Poor Bone Quality in Patients With Amyotrophic Lateral Sclerosis

Objective: Musculoskeletal functional deterioration in Amyotrophic lateral sclerosis (ALS) is associated with an increase in bone fractures. The purpose of this study was to evaluate the influence of sex, ALS type, on bone quality in patients with ALS compared to healthy controls. The impact on bone health of the clinical status and some metabolic parameters was also analyzed in ALS patients.

Methods: A series of 33 voluntary patients with ALS, and 66 healthy individuals matched in sex and age underwent assessment of bone mass quality using quantitative ultrasound (QUS) of the calcaneus. Ultrasonic broadband attenuation (BUA), the speed of sound (SOS), stiffness index and T-score were measured. Bone mineral density (BMD) was estimated using standard equations. Apart from fat and muscle mass percentage determinations, clinical baseline measures in ALS patients included ALSFRS-R score, Barthel index for activities of daily living, pulmonary function measured using FVC, and muscular strength assessed by a modified MRC grading scale. Laboratory tests included serum calcium, 25-HO-cholecalciferol (Vitamin D), alkaline phosphatase (ALP), T4 and TSH.

Results: All bone parameters evaluated were statistically significant lower in ALS patients than in healthy controls. ALS females showed significantly lower bone parameters than healthy females. According to the estimated BMD, there were 25 ALS patients (75.8%) and 36 (54.5%) healthy individuals showing an osteoporotic profile (BMD <0.700 g/cm²). Only 16.7% of the ALS females had T-scores indicative of healthy bones. There was no correlation between any of the clinical parameters analyzed and the bone QUS measurements. Vitamin D and TSH levels positively correlated with all the bone parameters.

Conclusions: This study confirms that ALS patients, particularly females, exhibited deteriorated bone health as compared to healthy individuals. These structural bone changes were independent of ALS subtype and clinical status. Bone health in ALS patients seems to be related to certain metabolic parameters such as Vitamin D and TSH levels.

Differences in Adiposity Profile and Body Fat Distribution between Forwards and Backs in Sub-Elite Spanish Female Rugby Union Players

The purpose of this study was to analyze the adiposity profile and the body fat distribution in 56 sub-elite female rugby union players involved in the Spanish National Women's Rugby Union Championships. The participants included in this study, which was the first to analyze sub-elite players, show thinner skinfolds, lower fat mass, and lesser fat percentage than previously reported for elite female rugby union players. Forwards were heavier and had higher body mass index (BMI) and fat mass, thicker skinfolds, and higher fat percentage than back players. Forwards also possessed significantly greater total fat-free mass than backs. All these differences were applicable only to players under 25 years of age. A negative correlation between age and both abdominal and lower extremity fat was found in forward players but not in the backs. Both Yuhasz and Faulkner equations tended to underestimate fat percentage in comparison to Reilly equation. Although Yuhasz equation provided higher systematic error, random error was lower in comparison to Faulkner equation. This study shows the relevance of analyzing and monitoring adiposity in female rugby union players to optimize adaptation to the sports requirements of different playing positions and age.

Women's acute anxiety variations before and after epidural anesthesia for childbirth

OBJECTIVE

This study assessed changes in anxiety during different phases of childbirth in a sample of women demanding epidural anesthesia.

DESIGN

Prospective, longitudinal case series.

SAMPLE

A total of 133 women who demanded epidural anesthesia for childbirth answered the questionnaires.

METHODS

Anxiety state was measured using the State Trait Anxiety Inventory (STAI) questionnaire. The STAI-S (anxiety state) was administered in three phases during childbirth: Phase 1 was before applying epidural anesthesia, Phase 2 was 45 min after the application of epidural anesthesia and Phase 3 was at less than 24 h after delivery. Data were collected in two general hospitals: a third-level public hospital and a well-recognized private hospital.

MAIN OUTCOME MEASURES

STAI scores.

RESULTS

Anxiety state decreases significantly after applying the epidural anesthesia (Phase 2) compared to before anesthesia (Phase 1), and it remains low levels 24 h after childbirth (Phase 3). There were statistically significant differences in STAI scores between the different phases administrated (Phases 1 and 2: p < 0.001; effect size, d = 1.40; Phases 1 and 3: p < 0.001; effect size, d = 1.39). In Phase 3, women with cesarean section birth had significant differences in STAI scores relative to those with spontaneous birth (p = 0.037; d = 0.44). The type of health-care setting (public or private), the educational level and the numbers of previous births does not affect the level of anxiety state in women in any of the three phases.

