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Prijatelj V, Grgic O, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C. Bone health index in the assessment of bone health: The Generation R Study. Bone 2024; 182:117070. [PMID: 38460828 DOI: 10.1016/j.bone.2024.117070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
Bone Health Index (BHI) has been proposed as a useful instrument for assessing bone health in children. However, its relationship with fracture risk remains unknown. We aimed to investigate whether BHI is associated with bone mineral density (BMD) and prevalent fracture odds in children from the Generation R Study. We also implemented genome-wide association study (GWAS) and polygenic score (PGS) approaches to improve our understanding of BHI and its potential. In total, 4150 children (49.4 % boys; aged 9.8 years) with genotyped data and bone assessments were included in this study. BMD was measured across the total body (less head following ISCD guidelines) using a GE-Lunar iDXA densitometer; and BHI was determined from the hand DXA scans using BoneXpert®. Fractures were self-reported collected with home questionnaires. The association of BHI with BMD and fractures was evaluated using linear models corrected for age, sex, ethnicity, height, and weight. We observed a positive correlation between BHI and BMD (ρ = 0.32, p-value<0.0001). Further, every SD decrease in BHI was associated with an 11 % increased risk of prevalent fractures (OR:1.11, 95 % CI 1.00-1.24, p-value = 0.05). Our BHI GWAS identified variants (lead SNP rs1404264-A, p-value = 2.61 × 10-14) mapping to the ING3/CPED1/WNT16 locus. Children in the extreme tails of the BMD PGS presented a difference in BHI values of -0.10 standard deviations (95% CI -0.14 to -0.07; p-value<0.0001). On top of the demonstrated epidemiological association of BHI with both BMD and fracture risk, our results reveal a partially shared biological background between BHI and BMD. These findings highlight the potential value of using BHI to screen children at risk of fracture.
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Affiliation(s)
- Vid Prijatelj
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Olja Grgic
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands; The Generation R Study, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015, GD, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, the Netherlands.
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Middelkoop K, Micklesfield LK, Walker N, Stewart J, Delport C, Jolliffe DA, Mendham AE, Coussens AK, van Graan A, Nuttall J, Tang JCY, Fraser WD, Cooper C, Harvey NC, Hooper RL, Wilkinson RJ, Bekker LG, Martineau AR. Influence of vitamin D supplementation on bone mineral content, bone turnover markers, and fracture risk in South African schoolchildren: multicenter double-blind randomized placebo-controlled trial (ViDiKids). J Bone Miner Res 2024; 39:211-221. [PMID: 38477739 PMCID: PMC11240149 DOI: 10.1093/jbmr/zjae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/27/2023] [Accepted: 01/05/2024] [Indexed: 03/14/2024]
Abstract
Randomized controlled trials (RCTs) to determine the influence of vitamin D on BMC and fracture risk in children of Black African ancestry are lacking. We conducted a sub-study (n = 450) nested within a phase 3 RCT of weekly oral supplementation with 10 000 IU vitamin D3 vs placebo for 3 yr in HIV-uninfected Cape Town schoolchildren aged 6-11 yr. Outcomes were BMC at the whole body less head (WBLH) and LS and serum 25-hydroxyvitamin D3 (25(OH)D3), PTH, alkaline phosphatase, C-terminal telopeptide, and PINP. Incidence of fractures was a secondary outcome of the main trial (n = 1682). At baseline, mean serum 25(OH)D3 concentration was 70.0 nmol/L (SD 13.5), and 5.8% of participants had serum 25(OH)D3 concentrations <50 nmol/L. Among sub-study participants, end-trial serum 25(OH)D3 concentrations were higher for participants allocated to vitamin D vs placebo (adjusted mean difference [aMD] 39.9 nmol/L, 95% CI, 36.1 to 43.6) and serum PTH concentrations were lower (aMD -0.55 pmol/L, 95% CI, -0.94 to -0.17). However, no interarm differences were seen for WBLH BMC (aMD -8.0 g, 95% CI, -30.7 to 14.7) or LS BMC (aMD -0.3 g, 95% CI, -1.3 to 0.8) or serum concentrations of bone turnover markers. Fractures were rare among participants in the main trial randomized to vitamin D vs placebo (7/755 vs 10/758 attending at least 1 follow-up; adjusted odds ratio 0.70, 95% CI, 0.27 to 1.85). In conclusion, a 3-yr course of weekly oral vitamin D supplementation elevated serum 25(OH)D3 concentrations and suppressed serum PTH concentrations in HIV-uninfected South African schoolchildren of Black African ancestry but did not influence BMC or serum concentrations of bone turnover markers. Fracture incidence was low, limiting power to detect an effect of vitamin D on this outcome.
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Affiliation(s)
- Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Lisa K Micklesfield
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Neil Walker
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Justine Stewart
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Carmen Delport
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - David A Jolliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
| | - Amy E Mendham
- Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), University of Cape Town, Newlands, Cape Town 7700, Western Cape, South Africa
- Department of Paediatrics, SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg 2193, Gauteng, South Africa
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria 3052, Australia
| | - Averalda van Graan
- Biostatistics Unit, SAFOODS Division, South African Medical Research Council, Tygerberg, Cape Town 7505, Western Cape, South Africa
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, Western Cape, South Africa
| | - James Nuttall
- Department of Paediatrics and Child Health, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town 7700, Western Cape, South Africa
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom
- Departments of Laboratory Medicine, Clinical Biochemistry and Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich NR4 7UY, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Richard L Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, United Kingdom
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- The Francis Crick Institute, London NW1 1AT, United Kingdom
- Imperial College London, London W12 0NN, United Kingdom
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Institute of Infectious Diseases & Molecular Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, Western Cape, South Africa
| | - Adrian R Martineau
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, United Kingdom
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Shawar RS, Puyau M, Shypailo R, Musaad S, Butte NF, Bacha F. Adiposity, Insulin Resistance, Cardiorespiratory Fitness, and Bone Health in Hispanic Children. J Clin Endocrinol Metab 2022; 107:e3797-e3804. [PMID: 35662345 PMCID: PMC9387690 DOI: 10.1210/clinem/dgac344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Childhood obesity disproportionately affects Hispanic youth. The skeletal system appears to be a target organ of the adverse effects of obesity. Yet, the relationship between adiposity and bone health in youth and the modulating factors are not well understood. OBJECTIVE This work aims to examine the relationship between adiposity, insulin resistance (IR), cardiorespiratory fitness (CRF), and bone mass in Hispanic youth. METHODS A total of 951 Hispanic youth (50% male), aged 4 to 19 years, participated in this cross-sectional design study from the Viva La Familia Study at Children's Nutrition Research Center. Bone mineral content (BMC) and density (BMD), lean mass (LM), total body fat mass (FM), truncal FM were obtained using dual-energy x-ray absorptiometry. Fasting glucose and insulin were obtained and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. CRF was measured using a treadmill ramp protocol. We applied linear regression models and mediation analyses. RESULTS Adiposity measures were negatively related to BMC and BMD after accounting for LM and sex. IR negatively contributed whereas CRF positively contributed to the variance in BMC and BMD, more notably in the pubertal age group. In mediation analysis, HOMA-IR partially mediated the negative relationship of adiposity to BMC (standardized indirect effect [IE] = -0.0382; 95% CI, -0.0515 to -0.0264) whereas the sequential IE of HOMA-IR and CRF partially attenuated (IE = -0.0026; 95% CI, -0.0053 to -0.0005) this relationship. Similar findings were seen with BMD as the primary outcome. CONCLUSION IR mediates the negative relationship between adiposity and bone mass whereas CRF may partially attenuate it.
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Affiliation(s)
- Reem S Shawar
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
- Division of Pediatric Endocrinology and Diabetes, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Maurice Puyau
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Roman Shypailo
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Salma Musaad
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Nancy F Butte
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Fida Bacha
- Correspondence: Fida Bacha, MD, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, 1100 Bates S, Houston, TX 77030, USA.
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Ibeneme SC, Uwakwe VC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun TA, Ezuma AD, Okonkwo UP, Fortwengel G. Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:469. [PMID: 35578192 PMCID: PMC9109396 DOI: 10.1186/s12879-022-07145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Symptoms of depression are prevalent in people living with human immune deficiency virus/acquired immune deficiency syndrome (PLWHA), and worsened by lack of physical activity/exercises, leading to restriction in social participation/functioning. This raises the question: what is the extent to which physical exercise training affected, symptoms of depression, physical activity level (PAL) and social participation in PLWHA compared to other forms of intervention, usual care, or no treatment controls? METHOD Eight databases were searched up to July 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Only randomised controlled trials involving adults who were either on HAART/HAART-naïve and reported in the English language, were included. Two independent reviewers determined the eligibility of the studies, extracted data, assessed their quality, and risk of bias using the Physiotherapy Evidence Database (PEDro) tool. Standardised mean difference (SMD) was used as summary statistics for the mean primary outcome (symptoms of depression) and secondary outcomes (PAL and social participation) since different measuring tools/units were used across the included studies. Summary estimates of effects were determined using a random-effects model (I2). RESULTS Thirteen studies met the inclusion criteria with 779 participants (n = 596 participants at study completion) randomised into the study groups, comprising 378 males, 310 females and 91 participants with undisclosed gender, and with an age range of 18-86 years. Across the studies, aerobic or aerobic plus resistance exercises were performed 2-3 times/week, at 40-60 min/session, and for between 6-24 weeks, and the risk of bias vary from high to low. Comparing the intervention to control groups showed significant difference in the symptoms of depression (SMD = - 0.74, 95% confidence interval (CI) - 1.01, - 0.48, p ≤ 0.0002; I2 = 47%; 5 studies; 205 participants) unlike PAL (SMD = 0.98, 95% CI - 0.25, 2.17, p = 0.11; I2 = 82%; 2 studies; 62 participants) and social participation (SMD = 0.04, 95% CI - 0.65, 0.73, p = 0.91; I2 = 90%; 6 studies; 373 participants). CONCLUSION Physical exercise training could have an antidepressant-like effect in PLWHA but did not affect PAL and social participation. However, the high heterogeneity in the included studies, implies that adequately powered randomised controlled trials with clinical/methodological similarity are required in future studies. TRAIL REGISTRATION NUMBER INPLASY202040048.
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Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa.
- University of Nigeria, University of Nigeria Centre for Clinical Trials (UNNCET), 1 College Road, New Layout, Enugu, 400001, Nigeria.
