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Lee S, Yun JM, Park JH, Kwon H. Association between Chronic Atrophic Gastritis and Bone Mineral Density among Women Older than 40 Years of Age in Korea. Korean J Fam Med 2024:kjfm.22.0139. [PMID: 38356173 DOI: 10.4082/kjfm.22.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/03/2023] [Indexed: 02/16/2024] Open
Abstract
Background Chronic atrophic gastritis causes hypochlorhydria, hypergastrinemia, and malabsorption of nutrients, leading to lower bone mineral density. The few studies that investigated the association between chronic atrophic gastritis and bone mineral density have reported inconsistent findings. As such, the present study assessed the association between chronic atrophic gastritis and bone mineral density among a large sample of women >40 years of age in Korea. Methods Data from 8,748 women >40 years of age who underwent esophagogastroduodenoscopy and bone densitometry were analyzed. Chronic atrophic gastritis was diagnosed using esophagogastroduodenoscopy. Bone mineral density of the lumbar vertebrae (L), femur neck, and femur total, measured using dual-energy X-ray absorptiometry, were the primary outcome variables. Low bone mineral density, which could be diagnosed as osteoporosis or osteopenia, was defined and analyzed as a secondary outcome. Linear regression was used to calculate adjusted mean values of bone mineral density. The association between low bone mineral density and chronic atrophic gastritis was analyzed using multiple logistic regression. Results The adjusted mean bone mineral density for L1-L4 was 1.063±0.003, femur neck (0.826±0.002), and femur total (0.890±0.002) were significantly lower in patients with chronic atrophic gastritis than others (1.073±0.002, 0.836±0.001, 0.898±0.002, respectively; all P<0.01). Women with chronic atrophic gastritis exhibited an increased likelihood for osteopenia or osteoporosis, even after adjusting for age and other confounding factors (odds ratio, 1.25; 95% confidence interval, 1.13-1.40; P<0.01). However, subgroup analysis revealed statistical significance only in postmenopausal women (odds ratio, 1.27; P<0.001). Conclusion Chronic atrophic gastritis was associated with lower bone mineral density and a higher risk for osteopenia or osteoporosis among postmenopausal women.
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Affiliation(s)
- Seulki Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Moon Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Ho Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Yadegari A, Safi Y, Shahbazi S, Yaghoutiazar S, Ghazizadeh Ahsaie M. Assessment of CBCT gray value in different regions-of-interest and fields-of-view compared to Hounsfield unit. Dentomaxillofac Radiol 2023; 52:20230187. [PMID: 37874074 DOI: 10.1259/dmfr.20230187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES Different factors can affect the discrepancy between the gray value (GV) measurements obtained from CBCT and the Hounsfield unit (HU) derived from multidetector CT (MDCT), which is considered the gold-standard density scale. This study aimed to explore the impact of region of interest (ROI) location and field of view (FOV) size on the difference between these two scales as a potential source of error. METHODS Three phantoms, each consisting of a water-filled plastic bin containing a dry dentate human skull, were prepared. CBCT scans were conducted using the NewTom VGi evo system, while MDCT scans were performed using Philips system. Three different FOV sizes (8 × 8 cm, 8 × 12 cm, and 12 × 15 cm) were used, and the GVs obtained from eight distinct ROIs were compared with the HUs from the MDCT scans. The ROIs included dental and bony regions within the anterior and posterior areas of both jaws. Statistical analyses were performed using SPSS v. 26. RESULTS The GVs derived from CBCT images were significantly influenced by both ROI location and FOV size (p < 0.05 for both factors). Following the comparison between GVs and HUs, the anterior mandibular bone ROI represented the minimum error, while the posterior mandibular teeth exhibited the maximum error. Moreover, the 8 × 8 cm and 12 × 15 cm FOVs resulted in the lowest and highest degrees of GV error, respectively. CONCLUSIONS The ROI location and the FOV size can significantly affect the GVs obtained from CBCT images. It is not recommended to use the GV scale within the posterior mandibular teeth region due to the potential for error. Additionally, selecting smaller FOV sizes, such as 8 × 8 cm, can provide GVs closer to the gold-standard numbers.
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Affiliation(s)
- Atiye Yadegari
- Department of Pediatric Dentistry, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Yaser Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Shahbazi
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Yaghoutiazar
- Department of Pediatric Dentistry, School of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mitra Ghazizadeh Ahsaie
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Julovi SM, Dao A, Trinh K, O'Donohue AK, Shu C, Smith S, Shingde M, Schindeler A, Rogers NM, Little CB. Disease-modifying interactions between chronic kidney disease and osteoarthritis: a new comorbid mouse model. RMD Open 2023; 9:e003109. [PMID: 37562858 PMCID: PMC10423836 DOI: 10.1136/rmdopen-2023-003109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE The prevalence of comorbid chronic kidney disease (CKD) and osteoarthritis (OA) is increasing globally. While sharing common risk factors, the mechanism and consequences of concurrent CKD-OA are unclear. The aims of the study were to develop a preclinical comorbid model, and to investigate the disease-modifying interactions. METHODS Seventy (70) male 8-10 week-old C57BL/6 mice were subjected to 5/6 nephrectomy (5/6Nx)±destabilisation of medial meniscus (DMM) or sham surgery. OA pathology and CKD were assessed 12 weeks postinduction by blinded histology scoring, micro-CT, immunohistochemistry for osteoclast and matrix metalloproteinase (MMP)-13 activity, and serum analysis of bone metabolic markers. RESULTS The 5/6Nx model recapitulated characteristic features of CKD, with renal fibrosis and deranged serum alkaline phosphatase, calcium and phosphate. There was no histological evidence of cartilage pathology induced by 5/6Nx alone, however, synovial MMP-13 expression and subchondral bone osteoclastic activity were increased (p<0.05), with accompanying reductions (p<0.05) in subchondral trabecular bone, bone volume and mineral density. DMM significantly (p<0.05) increased tibiofemoral cartilage damage, subchondral bone sclerosis, marginal osteophytes and synovitis, in association with increased cartilage and synovial MMP-13. DMM alone induced (p<0.05) renal fibrosis, proteinuria and increased (p<0.05) 5/6Nx-induced serum urea. However, DMM in 5/6Nx-mice resulted in significantly reduced (p<0.05) cartilage pathology and marginal osteophyte development, in association with reduced subchondral bone volume and density, and inhibition of 5/6Nx-induced subchondral bone osteoclast activation. CONCLUSION This study assessed a world-first preclinical comorbid CKD-OA model. Our findings demonstrate significant bidirectional disease-modifying interaction between CKD and OA.
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Affiliation(s)
- Sohel M Julovi
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Aiken Dao
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Katie Trinh
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra K O'Donohue
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Cindy Shu
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Susan Smith
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Meena Shingde
- Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Wentworthville, New South Wales, Australia
| | - Aaron Schindeler
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Bioengineering & Molecular Medicine (BAMM) Laboratory, the Children's Hospital at Westmead and the Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Natasha M Rogers
- Kidney Injury Group, Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher B Little
- The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Raymond Purves Bone and Joint Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Pielkenrood BJ, Visser TF, van Tol FR, Foppen W, Eppinga WSC, Verhoeff JJC, Bol GH, Van der Velden JM, Verlaan JJ. Remineralization of lytic spinal metastases after radiotherapy. Spine J 2023; 23:571-578. [PMID: 36623735 DOI: 10.1016/j.spinee.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/07/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND CONTEXT Palliative radiotherapy (RT) can lead to remineralization of osteolytic lesions thereby potentially restoring some of the weight-bearing capacity and preventing vertebral collapse. It is not clear, however, under which circumstances remineralization of osteolytic lesions occurs. PURPOSE The aim of this study was to investigate the change in bone mineral density in spinal metastases after RT compared to a reference region, and find associated factors. STUDY DESIGN Retrospective analysis within prospective observational cohort OUTCOME MEASURES: change in bone mineral density measured in Hounsfield Units (HU). PATIENT SAMPLE patients treated with RT for (painful) bone metastases. METHODS Patients with spinal metastases were included if computed tomography scans both pre- and post-RT were available. Bone density was measured in HU. A region of interest (ROI) was drawn manually in the metastatic lesion. As a reference, a measurement of bone density in adjacent, unaffected, and non-irradiated vertebrae was used. Factors tested for association were origin of the primary tumor, RT dose and fractionation scheme, and concomitant use of bisphosphonates. RESULTS A total of 31 patients with 49 spinal metastases, originating from various primary tumors, were included. The median age on baseline was 58 years (IQR: 53-63) and median time between baseline and follow-up scan was 8.2 months (IQR: 3.0-18.4). Difference in HU in the lesion before and after treatment was 146.9 HU (95% CI 68.4-225.4; p<.01). Difference in HU in the reference vertebra between baseline and first follow-up was 19.1 HU (95% CI -47.9 to 86.0; p=.58). Difference between reference vertebrae and metastatic lesions on baseline was -194.1 HU (95% CI -276.2 to -112.0; p<.01). After RT, this difference was reduced to -50.3 HU (95% CI -199.6 to 99.0; p=.52). Patients using bisphosphonates showed a greater increase in HU, 194.1 HU versus 60.6 HU, p=.01. CONCLUSIONS Palliative radiation of osteolytic lytic spinal metastases is positively associated with an increased bone mineral density at follow-up. The use of bisphosphonates was linked to an increased bone mineral density when used during or after RT.
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Affiliation(s)
- Bart J Pielkenrood
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas F Visser
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Floris R van Tol
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wietse S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gijs H Bol
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joanne M Van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Breit HC, Varga-Szemes A, Schoepf UJ, Emrich T, Aldinger J, Kressig RW, Beerli N, Andreas Buser T, Breil D, Derani I, Bridenbaugh S, Gill C, Fischer AM. CNN-based evaluation of bone density improves diagnostic performance to detect osteopenia and osteoporosis in patients with non-contrast chest CT examinations. Eur J Radiol 2023; 161:110728. [PMID: 36773426 DOI: 10.1016/j.ejrad.2023.110728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 12/29/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
PURPOSE As osteoporosis is still underdiagnosed by clinicians and radiologists, the aim of the present study was to assess the performance of an Artificial intelligence (AI)-based Convolutional Neuronal Network (CNN)-Algorithm for the detection of low bone density on routine non-contrast chest CT in comparison to clinical reports using DEXA scans as reference. METHOD This retrospective cross-sectional study included patients who underwent non-contrast chest CT and DEXA between April 2018 and June 2018 (n = 109, 19 men, mean age: 67.7 years). CT studies were evaluated for thoracic vertebral bone pathologies using a CNN-Algorithm, which calculates the attenuation profile of the spine. The content of the radiological reports was evaluated for the description of osteoporosis or osteopenia. DEXA was used as the reference standard. To estimate correlation the Spearman test was used and the comparison of the different groups was performed using the Wilcoxon rank sum test. Diagnostic was evaluated by performing a receiver operating characteristic curve analysis. RESULTS The DEXA examination revealed normal bone density in 42 patients, while 49 patients had osteopenia and 7 osteoporosis. There was a statistically significant correlation between the mean CNN-based attenuation of the thoracic spine and the bone density measured on the DEXA in the hip (r = 0.51, p < 0.001) and lumbar spine (r = 0.34, p = 0.01). The mean attenuation was significantly higher in patients with normal bone density (172 ± 44.5 HU) compared to those with osteopenia or osteoporosis (125.2 ± 33.8 HU), (p < 0.0001). Diagnostic performance in distinguishing normal from abnormal bone density was higher using the CNN-based vertebral attenuation (accuracy 0.75, sensitivity: 0.93, specificity: 0.61) compared to clinical reports (accuracy 0.51, sensitivity: 0.14, specificity: 0.53). CONCLUSION CNN-based evaluation of bone density may provide additional value over standard clinical reports for the detection of osteopenia and osteoporosis in patients undergoing routine non-contrast chest CT scans. This additional value could improve identification of fracture risk and subsequent treatment.
