Official Positions for FRAX® clinical regarding prior fractures from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

The 2010 Position Development Conference addressed four questions related to the impact of previous fractures on 10-year fracture risk as calculated by FRAX(®). To address these questions, PubMed was searched on the keywords "fracture, epidemiology, osteoporosis." Titles of retrieved articles were reviewed for an indication that risk for future fracture was discussed. Abstracts of these articles were reviewed for an indication that one or more of the questions listed above was discussed. For those that did, the articles were reviewed in greater detail to extract the findings and to find additional past work and citing works that also bore on the questions. The official positions and the supporting literature review are presented here. FRAX(®) underestimates fracture probability in persons with a history of multiple fractures (good, A, W). FRAX(®) may underestimate fracture probability in individuals with prevalent severe vertebral fractures (good, A, W). While there is evidence that hip, vertebral, and humeral fractures appear to confer greater risk of subsequent fracture than fractures at other sites, quantification of this incremental risk in FRAX(®) is not possible (fair, B, W). FRAX(®) may underestimate fracture probability in individuals with a parental history of non-hip fragility fracture (fair, B, W). Limitations of the methodology include performance by a single reviewer, preliminary review of the literature being confined to titles, and secondary review being limited to abstracts. Limitations of the evidence base include publication bias, overrepresentation of persons of European descent in the published studies, and technical differences in the methods used to identify prevalent and incident fractures. Emerging topics for future research include fracture epidemiology in non-European populations and men, the impact of fractures in family members other than parents, and the genetic contribution to fracture risk.

Official Positions for FRAX® Bone Mineral Density and FRAX® simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®.

Tools to predict fracture risk are useful for selecting patients for pharmacological therapy in order to reduce fracture risk and redirect limited healthcare resources to those who are most likely to benefit. FRAX® is a World Health Organization fracture risk assessment algorithm for estimating the 10-year probability of hip fracture and major osteoporotic fracture. Effective application of FRAX® in clinical practice requires a thorough understanding of its limitations as well as its utility. For some patients, FRAX® may underestimate or overestimate fracture risk. In order to address some of the common issues encountered with the use of FRAX® for individual patients, the International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) assigned task forces to review the medical evidence and make recommendations for optimal use of FRAX® in clinical practice. Among the issues addressed were the use of bone mineral density (BMD) measurements at skeletal sites other than the femoral neck, the use of technologies other than dual-energy X-ray absorptiometry, the use of FRAX® without BMD input, the use of FRAX® to monitor treatment, and the addition of the rate of bone loss as a clinical risk factor for FRAX®. The evidence and recommendations were presented to a panel of experts at the Joint ISCD-IOF FRAX® Position Development Conference, resulting in the development of Joint ISCD-IOF Official Positions addressing FRAX®-related issues.

Official positions of the International Society for Clinical Densitometry (ISCD) on DXA evaluation in children and adolescents.

Dual-energy X-ray absorptiometry (DXA) is the most widely used technical instrument for evaluating bone mineral content (BMC) and density (BMD) in patients of all ages. However, its use in pediatric patients, during growth and development, poses a much more complex problem in terms of both the technical aspects and the interpretation of the results. For the adults population, there is a well-defined term of reference: the peak value of BMD attained by young healthy subjects at the end of skeletal growth. During childhood and adolescence, the comparison can be made only with healthy subjects of the same age, sex and ethnicity, but the situation is compounded by the wide individual variation in the process of skeletal growth (pubertal development, hormone action, body size and bone size). The International Society for Clinical Densitometry (ISCD) organized a Pediatric Position Development Conference to discuss the specific problems of bone densitometry in growing subjects (9-19 years of age) and to provide essential recommendations for its clinical use.

