Aug 2026· Diagnostic and Interventional Imaging· 0 citations· 29 references
Medicine
TL;DR
Osteoporosis is associated with higher odds of SIF of the knee in women, while osteopenia is not, and small strata likely limited the power to detect a significant effect modification.
Abstract
Purpose The purpose of this study was to evaluate the association between systemic low bone mineral density (BMD) and subchondral insufficiency fracture (SIF) of the knee in women, and to explore whether this association is modified by radial meniscal tears. Materials and methods In this case-control study, women with and without MRI-confirmed SIF who had available dual-energy X-ray absorptiometry T-score measurements were included. Systemic BMD was categorized using T-scores. Multivariable logistic regression models with BMD as the exposure and SIF as the outcome, adjusting for age and body mass index were fitted. An exploratory stratified analysis to assess potential effect modification by meniscal radial tear status was also conducted. Results A total of 121 women with SIF (mean age, 69.1 ± 7.5 [standard deviation] years) and 124 controls (70.4 ± 8.3 [standard deviation] years) were analyzed. After adjustment, osteoporosis was associated with higher odds of SIF (odds ratio [OR], 2.29; 95% confidence interval [CI]: 1.03–5.09), whereas osteopenia (OR, 1.33; 95% CI: 0.69–2.55) showed no significant association. In exploratory stratified analysis to test for effect modification, there were no significant interactions between low BMD and radial root tears (P-interaction = 0.178). However, small strata likely limited the power to detect a significant effect modification, as evidenced by overlapping wide 95% CIs. Conclusion Osteoporosis is associated with higher odds of SIF of the knee in women, while osteopenia is not.
Purpose The purpose of this study was to assess the association between knee subchondral insufficiency fracture (SIF) and radial meniscal tears and evaluated medial meniscal extrusion as a mediator. Materials and methods A retrospective matched case-control study of knee MRIs obtained from November 2021 to November 2024 was performed. MRIs were reviewed for SIF, meniscal tear morphology, and meniscal extrusion grade. Associations between radial tears and SIF (overall and medial compartment) were evaluated using conditional logistic regression adjusted for age, sex, and body mass index. Medial-compartment mediation was examined using a natural effects model with medial meniscal extrusion as the mediator. Results The cohort included 343 patients with SIF (65.4 ± 10.1 [standard deviation] years; 226 women) and 343 patients without SIF (66.4 ± 10.0 [standard deviation] years; 224 women). Compared with knees without radial tears, odds of SIF were higher in the presence of radial root tears (odds ration [OR], 7.62; 95% confidence interval [CI]: 4.40–13.21) and radial non-root tears (OR, 5.26; 95% CI: 2.48–11.15), with similar findings in the medial compartment. In mediation analysis, medial radial root tears showed an indirect association with medial SIF through medial meniscal extrusion (OR, 1.46; 95% CI: 1.16–1.84), accounting for 16.6% of the total effect. Conclusion Radial root and non-root tears were strongly associated with SIF, particularly in the medial compartment. Meniscal extrusion explained a small proportion of this association, suggesting that additional biomechanical pathways are likely in play.
M. Alzaher, Wasim Issa, A. Huang et al.· Diagnostic and Interventiona...· 1 citation
BACKGROUND
Osteoporotic vertebral compression fractures (OVCFs) are prevalent but frequently remain unrecognized. While bone mineral density (BMD) is the primary assessment tool, MRI-based parameters associated with bone and muscle quality may offer additional value, yet sex-specific analyses are limited, despite sex differences in incidence and hormones.
PURPOSE
To explore the associations between MRI-based vertebral bone quality (VBQ) score, psoas muscle index (PMI), and paravertebral muscle fat infiltration (FI) fraction with OVCFs, and to assess the potential diagnostic performance of MRI parameters across sexes.
STUDY TYPE
Retrospective.
POPULATION
260 subjects (≥ 50 years); 130 OVCF patients (73.0 years (67.0-80.0), 89 females) and 130 non-fracture (NF) patients (64.5 years (58.0-73.0), 76 females).