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Styrkarsdottir U, Stefansdottir L, Thorleifsson G, Stefansson OA, Saevarsdottir S, Lund SH, Rafnar T, Hoshijima K, Novak K, Oreiro N, Rego-Perez I, Hansen C, Kazmers N, Kiemeney LA, Blanco FJ, Barker T, Kloppenburg M, Jurynec MJ, Gudbjartsson DF, Jonsson H, Thorsteinsdottir U, Stefansson K. Meta-analysis of erosive hand osteoarthritis identifies four common variants that associate with relatively large effect. Ann Rheum Dis 2023; 82:873-880. [PMID: 36931692 DOI: 10.1136/ard-2022-223468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Erosive hand osteoarthritis (EHOA) is a severe subset of hand osteoarthritis (OA). It is unclear if EHOA is genetically different from other forms of OA. Sequence variants at ten loci have been associated with hand OA but none with EHOA. METHODS We performed meta-analysis of EHOA in 1484 cases and 550 680 controls, from 5 populations. To identify causal genes, we performed eQTL and plasma pQTL analyses, and developed one zebrafish mutant. We analysed associations of variants with other traits and estimated shared genetics between EHOA and other traits. RESULTS Four common sequence variants associated with EHOA, all with relatively high effect. Rs17013495 (SPP1/MEPE, OR=1.40, p=8.4×10-14) and rs11243284 (6p24.3, OR=1.35, p=4.2×10-11) have not been associated with OA, whereas rs11631127 (ALDH1A2, OR=1.46, p=7.1×10-18), and rs1800801 (MGP, OR=1.37, p=3.6×10-13) have previously been associated with hand OA. The association of rs1800801 (MGP) was consistent with a recessive mode of inheritance in contrast to its additive association with hand OA (OR homozygotes vs non-carriers=2.01, 95% CI 1.71 to 2.37). All four variants associated nominally with finger OA, although with substantially lower effect. We found shared genetic components between EHOA and other OA measures, grip strength, urate levels and gout, but not rheumatoid arthritis. We identified ALDH1A2, MGP and BMP6 as causal genes for EHOA, with loss-of-function Bmp6 zebrafish mutants displaying EHOA-like phenotypes. CONCLUSIONS We report on significant genetic associations with EHOA. The results support the view of EHOA as a form of severe hand OA and partly separate it from OA in larger joints.
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Affiliation(s)
| | | | | | | | - Saedis Saevarsdottir
- Population Genomics, deCODE genetics / Amgen Inc, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sigrun H Lund
- Statistics, deCODE genetics / Amgen Inc, Reykjavik, Iceland
| | - Thorunn Rafnar
- Population Genomics, deCODE genetics / Amgen Inc, Reykjavik, Iceland
| | - Kazuyuki Hoshijima
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, USA
| | - Kendra Novak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Natividad Oreiro
- Rheumatology Division, A Coruna University Hospital, A Coruna, Spain
| | | | - Channing Hansen
- Enterprise Analytics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Nikolas Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Lambertus A Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Science, Radboud University, Nijmegen, The Netherlands
| | - Francisco J Blanco
- Rheumatology Division, A Coruna University Hospital, A Coruna, Spain.,Department of Phisiotherapy, Medicine and Biomedical Sciences, A Coruna University Hospital, A Coruna, Spain
| | - Tyler Barker
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA.,Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah, USA
| | - Margreet Kloppenburg
- Department of Rheumatology, Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael J Jurynec
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, USA
| | - Daniel F Gudbjartsson
- Statistics, deCODE genetics / Amgen Inc, Reykjavik, Iceland.,School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Helgi Jonsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Unnur Thorsteinsdottir
- Population Genomics, deCODE genetics / Amgen Inc, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland .,deCODE genetics / Amgen Inc, Reykjavik, Capital, Iceland
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Choi SS, Kim YA, Kim HJ, Cho YJ, Lee GH. The Relationship between Dietary Na/K Ratio and Bone Mineral Density in Korean Middle-Aged Women. Korean J Fam Med 2023; 44:21-27. [PMID: 36709957 PMCID: PMC9887444 DOI: 10.4082/kjfm.21.0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dietary Na+ or Na+/K+ ratio has been reported to be associated with bone mineral density (BMD). However, this remains unclear, and only a few studies have been reported on the Korean population. Therefore, this study aimed to determine the association between dietary Na+, K+, and Na+/K+ ratios and BMD in middle-aged Korean women. METHODS This study used data from the Korea National Health and Nutrition Examination Survey 2008-2011. A total of 3,690 women aged >50 years were included. Study participants were classified into quartiles (lowest quartile Q1-highest quartile Q4) according to dietary Na+, K+, and Na+/K+ ratio, and we examined the association of these parameters with BMD. Total femur and lumbar spine BMD were measured using dual-energy X-ray absorptiometry. Multiple linear regression analyses were performed using IBM SPSS ver. 19.0. RESULTS The mean age was 62 years, and a significant negative trend in the β-coefficient regarding dietary Na+ was only observed in the total femur BMD. However, the total femur and lumbar spine BMD decreased from Q1 to Q4 regarding the dietary Na+/K+ ratio (P-value for trend: 0.044 for total femur BMD and 0.002 for lumbar spine BMD). CONCLUSION A significant negative trend in the β-coefficient for both total femur and lumbar spine BMD was observed regarding the Na+/K+ ratio. Therefore, based on the results of this study, a higher dietary Na+/K+ ratio may be associated with a lower BMD.
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Affiliation(s)
- Seong Su Choi
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun-A Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hyun Ji Kim
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yoon Jeong Cho
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Geon Ho Lee
- Department of Family Medicine, Daegu Catholic University School of Medicine, Daegu, Korea,Corresponding Author: Geon Ho Lee https://orcid.org/0000-0003-0696-3804 Tel: +82-53-650-4696, Fax: +82-53-650-4122, E-mail:
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Shen P, Löhning M. Insights into osteoarthritis development from single-cell RNA sequencing of subchondral bone. RMD Open 2022; 8:rmdopen-2022-002617. [PMID: 36598005 PMCID: PMC9748989 DOI: 10.1136/rmdopen-2022-002617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ping Shen
- Pitzer Laboratory of Osteoarthritis Research, German Rheumatism Research Center (DRFZ), a Leibniz Institute, Berlin, Germany,Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Stem Cell and Biotherapy Engineering Research Center of Henan Province, College of Life Sciences and Technology, Xinxiang Medical University, Xinxiang, China
| | - Max Löhning
- Pitzer Laboratory of Osteoarthritis Research, German Rheumatism Research Center (DRFZ), a Leibniz Institute, Berlin, Germany,Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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9
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Anbiaee N, Shafieian R, Shiezadeh F, Shakeri M, Naqipour F. Correlation between gray values in cone-beam computed tomography and histomorphometric analysis. Imaging Sci Dent 2022; 52:375-382. [PMID: 36605865 PMCID: PMC9807799 DOI: 10.5624/isd.20220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose The aim of this study was to analyze the relationships between bone density measurements obtained using cone-beam computed tomography (CBCT) and morphometric parameters of bone determined by histomorphometric analysis. Materials and Methods In this in vivo study, 30 samples from the maxillary bones of 7 sheep were acquired using a trephine. The bone samples were returned to their original sites, and the sheep heads were imaged using CBCT. On the CBCT images, gray values were calculated. In the histomorphometric analysis, the total bone volume, the trabecular bone volume (referred to simply as bone volume), and the trabecular thickness were assessed. Results Statistical testing showed significant correlations between CBCT gray values and total bone volume (r=0.537, P=0.002), bone volume (r=0.672, P<0.001), and trabecular thickness (r=0.692, P<0.001), as determined via the histomorphometric analysis. Conclusion The results indicate a significant and acceptable association between CBCT gray values and bone volume, suggesting that CBCT may be used in bone densitometry.
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Affiliation(s)
- Najmeh Anbiaee
- Department of Oral and Maxillofacial Radiology, Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reihaneh Shafieian
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farid Shiezadeh
- Department of Periodontology, Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadtaghi Shakeri
- Department of Community Medicine and Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Naqipour
- Department of Oral and Maxillofacial Radiology, Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Cagliari M, Bressi B, Bassi MC, Fugazzaro S, Prati G, Iotti C, Costi S. Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review. Phys Ther 2022; 102:pzab288. [PMID: 34972863 PMCID: PMC8970430 DOI: 10.1093/ptj/pzab288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/30/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) experience the loss of bone mineral density (BMD) and lean body mass, which can increase their risk of falls and fractures. Physical exercise programs with appropriate components and dosage are suggested to preserve BMD and muscle strength, thereby potentially reducing accidental falls and fractures and associated morbidity and mortality. These benefits can be obtained if exercise programs are feasible and safe and if patient adherence is adequate. This systematic review investigates the feasibility and safety of exercise programs aimed at preventing the risk of accidental falls and fractures and BMD loss in men with PCa undergoing ADT. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from database inception to June 7, 2021. Randomized controlled trials were included when they analyzed the feasibility and safety of experimental exercise programs targeting bone health in men with PCa receiving ADT. Two reviewers independently selected the studies, assessed their methodological quality, and extracted the data. Exercise feasibility was measured through recruitment, retention, and adherence rates. Exercise safety was measured through the number, type, and severity of adverse events. Furthermore, the components, setting, intensity, frequency, and duration of exercise programs were extracted. RESULTS Ten studies were included, with a total of 633 participants. Exercise consisted of a combination of aerobic, resistance, and impact-loading exercise or football training. Exercise is feasible in men with PCa undergoing ADT, although football training should be prescribed with caution for safety reasons. CONCLUSION Multicomponent exercise programs targeting bone health seem feasible and safe in this population; however, adverse events should be systematically documented according to current guidelines. IMPACT The study shows that men with PCa receiving ADT can safely perform exercise programs to preserve bone health and supports that those programs should become part of lifestyle habits. LAY SUMMARY Men with PCa who are receiving ADT can safely perform exercise programs to preserve bone health and should make exercise an important part of their lifestyle.
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Affiliation(s)
- Maribel Cagliari
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Bressi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Fugazzaro
- Department of Neuromotor Physiopathology and Rehabilitation Medicine, Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Prati
- Department of Oncology and Advanced Technologies, Oncology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cinzia Iotti
- Department of Oncology and Advanced Technologies, Radiotherapy Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Costi
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Scientific Directorate, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Jones A, Duran I, Stark C, Spiess K, Semler O, Schoenau E. Vibration assisted rehabilitation in patients with Pompe disease: A case series. J Musculoskelet Neuronal Interact 2022; 22:284-291. [PMID: 35642707 PMCID: PMC9186463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
The results of three cases with infantile-onset Pompe disease participating in a rehabilitation program with home-based vibration training will be presented. In this retrospective observational case study, the cases participated in the neuromuscular training program "Auf die Beine", which combines two blocks of intensive, goal directed training with 6 months of home-based whole body vibration (WBV). Assessments by the means of a dual-energy X-ray absorptiometry and grip strength were applied at multiple points throughout the program. Two cases showed an increase in lean mass index of +0.319 kg/m2, +0.721 kg/m2 and bone mineral content of +0.028 kg/m2, +0.031 kg/m2 over one year. Additionally physiotherapeutic therapy goals could be achieved. In the remaining child lean mass index did not change, bone mineral content decreased by -0.03 kg. The neuromuscular rehabilitation program "Auf die Beine" has shown to be safe and effective in two of three cases for muscle and bone mass gain as well as in achievement of physiotherapeutic goals. To summarize, WBV is an innovative therapy in a rehabilitation concept, which might be helpful in Pompe disease, but further studies with larger cohorts are needed.
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Affiliation(s)
- Alicia Jones
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Ibrahim Duran
- University of Cologne, Centre of Prevention and Rehabilitation, Cologne, Germany,Corresponding author: Ibrahim Duran, Centre of Prevention and Rehabilitation, University of Cologne, Lindenburger Allee 44, 50931 Cologne, Germany E-mail:
| | - Christina Stark
- University of Cologne, Cologne Center for Musculoskeletal Biomechanics (CCMB), Cologne, Germany,University of Cologne, Klinik und Poliklinik für Neurologie, Cologne, Germany
| | - Karoline Spiess
- University of Cologne, Centre of Prevention and Rehabilitation, Cologne, Germany
| | - Oliver Semler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany
| | - Eckhard Schoenau
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, Cologne, Germany,University of Cologne, Centre of Prevention and Rehabilitation, Cologne, Germany,University of Cologne, Cologne Center for Musculoskeletal Biomechanics (CCMB), Cologne, Germany
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Dekker H, Schulten EAJM, Ten Bruggenkate CM, Bloemena E, van Ruijven LJ, Bravenboer N. Regional differences in microarchitecture and mineralization of the atrophic edentulous mandible: A microcomputed tomography study. Arch Oral Biol 2021; 133:105302. [PMID: 34773733 DOI: 10.1016/j.archoralbio.2021.105302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE The aim of the present study was to assess mineralization and trabecular microarchitecture in atrophic edentulous mandibles and to identify regional differences and relations with the extent of resorption. METHODS Cortical and trabecular bone volumes in anterior, premolar and molar regions of 10 edentulous cadaveric mandibles (5 males and 5 females; mean age ± SD: 85.4 ± 8.3 years) were assessed by microcomputed tomography. Mandibular height and Cawood & Howell classes were recorded. Concerning trabecular volumes, bone mineral density (BMD), bone volume fraction, trabecular tissue volume fraction, connectivity density, trabecular number, trabecular thickness, trabecular separation, degree of anisotropy, and structural model index were measured; concerning cortical volumes porosity, BMD and cortical thickness were measured. RESULTS In molar regions, the bone volume fraction and trabecular number were lower, whereas trabecular separation, degree of anisotropy and cortical BMD were higher compared to anterior regions. In premolar regions, mandibular height correlated negatively with trabecular number (Spearman's correlation r = 0.73, p = 0.017) and connectivity density (Spearman's correlation r = 0.82, p = 0.004), and correlated positively with trabecular separation (Spearman's correlation r = - 0.65, p = 0.04). Cortical BMD was higher at bucco-inferior cortex of molar and inferior border of premolar region and lower at anterior cranial buccal and lingual surface. CONCLUSIONS In the premolar region, increased resorption coincides with local impairment of trabecular bone quality. Cortical bone BMD is higher in areas with highest strains and lower in areas with most mandibular resorption. Trabecular bone volume and quality is superior in the anterior region of the edentulous mandible, which might explain improved primary stability of dental implants in this region.
