Dual-energy X-ray absorptiometry (DXA) is a widely used technology used to diagnosis osteoporosis and monitor changes in bone mineral density (BMD). The present paper reviews the clinical application of DXA in evaluating osteoporosis, including indications for BMD testing, interpretation of DXA results, diagnosis of osteoporosis, and serial BMD follow up. As the clinical utility of DXA depends on the quality of the scan acquisition, the precision assessment of DXA is also discussed.
Absorptiometry, Photon ; Bone Density ; Diagnosis ; Follow-Up Studies ; Osteoporosis

In the recent years, there has been a growing interest in research community towards the application of smart materials for bio-medical structural health monitoring. Amongst the smart materials, directly bonded piezo sensors (DBPS), based on the electro-mechanical impedance (EMI) technique, have been successfully employed for the above purpose. The principle behind the EMI technique is that high frequency excitations (typically > 30 kHz) generated by a surface bonded PZT patch are used to detect changes in structural drive point impedance caused by cracks or any other type of damage. Bone healing and damage have been shown to be successfully monitored using the DBPS. However, in most of the diagnostic cases of live human and animal subjects, directly bonding a PZT patch is always an irritant or hazard for a live subject. To circumvent direct bonding, the authors have developed and experimentally demonstrated a non-bonded piezo sensor (NBPS) configuration as a good alternative to DBPS while maintaining the effectiveness of measurement well within discernible limits. This paper presents further improvement in the NBPS configuration aiming at autonomous operation of the gripping mechanism using shape memory alloy (SMA) wires. The experiments are performed on replicas of femur bone in healthy and osteoporosis state. This paper shows the effective use of SMA clamping for bone identification and its damage assessment in comparison to earlier mechanical gripping using jubilee clamps. This paper also covers impedance based identification applied to SMA and clamp based NBPS configurations. In place of raw admittance signatures, effective drive point impedance is utilized for the purpose of bone diagnostics which provides a more realistic assessment of the condition of bone.
Alloys ; Animals ; Constriction ; Diagnosis ; Electric Impedance ; Femur ; Hand Strength ; Humans ; Memory ; Osteoporosis

BACKGROUND: A history of osteoporotic fractures is strongly associated with the subsequent osteoporotic fractures. To prevent subsequent fractures, the diagnosis and treatment of osteoporosis following osteoporotic fractures are very important. A distal radius fracture (DRF) is the second most common type of osteoporotic fracture in South Korea. We analyzed the rate of osteoporosis diagnosis within 6 months post-DRF.METHODS: We used data from the Korean Health Insurance Review and Assessment Service nationwide claims database from 2010 to 2016. International Classification of Diseases, 10th revision codes and procedures codes were used to identify patients aged over 50 years with newly diagnosed DRFs; the osteoporosis assessments of these patients were then analyzed. We used Cochran-Armitage trend test to examine trends in osteoporosis diagnosis.RESULTS: A search of database identified 77,209 DRFs in patient aged above 50 years of age from 2011 to 2016. Among these patients, only 19,305 (25.0%) underwent diagnostic examination for osteoporosis. The number of osteoporosis examinations increased slightly, but not significantly, every year (P=0.061).CONCLUSIONS: Clinicians who treat DRFs shoulder also evaluated patients for osteoporosis after DRFs.
Diagnosis ; Humans ; Insurance, Health ; International Classification of Diseases ; Korea ; Osteoporosis ; Osteoporotic Fractures ; Radius Fractures ; Radius ; Shoulder

Almost 50% of patients with inflammatory bowel disease (IBD) exhibit at least one extra-intestinal manifestation in their lifetime. Extra-intestinal manifestations of IBD are often associated with the intestinal disease activity, reducing the quality of life of the patient but rarely leading to fatal complications. Musculoskeletal involvement is the most frequent extra-intestinal manifestation of patients with IBD but this rarely occurs before IBD is diagnosed. They are manifested in various forms, such as arthropathy, fibromyalgia, and osteoporosis. Therefore, a multidisciplinary team approach including gastroenterologists and rheumatologists are necessary for optimal treatment. This review focuses on the diagnosis and treatment of musculoskeletal manifestations of IBD from the perspectives of rheumatologists who can assist gastroenterologists.
Diagnosis ; Fibromyalgia ; Humans ; Inflammatory Bowel Diseases ; Intestinal Diseases ; Joint Diseases ; Musculoskeletal Diseases ; Osteoporosis ; Quality of Life

