spine and femoral neck) and QUS (calcaneus). The performance of QUS in identifying individuals with low BMD (DXA T-score < −1) was evaluated using receiver-operating characteristic curve analysis. Results: The HIV-ART group showed significantly lower QUS indices compared to the non-HIV-ART group (p < 0.05). The performance of QUS in identifying individuals with low BMD was poor in the HIV-ART group (p > 0.05), but moderate in the non-HIV-ART group (p < 0.05). After optimising the cutoffs, the performance of QUS was improved in the non-HIV-ART group but not in the HIV-ART group. Conclusions: QUS was not effective in identifying individuals with low BMD in men with HIV on ART. Its utility as a standalone screening tool in this population may be limited. Additional or more sensitive methods should be prioritised for bone health screening. Full article

Background/Objectives: Skeletal impairment has been reported as a common finding in Hyperphenylalaninemia (HPA)/Phenylketonuria (PKU) patients regardless of age and method of diagnosis, both in children and adults. Quantitative Ultrasound (QUS) is a radiation-free and low-cost method for assessing bone quality, used in various chronic conditions. Methods: Bone quality was evaluated using a calcaneal QUS device. Auxological parameters, nutritional intakes, and plasma levels of key bone biomarkers were also registered. The population was divided into four groups: PKU patients under diet therapy and HPA patients on a free diet, both divided into receiving or not receiving single vitamin D supplementation. Results: All HPA/PKU patients had median bone quality index (BQI) Z- and T-score values lower than −1, with slightly better values in HPA children and PKU-supplemented adults. Dietary vitamin D intake in PKU patients was significantly higher than in HPA subjects (p < 0.001), due to protein substitute supplementation. However, plasma 25(OH) vitamin D levels, although increased compared to baseline, were still overlapping among groups (p = 0.845) after supplementation. Approximately a quarter of both pediatric and adult non-supplemented PKU patients had Z-score and T-score levels below −2, and this percentage decreased with vitamin D supplementation in all groups. In PKU-supplemented patients, the Broadband Ultrasound Attenuation (BUA) was significantly higher than in the other groups (p = 0.040). Conclusions: The improvement in BUA may represent preliminary evidence of the effect of vitamin D on bone architecture, which could encourage this supplementation to prevent the worsening of bone structure and reduce the risk of fractures. Full article

Background: Most of the studies that have investigated bone quality in inflammatory bowel disease (IBD) have utilized dual-energy X-ray absorptiometry (DXA). We assessed the bone status of IBD adult patients using a comprehensive array of non-invasive techniques. Methods: Fifty IBD patients (30 women) and 50 healthy volunteers—matched for age, gender, and body mass index—were prospectively recruited. Areal bone mineral density (aBMD) at the anteroposterior and lateral spine and the proximal femur was measured by DXA, including vertebral fracture assessment (VFA). Trabecular bone score (TBS), calcaneal quantitative ultrasound (QUS), volumetric bone mineral density (vBMD), and cortical thickness were assessed in the proximal femur with 3D-DXA. A comprehensive laboratory panel of calcium metabolism and bone turnover markers was included. Results: Twenty-nine and 21 patients were diagnosed with ulcerative colitis (UC) and Crohn’s disease (CD), respectively. VFA identified vertebral fractures in two IBD patients and no controls. No statistically significant differences were observed in TBS, aBMD, and vBMD between IBD and healthy controls. After excluding one predefined outlier, broadband ultrasound attenuation (BUA) showed lower values in IBD vs. controls [103.6 ± 14.3 vs. 111.3 ± 19.5 (p = 0.033)]. QUS analysis revealed statistically lower values in the CD group compared to controls. We found a positive correlation between all the QUS parameters with aBMD and vBMD. Conclusions: In our study of IBD subjects, most of whom had mild or quiescent disease, we did not observe significant bone quality deterioration. QUS was the only technique that showed lower values in IBD patients, especially in CD. Full article

