scholarly journals DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism

2021 ◽  
Author(s):  
Gaia Tabacco ◽  
Anda M Naciu ◽  
Carmelo Messina ◽  
Gianfranco Sanson ◽  
Luca Rinaudo ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Bone Quality ◽  
Quality Parameters ◽  
Bone Strain ◽  
Mineral Density ◽  
Strain Index ◽  
Significant Independent Predictor ◽  
Element Analysis

Abstract Context Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual X-ray absorptiometry images. Objective To assess the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT compared to controls and to investigate the association of BSI with vertebral fractures (VFs) in PHPT. Design case-control study Setting Outpatient clinic Patients 50 PHPT and 100 age- and sex-matched control subjects. Main Outcome Measures LS-BSI, FN-BSI, TH-BSI. Results FN bone mineral density (BMD) and 1/3 distal radius BMD were lower in the PHPT group than in controls (FN 0.633 ± 0.112 vs 0.666 ± 0.081 p= 0.042; radius 0.566 ± 0.07 vs 0.625 ± 0.06 p<0.001). PHPT group has significant lower TBS score compared to controls (1.24 ± 0.09 vs 1.30 ± 0.10 p <0.001).BSI was significantly higher at LS (2.28±0.59 vs 2.02±0.43, p=0.009), FN (1.72±0.41 vs 1.49±0.35, p=0.001) and TH (1.51±0.33 vs 1.36±0.25, p=0.002) in PHPT. LS-BSI showed moderate accuracy for discriminating VFs (AUC 0.667; 95% CI 0.513-0.820). LS-BSI ≥ 2.2 and was a statistically significant independent predictor of VFs, with an adjusted OR ranging from 5.7 to 15.1. Conclusion BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures.

scholarly journals Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index

2021 ◽  
Vol 7 ◽  
Author(s):  
Fabio Massimo Ulivieri ◽  
Luca Rinaudo
Keyword(s):  
Bone Mineral Density ◽  
Density Distribution ◽  
Bone Strength ◽  
Bone Quality ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Bone Strain ◽  
Mineral Density ◽  
Strain Index ◽  
X Ray

For a proper assessment of osteoporotic fragility fracture prediction, all aspects regarding bone mineral density, bone texture, geometry and information about strength are necessary, particularly in endocrinological and rheumatological diseases, where bone quality impairment is relevant. Data regarding bone quantity (density) and, partially, bone quality (structure and geometry) are obtained by the gold standard method of dual X-ray absorptiometry (DXA). Data about bone strength are not yet readily available. To evaluate bone resistance to strain, a new DXA-derived index based on the Finite Element Analysis (FEA) of a greyscale of density distribution measured on spine and femoral scan, namely Bone Strain Index (BSI), has recently been developed. Bone Strain Index includes local information on density distribution, bone geometry and loadings and it differs from bone mineral density (BMD) and other variables of bone quality like trabecular bone score (TBS), which are all based on the quantification of bone mass and distribution averaged over the scanned region. This state of the art review illustrates the methodology of BSI calculation, the findings of its in reproducibility and the preliminary data about its capability to predict fragility fracture and to monitor the follow up of the pharmacological treatment for osteoporosis.

scholarly journals Dxa-based bone strain index: A new tool to evaluate bone quality in primary hyperparathyroidism

Bone Reports ◽  
2021 ◽  
Vol 14 ◽  
pp. 100788
Author(s):  
Gaia Tabacco ◽  
Anda Mihaela Naciu ◽  
Carmelo Messina ◽  
Luca Rinaudo ◽  
Roberto Cesareo ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Quality ◽  
Bone Strain ◽  
Strain Index

scholarly journals Bone Mineral Density Compared to Trabecular Bone Score in Primary Hyperparathyroidism

2022 ◽  
Vol 11 (2) ◽  
pp. 330
Author(s):  
Alicia R. Jones ◽  
Koen Simons ◽  
Susan Harvey ◽  
Vivian Grill
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Primary Hyperparathyroidism ◽  
Fracture Risk ◽  
Trabecular Bone ◽  
Bone Quality ◽  
Bone Mineral ◽  
Trabecular Bone Score ◽  
Statistical Significance ◽  
Mineral Density

Individuals with primary hyperparathyroidism (PHPT) have reduced bone mineral density (BMD) according to dual X-ray absorptiometry at cortical sites, with relative sparing of trabecular BMD. However, fracture risk is increased at all sites. Trabecular bone score (TBS) may more accurately describe their bone quality and fracture risk. This study compared how BMD and TBS describe bone quality in PHPT. We conducted a retrospective cross-sectional study with a longitudinal component, of adults with PHPT, admitted to a tertiary hospital in Australia over ten years. The primary outcome was the TBS at the lumbar spine, compared to BMD, to describe bone quality and predict fractures. Secondary outcomes compared changes in TBS after parathyroidectomy. Of 68 included individuals, the mean age was 65.3 years, and 79% were female. Mean ± SD T-scores were −1.51 ± 1.63 at lumbar spine and mean TBS was 1.19 ± 0.12. Only 20.6% of individuals had lumbar spine BMD indicative of osteoporosis, while 57.4% of TBS were ≤1.20, indicating degraded architecture. There was a trend towards improved fracture prediction using TBS compared to BMD which did not reach statistical significance. Comparison of 15 individuals following parathyroidectomy showed no improvement in TBS.

