• Journal of Korean Neurosurgical Society
• /
• v.62 no.4
• /
• pp.442-449
• /
• 2019

Objective : Bone mineral density (BMD) is an important consideration during fusion surgery. Although dual X-ray absorptiometry is considered as the gold standard for assessing BMD, quantitative computed tomography (QCT) provides more accurate data in spine osteoporosis. However, QCT has the disadvantage of additional radiation hazard and cost. The present study was to demonstrate the utility of artificial intelligence and machine learning algorithm for assessing osteoporosis using Hounsfield units (HU) of preoperative lumbar CT coupling with data of QCT. Methods : We reviewed 70 patients undergoing both QCT and conventional lumbar CT for spine surgery. The T-scores of 198 lumbar vertebra was assessed in QCT and the HU of vertebral body at the same level were measured in conventional CT by the picture archiving and communication system (PACS) system. A multiple regression algorithm was applied to predict the T-score using three independent variables (age, sex, and HU of vertebral body on conventional CT) coupling with T-score of QCT. Next, a logistic regression algorithm was applied to predict osteoporotic or non-osteoporotic vertebra. The Tensor flow and Python were used as the machine learning tools. The Tensor flow user interface developed in our institute was used for easy code generation. Results : The predictive model with multiple regression algorithm estimated similar T-scores with data of QCT. HU demonstrates the similar results as QCT without the discordance in only one non-osteoporotic vertebra that indicated osteoporosis. From the training set, the predictive model classified the lumbar vertebra into two groups (osteoporotic vs. non-osteoporotic spine) with 88.0% accuracy. In a test set of 40 vertebrae, classification accuracy was 92.5% when the learning rate was 0.0001 (precision, 0.939; recall, 0.969; F1 score, 0.954; area under the curve, 0.900). Conclusion : This study is a simple machine learning model applicable in the spine research field. The machine learning model can predict the T-score and osteoporotic vertebrae solely by measuring the HU of conventional CT, and this would help spine surgeons not to under-estimate the osteoporotic spine preoperatively. If applied to a bigger data set, we believe the predictive accuracy of our model will further increase. We propose that machine learning is an important modality of the medical research field.

• Journal of radiological science and technology
• /
• v.23 no.2
• /
• pp.13-19
• /
• 2000

There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and Febuary in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry(DEXA). The result was compared using age matched paired T test. The results were as follows ; 1. The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. 2. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. 3. The bone density of neck, Ward's triangle, trochanter(P<0.05) and lumbar spine(P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. 4. The bone density of neck, Ward's triangle, trochanter(P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. 5. The bone density of neck, Ward's triangle, trochanter and lumbar spine(P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities(BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

• The Journal of Korean Medicine
• /
• v.42 no.2
• /
• pp.90-97
• /
• 2021

Bone mineral density (BMD) is a major diagnostic marker for bone health. A 44-year-old male had BMD of 0.81 g/cm² (Z-score: -3.1) in lumbar spine scan and 0.54 g/cm² (Z-score: -2.7) for femoral neck from regular medical checkup in Apr 2020. He had no other specific medical conditions except hyperlipidemia and alcohol was a single risk factor for fracture according to Fracture Risk Assessment Tool. After he was diagnosed with liver-kidney deficiency and treated for 20 weeks with Jeopgol-tang originally patented for promoting fracture recovery, lumbar spine BMD increased by 13.6 % (0.92 g/cm², Z-score: -2.1) and femoral neck BMD by 22.2% (0.66 g/cm², Z-score: -1.8) compared with those of Mar 2020. Herbal medicine treatment for tonifying liver and kidney to improve BMD warrants further investigation.

• The Journal of the Korea Contents Association
• /
• v.11 no.10
• /
• pp.488-493
• /
• 2011

The Korean spine geometry and property data for researchers were made by KISTI and Catholic Institute for Applied Anatomy. We took whole spine CT, X-Ray, BMD scan for making high resolution cross-sectional spine images using more 20 donated cadavers(60 - 80 years). Then we constructed 3-dimensional volume model using serial CT images by Mimics software. The major morphometric parameters of vertebrae were measured. Mechanical motion and property data were obtained by the same cadavers using the DEXA for BMD and the spine simulator. The Korean spine geometry and property data could be used for research and development of medical device.

