Prognostic assessment of 18F-boronophenylalanine positron emission tomography (BPA-PET) in salvage boron neutron capture therapy for malignant brain tumors.

Background: Boron neutron capture therapy (BNCT) stands out as a propitious anti-cancer modality. 18F-boronophenylalanine positron emission tomography (BPA-PET) holds the potential to ascertain the concentration of BPA within the tumor, enabling meticulous treatment planning and outcome evaluation. However, no studies have been conducted on comparing the outcomes of those treated with BNCT to those who did not undergo this therapy. This study endeavors to analyze the correlation between BPA-PET and BNCT in the context of malignant brain tumors, and assess the survival outcomes following BNCT. Methods: A cohort study was performed on patients who underwent BPA-PET between February 2017 and April 2022 in our hospital. Patients were stratified into two groups: those subjected to BNCT (Group 1) and those not (Group 2). The tumor to normal tissue (T/N) ratio derived from BPA-PET was set at 2.5. The findings were scrutinized based on clinical follow-up. Student's t-test and Chi-squared test were employed to discern differences between the groups. A cumulative survival curve was constructed employing the Kaplan-Meier method. Differences were considered statistically significant at P<0.05. Results: In total, 116 patients with T/N ratios obtained from BPA-PET were enrolled. BNCT was administered to 58 patients, while mortality was observed in 100 patients. The median overall survival (OS) for the two groups was 8.5 and 6.0 months, respectively. The cumulative OS exhibited no significant discrepancy between the two groups, nor in their T/N ratios. Within Group 1, 44 out of 58 (75.9%) patients exhibited T/N ratios exceeding 2.5. Excluding 3 patients who expired within 3 months, 55 out of 58 patients were evaluated for response after BNCT. The objective response rate (ORR) was 30.9%. Patients achieving ORR displayed substantially higher survival rates compared to those without (median OS 13.5 vs. 8.3 months, P=0.0021), particularly when T/N ratio exceeded 2.5 (median OS 14.8 vs. 9.0 months, P=0.0199). Conclusions: BNCT does not appear indispensable for prolonging the survival of patients afflicted with malignant brain tumors. Nevertheless, it proves advantageous when ORR is attained, a condition closely linked to the values of T/N ratio derived from BPA-PET.

Bone Scan With SPECT/CT Demonstrated Phthisis Bulbi.

ABSTRACT: A 46-year-old man has a history of right eye vision loss from childhood due to an injury, right hypopharyngeal cancer with metastasis to right neck lymph nodes treated with concurrent chemoradiotherapy, and left tonsillar cancer after resection and adjuvant chemotherapy. Whole-body bone scan showed abnormal uptake to the right eye region, whereas SPECT/CT imaging localized this uptake to sharply defined, round to oval bone density foci of calcium scattered in the sclera and surrounding tissues, indicative of phthisis bulbi with posttraumatic calcification. Phthisis bulbi represents a shrunken ocular globe with calcification or ossification, typically as a sequela of trauma.

Survival outcomes of radium-223 therapy for metastatic castration-resistant prostate cancer following national health insurance reimbursement in Taiwan.

BACKGROUND: Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan. METHODS: Patients with mCRPC who underwent Ra-223 treatment at Taipei Veterans General Hospital were retrospectively enrolled. Each intravenous Ra-223 dose was administered at 55 kBq/kg at four-week intervals. Clinical outcomes were obtained from medical records; potential prognostic factors for survival were assessed. Kaplan-Meier analysis was used to generate cumulative survival curves; between-group differences were evaluated using the Chi-squared test. Statistical significance was set at p < 0.05. RESULTS: Seventy-six patients underwent Ra-223 therapy; 62 patients received NHI reimbursement and the remainder self-paid. Fifty patients (65.8%) completed six cycles of treatment; 26 (34.2%) received 1‒5 cycles. Mortality occurred in 47 patients. Factors significantly associated with survival included ≦ five bone metastases (p = 0.0018), baseline prostate-specific antigen (PSA) ≦ 36 ng/mL (p = 0.0004), baseline alkaline phosphate (ALP) < 115 U/L (p = 0.0007), and baseline hemoglobin (Hb) > 12 g/dL (p = 0.0029). Patients who completed six cycles of treatment achieved significantly higher OS compared to those who did not (p < 0.0001). There has been a 4.4-fold increase in the number of patients since reimbursement began; there was no significant difference in OS between patients who received NHI reimbursement and those who self-paid. CONCLUSION: Administration of Ra-223 demonstrates considerable potential to extend the survival of patients with mCRPC. Survival outcomes may be influenced by various prognostic factors. However, no significant difference in OS was observed subsequent to reimbursement of Ra-223 therapy for mCRPC through the NHI system in Taiwan.

