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Background: The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown.Purpose: To determine the effect of the use of systemic steroids for 2–6 weeks on BMD and BMC in pediatric patients.Methods: Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2–6 weeks and 25 age- and sexmatched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction.Results: Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose.Conclusion: The use of systemic steroids for 2–6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.

Objectives To evaluate the predictive value of volumetric bone mineral density (BMD) assessment of the lumbar spine derived from phantomless dual-energy CT (DECT)-based volumetric material decomposition as an indicator for the 2-year occurrence risk of osteoporosis-associated fractures. Methods L1 of 92 patients (46 men, 46 women; mean age, 64 years, range, 19–103 years) who had undergone third-generation dual-source DECT between 01/2016 and 12/2018 was retrospectively analyzed. For phantomless BMD assessment, dedicated DECT postprocessing software using material decomposition was applied. Digital files of all patients were sighted for 2 years following DECT to obtain the incidence of osteoporotic fractures. Receiver operating characteristic (ROC) analysis was used to calculate cut-off values and logistic regression models were used to determine associations of BMD, sex, and age with the occurrence of osteoporotic fractures. Results A DECT-derived BMD cut-off of 93.70 mg/cm3 yielded 85.45% sensitivity and 89.19% specificity for the prediction to sustain one or more osteoporosis-associated fractures within 2 years after BMD measurement. DECT-derived BMD was significantly associated with the occurrence of new fractures (odds ratio of 0.8710, 95% CI, 0.091–0.9375, p p Conclusions Retrospective DECT-based volumetric BMD assessment can accurately predict the 2-year risk to sustain an osteoporosis-associated fracture in at-risk patients without requiring a calibration phantom. Lower DECT-based BMD values are strongly associated with an increased risk to sustain fragility fractures. Key Points •Dual-energy CT–derived assessment of bone mineral density can identify patients at risk to sustain osteoporosis-associated fractures with a sensitivity of 85.45% and a specificity of 89.19%. •The DECT-derived BMD threshold for identification of at-risk patients lies above the American College of Radiology (ACR) QCT guidelines for the identification of osteoporosis (93.70 mg/cm3 vs 80 mg/cm3).

The aim of this study is to use tibial Hounsfield unit measurements from preoperative computed tomography scans of ankle fractures to predict delayed union and nonunion. We hypothesize that patients with lower Hounsfield unit averages, an indirect measure of lower bone mineral density, in the distal tibia are more likely to develop delayed union and nonunion complications after ankle fracture surgery. Patient data from January 2010 to January 2020 were retrospectively analyzed from 2 institutions. Exposure cases of delayed union or nonunion that had preoperative computed tomography were compared to 5 controls matched for sex, age, and classification. 3 measurements were taken from the tibia on axial computed tomography and averaged to create a summative measure for overall bone health. Statistical analysis was used to analyze the relationship between the groups. 19 exposure patients were compared to 95 control patients. There were 16 females and 3 males in the exposure group aged from 30 to 88 years. Average follow-up was 1.6 years. The average exposure and control Hounsfield measurements were 186 (161-210) and 258 (248-269), respectively. Significant differences were found for all measured averages. This is the first study to our knowledge relating preoperative tibial Hounsfield measurements to healing rates of ankle fractures. Measurements taken from any of the 3 sites or the average could be an indicator of overall bone health. Using this technique on preoperative imaging will help surgeons adjust their perioperative planning for patients at higher risk for delayed union and nonunion.

