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Villani ER, Onder G, Marzetti E, Coelho-Junior H, Calvani R, Di Paola A, Carfì A. Body composition parameters and sarcopenia in adults with Down syndrome: a case-control study. Aging Clin Exp Res 2024; 36:81. [PMID: 38551714 PMCID: PMC10980647 DOI: 10.1007/s40520-023-02680-9] [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: 10/21/2023] [Accepted: 11/15/2023] [Indexed: 04/01/2024]
Abstract
BACKGROUND Individuals with Down syndrome (DS) experience premature aging. Whether accelerated aging involves changes in body composition parameters and is associated with early development of sarcopenia is unclear. AIMS To compare parameters of body composition and the prevalence of sarcopenia between adults with DS and the general population. METHODS Body composition was assessed by whole-body dual-energy X-ray absorptiometry (DXA). Fat mass (FMI) and skeletal mass indices (SMI) were calculated as the ratio between total body fat mass and appendicular lean mass and the square of height, respectively. Fat mass distribution was assessed by the android/gynoid fat ratio (A/G). Sarcopenia was defined according to the criteria and cut-points recommended by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Data on age- and sex-matched non-DS controls were retrieved from the 2001-2002 National Health and Nutrition Examination Survey (NHANES) population. RESULTS Sixty-four DS adults (mean age 37.2 ± 12.0 years, 20.3% women) were enrolled and compared with age- and sex-matched NHANES participants (n = 256), in a 1:4 ratio. FMI (7.96 ± 3.18 kg/m2 vs. 8.92 ± 4.83 kg/m2, p = 0.135), SMI (7.38 ± 1.01 kg/m2 vs. 7.46 ± 2.77 kg/m2, p = 0.825) and A/G (0.98 ± 0.17 vs. 1.01 ± 0.22, p = 0.115) were not significantly different between DS and control participants. When the sample was stratified by sex, women with DS had a higher FMI compared with their NHANES controls (10.16 ± 4.35 kg/m2 vs. 8.11 ± 4.29 kg/m2, p < 0.001), while men with DS had lower A/G ratio (1.04 ± 0.16 vs. 1.11 ± 0.22, p = 0.002). Sarcopenia was more frequent in individuals with DS than in controls (35.6% vs. 19.9%, p = 0.007). This association was stronger in men 40 years and older. CONCLUSIONS Adults with DS have a higher prevalence of sarcopenia compared with the general population. This finding suggests that DS is associated with early muscle aging and calls for the design of interventions targeting the skeletal muscle to prevent or treat sarcopenia.
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Affiliation(s)
- Emanuele Rocco Villani
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Graziano Onder
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Helio Coelho-Junior
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Antonella Di Paola
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Angelo Carfì
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
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Gyftopoulos S, Pelzl CE, Da Silva Cardoso M, Xie J, Kwon SC, Chang CY. Bone Density Screening Rates Among Medicare Beneficiaries: An Analysis with a focus on Asian Americans. Skeletal Radiol 2024:10.1007/s00256-024-04643-1. [PMID: 38459983 DOI: 10.1007/s00256-024-04643-1] [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: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To report osteoporosis screening utilization rates among Asian American (AsA) populations in the USA. METHODS We retrospectively assessed the use of dual-energy X-ray absorptiometry (DXA) screening using the Medicare 5% Research Identifiable Files. Using Current Procedural Terminology (CPT) codes indicative of a DXA scan, we identified patients recommended for DXA screening according to the ACR-SPR-SSR Practice Parameters (females ≥ 65 years, males ≥ 70 years). Sociodemographic factors and their association with screening were evaluated using chi-square tests. RESULTS There were 80,439 eligible AsA beneficiaries, and 12,102 (15.1%) received osteoporosis screening. DXA rate for women was approximately four times greater than the rate for men (19.8% vs. 5.0%; p < 0.001). AsA beneficiaries in zip codes with higher mean household income (MHI) were more likely to have DXA than those in lower MHI areas (17.6% vs. 14.3%, p < 0.001). AsA beneficiaries aged < 80 were more likely to receive DXA (15.5%) than those aged ≥ 80 (14.1%, p < 0.001). There were 2,979,801 eligible non-AsA beneficiaries, and 496,957 (16.7%) received osteoporosis screening during the study period. Non-Hispanic white beneficiaries had the highest overall screening rate (17.5%), followed by North American Native (13.0%), Black (11.8%), and Hispanic (11.1%) beneficiaries. Comparing AsA to non-AsA populations, there were significantly lower DXA rates among AsA beneficiaries when controlling for years of Medicare eligibility, patient age, sex, location, and mean income (p < 0.001). CONCLUSION We found lower than expected DXA screening rates for AsA patients. A better understanding of the barriers and facilitators to AsA osteoporosis screening is needed to improve patient care.
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Affiliation(s)
- Soterios Gyftopoulos
- Department of Radiology, NYU Langone Health, New York, NY, USA.
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
| | - Casey E Pelzl
- Harvey L. Neiman Health Policy Institute, American College of Radiology, Reston, VA, USA
| | | | - Juliana Xie
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Simona C Kwon
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Yegurla J, Qamar S, Gopi S, Madhusudhan KS, Agarwal S, Sati HC, Mani K, Tandon N, Gunjan D, Saraya A. Opportunistic screening for osteopathy with routine abdominal computed tomography scan in chronic pancreatitis. Pancreatology 2024; 24:41-47. [PMID: 38072684 DOI: 10.1016/j.pan.2023.11.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND AIMS Lumbar vertebral bone attenuation, measured in Hounsfield units (HU) can indirectly indicate the bone mineral density (BMD). The aim of this study is to determine the optimal HU threshold on abdominal computed tomography (CT) scans to detect osteopathy in patients with chronic pancreatitis (CP). METHODS This cross-sectional study included patients with CP who underwent CT scans to measure HU at L1 to L4 vertebrae. The mean lumbar vertebral attenuation of female renal transplant donors, aged 20-30 years was utilized to calculate the T-scoreHU of all patients at each vertebral level. Receiver operator characteristic analysis was used to determine the HU and T-scoreHU for diagnosis of osteopathy in patients with CP. Dual-energy X-ray absorptiometry value was used to categorize osteopenia and osteoporosis. RESULTS A total of 175 patients (mean age, 34.5 ± 10.9 years; 72 % males) and 33 female renal transplant donors (mean age, 28 ± 2.4 years) were included. A threshold HU value 212 or T scoreHU of -1.80 at L1 vertebra was found to have a 78 % sensitivity and 70 % specificity for differentiating between osteoporosis and non-osteoporosis (osteopenia and normal BMD). Similarly, a threshold HU value of 254 or a T-scoreHU of -0.46 at L1 vertebra had 78 % sensitivity and 71 % specificity for distinguishing between normal and low BMD (osteoporosis and osteopenia). CONCLUSION Abdominal CT images, which are routinely performed in chronic pancreatitis, can be used for opportunistic screening of osteoporosis and osteopenia without additional cost or radiation exposure.
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Affiliation(s)
- Jatin Yegurla
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Sumaira Qamar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Srikanth Gopi
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - K S Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
| | - Anoop Saraya
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
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Luengo-Pérez LM, Fernández-Bueso M, Ambrojo A, Guijarro M, Ferreira AC, Pereira-da-Silva L, Moreira-Rosário A, Faria A, Calhau C, Daly A, MacDonald A, Rocha JC. Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria. Nutrients 2023; 15:5133. [PMID: 38140392 PMCID: PMC10745907 DOI: 10.3390/nu15245133] [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] [Received: 10/21/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.
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Affiliation(s)
- Luis M. Luengo-Pérez
- Biomedical Sciences Department, University of Extremadura, 06008 Badajoz, Spain
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Mercedes Fernández-Bueso
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Ambrojo
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Marta Guijarro
- Clinical Nutrition and Dietetics Unit, Badajoz University Hospital, 06008 Badajoz, Spain; (M.F.-B.); (A.A.); (M.G.)
| | - Ana Cristina Ferreira
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
| | - Luís Pereira-da-Silva
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
| | - André Moreira-Rosário
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Ana Faria
- CHRC—Comprehensive Health Research Centre, Nutrition Group, NOVA Medical School, Universidade Nova de Lisboa, 1349-008 Lisboa, Portugal; (L.P.-d.-S.); (A.F.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Conceição Calhau
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
| | - Anne Daly
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Anita MacDonald
- Birmingham Children’s Hospital, Birmingham B4 6NH, UK; (A.D.); (A.M.)
| | - Júlio César Rocha
- Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisboa, Portugal; (A.C.F.); or (J.C.R.)
- NOVA Medical School (NMS), Faculdade de Ciências Médicas (FCM), Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal; (A.M.-R.); (C.C.)
- CINTESIS@RISE, Nutrition and Metabolism, NOVA Medical School (NMS), Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisboa, Portugal
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Kim S, Na Y, Ko M, Park JY, Yoon H, Song JY, Chung YJ, Shin I, Kim C, Park JH, Kim MR. Comparison of the Right and Left Femur Bone Mineral Densities in Postmenopausal Women. J Menopausal Med 2023; 29:112-118. [PMID: 38230594 PMCID: PMC10796208 DOI: 10.6118/jmm.23021] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES Bone mineral density (BMD) is measured in the hip and posteroanterior spine; moreover, according to the 2019 International Society for Clinical Densitometry guidelines, unilateral hip can be used. This study aimed to determine whether there is a difference between the BMD of both the femurs in postmenopausal women. METHODS A total of 343 postmenopausal women were enrolled in this study from January 1, 2010, to December 31, 2019 at a single tertiary hospital. By using the Hologic® Horizon W DXA System, the femur and spine BMD was measured; BMD was recorded in g/cm². Following regions were analyzed in both the femurs: the femur neck, the trochanter area, and total femur. RESULTS Mean age at imaging was 62 ± 9.7 years, and significant difference in the total BMD of both the femurs (P = 0.003) was observed. In secondary analysis, patients with osteoporosis showed significant contralateral BMD discrepancies in trochanter and total proximal femur BMD (P = 0.041 and P = 0.011, respectively). However, in women with normal BMD, no significant difference between the right and left femur BMD was observed. Furthermore, measurement of solely the unilateral hip can lead to a 16.9% of underdiagnosis in postmenopausal women. CONCLUSIONS In conclusion, it is necessary to check BMD in both hips, particularly in patients suspected of osteoporosis.
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Affiliation(s)
- Sejin Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoojin Na
- Department of Obstetrics and Gynecology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minji Ko
- Grace Women's Hospital, Goyang, Korea
| | - Jung Yoon Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyonjee Yoon
- Department of Obstetrics and Gynecology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn-Jee Chung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Inhye Shin
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chaewon Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Al-Bogami MM, Akanle OA, Aldawood S, Alkhorayef M, Sulieman A, Jawad AS, Mageed RA. Comparison of bone mineral density changes between male and female osteoporosis patients using dual energy X-ray absorptiometry scan. Appl Radiat Isot 2023; 194:110624. [PMID: 36774822 DOI: 10.1016/j.apradiso.2022.110624] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
The goal of the current research was to define the impact of individual characteristics on the response of osteoporosis patients to bisphosphonate medication, as well as the influence of gender on changes in the bone mineral density (BMD).The DXA scan was used to assess a group of 647 osteoporosis patients (533 females and 114 males) who visited the St Bartholomew's Hospitals and Royal London osteoporosis clinics. All male subjects received statistically substantial increases in BMD relative to baseline values after two years of therapy. When compared to prior therapy, men's BMD of the lumbar spine (LS) and hip joint (HJ) rose by 0.057 g/cm2 (6.9%, p0.001) and 0.021 g/cm2 (2.48 percent, p0.001), respectively.. Female patients had BMD changes of 0.028 g/cm2 (3.58 percent, p0.001 vs. prior therapy) and -0.006 g/cm2 (-0.78 percent, p0.001 vs. before treatment) in the lumbar spine and hip, respectively. Male patients exhibited a greater increase in BMD than female patients due to ovarian failure and significant oestrogen loss, which speeds up bone resorption by 90% following menopause, according the research findings.
