Focus on diffusion MR investigations of musculoskeletal tissue to improve osteoporosis diagnosis: A brief practical review

Nowadays, a huge number of papers have documented the ability of diffusion magnetic resonance imaging (D-MRI) to highlight normal and pathological conditions in a variety of cerebral, abdominal, and cardiovascular applications. To date, however, the role of D-MRI to investigate musculoskeletal tissue, specifically the cancellous bone, has not been extensively explored. In order to determine potentially useful applications of diffusion techniques in musculoskeletal investigation, D-MRI applications to detect osteoporosis disease were reviewed and further explained

A distributed bio-inspired method for multisite grid mapping

Computational grids assemble multisite and multiowner resources and represent the most promising solutions for processing distributed computationally intensive applications, each composed by a collection of communicating tasks. The execution of an application on a grid presumes three successive steps: the localization of the available resources together with their characteristics and status; the mapping which selects the resources that, during the estimated running time, better support this execution and, at last, the scheduling of the tasks. These operations are very difficult both because the availability and workload of grid resources change dynamically and because, in many cases, multisite mapping must be adopted to exploit all the possible benefits. As the mapping problem in parallel systems, already known as NP-complete, becomes even harder in distributed heterogeneous environments as in grids, evolutionary techniques can be adopted to find near-optimal solutions. In this paper an effective and efficient multisite mapping, based on a distributed Differential Evolution algorithm, is proposed. The aim is to minimize the time required to complete the execution of the application, selecting from among all the potential ones the solution which reduces the use of the grid resources. The proposed mapper is tested on different scenarios

Evaluation of the performance of TDR and capacitance techniques for soil moisture measurement

Though researchers have employed various techniques (gravimetric, electromagnetic, neutron scattering, heat pulse, micro-wave and optical remote sensing techniques) for soil moisture measurement, dielectric based techniques (Time Domain Reflectometry, TDR, and capacitance technique, CT) have gained much more popularity, mainly due to revolutionary developments in the field of electronics and data communication systems. However, suitability and relative performance of these techniques for moisture measurement of soils is a point of debate. Hence, in order to address this issue, extensive studies were conducted on the soils of entirely different characteristics, compacted at various compaction states (dry density and water content) by employing TDR and capacitance probes. Subsequently, the dielectric constant of the soil and its bulk electrical conductivity were obtained using these probes and compared against each other and that computed from Topp’s equation, which is a well-established relationship between the dielectric constant of the soil and its volumetric moisture content. An attempt was also made to correlate Ka values obtained from the dielectric techniques and Topp’s equation with that of Time Propagation (TP) mixing model, which incorporates in it the properties of the soil matrix as well. It has been observed that Ka-TDR matches well with the Ka-Topp and Ka-TP, while the best match has been observed between Ka-TDR and Ka- Topp as compared to the Ka-CT. As such, the study demonstrates, clearly, that Topp’s equation, which ignores the soil specific parameters, is capable of determining the soil moisture content appropriately . This study proposes an empirical equation which relates dielectric constants obtained from Topp's equation to those obtained from the TDR, capacitance technique and TP mixing model. Such a relationship can be further utilized for estimating the volumetric soil moisture content

Differential features of muscle fiber atrophy in osteoporosis and osteoarthritis

We demonstrated that osteoporosis is associated with a preferential type II muscle fiber atrophy, which correlates with bone mineral density and reduced levels of Akt, a major regulator of muscle mass. In osteoarthritis, muscle atrophy is of lower extent and related to disease duration and severity. INTRODUCTION: Osteoarthritis (OA) and osteoporosis (OP) are associated with loss of muscle bulk and power. In these diseases, morphological studies on muscle tissue are lacking, and the underlying mechanisms of muscle atrophy are not known. The aim of our study was to evaluate the OP- or OA-related muscle atrophy and its correlation with severity of disease. Muscle levels of Akt protein, a component of IGF-1/PI3K/Akt pathway, the main regulator of muscle mass, have been determined. METHODS: We performed muscle biopsy in 15 women with OP and in 15 women with OA (age range, 60-85 years). Muscle fibers were counted, measured, and classified by ATPase reaction. By statistical analysis, fiber-type atrophy was correlated with bone mineral density (BMD) in the OP group and with Harris Hip Score (HHS) and disease duration in the OA group. Akt protein levels were evaluated by Western blot analysis. RESULTS: Our findings revealed in OP a preferential type II fiber atrophy that inversely correlated with patients' BMD. In OA, muscle atrophy was of lower extent, homogeneous among fiber types and related to disease duration and HHS. Moreover, in OP muscle, the Akt level was significantly reduced as compared to OA muscles. CONCLUSIONS: This study shows that in OP, there is a preferential and diffuse type II fiber atrophy, proportional to the degree of bone loss, whereas in OA, muscle atrophy is connected to the functional impairment caused by the disease. A reduction of Akt seems to be one of the mechanisms involved in OP-related muscle atrophy

