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Osteoporosis (OP) is a chronic disease characterized by diminished bone mass and structural deterioration, ultimately leading to compromised bone strength and an increased risk of fractures. Diagnosis primarily relies on medical imaging findings and clinical symptoms. This study aims to explore an adjunctive diagnostic technique for OP based on surface-enhanced Raman scattering (SERS). Serum SERS spectra from the normal, low bone density, and osteoporosis groups were analyzed to discern OP-related expression profiles. This study utilized partial least squares (PLS) and support vector machine (SVM) algorithms to establish an OP diagnostic model. The combination of Raman peak assignments and spectral difference analysis reflected biochemical changes associated with OP, including amino acids, carbohydrates, and collagen. Using the PLS-SVM approach, sensitivity, specificity, and accuracy for screening OP were determined to be 77.78%, 100%, and 88.24%, respectively. This study demonstrates the substantial potential of SERS as an adjunctive diagnostic technology for OP. [ABSTRACT FROM AUTHOR]

Abstract Osteoporosis (OP) is a chronic disease characterized by diminished bone mass and structural deterioration, ultimately leading to compromised bone strength and an increased risk of fractures. Diagnosis primarily relies on medical imaging findings and clinical symptoms. This study aims to explore an adjunctive diagnostic technique for OP based on surface-enhanced Raman scattering (SERS). Serum SERS spectra from the normal, low bone density, and osteoporosis groups were analyzed to discern OP-related expression profiles. This study utilized partial least squares (PLS) and support vector machine (SVM) algorithms to establish an OP diagnostic model. The combination of Raman peak assignments and spectral difference analysis reflected biochemical changes associated with OP, including amino acids, carbohydrates, and collagen. Using the PLS-SVM approach, sensitivity, specificity, and accuracy for screening OP were determined to be 77.78%, 100%, and 88.24%, respectively. This study demonstrates the substantial potential of SERS as an adjunctive diagnostic technology for OP.

Premature ovarian insufficiency (POI) is one of many potential long-term consequences of childhood cancer treatment in females. Causes of POI in this patient population can include chemotherapy, especially alkylating agents, and radiation therapy. Rarely, ovarian tumors lead to ovarian dysfunction. POI can manifest as delayed pubertal development, irregular menses or amenorrhea, and infertility. This diagnosis often negatively impacts emotional health due to the implications of impaired ovarian function after already enduring treatment for a primary malignancy. The emerging adult may be challenged by the impact on energy level, quality of life, and fertility potential. POI can also lead to low bone density and compromised skeletal strength. This review discusses the health consequences of POI in childhood cancer survivors (CCS). We also explore the role of fertility preservation for CCS, including ovarian tissue cryopreservation and other available options. Lastly, knowledge gaps are identified that will drive a future research agenda. [ABSTRACT FROM AUTHOR]

Background/Objective: To ensure that implants are able to support prosthetic rehabilitation, a stable and functional union between the bone and the implant surface is crucial to its stability and success. To increase bone volume and density and excel bone-implant contact, a novel drilling method, called osseodensification (OD), was performed. To assess the effectiveness of the osseodensification drilling protocol versus the conventional surgical technique on implant stability. Methods: Bone Level Tapered Straumann implants were placed side-by-side with both OD and subtractive conventional drilling (SD) in 90 patients from CESPU—Famalicão clinical unit. IT was measured using a manual torque wrench, and the Implant stability quotient (ISQ) value was registered using the Osstell® IDX. Results: According to the multifactorial ANOVA, there were statistically significant differences in the mean IT values due to the arch only (F(1.270) = 4.702, p-value = 0.031 < 0.05). Regarding the length of the implant, there were statistically significant differences in the mean IT in the OD group (p = 0.041), with significantly lower mean IT values for the Regular implants compared to the Long. With respect to the arch, the analyses of the overall ISQ values showed an upward trend in both groups in the maxilla and mandible. High levels of IT also showed high ISQ values, which represent good indicators of primary stability. Conclusions: OD does not have a negative influence on osseointegration compared to conventional subtractive osteotomy. [ABSTRACT FROM AUTHOR]

Objective: Cushing's syndrome is caused by the excessive secretion of cortisol or the intake of exogenous cortisol. Morbidity caused by osteoporosis is a major complication that cannot be ignored. We conducted a study to evaluate bone density and fracture risk factors in patients with Cushing's syndrome. Patients and Methods: This retrospective case-control study involved 176 patients diagnosed with Cushing's syndrome [153 female and 34 male patients] and 84 controls [72 female and 12 male patients]. Patients admitted to the clinics within the last eight years were included in the analysis. We collected demographic, clinic laboratory data, and bone densitometry measurements from electronic patient files. The classification ofpatients into normal, osteopenia, or osteoporosis groups is determined by their Body Mineral Density measurements based on the World Health Organization criteria. Results: Among the patients, 135 were diagnosed with Cushing's disease and 41 with adrenal adenomas. Patients with Cushing' syndrome showed a higher incidence of osteopenia (11.4%) and osteoporosis (2.8%) when compared to the control group. No osteoporosis cases were found in the control group, while nine cases of osteopenia were detected. Osteopenia was significantly more common in adrenal adenoma patients than in those with pituitary Cushing's disease. Osteopenia was present in 39.1% of adrenal Cushing's patients, with only 8.7% (n = 2) having osteoporosis. Osteopenia was observed in 11 patients (23.4%) with pituitary Cushing's disease, while only 4 patients (8.5%) had osteoporosis. Conclusions: Osteopenia is more prevalent in patients with adrenal Cushing's syndrome. [ABSTRACT FROM AUTHOR]