Background: Monitoring bone mineral density (BMD) in adults is critical for early detection of osteoporosis and prevention of fracture, for which quantitative ultrasound (QUS) is a good non-invasive tool. We examined the associations of QUS measures, including stiffness index (SI) and T-score, with socio-demographic, lifestyle, and anthropometric correlates and risk of subsequent fracture. Methods: Calcaneal QUS was performed using GE’s Lunar Achilles EXPII among 24,651 adults (mean age 59.5 years, 61.7% women) from the China Kadoorie Biobank study. Socio-demographic and lifestyle information was collected using an interviewer-administered electronic questionnaire, and anthropometrics were measured following standard protocols. Incidence of fracture and osteoporosis was recorded via linkage with nationwide health insurance database. Linear and Cox regression analyses were conducted, adjusting for potential confounders. Results: On average, men had higher SI (92.8 vs. 86.0) but lower T-score (−0.85 vs. −0.64) than women. In both men and women, advanced age and smoking were inversely associated with SI and T-score, while physical activity and tea drinking were positively so (p < 0.0001 for all). Except for height, all other anthropometric measures were significantly and positively associated with both BMD measures. With each SD lower SI, the risk of subsequent fracture was 26% (95% confidence interval: 10–44%) and 40% (25–57%) higher in men and women, and the corresponding associations of T-score were identical. Conclusions: Among Chinese adults, the SI and T-score provided by Achilles EXPII had similar patterns and predictive values for subsequent fracture, despite the T-score for men and women not being directly comparable because of gender-specific references used. Future studies are needed to confirm or refute the causality of relationship between lifestyle and anthropometric factors and BMD. Full article

Screening for osteoporosis is crucial for early detection and prevention, yet it faces challenges due to the low accuracy of calcaneal quantitative ultrasound (QUS) and limited access to dual-energy X-ray absorptiometry (DXA) scans. Recent advances in AI offer a promising solution through opportunistic screening using existing medical images. This study aims to utilize deep learning techniques to develop a model that analyzes chest X-ray (CXR) images for osteoporosis screening. This study included the AI model development stage and the clinical validation stage. In the AI model development stage, the combined dataset of 5122 paired CXR images and DXA reports from the patients aged 20 to 98 years at a medical center was collected. The images were enhanced and filtered for hardware retention such as pedicle screws, bone cement, artificial intervertebral discs or severe deformity in target level of T12 and L1. The dataset was then separated into training, validating, and testing datasets for model training and performance validation. In the clinical validation stage, we collected 440 paired CXR images and DXA reports from both the TCVGH and Joy Clinic, including 304 pared data from TCVGH and 136 paired data from Joy Clinic. The pre-clinical test yielded an area under the curve (AUC) of 0.940, while the clinical validation showed an AUC of 0.946. Pearson’s correlation coefficient was 0.88. The model demonstrated an overall accuracy, sensitivity, and specificity of 89.0%, 88.7%, and 89.4%, respectively. This study proposes an AI model for opportunistic osteoporosis screening through CXR, demonstrating good performance and suggesting its potential for broad adoption in preliminary screening among high-risk populations. Full article

The study’s aim was to investigate bone condition and see its associations with body composition and age among office worker women in Hungary. In total, 316 individuals participated in this study from Csongrad-Csanad county in 2019. Participants’ ages ranged from 18 to 62, with a mean of 41 years. A questionnaire was used to gather sociodemographic information, whereas body composition was measured using the Inbody 230, and bone density and bone quality were measured with the SONOST 3000 ultrasound device. Results were analyzed using descriptive statistics, ANOVA with Tukey’s post hoc test, correlation analysis, and an independent sample t-test. The results show that Body Fat Mass, Body Mass Index, Obesity Degree, and Percent Body Fat increase significantly as age increases, and Bone Quality Index and t-score decrease substantially. Furthermore, Bone Density and Bone Quality Index were positively influenced by most components of body composition. The differences between normal and osteopenia bone quality showed that Basal Metabolic Rate, Bone Mineral Content, Fat-Free Mass, Mineral Mass, Skeletal Lean Mass, and Skeletal Muscle Mass were lower in participants with osteopenia. Our results provide more evidence of the effects of body composition and age on bone density and quality. It was the first study in Hungary investigating this phenomenon, which could be useful for professionals and researchers who intend to understand the associations of bone density. Full article

Reduced bone mineral density (BMD), osteoporosis, and their associated fractures are one of the main musculoskeletal disorders of the elderly. Quickness in diagnosis could prevent associated complications in these people. This study aimed to perform a systematic review (SR) to analyze and synthesize current research on whether a calcaneal quantitative ultrasound (QUS) can estimate BMD and predict fracture risk in elderly people compared to dual-energy x-ray absorptiometry (DXA), following the PRISMA guidelines. A search was conducted in the main open-access health science databases: PubMed and Web of Science (WOS). DXA is the gold standard for the diagnosis of osteoporosis. Despite controversial results, it can be concluded that the calcaneal QUS tool may be a promising method to evaluate BMD in elderly people, facilitating its prevention and diagnosis. However, further studies are needed to validate the use of calcaneal QUS. Full article