- Department of Physiotherapy, Faculty of Health Sciences & Technology, King David University of Medical Sciences, Amasir i- Afikpo Road, Uburu, 491101, Ebonyi State, Nigeria.
| | - Victor Chukwuebuka Uwakwe
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Franklin Onyedinma Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Division of Exercise Science and Sports Medicine, University of Cape Town/Sports Science, Institute of South Africa, Boundary Road, Newlands, Cape Town, 7725, Western Cape, South Africa
| | - Tunde Adedayo Ajidahun
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Amarachi Destiny Ezuma
- Department of Physiotherapy, University of Nigeria Teaching Hospital, KM 35 Enugu Port-Harcourt Expressway, Ituku/Ozalla, 400001, Enugu, Nigeria
| | - Uchenna Prosper Okonkwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, Nnamdi Azikiwe University, Okofia, Nnewi Campus, Nnewi, 435101, Anambra State, Nigeria
| | - Gerhard Fortwengel
- Fakultat III, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza, Hannover, 30539, Lower Saxony, Germany
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Banica T, Vandewalle S, Zmierczak HG, Goemaere S, De Buyser S, Fiers T, Kaufman JM, De Schepper J, Lapauw B. The relationship between circulating hormone levels, bone turnover markers and skeletal development in healthy boys differs according to maturation stage. Bone 2022; 158:116368. [PMID: 35181575 DOI: 10.1016/j.bone.2022.116368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/17/2022] [Accepted: 02/11/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This study investigates peri-pubertal changes in bone turnover markers, Wnt-signalling markers, insulin-like growth factor-1 (IGF-1) and sex steroid levels, and how they reflect skeletal development in peri-pubertal boys. MATERIALS AND METHODS Population-based study in 118 peri-pubertal boys from the NINIOS cohort (age range at baseline 5.1-17.3 years) with repeated measurements at baseline and after two years. Serum levels of the classical bone turnover markers (BTM) procollagen type 1 N-terminal propeptide and carboxy-terminal collagen crosslinks, as well as sex-hormone binding globulin, IGF-1, osteoprotegerin, sclerostin and dickkopf-1 were measured using immunoassays. Sex steroids (estradiol, testosterone, and androstenedione) were measured using mass spectrometry and free fractions calculated. Dual energy x-ray absorptiometry was used for bone measurements at the lumbar spine and whole body. Volumetric bone parameters and bone geometry at the proximal and distal radius were assessed by peripheral QCT. Pubertal development was categorized based on Tanner staging. RESULTS During puberty, sex steroid and IGF-1-levels along with most parameters of bone mass and bone size increased every next Tanner stage. In contrast, classical bone turnover markers and sclerostin peaked around mid-puberty, with subsequent declines towards adult values in late puberty. Especially classical BTM and sex steroid levels showed consistent associations with areal and volumetric bone parameters and bone geometry. However, observed associations differed markedly according to pubertal stage and skeletal site. CONCLUSION Serum levels of sex steroids, IGF-1 and bone metabolism markers reflect skeletal development in peri-pubertal boys. However, skeletal development during puberty is nonlinear, and the relations between skeletal indices and hormonal parameters are nonlinear as well, and dependent on the respective maturation stage and skeletal site.
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Affiliation(s)
- Thiberiu Banica
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
| | - Sara Vandewalle
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Hans-Georg Zmierczak
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Stefanie De Buyser
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Jean De Schepper
- Department of Endocrinology, Ghent University Hospital, Belgium and Free University of Brussels, Ghent, Brussels, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers 2022; 8:26. [PMID: 35484131 DOI: 10.1038/s41572-022-00352-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 01/11/2023]
Abstract
Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Belinda R Beck
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,The Bone Clinic, Brisbane, Queensland, Australia
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David B Burr
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
| | - Stuart J Warden
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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8
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Cho W, Nessim A, Gartenberg A, Sekerak R, Brill S, Lian J, Sperling K, Chang DG. Racial Differences in Iliac Crest Cancellous Bone Composition: Implications for Preoperative Planning in Spinal Fusion Procedures. Clin Spine Surg 2022; 35:E400-E404. [PMID: 34907927 DOI: 10.1097/bsd.0000000000001274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to determine whether race, specifically American white and American black, correlates with the ratio of cancellous to total bone at the iliac crest. SUMMARY OF BACKGROUND DATA Studies have demonstrated higher proximal femur bone density in American blacks than American whites. However, whether differences occur at the iliac crest, a common site for autologous graft material in spinal fusion surgery, is not well studied. Understanding such differences could aid orthopedic surgeon decision-making regarding graft options. MATERIALS AND METHODS A retrospective review was performed on 133 sequential patients ages 18-75 who underwent computed tomography scan of the pelvis, at a single academic medical center from January 1, 2014, to January 1, 2016. The cohort included 46 American white (21 females, 25 males) and 87 American black participants (40 females, 37 males), an average age of 51.8 years. Groups were matched regarding age, sex, body mass index, and Charlson Comorbidity Score. Measurements of cortical and cancellous bone thickness in the right and left iliac crests were performed using bone window protocol on computed tomography scans. Statistical significance was determined using a 2-tailed t test. RESULTS The interobserver interclass correlation coefficient reliability (N=2) for measurements at the right iliac crest is 0.895 (95% confidence interval, 0.852-0.925), and the interclass correlation coefficient for the left iliac crest is 0.912 (95% confidence interval, 0.877-0.938). A statistically significant difference in the mean cancellous bone ratio was found between American black (0.667±0.065) and American white (0.750±0.051) groups (P<0.001). CONCLUSIONS At the iliac crest, American black patients had a lower mean ratio of cancellous to the total bone as compared with American white patients. This population may benefit from alternative graft options. While iliac crest autograft remains the first option for fusion surgeries, alternative options should be considered to ensure that each patient receives the best-personalized care.
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Affiliation(s)
| | | | | | | | | | | | - Karen Sperling
- Radiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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9
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Turin CG, Khanjee N, Breaux K, Armamento-Villareal R, Rodriguez-Barradas MC, Clark EH. Evaluation of Adherence to Guideline-Based Bone Mineral Density Screening in Veterans with HIV. AIDS Res Hum Retroviruses 2022; 38:216-221. [PMID: 34969257 PMCID: PMC9464047 DOI: 10.1089/aid.2021.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
People with HIV (PWH) have a higher prevalence of bone mineral density (BMD) loss compared to people without HIV. The Infectious Diseases Society of America (IDSA) recommends BMD screening through dual energy X-ray absorptiometry (DXA) in PWH starting at age 50. We aimed to evaluate adherence to this recommendation in a population of Veterans with HIV (VWH). Retrospective cross-sectional analysis of VWH followed from 2014 to 2018 at the Michael E. DeBakey VA Medical Center Infectious Diseases Clinic, Houston, Texas. We collected data through registry extraction and chart review. We calculated the percentage of VWH with timely BMD loss screening by DXA within 5 years of turning 50. Secondary outcomes included prevalence of osteopenia, osteoporosis, and vitamin D deficiency. We included data from 1,243 VWH. Their average age was 52 years (range 18-86). Most were male (95%), and 59% were black. Of the 346 VWH who turned 50 years old during the study period, 78 (22.5%) underwent DXA within 5 years. Of these, 42 (53.8%) had normal BMD, 28 (35.9%) had osteopenia, and 8 (10.3%) had osteoporosis. Nine hundred ninety-three (79.9%) VWH had available 25-hydroxyvitamin D levels; of these, 453 (45%) had normal levels, 304 (30.6%) had vitamin D insufficiency, 184 (18.5%) had vitamin D deficiency, and 52 (5.2%) had severe vitamin D deficiency. Fewer than 25% of eligible VWH underwent timely BMD loss screening by DXA per IDSA guidelines. Almost half of screened VWH showed evidence of BMD loss. Although limited by lack of follow-up and fracture data, this study emphasizes the importance of improving BMD loss screening in this vulnerable population.
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Affiliation(s)
- Christie G. Turin
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Naveed Khanjee
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Katharine Breaux
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Reina Armamento-Villareal
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Endocrinology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Maria C. Rodriguez-Barradas
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Eva H. Clark
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA.,Health Services Research, Michael E. DeBakey VA Health Services Research Center of Innovations [IQuESt], Houston, Texas, USA.,Address correspondence to: Eva H. Clark, Section of Infectious Diseases, Baylor College of Medicine, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA
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10
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Yau MS, Kuipers AL, Price R, Nicolas A, Tajuddin SM, Handelman SK, Arbeeva L, Chesi A, Hsu YH, Liu CT, Karasik D, Zemel BS, Grant SFA, Jordan JM, Jackson RD, Evans MK, Harris TB, Zmuda JM, Kiel DP. A Meta-Analysis of the Transferability of Bone Mineral Density Genetic Loci Associations From European to African Ancestry Populations. J Bone Miner Res 2021; 36:469-479. [PMID: 33249669 PMCID: PMC8353846 DOI: 10.1002/jbmr.4220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/09/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
Genetic studies of bone mineral density (BMD) largely have been conducted in European populations. We therefore conducted a meta-analysis of six independent African ancestry cohorts to determine whether previously reported BMD loci identified in European populations were transferable to African ancestry populations. We included nearly 5000 individuals with both genetic data and assessments of BMD. Genotype imputation was conducted using the 1000G reference panel. We assessed single-nucleotide polymorphism (SNP) associations with femoral neck and lumbar spine BMD in each cohort separately, then combined results in fixed effects (or random effects if study heterogeneity was high, I2 index >60) inverse variance weighted meta-analyses. In secondary analyses, we conducted locus-based analyses of rare variants using SKAT-O. Mean age ranged from 12 to 68 years. One cohort included only men and another cohort included only women; the proportion of women in the other four cohorts ranged from 52% to 63%. Of 56 BMD loci tested, one locus, 6q25 (C6orf97, p = 8.87 × 10-4 ), was associated with lumbar spine BMD and two loci, 7q21 (SLC25A13, p = 2.84 × 10-4 ) and 7q31 (WNT16, p = 2.96 × 10-5 ), were associated with femoral neck BMD. Effects were in the same direction as previously reported in European ancestry studies and met a Bonferroni-adjusted p value threshold, the criteria for transferability to African ancestry populations. We also found associations that met locus-specific Bonferroni-adjusted p value thresholds in 11q13 (LRP5, p < 2.23 × 10-4 ), 11q14 (DCDC5, p < 5.35 × 10-5 ), and 17p13 (SMG6, p < 6.78 × 10-5 ) that were not tagged by European ancestry index SNPs. Rare single-nucleotide variants in AKAP11 (p = 2.32 × 10-2 ), MBL2 (p = 4.09 × 10-2 ), MEPE (p = 3.15 × 10-2 ), SLC25A13 (p = 3.03 × 10-2 ), STARD3NL (p = 3.35 × 10-2 ), and TNFRSF11A (p = 3.18 × 10-3 ) were also associated with BMD. The majority of known BMD loci were not transferable. Larger genetic studies of BMD in African ancestry populations will be needed to overcome limitations in statistical power and to identify both other loci that are transferable across populations and novel population-specific variants. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Michelle S Yau
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Allison L Kuipers
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan Price
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Aude Nicolas
- Laboratory of Neurogenetics, National Institute on Aging, Bethesda, MD, USA
| | - Salman M Tajuddin
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Samuel K Handelman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alessandra Chesi
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yi-Hsiang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - David Karasik
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Struan FA Grant
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca D Jackson
- Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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11
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Laster M, Denburg M, Okuda Y, Kumar J, Furth S, Warady B, Kalantar-Zadeh K, Norris K, Salusky IB. Race and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease. J Bone Miner Res 2021; 36:298-304. [PMID: 32960469 PMCID: PMC8893169 DOI: 10.1002/jbmr.4182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023]
Abstract
Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH)2 D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Michelle Denburg
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yusuke Okuda
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan.,Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Juhi Kumar
- Weill Cornell Medical College, New York, NY, USA
| | - Susan Furth
- The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bradley Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension and Kidney Transplantation, University of California, Irvine, Irvine, CA, USA
| | - Keith Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Isidro B Salusky
- Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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12
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Simultaneous determination of 24,25- and 25,26-dihydroxyvitamin D3 in serum samples with liquid-chromatography mass spectrometry - A useful tool for the assessment of vitamin D metabolism. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1158:122394. [PMID: 33091679 DOI: 10.1016/j.jchromb.2020.122394] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/06/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
Vitamin D status is typically assessed by the measurement of 25-hydroxyvitamin D (25(OH)D). However, in selected patient groups the sole determination of 25(OH)D has been proven insufficient for this purpose. The simultaneous measurement of additional vitamin D metabolites may provide useful information for a better evaluation of the vitamin D status. Therefore, we developed and validated a liquid chromatography tandem mass spectrometry (LC-MS/MS) method for the simultaneous determination of 25(OH)D3, 25(OH)D2, 24,25(OH)2D3 and additionally 25,26(OH)2D3, which was identified with a synthesized pure substance. Pure and deuterated substances were used to prepare calibrators and internal standards for all target metabolites. Pre-analytical sample preparation comprised protein precipitation followed by liquid-liquid-extraction and derivatization with 4-Phenyl-1,2,4-triazole-3,5-dione (PTAD) using 50 µL sample volume. Samples were analyzed on an Agilent HPLC 1260 system equipped with a silica-based Kinetex® 5 µm F5 100 Å core-shell column (150 × 4.6 mm) coupled to a Sciex 4500 mass spectrometer. For all four metabolites, limit of detection (LoD) and limit of quantification (LoQ) ranged from 0.3 to 1.5 nmol/L and 1.0 to 3.1 nmol/L, respectively. Recovery varied between 76.1 % and 84.3 %. Intra- and inter-assay imprecision were <8.6 % and <11.5 %, respectively. The analysis of external and internal quality control samples showed good accuracy for 25(OH)D3, 25(OH)D2, 24(R),25(OH)2D3 and 25,26(OH)2D3. Method comparison studies with human samples that were also analyzed with two other LC-MS/MS methods showed close agreement. Finally, the present method has been shown capable of identifying patients with 24-hydroxylase deficiency, which proves its clinical utility.
