Browsing by Subject "Osteoporosis"
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Item Age-related (type II) osteoporosis(1990-08-30) Rubin, Craig D.Item Bisphosphonate therapy for osteoporosis: the good, the bad and the ugly(2007-07-13) Odvina, Clarita V.Item Bone Health Outcomes in Post-Lung Transplant Patients with Cystic Fibrosis(2023-05-01T05:00:00.000Z) Tran, Triet Vincent Minh; Maalouf, Naim M.; Jain, Raksha; Lederer, Eleanor D.BACKGROUND: Osteoporosis is a common comorbidity in patients with cystic fibrosis (CF). Although lung transplantation (LTx) improves quality of life of CF patients, there is little research examining long-term bone health outcomes following LTx in these patients. OBJECTIVE: We sought to compare long-term bone health outcomes in LTx patients with and without CF, as well as determine factors associated with adverse bone health in CF patients. METHODS: Data were collected on 59 patients who underwent LTx between 2006-2019, including 30 with CF and 29 without CF. We compared baseline characteristics, long-term bone mineral density (BMD) trends, and fracture incidence between the two patient populations, and examined factors associated with post-LTx fractures in CF patients. RESULTS: Compared with non-CF patients, patients with CF were younger, had lower body mass index, and lower baseline BMD Z-scores at the lumbar spine, femoral neck, and total hip (all p<0.001). BMD at all sites declined in both groups in the first year post-LTx. In subsequent years, CF patients exhibited better BMD recovery relative to pre-transplantation, but continued to have lower BMD post-LTx. Post-transplant fractures occurred in 30% and 34% of CF and non-CF patients, respectively. CF patients who developed fractures after LTx had significantly lower BMD and lower pre-transplantation percent predicted forced expiratory volume in one second (FEV1%). CONCLUSION: Although CF patients exhibit better BMD recovery following LTx compared to their non-CF counterparts, CF patients start with significantly lower pre-LTx BMD and experience a similarly high rate of post-LTx fractures. These findings highlight the unique contribution of the CF disease process to bone health, as well as a clear need for better prevention and treatment of osteoporosis in CF patients before and after LTx.Item Bones of contention: osteoporosis 2021(2021-03-26) Saag, Kenneth G.Item Controversies in the management of osteoporosis(2002-12-12) Rubin, Craig D.Item Density Analysis of Spontaneous Lower Extremity Fractures Using Computed Tomography: A Case-Control Study(2020-05-01T05:00:00.000Z) Narayanan, Anish; Chhabra, Avneesh; Chalian, Majid; Pezeshk, ParhamBACKGROUND: Spontaneous fractures are predominantly caused by osteoporosis and have significant morbidity and mortality associated with them. The current gold standard of clinical imaging for these osteopenic patients, Dual Energy X-Ray Absorptiometry (DXA), has a number of inherent deficiencies, including limited scanner availability, inaccuracies of projective areal density measurements, and lag in visualized radiographic change when following disease and treatment progress of osteopenic bone. Computed Tomography (CT) imaging has the potential to address these limitations, but the existing literature which discusses its potential use in this situation is limited in scope. OBJECTIVE: It is hypothesized that the patients with spontaneous fractures will exhibit reduced bone mineral density (BMD) as quantified by Hounsfield (HU) measurements in the trabecular bone on CT imaging when compared to appropriately matched controls. METHODS: A retrospective consecutive series of 522 adult patients with admission for fracture were initially obtained from the hospital electronic medical record (EMR). A number of chart review exclusion criteria were then applied, including traumatic history, evidence of malignancy, known renal disease or other secondary pathology that could be ascribed as the etiology of the bone insufficiency, or surgical hardware placement. These patients with CT imaging of the fracture site were then subdivided by anatomic location to select for femoral fractures and were then age and sex matched to appropriate control patients who had 5underwent KUB (kidney, ureters, and bladder) non-contrast CT scans with clinical indication for nephrolithiasis. Following obtaining the case and control CT studies, elliptical fixed region 3 cm² measurements in the trabecular bone were obtained without cortical sampling at three locations (the site of the fracture, proximally at the femoral head, and distally at the lesser trochanter) on both the fractured and contralateral side in both fracture cases and controls. Inter- and intra-patient comparisons were performed, including Chi-square and t-test analyses. RESULTS: A total of 24 spontaneous fractures and 25 controls were analyzed in this study. No significant differences in all captured demographic parameters, including mean age, gender, height, weight, and body mass index (BMI), were observed. There were statistically significant differences in the recorded BMD between the fracture and contralateral non-fracture sides at (p = 0.0001) and distal (p < 0.0001) to the fracture, with elevation of the trabecular bone density at the fracture site's ROI. Proximal and distal bone density differences existed between case fracture and control non-fracture sites (p < 0.0001, p = 0.0001), and between the case non-fracture and control non-fracture sites (p < 0.0001, p < 0.0001). The reliability for measurements was good to excellent proximal to the fracture site (ICC = 0.63-0.87), moderate to excellent at the fracture site (ICC = 0.43-0.78), and fair to good distal to the fracture site (ICC = 0.24-0.68). Additionally, at the proximal site, the odds ratio of every 50 unit decrease in HU is 1.744 (95% CI: 1.291 to 2.356). CONCLUSION: Patients with spontaneous femoral fractures exhibit reduced BMD when compared to 6asymptomatic controls that can be distinguished on CT imaging per reduced HU density in