Risk factors of osteoporosis in elderly inpatients: A cross-sectional single-centre study

Opportunistic Osteoporosis Assessment and Fracture Risk Determination Using Cancellous Density Measurement in Hounsfield Units of Native Lumbar Computed Tomography Images-A Comparative Study with Conventional Bone Density Evaluation

Background/Objectives: Osteoporosis is a global problem that will increase as the population increases and ages, requiring prevention, early detection, and appropriate treatment. An increasing loss in bone mineral density (BMD) is the hallmark of osteoporosis, leading to an increased risk for insufficiency fractures. We aimed to investigate and analyze the applicability of native lumbar spine computed tomography (CT) scans for the evaluation of bone density compared with standard bone density measurements with quantitative computed tomography (QCT) and computed tomography X-ray absorptiometry of the hip (CTXA). Methods: Patients who were referred to our institution for diagnostic investigations and underwent CT imaging of the lumbar spine, as well as standard osteoporosis assessments including QCT and CTXA, were included in the study, resulting in a total of 240 patients (mean age: 65.9 years, range: 24-91). An ANOVA test was used to compare patient groups without a fracture, with one fracture, with more than one fracture, and with additional sacral fractures. An ROC analysis was performed to assess the predictive power of fracture risk estimation considering HU, QCT, and CTXA values. Results: At least one fracture was detected in 42.9% of these patients. For the lumbar spine, the median HU was 89.9 (range 67.9-126.9) and the median BMD was 73.7 (range 57.1-104.2) mg/cm3. With a correlation coefficient of 0.98 (p < 0.001), the HU values obtained from native lumbar CT scans can be calculated using the following formula: BMDspine = 0.84 + (0.81 × HU). With HU values < 80 and a BMD of the lumbar spine < 66 mg/cm3, a significantly increased number of osteoporotic vertebral fractures were found in the mid-thoracic, thoracolumbar, and sacral regions with an effect size of 0.89. In 32 patients (13.3%), additional sacral fractures were found; these patients showed the lowest density values with a median HU value of 31.8 (12.7-58.2). An ROC analysis of HU revealed a 93% sensitivity for the coincidence of a vertebral fracture. There was no significant difference compared with the AUC of QCT (p = 0.395) for concomitant vertebral body fractures. CTXA values also allowed for risk assessment but showed a significantly lower AUC. We found a negative correlation of BMD with age and a positive correlation of BMD with body mass index. Conclusions: Cancellous density measurements in HU values can be effectively converted into quantitative BMD values in mg/cm3, enabling a reliable assessment of osteoporosis severity and fracture risk prediction. Further quantitative density evaluation of the hip does not add value to fracture risk assessment for the axial skeleton. Based on this study's findings, using HU values in native CT of the lumbar spine alone offers a viable, opportunistic approach towards fracture risk evaluation of the spine.

Fracture risk prediction & kidney function at different stages of chronic kidney disease: A correlation study

Background & objectives Mineral bone disease commonly occurs in individuals with chronic kidney disease (CKD) and increases fracture risk due to deficiency in bone quality and quantity. The FRAX score attempts to estimate fracture risk better. The primary aim of this study was to evaluate the prediction and correlation of fracture risk with different stages of CKD. Methods This was a correlational study. Data were collected from 95 individuals at different stages of CKD using non-probability consecutive sampling. The clinical and laboratory parameters were compared with the FRAX score in all CKD patients. Results A total of 95 CKD patients with a mean age of 51.42±9.95 yr were selected. Of these, 66.3 per cent between 40-55 yr, 25.3 per cent were 56-70 yr, and 8.4 per cent were ≥70 yr. There were 62 (65.3%) males and 33 (34.7%) females, and more than half (60%) were from rural areas. Age (P<0.001), occupation (P<0.005), and area of residence (P<0.003) showed a significant association with the FRAX score for major osteoporotic fracture risk. The FRAX score for predicting hip fracture risk showed a significant association with factors such as age, occupation, and area of residence, with P values of <0.001, 0.003, and 0.031, respectively. Additionally, the FRAX score for assessing the risk of major osteoporotic fractures demonstrated a significant association with various stages of CKD (P=0.018). Similarly, for hip fracture, there was a significant increase in the risk between stage III and V CKD patients (P=0.038). Interpretation & conclusions Based on the study findings it was found that the FRAX score was significantly associated with different stages of CKD, both for major osteoporotic as well as hip fracture risk.

[Comparative evaluation of trabecular bone density in Hounsfield units in the lumbar native CT cross-section for osteoporosis diagnosis and fracture risk determination by different examiners]

BACKGROUND

An increasing loss of bone mineral density (BMD) in the axial skeleton leads to osteoporosis and fractures, with an increase found in the thoracic and thoracolumbar regions.

RESEARCH QUESTION

The extent to which an examiner-independent assessment of the extent of osteoporosis and fracture risk determination is possible by determining the trabecular density in Hounsfield units (HU) in the spine should be examined. The next question was whether quantitative BMD values can be calculated from the HU values.

