50 research outputs found
DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis
No full textOsteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone
Muscle parameters in fragility fracture risk prediction in older adults: a scoping review.
No full textHalf of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of ‘fragility fractures’, ‘muscle health assessment’ and ‘risk’. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921–5756), age 69.2 (63.5–73.6) years, follow-up 10.0 (4.4–12.0) years and number of incident fragility fractures 166 (88–277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods
Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)
No full textPurpose: trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustments for TBS have accelerated adoption. This position paper therefore presents a review of the updated scientific literature, and provides expert consensus statements and corresponding operational guidelines for the use of TBS.Methods: an Expert Working Group was convened by the ESCEO and a systematic review of the evidence was undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: 1) fracture prediction in men and women; 2) initiating and monitoring treatment in postmenopausal osteoporosis; 3) fracture prediction in secondary osteoporosis; and 4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: a total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and for anabolic agents. All expert consensus statements were voted as strongly recommended.Conclusion: the addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, and is useful in treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix.<br/
Review on the Utility of Trabecular Bone Score, a Surrogate of Bone Micro-architecture, in the Chronic Kidney Disease Spectrum and in Kidney Transplant Recipients
No full textChronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for >3 months, with implications for, among others, bone health. Advanced stages of CKD have an increased risk of fragility fractures. Trabecular bone score (TBS) is a relatively new gray-level textural parameter, which provides information on bone microarchitecture and has been shown to be a good predictor of fragility fractures independently of bone density and clinical risk factors. We aimed to review the scientific literature on TBS and its utility along the CKD spectrum and in kidney transplant recipients. In total, eight articles had investigated this topic: one article in patients with reduced kidney function, two in patients on hemodialysis, and five in kidney transplant recipients. In general, all the studies had shown an association between lower values of TBS and reduced kidney function; or lower TBS values among the hemodialysis or kidney transplant patients compared to healthy controls. Moreover, TBS was shown to be a good and independent predictor of fragility fractures in patients with CKD or who underwent kidney transplantation. TBS postulates itself as a valuable marker to be used in clinical practice as an assessor of bone microarchitecture and fracture risk predictor in these specific populations. However, evidence is to some extent limited and larger follow-up case-control studies would help to further investigate the TBS utility in the management of bone health damage and increased fracture risk in patients with CKD or kidney transplant
Reference curves for trabecular bone score adjusted for soft tissue thickness in children and adolescents from Mexico City.
No full textThis study proposes age- and sex-specific trabecular bone score (TBS) reference curves for Mexican children and adolescents. Using the latest software version, results highlight significant pubertal changes and provide reference data for assessing pediatric bone health, paving the way for a wider use of this technology in children and adolescents. Trabecular Bone Score (TBS) is a grey scale texture measure that correlates with bone microarchitecture derived from dual-energy X-ray absorptiometry (DXA). While extensively studied in adults, limited data exist for pediatric populations. This study aims to develop age- and sex-specific reference curves for TBS adjusted for abdominal soft tissue thickness in healthy children and adolescents from Mexico City. This cross-sectional study reanalyzed data from 1552 healthy participants (5-18 years) who underwent lumbar spine DXA scans using Lunar iDXA and TBS iNsight 4.0 (Core Module 19.4.0), which accounts for soft tissue thickness. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were employed to construct smoothed percentile curves. TBS values were stratified by age, sex, and Tanner stage, with descriptive statistics and outlier exclusions. TBS showed distinct age- and sex-related trajectories, with steep increases during puberty. Girls demonstrated a sharper rise in TBS starting at age 9, peaking by age 16, while boys exhibited a more gradual increase starting at age 10-11, peaking by age 18. Differences were also observed between Tanner stages, with the most significant changes occurring from stages 2 to 3. This study proposes the first TBS reference curves for Mexican children and adolescents using the latest software version. This data may prove to be a valuable tool for assessing bone health in pediatric populations. Yet further research to explore TBS's utility in predicting bone fragility in pediatric population as well as its life-course trends. [Abstract copyright: © 2025. The Author(s).