The main purpose was to describe the interference of gamma radiation emitted by 177Lu with simultaneous bone mineral density BMD measures for patients undergoing 177Lu-PSMA and 177Lu DOTATATE therapy. A cohort of 9 patients underwent 177Lu-PSMA therapy were randomly selected to speculate the activity in the abdominopelvic region. So that, SPECT/CT scan at 24 h was used with attenuation and scatter correction. The activities were derived from the delineated ROIs over the abdominopelvic zone showing a range of 34−274 MBq. Next, a water path was placed under spine phantom mimicking L1-L4 vertebrae and followed by consecutive DEXA scans made by Hologic 4500 W and GE-Lunar DPX-NT systems. Five scans were performed without/and with different Lu-177 activities 37, 185, 370 and 555 MBq under the same geometric conditions. The obtained BMD readings of L1-L4 by the Hologic device were 1.027, 1.024, 1.021, 1.013, and 1.006 g/cm2 with presence of 0, 37, 185, 370, and 555 MBq 177Lu activity, respectively. Whereas, in Lunar device, it was found as higher as 1.163, 1.121, 1.09, 1.072, and 1.043, respectively. There was no statistically significant difference between both devices (p value ≥ 0.05). The fluctuation ranges in the L1-L4 BMD readings at the presence of 37−555 MBq were 0.3%−2%, and 3.6%−10.3% for Hologic and Lunar systems, respectively. It was emphasized that gamma radiation emitted by 177Lu relatively influence DEXA scans and the yielded BMD measures. Postponing DEXA scans as early as 8 d after 177Lu-PMSA and 11 d after 177Lu-DOTATATE therapies is recommended to avoid the erroneous contribution of gamma radiation and provide precise bone assessment.

Background: Metabolic syndrome is closely related to cardiovascular disease, and the prevalence of metabolic syndrome in postmenopausal women is increasing rapidly. Objective: The purpose of this study is to investigate the association between the number of breastfed children and the risk factors for metabolic syndrome in postmenopausal women and to evaluate the association between metabolic syndrome and bone mineral density and body composition variables in postmenopausal women depending on the number of breastfed children. Methods: Data from KNHANES V-1 and 2 (2010-2011) were used, and a total of 939 PM women with 1 to 6 breastfed children aged 65-80 years participated in this study. We divided these women into three groups (group1 with 1-2, group2 with 3-4, group3 with 5-6) depending on the number of breastfed children. Result: In analysis of the associations between metabolic syndrome and its risk factors, high-density lipoprotein cholesterol was the most negatively strongly associated with group1 (OR=0.103 [0.047-0.225]), triglyceride showed the highest association with group2 (OR=7.760 [3.770-15.97]) and group3 (OR=7.668 [4.102-14.33]). The risk factors of metabolic syndrome except for high-density lipoprotein cholesterol and triglyceride was not associated with group1, while all risk factors of metabolic syndrome displayed a high association with group2 and group3. Conclusion: The findings of the present study suggest that the number of breastfed children is significantly associated with a greater number of risk factors of metabolic syndrome in postmenopausal women, and the association between metabolic syndrome and body composition variables may differ depending on the number of breastfed children.

We aimed to compare serum concentrations of sclerostin and DKK-1 in young (20-30 yrs, n = 25) and middle-aged (35-45 yrs, n = 25) premenopausal women and based on physical activity (PA) status. PA status was assessed by the International Physical Activity Questionnaire (low-moderate (≤ 2999 MET-min/week) and high (≥ 3000 MET-min/week). Serum sclerostin and DKK-1 levels were measured in fasting morning blood samples by ELISA. Areal bone mineral density (aBMD) was measured by DXA, and non-dominant tibia bone characteristics were assessed by pQCT. After adjusting for total body aBMD, middle-aged women had significantly (p0.001) higher (0.54 ± 0.01 ng/mL) serum sclerostin than young women (0.41 ± 0.01 ng/mL), and sclerostin was positively correlated with age (r