Sports participation has been shown to have many benefits. However, along with the many benefits of sporting activity, it seems that female athletes may experience symptoms related to a condition called the female athlete triad. The purpose of this review is to evaluate the studies that determined the prevalence of the Female Athlete Triad conditions (low Energy Availability (EA), Disordered Eating (DE), Menstrual Disorders (MD), and low Bone Mineral Density (BMD)) in female adult athletes. The electronic databases PubMed, EMBASE, CINAHL, and Cochrane Library were systematically searched for eligible studies. Inclusion and exclusion criteria were defined a priori. The selected studies were reviewed, and data extraction was carried out by the reviewers independently. Data extraction was carried out by the two researchers independently, using a predesigned and standardised form to record information and data. A total of 17 studies are included in this review (n = 1756). The prevalence of low EA ranged from 2.2% to 79.5% (mean: 35.8% ±25.4), of menstrual disturbance from 22.7% to 70.5% (mean: 34.9% ±14.7), and of low BMD from 0% to 45% (mean: 17.3% ± 15.3). Female athlete triad conditions are common among adult athletes. Prevention, early detection and treatment of both energy deficiency and menstrual dysfunctions could contribute to improved athletic performance, protect from injuries, and decrease the risk of stress fractures. [ABSTRACT FROM AUTHOR]

المخلص: أهداف البحث: يستقصي هذا البحث تأثير تعدد أشكال الجينات لإنترلوكين ١ وإنترلوكين ٦ على كثافة المعادن في العظام وفقدان العظم الهامشي حول زراعة الأسنان. ومع ذلك، فإن تأثير كثافة المعادن بالعظام النظامية على تباين فقدان العظام الهامشي المحيط بالزرعة ليس واضحا. وبالتالي، تم إجراء هذه الدراسة للتحقق من ارتباط تعدد أشكال الجينات إنترلوكين ١ وإنترلوكين ٦ مع كثافة المعادن بالعظام الجهازية و فقدان العظام الهامشي حول زراعة الأسنان. طرق البحث: شملت الدراسة ١٩٠ مشاركا تم اختيارهم لزراعة الأسنان في المنطقة الخلفية للفك السفلي. تم تصنيف المشاركين بناء على كثافة المعادن في العظام المقاسة بالأشعة السينية ثنائية الطاقة: كثافة المعادن الطبيعية في العظام (93 مشاركا)، معدل ت ≥ -1 كثافة المعادن المنخفضة في العظام بما في ذلك هشاشة العظام وترقق العظام (97 مشاركا)، معدل ت ≤ -1 الانحراف المعياري. تم وضع زرعات الأسنان وفقا للبروتوكولات الجراحية القياسية، وتم قياس فقدان العظم الهامشي بعد ٦ أشهر باستخدام المسح الطبقي المحوري قبل جراحة المرحلة الثانية. تم إجراء تحديد النمط الجيني لكافة المشاركين للجينات آي إل-1أ-889 أ/ج، آي إل-1ب-511 ج/أ، آي إل-1ب+3954 ، و آي إل-6-572 س/ج لتحليل تعدد أشكال الجينات. النتائج: قارنت الدراسة الخصائص الديموغرافية والسريرية للمشاركين ذوي الكثافة العظمية الطبيعية والمنخفضة. وجدت الدراسة ارتباطات هامة بين تعدد أشكال الجينات إنترلوكين ١ وإنترلوكين ٦ وزيادة فقدان العظم الهامشي حول زرعات الأسنان لدى المشاركين ذوي الكثافة العظمية المنخفضة. الاستنتاجات: كان الأفراد الذين يحملون الأنماط الجينية المعينة (إنترلوكين ١ب-٥١١ ألف ألف أو إنترلوكين ٦-٥٧٢ جي جي) في خطر متزايد للإصابة بترقق العظام أو هشاشة العظام. وكانوا أيضا أكثر عرضة لفقدان العظم الهامشي حول زرعات الأسنان. Abstract: Objectives: Interleukin 1 (IL-1) and interleukin 6 (IL-6) gene polymorphisms have been suggested to be responsible for diminished bone mineral density (BMD) and high crestal bone loss (CBL) in some individuals. However, the effects of systemic BMD on variations in peri-implant CBL are unclear. Hence, this study was aimed at investigating the association of IL-1 and IL-6 gene polymorphisms with systemic BMD and CBL around dental implants. Methods: A total of 190 participants undergoing dental implantation in the mandibular posterior region were selected according to predetermined selection criteria and divided into a normal BMD group (NBD, 93 participants, T-score ≥ −1) and low BMD group (LBD, including both osteoporosis and osteopenia, 97 participants, T-score

Background: Maxillary sinus pneumatization is a physiological process that can adversely affect bone availability for further dental rehabilitation. If a relation between the thickness of the mandibular cortex and maxillary sinus pneumatization is proven, future bone availability can be deducted. Material and methods: In this cross-sectional study, 85 panoramic radiographs were evaluated. All patients were between 19 and 70, had at least lost a second premolar, first molar, or second molar on one side of the maxilla, and had these teeth on the other side. Four lines were digitally drawn on the radiographs to determine the superior and inferior borders of the sinus on both sides. The amount of inferior sinus border progression was deducted using the digitally-measured lines' ratios. The following tests were done using IBM SPSS ver. 24: Pearson's correlation coefficient test, Tukey's dual comparison posthoc test, One-way ANOVA test, and the independent T-test (p = 0.05). Results: There was a negative correlation between the inferior mandibular cortex's thickness and the maxillary sinus's pneumatization (p

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Maxillary sinus pneumatization is a physiological process that can adversely affect bone availability for further dental rehabilitation. If a relation between the thickness of the mandibular cortex and maxillary sinus pneumatization is proven, future bone availability can be deducted. In this cross-sectional study, 85 panoramic radiographs were evaluated. All patients were between 19 and 70, had at least lost a second premolar, first molar, or second molar on one side of the maxilla, and had these teeth on the other side. Four lines were digitally drawn on the radiographs to determine the superior and inferior borders of the sinus on both sides. The amount of inferior sinus border progression was deducted using the digitally-measured lines' ratios. The following tests were done using IBM SPSS ver. 24: Pearson's correlation coefficient test, Tukey's dual comparison posthoc test, One-way ANOVA test, and the independent T-test (p = 0.05). There was a negative correlation between the inferior mandibular cortex's thickness and the maxillary sinus's pneumatization (p < 0.001). Also, there was a significant difference between maxilla sinus pneumatization in the second premolar, first, and second molar areas based on the inferior mandibular cortex's thickness (p = 0.009). Based on the present study, there is a significant relationship between the thickness of the inferior mandibular cortex and maxillary sinus pneumatization, especially for women and patients above 40 years old. [ABSTRACT FROM AUTHOR]