Effect of Abaloparatide on Bone Microarchitecture Assessed by Trabecular Bone Score in Women With Osteoporosis: Post Hoc Analysis of ACTIVE and ACTIVExtend
No full textAlthough bone mineral density (BMD) is a predictor of fracture, many fractures occur in women with T-scores > -2.5. Bone microarchitecture, assessed by trabecular bone score (TBS), predicts fracture risk independent of BMD. We evaluated whether abaloparatide improves TBS and whether TBS trends were associated with vertebral fracture risk reduction. Women with osteoporosis randomized to abaloparatide or placebo for 18 months (ACTIVE), followed by alendronate for 24 months (ACTIVExtend), with evaluable TBS, were included in this post hoc analysis (N = 911). TBS was calculated from spine BMD scans using an algorithm adjusted for tissue thickness (TBS th ) at baseline, 6, 18, and 43 months. Mean increments in TBS th from baseline within and between treatment groups, proportion of women with TBS th increments above least significant change (LSC) and proportion with degraded TBS th (th . Mean TBS th increased 4% after 18 months abaloparatide (p th increase was 4.4% with abaloparatide/alendronate and 1.7% with placebo/alendronate (group difference, p th had declined to 21% with abaloparatide/alendronate and 37% with placebo/alendronate (p th ≥ LSC was observed in 50% of abaloparatide-treated women at 18 months and was associated with decreased odds (odds ratio [OR]; 95% confidence interval [CI]) of vertebral fracture (0.19; 95% CI, 0.04-0.80, 6 months; 0.30; 95% CI, 0.11-0.79, 43 months). In conclusion, abaloparatide increased TBS th rapidly and progressively over 18 months and increments were maintained over 2 years with alendronate. TBS th increase was associated with vertebral fracture risk reduction. Microarchitectural improvement may be one mechanism by which abaloparatide strengthens vertebral bone. © 2023 Radius Health, Inc and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)
Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice
No full textOsteoporosis is a common bone disease characterized by low bone mass and altered bone microarchitecture, resulting in decreased bone strength with an increased risk of fractures. In clinical practice, physicians can assess the risk of fracture for a patient based on several risk factors. Some such as age, weight, and history of fractures after 50 years of age, parental fracture, smoking status, and alcohol intake are incorporated into FRAX, an assessment tool that estimates the 10-year probability of hip fracture and major osteoporotic fractures based on the individual's risk factors profile. The diagnosis of osteoporosis is currently based on bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry scans. Among other widely recognized limitations of BMD is that BMD considers only the density of the bone and fails in measuring bone microarchitecture, for which novel techniques, such as trabecular bone score (TBS), have been developed. TBS is a texture parameter related to bone microarchitecture that may provide skeletal information that is not captured from the standard BMD measurement. Several studies have examined the value of TBS on predicting osteoporotic fractures. Our study aimed to summarize a review of the current scientific literature with focus on fracture risk assessment and to present both its findings and its conclusions regarding how and when TBS should be used. The existing literature indicates that low lumbar spine TBS is associated with a history of fracture and the incidence of new fracture. The effect is largely independent of BMD and of sufficient magnitude to enhance risk stratification with BMD. The TBS effect is also independent of FRAX, with likely greatest utility for those individuals whose BMD levels lie close to an intervention threshold. The clinical and scientific evidence supporting the use of TBS, with the ability of this technology to be seamlessly integrated into a daily workflow, makes TBS an attractive and useful clinical tool for physicians to improve patient management in osteoporosis. Further research is ongoing and necessary to further clarify the role of TBS in additional specific disorders
Government cloud computing and the policies of data sovereignty
No full textGovernment cloud services are a new development at the intersection of electronic government and cloud computing which holds the promise of rendering government service delivery more effective and efficient. Cloud services are virtual, dynamic and potentially stateless which has triggered governments' concern about data sovereignty. This paper explores data sovereignty in relation to government cloud services and how national strategies and international policy evolve. It concludes that for countries data sovereignty presents a legal risk which can not be adequately addressed with technology or through contractual arrangements alone. Governments therefore adopt strategies to retain exclusive jurisdiction over government information. --cloud computing,electronic government,data sovereignty,data ownership,information assurance,international data transfers
Expressive and communicational properties of drawings in primary school
No full textCrtež je medij koji postavlja pitanja i stimulira odgovor. Svjedočimo kako su autori kroz
povijest putem crteža zapisivali, prenosili poruke, događaje, a naposljetku i izražavali vlastite
misli. Upotrebljavajući razne linije, krivulje, mrlje oslikavali su stanja, strahove, ali i ostale
prisutne emocije. Ono što povezuje svaki crtež, bilo da se radi o umjetničkom ili dječjem, upravo
je komunikacija koja se ostvaruje kroz djelo.
Dječji crtež ima svoja karakteristična obilježja s obzirom na dob, ali ono što razlikuje
svakoga od njih je vlastito viđenje svijeta i okoline koja ga okružuje. Putem crteža ono uči o sebi,
spoznaje svoje mogućnosti, usvaja i upotpunjuje svoj unutarnji svijet. Tijekom procesa školovanja
djeca usvajaju vještinu čitanja i pisanja, ali im je crtež najbliže sredstvo putem kojeg ostvaruju
komunikaciju s okolinom, a u istraživačkom dijelu rada se upravo istražuje zastupljenost crteža u
različitim nastavnim predmetima. U razrednoj nastavi on ima ključnu ulogu pri izražavanju i
prepoznavanju djetetovog unutarnjeg stanja. Naime, prilikom crtanja dijete reagira spontano i
nesvjesno te se uočavaju elementi koji su obično skriveni ili pripadaju potisnutim razinama
svijesti. Stoga, nije neuobičajeno da se crtež primjenjuje i kao pomoćna metoda u odgojno –
obrazovnim te terapijskim intervencijama.A drawing is a medium which asks questions and stimulates the answers. We are witnesses
to the fact that authors have, throughout history, written and passed on messages, events and,
finally, their own thoughts by means of drawings. Using various lines, curves and stains, they have
depicted various mental states, fears and other emotions that are present. What connects every
drawing, whether it's a work of art or a child's one, is the communication which is realized through
a certain piece.
A child's drawing has its distinctive features, which depend on the age of its author, but
what makes it different is their own worldview and understanding of the environment that
surrounds them. Through the act of drawing, children learn about themselves, they acknowledge
their possibilities, acquire and complete their inner world. During the schooling process, children
adopt the skills of reading and writing, but the drawing is the closest tool for communication with
the environment and the work researches the presence of drawing in various teaching subjects. In
classroom teaching, it has a key role in expressing and recognizing a child's inner state. In other
words, when a child draws, it reacts spontaneously and unconsciously, and the elements, which
are usually hidden or belong to the suppressed levels of consciousness, can be recognized.
Therefore, it is not uncommon for a drawing to be applied as an auxiliary method in educational
and therapeutic interventions