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13
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Vieth R. Weaker bones and white skin as adaptions to improve anthropological "fitness" for northern environments. Osteoporos Int 2020; 31:617-624. [PMID: 31696275 PMCID: PMC7075826 DOI: 10.1007/s00198-019-05167-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 01/12/2023]
Abstract
The vitamin D paradox relates to the lower risk of osteoporosis in people of sub-Saharan African ancestry (Blacks) compared with people of European ancestry (Whites). The paradox implies that for bone health, Blacks require less vitamin D and calcium than Whites do. Why should populations that migrated northward out of Africa have ended up needing more vitamin D than tropical Blacks? Human skin color became lighter away from the tropics to permit greater skin penetration of the UVB light that generates vitamin D. Lack of vitamin D impairs intestinal calcium absorption and limits the amount of calcium that can deposit into the protein matrix of bone, causing rickets or osteomalacia. These can cause cephalopelvic disproportion and death in childbirth. Whiter skin was more fit for reproduction in UV-light restricted environments, but natural selection was also driven by the phenotype of bone per se. Bone formation starts with the deposition of bone-matrix proteins. Mineralization of the matrix happens more slowly, and it stiffens bone. If vitamin D and/or calcium supplies are marginal, larger bones will not be as fully mineralized as smaller bones. For the same amount of mineral, unmineralized or partially mineralized bone is more easily deformed than fully mineralized bone. The evidence leads to the hypothesis that to minimize the soft bone that causes pelvic deformation, a decrease in amount of bone, along with more rapid mineralization of osteoid improved reproductive fitness in Whites. Adaptation of bone biology for reproductive fitness in response to the environmental stress of limited availability of vitamin D and calcium came at the cost of greater risk of osteoporosis later in life.
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Affiliation(s)
- R Vieth
- Department of Laboratory Medicine and Pathobiology, and Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Medical Sciences Building, 5th Floor, Room 5253A 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.
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14
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Al-Hafidh NN, Al-Khatib AR, Al-Hafidh NN. Assessment of the cortical bone thickness by CT-scan and its association with orthodontic implant position in a young adult Eastern Mediterranean population: A cross sectional study. Int Orthod 2020; 18:246-257. [PMID: 32147328 DOI: 10.1016/j.ortho.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was conducted to assess cortical bone thickness in the alveolar process of maxilla and mandible and to investigate its association with different orthodontic implant positions in Eastern Mediterranean young adults. MATERIALS AND METHODS Computed tomography images of 50 patients aged between 18-35 years were included. Buccal, palatal and lingual cortical bone thicknesses were measured at 2, 4, 6, and 8mm from cemento-enamel junction starting from the mesial side of the second molar to the contralateral side. Pearson correlation was used to assess the association between cortical bone thickness and proposed orthodontic implant positions at all inter-radicular sites (p<0.05). RESULTS The highest value of buccal cortical bone thickness was found mesial to the second molar in the maxilla and mandible for both genders. The value of palatal cortical bone thickness was found to be at the highest rate mesial to canine and first premolar in males and females respectively. On the other hand, the highest value of lingual cortical bone thickness was recorded to be mesial to the first molar in both genders. In addition to that, the buccal cortical bone thickness was significantly higher than palatal at the area mesial to the second molar at all four levels from the cemento-enamel junction. A significant correlation was found between cortical bone thickness and 2, 4, 6, and 8mm orthodontic implant levels in all inter-radicular sites. The values of correlation coefficients ranged from 0.280 to 0.674 in the maxillary arch and from 0.266 to 0.605 in the mandibular arch. CONCLUSIONS From this study, we can conclude that as the position of the orthodontic implant moved more posteriorly and apically more cortical bone thickness was expected to be found in both jaws. A significant correlation was found between cortical bone thickness and the site of the orthodontic implant. Cortical bone thickness and its relationship with implant position should be taken into consideration when attempts are made to insert the orthodontic implant.
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Affiliation(s)
- Nada Nashee Al-Hafidh
- University of Mosul, College of Dentistry, Department of Pedodontics Orthodontics and Preventive Dentistry, Mosul, Iraq
| | - Ali R Al-Khatib
- University of Mosul, College of Dentistry, Department of Pedodontics Orthodontics and Preventive Dentistry, Mosul, Iraq.
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15
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Galindo-Zavala R, Bou-Torrent R, Magallares-López B, Mir-Perelló C, Palmou-Fontana N, Sevilla-Pérez B, Medrano-San Ildefonso M, González-Fernández MI, Román-Pascual A, Alcañiz-Rodríguez P, Nieto-Gonzalez JC, López-Corbeto M, Graña-Gil J. Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children. Pediatr Rheumatol Online J 2020; 18:20. [PMID: 32093703 PMCID: PMC7041118 DOI: 10.1186/s12969-020-0411-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. METHODS An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. RESULTS Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. CONCLUSION In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future.
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Affiliation(s)
- Rocío Galindo-Zavala
- UGC Pediatría. Sección Reumatología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain.
| | - Rosa Bou-Torrent
- 0000 0001 0663 8628grid.411160.3Unidad de Reumatología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Berta Magallares-López
- 0000 0004 1768 8905grid.413396.aServicio de Reumatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Concepción Mir-Perelló
- 0000 0004 1796 5984grid.411164.7Unidad de Pediatría, Sección Reumatología Pediátrica, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Natalia Palmou-Fontana
- 0000 0001 0627 4262grid.411325.0Unidad de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Belén Sevilla-Pérez
- UGC Pediatría, Sección Reumatología Pediátrica, Hospital Campus de la Salud, Granada, Spain
| | | | - Mª. Isabel González-Fernández
- 0000 0001 0360 9602grid.84393.35Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital La Fe, Valencia, Spain
| | | | - Paula Alcañiz-Rodríguez
- Unidad de Pediatría, Sección de Reumatología Pediátrica, Hospital Virgen de la Arriaxaca, Murcia, Spain
| | - Juan Carlos Nieto-Gonzalez
- 0000 0001 0277 7938grid.410526.4Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mireia López-Corbeto
- 0000 0001 0675 8654grid.411083.fServicio de Reumatología Hospital Vall d’Hebron, Barcelona, Spain
| | - Jenaro Graña-Gil
- 0000 0004 1771 0279grid.411066.4Servicio de Reumatología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain ,Osteogenesis Imperfecta and Secondary Osteoporosis Working Group from the Spanish Pediatric Rheumatology Society, Madrid, Spain
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Laster M, Pereira RC, Salusky IB. Racial differences in bone histomorphometry in children and young adults treated with dialysis. Bone 2019; 127:114-119. [PMID: 31181383 PMCID: PMC6708779 DOI: 10.1016/j.bone.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 05/22/2019] [Accepted: 06/06/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Healthy African-Americans are known to have greater bone mineral density and decreased risk of fracture when compared to Caucasians. In fact, comparisons of bone histomorphometry in healthy South African children and adults reveal greater cortical thickness in Black subjects as compared to White. How these differences are reflected in the bone of American children and young adults on dialysis is unknown. METHODS Using tetracycline-labeled, iliac crest bone biopsies obtained in prior research protocols in pediatric and young adult dialysis patients, we compared trabecular and cortical parameters between non-Hispanic African-American subjects and non-Hispanic Caucasian subjects matched by age and gender. A linear regression model controlled for trabecular turnover and mineralization was used to further investigate the association of race with cortical thickness. RESULTS The matched cohort consisted of 52 subjects-26 African-American and 26 Caucasian. Turnover, mineralization and volume parameters in trabecular bone did not show significant differences between racial groups. Characterizing subjects by renal osteodystrophy type did not show a statistically significant difference although Caucasian patients had double the prevalence of mineralization defects. Consistent with this was a trend toward better mineralization parameters in African-Americans including shorter osteoid maturation time and lower osteoid volume. A sub-cohort of patients with cortical measures demonstrated greater median (IQR) cortical thickness in African-Americans (541 μm [354, 694]) than in Caucasians (371 μm [336, 446], p = 0.08). In a linear regression model controlling for trabecular turnover and mineralization, African-American subjects had 36.2% (95% CI 0.28 to 85.1%, p = 0.048) greater cortical thickness as compared to White subjects. There was no significant difference in cortical porosity. CONCLUSIONS Although likely limited by sample size, our findings suggest that, similar to findings in populations of normal children, African-American race in pediatric and young adults on dialysis is associated with greater cortical thickness. Additionally, there was a trend toward greater mineralization defects in Caucasian children. Both findings require further exploration with larger patient samples in order to thoroughly explore these racial differences and the implications on CKD-MBD treatment.
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Affiliation(s)
- Marciana Laster
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| | - Renata C Pereira
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Coheley LM, Shivappa N, Hebert JR, Lewis RD. Dietary inflammatory index® and cortical bone outcomes in healthy adolescent children. Osteoporos Int 2019; 30:1645-1654. [PMID: 31143990 DOI: 10.1007/s00198-019-04946-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED Diet is thought to modulate inflammation. This study shows no relationships between the dietary inflammatory index (DII) and biomarkers of inflammation or bone after adjusting for covariates. Monocyte chemoattractant protein-1 was inversely associated with peripheral tibia cortical thickness and prospective childhood studies should be conducted to better understand this relationship and to determine if there are long-term consequences in adulthood. INTRODUCTION Examine the relationships between the DII-scores and bone and biomarkers of inflammation in 290 adolescents, ages 9-13 years. METHODS DII-scores were calculated from 3-day diet records and categorized into tertiles, low (< - 1.34), medium (- 1.34 to 1.41), and high (> 1.41) inflammation. Radius and tibia bone were assessed via peripheral quantitative computed tomography (Stratec XCT 2000) at the 66% site relative to the distal growth plate. Fasting serum was measured for tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1). The relationships between DII-scores and bone and biomarkers of inflammation were assessed using bivariate and partial correlations adjusting for sexual maturation, sex, race, muscle cross-sectional area, and height. ANOVA/ANCOVA models were used to compare DII-tertiles with dependent variables. RESULTS DII-scores were negatively associated with tibia trabecular area (TtAr; r = - .141, P = .019), periosteal perimeter (PsPM; r = - .145, P = .016), endosteal perimeter (r = - .145, P = .016), strength strain index (SSI; r = - .129, P = .032), and radius TtAr (r = - .140, P = .020), PsPM (r = -.138, P = .027) and SSI (r = -.131, P = .036) but nullified when adjusting for covariates. Tibia PsPM was higher in the low DII group compared to the medium (P = .050) and high (P = .046) groups but nullified after controlling for covariates. DII-scores were not associated with TNF-α, VEGF, or IL-6, but were associated with MCP-1 only in the unadjusted model (r = .125, P = .042). In the adjusted model, MCP-1 was inversely associated with tibia cortical thickness (r = -.150 P = .030). CONCLUSION The DII-scores were not related to biomarkers of inflammation or bone; however, the biomarker of inflammation, MCP-1 was negatively associated with tibia CtTh. Future prospective pediatric studies should be conducted to better understand this relationship and determine if there are long-term implications in adulthood.