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Affiliation(s)
- Hannah Dekker
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Engelbert A J M Schulten
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Christiaan M Ten Bruggenkate
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Leo J van Ruijven
- Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Park SY, Ha HI, Lee I, Lim HK. Comparison of HU histogram analysis and BMD for proximal femoral fragility fracture assessment: a retrospective single-center case-control study. Eur Radiol 2021. [PMID: 34647175 DOI: 10.1007/s00330-021-08281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the feasibility of HU histogram analysis (HUHA) to assess proximal femoral fragility fractures with respect to BMD. METHODS This retrospective study included 137 patients with femoral fragility fractures who underwent hip CT and 137 control patients without fractures who underwent abdominal CT between January 2018 and February 2019. HUHA was calculated with the 3D volume of interest from the femoral head to the lesser trochanter. HUHAfat (percentage of negative HU values) and HUHAbone (percentage of HU values ≥ 125 HU) were assumed to be fat and bone components, respectively. Statistical significance was assessed using the area under the receiver operating characteristic curve (AUC), Spearman correlation (ρ), and odds ratio. RESULTS HUHAfat was strongly positively correlated (ρ = 0.56) and BMD was moderately negatively correlated with fragility fractures (ρ = - 0.37). AUC of HUHAfat (0.82, 95% CI [0.77, 0.87]) significantly differed from that of BMD (0.69, 95% CI [0.63, 0.75]) (p < .001). The cutoff value was 15.8% for HUHAfat (sensitivity: 90.4%; specificity: 67.7%) and 0.709 g/cm2 for BMD (sensitivity: 87.5%; specificity: 51.5%), with higher HUHAfat and lower BMD values indicating fragility fractures. The odds ratio of HUHAfat was 19.5 (95% CI [9.9, 38.2], p < .001), which was higher than that of BMD, 7.4 (95% CI [4.0, 13.6], p < .001). CONCLUSION HUHAfat revealed better performance than BMD and demonstrated feasibility in assessing proximal femoral fragility fractures. KEY POINTS • HUHAfat showed a strong positive correlation (Spearman ρ = 0.56, p < .001), and BMD showed a moderate negative correlation (Spearman ρ = - 0.37, p < .001) with proximal femoral fragility fractures. • HUHAfat (AUC = 0.82) performed significantly better than BMD in assessing proximal femoral fragility fractures (AUC = 0.69) (p < .001). • The odds ratio of HUHAfat for proximal femoral fragility fractures was higher than that of BMD (19.5 and 7.4, respectively; p < .001).
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Kim JS, Oh SW, Kim J. Milk Consumption and Bone Mineral Density in Adults: Using Data from the Korea National Health and Nutrition Examination Survey 2008-2011. Korean J Fam Med 2021; 42:327-333. [PMID: 34320801 PMCID: PMC8321909 DOI: 10.4082/kjfm.20.0182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Milk consumption is associated with bone mineral density (BMD), but reports are limited in terms of participant age, sex, and number of study subjects. We investigated the association between milk consumption and BMD in South Korean adults (≥20 years). Methods We analyzed men and women aged ≥20 years who participated in the Korean National Health and Nutrition Examination Survey, 2008–2011. We used linear regression to calculate the mean BMD and 95% confidence interval (CI) based on the frequency of milk consumption. Multivariate logistic regression analysis was used to estimate the odds ratios (ORs) and 95% CI for T-scores ≤-2.5 (osteoporosis) in both men aged ≥50 years and postmenopausal women. Results In total 8,539 subjects were studied. Drinking milk more than once a day was associated with higher BMD in the total femur and femoral neck in men aged <50 years and lumbar spine in men aged ≥50 years, compared to less than once a week. It was also associated with lower ORs for osteoporosis of the femoral neck and lumbar spine in men aged ≥50 years (OR, 0.35; 95% CI, 0.125–0.979 and OR, 0.34; 95% CI, 0.143–0.804, respectively). In postmenopausal women who consumed milk 2–6 times weekly, higher BMD and lower OR for osteoporosis were observed in the total femur (OR, 0.23; 95% CI, 0.055–0.958). Conclusion This study suggests that frequent milk consumption could potentially reduce osteoporosis incidence in South Korean adults. Further prospective study is necessary to elucidate the effect of milk consumption on BMD.
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Affiliation(s)
- Ji Soo Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung-Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
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Al-Ghaithi A, Husband J, Al-Maskari S. Analysis of Bone Microarchitectural Changes and Structural Damage in Sickle Cell Disease-Induced Avascular Necrosis Using Raman Spectroscopy: Is there potential for medical management? Sultan Qaboos Univ Med J 2021; 21:e297-e301. [PMID: 34221479 PMCID: PMC8219339 DOI: 10.18295/squmj.2021.21.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 12/03/2022] Open
Abstract
Objectives Bone failure due to avascular necrosis (AVN) is a complex pathological phenomenon. Analysis of molecular changes in the bone matrix may help to shed light on the disease process and guide management. This study aimed to explore changes in bone quality and structural damage caused by sickle cell disease (SCD)-induced AVN using Raman spectroscopy. Methods A total of 10 necrotic femoral heads were obtained from seven SCD patients who underwent total hip replacements. The femoral heads were cut in half and scanned using Raman spectroscopy in correlation with preoperative magnetic resonance imaging to identify necrotic and healthy control areas. Subsequently, samples were examined to determine changes in bone mineralisation, crystallinity, carbonate content, collagen cross-linking and mineral and collagen fibril orientation. Results Significant changes were observed in bone mineral content, mineral-to-organic content and collagen fibril orientation in necrotic compared to control areas (P ≤0.050). Conclusion The necrotic samples displayed severe structural damage and loss of mineral and organic contents. Similar Raman signals have been reported in other metabolic bone diseases such as osteoporosis, thereby potentially supporting the use of medical treatment in AVN to promote bone quality.
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Affiliation(s)
- Ahmed Al-Ghaithi
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - John Husband
- Department of Chemistry, College of Science, Sultan Qaboos University, Muscat, Oman
| | - Sultan Al-Maskari
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
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BRECH GUILHERMECARLOS, FREITAS JESSICASILLASDE, GOUVEA MARCIA, MACHADO-LIMA ADRIANA, BASTOS MARTAFERREIRA, TAKAYAMA LILIAM, PEREIRA ROSAMARIARODRIGUES, GREVE JULIAMARIAD, ALONSO ANGELICACASTILHO. DYNAMIC POSTURAL BALANCE IS MEDIATED BY ANTHROPOMETRY AND BODY COMPOSITION IN OLDER WOMEN. Acta Ortop Bras 2021; 29:87-91. [PMID: 34248407 PMCID: PMC8244842 DOI: 10.1590/1413-785220212902237921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/01/2020] [Indexed: 05/15/2023]
Abstract
Objective: To investigate the relationship between anthropometry and body composition with dynamic postural balance in elderly women with low bone mineral density (BMD). Methods: 45 older women (≥ 60 years), low BMD and nutritional diagnosis of low weight to overweight. For the assessment of body composition, Dual energy X-ray emission densitometry and anthropometric examination were used to measure: body mass (kg), height (cm) and BMI (k/m2). The assessment of dynamic postural balance was performed by the mini Balance Master Evaluation System clinical test and the computerized Balance Master® System test by the Sit to Stand and Step Up/Over tests. Results: There was a negative correlation between miniBESTest (r = − 0.566; p ≤ 0.001) and time to ascend and descend step (r = − 0.393; p ≤ 0.007) with fat mass, and positive correlation with miniBESTest (r = 0.526; p ≤0.001) and time to go up and down a step with muscle mass (r = 0.297; p ≤ 0.04). As for anthropometric variables, only height showed a positive correlation (r = 0.296; p ≤ 0.04) with the speed in the sit and stand test. Conclusion: Lean mass reduces postural oscillations; in contrast, fat mass negatively interfered with dynamic postural balance in women with low BMD. Height was related to dynamic postural balance, the taller the elderly, the worse their balance. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Ponzano M, Rodrigues IB, Hosseini Z, Ashe MC, Butt DA, Chilibeck PD, Stapleton J, Thabane L, Wark JD, Giangregorio LM. Progressive Resistance Training for Improving Health-Related Outcomes in People at Risk of Fracture: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Phys Ther 2021; 101:6048920. [PMID: 33367736 DOI: 10.1093/ptj/pzaa221] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Osteoporosis clinical practice guidelines recommend exercise to prevent fractures, but the efficacy of exercise depends on the exercise types, population studied, or outcomes of interest. The purpose of this systematic review was to assess the effects of progressive resistance training (PRT) on health-related outcomes in people at risk of fracture. METHODS Multiple databases were searched in October 2019. Eligible articles were randomized controlled trials of PRT interventions in men and women ≥50 years with low bone mineral density (BMD) or fracture history. Descriptive information and mean difference (MD) and SD were directly extracted for included trials. A total of 53 studies were included. RESULTS The effects of PRT on the total number of falls (incidence rate ratio [IRR] = 1.05; 95% CI = 0.91 - 1.21; 7 studies) and on the risk of falling (risk ratio [RR] = 1.23; 95% CI = 1.00 - 1.51; 5 studies) are uncertain. PRT improved performance on the Timed "Up and Go" test (MD = -0.89 seconds; 95% CI = -1.01 to -0.78; 13 studies) and health-related quality of life (standardized MD = 0.32; 95% CI = 0.22-0.42; 20 studies). PRT may increase femoral neck (MD = 0.02 g/cm2; 95% CI = 0.01-0.03; 521 participants, 5 studies) but not lumbar spine BMD (MD = 0.02 g/cm2; 95% CI = -0.01-0.05; 4 studies), whereas the effects on total hip BMD are uncertain (MD = 0.00 g/cm2; 95% CI = 0.00-0.01; 435 participants, 4 studies). PRT reduced pain (standardized MD = -0.26; 95% CI = -0.37 to -0.16; 17 studies). Sensitivity analyses, including PRT-only studies, confirmed these findings. CONCLUSION Individuals at risk of fractures should be encouraged to perform PRT, as it may improve femoral neck BMD, health-related quality of life, and physical functioning. PRT also reduced pain; however, whether PRT increases or decreases the risk of falls, the number of people experiencing a fall, or the risk of fall-related injuries is uncertain. IMPACT Individuals at risk of fractures should be encouraged to perform PRT, as it may have positive effects on femoral neck BMD, health-related quality of life, physical functioning, and pain, and adverse events are rare. LAY SUMMARY Exercise is recommended for people at risk of osteoporotic fractures. Our study showed that progressive resistance training improves physical functioning, quality of life, and reduces pain. The effects of progressive resistance training on the risk of falling are unclear. Adverse events are rare, and often minor (eg, soreness, pain, musculoskeletal injury). Considering the benefits and safety, people at risk of fractures should engage in progressive resistance training interventions.