The impact of diabetes, anemia, and renal function in the relationship between osteoporosis and fasting blood glucose among Taiwanese women: a cross-sectional study.

BACKGROUND: The aim of this study was to investigate the association between fasting blood glucose and osteoporosis in women with diabetes, anemia, and renal function. METHODS: The medical records of women who underwent a general health examination at a regional hospital in southern Taiwan were retrospectively reviewed. Logistic regression analysis was performed to assess the association between osteoporosis and fasting blood glucose separately for the eight subgroups (diabetes or non-diabetes, anemia or non-anemia, normal or decreased renal function), adjusting for other clinical characteristics and laboratory findings. RESULTS: A total of 11,872 women were included in the study. Among women with diabetes, anemia, and decreased renal function, an increment of 10 mg/dL in fasting blood glucose was associated with an increased risk of osteoporosis (adjusted odds ratio [aOR] = 1.57, p = 0.004). Among women without diabetes, fasting blood glucose was significantly associated with an increased risk of osteoporosis in those with anemia and normal renal function (OR = 1.14, p = 0.023) and those without anemia and normal renal function (OR = 1.04, p = 0.015), but these associations were not significant after adjusting for other covariates. CONCLUSIONS: Higher fasting blood glucose levels in women with diabetes, anemia, and decreased renal function were associated with an increased risk of osteoporosis. Clinicians should be vigilant about glucose control in patients with diabetes to reduce the risk of fracture.

Performance of ChatGPT incorporated chain-of-thought method in bilingual nuclear medicine physician board examinations.

Objective: This research explores the performance of ChatGPT, compared to human doctors, in bilingual, Mandarin Chinese and English, medical specialty exam in Nuclear Medicine in Taiwan. Methods: The study employed generative pre-trained transformer (GPT-4) and integrated chain-of-thoughts (COT) method to enhance performance by triggering and explaining the thinking process to answer the question in a coherent and logical manner. Questions from the Taiwanese Nuclear Medicine Specialty Exam served as the basis for testing. The research analyzed the correctness of AI responses in different sections of the exam and explored the influence of question length and language proportion on accuracy. Results: AI, especially ChatGPT with COT, exhibited exceptional capabilities in theoretical knowledge, clinical medicine, and handling integrated questions, often surpassing, or matching human doctor performance. However, AI struggled with questions related to medical regulations. The analysis of question length showed that questions within the 109-163 words range yielded the highest accuracy. Moreover, an increase in the proportion of English words in questions improved both AI and human accuracy. Conclusions: This research highlights the potential and challenges of AI in the medical field. ChatGPT demonstrates significant competence in various aspects of medical knowledge. However, areas like medical regulations require improvement. The study also suggests that AI may help in evaluating exam question difficulty and maintaining fairness in examinations. These findings shed light on AI role in the medical field, with potential applications in healthcare education, exam preparation, and multilingual environments. Ongoing AI advancements are expected to further enhance AI utility in the medical domain.

Hyperphosphatemia-Related False-Positive 99m Tc-Pyrophosphate Myocardial Scan: A Case Report With Endomyocardial Biopsy Result.

ABSTRACT: With documented high specificity, 99m Tc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99m Tc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition. In this case, hyperphosphatemia was the most likely and presumptive cause of the false-positive 99m Tc-PYP scan. With this case, our experiences of the potential causes of false-positive results of 99m Tc-PYP are further expanded.

Feasibility evaluation of middle-phase 18F-florbetaben positron emission tomography imaging using centiloid quantification and visual assessment.