DXA-based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism

2021 ◽  
Author(s):  
C. Messina ◽  
A. Naciu ◽  
L. Rinaudo ◽  
J. P. Bilezikian ◽  
A. Palermo ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Quality ◽  
Bone Strain ◽  
Strain Index

scholarly journals The threshold of bone mineral density for vertebral fractures in female patients with primary hyperparathyroidism

2005 ◽  
Vol 153 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Hiroshi Kaji ◽  
Mika Yamauchi ◽  
Kazuo Chihara ◽  
Toshitsugu Sugimoto
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Vertebral Fractures ◽  
Control Group ◽  
Mineral Density ◽  
Female Patients ◽  
Control Subjects

Background and objective: Primary hyperparathyroidism (pHPT) is one of the causal diseases that induce secondary osteoporosis. Although patients with pHPT have reduced bone mineral density (BMD) especially at the cortical bone, there have been controversies about risk of fracture. Moreover, no reports have been available about the threshold of BMD for fractures in pHPT patients. Methods: BMD values were measured by dual-energy x-ray absorptiometry at lumbar spine, femoral neck and distal one third of radius. Various indices were compared in 116 female pHPT patients and 716 control subjects. Moreover, we analyzed relationship between the cut-off values of BMD and the prevalence of vertebral fractures in pHPT and control subjects. Results: The prevalence of subjects with vertebral fractures was lower in pHPT patients, compared with that of control subjects. Age and body height were significantly higher and lower in pHPT women with vertebral fractures, respectively. Lumbar spine BMD was significantly lower in pHPT women with vertebral fractures, presumably due to their increased age. There were no differences in femoral neck and radius BMD or in bone metabolic indices between pHPT women with and without vertebral fractures. On the other hand, age-matched BMD was not significantly different between both groups at any measured site. Cut-off values of BMD at lumbar spine and femoral neck were lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group. Moreover, cut-off values of BMD at radius was much lower in postmenopausal pHPT patients, compared with those of the postmenopausal control group (pHPT vs control (g/cm2): 0.670 vs 0.706 at lumbar spine; 0.549 vs 0.570 at femoral; 0.394 vs 0.474 at radius). Sensitivity and specificity of vertebral fractures was lower in pHPT patients, compared with those in control group. Conclusions: The present cross-sectional study demonstrated that thresholds of BMD for vertebral fractures were lower especially at radial bone in female patients with pHPT, compared with those in the control group.

scholarly journals Trabecular Bone Score in Obese and Nonobese Subjects With Primary Hyperparathyroidism Before and After Parathyroidectomy

2018 ◽  
Vol 103 (4) ◽  
pp. 1512-1521 ◽  
Author(s):  
Yu-Kwang Donovan Tay ◽  
Natalie E Cusano ◽  
Mishaela R Rubin ◽  
John Williams ◽  
Beatriz Omeragic ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Trabecular Bone ◽  
Prospective Observational Study ◽  
Trabecular Bone Score ◽  
Marked Change ◽  
Mineral Density ◽  
Before And After ◽  
Obese Subjects

Abstract Context Obesity has been shown to be unfavorable to skeletal microarchitecture when assessed by trabecular bone score (TBS). The influence of adiposity on skeletal microstructure in primary hyperparathyroidism (PHPT) has not yet been evaluated. Objective To investigate the effect of obesity on TBS and bone mineral density (BMD) in subjects with PHPT at baseline and through 2 years after parathyroidectomy. Design Prospective observational study. Setting Referral center. Patients or Other Participants Thirty men and women with PHPT undergoing parathyroid surgery. Main Outcome Measures TBS and BMD by dual-energy X-ray absorptiometry (DXA). Results There were notable improvements in lumbar spine and femoral neck BMD in the obese (lumbar spine: 4.3 ± 4.7%, femoral neck: 3.8 ± 6.6%; P < 0.05 for both) and nonobese subjects (lumbar spine: 3.8 ± 5.6%, femoral neck 3.1 ± 5.0%; P < 0.05 for both) but no marked change in TBS in either group at 24 months postparathyroidectomy. Obese subjects had fully degraded TBS values compared with the nonobese subjects, whose TBS values were minimally below normal throughout the study (baseline: 1.199 ± 0.086 vs 1.327 ± 0.099, respectively; P = 0.003; 24 months: 1.181 ± 0.061 vs 1.352 ± 0.114, respectively; P = 0.001), despite improvements in BMD. Conclusions The detrimental effect of obesity on TBS, an index of bone quality, was demonstrated in subjects with PHPT. Obesity was associated with fully degraded skeletal microarchitecture as measured by TBS in PHPT, despite similar values in bone density by DXA compared with nonobese subjects. TBS values did not improve postparathyroidectomy in either obese or nonobese subjects.