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Affiliation(s)
| | | | | | - Maureen C Ashe
- The University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Debra A Butt
- University of Toronto, Toronto, Canada.,Scarborough Health Network, Scarborough, Canada
| | | | | | - Lehana Thabane
- McMaster University, Hamilton, Canada.,St Joseph's Healthcare Hamilton, Hamilton, Canada
| | - John D Wark
- University of Melbourne, Melbourne, Australia.,Royal Melbourne Hospital, Parkville, Australia
| | - Lora M Giangregorio
- University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Canada
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Iwasaki M, Sato M, Yoshihara A, Saito T, Kitamura K, Ansai T, Nakamura K. A 5-year longitudinal association between dietary fermented soya bean (natto) intake and tooth loss through bone mineral density in postmenopausal women: The Yokogoshi cohort study. Gerodontology 2021; 38:267-275. [PMID: 33393717 DOI: 10.1111/ger.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/23/2020] [Accepted: 12/12/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE In this 5-year cohort study, we aimed to determine whether the intake of natto, a fermented soya bean food product, has an indirect effect on tooth loss incidence through BMD changes among postmenopausal women. BACKGROUND Evidence indicates (1) that natto has a beneficial effect on bone health and (2) that a decrease in bone mineral density (BMD) is associated with tooth loss. METHODS The study recruited 435 postmenopausal women (average age = 64.2 years). Natto intake (exposure) was assessed at baseline using a food frequency questionnaire. Lumbar spine BMD and number of teeth were measured at baseline and 5-year follow-up. BMD change (mediator) and the number of teeth lost (outcome) over time were calculated. The mediation model consisted of these 3 variables. Mediation analysis was performed to test the indirect effect of the natto intake measured through BMD change on tooth loss. RESULTS During the study, the mean number of teeth lost was 1.2 (standard deviation = 1.8), and the mean BMD decline was 2.5% (standard deviation = 7.1). After adjusting for potential confounders, increasing habitual natto intake was significantly indirectly associated with a lower incidence of tooth loss mediated by BMD change (incidence rate ratio of tooth loss among women with "≥1 pack/day" natto intake was 0.90 [95% confidence interval = 0.82-0.99] compared to those with natto consumption of "rarely"). CONCLUSIONS Dietary natto intake is significantly indirectly associated with a lower incidence of tooth loss among postmenopausal women, and systemic bone density could be a mediator of this association.
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Affiliation(s)
| | - Misuzu Sato
- Division of Preventive Dentistry, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akihiro Yoshihara
- Division of Oral Science for Health Promotion, Department of Oral Health and Welfare, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiko Saito
- Department of Health and Nutrition, Niigata University of Health and Welfare, Niigata, Japan
| | - Kaori Kitamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshihiro Ansai
- Division of Community, Oral Health Development, Kyushu Dental University, Kitakyushu, Japan
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Ahad A, Haque E, Naaz S, Bey A, Rahman SA. Pattern of buccal and palatal bone density in the maxillary premolar region: an anatomical basis of anterior-middle superior alveolar (AMSA) anesthetic technique. J Dent Anesth Pain Med 2020; 20:387-395. [PMID: 33409367 PMCID: PMC7783380 DOI: 10.17245/jdapm.2020.20.6.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Methods Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.
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Affiliation(s)
- Abdul Ahad
- Department of Dentistry, Medini Rai Medical College, Palamu, Jharkhand, India
| | - Ekramul Haque
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Sabiha Naaz
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Afshan Bey
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | - Sajjad Abdur Rahman
- Department of Oral and Maxillofacial Surgery, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
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Marques ML, Ramiro S, Machado PM, van der Heijde D, van Gaalen FA. No relationship between bone mineral density and syndesmophyte formation at the same level in the lumbar spine of patients with radiographic axial Spondyloarthritis. RMD Open 2020; 6:rmdopen-2020-001391. [PMID: 33310864 PMCID: PMC7856152 DOI: 10.1136/rmdopen-2020-001391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 11/13/2020] [Indexed: 01/21/2023] Open
Abstract
Objective To investigate if in radiographic axial Spondyloarthritis (r-axSpA) low vertebral bone mineral density (BMD) is associated with development of new syndesmophytes at the same vertebral level. Methods In a post-hoc analysis from the ASSERT trial (infliximab vs placebo), dual-energy X-ray absorptiometry was used to measure baseline BMD (g/cm2) of the lumbar spine L1 to L4. Syndesmophyte formation was assessed in the same vertebrae on conventional radiographs defined as an increase in modified Stoke Ankylosing Spondylitis Spine Score from 0 or 1 to 2 or 3 after 2 years. Radiographs were scored by two readers. Generalised estimating equations (GEE) adjusted for within-patient correlation across multiple vertebrae, taking potential confounders into account. Results We analysed 599 vertebrae in 165 r-axSpA patients (78% male, mean (SD) age 38 (10) years, 67% with at least one syndesmophyte anywhere in the spine). In total, 24 to 74 new syndesmophytes developed in 9 (5%) to 30 (18%) patients and 13 (2%) to 39 (7%) vertebrae, if either a syndesmophyte was seen by both or only one of the readers (ie, specific and sensitive definitions) respectively. In multivariable analyses, no association was found between baseline local vertebral BMD and new syndesmophyte formation after 2 years: adjOR (95% CI): 0.56 (0.01, 44.45) (specific definition) and 0.26 (0.03, 2.63) (sensitive definition). Conclusion In patients with active and established r-axSpA, with an observed low incidence of lumbar spine syndesmophyte formation over 2 years, no relationship was found between baseline BMD and new radiographic syndesmophyte formation at the same vertebra.
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Affiliation(s)
- Mary Lucy Marques
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands .,Department of Rheumatology, Centro Hospitalar E Universitario De Coimbra EPE, Coimbra, Portugal
| | - Sofia Ramiro
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands.,Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - Floris A van Gaalen
- Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, Netherlands
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21
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Herrou J, Roux C. [Evidence of anti-fracture efficacy of osteoporotic treatments]. Rev Prat 2020; 70:1083-1088. [PMID: 33739647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evidence of anti-fracture efficacy of osteoporotic treatments. The number of osteoporotic fractures is increasing considerably because of an increase in the number of elderly patients at high risk of falls and fractures; consequences on morbidity and mortality and health costs are important. Despite the availability of effective treatments to reduce the risk of fractures, less than 15% of patients with recent low-trauma fractures receive anti-osteoporotic treatment. Lack of knowledge about the effectiveness of treatments and fear about adverse effects by both patients and health professionals partly explain this situation. These treatments have been shown to be highly effective in reducing the risk of vertebral and non-vertebral fractures and increasing bone mineral density in osteoporotic patients with or without a history of fractures, and with a low risk of adverse effects. In addition, recent data from a meta-analysis suggest that a therapeutic strategy based on a densitometric target may be effective in further reducing the risk of fractures.
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Affiliation(s)
- Julia Herrou
- Inserm U 1153, université de Paris, AP-HP Centre, hôpital Cochin, service de rhumatologie, Paris, France
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22
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Kang BH, Cho JH, Kim SY, Jeong KA, Kim SH, Kim C, Lim SJ, Shim KS. Growth and Bone Mineral Density Changes in Ovariectomized Rats Treated with Estrogen Receptor Alpha or Beta Agonists. J Korean Med Sci 2020; 35:e370. [PMID: 33230983 PMCID: PMC7683238 DOI: 10.3346/jkms.2020.35.e370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Estrogen controls the pubertal growth spurt, growth plate closure, and accretion of bone mineral density (BMD) of long bones after biding estrogen receptor (ER). There are two subtypes of ER, ERα and ERβ. If each ER subtype has different effects, we may control those actions by manipulating the estrogen binding intensity to each ER subtype and increase the final adult height without markedly reducing BMD or impairing reproductive functions. The purpose of our study was to compare these effects of ERα and ERβ on long bones in ovariectomized rats. METHODS Thirty female rats were ovariectomized and randomly divided into 3 groups. The control, propylpyrazole triol (PPT), and 2,3-bis (4-hydroxyphenyl) propionitrile (DPN) groups were subcutaneously injected for 5 weeks with sesame oil, PPT as an ERα agonist, and DPN as an ERβ agonist, respectively. The crown-lump length and body weight were measured weekly. BMD, serum levels of growth hormone (GH) and estradiol were checked before and after 5 weeks of injections. Pituitary GH1 expression levels were determined with quantitative real-time polymerase chain reaction, the proximal tibias were dissected, decalcified and stained with hematoxylin-eosin, and the thicknesses of epiphyseal plates including proliferative and hypertrophic zones were measured in 20-evenly divided sites after 5 weeks of injections. Comparisons for auxological data, serum hormone and pituitary GH1 expression levels, BMD, and epiphyseal plate thicknesses among 3 groups before and after injections were conducted. RESULTS There was no significant difference in body lengths among 3 groups. The body weights were significantly lower, but, serum GH, pituitary GH1 expression levels, and BMDs were higher in PPT group than the other 2 groups after 5 weeks of injections. There was no significant difference in the thicknesses of the total epiphyseal plate, proliferative, and hypertrophic zone among 3 groups. CONCLUSION ERα is more involved in pituitary GH secretion and bone mineral deposition than ERβ. Weight gain might be prevented with the ERα agonist.
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Affiliation(s)
- Byung Ho Kang
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ja Hyang Cho
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - So Youn Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kyoung A Jeong
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Shin Hee Kim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chanwoo Kim
- Department of Nuclear Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung Jig Lim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kye Shik Shim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
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Abstract
Objective: This study sought to determine serum sclerostin (SOST) expression in patients with osteoporotic thoracolumbar vertebral compression fractures before and after percutaneous kyphoplasty (PKP). Methods: Serum SOST levels were quantified with a sandwich enzyme-linked immunosorbent assay (ELISA) preoperatively and six months postoperatively. Anterior vertebral height, kyphotic angles, and Visual Analogue Scale (VAS) scores were also recorded. Results: Serum SOST was highly expressed in patients and remained negatively correlated with bone mineral density (BMD). Vertebral heights, local kyphotic angles, and VAS scores were all significantly improved after PKP. However, serum SOST was positively correlated with BMD six months after surgery. Conclusion: PKP was an effective treatment strategy for osteoporotic thoracolumbar vertebral compression fractures, improving BMD and decreasing serum SOST levels. Level of Evidence II, Prospective comparative study.
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Affiliation(s)
- ENZHI WANG
- Taizhou Integrated Chinese and Western Medicine Hospital, China
| | | | | | - XINHUA WANG
- Taizhou Integrated Chinese and Western Medicine Hospital, China
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24
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Florez H, Hernández-Rodríguez J, Carrasco JL, Prieto-González S, Muxi A, Filella X, Ruiz-Gaspà S, Gómez-Puerta JA, Cid M, Espinosa G, Monegal A, Guañabens N, Peris P. Vertebral fracture risk in glucocorticoid-induced osteoporosis: the role of hypogonadism and corticosteroid boluses. RMD Open 2020; 6:rmdopen-2020-001355. [PMID: 32917834 PMCID: PMC7520700 DOI: 10.1136/rmdopen-2020-001355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors associated with fragility fracture (FF) development in glucocorticoid (GC)-treated patients. METHODS 127 patients (aged 62±18 years, 63% women) on GC-treatment (mean dose 14.5±14.1 mg/day and duration 47.7±69 months) were included. The clinical data collected included bone metabolism study (including gonadal axis), GC-treatment, disease activity, dual-energy X-ray absorptiometry analysis (evaluating densitometric osteoporosis (OP) and trabecular bone score (TBS) degraded microarchitecture values (DMA)), X-ray (assessing vertebral fractures (VF)), FRAX risk (GC-adjusted) and previous FF. RESULTS 17% of the patients had VF, 28% FF (VF and/or non-VF), 29% OP and 52% DMA. Patients with VF received more GC boluses (57.1% vs 29.5%, p=0.03), were older (68±13 vs 60±19 years, p=0.02), postmenopausal (100% vs 67%, p=0.02), had low testosterone levels (57% vs 11%, p=0.02), lower TBS values (1.119±0.03 vs 1.237±0.013, p<0.001) and higher FRAX risk (17.2±16 vs 9.3±7.6, p=0.003). Patients with FF showed higher accumulated GC doses (16.6±18.4 vs 11.1±12.9 g, p=0.046). On multivariate analysis, hypogonadism (OR 12.38; 95% CI 1.85 to >100, p=0.01) and having received GC boluses (OR 3.45; 95% CI 1.04 to 12.15, p=0.01) were the main factors related to VF. Hypogonadism (OR 7.03; 95% CI 1.47 to 38.37, p=0.01) and FRAX >20 (OR 7.08; 95% CI 1.28 to 53.71, p=0.02) were factors related to FF. CONCLUSION Hypogonadism is the principal risk factor for developing fractures in GC-treated men and women, whereas receiving GC boluses is a major factor for VF. These results indicate the importance of evaluating the gonadal axis in these patients.
