Context Fractures are serious consequence of osteoporosis in old adults. However, few longitudinal studies showed the role of computed tomography (CT)-based radiomics in predicting osteoporotic fractures. Objective We evaluated the performance of CT radiomics-based model for osteoporotic vertebral fractures (OVF) in a longitudinal study. Methods 7906 subjects without OVF who were aged over 50 years, and underwent CT scans between 2016 and 2019 were enrolled and followed up until 2021. Seventy-two cases of new OVF were identified. One hundred and forty-four people without OVF during follow-up were selected as control. Radiomics features were extracted from baseline CT images. CT values of trabecular bone, and area and density of erector spinae were determined. Cox regression analysis was used to identify the independent associated factors. The predictive performance of the nomogram was assessed using the receiver operating characteristic (ROC) curve, calibration curve and decision curve. Results CT value of vertebra (adjusted hazard ratio (aHR) = 2.04, 95% confidence interval (CI): 1.07, 3.89), radiomics score (aHR = 6.56, 95%CI:3.47, 12.38) and area of erector spinae (aHR = 1.68, 95%CI: 1.02, 2.78) were independently associated with OVF. Radscore was associated with severe OVF (aHR = 6.00, 95% CI:2.78-12.93). The nomogram showed good discrimination with a C-index of 0.82 (95%CI: 0.77, 0.87). The area under the curve of nomogram and radscore were both higher than osteoporosis + muscle area for 3-year and 4-year risk of fractures (p < 0.05). Decision curve also demonstrated that the radiomics nomogram was useful. Conclusions Bone radiomics is associated with OVF and the nomogram based on radiomics signature and muscle provides a tool for the prediction of OVF.

Cadmium exposure is associated with renal dysfunction and bone damage. Chronic kidney disease and bone loss are also related to parathyroid hormone (PTH). However, whether cadmium exposure affect PTH level is not completely understood. In this study, we observed the association between environmental cadmium exposure and parathyroid hormone levels in a Chinese population. A ChinaCd study was performed in China in 1990s which included 790 subjects living in heavily, moderately and low cadmium polluted area. 354 of them (121men and 233 women) also had the data of serum PTH. The cadmium levels in blood (BCd) and urine (UCd) were determined by flame atomic absorption spectrometry. Serum PTH was detected by immunoradiometric assay. Renal function was assessed based on urinary N-acetyl-βd-glucosaminidase (UNAG) and urinary albumin (UALB). The median BCd and UCd levels were 4.69 µg/L and 5.50 µg/g creatinine. The BCd, UCd, UNAG and UALB levels in subjects with low PTH (< 5.0 ng/L) were significantly higher than those with PTH ≥ 5.0 ng/L (p < 0.05 or p < 0.01). Spearman correlation analysis also showed that UCd level was negatively correlated to PTH levels (r = -0.17, p = 0.008). A weak correlation was also observed between BCd and PTH level (r = -0.11, p = 0.09). Univariable and mutivariable logistic regression analysis demonstrated that high BCd (> 10 µg/L) (odds ratio (OR) = 2.26, 95% confidence interval (CI):1.10–4.63; OR = 2.36, 95%CI: 1.11–5.05) and UCd level (> 20 µg/g cr) (OR = 2.84, 95%CI:1.32–6.10; OR = 2.97, 95%CI: 1.25–7.05) were associated with high risk of low PTH. Our data showed that environmental cadmium exposure was associated with low PTH level.