BACKGROUND: Osteoporosis is a systemic skeletal disease characterized by reduced bone mineral density and skeletal microstructural abnormalities. We investigated the correlation between serum uric acid (SUA) levels and bone mineral content (BMC) values as a surrogate marker of bone health. Additionally, we assessed whether the correlation, if any, was evident even after classifying the study population into two groups based on a diagnosis of obesity in these individuals.METHODS: This study included 936 women who visited the healthcare centers that participated in this study. Fasting blood samples were obtained from all women to measure SUA, BMC of the lumbar spine was measured using dual-energy X-ray absorptiometry. We evaluated the correlation between SUA and BMC in obese and non-obese groups.RESULTS: SUA concentration and BMC were positively correlated (β=0.257, P=0.001); however, this correlation was significant only in the obese group (β=0.203, P=0.001).CONCLUSION: SUA concentration and BMC are positively correlated in women diagnosed obesity.
Absorptiometry, Photon ; Biomarkers ; Body Mass Index ; Bone Density ; Delivery of Health Care ; Diagnosis ; Fasting ; Female ; Humans ; Obesity ; Osteoporosis ; Spine ; Uric Acid

BACKGROUND: This study examined the change in the trabecular bone score (TBS), areal bone mineral density (aBMD), and osteoporosis in postmenopausal women who underwent thyrotropin (TSH)-suppressive therapy for treating papillary thyroid cancer after a total thyroidectomy procedure. METHODS: We evaluated 36 postmenopausal women who received a total thyroidectomy for papillary thyroid cancer and were undergoing TSH suppressive therapy with levothyroxine. Postmenopausal women (n=94) matched for age and body mass index were recruited as healthy controls. The aBMD and TBS of the lumbar spine were compared between dual energy X-ray absorptiometry (DXA) at baseline and at follow-up after an average of 4.92 years. RESULTS: There was no significant difference in the rate of diagnoses of osteoporosis, osteopenia, or normal bone status between the 2 groups during the baseline DXA evaluation. However, the TBS was significantly lower whereas aBMD did not show significant difference at the time of baseline DXA measurement (1st DXA, 1.343±0.098 vs. 1.372±0.06317, P < 0.001; 2nd DXA, 1.342±0.095 vs. 1.370±0.062, P < 0.001). The TBS and aBMD did not differ significantly between the initial and follow-up DXA images in both groups of TSH suppressive patients and controls. CONCLUSIONS: The average value of TBS and aBMD did not significantly change during the follow-up period. The TSH suppressive therapy was revealed as not a significant factor for the progressive deterioration of bone status during long term follow-up.
Absorptiometry, Photon ; Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Osteoporosis ; Postmenopause ; Spine ; Thyroid Neoplasms ; Thyroidectomy ; Thyrotropin ; Thyroxine

PURPOSE: The purpose of this study was to investigate the radiologic and serologic factors related to postoperative union using intramedullary (IM) internal fixation in atypical femoral fractures (AFF), which are closely related to bisphosphonates (BPs) for osteoporosis. MATERIALS AND METHODS: From February 2008 to December 2016, 65 patients (71 cases) who had undergone IM nail fixation after diagnosis of AFF were enrolled in this study. Patients were divided into group A, who experienced union within 6 months and group B, who did not experience union within 6 months. They were evaluated for duration of BPs use, radiologic factors and serological factors. RESULTS: The mean duration of BPs use was 6.17 years in group A and 8.24 years in group B (p=0.039). In the subtrochanteric area, there were 14 cases (27.5%) in group A and 14 cases (70.0%) in group B. In the femoral shaft, there were 37 cases (72.5%) in group A and 6 cases (30.0%) in group B (p=0.001). On the preoperative, the flexion in the coronal plane was 5.9° (2.1°–9.2°) in group A and 8.0° (3.1°–12.1°) in group B (p=0.041). On the postoperative, conversion to valgus was 15 cases (29.4%), 8 cases (40.0%); conversion to neutral was 34 cases (66.7%) and 8 cases (40.0%); conversion to varus was 2 cases (3.9%) and 4 cases (20.0%), each (p=0.037). The fracture site gap was 1.5 mm (0–2.9 mm) on the front side and 1.2 mm (0–2.2 mm) on lateral side and 2.2 mm (0.9–4.7 mm) and 1.9 mm (0.5–3.5 mm), each (p=0.042, p=0.049). Among serological factors, there was no significant difference between the two groups. CONCLUSION: Factors adversely affecting the union should be recognized before surgery, such as longterm BPs use or a severe degree of bending of the femur in the coronal plane. During surgery, proper reduction and spacing of the fracture site on the coronal plane should allow adequate reduction of the anterior and posterior surfaces. Obtaining anatomic reduction would be most beneficial for union, but if that is not possible, obtaining congenital valgus rather than varus on the coronal plane may be helpful for union.
Diagnosis ; Diphosphonates ; Femoral Fractures ; Femur ; Humans ; Osteoporosis