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Affiliation(s)
- Helena Florez
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain .,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Jose Hernández-Rodríguez
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Josep Lluis Carrasco
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Spain
| | - Sergio Prieto-González
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Africa Muxi
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - José A Gómez-Puerta
- Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Maria Cid
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Ana Monegal
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
| | - Pilar Peris
- Metabolic Bone Diseases Unit, Department of Rheumatology, IDIBAPS, CIBERehd, University of Barcelona, Hospital Clínic de Barcelona, Spain.,Department of Rheumatology, University of Barcelona, Hospital Clínic de Barcelona, Spain
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Abstract
Comorbidities are defined as coexistent clinical disorders that appear as a consequence of persistent inflammatory activity and/or treatment. Comorbidities in spondyloarthritis (SpA) are frequent, contributing to a poorer quality of life, higher mortality and incremented healthcare costs. Several recommendations for the screening and management of these comorbidities have been developed in recent years with the aim of improving the different outcomes in these patients. Osteoporosis is the most prevalent comorbidity in patients with SpA, mainly caused by systemic inflammation and a lack of mobility, while cardiovascular diseases explain the increased mortality in patients with SpA with regard to the general population. Data from randomised controlled trials show a low incidence of infections in both patients with and without immunosuppressive treatment, and no evidence of a high incidence of malignant diseases has been demonstrated in these patients. Finally, concomitant fibromyalgia deserves attention, since its coexistence with SpA leads to a poorer treatment response and more switches of anti-TNF treatments. In this review, we show an update of the most common comorbidities in patients with SpA, and we discuss the latest evidence on the management of such comorbidities.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Hôpital Cochin - APHP Centre, Paris, France .,ECAMO Team - INSERM (U1153) Clinical Epidemiology and Biostatistics PRES Sorbonne Paris-Cité Université De Paris, Paris, France.,Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.,Rheumatology Department, Reina Sofía University Hospital, Córdoba, Spain
| | - Anna Molto
- Rheumatology Department, Hôpital Cochin - APHP Centre, Paris, France.,ECAMO Team - INSERM (U1153) Clinical Epidemiology and Biostatistics PRES Sorbonne Paris-Cité Université De Paris, Paris, France
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26
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Chae JM, Gousman J, Seo JW, Bay RC, Jue SS, Park JH. A Retrospective CBCT Study of the Relationship between Mandibular Symphysis Bone Density and Mandibular Growth Direction. J Clin Pediatr Dent 2020; 44:356-65. [PMID: 33181848 DOI: 10.17796/1053-4625-44.5.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this retrospective study was to investigate the relationship between mandibular symphysis bone density (BD) and mandibular growth direction in adolescent patients by facilitating the measurement of cortical and cancellous BDs at the mandibular symphysis using cone beam computed tomography (CBCT). STUDY DESIGN 224 adolescent patients (98 males and 126 females) were categorized by sex, age, and mandibular growth direction. Cortical and cancellous BDs were measured along with a sagittal slice at multiple locations. RESULTS Females exhibited higher cortical BD than males at menton (Me, P =0.002). Patients with a posterior growth direction exhibited a higher cortical BD than those with anterior and normal growth direction at Me (P <0.021, P <0.001, respectively), pogonion (Pog, P =0.037, P =0.037, respectively) and genion (Ge, P =0.007, P =0.008, respectively). Patients with a posterior growth direction exhibited a higher cortical BD than those with anterior growth direction at B point (P =0.009). CONCLUSIONS Significant differences in BD were identified across anthropometric categories. These findings may be useful in determining mandibular growth direction in adolescents.
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ElDeeb AM, Abdel-Aziem AA. Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial. J Manipulative Physiol Ther 2020; 43:384-93. [PMID: 32868028 DOI: 10.1016/j.jmpt.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/29/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of whole-body vibration (WBV) on muscle work and bone mineral density (BMD) of the lumbar vertebrae and femur in postmenopausal women. METHODS Forty-three postmenopausal women with low BMD were randomly assigned to WBV and control groups. Both groups received calcium and vitamin D supplementations once daily, while the WBV group additionally received WBV exercise (twice/wk) for 24 successive weeks. Qualisys gait analysis system was used to measure hip power generation by hip extensors (H1S) and flexors (H3S), hip power absorption by hip flexors (H2S), knee power absorption by quadriceps during loading response (K1S) and preswing (K3S), knee power absorption by hamstring (K4S), knee power generation by quadriceps (K2S), ankle power absorption by dorsiflexors (A1S) and plantar flexors (A2S), and ankle power generation by plantar flexors (A3S). Also, dual-energy X-ray absorptiometry was used to measure BMD of the lumbar vertebrae and femur before and after the intervention. RESULTS There were significant increases (P < .05) in the hip muscle work (H1S, H2S, and H3S), knee muscle work (K1S, K2S, K3S, and K4S), ankle muscle work (A1S, A2S, and A3S) during gait, and BMD of the lumbar vertebrae and femur of the WBV group. However, there were no significant changes (P > .05) in the control group. The posttreatment values of the hip, knee, and ankle muscle work and BMD of the WBV group were significantly (P < .05) higher than the posttreatment values of the control group. CONCLUSION Whole-body vibration training improved the leg muscle work and lumbar and femoral BMD in postmenopausal women with low BMD.
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Gaêta-Araujo H, Nascimento EHL, Brasil DM, Madlum DV, Haiter-Neto F, Oliveira-Santos C. Influence of reconstruction parameters of micro-computed tomography on the analysis of bone mineral density. Imaging Sci Dent 2020; 50:153-159. [PMID: 32601590 PMCID: PMC7314611 DOI: 10.5624/isd.2020.50.2.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose This study was conducted evaluate the influence of reconstruction parameters of micro-computed tomography (micro-CT) images on bone mineral density (BMD) analyses. Materials and Methods The sample consisted of micro-CT images of the maxillae of 5 Wistar rats, acquired using a SkyScan 1174 unit (Bruker, Kontich, Belgium). Each acquisition was reconstructed following the manufacturer's recommendations (standard protocol; SP) for the application of artifact correction tools (beam hardening correction [BHC], 45%; smoothing filter, degree 2; and ring artifact correction [RAC], level 5). Additionally, images were reconstructed with 36 protocols combining different settings of artifact correction tools (P0 to P35). BMD analysis was performed for each reconstructed image. The BMD values obtained for each protocol were compared to those obtained using the SP through repeated-measures analysis of variance with the Dunnett post hoc test (α=0.05). Results The BMD values obtained from all protocols that used a BHC of 45% did not significantly differ from those obtained using the SP (P>0.05). The other protocols all yielded significantly different BMD values from the SP (P<0.05). The smoothing and RAC tools did not affect BMD values. Conclusion BMD values measured on micro-CT images were influenced by the BHC level. Higher levels of BHC induced higher values of BMD.
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Affiliation(s)
- Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Daniela Verardi Madlum
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Christiano Oliveira-Santos
- Department of Stomatology, Public Oral Health, Forensic Dentistry, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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Kim SM, Kim AS, Ko HJ, Moon H, Choi HI, Song J. Association between Bone Mineral Density and Serum Iron Indices in Premenopausal Women in South Korea. Korean J Fam Med 2020; 41:175-182. [PMID: 32456385 PMCID: PMC7272370 DOI: 10.4082/kjfm.18.0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/09/2019] [Indexed: 01/11/2023] Open
Abstract
Background Osteoporosis is characterized by a decrease in bone mineral density (BMD) and increased risk of fragility fractures. Serum iron level may interact with bone health status. This study investigated the correlations of BMD with serum iron level, hemoglobin level, and total iron-binding capacity (TIBC). Methods We performed a retrospective analysis of data from the medical records of premenopausal women in South Korea. The women’s BMDs and the Z scores of the BMDs were verified using dual-energy X-ray absorption. The participants were stratified into quartiles for analyses of the associations of BMD with serum iron level, TIBC, and hemoglobin level. Results A simple linear regression analysis revealed associations of changes in BMD with iron level (β=-0.001, standard error [SE]=0.001, P<0.001), hemoglobin level (β=0.015, SE=0.003, P<0.001), and TIBC (β=0.001, SE=0.001, P<0.001). This pattern was also observed in a multiple linear regression analysis. A multivariate logistic regression analysis of iron level and TIBC for low BMD revealed odds ratios of 1.005 (P<0.001) and 0.995 (P<0.001), respectively. Conclusion This study demonstrated clear relationships of changes in BMD with serum iron level and TIBC, and thus confirms the usefulness of these markers in the clinical evaluation of iron storage and BMD in younger women.
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Affiliation(s)
- Sung-Min Kim
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - A-Sol Kim
- Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hae-Jin Ko
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea.,Department of Family Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hana Moon
- Department of Family Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Hye-In Choi
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jieun Song
- Department of Family Medicine, Kyungpook National University Hospital, Daegu, Korea
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30
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Li F, Zhou C, Gao M, Xu L, Wen G, Zhao J, Yan J. Effect of 11β-HSD1 inhibitor on bone microstructure and bone density in rats with femoral head necrosis. J Musculoskelet Neuronal Interact 2020; 20:282-290. [PMID: 32481244 PMCID: PMC7288393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate the effect of 11β-hydroxysteroid dehydrogenase (11β-HSD1) inhibitor on bone microstructure and bone density in rats with femoral head necrosis. METHODS Eighty Sprague-Dawley (SD) rats were selected and randomly divided into two groups. One group was selected for femoral head necrosis modeling. Then the modeled rats were randomly divided into two groups, one group was injected with 11β-HSD1 inhibitor as the treatment group, and the other group was used as the model. The unmodeled rats were also randomly divided into two groups, one group was injected with 11β-HSD1 inhibitor as the control group, and the other group was taken as the normal group. The bone microstructure and femoral bone density of 4 groups of rats were observed. RESULTS There were no significant differences in bone microstructure and bone density between the treatment group and the model group before injection (P>0.050), but they were significantly improved after injection (P<0.001). There was no significant difference in superoxide dismutase (SOD) and malondialdehyde (MDA) between the control group and the normal group (P>0.050). SOD increased significantly, and MDA decreased significantly after injection in the treatment group (P<0.001). CONCLUSIONS 11β-HSD1 inhibitor can effectively improve the bone microstructure of femoral head necrosis rats and increase bone density, which can be used as a new scheme for the treatment of femoral head necrosis in the future.
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Affiliation(s)
- Feng Li
- Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Changlin Zhou
- Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Ming Gao
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, P.R. China
| | - Liang Xu
- Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Gang Wen
- Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Jingyi Zhao
- Department of Imaging, Heilongjiang Hospital of Traditional Chinese Medicine, P.R. China
| | - Jinglong Yan
- Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, P.R. China,Corresponding author: Dr. Jinglong Yan, Department of Orthopedic Surgery, The 2nd Affiliated Hospital of Harbin Medical University, No.148 Baojian Road, Harbin 150081, P.R. China E-mail:
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31
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Kinalski MA, Boscato N, Damian MF. The accuracy of panoramic radiography as a screening of bone mineral density in women: a systematic review. Dentomaxillofac Radiol 2019; 49:20190149. [PMID: 31596133 DOI: 10.1259/dmfr.20190149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES A systematic review and meta-analysis of diagnostic test accuracy studies was conducted to assess if the radiomorphometric indexes observed in panoramic radiographies could estimate reduced bone mineral density (BMD) similarly to standard technique the bone densitometry (dual energy X-ray absorptiometry) in females older than 30 years. METHODS A systematic search in four databases was conducted until January 2019. Two evaluators performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Data were synthesized on a subgroup meta-analysis with a random effect model and the hierarchical summary receiver-operating characteristic curve was used to calculate pooled estimates of studies. RESULTS Thirty three studies were included and 12 different radiomorphometric indexes identified, including Mandibular Cortical Index (MCI). The final number of cases pooled for the analysis was 5266 females.The MCI for BMD loss (osteopenia) presented values of sensitivity 0.81 [95% confidence interval (CI), 0.78-0.84] and specificity 0.48 (95% CI, 0.45-0.50), while for osteoporosis sensitivity 0.35 (95% CI, 0.30-0.40) and specificity 0.88 (95% CI, 0.86-0.90). The mandibular cortical width presented values of sensitivity 0.58 (95% CI, 0.40-0.73), specificity 0.73 (95% CI, 0.60-0.83) for osteopenia, while for osteoporosis sensitivity 0.57 (95% CI, 0.36-0.76) and specificity 0.83 (95% CI, 0.68-0.92). Due to the high sensitivity, MCI presented a potential value as a screening tool for initial BMD loss (osteopenia), once tests presenting high sensitivity are described as rarely missing subjects with the disease. To the other hand, MCI to osteoporosis and Mandibular Cortical Width for both conditions are not recommended because presented specificity higher than sensitivity. CONCLUSION The MCI can be recommended as a feasible tool to screen initial BMD loss (osteopenia) in females above 30 years old using panoramic radiography exams.