The aim of the study was to determine the effect of pregabalin as monotherapy on biochemical markers and bone mineral density. 40 patients diagnosed with neuropathic pain or fibromyalgia syndrome who were using pregabalin for at least 6 months and age and sex matched 40 healthy individuals were recruited for this cross-sectional study. Bone mineral density of both groups were measured by dual energy x ray absorbsiometry(DXA), bone biochemical markers, serum calcium, and vitamin D levels were investigated. Association between pregabalin use and bone biochemical markers, serum calcium, vitamin D levels were evaluated. The mean age of 40 patients (27 females, 13 males) was 40.6 ± 7.1 years and the mean age of 40 healthy individuals (27 females, 13 males) was 40.4 ± 7.3 years. The other demographic data were similar. There were no significant differences in lumbar and femur neck BMD scores between 2 groups. Also, there were no associations neither between pregabalin use and biochemical markers including serum calcium levels nor between pregabalin use and vitamin D levels. However, the patients who had been used pregabalin less than 24 months had low lumbar t and z scores than patients who had been used pregabalin more than 24 months. This effect was more prominent in male patients. Although no negative effect of pregabalin was found on bone metabolism in these group of patients, we have suggested that further prospective controlled studies with large sample size in different age groups could provide new data about the effects of pregabalin on bone metabolism. We suggest to investigate the bone metabolism especially in male patients on pregabalin treatment who had been used pregabalin treatment less than 24 months.

Bone provides structure to the vertebrate body that allows for movement and mechanical stimuli that enable and the proper development of neighboring organs. Bone morphology and density is also highly heritable. In humans, heritability of bone mineral density has been estimated to be 50-80%. However, genome wide association studies have so far explained only 25% of the variation in bone mineral density, suggesting that a substantial portion of the heritability of bone mineral density may be due to environmental factors. Here we explore the idea that the gut microbiome is a heritable environmental factor that contributes to bone morphology and density. The vertebrae skeleton has evolved over the past ~500 million years in the presence of commensal microbial communities. The composition of the commensal microbial communities has co-evolved with the hosts resulting in species-specific microbial populations associated with vertebrate phylogeny. Furthermore, a substantial portion of the gut microbiome is acquired through familial transfer. Recent studies suggest that the gut microbiome also influences postnatal development. Here we review studies from the past decade in mice that have shown that the presence of the gut microbiome can influence postnatal bone growth regulating bone morphology and density. These studies indicate that the presence of the gut microbiome may increase longitudinal bone growth and appositional bone growth, resulting differences cortical bone morphology in long bones. More surprising, however are recent studies showing that transfer of the gut microbiota among inbred mouse strains with distinct bone phenoytpes can alter postnatal development and adult bone morphology. Together these studies support the concept that the gut microbiome is a contributor to skeletal phenotype.

Background The purpose of this study was to compare initial fixation strength between various stemless and stemmed humeral components and to correlate implant fixation strength with bone mineral density (BMD). Methods Five humeral stem designs were investigated: Stemless-A (four hollow fins), Stemless-B (central body, three solid fins), Stemless-C (central screw, peripheral rim-fit), Short stem (50 mm), and Standard stem (130 mm). Fifty cadaveric human humerii were obtained and divided into five groups. BMD within the humeral head was determined for all samples. The mean BMD was similar between groups. The 25 samples with the lowest and highest BMDs were categorized as “Low” and “High,” respectively, with a BMD threshold of 0.35 g/cm2, creating BMD subgroups. After implantation, each sample underwent a standardized biomechanical testing protocol, with axial loading followed by torsional loading. Sensors attached to the specimen recorded micromotion throughout testing. Axial loading consisted of cyclic loading for 100 cycles at 3 peak forces (220, 520, and 820 N). Torsional loading consisted of 100 cycles of internal/external rotation at 0.1 Hz at 6 peak torques, or until failure (±2.5, 5, 7.5, 10, 12.5, and 15 Nm). Failure was defined as the torque at which any bone fracture, implant detachment from anchor/stem, or an excess of 50° internal/external rotation occurred. Groups and BMD subgroups were compared. Results At maximal axial loading, Stemless-B demonstrated greater micromotion (540 μm) than Stemless-C (192 μm) (P = .003). Stemless-B and Stemless-A (387 μm) also had greater micromotion than Short stem (118 μm, P Conclusion Stemless humeral implants should be used with caution in low-BMD settings ( Level of evidence Basic Science Study; Cadaveric Study

