Artificial neural network analysis of bone quality DXA parameters response to teriparatide in fractured osteoporotic patients

Abstract

Teriparatide is a bone-forming therapy for osteoporosis that increases bone quantity and texture, with uncertain action on bone geometry. No data are available regarding its influence on bone strain. To investigate teriparatide action on parameters of bone quantity and quality and on Bone Strain Index (BSI), also derived from DXA lumbar scan, based on the mathematical model finite element method. Forty osteoporotic patients with fractures were studied before and after two years of daily subcutaneous 20 mcg of teriparatide with dual Xray photon absorptiometry to assess bone mineral density (BMD), hip structural analysis (HSA), trabecular bone score (TBS), BSI. Spine deformity index (SDI) was calculated from spine X-ray. Shapiro-Wilks, Wilcoxon and Student's t test were used for classical statistical analysis. Auto Contractive Map was used for Artificial Neural Network Analysis (ANNs). In the entire population, the ameliorations after therapy regarded BSI (-13.9%), TBS (5.08%), BMD (8.36%). HSA parameters of femoral shaft showed a worsening. Dividing patients into responders (BMD increase >10%) and non-responders, the first presented TBS and BSI ameliorations (11.87% and-25.46%, respectively). Non-responders presented an amelioration of BSI only, but less than in the other subgroup (-6.57%). ANNs maps reflect the mentioned bone quality improvements. Teriparatide appears to ameliorate not only BMD and TBS, but also BSI, suggesting an increase of bone strength that may explain the known reduction in fracture risk, not simply justified by BMD increase. BSI appears to be a sensitive index of TPD effect. ANNs appears to be a valid tool to investigate complex clinical systems.

Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index

“…A recent clinical study validated the BSI ability to monitor the effect of anabolic treatment for osteoporosis ( 87 ). Forty osteoporotic patients with fractures were studied before and after 2 years of daily subcutaneous 20 mcg of teriparatide and BMD, HSA, TBS, and BSI were measured.…”

Beyond bone mineral density: new developments in dual X-ray absorptiometry assessment of bone quality

“…This pattern can be explained by the soft tissue superimposed on the bone, which affects the X-ray image by generating noise and reducing image quality and accuracy [52] . The ability of BSI to monitor the effect of anabolic treatment for osteoporosis has been assessed in a recent clinical validation study [53] . Forty osteoporotic patients with fractures were studied before and after two years of daily subcutaneous 20 mcg of teriparatide.…”

Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study

“…Recent clinical studies demonstrated the usefulness of BSI in identifying patients at risk of fracture ( Ulivieri et al, 2018a ), in predicting the first fragility fracture ( Ulivieri et al, 2021 ; Sornay-Rendu et al, 2022 ) and re-fracture ( Ulivieri et al, 2021 ; Messina et al, 2021 ; Ulivieri et al, 2020a ), and in characterizing young patients affected by secondary osteoporosis ( Ulivieri et al, 2018b ; Rodari et al, 2018 ; Ulivieri et al, 2020b ). BSI has also been demonstrated to be a significant independent predictor of vertebral fractures (VFs) in primary hyperparathyroidism ( Tabacco et al, 2021 ) and to be positively influenced by the anabolic treatments of fractured osteoporotic patients, defining an increase of bone strength not merely justified by BMD increase ( Messina et al, 2020 ). Whether BSI could also be influenced also by anti-resorptive drugs has not been investigated so far.…”