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Safari A, Borhani-Haghighi A, Dianatpour M, Heydari ST, Foroughinia F, Ranjbar Omrani G. Circulating Serum Amyloid A, hs-CRP and Vitamin D Levels in Postmenopausal Osteoporosis. Galen Med J 2019; 8:e1548. [PMID: 34466525 PMCID: PMC8343903 DOI: 10.31661/gmj.v8i0.1548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Both vitamin D and inflammation were investigated as important players in the pathogenesis of postmenopausal osteoporosis. This study compared vitamin D, inflammatory the biomarkers serum levels and their association with bone mineral density (BMD) in case and control groups to evaluate the possible immune-regulatory effect of vitamin D in this population. Materials and Methods: Participants in post-menopausal age, were categorized to 44 osteoporotic vs. 44 healthy aged-matched women according to WHO criteria. Total BMD, T- scores, Z-scores as well as fracture risk were measured in both groups, using Hologic system Dual-energy X-ray absorptiometry (DEXA). Serum 25-OH vitamin D, high sensitive CRP (hs-CRP) and serum amyloid A (SAA) were compared between groups. The association between serum biomarkers level and BMD were also investigated. The same evaluations were performed for vitamin D deficient (<20 ng/mL) and non-deficient (≥20 ng/mL) subgroups. Results: Vitamin D deficiency was higher in the osteoporotic group (32.6%) in comparison with the control group (25.6%), but the differences were not significant (P=0.47). There were no significant differences in serum levels of hs-CRP and SAA (P=0.83 and P=0.39) as well. No significant association between serum inflammatory biomarkers, vitamin D, and BMD were detected (P≥0.05). The results were the same for vitamin D deficient and non-deficient subgroups (P≥0.05). Conclusion: In the current study, the beneficial effects of vitamin D as a result of its immune-regulatory mechanisms was not reached. Larger scale studies might pave the way to define vitamin D benefits in postmenopausal osteoporosis.
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Affiliation(s)
- Anahid Safari
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences Shiraz, Iran
| | | | - Mehdi Dianatpour
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences Shiraz, Iran
| | - Seyed Taghi Heydari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Foroughinia
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Clinical Pharmacy Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ranjbar Omrani
- Endocrinology & Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence to: Gholamhossein Ranjbar Omrani, Endocrinology & Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Telephone Number: +98-713-6281569 Email Address:
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Lee SH, Ryu SY, Park J, Shin MH, Han MA, Choi SW. The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Bone Mineral Density in Korean Postmenopausal Women. Chonnam Med J 2019; 55:150-155. [PMID: 31598472 PMCID: PMC6769246 DOI: 10.4068/cmj.2019.55.3.150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 06/14/2019] [Accepted: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are known to be markers of the systemic inflammatory response. However, the few studies that have been done on the relationship between the NLR and PLR and osteoporosis have yielded inconsistent results. Therefore, we assessed the relationship between the NLR and PLR and bone mineral density (BMD). This study was conducted with postmenopausal patients admitted to an orthopaedic hospital. Data including BMD, NLR, PLR and covariates were obtained from the subjects' medical records. In total, 407 postmenopausal patients were enrolled in this study. Analysis of covariance was performed to identify significant differences in BMD according to NLR and PLR. After adjusting for other covariates, a quartile of NLR was negatively associated with the mean value of lumbar BMD (p=0.040, p for trend=0.005) but not with the mean value of femur neck BMD. However, there were no significant associations among the PLR, the BMD of the lumbar and the femur neck. In conclusion, the quartile of NLR was negatively associated with the mean value of lumbar BMD in Korean postmenopausal patients.
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Affiliation(s)
- San-Hui Lee
- Department of Health Science, Graduate School of Chosun University, Gwangju, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Mi-Ah Han
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
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Affiliation(s)
- Tilman B Drüeke
- Institut National de la Santé et de la Recherche Médicale U-1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris-Ile-de-France-Ouest University, Paris-Sud University, and Paris Saclay University, Villejuif, France;
| | - Pieter Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium; and.,Laboratory of Nephrology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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Keronen S, Martola L, Finne P, Burton IS, Kröger H, Honkanen E. Changes in Bone Histomorphometry after Kidney Transplantation. Clin J Am Soc Nephrol 2019; 14:894-903. [PMID: 31088851 PMCID: PMC6556726 DOI: 10.2215/cjn.09950818] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Over the past decade, the management of CKD-mineral and bone disorder has changed substantially, altering the pattern of bone disease in CKD. We aimed to evaluate the natural history of kidney bone disease in contemporary kidney transplant recipients and patients on dialysis. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS Sixty one patients on dialysis who were referred to kidney transplantation participated in this prospective cohort study during November 2009 and December 2010. We performed baseline bone biopsies while the patients were on dialysis and repeated the procedure in 56 patients at 2 years after kidney transplantation or 2 years after baseline if transplantation was not performed. Measurements of mineral metabolism and bone turnover, as well as dual energy x-ray absorptiometry scans, were obtained concurrently. RESULTS A total of 37 out of 56 participants received a kidney transplant, of which 27 underwent successful repeat bone biopsy. The proportion of patients with high bone turnover declined from 63% at baseline to 19% at 2 years after kidney transplantation, whereas the proportion of those with low bone turnover increased from 26% to 52%. Of 19 participants remaining on dialysis after 2 years, 13 underwent successful repeat biopsy. The proportion of patients remaining on dialysis with high bone turnover decreased from 69% to 31%, and low bone turnover increased from 8% to 38%. Abnormal bone mineralization increased in transplant recipients from 33% to 44%, but decreased in patients remaining on dialysis from 46% to 15%. Trabecular bone volume showed little change after transplantation, but low bone volume increased in patients remaining on dialysis. Bone mineral density did not correlate with histomorphometric findings. CONCLUSIONS Bone turnover decreased over time both in patients remaining on dialysis and in kidney transplant recipients. Bone mineral density and bone biomarkers were not associated with bone metabolism changes detected in bone biopsy specimens.
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Affiliation(s)
- Satu Keronen
- Abdominal Center, Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;
| | - Leena Martola
- Abdominal Center, Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrik Finne
- Abdominal Center, Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Inari S Burton
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland; and
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland; and.,Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Eero Honkanen
- Abdominal Center, Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Shahnazari B, Moghimi J, Foroutan M, Mirmohammadkhani M, Ghorbani A. Comparison of the effect of vitamin D on osteoporosis and osteoporotic patients with healthy individuals referred to the Bone Density Measurement Center. Biomol Concepts 2019; 10:44-50. [PMID: 30956224 DOI: 10.1515/bmc-2019-0005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 11/15/2022] Open
Abstract
Objective Osteoporosis is the most common metabolic disease of the bones. Osteoporosis reduces bone density, predisposes a person to fractures, and imposes high costs on societies. Osteoporosis develops from a variety of causes, one of the most significant is vitamin D deficiency. This study investigates the impact of vitamin D on osteoporosis. Materials and Methods In this clinical trial, 400 patients referred to the Bone Density Clinic of Kowsar Hospital in Semnan were selected by convenience sampling method. Bone densitometry tests were carried out using DEXA (x-ray absorptiometry) and serum vitamin D levels were measured by the ELISA method. Subjects with vitamin D deficiency were treated for 8 weeks with (50,000 Vitamin D units per week. At the end of the treatment period, all subjects were evaluated for bone density and the results of both groups were compared. Results 13% of subjects had osteoporosis and 14.2% had osteopenia. 19% of subjects had vitamin D deficiency, 38.8% had insufficient levels of vitamin D, and 42.3% had sufficient vitamin D levels. The level of vitamin D in patients with osteoporosis (5.50 ± 5.5 ng/ml) was less than those with osteopenia (7.83 ± 4.8 ng/ml) and those with normal bone mineral density (23.88 ± 18.42 ng/ml) (P <0.001). The prevalence of osteoporosis in the intervention group after intervention with vitamin D was significantly lower than the control group (32.3 versus 67.7 and P <0.001). Conclusion The prevalence of serum vitamin D deficiency in osteopenic and osteoporotic individuals was higher than in normal subjects, with a significant relationship between age and sex. Thus, treatment with vitamin D improves bone density indices.
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Affiliation(s)
| | | | - Majid Foroutan
- Internal Medicine Department, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinats of Health Research center, Semnan University of Medical Sciences, Semnan, Iran
| | - Amir Ghorbani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
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Abstract
CKD mineral and bone disease is a common complication of kidney disease, and it affects the majority of patients with moderate to severe CKD. Recently, prospective studies have shown that measurement of bone mineral density by dual energy x-ray absorptiometry predicts incident fracture, providing nephrologists the ability to risk classify patients for skeletal fragility and targeted antifracture strategies for the first time. Furthermore, an expanding body of literature and anecdotal evidence suggest that pharmacologic agents used to treat osteoporosis in the general population can be safely used in patients with CKD. This review highlights the effects of the Kidney Disease Improving Global Outcomes updates on the management of CKD-associated osteoporosis, discusses recent investigations on the effects of antiosteoporotic agents in patients with CKD, and provides an overview of novel antiosteoporosis agents and the potential challenges related to their use in CKD.
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Affiliation(s)
- Pascale Khairallah
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
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Abstract
Secondary hyperparathyroidism develops in CKD due to a combination of vitamin D deficiency, hypocalcemia, and hyperphosphatemia, and it exists in nearly all patients at the time of dialysis initiation. There is insufficient data on whether to prefer vitamin D analogs compared with calcimimetics, but the available evidence suggests advantages with combination therapy. Calcium derangements, patient adherence, side effects, and cost limit the use of these agents. When parathyroid hormone level persists >800 pg/ml for >6 months, despite exhaustive medical interventions, monoclonal proliferation with nodular hyperplasia is likely present along with decreased expression of vitamin D and calcium-sensing receptors. Hence, surgical parathyroidectomy should be considered, especially if concomitant disorders exist, such as persistent hypercalcemia or hyperphosphatemia, tissue or vascular calcification including calciphylaxis, and/or worsening osteodystrophy. Parathyroidectomy is associated with 15%-57% greater survival in patients on dialysis, and it also improves hypercalcemia, hyperphosphatemia, tissue calcification, bone mineral density, and health-related quality of life. The parathyroidectomy rate in the United States declined to approximately seven per 1000 dialysis patient-years between 2002 and 2011 despite an increase in average parathyroid hormone levels, reflecting calcimimetics introduction and uncertainty regarding optimal parathyroid hormone targets. Hospitalization rates are 39% higher in the first postoperative year. Hungry bone syndrome occurs in approximately 25% of patients on dialysis, and profound hypocalcemia requires high doses of oral and intravenous calcium along with calcitriol supplementation. Total parathyroidectomy with autotransplantation carries a higher risk of permanent hypocalcemia, whereas risk of hyperparathyroidism recurrence is higher with subtotal parathyroidectomy. Given favorable long-term outcomes from observational parathyroidectomy cohorts, despite surgical risk and postoperative challenges, it is reasonable to consider parathyroidectomy in more patients with medically refractory secondary hyperparathyroidism.
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Affiliation(s)
- Wei Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, California
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Saitz R, Mesic A, Ventura AS, Winter MR, Heeren TC, Sullivan MM, Walley AY, Patts GJ, Meli SM, Holick MF, Kim TW, Bryant KJ, Samet JH. Alcohol Consumption and Bone Mineral Density in People with HIV and Substance Use Disorder: A Prospective Cohort Study. Alcohol Clin Exp Res 2018; 42:10.1111/acer.13801. [PMID: 29873812 PMCID: PMC6281811 DOI: 10.1111/acer.13801] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND People living with HIV (PLWH) commonly have low bone mineral density (BMD) (low bone mass and osteoporosis) and are at high risk for fractures. Fractures and low BMD are significant causes of morbidity and mortality, increasingly relevant as PLWH age. Alcohol use is common among PLWH and known to affect bone health. The association between alcohol use and changes in BMD among PLWH is not well understood. METHODS We conducted a 3.5-year prospective cohort study of 250 PLWH with substance use disorder or ever injection drug use. Annual alcohol consumption was measured as a mean of grams per day of alcohol, mean number of heavy drinking days per month, mean number of days abstinent per month, and any heavy drinking, using the 30-day Timeline Followback method twice each year. The primary outcome was annual change in BMD measured each year by dual energy X-ray absorptiometry in grams per square centimeter (g/cm2 ) at the femoral neck. Additional dependent variables included annual change in total hip and lumbar spine BMD, >6% annual decrease in BMD at any site, and incident fractures in the past year. Regression models adjusted for relevant covariates. RESULTS The median age of participants was 50 years. The median duration of HIV infection was 16.5 years and the mean time since antiretroviral therapy initiation was 12.3 years. At study entry, 67% of participants met criteria for low BMD (46% low bone mass, 21% osteoporosis). Median follow-up was 24 months. We found no significant associations between any measure of alcohol consumption and changes in BMD (g/cm2 ) at the femoral neck (adjusted β for g/d of alcohol = -0.0032, p = 0.7487), total hip, or lumbar spine. There was no significant association between any measure of alcohol consumption and >6% annual decrease in BMD at any site, or incident fractures. CONCLUSIONS In this sample of PLWH and substance use disorders or ever injection drug use, we detected no association between any of the alcohol measures used in the study and changes in BMD or incident fractures.
