Assessment of Bone Density of Patients Referred to Arak Densitometry Center from 2016 to 2017: A Cross-Sectional Study

Background: Osteoporosis and subsequent fractures increased mortality and disability. Along with this fact, the demand for diagnostic tests has also increased in recent years, which has created a heavy financial burden on the health system. Objectives: The aim of this research was to evaluate the compatibility of the indications of performing the bone density measurement in Arak city with the criteria of the international sociality of clinical densitometry (ISCD). Methods: This cross-sectional study was performed from 2016 to 2017. Patients’ information was extracted from checklists recorded by a bone density measurement expert. Patients who lived in Arak and did not have an underlying condition that reduced the value of the bone mineral densitometry (BMD) test were studied. We collected the information of the patients who had undergone a bone density test at the discretion of their physician. Results: Here, 816 out of 1,354 bone density tests, requested by non-rheumatologists, were abnormal, and 538 were normal. In the abnormal group, 800 (98%) cases had ISCD indications for BMD application, and only 16 (2%) cases had no indication. However, 636 bone density tests were requested by rheumatologists that 474 were abnormal and 162 were normal, and in the abnormal group, 471 (99.4%) had ISCD indications for BMD, and only 3 (0.6%) cases had no indications. Conclusions: In many cases, bone mineral density has been requested based on ISCD indications (85.13%), and bone disorders have been well identified (64.83%). The study also demonstrates that BMD requests are common among different specialized groups, and when rheumatologists request a bone density, the test is highly sensitive (99.37%).

Impact of Measuring Bone Mineral Density at Bilateral Hip

Osteoporosis is a systemic disease characterized by low bone mineral density (BMD) leading to an increased risk of fracture. The current guidelines vary regarding the measurement of BMD at unilateral versus bilateral hip. We hypothesized that a discordance exists between bone densities measured at both hips and that patients undergoing unilateral hip imaging are at risk for under diagnosis. A retrospective chart review was performed to include all patients age 18 years and older, who underwent bone density measurement in 2019 at a single center using Hologic densitometer. Data gathering included BMD and T- scores at bilateral hip for all postmenopausal women and men above the age of 50 yrs. The continuous variables were expressed as means with standard deviation for normal distribution and analyzed with a two-sample t-test. Multiple regression analysis was used to test the effect of underlying medical conditions on T-score at bilateral hips. For all analyses, a p-value of <0.05 was considered significant. 150 patients were included in the study (127 females and 23 males) with a mean age at imaging of 65.2 + 9.7 years and body mass index (BMI) of 27.2 + 6.1 kg/m2. 9% (n=14) of patients were observed to have discordance between T scores at both hips, out of which 13 individuals would have been underdiagnosed if one side was measured alone. There was a significant difference between mean BMD at total hip (left hip 0.84 + 0.14 g/cm2 vs right hip 0.82 + 0.14 g/cm2; p<0.05). Among individuals with discordant T scores, a positive correlation was observed with BMI at the left femoral neck (r= 0.54, p= 0.04). Results: of multiple regression analysis showed that 67% of variation in the T score at right femoral neck could be accounted for by underlying medical conditions. Appointment duration and cost were unchanged when scanning unilateral or bilateral hip, 30 minutes, and $250 respectively. In summary, scanning bilateral hips provides treatment opportunities for patients who would otherwise be underdiagnosed without an additional increase in cost.

Biphasic Calcium Phosphate Microparticles Mixed With Autologous Blood: Application for the Reconstruction of a Large Mandibular Bone Defect in a Dog

Large mandibular bone defects can be difficult to treat in dogs, with a high risk of mal or nonunion due to instability and risk of infection. This case report describes the use of autologous clotted blood mixed with biphasic calcium phosphate microparticles to fill a defect in a nonunion fracture and promote bone regeneration in a dog using a 2-stage surgical approach. This new method was designed and tried in a dog with a chronic, unstable mandibular fracture associated with a large sequestrum. Initial treatment involved debridement of the lesion, then the oral wound and oral vestibule were reconstructed in 2 layers. Four weeks later a second stage surgery allowed placement of a pre-contoured maxillofacial plate to bridge the defect, which was filled with a blood/biphasic calcium phosphate compound implant. Cone-beam computed tomography was used prior to the initial surgery for preoperative planning and 3-D printing of a mandibular template for plate contouring. CT was subsequently used to document the healing process, using a bone density measurement tool to assess bone regeneration. Radiographic evidence suggestive of osseointegration was observed within 6 months with effective filling of the defect and restoration of alveolar ridge continuity. A return to normal and atraumatic occlusion was considered excellent. Cone-beam computed tomography was found useful to document radiographic evidence of osseointegration, bone regrowth and remodeling. This case report is to serve as a proof-of-concept study and should be followed by a prospective evaluation.