BackgroundOsteoporosis is becoming more common worldwide, imposing a substantial burden on individuals and society. The onset of osteoporosis is subtle, early detection is challenging, and population-wide screening is infeasible. Thus, there is a need to develop a method to identify those at high risk for osteoporosis.ObjectiveThis study aimed to develop a machine learning algorithm to effectively identify people with low bone density, using readily available demographic and blood biochemical data.MethodsUsing NHANES 2017–2020 data, participants over 50 years old with complete femoral neck BMD data were selected. This cohort was randomly divided into training (70%) and test (30%) sets. Lasso regression selected variables for inclusion in six machine learning models built on the training data: logistic regression (LR), support vector machine (SVM), gradient boosting machine (GBM), naive Bayes (NB), artificial neural network (ANN) and random forest (RF). NHANES data from the 2013–2014 cycle was used as an external validation set input into the models to verify their generalizability. Model discrimination was assessed via AUC, accuracy, sensitivity, specificity, precision and F1 score. Calibration curves evaluated goodness-of-fit. Decision curves determined clinical utility. The SHAP framework analyzed variable importance.ResultsA total of 3,545 participants were included in the internal validation set of this study, of whom 1870 had normal bone density and 1,675 had low bone density Lasso regression selected 19 variables. In the test set, AUC was 0.785 (LR), 0.780 (SVM), 0.775 (GBM), 0.729 (NB), 0.771 (ANN), and 0.768 (RF). The LR model has the best discrimination and a better calibration curve fit, the best clinical net benefit for the decision curve, and it also reflects good predictive power in the external validation dataset The top variables in the LR model were: age, BMI, gender, creatine phosphokinase, total cholesterol and alkaline phosphatase.ConclusionThe machine learning model demonstrated effective classification of low BMD using blood biomarkers. This could aid clinical decision making for osteoporosis prevention and management.

Research regarding bone density assessment using cone beam computed tomography (CBCT) in low bone density regions is sparse. This in vitro study aimed to evaluate the predictability of CBCT for low bone density regions and its correlations with primary implant stability when placing tapered design implants with a stepped osteotomy. Eighteen porcine mandibular condyles were used as simulated low bone density regions. Hounsfield units (HU), obtained via multislice computed tomography, and gray values (GVs), obtained via CBCT, were measured 3 times at 1-month intervals. The maximum implant insertion torque (MIT) and implant stability quotient (ISQ) were recorded as the taper design implants were placed using a stepped osteotomy. Hounsfield units and GV were measured as 335.05–803.07 and 389.98–906.40, respectively. For repeated measurements of HU and GV, the intraclass correlation coefficients were 0.989 and 0.980; the corresponding value for mean HU and GV was 0.768. Bland-Altman plots showed a mean difference between HU and GV of −78.15. Pearson correlation coefficients revealed a strong correlation between HU and GV (r = 0.91, P <.01). The mean ± SD values for MIT and ISQ were 36.44 ± 6.64 Ncm and 80.85 ± 2.03, respectively, but no statistically significant correlations were found with GV and HU. Within the study's limitations, GV showed similar bone density estimation compared with HU in soft bones. Tapered implant placement with a stepped osteotomy achieved stable primary implant stability in soft bones. However, these in vitro results need to be approved in further clinical studies. [ABSTRACT FROM AUTHOR]

Plain English summary Endocrine complications are common in anorexia nervosa (AN). Examples include absence of menstrual periods in women, low testosterone levels in men, and low thyroid hormone levels, all of which are considered adaptive to the state of undernutrition. Low bone density and increased risk of fractures are also common complications. In women, weight recovery and restoration of menstrual periods are important treatments for low bone density. Less is known about the treatment of endocrine complications in men with AN. In this article, we review the causes and treatment of endocrine abnormalities in AN.

Background: Microscopic colitis (MC) is a chronic inflammatory disease of the large bowel characterized by watery diarrhea, substantially decreasing the patient's quality of life. Scarce data suggest that MC is associated with low bone density (LBD). Objectives: We aimed to assess whether MC is a risk factor for LBD and the proportion of patients with MC having LBD. Design: A systematic review and meta-analysis of studies reporting bone density measurements in MC patients. Data Sources and Methods: We systematically searched five databases from inception to October 16, 2021 (Pubmed, Embase, Cochrane, Scopus, and Web of Science). We used the random-effect model to calculate pooled odds ratios (ORs) and pooled event rates with 95% confidence intervals (CIs). To ascertain the quality of evidence of our outcomes, we followed the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. Results: The systematic search yielded a total of 3046 articles. Four articles were eligible for quantitative synthesis. All of them used age- and sex-matched controls to evaluate LBD occurrence among patients with MC. The odds of having LBD were twofold increased (OR = 2.13, CI: 1.42–3.20) in the presence of MC, the odds of osteopenia occurrence were 2.4 (OR = 2.45, CI: 1.11–5.41), and of osteoporosis 1.4 (OR = 1.42, CI: 0.65–3.12). The proportion of LBD was 0.68 (CI: 0.56–0.78), osteopenia was 0.51 (CI: 0.43–0.58), and osteoporosis was 0.11 (CI: 0.07–0.16) among the MC population. Our findings' certainty of the evidence was very low following the GRADEPro guideline. Conclusion: Our data demonstrate that MC is associated with a twofold risk for LBD. Based on our findings, we suggest screening patients for bone mineral density upon diagnosis of MC. Further prospective studies with higher patient numbers and longer follow-up periods on this topic are needed. Registration: Our protocol was prospectively registered with PROSPERO (CRD42021283392). Plain language summary: Investigating microscopic colitis as a risk factor for having low bone density in a literature overview and statistical approach Microscopic colitis (MC) is an underdiagnosed chronic inflammatory large bowel disease, characterized by watery diarrhea, which substantially impacts the patient's quality of life. The etiology of MC is still unclear but is suspected to be multifactorial. Moreover, low bone density (LBD) has been associated with the disease. Scarce data investigate the relationship of MC with LBD, although they share common risk factors, like advanced age and female sex. LBD has two forms; the mild is osteopenia and the severe form is osteoporosis. The most severe complications of osteoporosis are osteoporotic fractures, which can culminate in a life-threatening state and amplify the hospital expenses burden. Our primary aim was to assess if MC increases the risk of LBD. Furthermore, we estimated the proportions of bone mineral changes in the MC population. Following a rigorous methodology, our data suggest that MC doubles the odds of LBD. Furthermore, we have shown that two-thirds of the MC population suffers from bone density decrease, half of them have osteopenia, and one in 10 MC patients has osteoporosis. In conclusion, we highly suggest screening patients with MC for bone mineral density at the moment of diagnosis. [ABSTRACT FROM AUTHOR]