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Affiliation(s)
- M M Al-Bogami
- Bone and Joint Research Unit, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
| | - O A Akanle
- The Royal London Hospital, Mile End Road, London, United Kingdom
| | - S Aldawood
- Physics and Astronomy Department, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - M Alkhorayef
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O Box 10219, Riyadh, 11433, Saudi Arabia
| | - A Sulieman
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - A S Jawad
- Department of Rheumatology, The Royal London Hospital, Mile End Road, London, UK
| | - R A Mageed
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
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Rasmussen NH, Kvist AV, Dal J, Jensen MH, van den Bergh JP, Vestergaard P. Bone parameters in T1D and T2D assessed by DXA and HR-pQCT - A cross-sectional study: The DIAFALL study. Bone 2023; 172:116753. [PMID: 37001628 DOI: 10.1016/j.bone.2023.116753] [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: 01/04/2023] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION/AIM People with type 1 diabetes(T1D) and type 2 diabetes(T2D) have an increased risk of fractures due to skeletal fragility. We aimed to compare areal bone mineral density(aBMD), volumetric BMD(vBMD), cortical and trabecular measures, and bone strength parameters in participants with diabetes vs. controls. METHODS In a cross-sectional study, we included participants with T1D(n = 111), T2D(n = 106) and controls(n = 328). The study comprised of whole-body DXA and HR-pQCT scans, biochemistry, handgrip strength(HGS), Timed Up and GO(TUG), vibration perception threshold (VPT), questionnaires, medical histories, alcohol use, and previous fractures. Group comparisons were performed after adjustment for sex, age, BMI, diabetes duration, HbA1c, alcohol, smoking, previous fractures, postmenopausal, HGS, TUG, and VPT. RESULTS We found decreased aBMD in participants with T1D at the femoral neck(p = 0.028), whereas T2D had significantly higher aBMD at peripheral sites(legs, arms, p < 0.01) vs. controls. In T1D we found higher vBMD(p < 0.001), cortical vBMD (p < 0.001), cortical area(p = 0.002) and thickness(p < 0.001), lower cortical porosity(p = 0.008), higher stiffness(p = 0.002) and failure load(p = 0.003) at radius and higher vBMD(p = 0.003), cortical vBMD(p < 0.001), bone stiffness(p = 0.023) and failure load(p = 0.044) at the tibia than controls. In T2D we found higher vBMD(p < 0.001), cortical vBMD(p < 0.001), trabecular vBMD(p < 0.001), cortical area (p < 0.001) and thickness (p < 0.001), trabecular number (p = 0.024), lower separation(p = 0.010), higher stiffness (p < 0.001) and failure load (p < 0.001) at the radius and higher total vBMD(p < 0.001), cortical vBMD(p < 0.011), trabecular vBMD(p = 0.001), cortical area(p = 0.002) and thickness(p = 0.021), lower trabecular separation(p = 0.039), higher stiffness(p < 0.001) and failure load(p = 0.034) at tibia compared with controls. CONCLUSION aBMD measures were as expected but favorable bone microarchitecture and strength parameters were seen at the tibia and radius for T1D and T2D.
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Affiliation(s)
| | - Annika Vestergaard Kvist
- Department of Endocrinology and Metabolism, Molecular Endocrinology & Stem Cell Research Unit (KMEB) Odense University Hospital, Odense, Denmark,; University of Southern Denmark, Odense, Denmark; Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark; Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH-Zurich, Zurich, Switzerland
| | - Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Denmark
| | - Morten H Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark; Department of Health Science and Technology, Aalborg University, Denmark
| | - Joop P van den Bergh
- School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark
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Gao H, Patel S, Fohtung RB, Cawthon PM, Newman AB, Cauley JA, Carbone L, Chaves PHM, Stein PK, Civitelli R, Kizer JR. Sex- and race-specific associations of bone mineral density with incident heart failure and its subtypes in older adults. J Am Geriatr Soc 2023; 71:742-755. [PMID: 36334030 PMCID: PMC10023291 DOI: 10.1111/jgs.18121] [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: 06/01/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have suggested an association between bone mineral density (BMD) and heart failure (HF) risk that may be race-dependent. METHODS We evaluated the relationship between BMD and incident HF in a cohort of older adults, the Health, Aging, and Body Composition (Health ABC) study (n = 2835), and next performed a pooled analysis involving a second older cohort, the Cardiovascular Health Study (n = 1268). Hip BMD was measured by dual-energy X-ray absorptiometry in both cohorts and spine BMD by computed tomography in a subset from Health ABC. RESULTS In Health ABC, lower BMD at the total hip was associated with higher incident HF in Black women after multivariable adjustment. Similar associations were found for BMD at the femoral neck and spine. In both cohorts, pooled analysis again revealed an association between lower total hip BMD and increased risk of HF in Black women (HR = 1.41 per 0.1-g/cm2 decrement [95% CI = 1.23-1.62]), and showed the same to be true for White men (HR = 1.12 [1.03-1.21]). There was a decreased risk of HF in Black men (HR 0.80 [0.70-0.91]), but no relationship in White women. The associations were numerically stronger with HFpEF for Black women and White men, and with HFrEF for Black men. Findings were similar for femoral neck BMD. Sensitivity analyses delaying HF follow-up by 2 years eliminated the association in Black men. CONCLUSIONS Lower BMD was associated with higher risk of HF and especially HFpEF in older Black women and White men, highlighting the need for additional investigation into underlying mechanisms.
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Affiliation(s)
- Hans Gao
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center; Los Angeles, CA
| | - Sheena Patel
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Raymond B. Fohtung
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Laura Carbone
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta GA
| | - Paulo H. M. Chaves
- Division of Internal Medicine and Benjamin Leon Jr Family Center for Geriatric Research and Education, Department of Medicine, Herbert Wertheim College of Medicine of Florida International University, Miami, FL
| | - Phyllis K. Stein
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO
| | - Roberto Civitelli
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Jorge R. Kizer
- Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center; Los Angeles, CA
- Cardiology Section, San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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9
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Mohseni M, Eisen S, Stum S, Civitelli R. The Association of Pelvic Bone Mineral Density and With Proximal Femoral and Spine Bone Mineral Density in Post-menopausal Women. J Clin Densitom 2022; 25:328-333. [PMID: 35177349 DOI: 10.1016/j.jocd.2022.01.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
Pelvic fragility fractures result in significant morbidity and their incidence has increased over the past 30 years. One of the main risk factors in skeletal fragility is bone mineral density (BMD). Most of the current literature has focused on understanding spine and hip BMD. We aimed to measure the BMD of pelvis in a cohort of post-menopausal women and compare it to BMD at other skeletal sites. A questionnaire regarding risk factors for osteoporosis was completed by each participant. DXA scan of the pelvis was performed using research software. Three areas of the pelvis corresponding to common fractures were defined on pelvic DXA: R1 = symphysis public, R2 = inferior public rami, R3 = superior public rami. Pelvic BMD was calculated as the average BMD of R1-3. BMD at each location was reported as mean and standard deviation (SD). ANOVA was used to compare BMD between R1-R3 and pelvis, femoral neck, total hip, and spine. Pearson correlation was used to correlate pelvic BMD to BMD of proximal femur and spine. BMD was compared in four participant groups: 1- osteoporosis in spine and hip, 2- osteoporosis in spine only, 3-osteoporosis in hip only, and 4- no osteoporosis in spine and hip. The effect of diabetes and obesity on BMD at various skeletal sites was analyzed. Among the one hundred postmenopausal women enrolled in the study, age was: 64 ± 8, 31% were obese (BMI ≥ 30), and 8% had a diagnosis of type 2 diabetes. Pelvic area R3 had significantly higher BMD than R1 or R2 (p < 0.001). Pelvic BMD (0.50 ± 0.16) was significantly lower than total hip (0.70 ± 0.20) and spine BMD (0.97 ± 0.19) (p < 0.001). Pelvic BMD correlated with BMD at other skeletal locations, with the highest correlation with total hip (total hip: R2: 0.70, femoral neck R2: 0.50, spine R2: 0.65). Pelvic BMD was significantly lower in patients with osteoporosis of both hip and spine compared to the group without osteoporosis at both locations (p = 0.02). Obesity and type 2 diabetes were both associated with significantly higher BMD at pelvis, spine, and total hip. Pelvic BMD is lower than at other skeletal sites and is highly correlated with total hip area bone density. Obesity and type 2 diabetes are associated with higher pelvic BMD. To establish guidelines for the treatment pelvic BMD, studies defining the association of pelvic BMD with pelvic fracture risk are needed.
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Affiliation(s)
- Mahshid Mohseni
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Seth Eisen
- Division of Rheumatology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Shannon Stum
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Roberto Civitelli
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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10
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Lupsa BC, Insogna KL, Micheletti RG, Caplan A. Corticosteroid use in chronic dermatologic disorders and osteoporosis. Int J Womens Dermatol 2022; 7:545-551. [PMID: 35024411 PMCID: PMC8721058 DOI: 10.1016/j.ijwd.2021.07.014] [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: 07/06/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 12/03/2022] Open
Abstract
Glucocorticoid-induced osteoporosis (GIOP) is a frequently encountered and serious side effect of glucocorticoid use. Bone loss leading to an increased risk for fracture occurs early in the use of glucocorticoids, yet patients at risk for this complication are often undertreated. All physicians prescribing glucocorticoids should therefore be familiar with a basic approach to anticipating and preventing GIOP when starting patients on glucocorticoid therapy. This manuscript and its case vignettes are designed to help dermatologists assess and manage bone health to prevent GIOP in patients receiving glucocorticoid therapy.
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Affiliation(s)
- Beatrice C Lupsa
- Yale School of Medicine, Department of Medicine (Endocrinology), New Haven, Connecticut
| | - Karl L Insogna
- Yale School of Medicine, Department of Medicine (Endocrinology), New Haven, Connecticut
| | - Robert G Micheletti
- Department of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Avrom Caplan
- NYU Grossman School of Medicine, The Ronald O. Perelman Department of Dermatology, New York, New York
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11
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Carvalho do Nascimento PR, Bilodeau M, Poitras S. How do we define and measure sarcopenia? A meta-analysis of observational studies. Age Ageing 2021; 50:1906-1913. [PMID: 34537833 DOI: 10.1093/ageing/afab148] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 07/30/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE this study aimed to investigate how sarcopenia has been defined and measured in the literature reporting its prevalence, and how different definitions and measurement tools can affect prevalence estimates. DESIGN systematic review and meta-analysis. SETTING AND PARTICIPANTS community-dwelling older people. METHODS meta-analysis of data collected from observational studies. We performed an electronic search in five databases to identify studies reporting the prevalence of sarcopenia. We used descriptive statistics to present data pertaining sarcopenia definition and measurement tools, and the quality-effects model for meta-analysis of pooled prevalence. RESULTS we found seven different operational definitions for sarcopenia and a variety of tools applied to assess the sarcopenic markers; muscle mass, muscle strength and physical performance. The prevalence of sarcopenia varied between the definitions with general estimates ranging from 5% based on the European Working Group on Sarcopenia in Older People (EWGSOP1) criterion to 17% with the International Working Group on Sarcopenia. According to the tool used to assess muscle mass, strength and physical performance, prevalence values also varied within definitions extending from 1 to 7%, 1 to 12% and 0 to 22%, respectively. CONCLUSION AND IMPLICATIONS the criteria used to define sarcopenia, as well as the measurement tools applied to assess sarcopenic markers have influence in the prevalence of sarcopenia. The establishment of a unique definition for sarcopenia, the use of methods that guarantee an accurate evaluation of muscle mass and the standardisation of measurement tools are necessary to allow a proper diagnosis and comparison of sarcopenia prevalence among populations.