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Sarcopenia and anemia are common complication in patients with Crohn's Disease (CD). However, few studies have showed the association between sarcopenia and hemoglobin level in patients with CD. This study aimed to explore such association in a Chinese population with CD. Two hundreds and twelve adult CD inpatients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) examinations from July 2019 to December 2021 were included. Sarcopenia was defined according to the cutoff value of skeletal muscle index of lumbar spine 3 (SMI-L3) (< 44.77cm2/m2 for male and < 32.5cm2/m2 for female). The inpatients with CD were divided into two groups based on the presence or absence of sarcopenia. The clinical data, hemoglobin levels and other laboratory data were retrospectively collected. The association between hemoglobin levels and sarcopenia were identified through univariate and multivariate logistic regression analysis. Sarcopenia occurred in 114 CD patients (53.8%). Compared to patients without sarcopenia, patients with sarcopenia had significantly lower proportion of L1 (30.7% vs 45.8%, p = 0.032) and B1 classification (58.8% vs 72.4%, P = 0.037). Patients with sarcopenia had significant lower level of hemoglobin (Hb) (116.5 ± 22.8 vs 128.1 ± 21.0, p < 0.001). The prevalence of sarcopenia increased with the decrease of hemoglobin level (p for trend < 0.05). Linear regression analysis showed that hemoglobin levels were associated to SMI-L3 (β = 0.091, p = 0.001). Multivariate logistic regression analysis found that higher Hb (OR:0.98; 95% CI: 0.96,0.99; p = 0.034) were independent associated factors for sarcopenia. Lower Hb levels are independent associated factors of sarcopenia in adult inpatients with CD.

Quantitative computed tomography (QCT) has been used to diagnose osteoporosis. Whether the thresholds of lumbar bone mineral density (LBMD) are applicable to the thoracic spine should be validated. This study explored the value of lower thoracic BMD (TBMD) in diagnosing osteoporosis in older adults during CT lung cancer screening. This study included 610 subjects who underwent QCT scans with both LBMD and TBMD. Osteoporosis was diagnosed based on LBMD using the ACR criteria (gold standard). Receiver operating characteristic (ROC) curve was used to define the TBMD thresholds. TBMD was translated into LBMD (TTBMD) and osteoporosis was defined based on TTBMD using ACR criteria. The performance of TBMD thresholds and TTBMD in identifying osteoporosis was determined using the Kappa test. In addition, 227 subjects with baseline TBMD data and followed up spine fracture were included to show the association between TBMD- and TTBMD-based osteoporosis and fracture. The performance of TBMD in identifying osteoporosis was low (kappa = 0.66) if using the ACR criteria. Two thresholds of TBMD for identifying osteopenia (128 mg/cm3) and in identifying osteoporosis (91 mg/cm3) were obtained with areas under the curve of 0.97 and 0.99, respectively. The performance of the identification of osteoporosis/osteopenia using the two thresholds or TTBMD both had good agreement with the gold standard (kappa = 0.78, 0.86). Osteopenia and osteoporosis identified using the thresholds (adjusted hazard ratio (HR) = 4.43, 95% confidence interval (CI): 1.31–15.06; adjusted HR = 18.72, 95% CI: 5.13–68.36) or TTBMD (adjusted HR = 2.78, 95% CI: 1.16–6.72; adjusted HR = 10.28, 95% CI: 4.22–25.08) were also associated with fractures. Calculating the threshold of TBMD or normalizing TBMD to LBMD both showed good performance in identifying osteoporosis in older adults during CT lung cancer screening.

Background Sarcopenia and bone loss are both common in older individuals. However, the association between sarcopenia and bone fractures has not been evaluated longitudinally. In this study, we evaluated the association between computed tomography (CT)-based erector spinae muscle area and attenuation and vertebral compression fracture (VCF) in elderly individuals in a longitudinal study. Methods This study recruited individuals aged 50 years or older, who did not have VCF and underwent CT imaging for lung cancer screening during January 2016-December 2019. Participants were followed up annually until January 2021. Muscle CT value and muscle area of the erector spinae were determined for muscle assessment. Genant score was used to define new-onset VCF. Cox proportional hazards models were used to assess the association between muscle muscle area/attenuation and VCF. Results Of the 7906 included participants, 72 developed new VCF over a median follow-up of two years. Large area of the erector spinae (adjusted hazard ratio (HR) = 0.2, 95% confidence interval (CI) 0.1-0.7) and high bone attenuation (adjusted HR = 0.2, 95% CI: 0.1-0.5) were independently associated with VCF. High muscle attenuation was associated with severe VCF (adjusted HR = 0.46, 95% CI 0.24-0.86). The addition of muscle area improved the area under the curve of bone attenuation from 0.79 (95%CI 0.74-0.86) to 0.86 (95% CI: 0.82-0.91) (P =.001). Conclusion CT-based muscle area/attenuation of the erector spinae was associated with VCF in elderly individuals, independently of bone attenuation. The addition of muscle area improved the performance of bone attenuation in predicting VCF.