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness with a high recurrence rate. This study aimed to analyze the recurrence rate and the risk factors for recurrence using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002–2013) data. SUBJECTS AND METHOD: Patients aged 20 years or older who were diagnosed with BPPV in the period of 2002–2012 and had at least 1 year of monitoring period were included in this study. The diagnosis of BPPV was made when the code for BPPV (KCD-6 code H811) was used or when canalith reposition therapy (EDI code MX035) was entered even in cases with different diagnoses. The risk factors of BPPV recurrence were analyzed. RESULTS: Of the total of 21355 patients diagnosed with BPPV, 5876 patients (28%) demonstrated recurrence. Multiple recurrences were common. When using the univariate regression analysis, age, sex, vestibular disease, headache, osteoporosis, and ischemic heart disease were found significant. When the patients were classified into 4 groups according to age and sex, vestibular diseases were found as a common risk factor for recurrence in all groups, while headache, osteoporosis, hypertension, and ischemic heart disease were significant in females. CONCLUSION: The recurrence rate of BPPV in the Korean adult population was approximately 28% and recurrences were more common in patients aged over 65 and in females. Patients with vestibular diseases were at a higher risk of recurrence regardless of age or sex, while headache, osteoporosis, hypertension and ischemic heart disease increased the risk of recurrence in females.
Adult ; Benign Paroxysmal Positional Vertigo* ; Cohort Studies ; Diagnosis ; Dizziness ; Female ; Headache ; Humans ; Hypertension ; Methods ; Myocardial Ischemia ; National Health Programs ; Osteoporosis ; Recurrence* ; Risk Factors* ; Vestibular Diseases

OBJECTIVES: Osteoporotic hip fractures are associated with high mortality in the older population. Few population studies have reported the long-term trends of incidence and mortality rate of hip fracture among the older in Korea. This study assessed the incidence and mortality rate within 1 year after hip fracture from 2006 to 2015 in South Korea. METHODS: The National Health Information Database was used to identify adults aged 60 years and older with a diagnosis of hip fracture and died within 1 year from hip fracture. Regression analyses were performed to estimate the change of the incidence of hip fracture and the related mortality rate. RESULTS: The events causing hip fracture increased 1.85 times (1.91 times in women and 1.71 times in men), and the incidence of hip fracture increased 1.23 times (1.30 times in women and 1.11 times in men) from 2006 to 2015. The mortality rate after hip fracture decreased by 10% in women; however, it increased by 13% in men. These trends were more prominent in the older population. CONCLUSIONS: Although the mortality rate after hip fracture in women decreased, other parameters associated with hip fracture have worsened during the last decade. Nationwide programs were urgently needed to reduce the future socioeconomic burdens of hip fractures.
Adult ; Cohort Studies ; Diagnosis ; Female ; Hip Fractures ; Hip ; Humans ; Incidence ; Korea ; Male ; Mortality ; Osteoporosis

Bone disease is a serious complication to diabetes. Patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) suffer from an increased risk of fracture, most notably at the hip, compared with patients without diabetes. Confounders such as patient sex, age, body mass index, blood glucose status, fall risk, and diabetes medications may influence the fracture risk. Different underlying mechanisms contribute to bone disease in patients with diabetes. Bone quality is affected by low bone turnover in T1D and T2D, and furthermore, incorporation of advanced glycation end-products, changes in the incretin hormone response, and microvascular complications contribute to impaired bone quality and increased fracture risk. Diagnosis of bone disease in patients with diabetes is a challenge as current methods for fracture prediction such as bone mineral density T-score and fracture risk assessment tools underestimate fracture risk for patients with T1D and T2D. This review focuses on bone disease and fracture risk in patients with diabetes regarding epidemiology, underlying disease mechanisms, and diagnostic methods, and we also provide considerations regarding the management of diabetes patients with bone disease in terms of an intervention threshold and different treatments.
Blood Glucose ; Body Mass Index ; Bone Density ; Bone Diseases ; Bone Remodeling ; Diagnosis ; Epidemiology ; Hip ; Humans ; Incretins ; Osteoporosis ; Risk Assessment