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Osteoporosis is the most common bone disease affecting millions of people worldwide, particularly in elderly or in post-menopausal women. The pathogenesis is useful to understand the possible mechanism of action of anti-osteoporotic drugs. Early diagnosis, possible with several laboratory and instrumental tests, allows a major accuracy in the choice of anti-osteoporosis drugs. Treatment of osteoporosis is strictly related to severity of pathology and consists on prevention of fragility fractures with a correct lifestyle and adequate nutritional supplements, and use of pharmacological therapy, started in patients with osteopenia and history of fragility fracture of the hip or spine. The purpose of this review is to focus on main current pharmacological products to treat osteoporotic patients.

Ziel dieser Arbeit war es, die Ergebnisse röntgenologischer, computertomographischer und myelographischer Untersuchung der Halswirbelsäule von gesunden Warmblutpferden miteinander zu vergleichen und insbesondere die Möglichkeiten zu erarbeiten, die ein Computertomograph mit einer außergewöhnlich großen Gantryöffnung von 85 cm bietet.Es wurden die knöchernen Diameter, die Kontrastmittelsäulen und das Rückenmark gemessen und für Warmblutpferde Orientierungswerte ermittelt, um bei erkrankten Pferden und insbesondere in unklaren Fällen mithilfe weiterer Arbeiten später Grenzwerte für eine Einengung des Wirbelkanals zu ermitteln.

Background Bioelectrical impedance analysis (BIA) operates under the assumption that the conductor has a uniform cylindrical shape. However, this assumption may be violated if measures are taken in the seated position, especially in people with a high waist circumference (WC). Aims The aims of this research were to determine whether posture (supine, standing, and seated) and WC affect agreement between BIA and dual‐energy X‐ray absorptiometry (DXA) measures of fat mass (FM) and fat‐free mass (FFM). Materials & Methods Baseline data were collected from 28 adults (mean = 61.4 ± 6.9 years, 64.3% female) with obesity (BMI 38.6 ± 5.0 kg/m2). Body composition was measured using BIA in the supine, standing, and seated positions and by DXA while supine. Intraclass correlation coefficient (ICC) analyses with two‐way mixed effects and absolute agreement were performed to determine agreement. Results Point estimates were excellent for FM and FFM while supine, excellent for FM and good for FFM while standing, and moderate for FM and good for FFM while seated. BIA measures in the supine position resulted in the narrowest 95% confidence intervals compared with other positions. Better agreement was observed across all positions in participants with a WC below the median (118.3 cm). Discussion Despite the potential pragmatic value of measuring with BIA in a seated position, the results of this analysis demonstrate the poorest agreement between DXA and BIA methods, especially in individuals with high WC. Conclusion Findings from this study demonstrate that BIA, particularly when measured in a supine position, can serve as a viable alternative to DXA for measuring body composition in people with obesity.

To date, sarcopenia is considered a patient-specific imaging biomarker able to predict clinical outcomes. Several imaging modalities, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance (MR), and ultrasound (US), can be used to assess muscle mass and quality and to achieve the diagnosis of sarcopenia. With different extent, all these modalities can provide quantitative data, being thus reproducible and comparable over time. DXA is the one most commonly used in clinical practice, with the advantages of being accurate and widely available, and also being the only radiological tool with accepted cutoff values to diagnose sarcopenia. CT and MR are considered the reference standards, allowing the evaluation of muscle quality and fatty infiltration, but their application is so far mostly limited to research. US has been always regarded as a minor tool in sarcopenia and has never gained enough space. To date, CT is probably the easiest and most promising modality, although limited by the long time needed for muscle segmentation. Also, the absence of validated thresholds for CT measurements of myosteatosis requires that future studies should focus on this point. Radiologists have the great potential of becoming pivotal in the context of sarcopenia. We highly master imaging modalities and know perfectly how to apply them to different organs and clinical scenarios. Similarly, radiologists should master the culture of sarcopenia, and its clinical aspects and relevant implications for patient care. The medical and scientific radiological community should promote specific educational course to spread awareness among professionals.Key Points• DXA is an accurate, reproducible, and widely available imaging modality to evaluate body composition, being the most commonly used radiological tool to diagnose sarcopenia in clinical practice• CT and MR are the gold standard imaging modalities to assess muscle mass and quality, but no clear cutoff values have been reported to identify sarcopenia, limiting the application of these modalities to research purposes• US has shown to be accurate in the evaluation of muscle trophism, especially in the thigh, but its current application in sarcopenia is limited

Murine subarachnoid hemorrhage (SAH) induced using the filament perforation method is a useful in vivo experimental model to investigate the pathophysiological mechanisms in the brain underlying SAH. However, identifying mice with comorbid acute neurogenic pulmonary edema (NPE), a life‐threatening systemic consequence often induced by SAH, in this model is difficult without histopathological investigations. Herein, we present an imaging procedure involving dual‐energy X‐ray absorptiometry (DXA) to identify NPE in a murine model of SAH. We quantified the lung lean mass (LM) and compared the relationship between micro‐computed tomography (CT) evidence of Hounsfield unit (HU) values and histopathological findings of PE. Of the 85 mice with successful induction of SAH by filament perforation, 16 (19%) had NPE, as verified by postmortem histology. The DXA‐LM values correlate well with CT‐HU levels (r = 0.63, p < 0.0001). Regarding the relationship between LM and HU in mice with post‐SAH NPE, the LM was positively associated with HU values (r2 = 0.43; p = 0.0056). A receiver operating characteristics curve of LM revealed a sensitivity of 87% and specificity of 57% for detecting PE, with a similar area under the curve as the HU (0.79 ± 0.06 vs. 0.84 ± 0.07; p = 0.21). These data suggest that confirming acute NPE using DXA‐LM is a valuable method for selecting a clinically relevant murine NPE model that could be used in future experimental SAH studies. Using a murine model of SAH, brain magnetic resonance imaging (MRI) was performed to confirm subarachnoid clot formation in the T2*‐weighted images sequence (left). Chest micro‐CT and DXA were performed to measure, respectively, the Hounsfield units (HU) and lean mass (LM) (middle) in order to test their relationship and ability to detect post‐SAH NPE (right).