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Affiliation(s)
- Paulo R Carvalho do Nascimento
- University of Ottawa, Faculty of Health Sciences, School of Rehabilitation Sciences, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Martin Bilodeau
- University of Ottawa, Faculty of Health Sciences, School of Rehabilitation Sciences, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Stéphane Poitras
- University of Ottawa, Faculty of Health Sciences, School of Rehabilitation Sciences, Ottawa, ON, Canada
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12
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Khojah A, Liu V, Morgan G, Shore RM, Pachman LM. Changes in total body fat and body mass index among children with juvenile dermatomyositis treated with high-dose glucocorticoids. Pediatr Rheumatol Online J 2021; 19:118. [PMID: 34376205 PMCID: PMC8353815 DOI: 10.1186/s12969-021-00622-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/03/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE High-dose glucocorticoids (GC) remain the primary therapy to induce remission in Juvenile Dermatomyositis (JDM). Studies of the natural history of GC associated weight gain in children are very limited, especially in the JDM population. This study aims to measure BMI changes in a cohort of JDM subjects over 60 months and to examine the changes in body composition by DXA. METHODS We included all subjects with JDM who had 5 years of follow-up data and multiple DXA studies. BMI and total body fat (TBF) percentiles were calculated based on the CDC published percentile charts. To study the natural history of weight gain and TBF, we assessed the data at four-time points (T0 = baseline, T1 > 1.5 years, T2 = 1.51-3.49 years, T3 = 3.5-5 years). RESULTS 68 subjects (78% female, 70% white) were included in this retrospective study. Paired T-test showed a significant increase in the mean BMI percentile by 17.5 points (P = 0.004) after the initiation of medical treatment, followed by a gradual decrease over the study period. However, the TBF percentile did not change over the study period. TBF in the last visit (T3) had a strong correlation with the T1 BMI, and T1 TBF percentile (correlation coefficients 0.63, 0.56 P < 0.001, 0.002 respectively). Also, there was a positive correlation (correlation coefficients 0.39, P = 0.002) between the TBF percentile and muscle DAS but not the skin DAS. CONCLUSIONS Although the BMI percentile decreased throughout the study, the TBF percentile remained high until the end of the study (60 months). This finding raises the concern that some of the reduction in the BMI percentile could reflect a drop in the lean body mass from muscle wasting rather than actual fat loss.
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Affiliation(s)
- Amer Khojah
- Division of Pediatric Rheumatology, Department of Pediatric, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA. .,Division of Allergy & Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. .,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL, USA.
| | - Victoria Liu
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
| | - Richard M. Shore
- grid.413808.60000 0004 0388 2248Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Lauren M. Pachman
- grid.413808.60000 0004 0388 2248Division of Pediatric Rheumatology, Department of Pediatric, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611 USA ,Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL USA
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13
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Almomen FA, Altaweel AM, Abunadi AK, Hashem AE, Alqarni RM, Alsiddiky AM. Determining the correlation between Cobb angle severity and bone mineral density in women with adolescent idiopathic scoliosis. J Taibah Univ Med Sci 2021; 16:365-368. [PMID: 34140863 PMCID: PMC8178678 DOI: 10.1016/j.jtumed.2020.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 09/04/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives To determine the correlation between Cobb angle severity and varying bone mineral density (BMD) and measure the prevalence of low BMD in women with adolescent idiopathic scoliosis (AIS) in KSA. Methods The sample included 54 women with AIS between 10 and 20 years of age. Data regarding Cobb angles and femoral and lumbar Z-scores according to dual-energy X-ray absorptiometry (DXA) scans performed between 2008 and 2018 were reviewed. Results Of the 54 patients recruited, 41 exhibited Cobb angles of 40–70° and 13 had Cobb angles >70°. The mean lumbar bone, right femur, and left femur BMDs were markedly higher in those with Cobb angles ≤70° compared with BMDs in those with Cobb angles >70°. Of the group with Cobb angles ≤70°, six (14.6%) and nine (22.0%) exhibited low BMD according to their lumbar and femoral Z-scores, respectively. Of the group with Cobb angles >70°, eight (61.5%) and nine (69.2%) exhibited low BMD according to their lumbar and femoral Z-scores, respectively. Conclusions Female AIS patients with greater higher Cobb angles exhibited a significantly higher frequency of low BMDs.
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14
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Mohseni M, Hosseinzadeh P, Civitelli R, Eisen S. Effect of peripheral neuropathy on bone mineral density in adults with diabetes: A systematic review of the literature and meta-analysis. Bone 2021; 147:115932. [PMID: 33757900 PMCID: PMC8224476 DOI: 10.1016/j.bone.2021.115932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Peripheral neuropathy occurs in two thirds of patients with diabetes mellitus (DM). It can lead to severe pathological changes in the feet, and it increases the risk of fracture more than any other diabetic complication. The objective of this review is to analyze available literature on the effect of peripheral neuropathy on BMD of the foot, spine, or hip. We hypothesize that the presence of diabetic neuropathy leads to lower BMD in adults with diabetes. METHODS Original studies investigating the effects of diabetic neuropathy on bone density were searched for inclusion in this systematic review. Studies were eligible if they met the following criteria: 1) participants included adults with either Type 1 DM or Type 2 DM; 2) Method used for the diagnosis of neuropathy described in the manuscript 3) DXA scan, ultrasound, or CT scan was used to measure proximal femur, spine, or foot bone mineral density were reported, and 4) bone parameters were analyzed based on the presence and absence of neuropathy. RESULTS Among the 5 studies that met eligibility criteria, 4 did not find a significant effect of neuropathy on BMD. One study showed a significant negative impact of neuropathy on calcaneal BMD in patients with type 1 diabetes. The meta-analysis did not show a significant effect of peripheral neuropathy on BMDs of proximal femur, spine, and calcaneus in diabetic adults. CONCLUSION Our study shows no evidence that peripheral neuropathy affects bone density or bone turnover in DM. However, this conclusion should be taken with caution since only a very limited number of studies were available for inclusion in the analysis and included both type 1 and type 2 DM patients. Improved measures of peripheral neuropathy and more advanced imaging technologies are needed to better assess the effect of diabetes on bone health.
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Affiliation(s)
- Mahshid Mohseni
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Pooya Hosseinzadeh
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Roberto Civitelli
- Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Seth Eisen
- Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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15
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Elmoneim MA, Mohamed HA, Awad A, El-Hawary A, Salem N, El Helaly R, Nasef N, Abdel-Hady H. Effect of tactile/kinesthetic massage therapy on growth and body composition of preterm infants. Eur J Pediatr 2021; 180:207-15. [PMID: 32666281 DOI: 10.1007/s00431-020-03738-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/29/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
Massage therapy (MT) improves growth parameters in preterm infants. The growth of lean mass rather than fat mass has been associated with better long-term outcomes. We aimed to study the effect of tactile/kinesthetic MT on growth and body composition parameters in preterm infants. Preterm (< 32 weeks gestation) infants were randomly assigned at corrected gestational age of 35 weeks to receive 3 consecutive, 15-min, sessions of MT over 5 days or routine care. Primary outcome was mean daily weight gain. Secondary outcomes included anthropometric measurements and body composition parameters assessed by dual X-ray absorptiometry (DXA) scan. Out of 218 infants screened, 86 were eligible and 60 infants (30 in each group) were recruited after parental consent. MT was associated with significant increase in daily weight gain [19.3 (10-34.3) versus 6.2 (2.5-18.4) g/day, p = 0.01] and growth velocity [12.5 (6-21) versus 3.6 (1.6-12.6) g/kg/d, p = 0.01] compared with routine care. Infants on MT showed significant increase in total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values compared with routine care group. In conclusions, MT improves growth quality as evident by increased total and regional lean masses, increased bone mineral density, and peripheral rather than central fat distribution. What is known on this subject? • Massage therapy (MT) for preterm infants leads to achievement of faster independent oral feeding, increased weight gain, less stress, less response to pain, less occurrence of sepsis, and shorter hospital stay. • Growth of lean mass rather than fat mass has been associated with better long-term outcomes. What this study adds? • Tactile/kinesthetic massage therapy in preterm infant is associated with improved growth parameters and anthropometric measures. • Tactile/kinesthetic massage therapy increased total body mass, fat mass (total/legs), lean mass (total/arms/legs/trunk), and bone mineral density (arms/legs/trunk) values.
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16
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Alay I, Kaya C, Cengiz H, Yildiz S, Ekin M, Yasar L. The relation of body mass index, menopausal symptoms, and lipid profile with bone mineral density in postmenopausal women. Taiwan J Obstet Gynecol 2020; 59:61-6. [PMID: 32039802 DOI: 10.1016/j.tjog.2019.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the relationship of menopausal symptoms, body mass index (BMI), and serum lipid profile with Bone Mineral Density (BMD) levels. MATERIALS AND METHODS 452 postmenopausal women were included in this case-control study at our outpatient clinic between January 2012 and January 2015. The patients were stratified according to their BMD, based on dual-energy X-ray absorptiometer (DXA) results, as the normal group (-1 ≤ T-score), osteopenia group (-2.5 < T-score < -1), and osteoporosis group (T-score ≤ -2.5). High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG), fasting plasma glucose (FPG) levels were measured. To assess the menopausal symptoms, the Menopause Rating Scale (MRS) questionnaire was used. RESULTS Waist circumference (WC) and BMI were significantly lower in the osteoporosis group than in normal and osteopenia groups (p: 0.001, p: 0.001, respectively). L2-L4 measurements were negatively correlated with Low Density Lipoprotein (LDL) levels, but positively correlated with WC. BMI showed significant positive correlation with Femur Neck (FN), L1-L2, and L2-L4 measurements. Among menopausal symptoms, there was a significant negative correlation between heart discomfort and L1-L2 levels. On multiple regression analysis, a relation between FN scores and somatic symptom scores was identified. CONCLUSION Hyperlipidemia, lower BMI, lower WC, and severe somatic symptoms may be associated with decreased BMD.