CONCLUSIONS

Women's anxiety decreases significantly after applying epidural anesthesia, and it remains low 24 h after delivery. Anxiety against childbirth was not influenced by the health system used by women, by the condition of primiparous or multiparous, or by the educational level. Women who received an epidural anesthesia with a cesarean section reported higher rates of anxiety state after birth.

Relationship of Overweight and Obesity with Body Self-Image Dissatisfaction in Urban Mediterranean Adolescents

The aim of this study was to analyze whether weight status has a relationship with the prevalence of body self-image dissatisfaction in Mediterranean urban teenagers. A series of 809 adolescents aged 11 to 17 years underwent anthropometric measurements according to ISAK protocols and completed the Body Shape Questionnaire (BSQ). The overall overweight prevalence according to International Obesity Task Force (IOTF) criteria was 11.5%, and 2.7% for obesity. Girls showed higher overweight prevalence than boys (18.4% vs. 12.9%; p < 0.05). At the late adolescence period (16–17 y), obesity was observed in the boys but not in the girls (8.7% vs. 0%; p < 0.01). There was a relative low prevalence of body image (BI) dissatisfaction among participants (boys 17.3%; girls 22.7%). In the late adolescence period, the girls were more often classified as being dissatisfied (31%). A weak correlation between the BSQ scores and all the anthropometric variables related to the adiposity profile was detected only in the boys. A logistic regression confirmed that female adolescents and the late pubertal period had a significant association with body dissatisfaction, regardless of their weight status. As BI are not related to weight status measured by body mass index (BMI) percentiles, other factors beyond anthropometry deserve further research to explain BI concerns specifically in girls.

Bone quality in young adults with intellectual disability involved in adapted competitive football

The objective of this study was to analyse bone quality parameters of football players with intellectual disability (ID) participating in adapted competitive football. Sixty-seven male football players with ID were studied: 22 with Down syndrome (DS) and 45 without DS. The average age was 26 years (range: 16 ̶ 50 years). A group of 25 age-matched sedentary individuals with ID (11 DS and 14 non-DS) and another group of 20 healthy participants of the same age group not involved in competitive football were comparatively analysed. There were no differences in the bone quality parameters when the healthy sedentary individuals were compared with both the sedentary and the football players with ID. However, the speed of sound (SOS), T-score, and estimated bone mineral density (BMD) were of higher values in the football players with ID than in the sedentary ID group (p < 0.05). On comparing the football players with non-DS ID with the sedentary non-DS individuals, significant differences were noted in SOS (p < 0.01), T-scores (p < 0.01), and estimated BMD (p < 0.01). Four of the 45 non-DS (8.9%) and none of the football players with DS had T-scores less than -1.5. Two of the 14 sedentary non-DS participants (14.3%) had T-scores indicating osteoporosis. In summary, the ID population actively involved in football showed higher values of bone mass parameters than their sedentary ID and healthy peers. The participants with non-DS ID showed a higher prevalence of osteoporosis than the football players with DS. Participation in sports seems to prevent bone loss in individuals with ID.

Bone Quality in Patients with Parkinson's Disease Determined by Quantitative Ultrasound (QUS) of the Calcaneus: Influence of Sex Differences

