The findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy and demonstrate the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency.
Abstract
Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to compare bilateral femoral neck BMD and Z-scores in pregnant and non-pregnant women using Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology, and to assess correlation between bilateral measurements. In this cross-sectional study, 100 women were enrolled, including 40 pregnant women and 60 non-pregnant women with comparable age and body mass index (BMI). Bilateral femoral neck BMD and age-adjusted Z-scores were evaluated using REMS. Pregnant women had a mean age of 33 ± 5 years, pre-pregnancy BMI of 25.8 ± 6.5 kg/m2, and gestational age of 21 ± 5 weeks, with no significant differences in age or pre-pregnancy BMI compared with controls. Pregnant women demonstrated significantly lower left femoral neck BMD than controls (0.805 vs. 0.862 g/cm2; p = 0.0018) and lower left femoral neck Z-scores (−0.08 vs. 1.18 SD; p = 0.003). A strong positive correlation between left and right femoral neck BMD was observed (R = 0.78). Similarly, right femoral neck BMD was significantly lower in pregnant women compared with controls (0.835 g/cm2 vs. 0.892 g/cm2; p = 0.0026). The right femoral neck Z-score was 0.15 ± 1.15 SD in pregnant women and 1.45 ± 1.10 SD in controls (p = 0.002). REMS demonstrated the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency. These findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy. However, the cross-sectional design and lack of longitudinal follow-up limit conclusions regarding the progression and reversibility of pregnancy-associated bone changes. Future prospective studies with larger cohorts and postpartum monitoring are needed to further define the clinical role of REMS in maternal bone health assessment.
Androgen deprivation therapy (ADT), used in selected patients with prostate cancer (PCa), is associated with accelerated bone loss and increased fragility fracture risk. Radiofrequency Echographic Multi-Spectrometry (REMS) is a non-ionizing ultrasound-based technique for axial bone mineral density (BMD) assessment.
To evaluate REMS-derived BMD at the lumbar spine and femoral neck in men with PCa receiving ADT and in age- and body mass index-matched healthy controls.
In this cross-sectional study, 143 Caucasian men were enrolled between October 2023 and October 2024: 83 patients with histologically confirmed PCa receiving ADT for at least 6 months and 60 healthy controls. REMS scans were performed at the lumbar spine and femoral neck. Between-group differences in BMD, T-score, and Z-score were assessed using an unpaired
t
-test.
Compared with controls, patients receiving ADT showed lower REMS-derived BMD at the lumbar spine (0.885 ± 0.08 vs. 0.945 ± 0.11 g/cm²;
p
= 0.007), corresponding to a 6.3% difference. Femoral neck BMD was also lower in the PCa group (0.691 ± 0.08 vs. 0.715 ± 0.10 g/cm²;
p
= 0.01), corresponding to a 3.4% difference.
These findings are consistent with the known skeletal effects of ADT and support the potential role of REMS as a radiation-free tool for identifying reduced axial BMD in men with PCa undergoing ADT. Longitudinal monitoring assessments are ongoing to clarify the temporal relationship between ADT exposure and progressive bone loss.
M. Montatore, Riccardo Guglielmi, Amanda Isaac et al.· Aging Clinical and Experimen...· 0 citations
Menopausal duration is the primary determinant of calcaneal bone quality in postmenopausal women, independent of body composition, and these findings support the use of calcaneal QUS as a field-friendly pre-screening tool for bone quality monitoring in non-clinical and large-scale epidemiological settings.
Federica De Luca, Federica Moro, E. Gualdi-Russo et al.· Anthropologiai Közlemények· 0 citations
Introduction: Osteoporosis is a systemic skeletal disorder that increases the risk of fragility fracture and constitutes a major global health burden. Dual-Energy X-Ray Absorptiometry (DEXA) is the clinical reference standard for Bone Mineral Density (BMD) assessment but, as a two-dimensional projection technique, does not directly evaluate trabecular microarchitecture or marrow composition. Magnetic Resonance Imaging (MRI) signal characteristics of vertebral marrow have been proposed as opportunistic markers of Vertebral Bone Quality (VBQ).
Aim: To evaluate the correlation between lumbar spine MRI signal alterations (T1- and T2-weighted) and DEXA-derived BMD parameters, including BMD, T-score and Z-score, in patients undergoing lumbar spine imaging.