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Delli Paoli G, van de Laarschot D, Friesema ECH, Verkaik R, Giacco A, Senese R, Arp PP, Jhamai PM, Pagnotta SM, Broer L, Uitterlinden AG, Lanni A, Zillikens MC, de Lange P. Short-Term, Combined Fasting and Exercise Improves Body Composition in Healthy Males. Int J Sport Nutr Exerc Metab 2020; 30:386-395. [PMID: 32998111 DOI: 10.1123/ijsnem.2020-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/10/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/12/2023]
Abstract
Fasting enhances the beneficial metabolic outcomes of exercise; however, it is unknown whether body composition is favorably modified on the short term. A baseline-follow-up study was carried out to assess the effect of an established protocol involving short-term combined exercise with fasting on body composition. One hundred seven recreationally exercising males underwent a 10-day intervention across 15 fitness centers in the Netherlands involving a 3-day gradual decrease of food intake, a 3-day period with extremely low caloric intake, and a gradual 4-day increase to initial caloric intake, with daily 30-min submaximal cycling. Using dual-energy X-ray absorptiometry analysis, all subjects substantially lost total body mass (-3.9 ± 1.9 kg; p < .001) and fat mass (-3.3 ± 1.3 kg; p < .001). Average lean mass was lost (-0.6 ± 1.5 kg; p < .001), but lean mass as a percentage of total body mass was not reduced. The authors observed a loss of -3.9 ± 1.9% android fat over total fat mass (p < .001), a loss of -2.2 ± 1.9% gynoid over total fat mass (p < .001), and reduced android/gynoid ratios (-0.05 ± 0.1; p < .001). Analyzing 15 preselected single-nucleotide polymorphisms in 13 metabolism-related genes revealed trending associations for thyroid state-related single-nucleotide polymorphisms rs225014 (deiodinase 2) and rs35767 (insulin-like growth factor1), and rs1053049 (PPARD). In conclusion, a short period of combined fasting and exercise leads to a substantial loss of body and fat mass without a loss of lean mass as a percentage of total mass.
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Affiliation(s)
- Giuseppe Delli Paoli
- Università degli Studi della Campania "Luigi Vanvitelli"
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
| | - Denise van de Laarschot
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- Erasmus University Medical Center
| | - Edith C H Friesema
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- Erasmus University Medical Center
| | - Remco Verkaik
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- European Nutraceutical Services
| | - Antonia Giacco
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- Università degli Studi del Sannio
| | - Rosalba Senese
- Università degli Studi della Campania "Luigi Vanvitelli"
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
| | | | | | | | | | - André G Uitterlinden
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- Erasmus University Medical Center
| | - Antonia Lanni
- Università degli Studi della Campania "Luigi Vanvitelli"
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
| | - M Carola Zillikens
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
- Erasmus University Medical Center
| | - Pieter de Lange
- Università degli Studi della Campania "Luigi Vanvitelli"
- European Consortium for Lifestyle, Exercise, Adaptation, and Nutrition (EULEAN)
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18
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Jazinizadeh F, Adachi JD, Quenneville CE. Advanced 2D image processing technique to predict hip fracture risk in an older population based on single DXA scans. Osteoporos Int 2020; 31:1925-1933. [PMID: 32415372 DOI: 10.1007/s00198-020-05444-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/29/2020] [Indexed: 01/04/2023]
Abstract
UNLABELLED A new technique to enhance hip fracture risk prediction in older adults was presented and assessed. The new method dramatically improved prediction at high specificity levels using only a standard clinical diagnostic scan. This has the potential to be implemented in clinical practice to enhance patient fragility diagnosis. INTRODUCTION Diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scans. However, studies have shown this to be insufficient to accurately predict hip fractures. Therefore, complementary methods are needed to enhance hip fracture risk prediction to identify vulnerable patients. METHODS Hip DXA scans were obtained for 192 subjects from the Canadian Multicenter Osteoporosis Study (CaMos), 50 of whom had experienced a hip fracture within 5 years of the scan. 2D statistical shape and appearance modeling was performed to account for the effect of the femur's geometry and BMD distribution on hip fracture risk. Statistical shape modeling (SSM), and statistical appearance modeling (SAM) were also used separately to predict the fracture risk based solely on the femur's geometry and BMD distribution, respectively. Combined with BMD, age, and body mass index (BMI), logistic regression was performed to estimate the fracture risk over the 5-year period. RESULTS Using the new technique, hip fractures were correctly predicted in 78% of cases compared with 36% when using the T-score. The accuracy of the prediction was not greatly reduced when using SSM and SAM (78% and 74% correct, respectively). Various geometric and BMD distribution traits were identified in the fractured and non-fractured groups. CONCLUSION 2D SSAM can dramatically improve hip fracture prediction at high specificity levels and estimate the year of the impending fracture using standard clinical images. This has the potential to be implemented in clinical practice to estimate hip fracture risk.
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Affiliation(s)
- F Jazinizadeh
- Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - C E Quenneville
- Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.
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Bonfanti P, De Vito A, Ricci E, Menzaghi B, Orofino G, Squillace N, Molteni C, De Socio GV, Salomoni E, Celesia BM, Dentone C, Colombo V, Madeddu G. Bone Safety of Dolutegravir-Containing Regimens in People Living with HIV: Results from a Real-World Cohort. Infect Drug Resist 2020; 13:2291-2300. [PMID: 32765005 PMCID: PMC7368553 DOI: 10.2147/idr.s260449] [Citation(s) in RCA: 4] [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: 04/29/2020] [Accepted: 06/27/2020] [Indexed: 12/30/2022] Open
Abstract
Objective Few data exist about the effect of dolutegravir (DTG) on bone mineral density (BMD) in real life. The aim of this study was to determine rates of change in BMD over time in people living with HIV (PLWH) treated with DTG. Design The SCOLTA project is a multicenter observational study enrolling HIV-infected people who start newly commercialized drugs prospectively, with the aim of identifying toxicities and adverse events (AE) in a real-life setting. Methods Dual-energy X-ray absorptiometry at the femoral neck (FN) and lumbar spine (LS) was performed at study entry (baseline, BL) and after 96 weeks. Percentage BMD change from BL was evaluated using a general linear model, including factors potentially associated with bone loss. Results One hundred and sixty PLWH were enrolled (26.3% female, mean age 49.9 ± 11.2 years) from April 2015 to April 2017. Overall, we could calculate BMD change from baseline, for at least one site, in 133 subjects (83.1%). After a median of 102 weeks (IQR: 90–110), mean FN BMD increased, but not significantly, whereas LS BMD showed a significant mean increase of 13.1 (95% confidence interval, CI: 1.7–24.6) mg/cm3 (+1.6%, 95% CI: 0.3%, 2.8%) after a median time of 102 weeks (IQR: 84–110). As regards LS BMD, patients with osteopenia/osteoporosis at study entry experienced a high increase from baseline (20.6, 95% CI: 3.1, 38.1 mg/cm3), as well as experienced subjects (16.9, 95% CI: 4.7, 29.2 mg/cm3) and those on vitamin D supplementation (26.8, 95% CI: 7.7, 45.9 mg/cm3). Conclusion Dolutegravir-containing regimens could reduce the negative impact of antiretroviral therapy on bone, especially in patients with low BMD.
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Affiliation(s)
- Paolo Bonfanti
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Milan, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Elena Ricci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona - Busto Arsizio (VA), Busto Arsizio, Italy
| | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Turin, Italy
| | - Nicola Squillace
- Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Milan, Italy
| | - Chiara Molteni
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Giuseppe Vittorio De Socio
- Department of Internal Medicine 2, Infectious Diseases Unit, Perugia "Santa Maria della Misericordia" General Hospital, Perugia, Italy
| | - Elena Salomoni
- Infectious Diseases Unit 1, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, Florence, Italy
| | | | - Chiara Dentone
- Division of Infectious Diseases, Department of Health Sciences, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Valeria Colombo
- Infectious Disease Unit, DIBC "Luigi Sacco", University of Milan, Milan, Italy
| | - Giordano Madeddu
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Adas-Okuma MG, Maeda SS, Gazzotti MR, Roco CM, Pradella CO, Nascimento OA, Porto EF, Vieira JGH, Jardim JR, Lazaretti-Castro M. COPD as an independent risk factor for osteoporosis and fractures. Osteoporos Int 2020; 31:687-697. [PMID: 31811311 DOI: 10.1007/s00198-019-05235-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023]
Abstract
UNLABELLED Fractures are common in individuals with COPD and occur at higher bone mass values than expected. COPD appears to be an important risk factor for bone fragility. INTRODUCTION Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of osteoporosis and fractures, but screening and prophylactic measures to prevent both disorders are often neglected in this population. This case-control study assessed the prevalence of osteopenia, osteoporosis, and fractures in patients with COPD, and identified potential risk factors for fractures in this population. METHODS Overall, 91 patients with COPD (COPD group; COPDG) and 81 age- and sex-matched controls (control group; CG) were assessed with bone mineral density (BMD), thoracic/lumbar spine radiographs, and serum PTH and 25-hydroxyvitamin D (25[OH]D) levels. The occurrence of prior fractures was retrieved from clinical history. RESULTS The prevalence of total fractures in the COPDG was 57.1% (odds of fracture 4.7 times greater compared with the CG), and the femoral neck T-score emerged as the best predictor of fractures. Compared with the CG, the COPDG had lower spine and femoral BMD (p ≤ 0.01) and 25(OH)D levels (p = 0.01) and 2.6 times greater odds of osteoporosis. Among men, vertebral fractures were more prevalent in the COPDG versus CG (25.9% vs. 6.5%, respectively, p = 0.01). The odds of fracture increased with femoral neck T-scores ≤ - 2.7 in the CG and ≤ - 0.6 in the COPDG. CONCLUSION These results add robust evidence to an increased odds of osteoporosis and fractures in COPD. Fractures in the COPDG occurred at higher BMD values than expected, suggesting that COPD may be an independent marker of fracture risk, reinforcing a need for regular osteoporosis screening with BMD measurement and prophylaxis of fractures in patients with this disorder.
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Affiliation(s)
- M G Adas-Okuma
- Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil.
| | - S S Maeda
- Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil
| | - M R Gazzotti
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - C M Roco
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - C O Pradella
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - O A Nascimento
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - E F Porto
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - J G H Vieira
- Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil
| | - J R Jardim
- Discipline of Pulmonology, Escola Paulista de Medicina (UNIFESP), Rua Botucatu, 989 Vila Clementino, São Paulo, SP, Brazil
| | - M Lazaretti-Castro
- Discipline of Endocrinology, Escola Paulista de Medicina (UNIFESP) Universidade Federal de São Pulo, Federal University of São Paulo, Rua Botucatu, 806, Vila Clementino, São Paulo, SP, Brazil
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21
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Jazinizadeh F, Quenneville CE. Enhancing hip fracture risk prediction by statistical modeling and texture analysis on DXA images. Med Eng Phys 2020; 78:14-20. [PMID: 32057626 DOI: 10.1016/j.medengphy.2020.01.015] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/14/2020] [Accepted: 01/26/2020] [Indexed: 01/09/2023]
Abstract
Each year in the US more than 300,000 older adults suffer from hip fractures. While protective measures exist, identification of those at greatest risk by DXA scanning has proved inadequate. This study proposed a new technique to enhance hip fracture risk prediction by accounting for many contributing factors to the strength of the proximal femur. Twenty-two isolated cadaveric femurs were DXA scanned, 16 of which had been mechanically tested to failure. A function consisting of the calculated modes from the statistical shape and appearance modeling (to consider the shape and BMD distribution), homogeneity index (representing trabecular quality), BMD, age and sex of the donor was created in a training set and used to predict the fracture load in a test group. To classify patients as "high risk" or "low risk", fracture load thresholds were investigated. Hip fracture load estimation was significantly enhanced using the new technique in comparison to using t-score or BMD alone (average R² of 0.68, 0.32, and 0.50, respectively) (P < 0.05). Using a fracture cut-off of 3400 N correctly predicted risk in 94% of specimens, a substantial improvement over t-score classification (38%). Ultimately, by identifying patients at high risk more accurately, devastating hip fractures can be prevented through applying protective measures.
