Rm Meertens

Computer-aided detection in musculoskeletal projection radiography: A systematic review

OBJECTIVES To investigated the accuracy of computer-aided detection (CAD) software in musculoskeletal projection radiography via a systematic review. KEY FINDINGS Following selection screening, eligible studies were assessed for bias, and had their study characteristics extracted resulting in 22 studies being included. Of these 22 three studies had tested their CAD software in a clinical setting; the first study investigated vertebral fractures, reporting a sensitivity score of 69.3% with CAD, compared to 59.8% sensitivity without CAD. The second study tested dental caries diagnosis producing a sensitivity score of 68.8% and specificity of 94.1% with CAD, compared to sensitivity of 39.3% and specificity of 96.7% without CAD. The third indicated osteoporotic cases based on CAD, resulting in 100% sensitivity and 81.3% specificity. CONCLUSION The current evidence reported shows a lack of development into the clinical testing phase; however the research does show future promise in the variation of different CAD systems.

Use of near-infrared systems for investigations of hemodynamics in human in vivo bone tissue: A systematic review: NIR FOR HEMODYNAMIC BONE MEASUREMENTS

A range of technologies using near infrared (NIR) light have shown promise at providing real time measurements of hemodynamic markers in bone tissue in vivo, an exciting prospect given existing difficulties in measuring hemodynamics in bone tissue. This systematic review aimed to evaluate the evidence for this potential use of NIR systems, establishing their potential as a research tool in this field. Major electronic databases including MEDLINE and EMBASE were searched using pre‐planned search strategies with broad scope for any in vivo use of NIR technologies in human bone tissue. Following identification of studies by title and abstract screening, full text inclusion was determined by double blind assessment using predefined criteria. Full text studies for inclusion were data extracted using a predesigned proforma and quality assessed. Narrative synthesis was appropriate given the wide heterogeneity of included studies. Eighty‐eight full text studies fulfilled the inclusion criteria, 57 addressing laser Doppler flowmetry (56 intra‐operatively), 21 near infrared spectroscopy, and 10 photoplethysmography. The heterogeneity of the methodologies included differing hemodynamic markers, measurement protocols, anatomical locations, and research applications, making meaningful direct comparisons impossible. Further, studies were often limited by small sample sizes with potential selection biases, detection biases, and wide variability in results between participants. Despite promising potential in the use of NIR light to interrogate bone circulation, the application of NIR systems in bone requires rigorous assessment of the reproducibility of potential hemodynamic markers and further validation of these markers against alternative physiologically relevant reference standards.

The use of near infrared spectroscopy (NIRS) as a diagnostic tool to measure microvascular haemodynamics in bone tissue.

S OF OSTEOPOROSIS CONFERENCE 2016 Invited Plenary Lecture Abstracts IS1 FROM FAMILY HISTORY TO EPIGENETICS OF OSTEOPOROSIS Trevor Cole West Midlands Regional Genetics Service and Birmingham Health Partners, Birmingham Women’s Hospital NHS Foundation Trust, Birmingham, UK With the development of greater genetic knowledge and the advent of more powerful genomic technologies there has been a greater impetus to develop more personalised service delivery and treatments for both rare diseases and common disorders. The “flagship” of such developments was in the field of oncology but similar models are now widespread and this includes disorders associated with bone fragility. Osteoporosis in the general population most frequently presents as an isolated finding, but to date, when presenting to a combined bone and genetic clinic is more likely to be seen as “compounding morbidity” in a patient or family with one of the many different rare causes of bone fragility such as osteogenesis imperfecta. Over 140 such rare bone fragility conditions are listed on the London dysmorphology database. These may present antenataly right through into old age, each with differing severity but often exacerbated by osteoporosis in those surviving into adulthood. One important lesson learnt from such clinical experience is that taking a good clinical history, including a family history, not a reliance on genomic testing, is frequently the most valuable first step in recognising the aetiology and identifying whether other family members should be seen in clinic. In past decades genetic studies in osteoporosis focused on large genomic wide association studies or rare Mendelian families in the belief that a small number of genes would be identified as the cause for more widespread osteoporosis in the general population. It was hoped such findings could be translated into simple algorithms to predict future osteoporotic risk as well as identifying novel therapeutic targets. More recently it has become apparent that this is an over-simplification and not only are there many more genetic influences present than originally suspected, but that many of these may relate to epigenetic phenomena, a mechanism by which gene expression may be modified. This now opens up a whole new therapeutic opportunity as our epigenome is modifiable by many pharmacological and nonpharmacological interventions. It also likely provides new insights into the mechanisms behind well recognised influences on osteoporosis such as physical activity. While basic research continues to focus on the genomic and epigenomic basis of osteoporosis and bone fragility disorders we will illustrate there is still plenty of scope to introduce simple practical measures, such as taking a family history, into the clinic which will improve the clinical management as well as identifying potential patient cohorts to participate in studies investigating the aetiology and future therapeutic trials. IS2 DIABETES AND BONE Serge Ferrari Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland Type 1 diabetes that develops during childhood or adolescence impairs bone formation and thereby peak bone mass acquisition. Taken together with their increased risk of falls due to other diabetes complications, these bone alterations in adults with type 1 diabetes result in a 6 to 12 fold increased risk of hip fractures and also in a higher risk of vertebral and non-vertebral fractures. This increased fracture probability is also reflected in the FRAX tool when it is used without BMD in T1DM subjects. Subjects with type 2 diabetes (T2DM) also have a 50 % to two fold increased risk of fracture, depending on the skeletal site, despite the fact their aBMD is on average higher than in the non-diabetic population. Their increased Osteoporos Int (2016) 27 (Suppl 2):S609–S685 DOI 10.1007/s00198-016-3743-zThis is an abstract of a paper presented at the Osteoporosis Conference 2016, Birmingham, UK, 7-9 November 2016. The final publication is available at link.springer.com via http://dx.doi.org/10.1007/s00198-016-3743-z.This is an abstract of a paper presented at the Osteoporosis Conference 2016, Birmingham, UK, 7-9 November 2016. The final publication is available at link.springer.com via http://dx.doi.org/10.1007/s00198-016-3743-z.