Abstract: This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.
Abstract: Osteoporosis is a common disease characterized by low bone mass and deterioration of micro-architectural bone tissue, which provokes an increased risk of fracture. This work treats the texture characterization of trabecular bone radiographs. The aim was to analyze according to clinical research a group of 174 subjects: 87 osteoporotic patients (OP) with various bone fracture types and 87 control cases (CC). To characterize osteoporosis, Fractal and MultiFractal (MF) methods were applied to images for features (attributes) extraction. In order to improve the results, a new method of MF spectrum based on the q-stucture function calculation was proposed and a combination of Fractal and MF attributes was used. The Support Vector Machines (SVM) was applied as a classifier to distinguish between OP patients and CC subjects. The features fusion (fractal and MF) allowed a good discrimination between the two groups with an accuracy rate of 96.22%.
Abstract: In the diagnostics of osteoporosis, the gold standard is considered to be bone mineral density; however, X-ray densitometry is not an accurate indicator of osteoporotic fracture risk under all circumstances. In this regard, the search for new methods that could determine the indicators not only of the mineral density, but of the bone tissue quality, is a logical step for diagnostic optimization. One of these methods is the evaluation of trabecular bone quality. The aim of this study was to examine the quality and mineral density of spine bone tissue, femoral neck, and body composition of women depending on the duration of the postmenopausal period, to determine the correlation of body fat with indicators of bone mineral density and quality. The study examined 179 women in premenopausal and postmenopausal periods. The patients were divided into the following groups: Women in the premenopausal period and women in the postmenopausal period at various stages (early, middle, late postmenopause). A general examination and study of the above parameters were conducted with General Electric X-ray densitometer. The results show that bone quality and mineral density probably deteriorate with advancing of postmenopausal period. Total fat and lean mass ratio is not likely to change with age. In the middle and late postmenopausal periods, the bone tissue mineral density of the spine and femoral neck increases along with total fat mass.
Abstract: Cole-Cole parameters of 40 post-menopausal women
are compared with their DEXA bone mineral density measurements.
Impedance characteristics of four extremities are compared; left and
right extremities are statistically same, but lower extremities are
statistically different than upper ones due to their different fat
content. The correlation of Cole-Cole impedance parameters to bone
mineral density (BMD) is observed to be higher for dominant arm.
With the post-menopausal population, ANOVA tests of the dominant
arm characteristic frequency, as a predictor for DEXA classified
osteopenic and osteoporic population around lumbar spine, is
statistically very significant. When used for total lumbar spine
osteoporosis diagnosis, the area under the Receiver Operating Curve
of the characteristic frequency is 0.830, suggesting that the Cole-Cole
plot characteristic frequency could be a useful diagnostic parameter
when integrated into standard screening methods for osteoporosis.
Moreover, the characteristic frequency can be directly measured by
monitoring frequency driven angular behavior of the dominant arm
without performing any complex calculation.
Abstract: Osteoporosis is a common multifactorial disease with
a strong genetic component characterized by reduced bone mass and
increased risk of fractures. Genetic factors play an important role in
the pathogenesis of osteoporosis. The aim of our study was to
identify the genotype and allele distribution of T245G polymorphism
in OPG gene in Slovak postmenopausal women. A total of 200
unrelated Slovak postmenopausal women with diagnosed
osteoporosis and 200 normal controls were genotyped for T245G
(rs3134069) polymorphism of OPG gene. Genotyping was performed
using the Custom Taqman®SNP Genotyping assays. Genotypes and
alleles frequencies showed no significant differences (p=0.5551;
p=0.6022). The results of the present study confirm the importance of
T245G polymorphism in OPG gene in the pathogenesis of
osteoporosis.
Abstract: Osteoporosis is a complex health disease characterized by low bone mineral density, which is determined by an interaction of genetics with metabolic and environmental factors. Current research in genetics of osteoporosis is focused on identification of responsible genes and polymorphisms. TNFRSF11B gene plays a key role in bone remodeling. The aim of this study was to investigate the genotype and allele distribution of A163G (rs3102735) osteoprotegerin gene promoter and G1181C (rs2073618) osteoprotegerin first exon polymorphisms in the group of 180 unrelated postmenopausal women with diagnosed osteoporosis and 180 normal controls. Genomic DNA was isolated from peripheral blood leukocytes using standard methodology. Genotyping for presence of different polymorphisms was performed using the Custom Taqman®SNP Genotyping assays. Hardy-Weinberg equilibrium was tested for each SNP in the groups of participants using the chi-square (χ2) test. The distribution of investigated genotypes in the group of patients with osteoporosis were as follows: AA (66.7%), AG (32.2%), GG (1.1%) for A163G polymorphism; GG (19.4%), CG (44.4%), CC (36.1%) for G1181C polymorphism. The distribution of genotypes in normal controls were follows: AA (71.1%), AG (26.1%), GG (2.8%) for A163G polymorphism; GG (22.2%), CG (48.9%), CC (28.9%) for G1181C polymorphism. In A163G polymorphism the variant G allele was more common among patients with osteoporosis: 17.2% versus 15.8% in normal controls. Also, in G1181C polymorphism the phenomenon of more frequent occurrence of C allele in the group of patients with osteoporosis was observed (58.3% versus 53.3%). Genotype and allele distributions showed no significant differences (A163G: χ2=0.270, p=0.605; χ2=0.250, p=0.616; G1181C: χ2= 1.730, p=0.188; χ2=1.820, p=0.177). Our results represents an initial study, further studies of more numerous file and associations studies will be carried out. Knowing the distribution of genotypes is important for assessing the impact of these polymorphisms on various parameters associated with osteoporosis. Screening for identification of “at-risk” women likely to develop osteoporosis and initiating subsequent early intervention appears to be most effective strategy to substantially reduce the risks of osteoporosis.