PurposesOur purpose was to use computed tomography (CT) Hounsfield unit (HU) values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases.MethodsA total of 334 patients with lumbar degenerative diseases were retrospectively reviewed and divided into two groups according to the degree of lumbar degenerative changes in preoperative lumbar CT images. Patients who had at least three vertebrae with severe degeneration at L1–L4 were placed in the degenerative group, and others were placed in the control group. HU value of trabecular bone in middle axial CT image of vertebral body, T-score and bone mineral density (BMD) at L1–L4 and hips were measured. CT HU thresholds for osteoporosis were obtained from control group and then applied to identify undiagnosed spinal osteoporosis.ResultsThere were 182 patients in the degenerative group and 152 patients in the control group. CT HU value had a positive correlation with T-score and BMD of lumbar spine in both groups (P < 0.001), while the correlation coefficients at L1–L4 were higher in the control group (> 0.7) than in the degenerative group (< 0.7). T-score and BMD of lumbar spine were higher in the degenerative group (P < 0.05), while CT HU value, T-score and BMD of hips had no significant difference between two groups. According to the linear regression equations of vertebral T-score and CT HU value in the control group, the thresholds matching T-score of − 2.5 were 110, 100, 85 and 80HU for L1, L2, L3 and L4, respectively. Defining CT osteoporosis as L1 ≤ 110HU or L2 ≤ 100HU or L3 ≤ 85HU or L4 ≤ 80HU was 88.5% (69/78) specific and 60.8% (45/74) sensitive for distinguishing DXA osteoporosis of lumbar spine in the control group. The rate of undiagnosed spinal osteoporosis was higher in the degenerative group than in the control group according to CT HU thresholds (38.7% vs. 11.5%, P < 0.05).ConclusionsDegenerative changes in the lumbar spine can increase BMD and T-score provided by lumbar DXA, leading to an underestimation of vertebral osteoporosis. Thresholds for osteoporosis based on CT HU values can be used as a complementary method to identify undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

The interest in non-invasive methods of body composition assessment is on the rise in health care, especially because of its association with clinical outcomes. Technology has revolutionized our understanding of body composition abnormalities, clinical prognostication, and disease follow-up, but translation to bedside is limited, especially in terms of cost effectiveness. Computed tomography gained increased attention in cancer and sarcopenia studies, for instance. Other methods also have interesting features and applications, including bedside ultrasonography, bioelectrical impedance analysis, and dual x-ray absorptiometry. Compelling evidence indicates these methods can be used to accurately and precisely measure skeletal muscle mass, adipose tissue, and edema; diagnose malnutrition-related diseases; and aid in determining prognoses. To apply this technology properly, it is important to understand the advantages and disadvantages of each technique in specific situations of interest. This review introduces concepts and reference studies published in the scientific literature about these techniques and describes important limitations and considerations necessary to incorporate these methods into clinical practice.

•Patients with walled-off necrosis experience great weight loss during admission.•Increased resting energy expenditure predicts increased muscle and fat loss.•Infected walled-off necrosis is associated with increased resting energy expenditure. Ensuring adequate nutritional support in patients with walled-off pancreatic necrosis (WON) is challenging and weight loss is often considerable. The aim of this study was to evaluate resting energy expenditure (REE) and body composition in patients with WON. We prospectively included 18 patients (67% men; median age 63 y; 44% gallstones; 39% alcohol) with WON undergoing endoscopic transgastric drainage and necrosectomy. Patients were followed for 4 wk after admission. We assessed hand-grip strength, REE using indirect calorimetry, and body composition with dual-energy x-ray absorptiometry to assess the percentage change in muscle mass (MM) and fat mass (FM). Data are summarized using medians (range). At baseline, the median body mass index was 27.9 kg/m2 (17.7–35.6 kg/m2). Fifteen patients (83%) had infected WON. Eight patients (44%) received total or supplemental parenteral nutrition. The median percentage loss in MM was 0.31% and FM was 6.2%. The median REE was 6870 kJ (3255–8870 kJ) at baseline. Compared with the predicted REE, the measured REE was 1049 kJ higher (–3065 to 2126 kJ) at baseline and –951 kJ lower (–2600 to 3202 kJ) at 4 wk. The difference between the predicted and measured REE at baseline was correlated with the percentage loss in MM (P = 0.043) and FM (P = 0.026). Additionally, patients with infected WON had significantly higher REE (P = 0.003). In patients with WON, an increased REE appears to predict increased muscle and fat loss. Additional studies are necessary to evaluate if REE may be used to improve nutritional support.

Type 2 diabetes (T2D) may be associated with increased risk of fractures, despite preserved bone mineral density (BMD). Obesity and insulin resistance (IR) may have separate effects on bone turnover and bone strength, which contribute to skeletal fragility. We characterized and assessed the relative associations of obesity, body composition, IR, and T2D on bone turnover markers (BTMs), BMD, and advanced hip analysis (AHA). In this cross‐sectional analysis of Dubbo Osteoporosis Epidemiology Study, 525 (61.3% women) participants were grouped according to T2D, IR (homeostasis model assessment insulin resistance [HOMA‐IR]