An important component in the treatment of anorexia nervosa (AN) is the evaluation and management of its endocrine complications, including functional hypogonadotropic hypogonadism and increased fracture risk. The body's adaptive response to chronic starvation results in many endocrine abnormalities, most of which are reversible upon weight restoration. A multidisciplinary team with experience in treating patients with AN is critical to improving endocrine outcomes in patients with this disorder, including in women with AN who are interested in fertility. Much less is understood about endocrine abnormalities in men, as well as sexual and gender minorities, with AN. In this article, we review the pathophysiology and evidence-based recommendations for the treatment of endocrine complications in AN, as well as discuss the status of clinical research in this area. Plain English summary: Endocrine complications are common in anorexia nervosa (AN). Examples include absence of menstrual periods in women, low testosterone levels in men, and low thyroid hormone levels, all of which are considered adaptive to the state of undernutrition. Low bone density and increased risk of fractures are also common complications. In women, weight recovery and restoration of menstrual periods are important treatments for low bone density. Less is known about the treatment of endocrine complications in men with AN. In this article, we review the causes and treatment of endocrine abnormalities in AN. [ABSTRACT FROM AUTHOR]

Background: Depression is a disease that is commonly accompanied by elderly chronic kidney disease (CKD) patients, but when the two diseases are accompanied, etiology or combination are not well known. We aimed to evaluate the etiology of CKD and comorbid depression by investigating bone disorders that are observed in persons affected by both CKD and depression.Methods: We conducted a cross-sectional study with a total of 646 patients with CKD. We compared the sociodemographic factors, kidney function, markers for CKD-Mineral and Bone Disorder (CKD-MBD) and bone mineral density according to the depressive symptoms. We conducted a univariate and multivariate logistic regression analysis to calculate odd ratios (95 % confidence interval) between depressive symptoms and low bone mineral density.Results: Individuals with CKD and depressive symptoms were associated with lower level of education attained, living alone, exercising less, low 24-hour urine phosphorus, and low bone density. Depressive symptoms were significantly associated with low bone density in lowest parts (1.55 [1.06-2.29]) and in total hip (1.72 [1.17-2.53]) even after adjusting for diabetes mellitus, hypertension, kidney function, proteinuria, age, sex, smoking, and body mass index.Limitations: A cross-sectional design was used in this study and the bone biopsy for diagnosis of CKD-MBD was not done because of invasiveness and practical difficulties.Conclusion: Low bone density was associated with depressive symptoms in elderly patients with non-dialysis chronic kidney disease. [ABSTRACT FROM AUTHOR]

Fontaine progeroid syndrome (FPS) is an autosomal dominant condition caused by pathogenic variants in the SLC25A24 gene. Eleven cases have been described in the literature, with early lethality in some. We discuss the clinical course of a patient from birth until his death at 7 months. [ABSTRACT FROM AUTHOR]

Background. Melatonin, N-acetyl-5-methoxy-tryptamine is the major secretion product of the pineal gland with important anti-inflammatory and antioxidant properties, also being an important marker of bone remodelling associated with menopause. Objectives. The aim of our study was to evaluate the effect of the co-administration of melatonin and estrogen on systemic inflammatory status and bone histopathological modifications in surgically induced menopausal female rats. Materials and methods. The study was performed on a number of 40 female rats, Wistar breed, which underwent bilateral surgical ovariectomy. Within 14 days postoperative, hormone replacement therapy with estrogen or estrogen with melatonin was initiated, in different doses. The treatment was administered for 12 consecutive weeks. At the end of the treatment we measured the serum levels of IL-6 and TNF-a. The femoral bones were harvested after sacrificing the animals and the thickness of the cortical bones was measured and histologically analysed. Results. Serum values of inflammatory markers were negatively correlated with melatonin administration, the differences being more important at higher doses of melatonin (for both IL-6 and TNF-a the difference between group E_2M with estrogen substitution and melatonin in double dose and control group W, without hormone replacement, was highly statistically significant with p <0.0001). Bone diameters improved in the case of female rats that received hormone replacement with estrogen and higher dose of melatonin (p = 0.0004 between group E_2M, with hormone replacement and group W, control group). Conclusions. Melatonin improved inflammatory status and bone histopathological changes in ovariectomized female rats. [ABSTRACT FROM AUTHOR]

Background. An important part of preventing major common diseases is identifying genetic factors that contribute to their occurrence. For the first time in our knowledge, we investigated the association between polymorphisms of five vitamin D receptor (VDR) genes (ApaI, BsmI, FokI, EcoRV, and TaqI) and low bone density/osteopenia/osteoporosis in individuals with type 2 diabetes using classification and regression tree (CART) algorithms. Methods. Data from 158 participants with T2D were used to develop the CART analysis. The binary output variable was "bone state" with low or normal values. Age and BMI (continuous variables), vitamin D deficiency (yes/no), and gender (binary variables), as well as polymorphisms of the five VDR genes (categorical variables) all played a role in the explanatory model. A 10-fold cross-validation process was used for model validation. Results. Participants were divided into three groups based on their sex. In all groups, age was the major factor predicting the low state in the final obtained tree model. The second most significant predictor in each model was BMI in both sexes (accuracy:75.32% and, AUC:0.748), EcoRV polymorphism in women (accuracy:78.79 %, AUC: 0.794), and TaqI polymorphism in men (accuracy:71.19%, AUC: 0.651). Conclusion Model validation of the final tree models demonstrated that the use of CART algorithms could be a valuable technique for identifying individuals with T2D who are at risk for early-onset osteoporosis based on their polymorphism of the studied VDR genes. Our recommendation is to conduct more population-based studies. We hope this study will serve as a basis for future research.

