X-Ray densitometry as a tool for determining bone mineral density children with malabsorption syndrome: a prospective study

Assessment of bone mineral density in patients on hemodialysis: diagnostic capabilities of dual-energy X-ray absorptiometry and limitations of FRAX

Background. Mineral and bone disorders are highly prevalent in hemodialysis patients with chronic kidney disease, yet the role of bone mineral density testing and optimal skeletal sites for measurement remain debated. Interpreting dual-energy X-ray absorptiometry in this population is challenging due to CKD-MBD characteristics and limitations of standard fracture risk models.Objective. To assess the diagnostic utility of dual-energy X-ray absorptiometry in stage 5 chronic kidney disease patients on maintenance hemodialysis and identify the most informative measurement sites considering method-specific limitations.Methods. This single-center comparative observational study enrolled 32 stage 5 chronic kidney disease patients on hemodialysis (main group) and 20 individuals without kidney disease (controls). All participants underwent clinical evaluation, laboratory assessment of bone-mineral metabolism, dual-energy X-ray absorptiometry of the proximal femur and lumbar spine, and 10-year fracture risk calculation using FRAX. The primary analysis compared densitometric parameters across anatomical sites and their clinical interpretation in hemodialysis patients.Results. Hemodialysis patients showed most pronounced bone density reduction at the femoral neck and total hip regions, while lumbar spine parameters demonstrated greater variability. Femoral neck T-scores were significantly lower in the main group versus controls, with higher osteopenia prevalence. Lumbar spine findings were less consistent, potentially reflecting degenerative changes and extraskeletal calcification. An inverse trend emerged between parathyroid hormone levels and femoral neck T-scores. FRAX calculations served as supplementary data requiring interpretation within the clinical context of underlying disease and mineral metabolism disturbances.Conclusion. In stage 5 chronic kidney disease patients receiving hemodialysis, proximal femur densitometric parameters—particularly femoral neck—demonstrated superior diagnostic informativeness compared to lumbar spine measurements. FRAX scores should complement rather than replace comprehensive evaluation of clinical, laboratory, and densitometric data in this population.

[Diagnosis of osteoporosis-importance of dual-energy X-ray absorptiometry].

Assessment of Bone Mass and Fracture Risk Using Trabecular Bone Score in Children with Autoimmune Gastrointestinal Diseases

Background/Objectives: Children with autoimmune gastrointestinal diseases are at increased risk of impaired bone health due to chronic inflammation, nutritional deficiencies, growth disturbances, and treatment-related factors. While dual-energy X-ray absorptiometry (DXA) is the standard method for assessing bone mineral density (BMD), it provides limited information on bone microarchitecture. The trabecular bone score (TBS), derived from lumbar spine DXA images, has emerged as a complementary marker of bone quality. This study aimed to evaluate bone mass and TBS in children with autoimmune gastrointestinal diseases and to assess the clinical utility of TBS in comparison with children with a history of fractures and healthy controls. Methods: This study included 152 children aged 5–18 years: 45 with autoimmune gastrointestinal diseases (Crohn’s disease, ulcerative colitis, or celiac disease), 37 with a history of fractures, and 70 healthy controls. Anthropometric measurements, serum 25-hydroxyvitamin D [25(OH)D] concentrations, DXA-derived parameters, and TBS values were analyzed. Bone mineral density was assessed at the lumbar spine and total body less head (TBLH), with additional adjustment for height-for-age Z-score (HAZ). TBS values were expressed as sex- and pubertal stage-adjusted Z-scores. Results: Low bone mass (aBMDfor age Z-score ≤ −2) was observed in 30.3% of participants at TBLH and 11.1% at the lumbar spine, whereas a TBS Z-score ≤ −2 was identified in 5.2% of children. No significant differences in TBS or TBS Z-scores were found among the study groups. In multivariable analysis, fracture history was independently associated with lower absolute TBS, whereas no independent predictors of TBS Z-score were identified. Children with fractures had significantly lower HAZ-adjusted lumbar spine aBMD Z-scores than children with autoimmune gastrointestinal diseases and controls. TBS Z-scores correlated positively with age-adjusted and HAZ-adjusted aBMD values but showed no association with BMI or serum 25(OH)D concentrations. Conclusions: In this cross-sectional study, TBS did not distinguish children with autoimmune gastrointestinal diseases from those with fractures or healthy controls in the unadjusted analyses. Although TBS was associated with selected DXA-derived measures of bone mineral density and fracture history was independently associated with lower absolute TBS after multivariable adjustment, no independent predictors of TBS Z-score were identified. These findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established. Larger prospective studies are crucial to determine whether TBS provides clinically meaningful information complementary to conventional DXA for the assessment of skeletal health and fracture risk in children. Larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.

