{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T03:11:30Z","timestamp":1779333090275,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2022R1A2C2092854"],"award-info":[{"award-number":["2022R1A2C2092854"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015098","name":"Seoul Metropolitan Government Seoul National University Boramae Medical Center","doi-asserted-by":"publisher","award":["30\u20102019\u201025"],"award-info":[{"award-number":["30\u20102019\u201025"]}],"id":[{"id":"10.13039\/501100015098","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Localized reduction in bone mineral density (BMD) within the proximal humerus may compromise anchor fixation strength and tendon\u2010to\u2010bone healing after rotator cuff repair; however, standardized dual\u2010energy X\u2010ray absorptiometry (DXA) protocols and diagnostic thresholds are lacking. This study aimed to develop a reproducible proximal humerus DXA protocol, evaluate regional BMD differences between affected and contralateral shoulders, and investigate the relationship between fatty infiltration and regional bone loss. A retrospective analysis was performed on 224 patients who underwent unilateral arthroscopic rotator cuff repair with preoperative bilateral shoulder DXA scans. The proximal humerus was divided into five anatomically defined regions of interest (R\n                    <jats:sub>1<\/jats:sub>\n                    \u2013R\n                    <jats:sub>5<\/jats:sub>\n                    ), and subgroup analysis was conducted according to supraspinatus fatty infiltration grade. The affected shoulder demonstrated lower BMD across all regions, although significant reductions were observed only in the medial humeral head (R\n                    <jats:sub>2<\/jats:sub>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and averaged humeral head BMD (R\n                    <jats:sub>234<\/jats:sub>\n                    ,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.011). Patients with mild fatty infiltration (Grades 0\u20132) showed BMD reduction primarily in periarticular regions, whereas advanced fatty infiltration (Grades 3\u20134) was associated with diffuse BMD loss across all regions. Femoral neck T\u2010score was moderately correlated with humeral head BMD (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.66,\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.488,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and regression analysis identified a proximal humerus osteoporosis threshold of 0.478\u2009g\/cm\n                    <jats:sup>2<\/jats:sup>\n                    , corresponding to a femoral neck T\u2010score of \u22122.17. This protocol enables reproducible regional BMD assessment and demonstrates fatty infiltration\u2013dependent bone loss progression. Femoral neck DXA may serve as a screening tool but is insufficient for definitive diagnosis.\n                  <\/jats:p>","DOI":"10.1002\/jor.70187","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T13:21:50Z","timestamp":1774963310000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Dual\u2010Energy X\u2010Ray Absorptiometry Protocol for the Proximal Humerus Reveals a Fatty Infiltration Dependent Reduction in Bone Mineral Density"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8517-8477","authenticated-orcid":false,"given":"Jae Woo","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, SMG\u2010SNU Boramae Medical Center Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Min","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, SMG\u2010SNU Boramae Medical Center Seoul National University College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3010-448X","authenticated-orcid":false,"given":"Sohee","family":"Oh","sequence":"additional","affiliation":[{"name":"Medical Research Collaborating Center SMG\u2010SNU Boramae Medical Center Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6161-5442","authenticated-orcid":false,"given":"Chris","family":"Hyunchul Jo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, SMG\u2010SNU Boramae Medical Center Seoul National University College of Medicine Seoul Korea"},{"name":"Department of Translational Medicine Seoul National University College of Medicine Seoul Korea"},{"name":"Institute of Reproductive Medicine and Population, Medical Research Center Seoul National University Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1096\/fj.202101484R"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.4055\/cios24015"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.20155"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-014-2795-1"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200311000-00021"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511415659"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518810763"},{"key":"e_1_2_10_9_1","first-page":"102","article-title":"Current Concepts in Arthroscopic Rotator Cuff Repair","volume":"28","author":"Lee K.\u2010S.","year":"2025","journal-title":"Clinics 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