Materials and Methods: A cross-sectional analytical study was conducted at Assam Down Town University, Guwahati, Assam, India, from October 2023 to April 2024. A total of 100 adults of either sex who underwent both lumbar spine MRI (1.5 Tesla) and DEXA were evaluated. A circular Region Of Interest (ROI) of 1 cm² was placed in the central trabecular portion of the L3 vertebral body on T1- and T2- weighted sagittal images, avoiding cortical bone, end-plate changes and focal lesions. DEXA-derived BMD was classified according to World Health Organisation (WHO) T-score criteria. Pearson’s correlation coefficient with 95% Confidence Intervals (CI) was used to assess associations; a two-tailed p-value <0.05 was considered significant.
Results: The cohort comprised 52 females (52%) and 48 males (48%). Based on lumbar (L1-L4) T-scores, 42 (42%) participants had normal BMD, 31 (31%) osteopenia and 27 (27%) osteoporosis. Reduced BMD was more frequent among females and older participants. The T-score showed weak but statistically significant negative correlations with T1-weighted (r=-0.214; 95% CI -0.394 to -0.018; p-value=0.033) and T2- weighted (r=-0.208; 95% CI -0.389 to -0.012; p-value=0.038) signal values. The Z-score correlated strongly with mean BMD (r=0.685; 95% CI 0.565 to 0.777; p-value <0.001); as the Z-score is derived from BMD, this served as an internal consistency check.
Conclusion: Lumbar vertebral MRI signal alterations showed weak but statistically significant associations with DEXAderived BMD, suggesting that routinely acquired lumbar MRI may provide supplementary, opportunistic information on VBQ. The modest strength of these correlations indicates that MRI signal cannot currently replace DEXA for the diagnosis of osteoporosis.
Amit Sarma, Mrinal Singha· Journal of Clinical and Diag...· 0 citations
PURPOSE
Radiographic bone age (BA) assessment involves ionizing radiation, limiting its utility in frequent longitudinal follow-up. This study developed and internally validated a radiation-free nomogram based on multi-site two-dimensional ultrasound area ossification ratios (ORs) to assess Zhonghua-05 (RUS-CHN) radiographic bone age and predicted adult height (PAH), evaluating its incremental value over chronological age.
METHODS
In this single-center prospective study (August 2024 ∼ December 2025), 1,053 children aged 3-15 years were randomized into training and validation sets (7:3). Ultrasound area ORs of the left distal radius, ulna, and femur were calculated. Using radiographic RUS-CHN BA as the reference standard, predictor variables were selected via LASSO regression to construct the nomogram. Model performance was evaluated across the cohort and within developmental discordance subgroups (advanced/delayed maturation).
RESULTS
Ultrasound OR measurements showed excellent reproducibility (ICC > 0.88). In the validation set, the nomogram predicted RUS-CHN BA with a mean absolute error (MAE) of 2.94 months (RMSE = 3.67 months, R2 = 0.989). Crucially, in children with advanced or delayed maturation, the nomogram reduced BA prediction MAE by over 60 % compared to a baseline clinical feature model. The secondary model for PAH achieved an MAE of 0.63 cm.
CONCLUSIONS
Multi-site ultrasound area ORs provide a highly reproducible, radiation-free index of skeletal maturity. As an internally validated, standard-specific research tool, the nomogram estimated RUS-CHN radiographic BA and corrected age-anchoring bias in children with discordant maturation. Because its numeric calibration is specific to the RUS-CHN standard, external multicenter and longitudinal validation is required before clinical use.
ABBREVIATIONS
BA, Bone age; BMI, Body mass index; CI, Confidence interval; GP, Greulich Pyle; ICC, Intraclass correlation coefficient; LASSO, Least absolute shrinkage and selection operator; LoA, Limits of agreement; MAE, Mean absolute error; MPH, Mid‑parental height; OR, Area ossification ratio; PAH, Predicted adult height; QC, Quality control; RMSE, Root mean square error; RUS‑CHN, Radius, ulna, and short bones RUS skeletal‑maturity score, Chinese standard; SOP, Standard operating procedure; TRIPOD, Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis.
Yongzhi Deng, Lu Qiang, Tailong Wang et al.· European Journal of Radiolog...· 0 citations
Preventing proximal femoral fractures in older adults is of paramount importance. In clinical practice, bone mineral density measured by dual-energy X-ray absorptiometry is the reference standard for assessing skeletal fragility, whereas muscle is rarely quantified. Skeletal muscles are also crucial for maintaining movement stability, and computed tomography (CT) has become a reliable and commonly used imaging modality. However, existing studies are limited by small sample sizes and a lack of clinically applicable reference thresholds. This study investigated whether CT-derived hip muscle and femoral parameters are associated with proximal femoral fracture status in older adults.