Abstract: Transpedicular screw fixation in spinal fractures,
degenerative changes, or deformities is a well-established procedure.
However, important rate of fixation failure due to screw bending,
loosening, or pullout are still reported particularly in weak bone stock
in osteoporosis. To overcome the problem, mechanism of failure has
to be fully investigated in vitro. Post-mortem human subjects are less
accessible and animal cadavers comprise limitations due to different
geometry and mechanical properties. Therefore, the development of a
synthetic model mimicking the realistic human vertebra is highly
demanded. A bone surrogate, composed of Polyurethane (PU) foam
analogous to cancellous bone porous structure, was tested for 3
different densities in this study. The mechanical properties were
investigated under uniaxial compression test by minimizing the end
artifacts on specimens. The results indicated that PU foam of 0.32
g.cm-3 density has comparable mechanical properties to human
cancellous bone in terms of young-s modulus and yield strength.
Therefore, the obtained information can be considered as primary
step for developing a realistic cancellous bone of human vertebral
body. Further evaluations are also recommended for other density
groups.
Abstract: The aim of the present study is to analyze the generation of osteoporotic vertebral bone induced by lack of calcium during growth period and analyze its effects for disc degeneration, based on biomechanical and histomorphometrical study. Mechanical and histomorphological characteristics of lumbar vertebral bones and discs of rats with calcium free diet (CFD) were detected and tracked by using high resolution in-vivo micro-computed tomography (in-vivo micro-CT), finite element (FE) and histological analysis. Twenty female Sprague-Dawley rats (6 weeks old, approximate weight 170g) were randomly divided into two groups (CFD group: 10, NOR group: 10). The CFD group was maintained on a refmed calcium-controlled semisynthetic diet without added calcium, to induce osteoporosis. All lumbar (L 1-L6) were scanned by using in vivo micro-CT with 35i.un resolution at 0, 4, 8 weeks to track the effects of CFD on the generation of osteoporosis. The fmdings of the present study indicated that calcium insufficiency was the main factor in the generation of osteoporosis and it induced lumbar vertebral disc degeneration. This study is a valuable experiment to firstly evaluate osteoporotic vertebral bone and disc degeneration induced by lack of calcium during growth period from a biomechanical and histomorphometrical point of view.
Abstract: In this article, we propose an Intelligent Medical
Diagnostic System (IMDS) accessible through common
web-based interface, to on-line perform initial screening for
osteoporosis. The fundamental approaches which construct the
proposed system are mainly based on the fuzzy-neural theory,
which can exhibit superiority over other conventional technologies
in many fields. In diagnosis process, users simply answer
a series of directed questions to the system, and then they
will immediately receive a list of results which represents the
risk degrees of osteoporosis. According to clinical testing results,
it is shown that the proposed system can provide the general
public or even health care providers with a convenient, reliable,
inexpensive approach to osteoporosis risk assessment.
Abstract: Bone remodeling occurs by the balanced action of
bone resorbing osteoclasts (OC) and bone-building osteoblasts.
Increased bone resorption by excessive OC activity contributes
to malignant and non-malignant diseases including osteoporosis.
To study OC differentiation and function, OC formed in
in vitro cultures are currently counted manually, a tedious
procedure which is prone to inter-observer differences. Aiming
for an automated OC-quantification system, classification of
OC and precursor cells was done on fluorescence microscope
images based on the distinct appearance of fluorescent nuclei.
Following ellipse fitting to nuclei, a combination of eight
features enabled clustering of OC and precursor cell nuclei.
After evaluating different machine-learning techniques, LOGREG
achieved 74% correctly classified OC and precursor cell
nuclei, outperforming human experts (best expert: 55%). In
combination with the automated detection of total cell areas,
this system allows to measure various cell parameters and most
importantly to quantify proteins involved in osteoclastogenesis.