Background: 18F-florbetaben (FBB) positron emission tomography (PET) scan has been widely used in research and routine clinical practice. Most studies used late-phase (scanning from 90 to 110 min after injection) FBB scans to generate beta-amyloid accumulation data. The feasibility of middle-phase scan is seldom discussed. Using the middle-phase data can shorten the patients' waiting between the injection and scan, and hospital can acquire more flexible schedule of routine scan. Methods: Paired middle-phase (60-80 min) FBB scans and standard (90-110 min) FBB scans were obtained from 27 subjects (12 neurodegenerative dementia, 8 mild cognitive impairment, 3 normal control, and 4 patients not suffering from neurodegenerative dementia). Standardized uptake value ratios (SUVRs) were calculated and converted to centiloid (CL) scale to investigate the impact on image quantification. CL pipeline validation were performed to build an equation converting the middle-phase data into equivalent standard scans. Cohen's kappa of binary interpretation and brain amyloid plaque load (BAPL) score were also used to evaluate the intrareader agreement of the FBB image from the two protocols. Results: The middle-phase FBB SUVR showed an excellent correlation, which provided a linear regression equation of SUVRFBB60-80 = 0.88 × SUVRFBB90-110 + 0.07, with R2=0.98. The slope of the equation indicated that there was bias between the middle and standard acquisition. This can be converted into the CL scale using CL = 174.68 × SUVR - 166.39. Cohen's kappa of binary interpretation and BAPL score were 1.0 (P<0.0001). Conclusions: Our findings indicate that the middle-phase FBB protocol is feasible in clinical applications for scans that are at either end of beta-amyloid spectrum, which provides comparable semiquantitative results to standard scan. Patient's waiting time between the injection and scan can be shortened.

Frontal Hypoperfusion and Cerebellar Hyperperfusion in Transient Alcoholic Cerebellar Degeneration.

ABSTRACT: A 55-year-old man consumed approximately 10 units of alcohol daily for 25 years, developing social withdrawal after retiring. For 2 months, he walked diagonally to the right, with a right shoulder droop. He spoke and walked slowly, but his speech was clear. After 20 days of abstinence, his symptoms improved, and his walk became more steady. Brain MRI revealed no specific finding. Brain perfusion scintigraphy with 99m Tc-ECD on 2-tailed view display in eZIS showed hypoperfusion in the prefrontal, frontal, and left anterior temporal lobes and left thalamus and hyperperfusion in the posterior white matter, parietal-occipital cortical regions, pons, and cerebellum.

Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer: A Systematic Review and Meta-analysis.

PURPOSE: Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68 Ga-PSMA-11, 18 F-DCFPyL, and 18 F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors. METHODS: This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools. RESULTS: Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences ( P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18 F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01). CONCLUSIONS: This meta-analysis found that whereas 18 F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.

Follow-up Tc-99 m pyrophosphate cardiac scan for patients with transthyretin cardiac amyloidosis treated with tafamidis.

BACKGROUND: Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported. METHODS: From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans. Tc-99 m PYP cardiac scan was performed with planar image and single photon emission computed tomography/computed tomography (SPECT/CT) 3 h after administration of Tc-99 m PYP. Perugini grading system was applied to determine positive or negative result of the scan. Heart to contralateral lung (H/CL) ratio as well as the difference of H/CL ratio between first and second Tc-99 m PYP cardiac scans (ΔH/CL ratio) was calculated. RESULTS: In the five patients participated in this study, three received tafamidis therapy and H/CL ratio was significantly decreased (p = 0.02) after tafamidis therapy. Besides, the ΔH/CL ratio was larger in patients with tafamidis therapy than that in those without tafamidis therapy, albeit not reaching statistical significance (p = 0.2). CONCLUSION: A decrease in H/CL ratio was found after tafamidis therapy in patients with ATTR-CA, albeit the magnitude of changes in the H/CL ratio (ΔH/CL ratio) was not significantly different from that of patients without tafamidis therapy. Future study with larger population might be required to further clarify the effect of tafamidis therapy on myocardial uptake of Tc-99 m PYP. CLINICAL TRIAL REGISTRATION: No clinical trial was conducted in our retrospective study.