• Genomics & Informatics
• /
• v.12 no.3
• /
• pp.114-120
• /
• 2014

Bone mineral density (BMD) is one of the quantitative traits that are genetically inherited and affected by various factors. Over the past years, genome-wide association studies (GWASs) have searched for many genetic loci that influence BMD. A recent meta-analysis of 17 GWASs for BMD of the femoral neck and lumbar spine is the largest GWAS for BMD to date and offers 64 single-nucleotide polymorphisms (SNPs) in 56 associated loci. We investigated these BMD loci in a Korean population called Korea Association REsource (KARE) to identify their validity in an independent study. The KARE population contains genotypes from 8,842 individuals, and their BMD levels were measured at the distal radius (BMD-RT) and midshaft tibia (BMD-TT). Thirteen genomic loci among 56 loci were significantly associated with BMD variations, and 3 loci were involved in known biological pathways related to BMD. In order to find putative functional variants, nearby SNPs in relation to linkage equilibrium were annotated, and their possible functional effects were predicted. These findings reveal that tens of variants, not a single factor, may contribute to the genetic architecture of BMD; have an important role regardless of ethnic group; and may highlight the importance of a replication study in GWASs to validate genuine loci for BMD variation.

• Journal of Nutrition and Health
• /
• v.39 no.5
• /
• pp.485-493
• /
• 2006

The purpose of this study was to investigate the relationships among nutrient intakes, BMD, serum copper, zinc and manganese contents in Korean postmenopausal women residing in Seoul and Kyunggi-do. Nutrient intakes analyses and anthropometric measurements were performed for 64 postmenopausal women. Also, fasting blood samples were collected. The BMDs of the lumbar spine (L2-L4) and femoral neck were measured by dual energy X-ray absorptiometry (DEXA). Subjects were classified into three groups: osteoporosis (T-score ${\leq}$ -2.5, n = 20), osteopenia (-2.5 < T-score ${\leq}$ -1, n = 24), and normal (T-score) -1, n = 20). The results are summarized as follows; the mean age, height and weight were 62.1 yrs, 153.8 em, and 56.1 kg, respectively, with no significant difference among three groups. On the other hand, the mean BMI $(23.7\;g/m^2)$ of normal group was significantly higher than those of other two groups. The mean energy intake was 1,395.3 kcal (77.5% of Dietary referance intakes for koreans (KDRls)). The average daily intakes of vitamin $B_2$, calcium and zinc did not reach KDRIs. The mean intakes of iron, copper, zinc and manganese were 10.9 mg, 1.6 mg, 7.8 mg and 5.1 mg respectively, with no significant difference among three groups, The mean serum levels of copper, zinc and manganese were 96.4 mg/dl, 91.5 mg/dl and 39.5 ng/dl, respectively with no significant differences among three groups. The BMD of lumbar spine showed a significantly negative correlation intakes of animal protein, fat and iron intakes after adjusting for age, Bill. However, the BMD of lumbar spine was not significantly correlated with animal iron intakes after adjusting for animal protein, and fat intakes, indicating animal food intake is a possible confounding factor. Proper intakes of vitamin $B_2$, vitamin C are required to protect osteoporosis in postmenopausal women. These results suggest that excessive animal food intakes may have adverse effect on bone mineral density. Further studies arc necessary to elucidate the role of serum minerals in BMD.