the trabecular bone. Bone insufficiency is best demonstrated proximal or distal to, rather than at, the fracture site as the site of fracture demonstrates trabecular bone compression and hemorrhage that artificially elevates the BMD and obscures any present osteopenia. Opportunistic use of pre-existing CT imaging could therefore be invaluable in identifying a patient's true osteopenic status, saving patients an additional DXA scan while providing accurate, three-dimensional information regarding the true material density of a patient's skeleton.Item Development of Deep Learning Artificial Intelligence to Detect Osteoporosis(2024-01-30) Fan, Christopher; Scanio, Angelo; Joshi, Parag; Öz, Orhan K.; Peshock, Ronald M.; Kay, FernandoOsteoporosis poses a substantial social and economic burden, with estimated treatment costs reaching a combined six trillion USD in the USA, Canada, and Europe. Although dual-energy X-ray absorptiometry (DEXA) is the diagnostic gold standard, computed tomography (CT) scans have proven to be reliable proxies for bone density measurement. Opportunistic screening for low bone density using CT obtained for other purposes can potentially reduce complications from osteoporotic fractures and health care costs. In this study, we developed an artificial intelligence (AI) algorithm using neural networks and the MONAI library to estimate DEXA bone density from non-contrast cardiac CT obtained for coronary calcium scoring purposes. A total of 2797 Dallas Heart Study phase 2 participants (39% male, 61% female) were included. The AI algorithm was first developed to automatically segment trabecular bone from cortical bone. This was trained and validated with manual segmentation of the trabecular bone by two medical students, a radiologist, using MONAI 3D autoseg. The ML algorithm achieved a Dice score of 0.97 when compared to human segmentation. A second AI model was developed utilizing segmentations of the first model. This AI was trained utilizing corresponding DEXA bone mineral density (BMD) for thoracic vertebrae. The best performing model was trained for 102 epochs, resulting in a training root mean square error (RMSE) of 0.0628 mg/cm2 and validation RMSE of 0.0842 mg/cm2. The final AI algorithm predictions yielded an R2 value of 0.71 compared to DEXA (Figure 1). Our findings underscore the clinical feasibility for an automated neural network to predict DEXA scores from non-contrast cardiac CT. This approach may help in the early detection of unsuspected low bone mineral density in patients undergoing CT scans for other reasons, allowing for potential improvements in patient outcomes and resourceful utilization of diagnostic imaging.Item Diet, bone health and aging(1999-07-01) Sakhaee, KhashayarItem Disorders of vitamin D excess(1992-07-02) Breslau, Neil A.Item Estrogen and metabolic bone disease(1983-08-25) Breslau, Neil A.Item Evaluating Bone by Ultrasound(2008-05-13) Liu, Peiying; Antich, Peter P.Bone fractures associated with osteoporosis, a major bone disease characterized by low density and high fracture risk, are common causes of disability and large medical care expenses around the world. Considering its low cost, high portability, and non-ionizing nature, non-invasive ultrasound techniques have been investigated as tools for evaluating bone quality and biomechanical competence. Quantitative ultrasound has been used clinically as a surrogate for the current gold standard measure in osteoporosis diagnosis - Bone Mineral Densitometry (BMD), which unfortunately utilizes ionizing radiation. This study proposes the application of a reflection ultrasound method to evaluate non-BMD properties of cancellous bone, including porosity and the microstructure of the trabecular network, all of which are directly related to bone morphological changes caused by osteoporosis and could result in better predictions of fracture risk. Computer simulations and phantom studies were adopted to guide the measurement of bone properties. In the computer simulations, the cellular model and the wire model of cancellous bone predict the backscattering dependence on porosity from two different perspectives, but reach the same result. This leads to the first conclusion that reflection ultrasound is not sensitive to the shape of a scatterer of wavelength size but to the spacing between scatterers. The in vitro cancellous bone study demonstrated that the average porosity is correlated with the density, while the local porosity depends upon the heterogeneity of the cancellous bone. The average porosity of cancellous bone can be directly determined from ultrasound signals reflected from the bone. Results of the ex vivo and in vivo short bone studies in patella are in agreement with that of Ultrasound Critical-angle Reflectometry (UCR). Thus, the second conclusion of this dissertation is that reflection ultrasound can be an effective tool for assessing bone properties in vivo. During the short bone-mimicking phantom study, the first critical angle detected by UCR was shown to correspond to the solid ultrasound velocity and is independent of porosity, but its amplitude is strongly related to porosity; the second critical angle, corresponding to bulk ultrasound velocity, is strongly related to porosity, but the correlation between its amplitude and the porosity is weak.Item Growth hormone: aging and osteoporosis(1992-05-21) Rubin, Craig D.Item Male osteoporosis: deadly, but ignored(2005-04-28) Gruntmanis, UgisItem Management of postmenopausal osteoporosis(1982-10-14) Pak, Charles Y. C.Item Medical management of established osteoporosis: attempts at augmentation of bone mass(1988-04-21) Pak, Charles Y. C.Item Metabolic bone diseases with special emphasis on osteoporosis(1980-01-03) Pak, Charles Y. C.Item Minimal trauma fractures, deadly but ignored (part II): HiROC and high value approach(2014-02-28) Gruntmanis, UgisItem New advances in the treatment of osteoporosis(1996-05-30) Rubin, Craig D.Item [News](1989-01-12) Rutherford, SusanItem [News](1991-10-25) Doremus, David