The primary purpose of this study was to determine prevalence of the Male Athlete Triad (MAT) conditions: low energy availability (EA), low bone mineral density (BMD), and low testosterone in male collegiate athletes from different sports. Participants included 44 collegiate male athletes (age, 20.4 ± 0.2 years; body mass index, 25.3 ± 1.3 kg/m2) from 7 sports (cross country, soccer, basketball, wrestling, track, golf, and baseball). Resting metabolic rate, 3-day food intake, 7-day exercise energy expenditure, body composition, and reproductive and metabolic hormones were assessed. Of the total participants, 15% had low EA, 0% had low BMD, 28% had low total testosterone (TT), and 80% had low calculated free testosterone (cFT). There were no significant correlations between EA, BMD, TT, and cFT. Insulin and sex hormone binding globulin (SHBG) were below and on the upper end of the reference range for healthy male adults, respectively. Insulin was negatively correlated with total (r = –0.330, p = 0.043) and lumbar spine BMD z-scores (r = –0.413, p = 0.010). Low TT and low cFT were the most prevalent MAT conditions among all athletes. Further research should investigate the relationship between insulin and SHBG and the role of these hormones in the MAT. Novelty: Assessment of energy availability alone is not sufficient to identify physiological disturbances in collegiate male athletes. Low total and/or free testosterone may be present in some collegiate male athletes, regardless of BMD status. Low insulin and high SHBG concentration may portray the presence of conditions of the MAT in male collegiate athletes.

Background: This study was performed to identify the incidence of screw in-type lateral anchor pull-out in patients older than 60 years who underwent rotator cuff repair for large to massive rotator cuff tears.Methods: This study reviewed 25 patients older than 60 years who were diagnosed with large to massive rotator cuff tear and underwent arthroscopic rotator cuff repair in our hospital from March 2017 to February 2021. Preoperative tear size (anterior to posterior, medial to lateral) was measured via preoperative magnetic resonance imaging (MRI), and the re-tear rate was evaluated at 3 months via MRI. All 25 patients underwent MRI scanning on postoperative day 1 and at 3 months after surgery. The change of lateral row anchor position was measured in axial views on MRI images. The change of anchor position was measured postoperative day 1 and 3 months after surgery by MRI and statistically compared according to bone mineral density (BMD), sex, and number of lateral anchors. Results: Two consecutive MRIs (postoperative day 1 and 3 months) in 25 patients were compared. Anchor pull-out occurred in six patients during 3 months (6.7%), and the mean pull-out length difference was 1.56 mm (range, 0.16–2.58). There was no significant difference in the number of pull-out anchors, degree of pull-out difference, or the re-tear rate by comparing BMD (A, BMD≤-2.5; B, BMD>-2.5), sex, or number of anchors used in each surgery (C, two anchors; D, three anchors) (p>0.05). Conclusions: Pull-out of screw in-type lateral anchors was observed in very few patients (6.7%), and the mean pull-out length difference was negligibly small (1.56 mm) in our study. The screw in-type lateral anchor seems to be a decent option without concern of anchor pull-out even in elderly patients (>60 yr).

The incidence of fractures is much higher in patients with chronic kidney disease, especially those on hemodialysis (HD). Denosumab is known to treat osteoporosis. However, no exact guideline exists for treatment with denosumab in patients, especially those with diabetes. This study analyzed the effect of denosumab in HD patients with or without diabetes.Dual-energy X-ray absorptiometry was performed in 89 HD patients: 42 were diagnosed with osteoporosis. 33 patients were treated with denosumab. An observational retrospective analysis was conducted in 25 HD patients whose follow-up biomarkers were measured at 6 months after denosumab treatment.Bone mineral density (BMD) of lumbar spine (LS) and femur neck (FN) were largely improved (+3.40% and 4.96%, respectively) 1 year after the treatment. The T-scores were also improved. Both bone turnover markers were significantly decreased 6 months after treatment; the levels of C-terminal telopeptide (CTX) and bone-specific alkaline phosphatase (bsALP) were decreased by -1.04 ± 1.24 ng/mL (p0.001) and -35.72 ± 36.07 IU/L (p0.001), respectively. The response was significantly different between the diabetes and non-diabetes group. The increase in LS BMD was significantly lower in the diabetes group than in the non-diabetes group (0.02 ± 0.03 vs. 0.07 ± 0.02, p = 0.02). Decrease in CTX, but not in bsALP, was also lower in the diabetes group compared to the non-diabetes group (-0.58 ± 0.70 vs. -1.55 ± 1.12, p = 0.03). Pretreatment with calcium and calcitriol prevented symptomatic hypocalcemia except in 1 case.Denosumab improved bone density and osteoclastic activity in HD patients, with a lower response in patients with diabetes.