(1) Background: Parkinson’s disease (PD) is a relatively common neurodegenerative disease in elderly individuals, with a high risk of falls. There is abundant literature on the relationship between PD and osteoporosis. The aim of this study is to describe the bone quality of a population with PD by calcaneal ultrasound and to compare it with a healthy control, assessing the influence of possible sex differences. (2) Methods: 21 patients diagnosed with PD were recruited. The control group was composed of 30 healthy individuals with similar sociodemographic characteristics. The bone quality of all participants was assessed using calcaneal quantitative ultrasound (QUS). The parameters recorded were broadband ultrasound attenuation (BUA, in decibels per megahertz), imaging speed of sound (SOS, in meters per second), stiffness index (SI) and T-score of each participant. Bone mineral density (BMD) was estimated using the equation BMD = 0.002592 × (BUA + SOS) − 3.687 (g/cm2). (3) Results: significant differences were observed between the healthy control and the PD group: the T-score was lower in the PD group (p < 0.05) and SOS was higher in Parkinson’s disease patients (p < 0.05), while 28.6% of the PD patients were osteoporotic with T-score values lower than −1.5 compared to 16.7% of osteoporotic individuals in the control group (p < 0.01). Regarding the sex, there were significant differences (p < 0.05) between the females of the PD group vs. control group, showing a significant difference in the SI (71.4 ± 14.7 vs. 87.8 ± 12), T-score (−2.19 ± 1.1 vs. −0.15 ± 0.8), BUA (104.5 ± 13 vs. 116 ± 10.6) and BMD (0.49 ± 0.09 vs. 0.60 ± 0.08), with no difference in the comparison between the male groups; and the comparison between both sexes in T-score only showed significant differences for the PD group (p < 0.05), with worse bone quality in women. (4) Conclusions: this study shows poorer bone quality in female patients with PD, who have a higher percentage of osteoporosis than healthy patients. The QUS technique of the calcaneus seems adequate for these determinations in patients with Parkinson’s disease.

Eating Disorder Attitudes and Body Self-Image of Urban Mediterranean Adolescents

BACKGROUND

Early detection tools for eating disorders play an essential role in their prevention. The aim of this study was to analyze different variables associated with the risk of eating disorders and their relation to anthropometric parameters, nutritional status and body self-image.

METHODS

The Eating Disorder Invetory-3 Referral Form (EDI-3 RF) and the Body Shape Questionnaire (BSQ) were administered to 809 adolescents (413 boys and 396 girls), aged 11 to 17 years, from three randomly chosen schools in a big Mediterranean city. Anthropometric measurements were taken following standardized methods. Overweight and obesity were determined according to the International Obesity Task Force (IOTF).

RESULTS

Overweight (23%) prevailed over obesity (9.37%). Girls registered a higher score in the Obsession for Thinness EDI-3 RF subscale and in the body dissatisfaction section of the BSQ. The only statistically significant differences in the Obsession for Thinness and Body Dissatisfaction levels among the different ages were seen in boys. In this series, body dissatisfaction assessed by the EDI-3 RF was not correlated with BSQ body dissatisfaction. Sex and age in adolescence determine the relationship between eating disorder attitudes and body shape dissatisfaction.

CONCLUSIONS

It is necessary to look for other parameters to investigate to determine body dissatisfaction.

Adiposity-Age Distribution and Nutritional Status in Girls With Adolescent Idiopathic Scoliosis

STUDY DESIGN

Cross-sectional comparative study.

OBJECTIVES

To assess the adiposity-age distribution in girls with adolescent idiopathic scoliosis (AIS) and to define the prevalence of underweight, overweight, and obesity in these patients as compared with healthy controls.

SUMMARY OF BACKGROUND DATA

The current literature focusing the nutritional status of individuals with AIS does not provide data on the prevalence of overweight in these patients.

METHODS

The sample consisted of 112 adolescent girls with idiopathic scoliosis and 231 healthy age-matched girls from the same geographic region. Three different validated body mass index (BMI) cutoffs for adolescents were used to define the nutritional status. Adiposity was labeled according to Adiposity & Fat Distribution for Adolescents (AFAD-A) criteria.

RESULTS

There were significant differences in BMI and fat percentage according to age (p < .005) in both AIS patients and healthy controls. The overall prevalence of underweight was similar in both groups (scoliotic girls, 4.5%; controls, 4.8%). Obesity was more prevalent in AIS patients than in healthy controls. The World Health Organization-2007 and the Centers for Disease Control and Prevention cutoffs detected similar percentages of AIS girls with obesity (10.7%) and healthy controls (5.4%). The International Obesity Taskforce detected a 6.3% of AIS girls with obesity and only 3.0% in controls. Fat-age distribution gradually decreases from 11-13 to 16-17 years in AIS patients (p < .05). The overall prevalence of adolescents with fat overload (body fat index [BFI] >7.6) was similar in both groups (AIS, 0.9%; controls, 0.8%).

CONCLUSIONS

The proportion of adolescents with obesity was twofold higher among AIS girls than in age-matched healthy controls. However, in AIS girls, the BFI differed from that shown by healthy peers, being lower along the middle adolescence period (13-15 years). AIS girls showed an important increase in underweight at late adolescence (16-17 years).

LEVEL OF EVIDENCE

Level III, diagnostic.