Extrastriatal 99m Tc-TRODAT-1 Uptake in the Previous Hemorrhage With Hemosiderin Deposition.

ABSTRACT: We reported a 91-year-old man who was suspected of having parkinsonism, and brain 99m Tc-TRODAT-1 scan revealed an extrastriatal uptake in the left side of brainstem, which was correlated to a previously hemorrhagic lesion with hemosiderin deposition. Macrophage or microglia might accumulate in the previous hemorrhagic lesion to phagocytize hemosiderin. We assumed that the 99m Tc-TRODAT-1 uptake in the hemosiderin deposition might be partially mediated by macrophage expressing dopamine transporter.

Comparison of Trabecular Bone Score-Adjusted Fracture Risk Assessment (TBS-FRAX) and FRAX Tools for Identification of High Fracture Risk among Taiwanese Adults Aged 50 to 90 Years with or without Prediabetes and Diabetes.

Background and Objectives: The burden of osteoporosis is projected to increase. Identification and prompt intervention for osteoporotic fractures are important. Adjusting the Fracture Risk Assessment (FRAX®) tool with trabecular bone score (TBS) could improve risk prediction. However, little is known about whether TBS-adjusted FRAX® would change the proportion of individuals qualified for osteoporosis intervention. Therefore, the aim of the present study was to compare the proportions of Taiwanese adults who qualified for intervention, according to the FRAX® and TBS-adjusted FRAX®, with stratification by sex, age group, and glucose regulation status. Materials and Methods: A medical record review on adults 50−90 years who had undergone a general health examination in a regional hospital in Taiwan was conducted. FRAX® and TBS-adjusted FRAX® were calculated. FRAX® cut-points of ≥ 20% for major osteoporotic fracture and ≥3% for hip fracture were adopted to identify individuals qualified for osteoporosis intervention. Individuals were classified as prediabetes and diabetes if their HbA1c was 5.7−6.4% and >6.4%, respectively. Results: A total of 8098 individuals with a mean age of 61.0 years were included. The proportion of men qualified for intervention for hip fracture was significantly lower according to TBS-adjusted FRAX® (17.2%) compared with FRAX® (20.7%) (p < 0.001), with a similar pattern across all three age groups and in those with prediabetes. In contrast, the proportion of women qualified for intervention for major osteoporotic fracture was significantly higher according to TBS-adjusted FRAX® (4.6%) compared with FRAX® (3.7%) (p < 0.001), particularly among those with prediabetes 60−69 years. Conclusions: TBS-adjusted FRAX® led to small but significant changes in the proportions of individuals qualified for intervention in specific age groups and glucose regulation status.

Astrocyte Dysregulation and Calcium Ion Imbalance May Link the Development of Osteoporosis and Alzheimer's Disease.

The typical symptoms of patients with Alzheimer's disease (AD) are amyloid-ß (Aß) plaques and tau hyperphosphorylation. However, recent studies show that these symptoms are not the cause of the disease but are generated after the pathogenesis. Compared with other types of dementia, AD has the obvious features of pineal gland calcification and decreased melatonin production. The pineal gland is mainly composed of pinealocytes that release melatonin and astrocytes. Astrocytes function to maintain a balanced concentration of calcium ions, provide nerve cell nutrients, and migrate nutrients in vivo. Calcium ions are among the most important neurotransmitters. Once triggered, a calcium wave can be formed between astrocytes to activate other astrocytes to transmit information. Most calcium is stored in the skeleton. Bone tissue is composed mainly of osteocytes, osteoblasts, and osteoclasts. Of these, osteocyte is a kind of astrocyte which regulates the activity of osteoclasts and osteoblasts. The pineal gland is composed mainly of astrocytes; osteocytes are also a kind of astrocyte. Therefore, we conclude that when astrocytes are gradually disabled, calcium may be lost from the bones, prompting osteoporosis. The calcium ions then released into the blood may accumulate and cause ectopic calcification in the pineal gland, which promotes the occurrence of AD. Finally, this study used aspects of drugs and hormones (bone and calcium metabolism hormones and melatonin) to infer the hypothesis, which proposes that astrocyte dysregulation promotes the long-term imbalance of calcium ions in vivo and leads to osteoporosis and AD.