Effect of 17ß-estradiol or alendronate on the bone densitometry, bone histomorphometry and bone metabolism of ovariectomized rats

The objective of the present study was to evaluate the effect of 17ß-estradiol or alendronate in preventing bone loss in 3-month-old ovariectomized Wistar rats. One group underwent sham ovariectomy (control, N = 10), and the remaining three underwent double ovariectomy. One ovariectomized group did not receive any treatment (OVX, N = 12). A second received subcutaneous 17ß-estradiol at a dose of 30 µg/kg for 6 weeks (OVX-E, N = 11) and a third, subcutaneous alendronate at a dose of 0.1 mg/kg for 6 weeks (OVX-A, N = 8). Histomorphometry, densitometry, osteocalcin and deoxypyridinoline measurements were applied to all groups. After 6 weeks there was a significant decrease in bone mineral density (BMD) at the trabecular site (distal femur) in OVX rats. Both alendronate and 17ß-estradiol increased the BMD of ovariectomized rats, with the BMD of the OVX-A group being higher than that of the OVX-E group. Histomorphometry of the distal femur showed a decrease in trabecular volume in the untreated group (OVX), and an increase in the two treated groups, principally in the alendronate group. In OVX-A there was a greater increase in trabecular number. An increase in trabecular thickness, however, was seen only in the OVX-E group. There was also a decrease in bone turnover in both OVX-E and OVX-A. The osteocalcin and deoxypyridinoline levels were decreased in both treated groups, mainly in OVX-A. Although both drugs were effective in inhibiting bone loss, alendronate proved to be more effective than estradiol at the doses used in increasing bone mass.

Femur biometry, densitometry and chemical composition from Moxoto goats supplemented with concentrate in a semiarid region

The aim of study was to investigate if different intake levels of concentrate (supplementation levels) would have an influence on chemical composition, biometric aspects and bone mineral density (BMD) of femurs from Moxoto growing goats in the Brazilian semiarid region. Thirty-two castrated kids (15.69 +/- 0.78 kg initial BW) were used allocated randomly to one of the four levels of supplementation (SL) (treatments groups: 0: 5; 10 and 15 g/kg BW). When the animals of treatment group 15 g/kg BW reached 25 kg BW, the animals in the others treatments groups were also slaughtered. The increase SL resulted in linear increase (P<0.001) in the performance of animals as well as in fresh and dry weight of the femur and decrease of relative weight of the femur. The dry matter contents (g/kg) of femur increased linearly, however, the amounts of MM, ether extract, Ca, P. Mg, Na and K were not affected by the treatments. The values found in this study ranged from 134.84 to 155.90g of Ca, 48.14 to 55.95g of P. 1.69 to 1.87g of Mg, 2.87 to 3.24g of Na and 1.42 to 1.61 g of K/kg of bone in natura for animals with smaller and higher slaughter weight, respectively. The biometric and densitometric variables increased linearly with increasing treatments, except for the thickness of the sponge layer of the proximal and distal epiphysis and BMD measured in the distal epiphysis. The supplementation with concentrate did not affect the chemical composition of the femur, although it has positively influenced the structure and the bone mineral density. A BMD estimated via radiographic bone aluminum equivalent did not have correspondence with bone mineral content measured chemically. (C) 2011 Elsevier BM. All rights reserved.

Effect of dietary phytase suplementation on the performance, bone densitometry, and phosphorus and nitrogen excretion of broilers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Use of radiograph optical densitometry to monitor bone quality in broiler breeders

This study was carried out at Faculdade de Medicina Veterinária e Zootecnia, Universidade Estadual Paulista, Botucatu, SP, Brazil, and evaluated bone quality in broiler breeders. Twenty-three families of Ross broiler breeders were housed in 5.0-m² pens. The families were comprised of 13 females and one male at the onset of the experimental period. The mean number of females per family was 9.34 at the end of the trial. The feeding program and management followed strain guidelines (Agroceres Ross, 2003). Bone analyses were performed in the right tibia and femur using optical radiographic densitometry at 4, 8, 12, 15, 20, 24, 30, 35, 42, 47 and 52 weeks of rearing. Trap nests were used to collect eggs from the breeders two weeks before and after the evaluation weeks. At each evaluation day, five birds were sacrificed after radiographs were taken and the tibias and femurs were collected to perform the following analyses: fatfree dry matter, ash percentage, bone resistance and Seedor index. Therefore, it was possible to establish correlations between bone quality and eggshell quality. Characteristics of bone quality were highly correlated to each other; on the other hand, there were no correlations between bone quality and external egg quality. In conclusion, there was no effect of egg production on egg quality, possibly because there was no reabsorption of bone minerals.