• Clinical and Experimental Pediatrics
• /
• v.60 no.12
• /
• pp.403-407
• /
• 2017

Purpose: Quadriplegic children with cerebral palsy are more susceptible to osteoporosis because of various risk factors that interfere with bone metabolism. Pamidronate is effective for pediatric osteoporosis, but there are no guidelines for optimal dosage or duration of treatment in quadriplegic children with osteoporosis. We aimed to evaluate the efficacy of low-dose pamidronate treatment in these patients. Methods: Ten quadriplegic patients on antiepileptic drugs (6 male, 4 female patients; mean age, $10.9{\pm}5.76years$), with osteoporosis and gross motor function classification system level V, were treated with pamidronate (0.5-1.0 mg/kg/day, 2 consecutive days) every 3-4 months in a single institution. The patients received oral supplements of calcium and vitamin D before and during treatment. The lumbar spine bone mineral density (BMD) z score and biochemical markers of bone metabolism were measured regularly during treatment. Results: The main underlying disorder was perinatal hypoxic brain damage (40%, 4 of 10). The mean cumulative dose of pamidronate was $4.49{\pm}2.22mg/kg/yr$, and the mean treatment period was $10.8{\pm}3.32months$. The BMD z score of the lumbar spine showed a significant increase from $-4.22{\pm}1.24$ before treatment to $-2.61{\pm}1.69$ during treatment (P=0.008). Alkaline phosphatase decreased during treatment (P=0.037). Significant adverse drug reactions and new fractures were not reported. Conclusion: Low-dose pamidronate treatment for quadriplegic children with cerebral palsy increased lumbar BMD and reduced the incidence of fracture.

• The Journal of Churna Manual Medicine for Spine and Nerves
• /
• v.1 no.1
• /
• pp.105-111
• /
• 2006

Objective : The aim of this study was to evaluate association between lumbar spinal stenosis, one of degenerative diseases, and bone mineral density. Methods : We monitored 9 lumbar spinal stenosis patients in women above 50 years, visiting outpatient clinic of the Jaseng Oriental Medicine Hospital between January 5 2006 and March 31, 2006. They were diagnosed by radiologist ist after taking Magnetic Resonance Imaging(MRI). The cases were Investigated the bone mineral density using Dual Energy X-ray Absorptiomerty(DEXA). and then Picture Archiving Communication System(PACS) were used to assess correlation between lumbar spinal stenosis and bone mineral density. Results : 1. In comparison of the spinal canal area and lumbar spine 2 level bone mineral density, the data showed a significant result 2. The data, between spinal canal area and lumbar spine 1-2 level bone mineral density, indicated a significant result. 3. Also, the result of comparison between spinal canal area and the lowest value of bone mineral density showed significance. Conclusions : It showed that there is a statistically significant correlation between lumbar spinal stenosis and bone mineral density.

• Journal of Nutrition and Health
• /
• v.32 no.8
• /
• pp.935-945
• /
• 1999

The factors affecting bone mineral density (BMD) of 103 rural women aged 30 to 76 years were investigated. Data for food and nutrient intake was obtained by 24-hour recall method. BMD of lumbar spine(L1-L4), femoral neck, ward's triangle and trochanter was measured by XR-series x-ray bone densitometer. Serum was collected and analyzed for total Ca, P and ionized Ca (Ca++)content. Relationship between the factors and BMDs was analyzed by Pearson's correlation coefficient(r) and multiple regression analysis. The results are summarized as follows. 50% of the subjects under 50 years of age($\leq$49 yr group) and 86.4% of the subjects from 50 up($\geq$50yr group) were classified as osteopenia or osteoporosis. Mean body weight, height and BMI were 153.1cm, 59.1kg and 25.0kg/$m^2$ in $\leq$49 yr group and 151.9cm, 55.9kg, and 24.2kg/$m^2$ in $\geq$50 yr group. BMDs of lumbar spines and femurs ranged from 0.84 to 1.05g/$m^2$ and from 0.67 to 1.16g/$m^2$ in $\leq$49 yr group, and ranged from 0.67 to 0.85kg/$m^2$ and from 0.68 to 0.44g/$m^2$ in $\geq$50 yr group, respectively. On the whole, the BMDs were reduced to 83.8 to 94.2% of peck bone mass in $\leq$49 yr group and 55.2 to 78.9% of those in $\geq$50 yr group. Mean daily intake of Ca was much less than the Korean RDA, \67.2% in $\leq$49 yr group and 62.3% in $\geq$50 yr group. The average concentration of total Ca, P and Ca++ in serum were within normal range in both age group. Both age and height were significantly related with BMD in both age group but the relationship tended to be stronger in $\geq$50 yr group than in $\leq$49 yr group. Body weight was also a potent determinant of BMD only in 50 yr group. In $\leq$49 yr group, total food intake was positively related with BMDs of ward's triangle, L1 and L2 and intake of cereals and grain products, sugars and sweets, milk and dairy products was positively related with BMDs measured in this study. On the contrary, intake of eggs, oil and fats were positively related with a few BMDs in 50 yr group. The BMDs were positively affected by intake of energy, protein, carbohydrate, Ca, P and Fe in $\leq$49 yr group and those of protein, fat Ca, P, vitamin B1, vitamin B2 and vitamin C in $\geq$50 yr group. It was noteworthy that serum Ca++ concentration was positively related with BMDs of lumbar spine in boty age groups. According to multiple regression analysis, the four factors, age, body weight, height and BMI additionally accounted for 21% of the variance in BMD of trochanter in $\leq$49 yr group and only two factors, age and C a intake accounted for 38% of that of femoral neck in $\geq$50 yr group. Further investigation is necessary to make sure of the relations between BMD and serum Ca++ level.