Purpose The study sought to investigate the reliability of CT-derived Hounsfield unit (HU) measurements and ascertain the correlation between HU with qCT-derived bone mineral density (BMD) in cases of traumatic thoracolumbar fracture, based on native CT scans. Methods This study is a retrospective cross-sectional analysis of data sets from patients, which received native CT scans and bone mineral density measurements (qCT) of the same vertebral body. Two different CT scanner models were used. The inter-rater reliability of four rater, which measured HU in native CT scans, was calculated using intra class correlation coefficient for absolute agreement (ICC(3, 1)). For the correlation between HU and qCT values, respectively the prediction of qCT based on HU, linear regression was used. Bland-Altman plots were used for visual comparison of predicted and measured qCT values. Results In total 305 datasets were analyzed. CT scanner model were found to have no significant impact on HU (p=0.125). The inter-rater reliability for HU measurements from native CT scans was ICC(3, 1)=0.932 (CI95: 0.919 – 0.943, p Conclusions HU measurement shows very high inter-rater reliability. The HU values correlate closely with qCT BMD values. In summary, it seems that HU measurement is a suitable tool to readily and accurately assess bone quality without further scans or effort in cases of thoracolumbar spinal trauma.

Objectives In elite figure skaters, to determine if there was a difference in volumetric bone mineral density and bone strength between 1) figure skaters and population-based normative data, 2) single or pair skaters and ice dancers, and 3) the landing and takeoff legs. Design Cross-sectional. Methods Figure skaters had their non-dominant distal radius and bilateral tibia scanned using high-resolution peripheral quantitative computed tomography. Volumetric bone mineral density was determined at the total, cortical and trabecular compartments, and finite element analysis estimated bone strength. Normative data was used to compare the total bone mineral density of figure skaters to a population-based cohort. Independent t-tests compared differences between skating discipline, and paired t-tests compared skeletal parameters for the landing and takeoff leg. Results Twenty elite skaters (mean age 22 ± 6.2; female = 11, male = 9) completed scans. Compared with the general population, the mean percentile rank for skaters' total volumetric bone mineral density was below normal at the radius (27th percentile) and normal at the tibia (54th percentile). Single or pair skaters had more robust bone in the landing compared with their takeoff leg. Specifically, the landing leg had higher total bone mineral density (2.8%) and trabecular bone mineral density (6.5%), and superior bone strength (8.5%) than the takeoff leg (p Conclusions Volumetric bone mineral density and strength differences in figure skaters were discipline dependent. Side-to-side differences were observed in single and pair skaters where the landing leg is denser, larger and stronger than the takeoff leg.

Osteoporosis is a disease of great social importance. Its treatment is a complicated problem and is associated with low compliance of patients and a risk for adverse reactions. First-line drugs are bisphosphonates, which have been used in the clinical practice for over 15 years. During this period, there were accumulated the data on adverse events, the incidence of which was very low, or which were not detected at all during the studies on the efficacy and safety of bisphosphonates. Today, it is raised the question about which categories of patients should use bisphosphonate therapy, for how long the drugs of this group needed to be administered, is it possible to stop taking bisphosphonates for a time without increasing the risk of fractures. An algorithm for a long-term treatment of osteoporosis using bisphosphonates and principles of monitoring the effectiveness of therapy are presented. The article describes two clinical cases of ibandronic acid application for the prevention and treatment of postmenopausal osteoporosis with a good clinical effect. The data on changes in bone mineral density during the observation from 12 to 27 months, as well as the risk of fractures by FRAX system are provided. Clinical experience shows that the use of Bonviva in the combination treatment of postmenopausal osteoporosis contributes not only the progressive increase in bone mineral density at the lumbar spine and proximal femur, but also reduces the risk of vertebral fractures.