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Affiliation(s)
- L M Coheley
- Department of Foods and Nutrition, The University of Georgia, 279 Dawson Hall, 305 Sanford Drive, Athens, GA, USA
| | - N Shivappa
- The Cancer Prevention and Control Program, Arnold School of Public Health, 915 Green Street, Columbia, SC, USA
| | - J R Hebert
- The Cancer Prevention and Control Program, Arnold School of Public Health, 915 Green Street, Columbia, SC, USA
| | - R D Lewis
- Department of Foods and Nutrition, The University of Georgia, 279 Dawson Hall, 305 Sanford Drive, Athens, GA, USA.
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Kindler JM, Laing EM, Liu W, Dain JA, Lewis RD. Pentosidine Is Associated With Cortical Bone Geometry and Insulin Resistance in Otherwise Healthy Children. J Bone Miner Res 2019; 34:1446-1450. [PMID: 31220375 PMCID: PMC6697211 DOI: 10.1002/jbmr.3727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 01/22/2023]
Abstract
Pentosidine is an advanced glycation end product (AGE) associated with fracture in adults with diabetes. AGE accumulation in bone collagen contributes to bone fragility but might also adversely influence bone turnover and, consequently, bone geometry. The relationships between AGEs and bone health have yet to be studied in children. Thus, the objective of this study was to assess relationships between pentosidine and cortical bone volumetric density, geometry, and estimated strength in children. Participants were otherwise healthy black and white boys and girls, ages 9 to 13 years, who were at sexual maturation stage 2 or 3 (N = 160). Tibia and radius cortical bone and muscle area (66% site) were assessed via pQCT. In fasting sera, insulin, glucose, and pentosidine were measured. The Quantitative Insulin Sensitivity Check Index (QUICKI), a measure of insulin sensitivity, was calculated. While controlling for race, sex, maturation, and height, pentosidine negatively correlated with QUICKI (P < 0.05). In unadjusted analyses, pentosidine was associated with lower radius and tibia cortical volumetric bone mineral density, bone mineral content (Ct.BMC), area (Ct.Ar), and thickness (Ct.Th); a larger radius endosteal circumference (Endo.Circ); and lower tibia polar strength strain index (all P < 0.05). While controlling for race, sex, maturation, height, and muscle area, pentosidine was negatively associated with tibia Ct.BMC, Ct.Ar, and Ct.Th but positively associated with Endo.Circ (all P < 0.05). Linear regression revealed a significant interaction between pentosidine and QUICKI in relation to tibia Ct.Th (pinteraction = 0.049), indicating that the negative relationship between pentosidine and Ct.Th was stronger in those with lower QUICKI (ie, greater insulin resistance). This is the first study to report evidence of a potentially adverse influence of AGEs on bone strength in otherwise healthy children. This relationship was strongest in children with the greatest insulin resistance, supporting further work in youth with chronic metabolic health conditions. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Joseph M Kindler
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Emma M Laing
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Weixi Liu
- Department of Chemistry, University of Rhode Island, Kingston, RI, USA
| | - Joel A Dain
- Department of Chemistry, University of Rhode Island, Kingston, RI, USA
| | - Richard D Lewis
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
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Wu X, Xia Q, Rong K, Gan M, Wen G, Yin X, Yang H. Preliminary exploration of a quantitative assessment index for the matching performance of anatomical bone plates using computer. J Orthop Surg Res 2019; 14:202. [PMID: 31272451 PMCID: PMC6610890 DOI: 10.1186/s13018-019-1229-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explore a new quantitative index to assess the matching performance of anatomical bone plates using digital technology. METHODS CT data of normal tibias of 40 adults were collected. Two brands of medial distal tibia plates were digitized. Two trained orthopedists simulated the surgical operation in Rhino 5.1 software by placing the plate curve on the medial distal tibia surface. The volume of the interstice between the plate curve and the bone surface was measured. The inverse value of this average interstice distance was used as the matching performance index (MPI). A wall thickness analysis tool was used to mark various interstice distances with varied colors. RESULTS The Kangli medial distal tibia plate had a MPI of 0.55 ± 0.08 by operator A and 0.55 ± 0.06 by operator B. The general care medial distal tibia plate had a MPI of 0.32 ± 0.06 by operator A and 0.31 ± 0.05 by operator B. There were significant variations in the MPI between the two types of plates by both operators (p < 0.001). And significant variations were observed in the MPI of general care medial distal tibia plates among various operator groups (p = 0.028). CONCLUSION This quantitative index of matching performance is straightforward and intuitive. However, we still need a method to improve the experimental repeatability, especially when it comes to a plate with poor matching performance.
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Affiliation(s)
- Xuhua Wu
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Qingquan Xia
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Ke Rong
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Minfeng Gan
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Gen Wen
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China
| | - Xiaofan Yin
- Department of orthopedics, Minhang Hospital, Fudan University, No.170, Xinsong Road, Shanghai, 201199, China
| | - Huilin Yang
- Department of orthopedics, The First Affiliated Hospital of Soochow University, No.899, Pinghai Road, Soochow, 215006, China.
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Impact of HIV-1 Infection and Antiretroviral Therapy on Bone Homeostasis and Mineral Density in Vertically Infected Patients. J Osteoporos 2019; 2019:1279318. [PMID: 30693083 PMCID: PMC6332871 DOI: 10.1155/2019/1279318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/26/2018] [Indexed: 01/27/2023] Open
Abstract
Daily assumption of antiretroviral drugs and HIV-related immune activation lead to important side effects, which are particularly evident in vertically infected patients. Bone homeostasis impairment and reduction of bone mineral density (BMD) is one of the most important side effects. Primary aim of this study is to assess the prevalence of bone homeostasis alterations in a group of vertically infected patients; secondary aim is to analyze the relationship between bone homeostasis alterations and anthropometric data, severity of HIV infection, and antiretroviral therapy. We studied 67 patients with vertically transmitted HIV-1 (aged 6-31 years), followed by the Pediatric Infectious Disease Unit of the University Hospital of Padua, Italy. We analyzed bone turnover markers (P1NP and CTx) and we performed lumbar spine and femoral dual energy X-ray absorption densitometry (DXA). Personal and anthropometric data and information on HIV-infection severity and antiretroviral therapy were collected for all patients. We found that BMD values recorded by DXA showed a significant correlation with age, race, BMI, physical activity, and antiretroviral therapy duration. P1NP was increased in 43% of patients, while CTX in 61% of them. P1NP alteration was related to age, race, BMI, physical activity, therapy duration, and ever use of protease inhibitors and nucleotide reverse transcriptase inhibitors. CTX alteration was found to be correlated only with age. In conclusion, our study confirms that a wide percentage of HIV vertically infected patients show reduced BMD and impaired bone homeostasis. Strict monitoring is needed in order to early identify and treat these conditions.
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Laster M, Soohoo M, Streja E, Elashoff R, Jernigan S, Langman CB, Norris KC, Salusky IB, Kalantar-Zadeh K. Racial-ethnic differences in chronic kidney disease-mineral bone disorder in youth on dialysis. Pediatr Nephrol 2019; 34:107-115. [PMID: 30267239 PMCID: PMC6420309 DOI: 10.1007/s00467-018-4048-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 07/02/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies in healthy pediatric populations and adults treated with dialysis demonstrate higher parathyroid hormone (PTH) and lower 25-hydroxyvitamin D levels in African-Americans. Despite these findings, African-Americans on dialysis demonstrate greater bone strength and a decreased risk of fracture compared to the Caucasian dialysis population. The presence of such differences in children and young adult dialysis patients is unknown. METHODS Differences in the markers of mineral and bone metabolism (MBM) were assessed in 661 incident dialysis patients (aged 1 month to < 21 years). Racial-ethnic differences in PTH, calcium, phosphate, and total alkaline phosphatase (AP) activity were analyzed over the first year of dialysis using multivariate linear mixed models. RESULTS African-American race predicted 23% higher serum PTH (95% CI, 4.7-41.3%) when compared to Caucasian patients, while Hispanic ethnicity predicted 17.5% higher PTH (95% CI, 2.3-38%). Upon gender stratification, the differences in PTH were magnified in African-American and Hispanic females: 38% (95% CI, 14.8-69.8%) and 28.8% (95% CI, 4.7-54.9%) higher PTH compared to Caucasian females. Despite higher PTH values, African-American females persistently demonstrated up to 10.9% lower serum AP activity (95% CI, - 20.6-- 0.7%). CONCLUSIONS There are racial-ethnic differences in the markers of MBM. Higher PTH is seen in African-American and Hispanic children and young adults on dialysis with a magnification of this difference amongst the female population. There is a need to consider how factors like race, ethnicity, and gender impact the goal-targeted treatment of MBM disorders.
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Affiliation(s)
- Marciana Laster
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
- Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Robert Elashoff
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
| | - Stephanie Jernigan
- Division of Pediatric Nephrology, Emory University School of Medicine, Atlanta, GA, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University and the Anne and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Keith C Norris
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA
| | - Isidro B Salusky
- Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte, Box 951752, Los Angeles, CA, 90095-1752, USA.
- Division of Pediatric Nephrology, Mattel Children's Hospital at UCLA, Los Angeles, CA, USA.
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA, USA
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22
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Yi LH, Li R, Zhu ZY, Bai CW, Tang JL, Zhao FC, Zheng X, Guo KJ. Anatomical study based on 3D-CT image reconstruction of the hip rotation center and femoral offset in a Chinese population: preoperative implications in total hip arthroplasty. Surg Radiol Anat 2018; 41:117-124. [PMID: 30488299 DOI: 10.1007/s00276-018-2143-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several anatomical studies regarding the value of hip rotation center (HRC) and femoral offset (FO) have been performed in Western populations. However, there are a few data on hip morphological values in the Chinese population based on CT scans. This study measured the values of the hip and pelvis, especially HRC and FO, in a Chinese population and compared them with the published values obtained from Western populations. PATIENTS AND METHODS One hundred patients (50 females and 50 males) were included in the present study, and 3D-CT reconstructions of the hip and pelvis were generated. The mean age was 51.4 ± 8.9 years and mean body mass index (BMI) was 23.5 ± 2.6 kg/m2. All the morphologic measurements were compared between genders and sides, and the relationships between different parameters were analyzed. RESULTS The mean FO values were 38.4 ± 4.7 mm and 35.6 ± 4.4 mm for the males and females, respectively. A significant negative correlation was noted between FO and neck shaft angle (NSA) in both genders (r = - 0.262, P = 0.009 for the males, r = - 0.350, P ≤ 0.001 for the females). A significant positive correlation was found between horizontal distance (HD) and diameter of the femoral head (DFH) in both genders (r = 0.734, P ≤ 0.001 for the males, r = 0.658, P ≤ 0.001 for the females). A significant positive correlation was noted between HD and pelvic width (PW) in males (r = 0.455, P ≤ 0.001). A significant positive correlation was also noted between HD and pelvic height (PH) in males (r = 0.318, P ≤ 0.001). A significant positive correlation was observed between FO and pelvic cavity height (PCH) in males (r = 0.411, P ≤ 0.001), and a significant positive correlation was observed between VD and PCH in females (r = 0.497, P ≤ 0.001). The tip of the greater trochanter was, on average, 7.0 mm higher than the femoral head center. Relationships between DFH and pelvic morphometric parameters were also observed. CONCLUSION The present morphological data and the relationships between them can be applied to design better ethnic-specific THA prostheses and preoperative plans.