Both veganism and high dietary acid load are linked to unfavorable bone health. However, the specific role of dietary alkali or acid load for the bone health of vegans is so far unknown. Thus, the renal biomarker for dietary acid or alkali load, i.e., urinary potential renal acid load (uPRAL), was measured in 24 h urine samples of 34 vegans and 35 omnivores (50.7% males). Bone health was assessed via calcaneal quantitative ultrasound. Associations between uPRAL and bone health indices were examined using multivariable general linear models. Compared to omnivores, vegans had a significantly lower uPRAL (mean difference = −34.5 mEq/24 h, p < 0.0001), a lower 24 h urinary phosphate excretion (p = 0.0004), a lower 24 h urinary sulfate excretion (p = 0.01), and a higher urine pH value (p < 0.0001). Broadband ultrasound attenuation (BUA) was lower among vegans versus omnivores (p = 0.037), yet it was not associated with uPRAL irrespective of adjustments. This study confirms different acid-base profiles of vegans and omnivores, with a pronounced alkaline excess among vegans and a rather low acid load among a group of omnivores with moderate protein intake. Within this spectrum of alkaline to low acid load, no association with bone health was found. Full article

(1) Background: Parkinson’s disease (PD) is a relatively common neurodegenerative disease in elderly individuals, with a high risk of falls. There is abundant literature on the relationship between PD and osteoporosis. The aim of this study is to describe the bone quality of a population with PD by calcaneal ultrasound and to compare it with a healthy control, assessing the influence of possible sex differences. (2) Methods: 21 patients diagnosed with PD were recruited. The control group was composed of 30 healthy individuals with similar sociodemographic characteristics. The bone quality of all participants was assessed using calcaneal quantitative ultrasound (QUS). The parameters recorded were broadband ultrasound attenuation (BUA, in decibels per megahertz), imaging speed of sound (SOS, in meters per second), stiffness index (SI) and T-score of each participant. Bone mineral density (BMD) was estimated using the equation BMD = 0.002592 × (BUA + SOS) − 3.687 (g/cm²). (3) Results: significant differences were observed between the healthy control and the PD group: the T-score was lower in the PD group (p < 0.05) and SOS was higher in Parkinson’s disease patients (p < 0.05), while 28.6% of the PD patients were osteoporotic with T-score values lower than −1.5 compared to 16.7% of osteoporotic individuals in the control group (p < 0.01). Regarding the sex, there were significant differences (p < 0.05) between the females of the PD group vs. control group, showing a significant difference in the SI (71.4 ± 14.7 vs. 87.8 ± 12), T-score (−2.19 ± 1.1 vs. −0.15 ± 0.8), BUA (104.5 ± 13 vs. 116 ± 10.6) and BMD (0.49 ± 0.09 vs. 0.60 ± 0.08), with no difference in the comparison between the male groups; and the comparison between both sexes in T-score only showed significant differences for the PD group (p < 0.05), with worse bone quality in women. (4) Conclusions: this study shows poorer bone quality in female patients with PD, who have a higher percentage of osteoporosis than healthy patients. The QUS technique of the calcaneus seems adequate for these determinations in patients with Parkinson’s disease. Full article

Different factors may contribute to the development of osteopenia or osteoporosis. Fatty acids are key nutrients for health, and a number of studies have reported an association between bone mineral density (BMD) and fatty acid intake. We aimed to investigate the relationships between serum levels of different fatty acids and bone parameters determined by quantitative bone ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA) in a sample of Spanish postmenopausal women. We enrolled a total of 301 postmenopausal women (median age 59 years; interquartile range (IQR) 7) in this study. All participants underwent full densitometric screening, including calcaneal quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA), as well as plasma fatty acid measurement. After adjustment for potential confounders, plasma n-3 polyunsaturated fatty acid (PUFA) levels correlated with BMD in the spine (r = 0.150; p = 0.014) and femoral neck (r = 0.143; p = 0.019). By multiple linear regression, an independent statistically significant positive relationship was observed between BMD in the spine and BMI (β = 0.288; p = 0.001) as well as total plasma n-3 PUFAs (β = 0.155; p = 0.009). The plasma n-3 PUFA level was also a significant and positive predictor of BMD at the femoral neck (β = 0.146; p = 0.009). Independent risk factors for low BMD (T-score ≤ 1) were determined by logistic regression analysis, and a relatively high level of plasma n-3 PUFAs (OR = 0.751; 95% CI 0.587-0.960, p = 0.022) was identified as a protective factor against low bone mass. In this single-center sample of Spanish postmenopausal women, we reported a significant positive and statistically independent association between BMD and plasma levels of n-3 PUFAs. Full article