Determination and padronization of normal values of bone mineral density (BMD) of the acessory carpus bone in young Thoroughbred horse using optical densitometry in radiographic image

Em 12 fêmeas e 12 machos da raça Puro Sangue Inglês com idade média de 12 meses, avaliou-se os valores normais da densidade mineral óssea do carpo acessório em milímetros de alumínio (mmAl) até o momento do fechamento completo da epífise distal do rádio, por meio do método de densitometria óptica em imagens radiográficas. A avaliação foi realizada por meio de um programa computacional (software) especialmente desenvolvido para medida de densidade óptica em filmes de raios-X, o qual contém a imagem radiográfica do osso carpo acessório, região de partes moles adjacente ao carpo acessório e os degraus de uma escala de alumínio (phatom), que permitiu a medida de densidade mineral óssea, sendo esta a média aritmética da região de interesse determinada no osso carpo acessório correspondente ao valor em milímetros da escala. Os valores da densidade mineral óssea em mmAl do acessório do carpo em função da idade não apresentaram diferenças entre os sexos (p=0,86) permitindo que uma equação de reta fosse ajustada para ambos os sexos (densidade mineral óssea (DMO) mmAl = 3.109 + 0,056 x idade em meses), na faixa etária estudada.

Alveolar bone healing process in spontaneously hypertensive rats (SHR). A radiographic densitometry study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Densitometry, radiography, and histological assessment of collagen as methods to evaluate femoral bones in an experimental model of osteoporosis

All methods to detect experimental loss of bone present technique limitations. The sensitivities of image and histological analyses to detect the effects of teriparatide in rats with bone loss after ovariectomy were evaluated. All methods were qualitatively valid.The standardization of methods to assess bone loss after ovariectomy is crucial to establish the degree of experimental osteoporosis. In general, methods per image or histological techniques are used. To validate these two ways to determine the degree of bone loss in ovariectomized rats, we evaluated the sensitivities of bone densitometry, conventional radiography, and histological analysis of the area occupied by collagen, detecting the effects of teriparatide treatment in the femur of ovariectomized rats with bone loss.Wistar rats were divided into three groups: a control group, in which the animals were only subjected to laparotomy; an ovariectomized group, in which bilateral removal of the ovaries was performed; and an ovariectomized + teriparatide group, in which bilateral removal of the ovaries was performed, and the animals were treated with 3 mu g/100 g/day of teriparatide. Three months following the ovariectomy, bone densitometry, radiographic densitometry, and histological analysis of the area occupied by collagen fibers were carried out in the femur diaphysis.The bone densitometry revealed 11.2% reduction in femur density; in the conventional radiography, the loss of bone mass was 14.5%, and with the histological analysis, a 40.9% reduction in the area occupied by collagen was detected in the femur diaphysis.In conclusion, histological analysis could not be quantitatively compared with the methods of bone densitometry and conventional radiography; however, all of these methods were qualitatively valid for assessing the loss of bone stemming from ovariectomy and the therapeutic effect of teriparatide in the prevention of osteoporosis.

Physiologic values of broiler femurs at different growth phases using Bone densitometry and Bone Breaking Strength

The objective of this experiment was to determine the normal values of Bone Radiographic Density (BRD) by using the optical densitometry in radiographic images and the Bone Breaking Strength (BBS) of broiler femurs at different ages (8, 22 and 42 d of age). A total of 60 Cobb male broilers were distributed in three age groups of 20 birds. The BRD and the BBS (maxim force and rigidity) values increased (p<0.01) over the course of ages, presenting greater values at 42 d of age when comparing to 8 and 22 d of age, evidencing a biomechanical adaptation of femur to growth. This experiment offers results that can be used in other experiments of broilers fed with different nutritional levels and they can also be related to pathological values, allowing the diagnosis of diseases that affect the integrity of the poultry leg. © Asian Network for Scientific Information, 2011.

Bone densitometry and calcium serum levels in chickens treated with filtered or unfiltered water

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)