Glucocorticoids Increase Fracture Risk and Fracture Prevalence Independently from Bone Mineral Density and Clinical Risk Factors: Results from the Gliwice Osteoporosis (GO) Study

The aim of the study was to establish the influence of glucocorticoids (GC) on fracture risk, probability, and prevalence. A set of 1548 postmenopausal women were divided into study group – treated with GC (n=114, age 66.48±7.6 years) and controls (n=1434, age 66.46±6.83 years). Data on clinical risk factors for osteoporosis and fractures were collected. Hip bone densitometry was performed using a device Prodigy (GE, USA). Fracture probability was established by FRAX, and fracture risk by Garvan algorithm and POL-RISK. Fracture risk and fracture probability were significantly greater for GC-treated women in comparison to controls. In the study group, there were 24, 3, 24, and 6 fractures noted at spine, hip, forearm, and arm, respectively. The respective numbers of fractures reported in controls at those skeletal sites were: 186, 23, 240, and 25. The use of GCs increased significantly prevalence of all major, spine and arm fractures. Also the number of all fractures was affected by GC use. Following factors significantly increased fracture probability: age (OR 1.04 per each year; 95% CI: 1.03–1.06), GC use (OR 1.54; 95% CI: 1.03–2.31), falls (OR 2.09; 95% CI: 1.60–2.73), and FN T-score (OR 0.62 per each unit; 95% CI: 0.54–0.71). In conclusion, in patients treated with GCs the fracture risk, probability, and prevalence were increased. This effect was evident regardless of whether GC therapy is included in the algorithm as a risk factor (FRAX, POL-RISK) or not taken into consideration (Garvan nomogram).

A probabilistic model for fracture events of Petermann ice islands under the influence of atmospheric and oceanic conditions

Four calving events of Petermann Glacier happened in 2008, 2010, 2011, and 2012, which resulted in the drift and deterioration of numerous ice islands, some reaching as far as offshore Newfoundland. The presence of these ice islands in the eastern Canadian Arctic increases the risk of interaction with offshore operations and shipping activities. This study uses the recently developed Canadian Ice Island Drift, Deterioration and Detection database to investigate the fracture events that these ice islands experienced, and it presents a probabilistic model for the conditional occurrence of such events by analyzing the atmospheric and oceanic conditions that drive the causes behind the ice island fracture events. Variables representing the atmospheric and oceanic conditions that the ice islands were subjected to are extracted from reanalysis datasets and then interpolated to evaluate their distributions for both fracture and non-fracture events. The probability of fracture event occurrence for different combinations of input variable conditions is quantified using Bayes' theorem. Out of the seven variables analyzed in this study, water temperature and ocean current speed are identified as the most and least important contributors, respectively, to the fracture events of the Petermann ice islands. It is also revealed that the ice island fracture probability increases to 75 % as the ice islands encounter extreme (very high) atmospheric and oceanic conditions. A validation scheme is presented using the cross-validation approach and Pareto principle, and an average error of 13 %–39 % is reported in the fracture probability estimations. The presented probabilistic model has a predictive capability for future fracture events of ice islands and could be of particular interest to offshore and marine ice and risk management in the eastern Canadian Arctic. Future research, however, is necessary for model training and testing to further validate this ice island fracture model.

Laser-Assisted Field Evaporation of (R = Gd, Sm) High-Temperature Superconducting Coated Conductors