FIELD STRENGTH AND SEQUENCES
3 T and 1.5 T. T1-weighted TSE and T2-weighted TSE (Siemens) and T1-weighted FSE and T2-weighted FSE (United Imaging).
ASSESSMENT
VBQ was calculated on sagittal T1-weighted MRI; PMI and FI were quantified on axial T2-weighted MRI at the L3 endplate by ImageJ. BMD was derived from CT using QCT PRO software. Two trained observers, blinded to clinical data, performed all MRI measurements.
STATISTICAL TESTS
Significance level was set at p < 0.05. t-test/Mann-Whitney U test, chi-squared test (χ2), Spearman's rank correlation coefficient, multivariate logistic regression, receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). Bootstrap resampling (1000 iterations) for internal validation.
RESULTS
The OVCF group exhibited significantly elevated VBQ (3.71 ± 0.55 vs. 3.25 ± 0.58) and FI (24.11% (21.66-28.92) vs. 20.31% (18.90-22.14)), while PMI (3.42 ± 1.02 vs. 4.08 ± 1.14) and BMD (55.82 mg/cm3 (38.75-70.90) vs. 89.24 mg/cm3 (67.80-110.00)) were reduced. FI was independently associated with OVCFs exclusively in females (OR = 1.566). The combined MRI model (VBQ + FI + PMI) yielded a significantly higher AUC in females (AUC = 0.896) than in males (AUC = 0.720).
DATA CONCLUSION
VBQ, PMI, and FI reveal significant sex-specific correlations with OVCFs. The multi-parametric MRI model shows considerable potential as a diagnostic aid for OVCFs in individuals aged over 50, particularly in females.
LEVEL OF EVIDENCE: 4
TECHNICAL EFFICACY STAGE
2 (Diagnostic Accuracy).
Meng Sun, Wanling Jiang, Haoyu Wang et al.· Journal of Magnetic Resonanc...· 1 citation
The importance of adhering to standardized protocols and continuously refining measurement approaches to enhance reliability of 2MCI as screening tool for either osteopenia or osteoporosis is highlighted.
Elson Kow, Wiria Aryanta· The Egyptian Journal of Radi...· 0 citations
BACKGROUND
Distal radius fractures (DRFs) are common fragility fractures and may be indicators of osteoporosis. The management of these fractures in older people is controversial, with osteoporosis identified as a potential cause of DRF instability. A correlation has been observed between the second metacarpal cortical percentage (2MCP) and bone density, which is essential for understanding postoperative reduction loss. This study aimed to evaluate the relationship between osteoporosis, measured by 2MCP, and loss of reduction in patients older than 65 years with DRFs treated using a volar locking plate (VLP). The secondary aim was to assess factors related to reduction loss.
METHODS
A retrospective analytical cohort study included patients older than 65 years with DRFs treated with VLP between 2017 and 2023. Baseline characteristics and fracture patterns were recorded. Bone density was assessed using 2MCP from preoperative wrist radiographs. Instability was defined by Lafontaine criteria. Radiological parameters (radial inclination, volar tilt, radial height, and ulnar variance) were measured immediately postoperatively and at follow-up (≥12 weeks). Screw lengths and distances between locking screws and the subchondral articular surface were also evaluated. Patients were divided into 2 groups: osteoporosis (2MCP <50%) and non-osteoporosis (2MCP ≥50%). Comparative and logistic regression analyses were performed.
RESULTS
A total of 315 patients were included, with 256 in the <50% 2MCP group and 59 in the >50% 2MCP group. Patients in the <50% group were older compared with those in the >50% 2MTC group (74.8 vs 72 years). Statistically significant changes were noted in radiographic parameters, but no significant differences were found between groups. Logistic regression revealed associations between screw positioning, fracture severity, and reduction loss.
CONCLUSIONS
This study found no association between 2MCP and loss of reduction in DRFs treated with VLP. Screw positioning and fracture severity were more significant factors than bone density in influencing postoperative reduction loss.