Bone Scan With SPECT/CT Demonstrated C1 to C2 Involvement in Rheumatic Arthritis.

ABSTRACT: An 80-year-old man was treated with rituximab for active rheumatoid arthritis until 2019, now controlled with Salazopyrin, prednisolone, methotrexate, and folic acid. However, laboratory data showed elevated C-reactive protein and erythrocyte sedimentation rate. Whole-body bone scan showed bony and joint destruction to the upper cervical vertebra (C spine), bilateral shoulders, wrists, finger joints, ankles, and left knee. SPECT/CT localized the upper C spine uptake to the C1/C2 joint and adjacent C1 and C2 with C1/C2 subluxation. C spine CT showed vertical atlantoaxial subluxation and bony erosions.

Changes in Bone Mineral Density and Trabecular Bone Score over Time between Vegetarian and Non-Vegetarian Middle-Aged and Older Women: A Three-Year Retrospective Medical Record Review.

The effect of a vegetarian diet on bone health remains controversial. This retrospective medical record review compared changes in bone mineral density (BMD) and trabecular bone score (TBS) between vegetarian and non-vegetarian middle-aged and older women who underwent two general health examinations (T1 and T2) that were approximately three years apart. Generalized estimating equations were used to compare the change in lumbar spine and bilateral hip BMD and TBS over time. At T1, the mean age of the patients was 56.6 years (standard deviation 9.7 years) and the mean interval between T1 and T2 was 2.7 years. For women aged 40-55 years, compared with non-vegetarians, vegetarians were significantly associated with a larger reduction in lumbar spine BMD (p < 0.001) and left hip femoral neck BMD (p = 0.015) over the three-year interval. On the contrary, changes in BMD were not significant at any site in women aged ≥ 56 years. Moreover, the changes in BMD and TBS over the three-year interval did not significantly differ between vegetarian and non-vegetarian women aged 65-90 years. In conclusion, for women aged 40-55 years, vegetarian diets reduced bone quantity, as measured by BMD, but not bone quality, as measured by TBS.

Association of Trabecular Bone Score-Adjusted Fracture Risk Assessment Tool with Coronary Artery Calcification in Women.

The trabecular bone score (TBS) was found to be significantly associated with moderate coronary artery calcification (CAC). The aim of this study was to further explore the association between TBS-adjusted Fracture Risk Assessment Tool (FRAX) and CAC score in women. The electronic medical record database of a regional teaching hospital in southern Taiwan yielded women who received both coronary computed tomography and bone mineral density (BMD) measurement during their general health examination. Health history, anthropomorphic measurements, laboratory results, BMD, and T-scores were obtained. TBS values were calculated from database spine dual-energy X-ray absorptiometry files. Linear regression analyses tested the association between CAC score and 10-year probability of major osteoporotic fracture (MOF) and hip fracture (HF) determined by TBS-adjusted FRAX. Of the 116 women (mean age 55.8 years) studied, 24.1% had osteoporosis. Simple linear regression showed a significant association of CAC score with an increase in MOF and HF risk as measured by TBS-adjusted FRAX. In multiple linear regression adjusted for potential confounders, CAC score remained significantly associated with TBS-adjusted FRAX for right MOF (p = 0.002), left MOF (p = 0 006), right HF (p = 0.005), and left HF (p = 0.015). In conclusion, clinicians should be vigilant to the potential increased risk of coronary events among women with increased TBS-adjusted FRAX for MOF and HF.

Seeing the Invisible: The Value of Bone Scan to Distinguish Chondroblastic Osteosarcoma From Prosthesis Loosening.

ABSTRACT: A 76-year-old woman with uterine cervical cancer 20 years ago received right total hip replacement 3 months ago for right hip avascular necrosis without specific intraoperative finding. She reported persistent right hip pain after falling from bed. Pelvic x-ray showed right pubic ramus fracture. To evaluate prosthesis loosening, 99mTc-MDP 3-phase bone scan was arranged, showing diffusely and heterogeneously increased vascularity and tracer perfusion over the right hip, with intensely and heterogeneously increased metabolism in the right iliac bone and hip. SPECT/CT showed nearby swelling of calcified muscles. After debridement and synovectomy, the pathologic report showed chondroblastic osteosarcoma.