Effect of Vitex agnus-castus on Depression of Postmenopausal Women: A Randomized Clinical Trial

Background: During menopause, women undergo biological, social, and psychological changes and are sensitive to stressors, especially anxiety and depression. Decreased estrogen in postmenopausal women causes mood swings, especially depression and anxiety. Objectives: We aimed to determine the effect of the Vitex agnus-castus extract on depression in postmenopausal women referring to a bone density measurement center in Shiraz. Methods: In a randomized controlled tria1, 60 postmenopausal women were randomly divided into an intervention group and a control group. In the intervention group, the research units were assigned to two groups of Vitex agnus-castus tablets and placebo, using random permuted blocks with a block size from one to six for each eligible case. After three months, depression was evaluated by the Edinburg Postnatal Depression Scale (EPDS) in both groups. Then, the results were analyzed using the independent t-test for quantitative variables. The obtained data were analyzed by a statistician using SPSS21. Results: Based on the results, the two groups were homogeneous in terms of the level of education, occupation, and housing, and a significant decrease was observed in the mean depression score in the Agnugolgroup (P < 0.001). Conclusions: Because depression increases during menopause, it is recommended that it should be used as a supplement during menopause.

Evaluation of Osteoporosis Frequency in Patients With Recurrent Kidney Stones

Osteoporosis is defined as a reduction in bone density up to 2.5 standard deviations less than the maximum mean bone density in humans. It is estimated that 50% to 80% of the differences in the bone mass of the individuals are related to their genetic and heredity. The prevalence of osteoporosis is 6% in Iran, in which it is more than Japanese and less than in the United States. In this cross-sectional descriptive-analytical study, patients with a history of recurrent kidney stones (those who had referred to the stone clinic more than one time) undergoing bone density measurement using the DEXA method to determine the presence or absence of osteoporosis (Reduction of bone density up to 2.5 standard deviations less than the maximum mean bone density) were enrolled. Exclusion criteria were patients with metabolic diseases, corticosteroid intake, renal failure, hyperparathyroidism, and age >60 years. According to the results of this study, there were 61 patients with a history of recurrent kidney stones, which 34 of them (55.74%) were male and 27 (44.26%) were female; the mean age was 42.41±9.8 years (ranging from 18 to 60 years). Evaluation of frequency distribution of patients showed that 18% of patients had osteoporosis. In this study, 52.5% of patients were without osteoporosis and osteopenia. It should be noted that 29.5% of patients had only osteopenia. The frequency distribution of osteoporosis in patients with a history of recurrent kidney stones by gender showed that four males (36.4%) and seven females (63.6%) had osteoporosis. There was no significant relationship between gender and osteoporosis in patients with a history of recurrent kidney stones (P=0.153). There was also no significant relationship between gender and osteopenia in these patients (P=0.380). There was no significant relationship between age and osteoporosis in patients with a history of recurrent kidney stones (P=0.203). There was no significant relationship between BMI and osteoporosis in patients with a history of recurrent kidney stones (P=0.344). There was no significant relationship between osteoporosis with age and BMI in patients with a history of recurrent kidney stones, and the highest percentage of osteoporosis was in the spine region, which consisted of 8.2% of all patients. There was no significant relationship between osteopenia with gender and BMI in patients with a history of recurrent kidney stones, but there was a significant relationship between age and osteopenia in patients with recurrent kidney stones.