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Affiliation(s)
- Lin-Hong Yi
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Li
- Department of Medical Imaging, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zheng-Ya Zhu
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao-Wen Bai
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jin-Long Tang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng-Chao Zhao
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Zheng
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Kai-Jin Guo
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Wright CS, Laing EM, Pollock NK, Hausman DB, Weaver CM, Martin BR, McCabe GP, Peacock M, Warden SJ, Hill Gallant KM, Lewis RD. Serum 25-Hydroxyvitamin D and Intact Parathyroid Hormone Influence Muscle Outcomes in Children and Adolescents. J Bone Miner Res 2018; 33:1940-1947. [PMID: 30001469 PMCID: PMC6556206 DOI: 10.1002/jbmr.3550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 01/31/2023]
Abstract
Increases in 25-hydroxyvitamin D concentrations are shown to improve strength in adults; however, data in pediatric populations are scant and equivocal. In this ancillary study of a larger-scale, multi-sited, double-blind, randomized, placebo-controlled vitamin D intervention in US children and adolescents, we examined the associations between changes in vitamin D metabolites and changes in muscle mass, strength, and composition after 12 weeks of vitamin D3 supplementation. Healthy male and female, black and white children and adolescents between the ages of 9 and 13 years from two US states (Georgia 34°N and Indiana 40°N) were enrolled in the study and randomly assigned to receive an oral vitamin D3 dose of 0, 400, 1000, 2000, or 4000 IU/d for 12 weeks between the winter months of 2009 to 2011 (N = 324). Analyses of covariance, partial correlations, and regression analyses of baseline and 12-week changes (post-baseline) in vitamin D metabolites (serum 25(OH)D, 1,25(OH)2 D, intact parathyroid hormone [iPTH]), and outcomes of muscle mass, strength, and composition (total body fat-free soft tissue [FFST], handgrip strength, forearm and calf muscle cross-sectional area [MCSA], muscle density, and intermuscular adipose tissue [IMAT]) were assessed. Serum 25(OH)D and 1,25(OH)2 D, but not iPTH, increased over time, as did fat mass, FFST, forearm and calf MCSA, forearm IMAT, and handgrip strength (p < 0.05). Vitamin D metabolites were not associated with muscle strength at baseline nor after the 12-week intervention. Changes in serum 25(OH)D correlated with decreases in forearm IMAT, whereas changes in serum iPTH predicted increases in forearm and calf MCSA and IMAT (p < 0.05). Overall, increases in 25(OH)D did not influence muscle mass or strength in vitamin D-sufficient children and adolescents; however, the role of iPTH on muscle composition in this population is unknown and warrants further investigation. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Christian S Wright
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, IN, USA
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Emma M Laing
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Norman K Pollock
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA
| | - Dorothy B Hausman
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Berdine R Martin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - George P McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, IN, USA
| | - Kathleen M Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard D Lewis
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
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Coheley LM, Kindler JM, Laing EM, Oshri A, Hill Gallant KM, Warden SJ, Peacock M, Weaver CM, Lewis RD. Whole egg consumption and cortical bone in healthy children. Osteoporos Int 2018; 29:1783-1791. [PMID: 29713797 PMCID: PMC6604058 DOI: 10.1007/s00198-018-4538-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
UNLABELLED Eggs contain bioactive compounds thought to benefit pediatric bone. This cross-sectional study shows a positive link between childhood egg intake and radius cortical bone. If randomized trials confirm our findings, incorporating eggs into children's diets could have a significant impact in preventing childhood fractures and reducing the risk of osteoporosis. INTRODUCTION This study examined the relationships between egg consumption and cortical bone in children. METHODS The cross-sectional study design included 294 9-13-year-old black and white males and females. Three-day diet records determined daily egg consumption. Peripheral quantitative computed tomography measured radius and tibia cortical bone. Body composition and biomarkers of bone turnover were assessed using dual-energy X-ray absorptiometry and ELISA, respectively. RESULTS Egg intake was positively correlated with radius and tibia cortical bone mineral content (Ct.BMC), total bone area, cortical area, cortical thickness, periosteal circumference, and polar strength strain index in unadjusted models (r = 0.144-0.224, all P < 0.050). After adjusting for differences in race, sex, maturation, fat-free soft tissue mass (FFST), and protein intakes, tibia relationships were nullified; however, egg intake remained positively correlated with radius Ct.BMC (r = 0.138, P = 0.031). Egg intake positively correlated with total body bone mineral density, BMC, and bone area in the unadjusted models only (r = 0.119-0.224; all P < 0.050). After adjusting for covariates, egg intake was a positive predictor of radius FFST (β = 0.113, P < 0.050) and FFST was a positive predictor of Ct.BMC (β = 0.556, P < 0.050) in path analyses. There was a direct influence of egg on radius Ct.BMC (β = 0.099, P = 0.035), even after adjusting for the mediator, FFST (β = 0.137, P = 0.020). Egg intake was positively correlated with osteocalcin in both the unadjusted (P = 0.005) and adjusted (P = 0.049) models. CONCLUSION If the positive influence of eggs on Ct.BMC observed in this study is confirmed through future randomized controlled trials, whole eggs may represent a viable strategy to promote pediatric bone development and prevent fractures.
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Affiliation(s)
- L M Coheley
- Department of Foods and Nutrition, The University of Georgia, 279 Dawson Hall, 305 Sanford Drive, Athens, GA, USA
| | - J M Kindler
- Department of Nutrition Science, Purdue University, Stone Hall 220-B, 770 West State Street, West Lafayette, IN, USA
| | - E M Laing
- Department of Foods and Nutrition, The University of Georgia, 279 Dawson Hall, 305 Sanford Drive, Athens, GA, USA
| | - A Oshri
- Department of Human Development and Family Science, The University of Georgia, 208 Family Science Center (House A), 403 Sanford Drive, Athens, GA, USA
| | - K M Hill Gallant
- Department of Nutrition Science, Purdue University, STON 207, 700 West State Street, West Lafayette, IN, USA
| | - S J Warden
- School of Health and Rehabilitation Sciences, Indiana University-Purdue University Indianapolis, 1140 West Michigan Street, Indianapolis, IN, USA
| | - M Peacock
- Department of Medicine, Indiana University, Gatch Hall Suite 265, 1120 West Michigan Street, Indianapolis, IN, USA
| | - C M Weaver
- Department of Nutrition Science, Purdue University, Stone Hall 220-B, 770 West State Street, West Lafayette, IN, USA
| | - R D Lewis
- Department of Foods and Nutrition, The University of Georgia, 279 Dawson Hall, 305 Sanford Drive, Athens, GA, USA.
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Popp KL, Hughes JM, Martinez-Betancourt A, Scott M, Turkington V, Caksa S, Guerriere KI, Ackerman KE, Xu C, Unnikrishnan G, Reifman J, Bouxsein ML. Bone mass, microarchitecture and strength are influenced by race/ethnicity in young adult men and women. Bone 2017; 103:200-208. [PMID: 28712877 DOI: 10.1016/j.bone.2017.07.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/18/2017] [Accepted: 07/12/2017] [Indexed: 02/05/2023]
Abstract
UNLABELLED Lower rates of fracture in both Blacks compared to Whites, and men compared to women are not completely explained by differences in bone mineral density (BMD). Prior evidence suggests that more favorable cortical bone microarchitecture may contribute to reduced fracture rates in older Black compared to White women, however it is not known whether these differences are established in young adulthood or develop during aging. Moreover, prior studies using high-resolution pQCT (HR-pQCT) have reported outcomes from a fixed-scan location, which may confound sex- and race/ethnicity-related differences in bone structure. PURPOSE We determined differences in bone mass, microarchitecture and strength between young adult Black and White men and women. METHODS We enrolled 185 young adult (24.2±3.4yrs) women (n=51 Black, n=50 White) and men (n=34 Black, n=50 White) in this cross-sectional study. We used dual-energy X-ray absorptiometry (DXA) to determine areal BMD (aBMD) at the femoral neck (FN), total hip (TH) and lumbar spine (LS), as well as HR-pQCT to assess bone microarchitecture and failure load by micro-finite element analysis (μFEA) at the distal tibia (4% of tibial length). We used two-way ANOVA to compare bone outcomes, adjusted for age, height, weight and physical activity. RESULTS The effect of race/ethnicity on bone outcomes did not differ by sex, and the effect of sex on bone outcomes did not differ by race/ethnicty. After adjusting for covariates, Blacks had significantly greater FN, TH and LS aBMD compared to Whites (p<0.05 for all). Blacks also had greater cortical area, vBMD, and thickness, and lower cortical porosity, with greater trabecular thickness and total vBMD compared to Whites. μFEA-estimated FL was significantly higher among Blacks compared to Whites. Men had significantly greater total vBMD, trabecular thickness and cortical area and thickness, but greater cortical porosity than women, the net effects being a higher failure load in men than women. CONCLUSION These findings demonstrate that more favorable bone microarchitecture in Blacks compared to Whites and in men compared to women is established by young adulthood. Advantageous bone strength among Blacks and men likely contributes to their lower risk of fractures throughout life compared to their White and women counterparts.
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Affiliation(s)
- Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA 02114, USA.