In this retrospective case–control study, 354 patients aged ≥ 60 years who underwent hip CT at The Second Affiliated Hospital of Xi’an Jiaotong University from October 2023 to October 2025 were included and divided into a fracture group (
n
= 125) and a non-fracture group (
n
= 229) according to clinical diagnosis. CT images were used to evaluate the following regions of interest: gluteus maximus muscle (G max), gluteus medius muscle (G med), iliopsoas muscle, femoral head (FH), femoral neck (FN), femoral intertrochanteric (FIT), and the cortical thickness index (CTI) of the femur and calcar. Skeletal muscle cross-sectional area (CSA), Hounsfield unit (HU) radiodensity, and bone parameters were used to assess the hip.
Compared with the non-fracture group, the CSA and radiodensity of several muscle and femoral parameters were lower in the fracture group (
P
< 0.001). In a fully adjusted hierarchical logistic regression model, G med radiodensity (odds ratio [OR] 0.758, 95% confidence interval [CI] 0.588–0.977), Iliopsoas radiodensity (OR 0.776, 95% CI 0.617–0.976), FH radiodensity (OR 0.972, 95% CI 0.950–0.994), and femoral cortical radiodensity (OR 0.993, 95% CI 0.987–0.999) were independently associated with fracture status after adjustment for age, sex, and BMI. The model discriminated fracture status with an area under the curve (AUC) of 0.846 (95% confidence interval [CI] 0.798–0.894; sensitivity 79.4%, specificity 77.8%) in the derivation dataset and a mean AUC of 0.834 ± 0.077 in five-fold internal cross-validation; no external validation was performed. Correlation analysis showed consistent associations between muscle and femoral parameters.
In this retrospective case–control cohort, CT-derived hip muscle radiodensity, particularly that of the G med and Iliopsoas muscle, was associated with proximal femoral fracture status independently of age, sex, and BMI. When reduced muscle radiodensity or a thin calcar is identified on CT obtained for another indication, clinicians may consider further fracture risk assessment. Prospective and external validation are required before clinical use.
Xiang-Yu Wang, Xing-Hua Li, Rui-Yu Liu· European Journal of Medical...· 0 citations
OBJECTIVES
Developing methods that minimize radiation exposure in skeletal age assessment for orthodontic planning and growth monitoring in pediatric populations is a priority. This study aimed to evaluate the diagnostic efficacy of ultrasonography as a non-ionizing alternative in bone age estimation and to analyze the correlation between ultrasonographic skeletal maturation and chronological age.
METHODS
In this cross-sectional study, the left hand-wrist region of 131 individuals aged 8-18 years was evaluated simultaneously using digital radiography and ultrasonography. Skeletal maturation was analyzed based on the epiphysis-diaphysis relationship of the phalanges and radius, the presence of sesamoid bone, and bone age estimation based on the Greulich-Pyle atlas. In addition, the ossification ratios (o/O) of the distal radius and ulna were calculated. Friedman, Wilcoxon signed-rank, McNemar tests, and regression analyses were used to compare the data.
RESULTS
A strong correlation was found between chronological age, ultrasonographic age, and radiographic age. Statistically significant differences were found between ultrasonography and radiography measurements in all middle phalanges (MP2-MP5), the distal phalanx of the fourth finger (DP4), the distal and proximal phalanges of the first finger (DP1, PP1), proximal phalanges of the second finger (PP2) and the radius (p < 0.05). A high correlation (r = 0.862) was observed between the two methods used to detect sesamoid bones. A strong positive correlation (rs ≈ 0.70) was observed between chronological age and ultrasonographic ossification rates; the explanatory power of radius and ulna measurements on age was 54%.
CONCLUSIONS
Ultrasonography shows a strong correlation with both chronological and radiographic age and demonstrates high efficacy in detecting sesamoid bones and monitoring ossification rates. Statistically significant differences have been found between radiographic examination and ultrasonography in evaluating the epiphysis-diaphysis relationship of the phalanges.
ADVANCES IN KNOWLEDGE
This research demonstrates that ultrasonography is a reliable, non-ionizing method for skeletal age assessment and shows significant diagnostic consistency across anatomical regions, similar to that of conventional radiography. Furthermore, it supports the clinical utility of ultrasonography as a reliable, radiation-free method and contributes to ongoing efforts to establish standardized, non-invasive assessment methods.
G. Akay, Çağrı Erdoğdu, Nuray Bağcı et al.· Dento maxillo facial radiolo...· 0 citations
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