This study aimed to investigate the effect of nanomicelle curcumin (CUR), Nigella sativa oil (NS), and CUR and NS on the plasma levels of miR‐21, miR‐422a, and miR‐503 expression in postmenopausal women with low bone mass density (BMD). This randomized, triple‐blind, placebo‐controlled clinical trial with a factorial design was conducted on 120 postmenopausal women from the integrated healthcare system, Tabriz‐Iran. The BMD was determined using dual‐energy X‐ray absorptiometry (DEXA). Women were randomly divided into four groups of 30 participants: (a) CUR (80 mg) and placebo of NS, (b) NS (1,000 mg) and placebo of CUR, (c) CUR (80 mg) and NS (1,000 mg), and (d) both placebos (containing microcrystalline cellulose). The plasma level of miRNA‐21, miRNA‐422a, and miRNA‐503 was determined by qRT‐PCR. The expression level of miRNAs at the baseline was similar. At the end of the intervention, only the expression level of miRNA‐21 changed statistically significantly between the four groups (p =.037) and between the NS and placebo groups (p =.005). Also, its expression in the two groups receiving NS (p =.037) and NS–CUR (p =.043) was significantly increased. NS and NS–CUR supplementation can increase the expression level of miRNA‐21 in postmenopausal women with low bone density, and bring perspective to further studies of the target. [ABSTRACT FROM AUTHOR]

The LRP5 gene encodes a Wnt signaling receptor to which Wnt binds directly. In humans, pathogenic monoallelic variants in LRP5 have been associated with increased bone density and exudative vitreoretinopathy. In mice, LRP5 plays a role in tooth development, including periodontal tissue stability and cementum formation. Here, we report a 14‐year‐old patient with a de novo non‐synonymous variant, p.(Val1245Met), in LRP5 who exhibited mildly reduced bone density and mild exudative vitreoretinopathy together with a previously unreported phenotype consisting of dental abnormalities that included fork‐like small incisors with short roots and an anterior open bite, molars with a single root, and severe taurodontism. In that exudative vitreoretinopathy has been reported to be associated with heterozygous loss‐of‐function variants of LRP5 and that our patient reported here with the p.(Val1245Met) variant had mild exudative vitreoretinopathy, the variant can be considered as an incomplete loss‐of‐function variant. Alternatively, the p.(Val1245Met) variant can be considered as exerting a dominant‐negative effect, as no patients with truncating LRP5 variants and exudative vitreoretinopathy have been reported to exhibit dental anomalies. The documentation of dental anomalies in the presently reported patient strongly supports the notion that LRP5 plays a critical role in odontogenesis in humans, similar to its role in mice. [ABSTRACT FROM AUTHOR]

• Sacral alar-iliac screws (SAISs), especially S2AIS have been used for sacroiliac joint and were superiority to traditional sacroiliac screws (SISs) in patients with low bone density. However, no comparative study has examined both the insertion safety and biomechanical stability of different sacroiliac fixation methods. • This study investigated the insertion safety and biomechanical stability of different sacroiliac fixation methods, including SIS, transsacral-transiliac screw (TSTIS), S1 alar-iliac screw (S1AIS) and S2AIS in the treatment of sacroiliac joint in patients with low bone density. • We have demonstrated that the stability of S1AIS and S2AIS is similar, both stronger than that of SIS and TSTIS, which have shorter lengths of the screw trajectory on the ilium side. However, the safety zone of S2AIS at the insertion point is smaller than that of S1AIS. • Considering both safety and stability, S1AIS is the preferred choice for fixation of sacroiliac joint in patients with low bone density. Sacral alar-iliac screws (SAISs) have been used for sacroiliac joint and are superiority to traditional sacroiliac screws (SISs) in patients with low bone density. The aim of this study was to investigate the operation safety and biomechanical stability of the SIS, transsacral-transiliac screw (TSTIS), S1AIS and S2AIS in the treatment of sacroiliac joint in simulated models of low bone density. CT data from 80 normal pelvic structures were employed to measure the anatomical parameters, including the safety zones of the S1AIS and S2AIS at the insertion point and the trajectory lengths of the SIS, TSTIS, S1AIS and S2AIS. Sixteen synthetic pelvises with simulated osteoporotic bone structure were used to simulate type C Tile lesions and divided into 4 groups with an anterior plate and posterior fixation using one of the following: 1) one SIS on each side, 2) one TSTIS fixing both sides, 3) one S1AIS on each side, or 4) one S2AIS on each side. The stiffness and maximum load of the specimens were analyzed using a biomechanical machine under vertical loading. The safety zone of S1AIS was larger than that of S2AIS (p < 0.05). The TSTIS had the largest trajectory length, followed by the S1AIS and S2AIS, and the SIS had the smallest trajectory length (p < 0.05). However, the lengths of the TSTIS (26.1 ± 1.7 mm) and SIS (27.8 ± 1.8 mm) trajectories on the short side (the iliac side) were smaller than those of S1AIS (40.4 ± 3.8 mm) and S2AIS (39.1 ± 3.8 mm), thus indicating significant differences (p < 0.05). The stiffness and maximum load of S1AIS and S2AIS were similar and the greatest, followed by TSTIS and SIS (p < 0.05). The stability of S1AIS and S2AIS is similar, both stronger than that of SIS and TSTIS, which have shorter lengths of the screw trajectories on the ilium side. However, the safety zone of S2AIS at the insertion point is smaller than that of S1AIS. Therefore, considering both safety and stability, S1AIS is the preferred choice for fixation of sacroiliac joint dislocation in simulated models of low bone density. [ABSTRACT FROM AUTHOR]

Background. Melatonin, N-acetyl-5-methoxy-tryptamine is the major secretion product of the pineal gland with important anti-inflammatory and antioxidant properties, also being an im-portant marker of bone remodelling associated with menopause. Objectives. The aim of our study was to evaluate the effect of the co-administration of melatonin and estrogen on systemic inflammatory status and bone histopathological modifications in surgically induced menopau-sal female rats. Materials and methods. The study was performed on a number of 40 female rats, Wistar breed, which underwent bilateral surgical ovariectomy. Within 14 days postoperative, hormone replacement therapy with estrogen or estrogen with melatonin was initiated, in differ-ent doses. The treatment was administered for 12 consecutive weeks. At the end of the treatment we measured the serum levels of IL-6 and TNF-α. The femoral bones were harvested after sacri-ficing the animals and the thickness of the cortical bones was measured and histologically ana-lysed. Results. Serum values of inflammatory markers were negatively correlated with melatonin ad-ministration, the differences being more important at higher doses of melatonin (for both IL-6 and TNF-α the difference between group E_2M with estrogen substitution and melatonin in double dose and control group W, without hormone replacement, was highly statistically signif-icant with p

Background: Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta-analysis. Methods: This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA Ver. 15 software. Results: In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%). Conclusion: The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one-third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density.