| | - Julie M Hughes
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA
| | | | - Matthew Scott
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA
| | - Victoria Turkington
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA
| | - Signe Caksa
- Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA 02114, USA
| | - Katelyn I Guerriere
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA 01760, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA 02114, USA; Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue, Boston, MA, USA 02115
| | - Chun Xu
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, United States Army Medical Research and Materiel Command, 2405 Whittier Drive, Suite 200, Frederick, MD 21702, USA
| | - Ginu Unnikrishnan
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, United States Army Medical Research and Materiel Command, 2405 Whittier Drive, Suite 200, Frederick, MD 21702, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, United States Army Medical Research and Materiel Command, 2405 Whittier Drive, Suite 200, Frederick, MD 21702, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, THR-1051, Boston, MA 02114, USA; Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, One Overland Street, Boston, MA 02215, USA; Department of Orthopedic Surgery, Harvard Medical School, One Overland Street, Boston, MA, 02215, USA
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Bulathsinhala L, Hughes JM, McKinnon CJ, Kardouni JR, Guerriere KI, Popp KL, Matheny RW, Bouxsein ML. Risk of Stress Fracture Varies by Race/Ethnic Origin in a Cohort Study of 1.3 Million US Army Soldiers. J Bone Miner Res 2017; 32:1546-1553. [PMID: 28300324 DOI: 10.1002/jbmr.3131] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/08/2017] [Accepted: 03/12/2017] [Indexed: 11/11/2022]
Abstract
Stress fractures (SF) are common and costly injuries in military personnel. Risk for SF has been shown to vary with race/ethnicity. Previous studies report increased SF risk in white and Hispanic Soldiers compared with black Soldiers. However, these studies did not account for the large ethnic diversity in the US military. We aimed to identify differences in SF risk among racial/ethnic groups within the US Army. A retrospective cohort study was conducted using data from the Total Army Injury and Health Outcomes Database from 2001 until 2011. SF diagnoses were identified from ICD-9 codes. We used Cox-proportional hazard models to calculate time to SF by racial/ethnic group after adjusting for age, education, and body mass index. We performed a sex-stratified analysis to determine whether the ethnic variation in SF risk depends on sex. We identified 21,549 SF cases in 1,299,332 Soldiers (more than 5,228,525 person-years of risk), revealing an overall incidence rate of 4.12 per 1000 person-years (7.47 and 2.05 per 1000 person-years in women and men, respectively). Using non-Hispanic blacks as the referent group, non-Hispanic white women had the highest risk of SF, with a 92% higher risk of SF than non-Hispanic black women (1.92 [1.81-2.03]), followed by American Indian/Native Alaskan women (1.72 [1.44-1.79]), Hispanic women (1.65 [1.53-1.79]), and Asian women (1.32 [1.16-1.49]). Similarly, non-Hispanic white men had the highest risk of SF, with a 59% higher risk of SF than non-Hispanic black men (1.59 [1.50-1.68]), followed by Hispanic men (1.19 [1.10-1.29]). When examining the total US Army population, we found substantial differences in the risk of stress fracture among racial/ethnic groups, with non-Hispanic white Soldiers at greatest risk and Hispanic, American Indian/Native Alaskan, and Asian Soldiers at an intermediate risk. Additional studies are needed to determine the factors underlying these race- and ethnic-related differences in stress fracture risk. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lakmini Bulathsinhala
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Julie M Hughes
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Craig J McKinnon
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Joseph R Kardouni
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Katelyn I Guerriere
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald W Matheny
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Department of Orthopedic Surgery, Harvard Medical School, Boston MA, USA
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Kindler JM, Pollock NK, Laing EM, Oshri A, Jenkins NT, Isales CM, Hamrick MW, Ding KH, Hausman DB, McCabe GP, Martin BR, Hill Gallant KM, Warden SJ, Weaver CM, Peacock M, Lewis RD. Insulin Resistance and the IGF-I-Cortical Bone Relationship in Children Ages 9 to 13 Years. J Bone Miner Res 2017; 32:1537-1545. [PMID: 28300329 PMCID: PMC5489353 DOI: 10.1002/jbmr.3132] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/27/2022]
Abstract
IGF-I is a pivotal hormone in pediatric musculoskeletal development. Although recent data suggest that the role of IGF-I in total body lean mass and total body bone mass accrual may be compromised in children with insulin resistance, cortical bone geometric outcomes have not been studied in this context. Therefore, we explored the influence of insulin resistance on the relationship between IGF-I and cortical bone in children. A secondary aim was to examine the influence of insulin resistance on the lean mass-dependent relationship between IGF-I and cortical bone. Children were otherwise healthy, early adolescent black and white boys and girls (ages 9 to 13 years) and were classified as having high (n = 147) or normal (n = 168) insulin resistance based on the homeostasis model assessment of insulin resistance (HOMA-IR). Cortical bone at the tibia diaphysis (66% site) and total body fat-free soft tissue mass (FFST) were measured by peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA), respectively. IGF-I, insulin, and glucose were measured in fasting sera and HOMA-IR was calculated. Children with high HOMA-IR had greater unadjusted IGF-I (p < 0.001). HOMA-IR was a negative predictor of cortical bone mineral content, cortical bone area (Ct.Ar), and polar strength strain index (pSSI; all p ≤ 0.01) after adjusting for race, sex, age, maturation, fat mass, and FFST. IGF-I was a positive predictor of most musculoskeletal endpoints (all p < 0.05) after adjusting for race, sex, age, and maturation. However, these relationships were moderated by HOMA-IR (pInteraction < 0.05). FFST positively correlated with most cortical bone outcomes (all p < 0.05). Path analyses demonstrated a positive relationship between IGF-I and Ct.Ar via FFST in the total cohort (βIndirect Effect = 0.321, p < 0.001). However, this relationship was moderated in the children with high (βIndirect Effect = 0.200, p < 0.001) versus normal (βIndirect Effect = 0.408, p < 0.001) HOMA-IR. These data implicate insulin resistance as a potential suppressor of IGF-I-dependent cortical bone development, though prospective studies are needed. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Joseph M Kindler
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | | | - Emma M Laing
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Assaf Oshri
- Department of Human Development and Family Science, The University of Georgia, Athens, GA, USA
| | - Nathan T Jenkins
- Department of Kinesiology, The University of Georgia, Athens, GA, USA
| | - Carlos M Isales
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA
| | - Mark W Hamrick
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Ke-Hong Ding
- Department of Neuroscience and Regenerative Medicine, Augusta University, Augusta, GA, USA
| | - Dorothy B Hausman
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - George P McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Berdine R Martin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - Stuart J Warden
- Department of Physical Therapy, Indiana University, Indianapolis, IN, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Munro Peacock
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Richard D Lewis
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
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Vogel KA, Martin BR, McCabe LD, Peacock M, Warden SJ, McCabe GP, Weaver CM. The effect of dairy intake on bone mass and body composition in early pubertal girls and boys: a randomized controlled trial. Am J Clin Nutr 2017; 105:1214-1229. [PMID: 28330908 DOI: 10.3945/ajcn.116.140418] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 02/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Calcium retention increases with increasing body mass index (BMI) on recommended calcium intakes. Dairy foods are an excellent source of essential nutrients that are needed to increase bone mineral content (BMC) and potentially decrease fracture.Objective: We compared children who were overweight with children who were healthy weight for the accrual of bone mass in response to an extra 3 servings dairy/d compared with usual intake.Design: Participants were 240 healthy boys and girls (64%), aged 8-15.9 y (mean ± SD age: 11.8 ± 1.5 y), who consumed low amounts of dairy (<800 mg Ca/d). A total of 181 subjects completed the trial-61% were black, 35% were white, and 4% were other; 50% of subjects were healthy weight [5th through 70th BMI percentiles for age (percentile)], and 50% of subjects were overweight (≥85th percentile). Participants were randomly assigned within BMI categories to receive an 18-mo dairy intervention (3 servings/d equivalent to ∼900 mg Ca/d) or control. Main outcome measures assessed every 6 mo included the total-body bone mineral content and density, cortical and trabecular bone mineral density (BMD), BMC, and bone area at the 4% tibia and anthropometric measures.Results: No significant differences in the change of BMD, BMC, or bone area for the total-body radius, lumbar spine, and total hip were observed between subjects who received the dairy intervention (achieved consumption of 1500 mg Ca/d) and subjects who did not (achieved 1000 mg Ca/d, which represented ∼2 cups milk or other dairy as part of the diet) with the exception of a tibial BMC gain, which was greater in the group who were given dairy (P = 0.02). Body fat was not influenced by the diet assignment.Conclusions: Dairy food interventions generally had no effect on bone mineral acquisition or body composition either within or between weight groups. This study suggests that 2 cups milk or the dairy equivalent is adequate for normal bone gain between ages 8 and 16 y. This trial was registered at clinicaltrials.gov as NCT00635583.
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Affiliation(s)
| | | | | | | | - Stuart J Warden
- Physical Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, IN
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Shieh A, Aloia JF. Assessing Vitamin D Status in African Americans and the Influence of Vitamin D on Skeletal Health Parameters. Endocrinol Metab Clin North Am 2017; 46:135-152. [PMID: 28131129 DOI: 10.1016/j.ecl.2016.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the United States, there is a significant disparity in vitamin D status among individuals of African versus European descent. Despite having lower total 25-hydroxyvitamin D levels compared with white Americans, African Americans have higher bone mineral density and lower fracture risk. This article reviews classical and nonclassical vitamin D physiology, describes whether total versus free 25-hydroxyvitamin D is a better marker of vitamin D status in African Americans, and summarizes the influence of vitamin D status and vitamin D supplementation on markers of vitamin D bioactivity (intestinal calcium absorption, parathyroid hormone secretion, bone mineral density, fracture) in African Americans.
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Affiliation(s)
- Albert Shieh
- Division of Geriatrics, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10945 LeConte Avenue, Suite 2339, Los Angeles, CA 90095-1687, USA; Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10945 LeConte Avenue, Suite 2339, Los Angeles, CA 90095-1687, USA.
| | - John F Aloia
- Department of Medicine, Bone Mineral Research and Treatment Center, Dean Winthrop University Hospital Clinical Campus, Stony Brook University School of Medicine, 222 Station Plaza North, Suite 510, Mineola, NY 11501, USA
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Herrmann M, Farrell CJL, Pusceddu I, Fabregat-Cabello N, Cavalier E. Assessment of vitamin D status – a changing landscape. ACTA ACUST UNITED AC 2017; 55:3-26. [DOI: 10.1515/cclm-2016-0264] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/30/2016] [Indexed: 01/14/2023]
Abstract
Abstract
In recent years it has been shown that vitamin D deficiency is associated with an increased incidence as well as the progression of a broad range of diseases including osteoporosis, rickets, cardiovascular disease, autoimmune disease, multiple sclerosis and cancer. Consequently, requests for the assessment of vitamin D status have increased dramatically. Despite significant progress in the analysis of vitamin D metabolites and an expansion of our pathophysiological knowledge of vitamin D, the assessment of vitamin D status remains a challenging and partially unresolved issue. Current guidelines from scientific bodies recommend the measurement of 25-hydroxy vitamin D (25-OHD) in blood as the preferred test. However, growing evidence indicates significant limitations of this test, including analytical aspects and interpretation of results. In addition, the relationships between 25-OHD and various clinical indices, such as bone mineral density and fracture risk, are rather weak and not consistent across races. Recent studies have systematically investigated new markers of vitamin D status including the vitamin D metabolite ratio (VMR) (ratio between 25-OHD and 24,25-dihydroxy vitamin D), bioavailable 25-OHD [25-OHD not bound to vitamin D binding protein (DBP)], and free 25-OHD [circulating 25-OHD bound to neither DBP nor albumin (ALB)]. These parameters may potentially change how we will assess vitamin D status in the future. Although these new biomarkers have expanded our knowledge about vitamin D metabolism, a range of unresolved issues regarding their measurement and the interpretation of results prevent their use in daily practice. It can be expected that some of these issues will be overcome in the near future so that they may be considered for routine use (at least in specialized centers). In addition, genetic studies have revealed several polymorphisms in key proteins of vitamin D metabolism that affect the circulating concentrations of vitamin D metabolites. The affected proteins include DBP, 7-dehydrocholesterol synthase and the vitamin D receptor (VDR). Here we aim to review existing knowledge regarding the biochemistry, physiology and measurement of vitamin D. We will also provide an overview of current and emerging biomarkers for the assessment of vitamin D status, with particular attention methodological aspects and their usefulness in clinical practice.
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Meiring RM, Micklesfield LK, McVeigh JA. The effect of loading and ethnicity on annual changes in cortical bone of the radius and tibia in pre-pubertal children. Ann Hum Biol 2016; 43:520-526. [PMID: 26452753 DOI: 10.3109/03014460.2015.1106009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is unclear what effect habitual physical activity or ethnicity has on annual changes in bone size and strength in pre-pubertal children. AIM To determine whether the annual relative change in bone size and strength differed between high and low bone loaders and also between black and white pre-pubertal children. SUBJECTS AND METHODS Peripheral quantitative computed tomography (pQCT) scans of the 65% radius and tibia were completed on 41 black and white children (15 boys, 26 girls) between the ages of 8-11 years, at baseline and 1 year later. Children were categorised into either a high or low bone loading group from a peak bone strain score obtained from a bone-specific physical activity questionnaire. Total area (ToA), cortical area (CoA), cortical density (CoD), strength-strain index (SSI), periosteal circumference (PC), endosteal circumference (EC) and cortical thickness (CT) were assessed. RESULTS There was no difference in annual relative change in radial or tibia bone size and strength between the low and high bone loaders. Black children had a greater annual relative change in CoD (p = 0.03) and SSI (p = 0.05) compared to the white children. CONCLUSION Children who performed high bone loading activities over a 1-year period had similar bone growth to children who did low bone loading activities over the same period. Rapid maturational growth over this period may have resulted in bone adapting to the strains of habitual physical activity placed on it. Black children may have greater tibial bone strength compared to white children due to a greater annual increase in cortical density.