Age-Specific Normative Values of Lumbar Spine Trabecular Bone Score (TBS) in Taiwanese Men and Women.

Trabecular bone score (TBS) is a novel method for assessing trabecular microarchitecture. Normative values of TBS are available for various populations of the world but are not yet available for Taiwanese adults. Therefore, the purpose of this study was to estimate age-specific, normative TBS curves for Taiwanese men and women. Medical records of general health examinations from a regional hospital in Southern Taiwan were reviewed. Individuals aged 30-90 years with data on lumbar spine bone mineral density (BMD) were included. TBS was retrospectively calculated from dual-energy X-ray absorptiometry scans using TBS iNsight software. Of the 12,028 patients included, 4533 (37.7%) were male and the mean age was 55.8 years. The mean TBS was 1.392 (standard deviation (SD) 0.089) for men and 1.344 (SD 0.107) for women. In women, TBS declined at a rate of 0.0004/year among those aged 30.0-45.9 years, 0.0106/year among those 46.0-60.7 years, and 0.0028/year among those 60.8-90.0 years. In men, TBS declined at a constant rate of 0.0023/year over the entire age range. In conclusion, age-adjusted, normative curves of TBS for Taiwanese men and women are presented, which could be used to facilitate the use of TBS in assessing bone status in clinical practice.

Research trends in trabecular bone score: A bibliometric review from 2008 to 2019.

OBJECTIVE: Trabecular bone score (TBS) is a novel index for assessing bone microarchitecture quality. No bibliometric reviews to date have yet explored the literature of TBS. Therefore, this study aimed to provide a bibliometric review on the trends of research publications on TBS indexed in the Science Citation Index Expanded and the Social Sciences Citation Index from 2008 to 2019. MATERIALS AND METHODS: Using the Science Citation Index Expanded and the Social Sciences Citation Index, articles designated as original articles or review articles were searched using the keyword "trabecular bone score." The retrieved articles were analyzed using Histcite 12.03.17 and VOSviewer v. 1.6.15 to identify top authors, journals, countries, and occurrence of keywords. RESULTS: A total of 430 original and review articles on TBS published between 2008 and 2019 were identified. The number of articles increased steadily from 2008 to 2019, reaching 80 articles in 2019 alone. The United States of America, Switzerland, and France were the countries with the highest output of publications. The journal Osteoporosis International published the largest number of articles on TBS. Analysis of co-occurrence of author-supplied keywords revealed four clusters, with TBS, bone mineral density, and osteoporosis as the most prominent keywords. CONCLUSION: This bibliometric study on TBS published between 2008 and 2019 revealed the collaborative network of countries and the highly published journals and authors. Co-occurrence of keywords also revealed clusters of research hotspots, which could contribute to the understanding of the current state of TBS research and the identification of research gap.

Bone Mineral Density and Hemoglobin Levels: Opposite Associations in Younger and Older Women.

This cross-sectional, retrospective medical record review study aimed to investigate the association between hemoglobin levels and bone mineral density (BMD) in adult women. Medical records obtained from general health examinations conducted from June 2014 to July 2020 at a regional hospital in southern Taiwan were reviewed. Anthropometric and laboratory data were recorded. BMD of the lumbar spine and bilateral femoral neck regions was assessed by dual energy X-ray absorptiometry. Linear regression analysis was used to assess the association between BMD and hemoglobin level with and without adjusting for other anthropometric and laboratory data. The study included 9606 female patients with a mean age of 55.9 years. Of these, 2756 (28.7%) were aged ≤ 50 years and 6850 (71.3%) were aged > 50 years. Results from multiple linear regression analysis showed that hemoglobin and femoral and lumbar spine BMD were significantly correlated. A higher hemoglobin level was significantly associated with a lower BMD level in females aged ≤ 50 years, but with a higher BMD level in those aged > 50 years. Given the relationship between bone metabolism and hematopoiesis, additional research is needed to elucidate the association between hemoglobin and BMD levels in different age groups, particularly in premenopausal and perimenopausal women.