In the field of high-temperature superconductors, atom probe tomography is a relatively new instrument, with the ability to provide a new perspective on the 3D nanoscale microstructure. However, field evaporation of nonmetallic materials is fraught with unique challenges that matter little in the world of metallic evaporation. In this study, we review the laser absorption, correlated evaporation, molecular dissociation, and the crystallographic effects on the field evaporation of 800-m ${\rm RB}{\rm a}_ 2{\rm C}{\rm u}_ 3{\rm O}_{ 7-{\rm \delta }}$ (R = Gd, Sm) coated conductor tapes deposited by Reactive Co-Evaporation Cyclic Deposition and Reaction (RCE-CDR). Ultraviolet 355 nm laser pulsing was found to have a substantial beneficial effect on minimizing the fracture probability compared with 532 nm illumination, especially when evaporating insulating oxide precipitates. This, in turn, allows for the 3D compositional analysis of defects such as flux pinning centers introduced by precipitation and doping. As a result, evidence for the precipitation of nanoscale ${\rm G}{\rm d}_ 2{\rm C}{\rm u}_ 2{\rm O}_ 5$ is discussed. The effect of crystallographic orientation is studied, where [001] aligned evaporation is found to develop compositional aberrations.

Substantiation of probabilistic safety factors as a factor for optimizing the metal consumption of pipelines and the permissible operating pressure

Проведен анализ влияния коэффициентов вариации сопротивления материала разрушению и коэффициентов вариации нагрузки на вероятность разрушения и, следовательно, на коэффициенты запаса по характеристикам сопротивления материала разрушению при заданных показателях вероятности разрушения. Снижение неопределенности в условиях нагружения и повышение качества материала позволяют снизить коэффициенты запаса по пределу текучести и вязкости разрушения для заданных целевых показателей безопасности. На примере трубных сталей марок Ст 20 и 16ГС показана возможность снижения коэффициента запаса по пределу текучести до значений n = 1,45 при коэффициенте вариации нагрузки 0,1 и сохранении целевого показателя безопасности в терминах вероятности разрушения на уровне 10. Возможность снижения коэффициентов запаса по пределу текучести и вязкости разрушения при заданных целевых показателях безопасности в терминах вероятности разрушения позволяет оптимизировать металлоемкость и максимальные допустимые давления в эксплуатируемых трубопроводах. The analysis of the influence of the coefficients of variation of the material resistance and the coefficients of the load variation on the probability of failure as well as on the safety factors for the characteristics of the material resistance to failure has been done at given indicators of the probability of failure. Reducing uncertainty under loading conditions and improving material quality allow reducing the safety factors against fracture and collapse for given targets safety. Using the example of pipe steels of grades St 20 and 16GS, it seems possible to reduce the safety factor against collapse up to 1.45 with a load variation coefficient of 0.1 and maintaining the safety target in terms of the fracture probability at the level of 10. The possibility of reducing the safety factors against collapse and fracture at the given target safety indicators in terms of the fracture probability allows optimizing the metal consumption and the maximum allowable pressures in the operating pipelines.

Clinical Usefulness of FRAX Score for Predicting Sarcopenia in Patients with Chronic Liver Disease

We investigated the usefulness of the Fracture Risk Assessment tool (FRAX) for predicting sarcopenia in chronic liver disease (CLD). In this cross-sectional study, we evaluated 321 patients with CLD. The FRAX with and without bone mineral density (BMD) was employed to calculate the 10-year risks of major osteoporotic and hip fractures. The FRAX score for high fracture risk was defined as a 10-year major osteoporotic fracture probability of ≥20% or a 10-year hip fracture probability of ≥3%. The diagnosis of sarcopenia was based on the Japan Society of Hepatology criteria. According to the FRAX, with and without BMD, 134 (41.7%) and 193 (60.1%) patients had a high fracture risk, respectively. The high fracture risk group had a significantly higher frequency of sarcopenia than the non-high fracture risk group. FRAX scores of major osteoporotic and hip fractures were negatively correlated with handgrip strength and muscle mass. Using the FRAX with BMD, the cutoff scores of major osteoporotic and hip fractures for predicting sarcopenia were 8.55% (sensitivity/specificity, 0.847/0.568) and 3.35% (0.729/0.746), respectively. Using the FRAX without BMD, they were 18.5% (0.635/0.725) and 7.65% (0.729/0.758), respectively. The FRAX is a simple and convenient screening tool for predicting sarcopenia in patients with CLD.