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Affiliation(s)
- Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Aldina Mesic
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Alicia S Ventura
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy C Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Meg M Sullivan
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Gregory J Patts
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts
| | - Seville M Meli
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Michael F Holick
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Theresa W Kim
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
| | - Kendall J Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Jeffrey H Samet
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, School of Medicine and Boston Medical Center, Boston University, Boston, Massachusetts
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Kim J, Kwon H, Heo BK, Joh HK, Lee CM, Hwang SS, Park D, Park JH. The Association between Fat Mass, Lean Mass and Bone Mineral Density in Premenopausal Women in Korea: A Cross-Sectional Study. Korean J Fam Med 2018; 39:74-84. [PMID: 29629038 PMCID: PMC5876052 DOI: 10.4082/kjfm.2018.39.2.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022] Open
Abstract
Background We investigated the association between body composition, especially truncal or non-truncal fat mass (FM), and bone mineral density (BMD) in premenopausal women in Korea. Methods A cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey IV and V (2008–2011). Total lean mass (LM), total FM (TFM), truncal FM, and non-truncal FM, and BMD of the total femur, femoral neck (FN), and lumbar spine were measured using dual-energy X-ray absorptiometry. The association between body composition and BMD was analyzed using multiple linear regression. The risk of low BMD according to quartiles of TFM, truncal FM, and non-truncal FM was calculated using logistic regression. Subgroup analysis according to body mass index was also performed. Results In 4,343 premenopausal women, total LM was positively associated with BMD regardless of weight adjustment. TFM, truncal FM, and non-truncal FM were inversely associated with BMD after adjusting for weight. Odds ratios (ORs) for low BMD and 95% confidence intervals (CIs) of the highest quartile of TFM, truncal FM, and non-truncal FM compared with the lowest quartile were calculated. The risk of low BMD of the FN was higher in the highest quartile of TFM (OR, 4.48; 95% CI, 1.11–18.01) and truncal FM (OR, 5.48; 95% CI, 1.75–17.20). Truncal FM and not-truncal FM had an inverse association with BMD in the non-obese and obese subgroups of women. Conclusion Total LM has a protective effect on BMD and FM can have a detrimental effect on BMD besides its skeletal loading effect.
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Affiliation(s)
- Jeehyun Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyuktae Kwon
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bo-Kyoung Heo
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Kyung Joh
- Department of Family Medicine, Seoul National University Health Service Center, Seoul, Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea
| | - Danbee Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Hong Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
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Shokri A, Ramezani L, Bidgoli M, Akbarzadeh M, Ghazikhanlu-Sani K, Fallahi-Sichani H. Effect of field-of-view size on gray values derived from cone-beam computed tomography compared with the Hounsfield unit values from multidetector computed tomography scans. Imaging Sci Dent 2018; 48:31-39. [PMID: 29581947 PMCID: PMC5863017 DOI: 10.5624/isd.2018.48.1.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/15/2018] [Accepted: 01/30/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of field-of-view (FOV) size on the gray values derived from conebeam computed tomography (CBCT) compared with the Hounsfield unit values from multidetector computed tomography (MDCT) scans as the gold standard. Materials and Methods A radiographic phantom was designed with 4 acrylic cylinders. One cylinder was filled with distilled water, and the other 3 were filled with 3 types of bone substitute: namely, Nanobone, Cenobone, and Cerabone. The phantom was scanned with 2 CBCT systems using 2 different FOV sizes, and 1 MDCT system was used as the gold standard. The mean gray values (MGVs) of each cylinder were calculated in each imaging protocol. Results In both CBCT systems, significant differences were noted in the MGVs of all materials between the 2 FOV sizes (P<.05) except for Cerabone in the Cranex3D system. Significant differences were found in the MGVs of each material compared with the others in both FOV sizes for each CBCT system. No significant difference was seen between the Cranex3D CBCT system and the MDCT system in the MGVs of bone substitutes on images obtained with a small FOV. Conclusion The size of the FOV significantly changed the MGVs of all bone substitutes, except for Cerabone in the Cranex3D system. Both CBCT systems had the ability to distinguish the 3 types of bone substitutes based on a comparison of their MGVs. The Cranex3D CBCT system used with a small FOV had a significant correlation with MDCT results.
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Affiliation(s)
- Abbas Shokri
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Leila Ramezani
- Dental Implant Research Center, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohsen Bidgoli
- Department of Periodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Akbarzadeh
- Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Karim Ghazikhanlu-Sani
- Department of Radiology, Faculty of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamed Fallahi-Sichani
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran
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Huyut Z, Bakan N, Yıldırım S, Alp HH. Effects of the Phosphodiesterase-5 (PDE-5) Inhibitors, Avanafil and Zaprinast, on Bone Remodeling and Oxidative Damage in a Rat Model of Glucocorticoid-Induced Osteoporosis. Med Sci Monit Basic Res 2018; 24:47-58. [PMID: 29557941 PMCID: PMC5865409 DOI: 10.12659/msmbr.908504] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/08/2018] [Indexed: 01/06/2023] Open
Abstract
Background The aim of this study was to evaluate the effects of the phosphodiesterase-5 (PDE-5) inhibitors, zaprinast and avanafil, on NO signalling pathway, bone mineral density (BMD), epiphyseal bone width, bone marrow angiogenesis, and parameters of oxidative stress in a rat model of glucocorticoid-induced osteoporosis (GIOP). Material/Methods Twenty-four 8-month-old male rats in four groups were given a single daily treatment during a 30-day period: an (untreated) control group (n=6): a dexamethasone-treated group (120 μ/kg) (n=6); a group treated with dexamethasone (120 μ/kg) and zaprinast (10 mg/kg) (n=6): and a group treated with dexamethasone (120 μ/kg) and avanafil (10 mg/kg) (n=6). Rat whole body bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA), and bone histology was performed. Also, selected oxidative stress parameters by HPLC method and the other biochemical parameters by ELISA method were measured. Results The GIOP model rats treated with zaprinast and avanafil showed a significant increase in NO, cyclic guanosine monophosphate (cGMP), and protein kinase G (PKG) (NO/cGMP/PKG) signaling-pathway components, and in C-terminal telopeptide of type I collagen (CTX-1), bone marrow angiogenesis, BMD, and epiphyseal bone width, compared with the (untreated) control rats (p<0.05). Levels of pyridinoline (PD) and deoxypyridinoline (DPD) were significantly reduced in the dexamethasone + zaprinast, and dexamethasone + avanafil treatment groups (p<0.05). Malondialdehyde (MDA), ubiquinone-10 (CoQ10), ubiquinol CoQ10 (CoQ10H), and 8-hydroxy-2′-deoxyguanosine (8-OHdG) were significantly increased in the dexamethasone-treated group, compared with the (untreated) controls (p<0.05). Conclusions In the GIOP rat model, markers of oxidative stress and bone atrophy were significantly reduced by treatment with the PDE-5 inhibitors, zaprinast and avanafil.
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Affiliation(s)
- Zübeyir Huyut
- Department of Biochemistry, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
| | - Nuri Bakan
- Department of Biochemistry, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Serkan Yıldırım
- Department of Pathology, Faculty of Veterinary, Atatürk University, Erzurum, Turkey
| | - Hamit Hakan Alp
- Department of Biochemistry, Medical Faculty, Yuzuncu Yıl University, Van, Turkey
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Peiseler M, Liebscher T, Sebode M, Zenouzi R, Hartl J, Ehlken H, Pannicke N, Weiler-Normann C, Lohse AW, Schramm C. Efficacy and Limitations of Budesonide as a Second-Line Treatment for Patients With Autoimmune Hepatitis. Clin Gastroenterol Hepatol 2018; 16:260-267.e1. [PMID: 28126427 DOI: 10.1016/j.cgh.2016.12.040] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Many patients with autoimmune hepatitis (AIH) develop steroid-specific side effects or require doses of steroids that are unacceptable for long-term treatment. We investigated the efficacy of budesonide as an alternative steroid for patients previously treated with prednisolone who developed side effects or were unable to reduce their dose of prednisolone below acceptable levels. We also report the effects of more than 12 months of budesonide treatment in a large cohort of patients with AIH. METHODS We performed a retrospective analysis of data from 60 patients (51 female) with AIH who were treated initially with prednisolone (mean time, 47 mo) but then switched to budesonide, managed at a single center in Germany from 2001 through June 2016. Patients were evaluated after 6 months, 12 months, 24 months, 36 months, and at the last follow-up evaluation; response to treatment with budesonide was assessed based on normal serum levels of aminotransferases and IgG (biochemical response). RESULTS Thirty patients were switched to budesonide therapy because of prednisolone-induced side effects and 30 patients switched because of prednisolone dependency. Overall, a biochemical response was detected in 55% of patients after 6 months of budesonide treatment, in 70% after 12 months, and in 67% after 24 months. At the last follow-up evaluation (mean time, 63 mo) 23 patients (38%) still were receiving budesonide treatment. Fifteen patients (25%) had switched back to prednisolone therapy because of insufficient response to budesonide or its side effects. Fifteen patients with osteopenia at the beginning of budesonide treatment were followed up and evaluated by dual-energy X-ray absorptiometry. After a median of 24 months of budesonide treatment, bone mineral density had improved in 6 patients, remained stable in 8 patients, and worsened in 1 patient. CONCLUSIONS We performed a retrospective analysis of patients with AIH that confirmed the therapeutic value of budesonide beyond 12 months of treatment in patients who are intolerant to or dependent on prednisolone. Although budesonide-induced side effects appear to be mild in real life, effectiveness was limited in a considerable proportion of patients; close monitoring is advised.
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Basurto-Acevedo L, Saucedo-García R, Vázquez-Martínez A, Cruz-García M, Valle-Hernández MM, Rosales-Cruz E, Sánchez-Arenas R. [Relationship between bone remodeling and metabolism in the elderly]. Rev Med Inst Mex Seguro Soc 2018; 56:S6-S11. [PMID: 29624339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Recent studies have shown that osteocalcin (OC) is related to not only bone metabolism but also energy metabolism. The aim of the present study was to investigate whether OC was associated with metabolic factors and bone mineral density (BMD) in elderly men. METHODS A cross-sectional study was done including 122 healthy men aged 60 years or older. Serum glucose, lipids, insulin, adiponectin and OC were measured and BMD was estimated using dual energy X-ray absorptiometry. RESULTS 42.8% of men had metabolic syndrome (MetS). OC levels were not significantly different between men with and without MetS. OC concentrations were inversely associated with body mass index (BMI) (r = −0.226, p = 0.04), waist circumference (r = −0.261, p = 0.02), glucose (r = −0.245, p = 0.03), insulin (r = −0.235, p = 0.03), and HOMA-IR (r = −0.211, p = 0.04). In addition, OC levels were higher in patients with diminished BMD compared with those with normal BMD. CONCLUSIONS OC levels correlate negatively with BMI, waist circumference, glucose, insulin and HOMA-IR in elderly men, which suggests a connection between bone and energy metabolism.