Diffusion tensor imaging and magnetic resonance spectroscopy assessment of cancellous bone quality in femoral neck of healthy, osteopenic and osteoporotic subjects at 3T: Preliminary experience.

We assessed the potential of diffusion tensor imaging (DTI) in combination with proton magnetic resonance spectroscopy ((1)H-MRS), in cancellous bone quality evaluation of the femoral neck in postmenopausal women. INTRODUCTION: DTI allows for non-invasive microarchitectural characterization of heterogeneous tissue. In this work we hypothesized that DTI parameters mean diffusivity (MD) and fractional anisotropy (FA) of bone marrow water, can provide information about microstructural changes that occur with the development of osteoporosis disease. Because osteoporosis is associated with increased bone marrow fat content, which in principal can alter DTI parameters, the goal of this study was to examine the potential of MD and FA, in combination with bone marrow fat fraction (FF), to discriminate between healthy, osteopenic and osteoporotic subjects, classified according to DXA criteria. MATERIALS AND METHODS: Forty postmenopausal women (mean age, 68.7years; range 52-81years), underwent a Dual-energy X-ray absorptiometry (DXA) examination in femoral neck, to be classified as healthy (n=12), osteopenic (n=14) and osteoporotic (n=14) subjects. (1)H-MRS and DTI (with b value=2500s/mm(2)) of femoral neck were obtained in each subject at 3T. The study protocol was approved by local Ethics Committee. MD, FA, FF and MD/FF, FA/FF were obtained and compared among the three bone-density groups. One-way ANOVA with multiple comparisons Bonferroni test and Pearson correlation analysis were applied. Receiver operating characteristic (ROC) curve analysis was also performed. RESULTS: Reproducibility of DTI measures was satisfactory. CV was approximately 2%-3% for MD and 4%-5% for FA measurements. Moreover, no significant difference was found in both MD and FA measurements between two separate sessions (median 34days apart) comprised of six healthy volunteers. FF was able to discriminate between healthy and osteoporotic subjects only. Conversely MD and FA were able to discriminate healthy from osteopenic and healthy from osteoporotic subjects, but they were not able to discriminate between osteopenic and osteoporotic patients. A significant correlation between MD and FF was observed in healthy group only. A moderate correlation was found between MD and T-score when all groups together are considered. No significant correlation was found between MD and T-score within groups. A significant positive correlation between FA and FF was found in both osteopenic and osteoporotic groups. Vice-versa no correlation between FA and FF was observed in healthy group. A high significant positive correlation was found between FA and T-score in all groups together, in healthy and in osteoporotic groups. MD/FF and FA/FF are characterized by a higher sensitivity and specificity compared to MD and FA in the discrimination between healthy, and osteoporotic subjects. MD/FF vs FA/FF graph extracted from femoral neck, identify all healthy individuals according to DXA results. CONCLUSION: DTI-(1)H-MRS protocol performed in femoral neck seems to be highly sensitive and specific in identifying healthy subjects. A MR exam is more expensive when compared to a DXA investigation. However, even though DXA BMD evaluation has been the accepted standard for osteoporosis diagnosis, DXA result has a low predictive value on patients' risk for future fractures. Thus, new approaches for examining patients at risk for developing osteoporosis would be desirable. Preliminary results showed here suggest that future studies on a larger population based on DTI assessment in the femoral neck, in combination with (1)H-MRS investigations, might allow screening of high-risk populations and the establishment of cut-off values of normality, with potential application of the method to single subjects

Changes in serum levels of TNF-α, IL-6, OPG, RANKL and their correlation with radiographic and clinical assessment in fragility fractures and high energy fractures