Effect of Microstructure Refinement on Surface Morphology and Dynamic Mechanical Properties of W-Cu Alloys

Two ultrafine-grained W-Cu alloys and two coarse-grained W-Cu alloys were prepared to study the effect of tungsten grain refinement on the interface characteristics between coating and W-Cu alloys. The experimental results show that in the coarse-grained W-Cu alloys, the tungsten phase near the surface is easy to form pits and cracks during impact loading, while the fine-grained tungsten alloy is not prone to this phenomenon. Simulations show that refining tungsten grains can not only reduce the impact absorption energy, but also increase the contact area of tungsten and copper phases, thereby reducing the fracture probability of tungsten phases and improving the dynamic mechanical properties of the W-Cu alloys under impact loading. The tested results show that the shear strength of gold studs on the coating is increased by about 33%, after grain refinement for the W-Cu alloys.

Transfer Learning for an Automated Detection System of Fractures in Patients with Maxillofacial Trauma

An original maxillofacial fracture detection system (MFDS), based on convolutional neural networks and transfer learning, is proposed to detect traumatic fractures in patients. A convolutional neural network pre-trained on non-medical images was re-trained and fine-tuned using computed tomography (CT) scans to produce a model for the classification of future CTs as either “fracture” or “noFracture”. The model was trained on a total of 148 CTs (120 patients labeled with “fracture” and 28 patients labeled with “noFracture”). The validation dataset, used for statistical analysis, was characterized by 30 patients (5 with “noFracture” and 25 with “fracture”). An additional 30 CT scans, comprising 25 “fracture” and 5 “noFracture” images, were used as the test dataset for final testing. Tests were carried out both by considering the single slices and by grouping the slices for patients. A patient was categorized as fractured if two consecutive slices were classified with a fracture probability higher than 0.99. The patients’ results show that the model accuracy in classifying the maxillofacial fractures is 80%. Even if the MFDS model cannot replace the radiologist’s work, it can provide valuable assistive support, reducing the risk of human error, preventing patient harm by minimizing diagnostic delays, and reducing the incongruous burden of hospitalization.

Detection of osteoporosis in lumbar spine [L1-L4] trabecular bone: a review article

<p class="abstract">The human bones are categorized based on elemental micro architecture and porosity. The porosity of the inner trabecular bone is high that is 40-95% and the nature of the bone is soft and spongy where as the cortical bone is harder and is less porous that is 5 to 15%. Osteoporosis is a disease that normally affects women usually after their menopause. It largely causes mild bone fractures and further stages lead to the demise of an individual. This analysis is on the basis of bone mineral density (BMD) standards obtained through a variety of scientific methods experimented from different skeletal regions. The detection of osteoporosis in lumbar spine has been widely recognized as a promising way to frequent fractures. Therefore, premature analysis of osteoporosis will estimate the risk of the bone fracture which prevents life threats. This paper focuses on the advanced technology in imaging systems and fracture probability analysis of osteoporosis detection. The various segmentation techniques are explored to examine osteoporosis in particular region of the image and further significant attributes are extracted using different methods to classify normal and abnormal (osteoporotic) bones. The limitations of the reviewed papers are more in feature dimensions, lesser accuracy and expensive imaging modalities like computed tomography (CT), magnetic resonance imaging (MRI), and DEXA. To overcome these limitations it is suggested to have less feature dimensions, more accuracy and cost-effective imaging modality like X-ray. This is required to avoid bone fractures and to improve BMD with precision which further helps in the diagnosis of osteoporosis.</p>