To investigate the skeletal phenotype of adolescent girls with premature ovarian insufficiency (POI). Data are presented from two adolescent girls who participated in a clinical research protocol to evaluate axial bone mineral density (BMD) (via dual-energy x-ray absorptiometry, DXA) and appendicular bone density, microarchitecture, and strength (via high-resolution peripheral quantitative computed tomography, HRpQCT). Anthropometric data were also obtained, and pubertal staging was performed by a clinician. Both cases presented with an undetectable estradiol concentration and an elevated follicle stimulating hormone (FSH), meeting the criteria for POI. Each also received alkylating agents as part of their chemotherapy and radiotherapy, but in different locations as one presented with stage IV neuroblastoma and the other, metastatic medulloblastoma. Both had a low BMD of the axial and appendicular skeleton, as well as microarchitectural changes of the latter. The low BMD Z-score (<−2.0) seen when interpreting their DXA measurements for chronological age improved when adjusted for short stature, but it was not normalized. Lastly, most variables obtained by HRpQCT were abnormal for each participant, indicating that appendicular bone structure and strength were compromised. Chemotherapy and radiation affect growth, puberty, and bone accrual deleteriously. However, as these cases show, POI in an adolescent is not always classic primary ovarian insufficiency. Adolescents with brain cancer can present with signs of estrogen deficiency but may not be able to secrete FSH to the extent of elevation typically seen in long-term cancer survivors. Estrogen deficiency is almost universally present in either clinical setting and prompt recognition facilitates early provision of hormone replacement therapy that may then allow for a resumption of bone accrual as an adolescent approaches her peak bone mass. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below -2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below -1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad. [ABSTRACT FROM AUTHOR]

Tetrasomy 18p is a rare chromosomal abnormality, resulting from an additional iso‐chromosome composed of two copies of the short arm. It is characterized by craniofacial abnormalities, neuromuscular dysfunction, and developmental delay. The Chromosome 18 Clinical Research Center has established the largest cohort of individuals with this rare genetic condition. Here, we describe a case series of 21 individuals with tetrasomy 18p who have a previously unreported clinical finding: low bone mineral density. Most individuals met criteria for low bone density despite being relatively young (mean age of 21 years). Clinicians providing care to individuals affected by Tetrasomy 18p should be aware of their increased risk for decreased bone density and pathological fractures. [ABSTRACT FROM AUTHOR]

Anorexia nervosa (AN) and hypothalamic amenorrhea (HA) are states of chronic energy deprivation associated with severely compromised bone health. Poor bone accrual during adolescence followed by increased bone loss results in lifelong low bone density, degraded bone architecture, and higher risk of fractures, despite recovery from AN/HA. Amenorrhea is only one of several compensatory responses to the negative energy balance. Other hypothalamic-pituitary hormones are affected and contribute to bone deficits, including activation of hypothalamic-pituitary-adrenal axis and growth hormone resistance. Adipokines, particularly leptin, provide information on fat/energy stores, and gut hormones play a role in the regulation of appetite and food intake. Alterations in all these hormones influence bone metabolism. Restricted in scope, current pharmacologic approaches to improve bone health have had overall limited success. [ABSTRACT FROM AUTHOR]

The article focuses on impact and treatment of osteopenia and osteoporosis in female athletes, and mentions challenges due to low bone mass faced by athletes as it predisposes to stress-related bone injuries.

Introduction: Zoledronic acid is an intravenous bisphosphonate used to increase bone mineral density and reduce the risk of fractures. Its safety profile compares well with pamidronate in pediatric patients. We describe an acute, severe, life-threatening, inflammatory reaction in a child. Methods: A 7-year-old boy with complex medical problems and chronic ventilator requirements was admitted to the pediatric intensive care unit (due to ventilator needs) for zoledronic acid infusion and subsequent monitoring. His history was significant for osteoporosis secondary to immobilization with multiple fractures since 2 years of age, hypoxic-ischemic encephalopathy, quadriplegic cerebral palsy, seizure disorder, ventilator dependence, and pulmonary hypertension. He had previously been treated with four cycles of pamidronate without adverse events. He received 0.013 mg/kg of zoledronic acid infused over 30 minutes. Beginning 3 hours after completion of the infusion, he developed progressive tachycardia, fever, hypotension requiring vasopressor infusion, and increasing oxygen requirements. Laboratory studies revealed leukopenia, thrombocytopenia, elevated C-reactive protein, abnormal coagulation profile, metabolic acidosis, and negative cultures. The following day, he developed moderate acute respiratory distress syndrome and pulmonary hemorrhage requiring higher ventilatory settings, and subsequently diarrhea and abdominal distension. Initial clinical resolution was noted from the third day onward, and he was discharged on the sixth day after zoledronate administration. Results: Our pediatric patient demonstrated an acute, severe, life-threatening reaction to zoledronic acid requiring intensive cardiorespiratory support without an underlying pre-existing inflammatory disorder. Conclusion: Our case highlights the importance of careful monitoring of children following zoledronic acid therapy. We recommend inpatient observation after an initial infusion of zoledronic acid in medically complex children. Children and their parents should be thoroughly counseled on the potential risks of bisphosphonate treatment, which can sometimes be severe and life threatening. [ABSTRACT FROM AUTHOR]