Facilitating Osteogenesis of Chitosan with Autogenous Bone Marrow (experimental Study on Rabbits)

Bone quality is the result of a complex relationship between the intrinsic properties of the materials that comprise the bone matrix mineralization, bone mass and the spatial distribution of the bone mass. Chitosan has been shown to be suitable bone replacement material. To evaluate the accelerating effect of chitosan on the bone regeneration process and assessing by CT Scan were conduct this study. Several important biological effect of chitosan has been characterized, these are high osteoinductivity, osteointegrability and gradual biodegrability that make it a good candidate for bone regeneration. Materials and Methods: 20 rabbits of both sex were enrolled in this study, two monocortical defects were created on Mandible, one considered as control and the other implanted with chitosan, other two monocortical defects were created on Tibia on the same animal. Post-operative follow up date 7,14,21and 28 Days. C.T. scan was used as parameter for bone density measurement. Results: showed that non- significant difference at Day7 and14 in Mandible and significant at Day21 and 28 compared to control, While non-significant at Day 7 in Tibia and significant at 14 and 21 post-operatively with highly significant at Day28 compared to control. Conclusion: Chitosan has ability to osteogenesis when it is used alone and the process of osteogenesis was facilitating when it is mixed with Bone marrow.

Facilitating Osteogensis of Mineral Trioxide Aggregate And Biodentine by Autogenous Bone Marrow. (experimental Study on Rabbit)

Maxillofacial surgery employs several surgical procedures in soft and hard tissues. When hard tissues are involved, for instance, periapical surgery, cyst enucleation, tumor resection, preprosthetic surgery, when the large bony defect remaining intact it is necessary to replace by bone grafting. An in vivo and vitro studies has also shown that Mineral trioxide aggregate (MTA) and biodentine promotes both dental and bony regeneration in pulp and periradicular tissues and both have excellent biocompatibility. Materials and Methods: 20 rabbits of both sexes were enrolled in this study, three monocortical defects were created on Mandible, one considered as control and the others implanted with MTA and biodentine, on tibia, three monocortical defects were created on the same animal. Post-operative follow up date 7,14,21and 28 Days. C.T. scan was used as parameter for bone density measurement. Results: showed that non-significant difference at Day7 and14 in Mandible and significant at Day21 and 28 compared to control, While nonsignificant at Day 7 in Tibia and significant at 14 and21 post-operatively with highly significant at Day28 compared to control. Conclusion: MTA and biodentine have effect on process of osteogenesis and will facilitating when it implanted with Bone marrow.

Bone density measurements from CT scans may predict the healing capacity of scaphoid waist fractures

Aims We quantitatively compared the 3D bone density distributions on CT scans performed on scaphoid waist fractures subacutely that went on to union or nonunion, and assessed whether 2D CT evaluations correlate with 3D bone density evaluations. Methods We constructed 3D models from 17 scaphoid waist fracture CTs performed between four to 18 weeks after fracture that did not unite (nonunion group), 17 age-matched scaphoid waist fracture CTs that healed (union group), and 17 age-matched control CTs without injury (control group). We measured the 3D bone density for the distal and proximal fragments relative to the triquetrum bone density and compared findings among the three groups. We then performed bone density measurements using 2D CT and evaluated the correlation with 3D bone densities. We identified the optimal cutoff with diagnostic values of the 2D method to predict nonunion with receiver operating characteristic (ROC) curves. Results In the nonunion group, both the distal (100.2%) and proximal (126.6%) fragments had a significantly higher bone density compared to the union (distal: 85.7%; proximal: 108.3%) or control groups (distal: 91.6%; proximal: 109.1%) using the 3D bone density measurement, which were statistically significant for all comparisons. 2D measurements were highly correlated to 3D bone density measurements (Spearman’s correlation coefficient (R) = 0.85 to 0.95). Using 2D measurements, ROC curve analysis revealed the optimal cutoffs of 90.8% and 116.3% for distal and proximal fragments. This led to a sensitivity of 1.00 if either cutoff is met and a specificity of 0.82 when both cutoffs are met. Conclusion Using 3D modelling software, nonunions were found to exhibit bone density increases in both the distal and proximal fragments in CTs performed between four to 18 weeks after fracture during the course of treatment. 2D bone density measurements using standard CT scans correlate well with 3D models. In patients with scaphoid fractures, CT bone density measurements may be useful in predicting the likelihood of nonunion. Cite this article: Bone Joint J 2020;102-B(9):1200–1209.