PATIENTS AND METHODS

225 patients (pt.) with an average age of 64.9 ± 13.1 years and a body-mass-index (BMI) of 26.8 ± 6.8 kg/m2, of which 37 were men and 188 were women, were examined to determine whether they had osteoporosis. The BMD was determined in mg/cm3 using quantitative computed tomography (QCT) in the lumbar region. After anonymization by three experienced radiologists, an additional measurement of the trabecular bone density in HU, was carried out in the same vertebral bodies (a total of 675 vertebral bodies), each using a region of interest (ROI) positioned in the midvertebral cancellous space in the sagittal reformed CT image. In additional lateral X‑rays of the thoracic and lumbar spine, vertebral fractures were detected and graded. Sacral insufficiency fractures that occurred at the same time were also recorded.

RESULTS

The median BMD was 73.2 (57.05-104.17) mg/cm3 and the median HU was 89.93 (67.90-126.95). With a correlation of 0.988 (p < 0.001), quantitative values in mg/cm3 can be calculated using the following formula: Xq = 12.1 + 0.68 × HU. With HU values less than 69.84 and a BMD of the lumbar spine below 59.54 mg/cm3, there was a significantly increased number of OVF. At least one OVF was found in 137/225 pt. In 17/137 pt., sacral fractures were also found; these patients showed the significantly lowest values with a median BMD of 41.81 (16.2-53.7) mg/cm3. Comparable HU values were determined independently of the examiners (p > 0.05).

DISCUSSION

The trabecular density measurements in HU values can be converted into quantitative BMD values in mg/cm3, which enables a good assessment of osteoporosis and fracture risk. Taking the results obtained into account, an opportunistic evaluation using HU values in native CT alone seems quite possible. Experienced examiners have arrived at comparable results.

CircCOX6A1 suppresses osteogenic differentiation and aggravates osteoporosis via miR-512-3p/DYRK2 axis

BACKGROUND

Osteoporosis (OP), characterized by compromised bone integrity and increased fracture risk, poses a significant health challenge. Circular RNAs (circRNAs) have emerged as crucial regulators in various pathophysiological processes, prompting investigation into their role in osteoporosis. This study aimed to elucidate the involvement of circCOX6A1 in OP progression and understand its underlying molecular mechanisms. The primary objective was to explore the impact of circCOX6A1 on bone marrow-derived mesenchymal stem cells (BMSCs) and its potential interactions with miR-512-3p and DYRK2.

METHODS

GSE161361 microarray analysis was employed to assess circCOX6A1 expression in OP patients. We utilized in vitro and in vivo models, including BMSC cultures, osteogenic differentiation assays, and an OVX-induced mouse model of OP. Molecular techniques such as quantitative RT-PCR, western blotting, and functional assays like alizarin red staining (ARS) were employed to evaluate circCOX6A1 effects on BMSC proliferation, apoptosis, and osteogenic differentiation. The interaction between circCOX6A1, miR-512-3p, and DYRK2 was investigated through dual luciferase reporter assays, RNA immunoprecipitation, and RNA pull-down assays.

RESULTS

CircCOX6A1 was found to be upregulated in osteoporosis patients, and its expression inversely correlated with osteogenic differentiation of BMSCs. CircCOX6A1 knockdown enhanced osteogenic differentiation, as evidenced by increased mineralized nodule formation and upregulation of osteogenic markers. In vivo, circCOX6A1 knockdown ameliorated osteoporosis progression in OVX mice. Mechanistically, circCOX6A1 acted as a sponge for miR-512-3p, subsequently regulating DYRK2 expression.

CONCLUSION

This study provides compelling evidence for the role of circCOX6A1 in osteoporosis pathogenesis. CircCOX6A1 negatively regulates BMSC osteogenic differentiation through the miR-512-3p/DYRK2 axis, suggesting its potential as a therapeutic target for mitigating OP progression.

Smoking, alcohol consumption, drug abuse, and osteoporosis among older adults: a cross-sectional study on PERSIAN cohort study in Fasa

BACKGROUND

With increasing life expectancy and a growing population of older adults, the prevalence of osteoporosis has risen, resulting in a higher incidence of bone fractures, which necessitate extended treatment and specialized medical care. This study investigates the relationship between smoking, alcohol consumption, drug abuse, and osteoporosis among older adults in southern Iran, utilizing cohort data.

METHODS

This cross-sectional study is derived from the Fasa Adult Cohort Study (FACS), which included 10,133 individuals. From this cohort, we selected 1,631 older adults using census sampling methods. Our study aimed to explore the correlation between smoking, alcohol consumption, and drug abuse among older adults and the incidence of osteoporosis. We collected demographic information, nutritional indexes, medical history, glucocorticoid usage, and self-reported data on smoking, alcohol consumption, drug abuse, and osteoporosis through questionnaires. To investigate the relationship between smoking, alcohol, and drug use with osteoporosis while accounting for confounding factors, we employed logistic regression analysis.

RESULTS

The average age of the study participants was 64.09 ± 3.8 years, with a majority (898 (55.1%)) being female. Osteoporosis prevalence among the subjects was 25.20%. The results did not reveal a significant correlation between smoking, alcohol consumption, drug abuse, and osteoporosis (p > 0.05). Regression analysis identified gender, recent history of fractures within the past five years, history of using glucocorticoids, and physical activity as significant predictive risk factors for osteoporosis within the study population (p < 0.05).

CONCLUSION

The study underscores the significance of addressing osteoporosis risk factors in older adults. Healthcare policymakers and administrators can use these findings to identify and mitigate influential factors contributing to osteoporosis in this demographic.