Purpose: To study the effects of two home-based impact exercise programs on areal bone mineral density (aBMD) in adult premenopausal women with below average aBMD for age (negative Z-scores; 40.8 years; n = 107).Methods: Two unilateral impact exercise programs were employed, one targeting the total hip and lumbar spine (n = 42 pairs), the other the distal radius (n = 24 pairs) with some individuals performing both. Force plate data were used to establish exercise loading characteristics (peak loads, time to peak), dual-energy X-ray absorptiometry (DXA) provided bone data. Calcium intake, health and extraneous physical activity (PA) were determined by survey. Exercise for both hip and spine consisted of unilateral landings from adjustable steps (maximum height 63.5 cm) while impacts were delivered to the forearm by arresting falls against a wall. An exercise log was used to provide the exercise prescription, record each exercise bout and any injuries. Participants were randomly assigned to exercise or control groups and pair-matched (age, BMI, Z-score, aBMD). Compliance was calculated as the number of sessions completed divided by the total prescribed number (mean ~50 %).Results: The programs delivered significant gains pre to post at each site compared with significant losses in controls (forearm: 3.9 vs -3.9 %; total hip: 2.0 vs -2.6 %; lumbar spine: 2.8 vs -2.9 % exercise and controls, respectively, all p < 0.001). No exerciser lost bone at the target site regardless of compliance which was strongly correlated with bone gains (R (2) = 0.53-0.68, all p < 0.001).Conclusions: Impact exercise provides an effective means of improving below average aBMD without supervision in this at risk population. [ABSTRACT FROM AUTHOR]

Summary: We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90 % at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments. Introduction: The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density. Methods: Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references. Results: One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89 % (95%CI 82-96 %) and 41 % (95%CI 23-59 %), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88 % (95%CI 79-97 %) and 55 % (95%CI 42-68 %), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90 % but always with a trade-off of relatively low specificity. Conclusions: Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90 % for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional study concerning the correlation between low bone density and disease activity in patients with ulcerative colitis. The study used colorimetry method, data analysis, and Kolmogorov-Smirnov test. An acceptable rate of low bone density in ulcerative colitis was shown, without any correlation with the disease activity index.

Objective: We aimed to assess the effect and duration of gluten-free diet on bone health in children with celiac disease in our study. Methods: Sixty three patients with celiac disease (CD) formed the study group. They were divided into two subgroups according to their dietary compliance. Bone mineral density (BMD) values of the patients at two and five years of gluten-free diet (GFD) were determined. Findings: The relationship between BMD and compliance to GFD was found to be statistically significant (P<0.01). BMD z-scores were increased (0.12±0.15 and 0.10±0.14 units respectively) (P<0.01). The patients in group 1 and 2 had mean -1.18±0.83 and -2.06±0.73 z-scores in the first DXA. In the second DXA, these values were -1.10±0.73 and-1.94±0.93 respectively. Conclusion: Dietary compliance is important for bone health, and the time needed to normalize the BMD is not known. Patients with positive anti-endomysium antibody (EMA), poor dietary history and history of bone pain should be evaluated with DXA during follow-up. [ABSTRACT FROM AUTHOR]

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities and identify the bone health predictors within this population. One hundred and forty transfusion-dependent beta thalassemic subjects 8-18 years old in Mashhad, Iran, participated in this cross-sectional study. Anthropometric measures, dietary intake, bone-related biomarkers and bone densitometry, were assessed. The incidence of underweight and short stature was 33.6 and 41.4 %, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density was detected in the lumbar spine and femoral region in 82 and 52 % of subjects, respectively. Hypocalcemia and hypophosphatemia were seen in 22 and 18.2 %, whilst vitamin D deficiency was present in more than 85 % of thalassemic children and adolescents. The relationships between weight, height and other anthropometric indices, serum calcium and bone markers, intake of macronutrients, zinc and vitamin E with bone mineral density (BMD) and bone mineral content (BMC) in the lumbar spine and femoral area were positively related, indicating that better nutritional status were associated with higher BMD and BMC values. Puberty, gender and serum osteocalcin were negative predictors for BMD and BMC values, whereas age, weight and height were the positive predictors. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies. [ABSTRACT FROM AUTHOR]

Summary: In sickle cell disease, erythroid hyperplasia causes trabecular destruction leading to low bone density. This condition could be suspected by the radiomorphometric indices and your diagnosis becomes relevant in a multidisciplinary context of health care for sickle cell subjects, providing prognostics and contributing to determine adequate therapeutic and preventive actions. Introduction: The aim of this study was to assess the risk of low bone density in subjects with sickle cell disease (SCD) through analysis of panoramic radiographic exams by radiomorphometric indices. Methods: Seventy-eight Brazilian subjects with SCD took part in this study and were subdivided into four groups: (I) 31 SCD subjects aged under 40 years; (II) 13 SCD subjects aged 40 years or more; (III) 12 normal subjects aged under 40 years; and (IV) 22 normal subjects aged 40 years or more. In the panoramic radiographs, the mandibular cortical index (MCI) classification, increased spacing of the trabecular bone, panoramic mandibular index (PMI), and mental index (MI) were evaluated. Exact Fisher's test was used to compare age between the different groups. Descriptive analysis of the data was performed to evaluate the simple visual estimation of low bone density (increased bone trabecular space and MCI), and a one-way analysis of variance (Bonferroni criteria) was used to compare the means of the quantitative indices (PMI and MI). The significance level was p < 0.05. Results: In the MCI classification, C2 was more prevalent, especially in groups I and IV. Increased spacing of the trabecular bone was more frequent in groups I and II. MI did not show a statistically significant difference among the groups. PMI showed a statistically significant difference only between groups III and IV. Conclusions: The radiomorphometric indices applied in the present study can be used on panoramic radiographs to detect the presence of low bone density in SCD subjects. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis in the elderly has dangerous complications, the most important of which are bone fractures and reduced quality of life in the elderly. The present study was aimed at estimating the prevalence of osteoporosis in Iranian elderly using systematic review and meta-analysis. Methods: This search was conducted using authentic Persian and English keywords in national and international databases including Scientific Information Database, Magiran, IranDoc, PubMed, Scopus, Cochrane, Embase, and Web of Sciencewith no time limit until 20.06.2020. Heterogeneity of studies was assessed using I2 index. Data were analyzed using STATA Ver. 15 software. Results: In 30 studies with a sample size of 13,347 people, the prevalence of osteoporosis and low bone density in people over 60 years in Iran were 34% (95% CI: 27%, 42%) and 47% (95% CI: 41%, 53%), respectively. We also found that 34% of women and 41% of men over the age of 60 suffer from osteoporosis. Prevalence of osteoporosis was in lumbar bone 23% (95% CI: 20%, 26%), spine 25% (95% CI: 19%, 31%), hip 35% (95% CI: 7%, 62%), and femur 23% (95% CI: 15%, 31%). Prevalence of low bone density was in lumbar bone 41% (95% CI: 19%, 63%), spine 30% (95% CI: 15%, 46%), and femur 35% (95% CI: 21%, 48%). Conclusion: The prevalence of low bone density in people over 60 years is higher than the prevalence of osteoporosis in them. About one-third of Iranian elderly people suffer from osteoporosis, but about half of them have low bone density. [ABSTRACT FROM AUTHOR]