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Affiliation(s)
- Fatemeh Jazinizadeh
- Department of Mechanical Engineering, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8, Canada
| | - Cheryl E Quenneville
- Department of Mechanical Engineering, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8, Canada; School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.
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Sejersen TS, Vinding RK, Stokholm J, Chawes B, Bønnelykke K, Krakauer M, Bisgaard H. Antibiotic exposure in infancy and development of BMI and body composition in childhood. EClinicalMedicine 2019; 17:100209. [PMID: 31891142 PMCID: PMC6933179 DOI: 10.1016/j.eclinm.2019.10.020] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has been hypothesized that antibiotic usage in early life could contribute to development of overweight in childhood. Studies have seen association between antibiotic usage and overweight in childhood. We aimed to investigate the relationship between antibiotic exposure in infancy and development of body mass index (BMI) and body composition. METHODS A prospective mother-child cohort study of 738 pregnant women and their 700 children, Copenhagen Prospective Studies on Asthma in Childhood2010 (COPSAC2010). Information on antibiotic exposure was collected by interviews. Height/length and weight measures were collected at age 1, 2, 3, 4, 5 and 6 years and body composition was determined by a dual-energy X-ray absorptiometry (DXA) scan at age 3.5 and 6 years. FINDINGS 306 (46%) of the 661 children were exposed to antibiotics before 1 year of age. There were no differences in BMI z-score development at age 1-6 years between children exposed to antibiotics compared to unexposed: z-score difference, -0.06 (95%CI: -0.17;0.06), p = 0.33, and no sex-differences (p-interaction = 0.48). Children exposed vs. not exposed to antibiotics had comparable fat percentage at 6 years of age: log(mean difference), 0.60% (95%CI: -0.212 to 1.41), p = 0.15. INTERPRETATION Children exposed to antibiotics had similar BMI, BMI z-score and body composition between 1 and 6 years of life compared to unexposed children. Our study does not support the hypothesis that antibiotic exposure in infancy leads to development of obesity in the first 6 years of life. FUNDING The Lundbeck Foundation, The Ministry of Health, Danish Council for Strategic Research and The Capital Region Research Foundation.
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Affiliation(s)
- Tobias Steen Sejersen
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
- Department of Pediatrics, Naestved Hospital, Denmark
| | - Rebecca Kofod Vinding
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
- Department of Pediatrics, Naestved Hospital, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
- Department of Pediatrics, Naestved Hospital, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
| | - Martin Krakauer
- Department of Clinical Physiology and Nuclear Medicine, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood, Health Sciences, University of Copenhagen, 2820 Gentofte, Denmark
- Corresponding author.
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23
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Lajlev SE, Rejnmark L, Harsløf T. T-score differences and nonprogression in lumbar vertebrae as predictors of vertebral fractures. Clin Endocrinol (Oxf) 2019; 91:58-62. [PMID: 30973641 DOI: 10.1111/cen.13987] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/07/2019] [Accepted: 04/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE In case of a vertebral fracture, the area of the vertebrae decreases with a concomitant increase in BMD, as assessed by a DXA scanning. Furthermore, a vertebral fracture may disrupt the normal increase in vertebral body area from L1 to L4 (nonprogression). We aimed to examine associations between T-score difference and nonprogression of vertebral area and vertebral fractures. METHODS We identified 100 patients with 1 or more fractures in L1-L4 and 106 patients without fractures. All patients had undergone a DXA scan and a lumbar spine X-ray. In fracture patients, we recorded T-score difference between the fractured vertebra and the adjacent vertebra, and whether the fractured vertebra was smaller than the one above (nonprogression). In nonfracture patients, the greatest positive T-score difference was recorded, and nonprogression was present if vertebral area did not increase successively from L1 to L4. RESULTS With a T-score difference ≥1 SD odds ratio for fracture was 1.30 (0.74-2.29). Sensitivity and specificity were 0.40 and 0.66, respectively. With T-score difference ≥1.5 SD, odds ratio for fracture was 2.26 (1.08-4.73). Sensitivity and specificity were 0.24 and 0.88, respectively. Nonprogression was very common in the no-fracture group (38%), while only 23% of X-ray verified fractures had nonprogression. CONCLUSION A randomly found T-score difference ≥1.5 SD between adjacent vertebrae on a DXA scan is associated with a small increased risk of compression fracture. Nonprogression is very common in patients without fractures.
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Affiliation(s)
- Siv E Lajlev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
| | - Torben Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus C, Denmark
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24
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Alqahtani FF, Messina F, Offiah AC. Are semi-automated software program designed for adults accurate for the identification of vertebral fractures in children? Eur Radiol 2019; 29:6780-6789. [PMID: 31119416 PMCID: PMC6828619 DOI: 10.1007/s00330-019-06250-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/25/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 11/05/2022]
Abstract
Objectives To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. Materials and methods Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen’s kappa. Results For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26–0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16–0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. Conclusion AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children. Key Points • SpineAnalyzer™ and AVERT™ have low diagnostic accuracy and observer agreement when compared to three paediatric radiologists’ readings for the diagnosis of vertebral fractures (VF) in children. • Neither AVERT™ nor SpineAnalyzer™ is satisfactorily reliable for VF diagnosis in children. • Development of specific paediatric software and normative values (incorporating age-related physiological variation in children) is required.
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Affiliation(s)
- Fawaz F Alqahtani
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK. .,Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Kingdom of Saudi Arabia.
| | - Fabrizio Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK.,Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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25
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Ceballos-Sáenz D, Zapata-Aldana E, Singeris S, Hicks R, Johnson N, Campbell C. Body composition in patients with congenital myotonic dystrophy. Muscle Nerve 2019; 60:176-179. [PMID: 31074869 DOI: 10.1002/mus.26509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/03/2018] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Congenital myotonic dystrophy (CDM) is a rare neuromuscular disorder characterized by severe hypotonia and muscle weakness at birth that tends to improve with age. Understanding lean body and bone mass in this population has important research and clinical implications. The main objective of this study was to determine whether older children with CDM had muscle mass similar to healthy controls. METHODS Thirty-five patients with CDM (3-13 years old) were enrolled. We analyzed lean body mass (LBM) and bone mineral content using the mechanostat framework, which allows calculation of z-scores for sex, age, and height. RESULTS All patients had low LBM z-scores (muscle mass); however, higher LBM z-score was positively correlated with age (r = 0.45, P = 0.006), showing that it is closer to normal in older patients. DISCUSSION Unlike other neuromuscular diseases, older children with CDM have a muscle mass closer to age-matched controls, consistent with the clinical profile of increasing strength in childhood. Muscle Nerve 60: 176-179, 2019.
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Affiliation(s)
- Delia Ceballos-Sáenz
- Paediatric Neurology Department, Children's Hospital, London Health Science Centre, 800 Commissioners Road East, PO Box 5012, London, Ontario, Canada, N6A 5W9
| | - Eugenio Zapata-Aldana
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Singeris
- Paediatric Neurology Department, Children's Hospital, London Health Science Centre, 800 Commissioners Road East, PO Box 5012, London, Ontario, Canada, N6A 5W9
| | - Rhiannon Hicks
- Paediatric Neurology Department, Children's Hospital, London Health Science Centre, 800 Commissioners Road East, PO Box 5012, London, Ontario, Canada, N6A 5W9
| | - Nicholas Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Craig Campbell
- Paediatric Neurology Department, Children's Hospital, London Health Science Centre, 800 Commissioners Road East, PO Box 5012, London, Ontario, Canada, N6A 5W9.,Department of Paediatrics, Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Holmberg T, Möller S, Rothmann MJ, Gram J, Herman AP, Brixen K, Tolstrup JS, Høiberg M, Bech M, Rubin KH. Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study. Osteoporos Int 2019; 30:343-353. [PMID: 30465216 DOI: 10.1007/s00198-018-4768-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/07/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.
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Affiliation(s)
- T Holmberg
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark.
| | - S Möller
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M J Rothmann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Gram
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Hospital of Southwest Denmark, Esbjerg, Denmark
| | - A P Herman
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K Brixen
- Odense University Hospital, Odense, Denmark
| | - J S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1355, Copenhagen K, Denmark
| | - M Høiberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Hospital of Southern Norway, Kristiansand, Norway
| | - M Bech
- Department of Political Science, Aarhus University, Aarhus, Denmark
| | - K H Rubin
- OPEN - Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Abstract
Context
Osteoporosis is a silent disease until it is complicated by trivial fall fractures. There is an increasing interest within the orthopaedic community in the noninvasive cost-effective measurement of the bone mineral density.
Aims
The aim of the study is to assess whether urinary N-telopeptide level can be a new diagnostic tool in diagnosing osteoporosis.
Methods and Material
This prospective study was done at Sri Ramachandra Medical Centre (SRMC) hospital from October 2015 to October 2017. The study was conducted among patients who comes to SRMC as inpatient or outpatient with suspected osteoporosis and underwent dual-energy X-ray absorptiometry (DXA) scan and urinary N-telopeptide. The inclusion criteria were women aged 65 or older, women aged less than 65 with risk factors, younger postmenopausal women with one or more risk factors, men aged 70 or older, men less than 70 with risk factors, and any above group patients who comes within 24 hours following trivial fall fractures. The exclusion criteria were pathological fracture, history of any illness affecting bone metabolism. The results from DXA scan were taken as gold standard against urinary N-telopeptide. Then the patients were divided into two groups control and study. The control group contains patients who had normal DXA, while study group contains patients having either osteopenia or osteoporosis. Based on our inclusion and exclusion criteria, 110 persons were included in the study. We had 60 study and 50 controls patients. We had 88 females and 22 males. The results obtained were statistically analyzed.
Statistical Analysis Used
The collected data were analyzed with IBM SPSS statistics software 23.0 version. To describe about the data descriptive statistics frequency analysis, percentage analysis was used for categorical variables and the mean and standard deviation were used for continuous variables. To find the significant difference between the bivariate samples in independent groups, the unpaired sample
t
-test was used. To find the significance in categorical data, chi-square test was used. In both the earlier statistical tools, the probability value of 0.05 is considered as significant level.
Results
In our study, we had 18.2% osteopenic and 36.4% osteoporotic patients. The mean value of urinary N-telopeptide in control was 49.8 and in case was 182.5. The standard deviation of urinary N-telopeptide value in case was 159.9.
Conclusion
Urinary N-telopeptide can give reproducible results and be able to assist in the evaluation of the quantity as well as the quality and be a good judge of someone's risk of fracture. Hence, urinary N-telopeptide can be used as a diagnostic tool for diagnosing osteoporosis.