Stages of bone turnover during fracture repair can be assessed employing serum markers of osteoblastic and osteoclastic activity, inflammatory cytokines, clinical evaluation and imaging instruments. Our study compare the fracture healing process in fragility fractures and high energy fractures by evaluating serum changes of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), osteoprotegerin (OPG) and receptor activator of the nuclear factor-kB ligand (RANKL) in combination with radiographic (Radiographic Union Scale for Tibial fractures, RUST) and clinical (Lower extremity measure, LEM) assessments. We enrolled 56 patients divided into four corresponding groups: group A with high energy trauma fracture (tibial/femoral shaft); group B with low energy trauma fracture (femoral fractures); healthy (control A) and osteoporotic subjects (control B). Blood samples were collected before surgery (T0) and after 10 weeks (T10). Serum concentrations of IL-6, TNF-α, RANKL and OPG were quantified using commercial enzyme-linked immunosorbent assay (ELISA) kits. Our results show that RANKL values are significantly higher at T10 than at T0 in low energy trauma fractures (group B). OPG is significantly lower in each control group than that of the respective fractured group and its concentration at T0 and at T10 is significantly lower in high than in low energy fractures. RANKL/OPG ratio is significantly higher in both controls than in fractured groups, and significantly increases after 10 weeks. IL-6 and TNF-α concentrations significantly decrease during fracture healing and are higher in high (group A) than in low energy fractures (group B). Significant differences were also found in both RUST score and LEM between groups A and B. Changes in TNF-α and IL-6 levels correlate with RUST and LEM in fragility and high energy fractures, while RANKL/OPG ratio is associated with these clinical parameters only in fragility fractures. These findings suggest that serum levels of IL-6, TNF-α, RANKL and OPG might be used to monitor the stages of fracture repair. Further studies will be needed to confirm the role of these cytokines in fracture repair

Vitamin D deficiency in myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is a multisystemic disorder affecting, among others, the endocrine system, with derangement of steroid hormones functions. Vitamin D is a steroid recognized for its role in calcium homeostasis. In addition, vitamin D influences muscle metabolism by genomic and non-genomic actions, including stimulation of the insulin-like-growth-factor 1 (IGF1), a major regulator of muscle trophism. To verify the presence of vitamin D deficit in DM1 and its possible consequences, serum 25-hydroxyvitamin D (25(OH)D), calcium, parathormone (PTH), and IGF1 levels were measured in 32 DM1 patients and in 32 age-matched controls. Bone mineral density (BMD) and proximal muscle strength were also measured by DXA and a handheld dynamometer, respectively. In DM1 patients, 25(OH)D levels were reduced compared to controls, and a significant decrease of IGF1 was also found. 25(OH)D levels inversely correlated with CTG expansion size, while IGF1 levels and muscle strength directly correlated with levels of 25(OH)D lower than 20 and 10 ng/ml, respectively. A significantly higher percentage of DM1 patients presented hyperparathyroidism as compared to controls. Calcium levels and BMD were comparable between the two groups. Oral administration of cholecalciferol in 11 DM1 patients with severe vitamin D deficiency induced a normal increase of circulating 25(OH)D, ruling out defects in intestinal absorption or hepatic hydroxylation. DM1 patients show a reduction of circulating 25(OH)D, which correlates with genotype and may influence IGF1 levels and proximal muscle strength. Oral supplementation with vitamin D should be considered in DM1 and might mitigate muscle weakness

Development and testing of a new instrument to measure self-care in patients with osteoporosis: the self-care of osteoporosis scale

Purpose: The aim of this study was to develop and test the Self-Care of Osteoporosis Scale (SCOS), a new instrument to measure self-care in postmenopausal women with osteoporosis. Methods: A cross-sectional study was conducted. The SCOS was developed by a panel of experts and it was theory-driven. Confirmatory factor analysis (N = 544) was used to test the instrument’s factorial validity; Cronbach’s alpha and McDonald’s omega were used to derive the measure’s internal consistency reliability; an intraclass correlation coefficient was used to evaluate test-retest reliability. Results: Confirmatory factor analysis resulted in supportive fit indices for the hypothesized three-factor structure of the SCOS (RMSEA = 0.065; CFI = 0.99). The SCOS was demonstrated to have content validity, internal consistency and test-retest reliability. Conclusions: The SCOS demonstrated excellent psychometric characteristics in terms of validity and reliability. It may be used by healthcare providers to identify if patients show lower self-care and require educational interventions