Paget's disease is a disorder of bone that results in the replacement of normal bone with highly vascularized, low density bone. The diminished bone quality associated with Paget's disease is a relative contraindication to the use of dental implants, as it interferes with achievement of osseointegration. There is no current literature on the success of dental implants in patients with Paget's disease. Furthermore, there is no current literature on dental implant success in patients with remissive Paget's disease or in bone that appears to be unaffected by the disease in patients with Paget's. This case report follows the treatment of a patient with a partially edentulous maxilla and mandible (ACP PDI Classification III) who presented with remissive Paget's disease. Definitive treatment included the placement of four endosseous implants used to retain full veneer crowns. Despite the radiographic appearance of adequate bone quality, upon surgical placement it was discovered that the quality of bone was poor, yet implant survival was achieved through careful surgical management and rigid splinting of some of the endosseous implants. [ABSTRACT FROM AUTHOR]

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: PurposePrior research has shown that women with either osteoporotic fracture or low bone density are at a decreased risk of breast cancer. Little prior work has evaluated whether women with breast cancer are at a decreased risk of osteoporotic fracture.: MethodsWe used data from the National Cancer Institute''s Surveillance Epidemiology and End Results (SEER)-Medicare program to study the risk of hip fracture among elderly female Medicare beneficiaries with and without histories of breast cancer. Using the SEER file, we identified elderly women survivors of stage 0, I, or II breast cancer (N = 5980) diagnosed between the ages of 55 and 64 years; using the Medicare 5% file, we identified elderly women without histories of cancer (N = 23,165) from SEER regions. Using Medicare claims from 1993 through 1998, we followed women for hospitalization for hip fracture or death until December 31, 1998.: ResultsWe found the rate ratio of hospitalization for hip fracture for breast cancer survivors relative to comparison patients was 0.63 (95% CI: 0.43–0.94) after adjusting for age, race, socioeconomic status, geographic location, cohort entry year, and medical comorbidity.: ConclusionWe conclude that survivors of early stage post-menopausal breast cancer are at significantly lower risk of hip fracture than women who do not have histories of breast cancer. [Copyright &y& Elsevier]

Background: Dual x-ray absorptiometry (DEXA) is widely used to identify persons at increased risk for osteoporotic fractures. It does not, per se, give us any diagnostic information that is necessary to determine the best therapeutic approach in an individual case.Objective: Identify conditions and tests that may impact on the diagnosis and the treatment of subjects with low bone densitometry scores.Subjects and Methods: We evaluated clinically, by history, physical examination and laboratory tests, 272 persons with low spinal and/or femoral bone absorptiometry for potential causes of osteoporosis.Results: We found that 25.3% of the patients had significant underlying conditions: 17.9% had subclinical vitamin D deficiency (osteomalacia), 6.7% had hypercalciuria and 0.7% had primary hyperparathyroidism.Conclusion: It is mandatory to go through a differential diagnosis in every case with absorptiometric data compatible with the diagnosis of osteoporosis. At the minimum, blood calcium and 25-hydroxyvitamin D and 24-hour urinary calcium excretion should be examined. This will allow the physician to determine the appropriate course of therapy in any individual patient who has abnormal DEXA findings. [ABSTRACT FROM AUTHOR]

To review the extant literature relating to bone health in the idiopathic inflammatory myopathies (IIM) including both adult and juvenile patients. A PubMed search® identified relevant studies from 1966 to 2020 in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts, and a third author was consulted in the case of disagreement. We identified 37 articles (3 review articles, 2 RCTs, 9 cross-sectional, 16 cohort and 7 case-control studies). The prevalence of osteopenia (n = 7) ranges from 7 to 75% and osteoporosis (n = 7) between 13% to 27%. The prevalence of vertebral fractures ranged from 11 to 75%. Systemic inflammation likely contributes to reduced bone mineral density (BMD) in children with IIM but data is currently lacking in adult patients. Association between with impaired BMD and Vitamin D or calcium intake and physical activity has not been demonstrated in IIM. There is no clear consensus regarding the impact of age, menopause or BMI on bone health. Gender, smoking status, disease activity and inflammatory markers are not obvious independent predictors of low BMD. Several studies have demonstrated that glucocorticoids are associated with an increased risk of low BMD. There are no specific guidelines relating to the management of bone health in adult and juvenile patients with IIM. Both adult and juvenile patients with IIM are at high risk of impaired bone health and fracture. The mechanisms behind this are likely multifactorial including systemic inflammation, glucocorticoid treatment, reduced mobility and impaired calcium/vitamin D homeostasis. There are a lack of guidelines and studies relating to the screening, prevention and treatment of impaired bone health in adult and juvenile patients with IIM. Future research is required to understand the complexity of bone health in IIM including to develop much needed disease-specific management recommendations. • Patients with IIM are at high risk of impaired bone health and fracture. • Possible mechanisms for this include systemic inflammation, glucocorticoid use, reduced mobility and impaired calcium/vitamin D homeostasis. • There are a lack of guidelines or studies relating to the screening, prevention and treatment of impaired bone health in IIM patients. [ABSTRACT FROM AUTHOR]