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Affiliation(s)
- Ganesan Ram Ganesan
- Department of Orthopaedics, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Abstract
The mainstay of diagnosis of osteoporosis is dual-energy X-ray absorptiometry (DXA) scan measuring areal bone mineral density (BMD) (g/cm2). The aim of the present study was to compare the Indian Council of Medical Research database (ICMRD) and the Lunar ethnic reference database of DXA scans in the diagnosis of osteoporosis in male patients. In this retrospective study, all male patients who underwent a DXA scan were included. The areal BMD (g/cm2) was measured at either the lumbar spine (L1-L4) or the total hip using the Lunar DXA machine (software version 8.50) manufactured by GE Medical Systems (Shanghai, China). The Indian Council of Medical Research published a reference data for BMD in the Indian population derived from the population-based study conducted in healthy Indian individuals, which was used to analyze the BMD result by Lunar DXA scan. The 2 results were compared for various values using statistical software SPSS for Windows (version 16; SPSS Inc., Chicago, IL). A total 238 male patients with a mean age of 57.2 yr (standard deviation ±15.9) were included. Overall, 26.4% (66/250) and 2.8% (7/250) of the subjects were classified in the osteoporosis group according to the Lunar database and the ICMRD, respectively. Out of the 250 sites of the DXA scan, 28.8% (19/66) and 60.0% (40/66) of the cases classified as osteoporosis by the Lunar database were reclassified as normal and osteopenia by ICMRD, respectively. In conclusion, the Indian Council of Medical Research data underestimated the degree of osteoporosis in male subjects that might result in deferring of treatment. In view of the discrepancy, the decision on the treatment of osteoporosis should be based on the multiple fracture risk factors and less reliably on the BMD T-score.
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Affiliation(s)
- Surya K Singh
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
| | - Vivek H Patel
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Balram Gupta
- Department of Endocrinology and Metabolism, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Dadra A, Aggarwal S, Kumar P, Kumar V, Dibar DP, Bhadada SK. High prevalence of vitamin D deficiency and osteoporosis in patients with fragility fractures of hip: A pilot study. J Clin Orthop Trauma 2019; 10:1097-1100. [PMID: 31708635 PMCID: PMC6834936 DOI: 10.1016/j.jcot.2019.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/12/2019] [Revised: 03/15/2019] [Accepted: 03/17/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) is a major cause of poor bone health that could lead to fragility fractures, however, there is paucity of literature on prevalence of VDD and associated bone mass in patients of fragility fractures. Hip and spine are the commonest region affected by these fractures and the present study was conceptualised to ascertain the prevalence of VDD and bone mass in patients of hip fragility fractures (proximal femur) to evaluate their role in incidence of these fractures. METHODS AND MATERIALS Between January 2013 and December 2013, 66 patients of fragility fractures around hip with age more than 50 years presented to our out patient department. Baseline evaluation of calcium profile, renal function tests, parathyroid hormone and 25(OH)D were done. All patients underwent DXA scan of the non -fractured hip. RESULTS Total number of male patients was 29 and females was 37, with mean age of 64.1 and 70.3 years, respectively. Intertrochanteric femur fractures were the most common type with 35 cases. Fall in bathroom was the most common mode of injury with 36 cases (54.5%). VDD was found in 74.2% of all patients. Prevalence of secondary hyperparathyroidism was observed in 27 patients. Osteopenia, osteoporosis and severe osteoporosis were observed in 15.2%, 62.1% and 18.2% of patients respectively. Sun light exposure was inadequate in 59% of patients with only 1 female patient having adequate exposure. CONCLUSION Prevalence of Vitamin D deficiency is very high in patients with hip fragility (proximal femur) fractures with secondary hyperparathyroidism and osteoporosis commonly associated. These fractures in our part of the world, occur at a younger age group as compared to the Western population. Majority of the patients sustain in-house fractures.
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Brown EC, Hew-Butler T, Marks CRC, Butcher SJ, Choi MD. The Impact of Different High-Intensity Interval Training Protocols on Body Composition and Physical Fitness in Healthy Young Adult Females. Biores Open Access 2018; 7:177-185. [PMID: 30622842 PMCID: PMC6323591 DOI: 10.1089/biores.2018.0032] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Although traditional high-intensity interval training (HIIT) has been effective in improving body composition and physical fitness, it is unclear how multimodal HIIT affects these variables. This study compared the differences between these two training programs on body composition and physical fitness in apparently healthy, nonobese young adult females. A total of 16 participants (mean age = 23 ± 5.08 years) completed a 12-week HIIT intervention with two treatment groups: rowing and multimodal. Immediately before and after the intervention, the following measures were assessed: body mass index (BMI), total body mass, waist circumference, waist-to-height ratio, total body fat %, visceral adipose tissue, lean mass, bone mineral outcomes, cardiovascular fitness, and muscular fitness. A general linear model with repeated measures was used to assess changes over time for the group as a whole, as well as between-group differences. For the group as a whole, there were significant decrease in total body fat % (p = 0.04) and significant increases in BMI (p = 0.015), total body mass (p = 0.003), lean mass (p < 0.001), bone mineral content (BMC) (p < 0.001), VO2max (p = 0.01), broad jump (p = 0.001), squat endurance (p = 0.006), press (p < 0.001), back squat (p < 0.001), and deadlift (p < 0.001) one repetition maximum (1RM). The multimodal group (p < 0.001) increased deadlift 1RM significantly more than the rowing group (p = 0.002). HIIT can be an effective means for improving cardiovascular and muscular fitness, increasing lean mass and BMC, and thereby improving cardiometabolic as well as musculoskeletal health in nonobese females. Using a multimodal approach may give the added benefit of superior muscular strength increases.
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Affiliation(s)
- Elise C Brown
- School of Health Sciences, Oakland University, Rochester, Michigan
| | | | | | - Scotty J Butcher
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myung D Choi
- School of Health Sciences, Oakland University, Rochester, Michigan
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Samra NM, Emad El Abrak S, El Dash HH, El Said El Raziky M, El Sheikh MA. Evaluation of vitamin D status bone mineral density and dental health in children with cholestasis. Clin Res Hepatol Gastroenterol 2018; 42:368-77. [PMID: 29551613 DOI: 10.1016/j.clinre.2017.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/27/2017] [Revised: 10/24/2017] [Accepted: 11/20/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hepatic osteodystrophy caused by vitamin D and calcium malabsorption is thought to develop in children with cholestatic liver disease leading to secondary hyperparathyroidism and rickets or osteomalacia. The aim of this study was to evaluate the dental and bone mineral densities and the serum level of vitamin D in cholestatic infants and children and to correlate this process with clinical and laboratory parameters. METHODS This is a cross-sectional study that include 50 patients presenting with cholestasis. Thirty age and sex matched controls recruited not complaining of liver disease. All cases were subjected to full history taking, clinical and dental examination, 25(OH)D level, ALT, AST, bilirubin, albumin, GGT, alkaline phosphatase, PT, INR, calcium, corrected calcium, phosphorus and DXA scan to those above 5 years old. Controls were subjected to measuring the serum levels of 25(OH)D, total bilirubin, direct bilirubin, ALT, GGT, AST, PT, INR, alkaline phosphatase, albumin, calcium and phosphorus. RESULTS Out of the 50 cases; 23 were females (46%), with a mean age of 6.17±3.9 years ranging from 1.1 to 17 years. Twenty-eight of the cases had signs of rickets (56%), 6 of them had bone fracture (12%) and 42.8% had milky teeth caries. The level of 25(OH) vitamin D was below normal range in around half of the patients. There was significant difference between cases and controls in calcium and phosphorus levels, ALT and alkaline phosphatase. Low bone mineral density (BMD) was present in 50% and 5 cases (17.9%) were diagnosed as having osteoporosis. There was a negative correlation between the Z-score, BMD of total body, BMD and bone mineral content (BMC) of spine and total and direct bilirubin. There was a positive correlation between (BMD of total body, spine and BMC of spine) and serum phosphorus, alkaline phosphatase and albumin. There was a positive correlation between the Z-score of total body and serum calcium. CONCLUSION Decreased level of 25-OH vitamin D is present in more than half of cholestatic patients, and is correlated positively to serum calcium. Decreased BMD was present in more than half of studied cholestatic patients correlated to the low serum calcium rather than the vitamin D level. The decreased BMD and the dental affection in cholestatic children is related to the level of hyperbilirubinemia.
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Tortora R, Imperatore N, Capone P, Gerbino N, Rea M, Affinito G, Caporaso N, Rispo A. FRAX Score Can Be Used to Avoid Superfluous DXA Scans in Detecting Osteoporosis in Celiac Disease: Accuracy of the FRAX Score in Celiac Patients. J Clin Densitom 2018. [PMID: 28625602 DOI: 10.1016/j.jocd.2017.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Fracture Risk Assessment (FRAX) tool has been developed to estimate patients' 10-yr probability of fracture, thus establishing which patients should undergo dual-energy X-ray Absorptiometry (DXA) scan. This study aimed to evaluate if the FRAX tool can replace or optimize the use of DXA scan in celiac disease (CD). We prospectively enrolled all CD patients aged over 40 yr diagnosed at our third-level unit. At time of CD diagnosis, all patients underwent FRAX score calculation for risk of major osteoporotic and hip fractures and DXA scan (used as gold standard) to assess the accuracy of the FRAX score. The FRAX score calculation was based on the following 10 variables: age (>40 yr), sex (M/F), body mass index, history of previous fracture (yes/no), parent fractured hip (yes/no), current smoking (yes/no), use of steroids (yes/no), rheumatoid arthritis (yes/no), secondary osteoporosis (yes/no), and alcohol ≥3 units/d (yes/no). DXA assessment was performed within 1 week from FRAX calculation. The FRAX score was dichotomized as normal or pathologic in accordance with the National Osteoporosis Guideline Group. A total of 160 CD patients were enrolled (M/F = 20/140; mean age 48.7 yr). A pathologic FRAX score was evident in 14 out of 160 patients (8.7%), whereas osteoporosis based on DXA scan was found in 10 patients (6%) (κ = 0.6); 3 patients with osteoporosis (1.9%) showed a 10-yr risk of major fracture >10% according to the National Osteoporosis Guideline Group criteria. With regard to diagnostic accuracy, the FRAX score showed sensitivity of 0%, specificity of 91%, positive predictive value of 0%, and negative predictive value of 94%. The prevalence of osteoporosis in adult CD appears to be quite low and only a small proportion of patients would require a DXA investigation. The FRAX score could be an effective tool to avoid useless DXA scans in CD patients in view of its high negative predictive value.
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Affiliation(s)
- Raffaella Tortora
- Gastroenterology, University "Federico II" of Naples, Naples, Italy.
| | | | - Pietro Capone
- Gastroenterology, University "Federico II" of Naples, Naples, Italy
| | - Nicolò Gerbino
- Gastroenterology, University "Federico II" of Naples, Naples, Italy
| | - Matilde Rea
- Gastroenterology, University "Federico II" of Naples, Naples, Italy
| | - Giovanna Affinito
- Endoscopy Nurse, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Nicola Caporaso
- Gastroenterology, University "Federico II" of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, University "Federico II" of Naples, Naples, Italy
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Tewari N, Awad S, Macdonald IA, Lobo DN. A comparison of three methods to assess body composition. Nutrition 2018; 47:1-5. [PMID: 29429527 DOI: 10.1016/j.nut.2017.09.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 04/12/2017] [Revised: 07/24/2017] [Accepted: 09/17/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of measurements of body composition made using dual x-ray absorptiometry (DXA), analysis of computed tomography (CT) scans at the L3 vertebral level, and bioelectrical impedance analysis (BIA). METHODS DXA, CT, and BIA were performed in 47 patients recruited from two clinical trials investigating metabolic changes associated with major abdominal surgery or neoadjuvant chemotherapy for esophagogastric cancer. DXA was performed the week before surgery and before and after commencement of neoadjuvant chemotherapy. BIA was performed at the same time points and used with standard equations to calculate fat-free mass (FFM). Analysis of CT scans performed within 3 mo of the study was used to estimate FFM and fat mass (FM). RESULTS There was good correlation between FM on DXA and CT (r2 = 0.6632; P < 0.0001) and FFM on DXA and CT (r2 = 0.7634; P < 0.0001), as well as FFM on DXA and BIA (r2 = 0.6275; P < 0.0001). Correlation between FFM on CT and BIA also was significant (r2 = 0.2742; P < 0.0001). On Bland-Altman analysis, average bias for FM on DXA and CT was 0.2564 with 95% limits of agreement (LOA) of -9.451 to 9.964. For FFM on DXA and CT, average bias was -0.1477, with LOA of -8.621 to 8.325. For FFM on DXA and BIA, average bias was -3.792, with LOA of -15.52 to 7.936. For FFM on CT and BIA, average bias was -2.661, with LOA of -22.71 to 17.39. CONCLUSION Although a systematic error underestimating FFM was demonstrated with BIA, it may be a useful modality to quantify body composition in the clinical situation.