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Affiliation(s)
- Rebecca M Meiring
- a Exercise Laboratory, School of Physiology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa and
| | - Lisa K Micklesfield
- b MRC/WITS Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | - Joanne A McVeigh
- a Exercise Laboratory, School of Physiology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa and
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Manavalan JS, Arpadi S, Tharmarajah S, Shah J, Zhang CA, Foca M, Neu N, Bell DL, Nishiyama KK, Kousteni S, Yin MT. Abnormal Bone Acquisition With Early-Life HIV Infection: Role of Immune Activation and Senescent Osteogenic Precursors. J Bone Miner Res 2016; 31:1988-1996. [PMID: 27283956 PMCID: PMC5399769 DOI: 10.1002/jbmr.2883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 03/03/2016] [Accepted: 03/11/2016] [Indexed: 12/30/2022]
Abstract
Chronic immune activation associated with human immunodeficiency virus (HIV) infection may have negative consequences on bone acquisition in individuals infected with HIV early in life. Bone mineral density (BMD) and microarchitecture were characterized in 38 HIV-infected men on antiretroviral therapy (18 perinatally-infected, 20 adolescence-infected) and 20 uninfected men age 20 to 25 years by dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HRpQCT). Flow cytometry was utilized to measure CD4+/CD8+ activation (HLADR+CD38+) and senescence (CD28-CD57+) and to quantify circulating osteogenic precursor (COP) cells in peripheral blood mononuclear cells using antibodies to RUNX2 and osteocalcin (OCN). Telomere lengths were measured in sorted COP cells using qPCR. DXA-derived areal BMD Z-scores and HRpQCT-derived volumetric BMD (vBMD) measures were lower in HIV-infected than uninfected men. Proportion of activated and senescent CD4+ and CD8+ T cells were higher in HIV-infected than uninfected men. The percentage of COP cells (mean ± SE) was lower in HIV-infected than uninfected (0.19% ± 0.02% versus 0.43% ± 0.06%; p < 0.0001) men, and also lower in perinatally-infected than adolescence-infected men (0.15% ± 0.02% versus 0.22% ± 0.03%; p < 0.04). A higher proportion of COP cells correlated with higher bone stiffness, a measure of bone strength, whereas a higher proportion of activated CD4+ T cells correlated with lower BMD and stiffness and lower proportion of COP cells. T cell activation with HIV-infection was associated with decreased numbers of osteogenic precursors as well as lower peak bone mass and bone strength. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- John S Manavalan
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Stephen Arpadi
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | | | - Jayesh Shah
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Chiyuan A Zhang
- Department of Medicine, University of California, San Francisco, CA
| | - Marc Foca
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Natalie Neu
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - David L Bell
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Kyle K Nishiyama
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Stavroula Kousteni
- Department of Physiology and Cellular Biophysics, Columbia University Medical Center, New York, NY
| | - Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, NY
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Davis G, Patel RP, Tan TL, Alijanipour P, Naik TU, Parvizi J. Ethnic differences in heterotopic ossification following total hip arthroplasty. Bone Joint J 2016; 98-B:761-6. [DOI: 10.1302/0301-620x.98b6.36050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 11/10/2015] [Indexed: 11/05/2022]
Abstract
Aims We aimed to assess the influence of ethnicity on the incidence of heterotopic ossification (HO) after total hip arthroplasty (THA). Patients and Methods We studied the six-month post-operative anteroposterior radiographs of 1449 consecutive primary THAs (1324 patients) and retrospectively graded them for the presence of HO, using the Brooker Classification. Results Based on multivariate analysis, African-American ethnicity was an independent risk factor for HO formation following THA with an adjusted odds ratio (OR) of 2.6 (95% confidence interval (CI) 1.3 to 5.2, p = 0.007) for severe HO and 1.9 (95% CI 1.3 to 2.7, p < 0.001) for any grade of HO. Conclusion Given the increased risk of HO formation, particularly high grade HO, and the potentially poorer outcomes associated with HO, it is important to consider using prophylaxis against HO in patients of African-American ethnicity undergoing THA. Take home message: African Americans are at an increased risk for developing heterotopic ossification and thus may benefit from HO prophylaxis. Cite this article: Bone Joint J 2016;98-B:761–6.
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Affiliation(s)
- G. Davis
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - R. P. Patel
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - T. L. Tan
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - P. Alijanipour
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - T. U. Naik
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
| | - J. Parvizi
- Rothman Institute, Thomas
Jefferson University, Philadelphia, PA, USA
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Pfeiffer S, Heinrich J, Beresheim A, Alblas M. Cortical bone histomorphology of known-age skeletons from the Kirsten collection, Stellenbosch university, South Africa. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 160:137-47. [PMID: 26865244 PMCID: PMC5067612 DOI: 10.1002/ajpa.22951] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/08/2015] [Accepted: 01/12/2016] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Normal human bone tissue changes predictably as adults get older, but substantial variability in pattern and pace remains unexplained. Information is needed regarding the characteristics of histological variables across diverse human populations. METHODS Undecalcified thin sections from mid-thoracic ribs of 213 skeletons (138 M, 75 F, 17-82 years, mean age 48 years), are used to explore the efficacy of an established age-at-death estimation method and methodological approach (Cho et al.: J Forensic Sci 47 (2002) 12-18) and expand on it. The ribs are an age-balanced sample taken from skeletonized cadavers collected from 1967 to 1999 in South Africa, each with recorded sex, age, cause of death and government-defined population group (129 "Colored," 49 "Black," 35 "White"). RESULTS The Ethnicity Unknown equation performs better than those developed for European-Americans and African-Americans, in terms of accuracy and bias. A new equation based solely on the study sample does not improve accuracy. Osteon population densities (OPD) show predicted values, yet secondary osteon areas (On.Ar) are smaller than expected for non-Black subgroups. Relative cortical area (Ct.Ar/Tt.Ar) is low among non-Whites. CONCLUSIONS Results from this highly diverse sample show that population-specific equations do not increase estimate precision. While within the published range of error for the method (±24.44 years), results demonstrate a systematic under-aging of young adults and over-aging of older adults. The regression approach is inappropriate. The field needs fresh approaches to statistical treatment and to factors behind cortical bone remodeling.
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Affiliation(s)
- Susan Pfeiffer
- Department of AnthropologyUniversity of TorontoTorontoM5S 2S2Canada
- Department of ArchaeologyUniversity of Cape TownRondeboschSouth Africa 7701
| | - Jarred Heinrich
- Department of AnthropologyUniversity of TorontoTorontoM5S 2S2Canada
| | - Amy Beresheim
- Department of AnthropologyUniversity of TorontoTorontoM5S 2S2Canada
| | - Mandi Alblas
- Department of Biomedical SciencesUniversity of StellenboschCape TownSouth Africa 8000
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Anatomical Study of the Clavicles in a Chinese Population. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6219761. [PMID: 27088088 PMCID: PMC4819086 DOI: 10.1155/2016/6219761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND A reemergence of interest in clavicle anatomy was prompted because of the advocacy for operative treatment of midshaft clavicle fractures. Several anatomical studies of the clavicle have been performed in western population. However, there was no anatomical study of clavicle in Chinese population. PATIENTS AND METHODS 52 patients were included in the present study. Three-dimensional reconstructions of the clavicles were generated. The length of the clavicle, the widths and thicknesses of the clavicle, curvatures of the clavicle, the areas of the intramedullary canal, and sectional areas of the clavicle were measured. All the measurements were compared between genders and two sides. RESULTS The mean length of the clavicles was 144.2 ± 12.0 mm. Clavicles in males were longer, wider, and thicker than in females; also males have different curvatures in both planes compared with females. The men's intramedullary canals and sectional areas of the clavicle were larger than those of women. No significant difference between the sides was found for all the measurements. CONCLUSION This study provided an anatomical data of the clavicle in a Chinese population. These clavicle dimensions can be applied to the modifications of the contemporary clavicle plate or a new development for the Chinese population.
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Moon RJ, Harvey NC, Curtis EM, de Vries F, van Staa T, Cooper C. Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom. Bone 2016; 85:9-14. [PMID: 26802259 PMCID: PMC4841386 DOI: 10.1016/j.bone.2016.01.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fractures are common in childhood, and there is considerable variation in the reported incidence across European countries, but few data relating to ethnic and geographic differences within a single country. We therefore aimed to determine the incidence of childhood fractures in the United Kingdom (UK), and to describe age-, ethnicity- and region- specific variations. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 7% of the UK population. The occurrence of a fracture between 1988 and 2012 was determined from the CPRD for all individuals <18years of age, and used to calculate fracture incidence rates for age, sex and ethnicity. Regional fracture incidence rates were also calculated based on general practitioner location within 14 Strategic Health Authorities (SHA) within the UK. RESULTS The overall fracture incidence rate was 137 per 10,000 person-years (py). This was higher in boys (169 per 10,000 py) than girls (103 per 10,000 py) and white children (150 per 10,000 py) compared to those of black (64 per 10,000 py) and South Asian (81 per 10,000 py) ethnicity. Marked geographic variation in incidence was observed. The highest fracture rates were observed in Wales, where boys and girls had 1.82 and 1.97 times greater incidence, respectively, than those residing in Greater London. CONCLUSION In the period 1988-2012, there was marked geographic and ethnic variation in childhood fracture incidence across the UK. These findings also implicate lifestyle and socio-economic differences associated with location and ethnicity, and are relevant to policy makers in the UK and internationally.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth, Road, M13 9PL, UK; Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508, TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
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Liu Z, Kennedy OD, Cardoso L, Basta-Pljakic J, Partridge NC, Schaffler MB, Rosen CJ, Yakar S. DMP-1-mediated Ghr gene recombination compromises skeletal development and impairs skeletal response to intermittent PTH. FASEB J 2015; 30:635-52. [PMID: 26481310 DOI: 10.1096/fj.15-275859] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022]
Abstract
Bone minerals are acquired during growth and are key determinants of adult skeletal health. During puberty, the serum levels of growth hormone (GH) and its downstream effector IGF-1 increase and play critical roles in bone acquisition. The goal of the current study was to determine how bone cells integrate signals from the GH/IGF-1 to enhance skeletal mineralization and strength during pubertal growth. Osteocytes, the most abundant bone cells, were shown to orchestrate bone modeling during growth. We used dentin matrix protein (Dmp)-1-mediated Ghr knockout (DMP-GHRKO) mice to address the role of the GH/IGF axis in osteocytes. We found that DMP-GHRKO did not affect linear growth but compromised overall bone accrual. DMP-GHRKO mice exhibited reduced serum inorganic phosphate and parathyroid hormone (PTH) levels and decreased bone formation indices and were associated with an impaired response to intermittent PTH treatment. Using an osteocyte-like cell line along with in vivo studies, we found that PTH sensitized the response of bone to GH by increasing Janus kinase-2 and IGF-1R protein levels. We concluded that endogenously secreted PTH and GHR signaling in bone are necessary to establish radial bone growth and optimize mineral acquisition during growth.
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Affiliation(s)
- Zhongbo Liu
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Oran D Kennedy
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Luis Cardoso
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Jelena Basta-Pljakic
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Nicola C Partridge
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Mitchell B Schaffler
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Clifford J Rosen
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
| | - Shoshana Yakar
- *Department of Basic Science and Craniofacial Biology, David B. Kriser Dental Center, New York University College of Dentistry, New York, New York, USA; Department of Biomedical Engineering, City College of New York, New York, New York, USA; and Maine Medical Center Research Institute, Scarborough, Maine, USA
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DeBoer MD, Weber DR, Zemel BS, Denburg MR, Herskovitz R, Long J, Leonard MB. Bone Mineral Accrual Is Associated With Parathyroid Hormone and 1,25-Dihydroxyvitamin D Levels in Children and Adolescents. J Clin Endocrinol Metab 2015; 100:3814-21. [PMID: 26241322 PMCID: PMC4596042 DOI: 10.1210/jc.2015-1637] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Rapid bone accrual and calcium demands during puberty may result in compensatory increases in PTH and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels; however, these relations have not been established in longitudinal studies. OBJECTIVE To determine whether greater bone accrual velocity is associated with greater PTH and 1,25(OH)2D levels in healthy children and adolescents. DESIGN Prospective cohort study with baseline PTH, 25-hydroxyvitamin D [25(OH)D], and 1,25(OH)2D levels and dual-energy x-ray absorptiometry whole-body bone mineral content (BMC) accrual over 12 months. Secondary analyses examined bone biomarkers and tibia quantitative computed tomography midshaft cortical-BMC. PARTICIPANTS A total of 594 healthy participants, ages 5-21 years, with longitudinal measures in a subset of 145 participants. MAIN OUTCOME MEASURES PTH and 1,25(OH)2D levels. RESULTS PTH levels were higher during Tanner stages 3 and 4 compared to Tanner 1 (P < .05) in males and females and were inversely and significantly associated with 25(OH)D levels and dietary calcium intake. In multivariable analyses, greater bone accrual [measured directly as change in dual-energy x-ray absorptiometry-BMC (P < .001) or quantitative computed tomography-BMC (P < .05), or indirectly as growth velocity (P < .05) or greater bone-formation biomarker level (P < .01)] was associated with higher PTH levels, independent of 25(OH)D level and dietary calcium intake. Similar associations were observed between these direct and indirect indices of bone accrual and 1,25(OH)2D levels. CONCLUSIONS PTH levels rise in midpuberty, in association with multiple measures of bone accrual. This is consistent with compensatory increases in PTH to drive 1,25(OH)2D production and calcium absorption during periods of increased calcium demands. Additional studies are needed to address PTH effects on bone modeling and remodeling during growth and development.