• Journal of Nutrition and Health
• /
• v.31 no.9
• /
• pp.1446-1456
• /
• 1998

Bones are important parts in sustaining the shape of the body, but they are also metabolic organs which undergo bone remodeling by constant bone resorption and formation. Osteoporosis, the typical metabolic bone disease, is characterized by a reduction in bone mineral density (BMD). Women more than men are at risk fir osteoporosis-related fractures, especially in the lumbar spine, wrist, and hip region. Risk of fracture depends on one's BMD, which open determined by the peak bone mass value achieved at skeletal maturity and followed by subsequent age-and menopause-related bone loss. Genetic and environmental factors are known to play a key role in bone metabolism and diet is considered as one of the important environmental factors. The purpose of the present study was to assess the status of BMD and bone mineral content(BMC) to clarify the relationships between dietary intakes and the risk of osteoporosis in adult women in Taegu. Subjects were 130 healthy females in between 20 and 69 years of age. BMD and BMC of the lumbar spine(venebrae L2-4) of the subjects were measured by dual energy X-ray absorptiometry. The average age of the subjects was 47.4${\pm}$11.7 years old, the average weight was 57.2${\pm}$8.4kg, the average age of menarche was 16.6${\pm}$1.9 years old and the average age of menopause was 48.4${\pm}$5.3 years old. The nutrient intakes of the subjects measured by the convenient method were generally lower than the level of RDA. The result of nutrient intake assessed has shown that the average energy intake was 1701${\pm}$316kca1 which is 85.1% of the RDA and the average calcium intake was 485.4${\pm}$172.3mg which is 69.3% of the RDA. The intakes of protein, vitamin A, vitamin B$_1$, niacin were greater than the RDA, whereas the remaining nutrient intakes were lower than the RDA. The average BMD of the subjects was shown to be 1.06${\pm}$1.09g/$\textrm{cm}^2$. The highest BMD of 1.24${\pm}$0.14g/$\textrm{cm}^2$ was noticed in the subjects of 30s compared to 20s, 40s, 50s, 60s. The BMD values were compared by the relative body weight(R3W) of the menopause subjects, and it was found that the underweight group had significant lower BMB while the rest of the groups did not have any differences in BMD. The most strongly correlated nutrient with BMD among the menopause subjects appeared to be calcium. The women whose Ca intakes were higher than 500mg showed the significantly higher BMD than those with Ca intakes lower than 500mg. This study suggests that the most effective way to prevent osteoporosis and to reduce the incidences of fractures seems to be minimizing bone loss through the adequate intake of calcium as well as avoiding underweight, especially in menopausal women. (Korean J Nutrition 31(9) . 1446-1456, 1998)