M. O. Abrego, F. Holc, Pedro Bronenberg Victorica et al.· HAND· 0 citations
BACKGROUND
Osteoporosis is frequently underdiagnosed in trauma patients. However, contrast-enhanced whole-body computed tomography (WBCT) in polytrauma care enables opportunistic assessment of bone status without additional radiation exposure. The aim of this study was to investigate whether vertebral, femoral, and dentomaxillofacial CT parameters can identify patients with documented osteopenia or osteoporosis and whether a combined score improves classification.
MATERIALS AND METHODS
This retrospective, single-center study included 60 WBCT cases. Twenty patients with osteopenia or osteoporosis documented in their initial trauma report were compared with 20 age- and sex-matched reference patients and 20 younger patients. The final classification of bone status was based on an evaluation of patient records, including dual-energy X‑ray absorptiometry (DXA) data (where available), and medical history. Trabecular density was measured in the lumbar spine (L1-L3), femoral neck, and maxillary alveolar ridge. Hard palate cortical thickness (HPT) was measured in millimeters. The whole-body osteoporosis screening score was defined as WBOS = ƒ(HPT, hip HU, lumbar HU).
RESULTS
Measurements of HPT, maxilla, hip, and lumbar spine decreased significantly in patients with osteopenia/osteoporosis patients. The combined WBOS score demonstrated the best exploratory performance, with a sensitivity of 100.0%, a specificity of 97.1%, an accuracy of 98.3%, and an AUC of 0.994 at a preliminary threshold of 361.
CONCLUSION
Opportunistic multisite assessment of bone status using WBCT in polytrauma appears feasible. The WBOS showed the best exploratory discrimination but requires further validation against DXA or quantitative CT before clinical implementation.
Studies evaluating skeletal differences by fracture status used predominantly White female cohorts with limited data in other races and men. Using high-resolution peripheral quantitative CT and microfinite element analysis, we compared skeletal health by fracture status and assessed the effect of socioeconomic (SE) factors and effect modification by race and sex in a population-based study in New York City. Participants with historical fractures (Fx) included adult fractures (18+ yrs; no digits, skull, face). Of 935 (age 76.1±6.3 yrs, 71% female, 27.7% Black, 29.7% White, 41.3% Mixed), 32% had 444 fractures. Results were adjusted for age, BMI, sex, race, ethnicity, past osteoporosis treatment, and oral glucocorticoid use. At the distal radius, the Fx group had worse trabecular (Tb) and cortical (Ct) parameters with 9.7-10.3% lower failure load (FL) and stiffness (p<0.001). At the distal tibia, results were similar with 5.9% lower FL and stiffness in the Fx group (p<0.001). Adjusting for SE factors, Tb and Ct parameters remained worse in the Fx group with lower FL and stiffness. Stiffness and FL varied by race and sex but were lower in Fx vs. NoFx groups within each race and sex. Race and sex did not modify the relationship between stiffness or FL and fracture status. In the whole cohort, higher stiffness (ORRadius 0.732, [95%CI: 0.563, 0.931], p=0.014; ORTibia 0.866, [95%CI: 0.783, 0.954], p=0.004) and FL (ORRadius 0.597, [95%CI: 0.404, 0.893], p=0.011; ORTibia 0.778, [95%CI: 0.681, 0.888], p<0.001) at the distal radius and tibia were associated with lower odds of incident fracture. Hispanic ethnicity was associated with lower odds of incident fracture independent of radial stiffness (OR 0.289, [95%CI: 0.081, 0.845], p=0.038) and FL (OR 0.286, [95%CI: 0.080, 0.842], p=0.038). In conclusion, in this multiethnic cohort, stiffness and FL were independently associated with prevalent and incident fractures, regardless of race or sex.
Ragyie Rawal, Sanchita Agarwal, Carmen Germosen et al.· Journal of Bone and Mineral...· 0 citations
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