Fracture risk prediction based on multivariable diagnostic models incorporating dual-energy X-ray absorptiometry based bone mineral density, trabecular bone score, and clinical risk factors in women aged ≥ 50 years: a prospective study

According to the available reports, there is a major treatment gap in the management of osteoporotic fractures in Poland. It is crucial to identify those at high risk of low-energy fractures who ought to be treated. The study aimed to assess the diagnostic value of dual-energy X-ray absor­ptiometry (DXA) and the DXA-derived trabecular bone score (TBS) in fracture risk prediction in Polish women ≥ 50 years of age at risk of osteoporosis. Additional measures included the analysis of how incorporating other risk factors may improve the fracture prediction model. From a database of 5,000 randomly selected women, a total of 411 women aged ≥ 50 years were finally included – those who had a DXA examination followed by a complete medical questionnaire performed. After 5–9 years of observation, participants completed a follow-up questionnaire similar to the baseline questionnaire. In addition, TBS analysis was performed retrospectively using lumbar spine DXA scans. Then their fracture risk was calculated using the FRAX algorithm. Most patients with osteoporotic fractures were in a group with a degraded bone microarchitecture and a diagnosis of osteoporosis. Fracture patients without osteoporosis (T-score > –2.5) were mostly (73%) characterised by a partially or significantly degraded bone microarchitecture. The highest predictive value (AUC 0.6) was observed in relation to the models FRAX BMD and FRAX BMD-TBS (p < 0.05), which included both skeletal and other clinical risk factors. Also, the outcomes for all other analysed models (FRAX BMI + TBS, FRAX BMD + TBS, FRAX BMI + BMD spine + TBS) were statistically significant. Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland. Further studies on fracture prediction models in patients with osteopenia are required.

Clinical Application of FRAX: A Practical Tool for Assessment of the Accuracy of Osteoporosis Fracture Risk.

Abstract: Background: Osteoporosis is a chronic systemic skeletal disorder marked by a reduction in bone mineral density and structural deterioration of bone tissue, resulting in a substantially increased risk of fragility fractures. Objective: To assess the accuracy and reliability of the FRAX tool in predicting the 10-year risk of osteoporosis-related fractures, and to determine its potential utility in guiding clinical decisions for fracture prevention and patient management. Method: This case-control study included 100 adult women aged between 40 ≥ 60 years who had been diagnosed with osteoporosis. Participants were grouped by menopausal status (pre- and postmenopausal) and type 2 diabetes status, as well as a healthy control group, resulting in five distinct groups. Measured variables included fasting blood glucose, fasting blood insulin, and HOMA-IR. Bone mineral density (BMD) was assessed for all participants using dual-energy X-ray absorptiometry (DEXA). Additionally, the FRAX tool was employed to estimate the 10-year probability of major osteoporotic and hip fractures. Results: Significant differences were observed among study groups in age, BMI, waist-to-hip ratio, BMD, and FRAX scores (p < 0.05). Diabetic and postmenopausal groups showed higher risks of major osteoporotic and hip fractures. Reduced BMD was significantly associated with higher HbA1c levels and increased insulin resistance. ROC analysis showed that fasting blood glucose (AUC = 0.941) and HOMA-IR (AUC = 0.879) had the highest diagnostic performance. Conclusion: FRAX is significantly associated with clinical and metabolic risk factors; however, its predictive accuracy may be influenced by metabolic disturbances, especially in type 2 diabetes mellitus. Insulin resistance and poor glycemic control are strongly associated with reduced bone mineral density, underscoring the importance of including metabolic parameters in fracture risk assessment.

Cross Sectional Magnetic Resonance Imaging-Based Vertebral Bone Quality Score and Dual-Energy X-Ray Absorptiometry Bone Mineral Density Measurement in Post Menopausal Women in South Indian Population with or Without Fragility Fracture

The equal categorization of fractures and their improved correlation with signal intensity radiating pain VBQ scores and DEXA scores indicate that these variables may be useful in predicting fracture risk.