Scientific evidence suggests that a vegan diet might be associated with impaired bone health. Therefore, a cross-sectional study (n = 36 vegans, n = 36 omnivores) was used to investigate the associations of veganism with calcaneal quantitative ultrasound (QUS) measurements, along with the investigation of differences in the concentrations of nutrition- and bone-related biomarkers between vegans and omnivores. This study revealed lower levels in the QUS parameters in vegans compared to omnivores, e.g., broadband ultrasound attenuation (vegans: 111.8 ± 10.7 dB/MHz, omnivores: 118.0 ± 10.8 dB/MHz, p = 0.02). Vegans had lower levels of vitamin A, B2, lysine, zinc, selenoprotein P, n-3 fatty acids, urinary iodine, and calcium levels, while the concentrations of vitamin K1, folate, and glutamine were higher in vegans compared to omnivores. Applying a reduced rank regression, 12 out of the 28 biomarkers were identified to contribute most to bone health, i.e., lysine, urinary iodine, thyroid-stimulating hormone, selenoprotein P, vitamin A, leucine, α-klotho, n-3 fatty acids, urinary calcium/magnesium, vitamin B6, and FGF23. All QUS parameters increased across the tertiles of the pattern score. The study provides evidence of lower bone health in vegans compared to omnivores, additionally revealing a combination of nutrition-related biomarkers, which may contribute to bone health. Further studies are needed to confirm these findings. Full article

We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ² = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ²p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ²p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease. Full article

Background: Calcaneal quantitative ultrasound (QUS) is widely used in osteoporosis screening, but the cut-off values for risk stratification remain unclear. This study validates the performance of a calcaneal QUS device (CM-200) using dual-energy X-ray absorptiometry (DXA) as the reference and establishes a new set of cut-off values for CM-200 in identifying subjects with osteoporosis. Methods: The bone health status of Malaysians aged ≥40 years was assessed using CM-200 and DXA. Sensitivity, specificity, area under the curve (AUC) and the optimal cut-off values for risk stratification of CM-200 were determined using receiver operating characteristic (ROC) curves and Youden’s index (J). Results: From the data of 786 subjects, CM-200 (QUS T-score <−1) showed a sensitivity of 82.1% (95% CI: 77.9–85.7%), specificity of 51.5% (95% CI: 46.5–56.6%) and AUC of 0.668 (95% CI: 0.630–0.706) in identifying subjects with suboptimal bone health (DXA T-score <−1) (p < 0.001). At QUS T-score ≤−2.5, CM-200 was ineffective in identifying subjects with osteoporosis (DXA T-score ≤−2.5) (sensitivity 14.4% (95% CI: 8.1–23.0%); specificity 96.1% (95% CI: 94.4–97.4%); AUC 0.553 (95% CI: 0.488–0.617); p > 0.05). Modified cut-off values for the QUS T-score improved the performance of CM-200 in identifying subjects with osteopenia (sensitivity 67.7% (95% CI: 62.8–72.3%); specificity 72.8% (95% CI: 68.1–77.2%); J = 0.405; AUC 0.702 (95% CI: 0.666–0.739); p < 0.001) and osteoporosis (sensitivity 79.4% (95% CI: 70.0–86.9%); specificity 61.8% (95% CI: 58.1–65.5%); J = 0.412; AUC 0.706 (95% CI: 0.654–0.758); p < 0.001). Conclusion: The modified cut-off values significantly improved the performance of CM-200 in identifying individuals with osteoporosis. Since these values are device-specific, optimization is necessary for accurate detection of individuals at risk for osteoporosis using QUS. Full article

Young adulthood is an important stage in the accrual of bone mass. Young women are often unaware of the need, and how to optimize modifiable risk factors, particularly intake of nutrients associated with good bone health. In this study, an accessible way to estimate osteoporosis risk, quantitative ultrasound (QUS), is compared to the gold-standard technique dual X-ray absorptiometry (DXA) in a group of 54 healthy young women (18–26 years) from Manawatu, New Zealand, and the relationship with nutrient intake is investigated. Broadband ultrasound attenuation and speed of sound (BUA, SOS) were assessed by QUS calcaneal scans and bone mineral concentration/density (BMC/BMD) were determined by DXA scans of the lumbar spine and hip (total and femoral neck). Dietary intake of energy, protein, and calcium was estimated using three-day food diaries and questionnaires. DXA mean Z-scores (>−2.0) for the hip (0.19) and spine (0.2) and QUS mean Z-scores (>−1.0) (0.41) were within the expected ranges. DXA (BMD) and QUS (BUA, SOS) measurements were strongly correlated. Median intakes of protein and calcium were 83.7 g/day and 784 mg/day, respectively. Protein intake was adequate and, whilst median calcium intake was higher than national average, it was below the Estimated Average Requirement (EAR). No significant relationship was found between dietary intake of calcium or protein and BMD or BMC. To conclude, QUS may provide a reasonable indicator of osteoporosis risk in young women but may not be an appropriate diagnostic tool. Increased calcium intake is recommended for this group, regardless of BMD. Full article