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Affiliation(s)
- Nilanjana Tewari
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Sherif Awad
- The East-Midlands Bariatric & Metabolic Institute, Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Ian A Macdonald
- Metabolic Physiology Group, School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom.
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El-Mashad GM, El-Hawy MA, El-Hefnawy SM, Mohamed SM. Bone mineral density in children with idiopathic nephrotic syndrome. J Pediatr (Rio J) 2017; 93:142-147. [PMID: 27821253 DOI: 10.1016/j.jped.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/26/2015] [Revised: 05/14/2016] [Accepted: 05/24/2016] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To assess bone mineral density (BMD) in children with idiopathic nephrotic syndrome (NS) and normal glomerular filtration rate (GFR). METHODS Cross-sectional case-control study carried out on 50 children: 25 cases of NS (16 steroid-sensitive [SSNS] and nine steroid-resistant [SRNS] under follow up in the pediatric nephrology unit of Menoufia University Hospital, which is tertiary care center, were compared to 25 healthy controls with matched age and sex. All of the participants were subjected to complete history taking, thorough clinical examination, laboratory investigations (serum creatinine, blood urea nitrogen [BUN], phosphorus [P], total and ionized calcium [Ca], parathyroid hormone [PTH], and alkaline phosphatase [ALP]). Bone mineral density was measured at the lumbar spinal region (L2-L4) in patients group using dual-energy X-ray absorptiometry (DXA). RESULTS Total and ionized Ca were significantly lower while, serum P, ALP, and PTH were higher in SSNS and SRNS cases than the controls. Osteopenia was documented by DXA scan in 11 patients (44%) and osteoporosis in two patients (8%). Fracture risk was mild in six (24%), moderate in two (8%), and marked in three (12%) of patients. CONCLUSION Bone mineralization was negatively affected by steroid treatment in children with NS.
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Tan DHS, Raboud J, Szadkowski L, Szabo E, Hu H, Wong Q, Cheung AM, Walmsley SL. Novel imaging modalities for the comparison of bone microarchitecture among HIV+ patients with and without fractures: a pilot study. HIV Clin Trials 2016; 18:28-38. [PMID: 27951753 DOI: 10.1080/15284336.2016.1266074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND HIV-infected adults have increased fracture risk. OBJECTIVES To generate pilot data comparing bone density, structure, and strength between HIV-infected adults with and without a prior fracture. METHODS Adults with and without a prior fracture after their HIV diagnosis were matched 1:1 based on age, sex, race, and smoking history. Participants underwent dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), hip structural analyses (HSA), vertebral fracture assessment (VFA), high-resolution peripheral quantitative tomography (HR-pQCT) and measurement of bone turnover markers. Results were compared between cases and controls, with differences expressed as percentages of control group values. RESULTS 23 pairs were included. On DXA, cases had lower areal bone mineral density (aBMD) at the total hip (median difference in T-score -0.25, p = 0.04), but not the lumbar spine (median difference in T-score 0.10, p = 0.68). Cases had greater abnormalities in HSA and most HR-pQCT and HSA measures, by up to 15%. VFA revealed two subclinical fractures among cases but none among controls. TBS, CTX, and P1NP levels were similar between groups, with differences of 1.9% (p = 0.90), 9.7% (p = 0.55), and 10.0% (p = 0.24), respectively. For each parameter, we report the median and interquartile range for the absolute and relative difference between cases and controls, the correlation between cases and controls, and our recruitment rates, to inform the design of future studies. CONCLUSIONS These pilot data suggest potential differences in bone structure, estimated bone strength, and asymptomatic vertebral fractures among HIV-infected adults with and without fracture, warranting further study as markers of fracture risk in HIV.
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Affiliation(s)
- Darrell H S Tan
- a Division of Infectious Diseases , St. Michael's Hospital , Toronto , Canada.,b Division of Infectious Diseases , University Health Network , Toronto , Canada.,c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,e CIHR - Canadian HIV Trials Network , Vancouver , Canada
| | - Janet Raboud
- c Toronto General Research Institute , University Health Network , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada
| | - Leah Szadkowski
- c Toronto General Research Institute , University Health Network , Toronto , Canada
| | - Eva Szabo
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Hanxian Hu
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Queenie Wong
- g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada
| | - Angela M Cheung
- c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,f Dalla Lana School of Public Health , University of Toronto , Toronto , Canada.,g Centre for Excellence in Skeletal Health Assessment , University Health Network , Toronto , Canada.,h Divisions of General Internal Medicine and Endocrinology , University Health Network , Toronto , Canada
| | - Sharon L Walmsley
- b Division of Infectious Diseases , University Health Network , Toronto , Canada.,c Toronto General Research Institute , University Health Network , Toronto , Canada.,d Department of Medicine , University of Toronto , Toronto , Canada.,e CIHR - Canadian HIV Trials Network , Vancouver , Canada
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Krasniqi E, Koni M, Kabashi A, Bahtiri A, Gjeli S, Boshnjaku A. SIDE TO SIDE DIFFERENCES BETWEEN DOMINANT AND NON-DOMINANT ARM'S BONE DENSITY AND ISOMETRIC HANDGRIP STRENGTH IN MALES AND FEMALES AGED 40-65 YEARS OLD. Mater Sociomed 2016; 28:333-337. [PMID: 27999479 PMCID: PMC5149437 DOI: 10.5455/msm.2016.28.333-337] [Citation(s) in RCA: 4] [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: 08/13/2016] [Accepted: 10/10/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This observational, cross-sectional study, investigates and compares the differences of BMD, T-score, Z-score and isometric strength between dominant (D) versus non-dominant (ND) arms of 162 subjects aged 40-65 in a developing, low income country (Kosova). MATERIAL AND METHODS Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions of both arms (measured by DXA scan), together with the Handgrip Isometric Strength (HIS) (by handgrip) were evaluated in a total subjects (53 Males and 109 Females). Additionally, General Healthcare Status Questionnaire together with self-administrated International Physical Activity Questionnaire (IPAQ) were filled. RESULTS Significant differences (p<0.05) between arms were found in BMD, T-score, and Z-score in total subjects and in females, whereas not significant differences (p>0.05) were observed in Males BMD comparing to significantly higher results (p<0.05) in T-score and Z-score. Significant differences (p<0.05) were also found in total subjects and in females handgrip, but not (p>0.05) in males. When comparing the total subject's BMD, T-score, Z-score and Handgrip based on the PA levels (1 to 3 according to IPAQ scoring) no significant differences (p>0.05) were found between PA1, as well as PA3 whereas significantly differences (p<0.05) were found in D arms of PA2 level. CONCLUSION The study analyses side-to-side differences in bone density and muscular force between D and ND arms amongst a population which is frequently exposed to diagnostic screenings for age related osteomuscular conditions (aged 40-60), and demonstrates that these differences should be in consideration amongst clinicians, but not in the way it is done right now.
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Affiliation(s)
- Ermira Krasniqi
- Faculty of Technical Medical Sciences, Medical University of Tirana, Tirana, Albania
| | - Mynyr Koni
- Faculty of Natural Sciences, University of Tirana, Tirana, Albania
| | - Antigona Kabashi
- Faculty of Technical Medical Sciences, Medical University of Tirana, Tirana, Albania; Radiology Department, University Clinical Center of Kosova, Prishtina, Kosovo
| | - Abedin Bahtiri
- Department of Sport Sciences, University College, Prishtina, Kosovo
| | - Selda Gjeli
- University Clinical Stomatological Center of Kosova, Prishtina, Kosovo
| | - Arben Boshnjaku
- Faculty of Natural/Life Sciences, University of Vienna, Vienna, Austria
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Izadyar S, Golbarg S, Takavar A, Zakariaee SS. The Effect of the Lumbar Vertebral Malpositioning on Bone Mineral Density Measurements of the Lumbar Spine by Dual-Energy X-Ray Absorptiometry. J Clin Densitom 2016; 19:277-81. [PMID: 26778450 DOI: 10.1016/j.jocd.2015.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/24/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
A significant discrepancy between the results of previous human and phantoms studies is identified regarding the effects of vertebral positioning on bone mineral density (BMD) measurements. We aimed to evaluate the effects of lumbar vertebral positioning on BMD measurements by dual-energy X-ray absorptiometry in a human cadaveric spine phantom. A spine phantom was designed using L1-L4 vertebrae harvested from a 48-year-old male cadaver without coronal or sagittal deformity. The spine phantom was scanned by DEXXUM T bone densitometer in a constant scanning speed of 30 mm/s and resolution of 1.0 × 1.0 mm. BMD values were measured in a positive and negative lumbar lordosis and kyphosis tilt angles in the sagittal plane, from 0° to 35°, with 7° increments. Also BMD values were measured in axial and lateral rotations with 5° increments. Projectional dual-energy X-ray absorptiometry measurements are significantly affected by positioning of the lumbar spine, more severely affected by kyphotic curvature, but also by axial and lateral rotational scoliosis as well as lordotic curvature. Increasing the severity of lordosis and kyphosis curvatures leads to false reduction of BMD value up to 17.5% and 11.5%, respectively. Increasing the degree of lateral and axial rotational scolioses results in a false decrease in BMD measurements by up to 10.8% and 9.6%, respectively. To achieve the most accurate scanning results, error sources and abnormal positioning should be identified and minimized as much as possible. If not correctable, they should be taken into consideration while interpreting the results.