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Affiliation(s)
- Lourdes Basurto-Acevedo
- Instituto Mexicano del Seguro Social, Coordinación de Investigación en Salud, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Endócrinas. Ciudad de México, México
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Balakumar B, Jasper A, Livingstone RS, Gangadharan S, Gibikote S, Madhuri V. Can Pixel Value Ratio be Used in the Assessment of Ceramic Bone Substitute Incorporation? Observations from a Pilot Study. Pol J Radiol 2017; 82:706-712. [PMID: 29657637 PMCID: PMC5894053 DOI: 10.12659/pjr.903022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/10/2017] [Indexed: 11/09/2022] Open
Abstract
Background Assessment of bone graft substitute incorporation is critical in the clinical decision making process and requires special investigations. We examined if the pixel value ratio (PVR) obtained in routine follow-up digital radiographs could be used for such assessment. Material/Methods Radiographic images were acquired using either computed radiography or flat panel digital radiography systems. The PVR from radiographs of thirty children with ceramic bone substitute grafting were analyzed using the software from the picture archival and communication system (PACS) workstation. Graft incorporation was also assessed using the van Hemert scale. Three independent observers (A, B, C) measured PVRs at two different time points during the first and the last follow-up visits. PVR was compared with the van Hemert scale scores and analyzed using Spearman's rank correlation. Results The mean intra-observer reliability was 0.8996, and inter-observer reliabilities were 0.69 (A vs. C), 0.78 (A vs. B), and 0.85 (B vs. C) for the first follow-up visit and 0.74 (A vs. C), 0.82 (A vs. B), and 0.70 (B vs. C) for the last follow-up measurements. Spearman's correlation showed a strong negative association between PVR values and van Hemert scale scores, as the healing process advanced on serial measurements at each follow-up (r=-0.94, n=60, z=-7.24, p≤0.0001). The reliability of the PVR measurements was assessed using an aluminum step wedge and ceramic graft. Conclusions PVR is potentially a reliable indicator of bone graft incorporation and can aid in clinical decision making provided standard radiographic techniques are used.
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Affiliation(s)
| | - Anitha Jasper
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | | | | | - Sridhar Gibikote
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Vrisha Madhuri
- Pediatric Orthopedic Unit, Christian Medical College, Vellore, India
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Abdelmohsen AM. Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women. J Chiropr Med 2017; 16:199-203. [PMID: 29097949 DOI: 10.1016/j.jcm.2017.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 01/23/2023] Open
Abstract
Objectives The purpose of the current study was to compare central and peripheral bone mineral density at different regions including spine, hip, and wrist in postmenopausal women. Methods Forty postmenopausal women participated in this study. Their mean age, body mass, height, and body mass index were 53.5 ± 2.75 y, 68.6 ± 8.68 kg, 167.8 ± 6.46 cm, and 24.31 ± 1.69 kg/m2, respectively. Bone mineral density (BMD) T-scores of spine, hip, and wrist regions were measured for all participants with a dual-energy X-ray absorptiometry scan. Results All measured regions (spine, hip, and wrist) had low BMD T-scores. Bone mineral density of the wrist was significantly lower (-2.58 ± 2.18) than that of both spine (-1.79 ± 0.98) and hip (-1.69 ± 1.37). In addition, there were no statistically significant differences in BMD between the spine and hip. Conclusions In this group of postmenopausal women, wrist BMD decreased more than spine and hip BMD. Both spine and hip BMD decreased by nearly the same percentage in postmenopausal women. Peripheral sites may be more representative of osteoporosis than central sites. Trial Registration: PACTR201602001478123.
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Kim HY, Jung HW, Hong H, Kim JH, Shin CH, Yang SW, Lee YA. The Role of Overweight and Obesity on Bone Health in Korean Adolescents with a Focus on Lean and Fat Mass. J Korean Med Sci 2017; 32:1633-1641. [PMID: 28875607 PMCID: PMC5592177 DOI: 10.3346/jkms.2017.32.10.1633] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/21/2017] [Indexed: 02/01/2023] Open
Abstract
As the associations between pediatric overweight/obesity and bone health remain controversial, we investigated the effects of overweight/obesity as well as lean mass (LM) and fat mass (FM) on bone parameters in adolescents. Bone parameters were evaluated using dual-energy X-ray absorptiometry (DXA) data of 982 adolescents (aged 12-19 years) from the Korea National Health and Nutrition Examination Survey (2009-2010). Z-scores for LM, FM, bone mass, bone mineral density (BMD), and bone mineral apparent density (BMAD) using Korean pediatric reference values were used for analysis. Adolescents with overweight/obesity had significantly higher bone mass and density of the total-body-less-head (TBLH), lumbar spine, and femur neck than underweight or normal-weight adolescents (P < 0.001) after adjusting for vitamin D deficiency, calcium intake, and insulin resistance in both sexes. LM was positively associated with bone parameters at all skeletal sites in both sexes (P < 0.001). FM was negatively related to TBLH BMD in boys (P = 0.018) but was positively associated to BMD and BMAD of the lumbar spine and femur neck in girls. In conclusion, overweight/obesity and LM play a positive role in bone health in adolescents. The effect of FM on bone parameters is sex- and site-specific.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
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Prochaska M, Taylor E, Vaidya A, Curhan G. Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones. Clin J Am Soc Nephrol 2017; 12:1284-1290. [PMID: 28576907 PMCID: PMC5544505 DOI: 10.2215/cjn.01420217] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/05/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated lower bone density in patients with kidney stones, but no longitudinal studies have evaluated kidney stone risk in individuals with low bone density. Small studies with short follow-up reported reduced 24-hour urine calcium excretion with bisphosphonate use. We examined history of low bone density and bisphosphonate use and the risk of incident kidney stone as well as the association with 24-hour calcium excretion. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a prospective analysis of 96,092 women in the Nurses' Health Study II. We used Cox proportional hazards models to adjust for age, body mass index, thiazide use, fluid intake, supplemental calcium use, and dietary factors. We also conducted a cross-sectional analysis of 2294 participants using multivariable linear regression to compare 24-hour urinary calcium excretion between participants with and without a history of low bone density, and among 458 participants with low bone density, with and without bisphosphonate use. RESULTS We identified 2564 incident stones during 1,179,860 person-years of follow-up. The multivariable adjusted relative risk for an incident kidney stone for participants with history of low bone density compared with participants without was 1.39 (95% confidence interval [95% CI], 1.20 to 1.62). Among participants with low bone density, the multivariable adjusted relative risk for an incident kidney stone for bisphosphonate users was 0.68 (95% CI, 0.48 to 0.98). In the cross-sectional analysis of 24-hour urine calcium excretion, the multivariable adjusted mean difference in 24-hour calcium was 10 mg/d (95% CI, 1 to 19) higher for participants with history of low bone density. However, among participants with history of low bone density, there was no association between bisphosphonate use and 24-hour calcium with multivariable adjusted mean difference in 24-hour calcium of -2 mg/d (95% CI, -25 to 20). CONCLUSIONS Low bone density is an independent risk factor for incident kidney stone and is associated with higher 24-hour urine calcium excretion. Among participants with low bone density, bisphosphonate use was associated with lower risk of incident kidney stone but was not independently associated with 24-hour urine calcium excretion.
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Affiliation(s)
- Megan Prochaska
- Divisions of Renal Medicine and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Eric Taylor
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
- Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine
| | | | - Gary Curhan
- Divisions of Renal Medicine and
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and
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Luckman M, Hans D, Cortez N, Nishiyama KK, Agarawal S, Zhang C, Nikkel L, Iyer S, Fusaro M, Guo EX, McMahon DJ, Shane E, Nickolas TL. Spine Trabecular Bone Score as an Indicator of Bone Microarchitecture at the Peripheral Skeleton in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2017; 12:644-652. [PMID: 28348031 PMCID: PMC5383391 DOI: 10.2215/cjn.09850916] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 01/09/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies using high-resolution peripheral quantitative computed tomography showed progressive abnormalities in cortical and trabecular microarchitecture and biomechanical competence over the first year after kidney transplantation. However, high-resolution peripheral computed tomography is a research tool lacking wide availability. In contrast, the trabecular bone score is a novel and widely available tool that uses gray-scale variograms of the spine image from dual-energy x-ray absorptiometry to assess trabecular quality. There are no studies assessing whether trabecular bone score characterizes bone quality in kidney transplant recipients. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS Between 2009 and 2010, we conducted a study to assess changes in peripheral skeletal microarchitecture, measured by high-resolution peripheral computed tomography, during the first year after transplantation in 47 patients managed with early corticosteroid-withdrawal immunosuppression. All adult first-time transplant candidates were eligible. Patients underwent imaging with high-resolution peripheral computed tomography and dual-energy x-ray absorptiometry pretransplantation and 3, 6, and 12 months post-transplantation. We now test if, during the first year after transplantation, trabecular bone score assesses the evolution of bone microarchitecture and biomechanical competence as determined by high-resolution peripheral computed tomography. RESULTS At baseline and follow-up, among the 72% and 78%, respectively, of patients having normal bone mineral density by dual-energy x-ray absorptiometry, 53% and 50%, respectively, were classified by trabecular bone score as having high fracture risk. At baseline, trabecular bone score correlated with spine, hip, and ultradistal radius bone mineral density by dual-energy x-ray absorptiometry and cortical area, density, thickness, and porosity; trabecular density, thickness, separation, and heterogeneity; and stiffness and failure load by high-resolution peripheral computed tomography. Longitudinally, each percentage increase in trabecular bone score was associated with increases in trabecular number (0.35%±1.4%); decreases in trabecular thickness (-0.45%±0.15%), separation (-0.40%±0.15%), and network heterogeneity (-0.48%±0.20%); and increases in failure load (0.22%±0.09%) by high-resolution peripheral computed tomography (all P<0.05). CONCLUSIONS Trabecular bone score may be a useful method to assess and monitor bone quality and strength and classify fracture risk in kidney transplant recipients.
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Affiliation(s)
| | - Didier Hans
- Center of Bone Diseases, Bone and Joint Department, Medical University of Lausanne, Lausanne, Switzerland
| | | | | | | | | | - Lucas Nikkel
- Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, New York
| | - Sapna Iyer
- Department of Medicine, Kaiser Oakland Medical Center, Oakland, California; and
| | - Maria Fusaro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Edward X. Guo
- Biomedical Engineering, Columbia University, New York, New York
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Rahimdel A, Dehghan A, Moghadam MA, Ardekani AM. Relationship between Bone Density and Biochemical Markers of Bone among Two Groups Taking Carbamazepine and Sodium Valproate for Epilepsy in Comparison with Healthy Individuals in Yazd. Electron Physician 2016; 8:3257-3265. [PMID: 28070260 PMCID: PMC5217819 DOI: 10.19082/3257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 02/16/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Chronic antiepileptic therapy has been associated with metabolic bone diseases including osteomalacia and osteoporosis. The aim of this study was to determine frequency of changes in biochemical and bone mineral density (BMD) in adults receiving valproaic acid (VPA) & carbamazepine (CBZ). Methods In a cross sectional study evaluating adults (age 20–50 y) epileptic patients receiving valproic acid or carbamazepine for at least 2 years. This study was conducted from May 2014 to May 2015 in Shahid Sadoughi Hospital of Yazd University of Medical Science, Yazd, Iran. Bone metabolism was evaluated by measurement of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) and parathormone hormone (PTH), BMD at lumbar and femoral measured by dual energy X ray absorptiometry (DXA). SPSS software (version 18) was used for data analysis. The t-test was used for quantitative data, and the chi-squared test was used for the qualitative variables. Results Eighty two epileptic patients (mean age: 31.67±10.69 year) treated with either carbamazepine (n=41) or valproate sodium (n=41) were studied. Normal serum Ca and P levels were observed in 98.8% and 97.6% of patients respectively. Serum ALP and PTH were normal in 97.6% and 97.6% of patients. Means of Ca and P in CBZ group were significantly lower than VPA group (Ca: 9.02 vs. 9.1, p-value: 0.03 and P: 3.54 vs. 3.76 p-value: 0.004). BMD values at lumbar spine were not significant in either group (T. score CBZ: −0.43± 0.744 vs. T. score VPA: −0.615± 0.904 and p-value: 0.333) and were significantly higher than Iranian normal population BMD value at femoral neck in CBZ group was lower than VPA group (T. score CBZ: −0.707± 0.896 vs. T. score VPA: − 0.297± 0.850 p-value: 0.04). Dosage of CBZ and VPA did not correlate with BMD and biochemical parameters. Duration of CBZ use had correlation with increased ALP and duration of VPA use had correlation with decreased BMD in adult patients. Conclusion long term anti-epileptic drug treatment either with CBZ and VPA which has unknown effects on skeletal mineralization and induces a state of decreased bone mineral density BMD values at femoral neck were significant in CBZ group Therefore regular screening for monitoring of biochemical markers of bone turnover and BMD with DXA during the treat period is recommended. In addition, Ca supplement could be considered for all patients with epilepsy upon initiation of CBZ and VPA therapy.
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Affiliation(s)
- Abolghasem Rahimdel
- Neurologist, Associated Professor, Neurology Department, Shahid Sadoughi Hospital, Yazd University of Medical Science, Yazd, Iran
| | - Ali Dehghan
- Rheumatologist, Assistant Professor, Internal Medicine Department, Shahid Sadoughi Hospital, Yazd University of Medical Science, Yazd, Iran
| | | | - Ali Mellat Ardekani
- Neurologist, Associated Professor, Neurology Department, Shahid Sadoughi Hospital, Yazd University of Medical Science, Yazd, Iran
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