FRAX-Based Intervention Thresholds for Osteoporosis Treatment in Ukraine

Objectives. Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. FRAX® is a well-established, validated, web-based tool which calculates the 10-year probability of fragility fractures. A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis. Methods. In a referral population sample of 3790 Ukrainian women, 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture separately were calculated using the Ukrainian FRAX model, with and without femoral neck bone mineral density (BMD). We used a similar approach to that first proposed by the UK National Osteoporosis Guideline Group, whereby treatment is indicated if the probability equals or exceeds that of a woman of the same age with a prior fracture. Results. The MOF intervention threshold in females (the age-specific 10-year fracture probability) increased with age from 5.5% at the age of 40 years to 11% at the age of 75 years where it plateaued and then decreased slightly at age 90 (10%). Lower and upper thresholds were also defined to determine the need for BMD, if not already measured; the approach targets BMD measurements to those at or near the intervention threshold. The proportion of the referral populations eligible for treatment, based on prior fracture or similar or greater probability, ranged from 44% to 69% depending on age. The prevalence of the previous fracture rose with age, as did the proportion eligible for treatment. In contrast, the requirement for BMD testing decreased with age. Conclusions. The present study describes the development and application of FRAX-based assessment guidelines in Ukraine. The thresholds can be used in the presence or absence of access to BMD and optimize the use of BMD where access is restricted.

POS1106 FRAX AND THE EFFECT OF TERIPARATIDE ON BONE MINERAL DENSITY IN SECONDARY OSTEOPOROSIS

Background:Teriparatide has been shown to increase spine and hip bone mineral density (BMD) and to reduce vertebral and non-vertebral fractures. (1) It is currently not clear whether the effect of teriparatide is dependent on the baseline risk of fracture or osteoporosis (OP) type, a finding that could have an impact on our therapeutic decision.Objectives:Investigate if there is a relationship between teriparatide effect in BMD and baseline 10-year fracture probability, assessed using FRAX®, in primary and secondary OP patients.Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of OP treated with teriparatide for 24 months, with a ten-year follow-up period, at our rheumatology department. Demographic, clinical, laboratorial, BMD and occurrence of fracture data were collected. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v 4.1 with the Portuguese population reference. Statistical analysis was performed using the software SPSS 23.0. Correlations between continuous variables were evaluated with spearman coefficient. p<0.05 was considered statistically significant.Results:Eighty patients (88.8% female, median age 65.00 (59; 75)) were included. Forty-nine patients (61.3%) has secondary OP, mainly of cortisonic etiology (61.2%, n=30). Before treatment, median lumbar spine BMD was 0.870 [0.767, 0.964] g/cm2, median T-score of -2.60 (-3.30, -1.90); median total femur BMD was 0.742 [0.667, 0.863] g/cm2, median T-score of -2.10 (-2.80, -1.30); median femoral neck BMD was 0.671 [0.611, 0.787] g/cm2, median T-score of -2.50 [-3.20, -1.85]. Regarding fracture risk, median FRAX-based 10-year major fracture risk (with BMD) at baseline was 16% [10.0; 23], and median hip fracture risk was 7.2% [3.4; 13.8].The median variation of BMD, after finishing teriparatide treatment, in the spine was 0.107 [0.029; 0.228]; median BMD variation in total femur was 0.013 [-0.013; 0.068] and median BMD femoral neck was 0.046 [-0.002; 0.109]. We observed a numerically superior effect, albeit without any statistical significance, of teriparatide on bone mineral density gain in secondary OP (versus primary OP) at lumbar spine, total femur and femoral neck.Most patients continued anti-osteoporotic treatment with a bisphosphonate (81.2%, n=65) and, during follow-up, 17 patients had an incident fracture (8 hip fractures and 6 vertebral fractures), median of 5 [1.75, 8.25] years after ending teriparatide.We found a discrete correlation between FRAX-based hip fracture probability and the variation of bone mineral density in total femur (Spearman’s coefficient 0.248, p = 0.04). There was no correlation between FRAX-based major fracture probability and and the variation of bone mineral density in the spine or femur. When we separately analyze the relationship between the variation in total hip BMD and the FRAX-based fracture risk, depending on whether it is a secondary or primary OP, we find that the correlation is stronger and only remains in secondary OP (Spearman’s coefficient 0.348, p = 0.03).Conclusion:Our data suggest that teriparatide could be an important weapon in the treatment of secondary cause OP, particularly cortisonic, and in patients at high fracture risk, although further larger studies are needed to confirm these findings.References:[1]Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2.Disclosure of Interests:None declared.