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Affiliation(s)
- Sina Izadyar
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shima Golbarg
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Takavar
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Salman Zakariaee
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Lim Y, Chun S, Lee JH, Baek KH, Lee WK, Yim HW, Kang MI. Association of bone mineral density and diabetic retinopathy in diabetic subjects: the 2008-2011 Korea National Health and Nutrition Examination Survey. Osteoporos Int 2016; 27:2249-2257. [PMID: 26883444 DOI: 10.1007/s00198-016-3527-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/04/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Because diabetic retinopathy increases fracture risk, we studied the association between bone mineral density (BMD) and diabetic retinopathy in a nationally representative sample. A significant association between the presence of diabetic retinopathy and low BMD was observed. Therefore, diabetic retinopathy might be considered as a marker of low BMD. INTRODUCTION Several diabetic complications, including nephropathy, retinopathy, and peripheral neuropathy, are associated with a higher fracture risk in diabetic subjects. However, in contrast to diabetic nephropathy and peripheral neuropathy, which are associated with low bone mineral density (BMD), little is known about the association between BMD and diabetic retinopathy. The aim of the present study was to determine whether the prevalence of diabetic retinopathy is associated with BMD. METHODS This cross-sectional study included a nationally representative sample consisting of 4357 men aged 50 years and older and 4392 postmenopausal women who participated in the Korea National Health and Nutritional Examination Survey (KNHANES) from 2008 to 2011 and underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) and diabetic retinopathy assessments using seven standard gradable photographs. RESULTS The diabetic women with retinopathy had lower mean BMD at all measured sites than those without retinopathy, although the BMD difference between the two groups was small (3-5 %). In addition, the diabetic women with retinopathy were 2.27 times more likely to have osteoporosis following adjustments for all clinically relevant covariates. However, the prevalence of diabetes mellitus (DM) or diabetic retinopathy was not associated with the prevalence of osteoporosis in men. CONCLUSIONS This study has shown that the presence of diabetic retinopathy is significantly associated with a reduced BMD and increased prevalence of osteoporosis in diabetic women.
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Affiliation(s)
- Y Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea
| | - S Chun
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - J H Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - K H Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea
| | - W K Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - H-W Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Republic of Korea
| | - M-I Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 137-701, Seoul, Korea.
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Orgel E, Mueske NM, Sposto R, Gilsanz V, Freyer DR, Mittelman SD. Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy. Leuk Lymphoma 2016; 59:138-145. [PMID: 26818609 DOI: 10.3109/10428194.2015.1136741] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 12/26/2022]
Abstract
Obesity as defined by body mass index percentile (BMI%) is strongly associated with relapse and poorer survival in childhood ALL. Whether BMI% accurately reflects body fat percentage (BF%) in this population is unknown. We conducted a prospective study assessing body composition during frontline ALL therapy. Dual-energy X-ray absorptiometry measured BF% and lean muscle mass (LMM) at diagnosis, end of Induction, and end of Delayed Intensification. Sarcopenic obesity (gain in BF% with loss of LMM) was surprisingly common during ALL treatment, resulting in poor correlation between changes in BMI% (expressed as Z-score) and BF% overall (r = -0.05) and within patients (r = -0.09). BMI Z-score and BF% changed in opposite directions in >50% of interval assessments. While BMI% at diagnosis is a suitable predictor of obesity/BF% for epidemiological studies, change in BMI% (as expressed as Z-score) does not reflect body composition. Studies evaluating obesity in leukemia should consider using direct measures of body composition.
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Affiliation(s)
- Etan Orgel
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,b Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach , Long Beach , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Nicole M Mueske
- d Children's Orthopaedic Center, Children's Hospital Los Angeles , Los Angeles , CA , USA
| | - Richard Sposto
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Vicente Gilsanz
- e Department of Radiology , Children's Hospital Los Angeles , Los Angeles , CA , USA
| | - David R Freyer
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Steven D Mittelman
- c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.,f Center for Endocrinology, Children's Hospital Los Angeles , Los Angeles , CA , USA
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Jiang X, Good LE, Spinka R, Schnatz PF. Osteoporosis screening in postmenopausal women aged 50-64 years: BMI alone compared with current screening tools. Maturitas 2015; 83:59-64. [PMID: 26471931 DOI: 10.1016/j.maturitas.2015.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/20/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Consensus on when to initiate DXA screening for early postmenopausal women (< 65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥ 1 risk factors], the osteoporosis self-assessment tool [OST < 2], the osteoporosis risk assessment instrument [ORAI ≥ 9], and the simple calculated osteoporosis risk estimation [SCORE ≥ 6]) in identifying early postmenopausal women with osteoporosis. METHODS Postmenopausal women aged 50-64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared. RESULTS Of 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤ -2.5). BMI (< 28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥ 6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9). CONCLUSION BMI (< 28) had a comparable numerical screening performance overall to the current screening modalities. BMI (< 28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.
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Affiliation(s)
- Xuezhi Jiang
- Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, United States.
| | - Lauren E Good
- Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States
| | - Ryan Spinka
- Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States
| | - Peter F Schnatz
- Reading Hospital, Department of Obstetrics and Gynecology, Reading, PA, United States; Reading Hospital, Department of Internal Medicine, Reading, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Obstetrics and Gynecology, Philadelphia, PA, United States; Sidney Kimmel Medical College of Thomas Jefferson University, Department of Internal Medicine, Philadelphia, PA, United States
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Singh A, Adams AL, Burchette R, Dell RM, Funahashi TT, Navarro RA. The effect of osteoporosis management on proximal humeral fracture. J Shoulder Elbow Surg 2015; 24:191-8. [PMID: 25240809 DOI: 10.1016/j.jse.2014.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 03/20/2014] [Revised: 07/06/2014] [Accepted: 07/13/2014] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Proximal humeral fractures comprise 10% of fractures in the Medicare population. The effect, if any, of treating osteoporosis to prevent these fractures has not been determined. The primary objective is to determine the effectiveness of a systematic osteoporosis screening and treatment program on the hazard of developing a fracture over the treatment period. The secondary aim is to determine demographic risk factors. METHODS This is a retrospective cohort study in a health care organization serving 3.3 million members. Individuals selected for dual-energy x-ray absorptiometry screening were (1) women aged 65 years or older; (2) men aged 70 years or older; and (3) individuals aged 50 years or older who have a history of fragility fracture, use glucocorticoids, have a parental history of hip fracture, have rheumatoid arthritis, use alcohol at a high rate, or are cigarette smokers. Treatment consisted primarily of pharmacologic intervention with bisphosphonates. RESULTS Individuals diagnosed with osteoporosis had a hazard ratio of 7.43 for sustaining a fracture over the study period. Patients screened with dual-energy x-ray absorptiometry had a hazard ratio of 0.17 whereas those treated medically had a hazard ratio of 0.55 versus untreated controls. Risk factors that significantly increased the risk of a fracture developing included age, female gender, white race, diabetes mellitus, and history of a distal radius fracture. DISCUSSION AND CONCLUSION Over the study period, screening and treatment for osteoporosis significantly decreased the hazard ratio for proximal humeral fracture. This information broadens the impact of such programs because current best practices are primarily based on prevention of spine and hip fractures.
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Affiliation(s)
- Anshuman Singh
- Department of Orthopaedics, Southern California Permanent Medical Group, San Diego, CA, USA.
| | - Annette L Adams
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Raoul Burchette
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Richard M Dell
- Department of Orthopaedics, Southern California Permanente Medical Group, Downey, CA, USA
| | - Tadashi T Funahashi
- Department of Orthopaedics, Southern California Permanente Medical Group, Downey, CA, USA
| | - Ronald A Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, Torrance, CA, USA
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Henderson RC, Henderson BA, Kecskemethy HK, Hidalgo ST, Nikolova BA, Sheridan K, Harcke HT, Thorpe DE. Adaptation of the lateral distal femur DXA scan technique to adults with disabilities. J Clin Densitom 2015; 18:102-8. [PMID: 24932899 PMCID: PMC4254380 DOI: 10.1016/j.jocd.2014.04.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 04/18/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
The technique that best addresses the challenges of assessing bone mineral density in children with neuromuscular impairments is a dual-energy X-ray absorptiometry (DXA) scan of the lateral distal femur. The purpose of this study was to adapt this technique to adults with neuromuscular impairments and to assess the reproducibility of these measurements. Thirty-one adults with cerebral palsy had both distal femurs scanned twice, with the subject removed and then repositioned between each scan (62 distal femurs, 124 scans). Each scan was independently analyzed twice by 3 different technologists of varying experience with DXA (744 analyses). Precision of duplicate analyses of the same scan was good (range: 0.4%-2.3%) and depended on both the specific region of interest and the experience of the technologist. Precision was reduced when comparing duplicate scans, ranging from 7% in the metaphyseal (cancellous) region to 2.5% in the diaphyseal (cortical) region. The least significant change was determined as recommended by the International Society for Clinical Densitometry for each technologist and each region of interest. Obtaining reliable, reproducible, and clinically relevant assessments of bone mineral density in adults with neuromuscular impairments can be challenging. The technique of obtaining DXA scans of the lateral distal femur can be successfully applied to this population but requires a commitment to developing the necessary expertise.
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Affiliation(s)
- Richard C. Henderson
- Departments of Orthopaedics and Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Brent A. Henderson
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Heidi K. Kecskemethy
- Departments of Biomedical Research and Medical Imaging, Nemours/A. I. duPont Hospital for Children, Wilmington, DE
| | | | - Beth Ann Nikolova
- Imaging Technologist, Gillette Children’s Specialty Care, St. Paul, MN
| | - Kevin Sheridan
- Adult and Pediatric Endocrinology, Gillette Children’s Specialty Care
| | - H. Theodore Harcke
- Department of Medical Imaging, Nemours/A. I. duPont Hospital for Children, Wilmington, DE
| | - Deborah E. Thorpe
- School of Medicine, Division of Physical Therapy, Center for Human Movement Science, University of North Carolina, Chapel Hill, NC
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Negredo E, Domingo P, Pérez-Álvarez N, Gutiérrez M, Mateo G, Puig J, Escrig R, Echeverría P, Bonjoch A, Clotet B. Improvement in bone mineral density after switching from tenofovir to abacavir in HIV-1-infected patients with low bone mineral density: two-centre randomized pilot study (OsteoTDF study). J Antimicrob Chemother 2014; 69:3368-71. [PMID: 25125679 DOI: 10.1093/jac/dku300] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tenofovir has been associated with a decrease in bone mineral density (BMD). However, data on changes in BMD after discontinuing tenofovir are lacking. METHODS We performed a two-centre randomized pilot study in virologically suppressed HIV-infected patients receiving tenofovir with osteopenia/osteoporosis (OsteoTDF study, ClinicalTrials.gov number NCT 01153217). Fifty-four patients were randomly assigned to switch from tenofovir to abacavir (n = 26) or to continue with tenofovir (n = 28). Changes in lumbar and total hip BMD were evaluated at Week 48 from baseline. RESULTS Five patients discontinued the study (three from the tenofovir group and two from the abacavir group). No significant differences were detected between the groups at Week 48 (P = 0.229 for total hip and P = 0.312 for lumbar spine). However, hip BMD improved by 2.1% (95% CI -0.6 to 4.7) (P = 0.043) in the abacavir group and 0.7% (95% CI -0.9 to 2.4) (P = 0.372) in the tenofovir group. Lumbar spine BMD varied by -0.7% (95% CI -3.8 to 3.3) (P ≤ 0.001) in the abacavir group and -1.2% (95% CI -3.8 to 0.4) (P < 0.001) in the tenofovir group. CONCLUSIONS Switching from tenofovir to abacavir led to a slight improvement in femoral BMD although no differences were detected between groups. Larger studies are necessary before firm recommendations can be made on the discontinuation of tenofovir in patients with a low BMD.
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Affiliation(s)
- Eugènia Negredo
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Domingo
- Santa Creu i Sant Pau Hospital, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Pérez-Álvarez
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain Statistics and Operations Research Department, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Mar Gutiérrez
- Santa Creu i Sant Pau Hospital, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gracia Mateo
- Santa Creu i Sant Pau Hospital, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Puig
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roser Escrig
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia Echeverría
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Bonjoch
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bonaventura Clotet
- Lluita contra la Sida Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain Irsicaixa Foundation, Germans Trias i Pujol University Hospital, Badalona, Spain
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