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Affiliation(s)
- Mark D DeBoer
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - David R Weber
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - Babette S Zemel
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - Michelle R Denburg
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - Rita Herskovitz
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - Jin Long
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
| | - Mary B Leonard
- Department of Pediatrics (M.D.D.), University of Virginia, Charlottesville, Virginia 22908; Department of Pediatrics (D.R.W.), University of Rochester, Rochester, New York 14642; Department of Pediatrics (B.S.Z., M.R.D., R.H., J.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Departments of Pediatrics and Medicine (M.B.L.), Stanford University, Stanford, California 94305
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Rajakumar K, Moore CG, Yabes J, Olabopo F, Haralam MA, Comer D, Bogusz J, Nucci A, Sereika S, Dunbar-Jacob J, Holick MF, Greenspan SL. Effect of Vitamin D3 Supplementation in Black and in White Children: A Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab 2015; 100:3183-92. [PMID: 26091202 PMCID: PMC4524986 DOI: 10.1210/jc.2015-1643] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Dosages of vitamin D necessary to prevent or treat vitamin D deficiency in children remain to be clarified. OBJECTIVE To determine the effects of vitamin D3 1000 IU/d on serum 25-hydroxyvitamin D [25(OH)D], PTH, and markers of bone turnover (osteocalcin and collagen type 1 cross-linked C-telopeptide) in black children and white children, and to explore whether there is a threshold level of 25(OH)D associated with maximal suppression of serum PTH concentration. DESIGN Healthy 8- to 14-year-old Pittsburgh-area black (n = 84) and white (n = 73) children not receiving vitamin supplements, enrolled from October through March from 2008 through 2011, were randomized to vitamin D3 1000 IU or placebo daily for 6 months. RESULTS The mean baseline concentration of 25(OH)D was <20 ng/mL in both the vitamin D-supplemented group and the placebo group (19.8 ± 7.6 and 18.8 ± 6.9 ng/mL, respectively). The mean concentration was higher in the supplemented group than in the placebo group at 2 months (26.4 ± 8.1 vs 18.9 ± 8.1 ng/mL; P < .0001) and also at 6 months (26.7 ± 7.6 vs 22.4 ± 7.3; P = .003), after adjusting for baseline 25(OH)D, race, gender, pubertal status, dietary vitamin D intake, body mass index, and sunlight exposure. Increases were only significant in black children, when examined by race. The association between 25(OH)D and PTH concentrations was inverse and linear, without evidence of a plateau. Overall, vitamin D supplementation had no effect on PTH and bone turnover. CONCLUSIONS Vitamin D3 supplementation with 1000 IU/d in children with mean baseline 25(OH)D concentration <20 ng/mL effectively raised their mean 25(OH)D concentration to ≥20 ng/mL but failed to reach 30 ng/mL. Vitamin D supplementation had no effect on PTH concentrations.
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Affiliation(s)
- Kumaravel Rajakumar
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Charity G Moore
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Jonathan Yabes
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Flora Olabopo
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Mary Ann Haralam
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Diane Comer
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Jaimee Bogusz
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Anita Nucci
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Susan Sereika
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Jacqueline Dunbar-Jacob
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Michael F Holick
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
| | - Susan L Greenspan
- Department of Pediatrics (K.R., F.O., M.A.H.), and Center for Research on Health Care (C.G.M., J.Y., D.C.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Medicine (J.B., M.F.H.), Boston University School of Medicine, Boston, Massachusetts, 02118; Department of Nutrition (A.N.), Georgia State University, Atlanta, Georgia 30302; University of Pittsburgh School of Nursing (S.S., J.D.-J.), Pittsburgh, Pennsylvania 15213; and Department of Medicine (C.G.M., J.Y., D.C., S.L.G.), University of Pittsburgh, Pittsburgh 15213
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Moon RJ, Harvey NC, Davies JH, Cooper C. Vitamin D and skeletal health in infancy and childhood. Osteoporos Int 2014; 25:2673-84. [PMID: 25138259 PMCID: PMC4224585 DOI: 10.1007/s00198-014-2783-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/18/2014] [Indexed: 01/25/2023]
Abstract
During growth, severe vitamin D deficiency in childhood can result in symptomatic hypocalcaemia and rickets. Despite the suggestion from some studies of a secular increase in the incidence of rickets, this observation may be driven more by changes in population demographics than a true alteration to age, sex and ethnicity-specific incidence rates; indeed, rickets remains uncommon overall and is rarely seen in fair-skinned children. Additionally, the impact of less severe vitamin D deficiency and insufficiency has received much interest in recent years, and in this review, we consider the evidence relating vitamin D status to fracture risk and bone mineral density (BMD) in childhood and adolescence. We conclude that there is insufficient evidence to support the suggestion that low serum 25-hydroxyvitamin D [25(OH)D] increases childhood fracture risk. Overall, the relationship between 25(OH)D and BMD is inconsistent across studies and across skeletal sites within the same study; however, there is evidence to suggest that vitamin D supplementation in children with the lowest levels of 25(OH)D might improve BMD. High-quality randomised trials are now required to confirm this benefit.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK SO16 6YD
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK
| | - Justin H Davies
- Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, UK SO16 6YD
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK SO16 6YD
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford, OX3 7HE
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Berger PK, Pollock NK, Laing EM, Warden SJ, Hill Gallant KM, Hausman DB, Tripp RA, McCabe LD, McCabe GP, Weaver CM, Peacock M, Lewis RD. Association of adenovirus 36 infection with adiposity and inflammatory-related markers in children. J Clin Endocrinol Metab 2014; 99:3240-6. [PMID: 24926952 PMCID: PMC4154093 DOI: 10.1210/jc.2014-1780] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Although animal studies suggest that adenovirus 36 (Ad36) infection is linked to obesity and systemic inflammation, human data are scant and equivocal. OBJECTIVE Associations of Ad36 infection with total body adiposity and inflammatory-related markers were determined in 291 children aged 9-13 years (50% female, 49% black). DESIGN Fasting blood samples were measured for presence of Ad36-specific antibodies and TNF-α, IL-6, vascular endothelial growth factor (VEGF), and monocyte chemoattractant protein-1 (MCP-1). Fat mass and fat-free soft tissue mass were measured by dual-energy X-ray absorptiometry. RESULTS The overall prevalence of Ad36 seropositivity [Ad36(+)] was 42%. There was a higher percentage of Ad36(+) children in the highest tertiles of TNF-α and IL-6 compared with their respective middle and lowest tertiles (both P < .03). There was also a trend toward a higher prevalence of Ad36(+) children in the highest tertile of VEGF compared with tertiles 1 and 2 (P = .05). Multinomial logistic regression, adjusting for age, race, sex, and fat-free soft tissue mass, revealed that compared with children with the lowest TNF-α, IL-6, and VEGF levels (tertile 1), the adjusted odds ratios for Ad36(+) were 2.2 [95% confidence interval (CI) 1.2-4.0], 2.4 (95% CI 1.4-4.0), and 1.8 (95% CI 1.0-3.3), respectively, for those in the highest TNF-α, IL-6, and VEGF levels (tertile 3). No association was observed between Ad36(+) and greater levels of fat mass or MCP-1 (all P > .05). CONCLUSIONS In children, our data suggest that Ad36(+) may be associated with biomarkers implicated in inflammation but not with greater levels of fat mass.
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Affiliation(s)
- P K Berger
- Department of Foods and Nutrition (P.K.B., E.M.L., D.B.H., R.D.L.), The University of Georgia, Athens, Georgia 30602; Department of Pediatrics (N.K.P.), Georgia Regents University, Augusta, Georgia 30912; Department of Physical Therapy (S.J.W.), Indiana University School of Health and Rehabilitation Sciences, and Department of Medicine (K.M.H.G., M.P.), Indiana University School of Medicine, Indianapolis, Indiana 46202; Departments of Nutrition Science (K.M.H.G., L.D.M., C.M.W.) and Statistics (G.P.M.), Purdue University, West Lafayette, Indiana 47907; and Department of Infectious Diseases (R.A.T.), The University of Georgia, Athens, Georgia 30602
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Adams JE, Engelke K, Zemel BS, Ward KA. Quantitative computer tomography in children and adolescents: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:258-74. [PMID: 24792821 DOI: 10.1016/j.jocd.2014.01.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
In 2007, International Society of Clinical Densitometry Pediatric Positions Task Forces reviewed the evidence for the clinical application of peripheral quantitative computed tomography (pQCT) in children and adolescents. At that time, numerous limitations regarding the clinical application of pQCT were identified, although its use as a research modality for investigation of bone strength was highlighted. The present report provides an updated review of evidence for the clinical application of pQCT, as well as additional reviews of whole body QCT scans of the central and peripheral skeletons, and high-resolution pQCT in children. Although these techniques remain in the domain of research, this report summarizes the recent literature and evidence of the clinical applicability and offers general recommendations regarding the use of these modalities in pediatric bone health assessment.
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Affiliation(s)
- Judith E Adams
- Department of Clinical Radiology, The Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England, UK.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany and Synarc A/S, Germany
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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Meiring RM, Avidon I, Norris SA, McVeigh JA. A two-year history of high bone loading physical activity attenuates ethnic differences in bone strength and geometry in pre-/early pubertal children from a low-middle income country. Bone 2013; 57:522-30. [PMID: 24012701 DOI: 10.1016/j.bone.2013.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/12/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
We examined the interplay between ethnicity and weight-bearing physical activity on the content and volumetric properties of bone in a pre- to early pubertal South African Black and White population. Sixty six children [Black boys, 10.4 (1.4)yrs, n=15; Black girls, 10.1 (1.2)yrs, n=27; White boys, 10.1 (1.1)yrs, n=7; White girls, 9.6 (1.3)yrs, n=17] reported on all their physical activities over the past two years in an interviewer administered physical activity questionnaire (PAQ). All participants underwent a whole body and site-specific DXA scan and we also assessed bone structure and estimated bone strength with pQCT. Children were classified as being either high or low bone loaders based on the cohort's median peak bone strain score estimated from the PAQ. In the low bone loading group, Black children had greater femoral neck bone mineral content (BMC) (2.9 (0.08)g) than White children (2.4 (0.11)g; p=0.05). There were no ethnic differences in the high bone loaders for femoral neck BMC. At the cortical site, the Black low bone loaders had a greater radius area (97.3 (1.3) vs 88.8 (2.6)mm(2); p=0.05) and a greater tibia total area (475.5 (8.7) vs. 397.3 (14.0)mm(2); p=0.001) and strength (1633.7 (60.1) vs. 1271.8 (98.6)mm(3); p=0.04) compared to the White low bone loaders. These measures were not different between the Black low and high bone loaders or between the Black and White high bone loaders. In conclusion, the present study shows that there may be ethnic and physical activity associations in the bone health of Black and White pre-pubertal children and further prospective studies are required to determine the possible ethnic specific response to mechanical loading.
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Affiliation(s)
- Rebecca M Meiring
- Exercise Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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