Postoperative Zoledronic Acid for Osteoporosis in Primary Hyperparathyroidism: a Randomized Placebo-controlled Study

2021 ◽  
Author(s):  
E M Ryhänen ◽  
A M Koski ◽  
Eliisa Löyttyniemi ◽  
M J Valimaki ◽  
Ulla Kiviniemi ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Zoledronic Acid ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Bone Turnover ◽  
Bone Turnover Markers ◽  
Controlled Study ◽  
Mineral Density ◽  
Turnover Markers

Objective: In primary hyperparathyroidism (PHPT) with osteoporosis, bone mineral density (BMD) improves after parathyroidectomy. It is unclear whether combining surgery with postoperative bisphosphonate treatment can further improve bone health. Design: This randomized, placebo-controlled study compared the effects of surgery alone and surgery combined with zoledronic acid on bone metabolism in PHPT with osteoporosis. Methods: Fifty-six patients (f/m 47/9, mean age 68.4 years) with PHPT and osteoporosis were randomized 1–3 months after parathyroidectomy to receive a two-year treatment of zoledronic acid or placebo. Dual-energy X-ray absorptiometry (DXA) and bone turnover markers (N-terminal propeptide of type 1 procollagen, C-terminal telopeptide of type 1 collagen, and alkaline phosphatase) were measured annually during the 2-year follow-up. Results: Two years after parathyroidectomy, BMD was significantly higher in the zoledronic acid (ZOL) group compared with the placebo (PBO) group at the femoral neck (P = 0.045 for Z-score) and lumbar spine (P = 0.039 and 0.017 for T- and Z-scores, respectively). Bone turnover markers were significantly lower in the ZOL group (P < 0.001 for all markers). Of the 18 patients who had received bisphosphonates for >1 year before surgery, BMD improved significantly in the ZOL group both in the femoral neck and lumbar spine (N = 10; all P < 0.001–0.01) but in the PBO group only in the lumbar spine (N = 8, P = 0.03), (P= 0.08-0.95 for between-group changes). Conclusion: BMD increases after parathyroidectomy both with and without zoledronic acid but the increase is significantly higher with postoperative zoledronic acid.

scholarly journals Changes in bone mineral density after parathyroidectomy in patients with moderate to severe primary hyperparathyroidism

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096469
Author(s):  
Shuai Lu ◽  
Maoqi Gong ◽  
Yejun Zha ◽  
Aimin Cui ◽  
Chen Chen ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Primary Hyperparathyroidism ◽  
Bone Mineral ◽  
Great Trochanter ◽  
Severe Damage ◽  
Mineral Density ◽  
Total Hip ◽  
Z Scores

Objective Primary hyperparathyroidism (PHPT) is relatively common in China and results in severe damage to the skeletal system. This study aimed to investigate changes in bone mineral density (BMD) over 2 years in patients with PHPT after parathyroidectomy. Methods This retrospective cohort study included patients with PHPT who underwent parathyroidectomy between January 2010 and December 2015. BMD and T-scores and Z-scores of the lumbar spine (L1, L2, L3, and L4) and total hip (femoral neck, great trochanter, and Ward’s triangle) at baseline and 2 years after surgery were measured by dual-energy X-ray absorptiometry. Results Thirty patients with moderate to severe PHPT (17 men and 13 women) aged 38.90±15.48 years were included. BMD, and T-score and Z-score values at the lumbar spine and total hip at 6 months, 1 year, and 2 years after parathyroidectomy were significantly improved compared with preoperative values. Improvement in BMD was largest at L4 (46.7%) and smallest at L1 (37.4%) in the lumbar spine 2 years after parathyroidectomy. For the total hip, the increase in BMD was largest at Ward’s triangle (42.6%) and smallest at the femoral neck (37.5%). Conclusions BMD of the lumbar spine and total hip is improved after parathyroidectomy in patients with PHPT.

Evaluation of bone quality by dxa-based bone strain index in primary hyperparathyroidism

2021 ◽  
Author(s):  
Gaia Tabacco ◽  
Anda Mihaela Naciu ◽  
Carmelo Messina ◽  
Luca Rinaudo ◽  
Roberto Cesareo ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Quality ◽  
Bone Strain ◽  
Strain Index

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

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

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

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