Relevance. Rheumatoid arthritis (RA) belongs to the most common inflammatory diseases of the joints, and the number of patients with this pathology increases everywhere, causing enormous medical, social and economic damage. An important role in the pathogenesis of RA is given to dysfunctions of the autonomic neural system (ANS), which condition is closely related to the bone metabolism and bone mineral density. The purpose and objectives: to assess the incidence of osteoporosis at different «vegetative passport» of RA patients, to explore the relationship of vegetative dysfunction (VD) signs with the nature of bone density. Material and methods. There were examined 173 patients with RA aged 18 to 79 years (average age — 46 years), among them 21 % males and 79 % females. The duration of disease manifestations was 10 years, variation of RA, seropositive for rheumatoid factor and citrulline antibodies, was detected in 3/4 of cases, extraarticular (systemic) form of the disease was diagnosed in 37 % of cases. Results. Osteoporosis develops in 2/3 of RA patients, and its pathogenic constructions are closely associated with the presence of VD, the severity of which is correlated with indicators of bone density, and those, in turn, — with parameters of variation pulsometry, activity and bone-destructive components of articular syndrome, depends on the vegetative type of patients (vagotonia is more typical for patients with osteoporosis, and for the rest of the patients — sympathotony). The imbalance of bone metabolism markers in RA patients enhances the existing violations of ANS, and the content of magnesemia has prognostic value in relation to VD. Its severity correlates with the severity of osteoporosis, wherein unfavorable prognostic indicators are blood calcium level more than 80 mg/l and alkaline phosphatase activity over 180 U/l. Conclusion. The development of osteoporosis is associated not only with features of the articular syndrome course and extraarticular RA symptoms, but also with the state of the ANS, which is involved in the pathogenetic constructions of bone density reduction and imbalance of bone metabolism markers. In the future, the active identification of VD will be useful for subsequent timely rehabilitation.

Традиційно мінеральна щільність кісткової тканини (МЩКТ) вважалась основним чинником, що визначає міцність кісткової тканини. Однак було показано, що міцність кістки й ризик перелому залежать від декількох параметрів: макрогеометрії кори кістки, МЩКТ, мікроархітектури губчастої кісткової тканини, мікропошкоджень, мінералізації та метаболізму кісткової тканини. Попередні дослідження виявили, що якість трабекулярної кісткової тканини (TBS) вірогідно знижується в чоловіків із віком, проте досі не вивчено показник TBS в українських чоловіків із переломами, зокрема, тіл хребців. Метою дослідження є визначення показників якості та МЩКТ у чоловіків із переломами тіл хребців. Обстежені 243 чоловіки віком 30–89 років, які були розділені на групи згідно з геронтологічною класифікацією: 30–44 роки (n = 46), 45–59 років (n = 83), 60–74 роки (n = 86), 75–89 років (n = 28). Основну групу становили 52 чоловіки з низькоенергетичними переломами тіл хребців в анамнезі (середній вік — 59,8 ± 13,7 року, середній зріст — 1,73 ± 6,98 м, середня маса тіла — 79,0 ± 14,9 кг), контрольну групу — 191 чоловік без переломів (середній вік — 57,4 ± 13,7 року, середній зріст — 1,74 ± 6,89 м, середня маса тіла — 76,5 ± 9,3 кг). Методом двох­енергетичної рентгенівської денситометрії (Prodigy, GE Lunar, Мадісон, США) досліджували МЩКТ на рівні поперекового відділу хребта (L1–L4), шийки стегнової кістки, усього скелета та ультрадистального відділу кісток передпліччя. Показник TBS (L1–L4) поперекового відділу хребта визначали за допомогою методики TBS iNsight (Med-Imaps, Pessac, Франція). У результаті проведеного дослідження встановлено, що показник TBS (L1–L4) був вірогідно нижчим в основній групі (30–44 роки — 1,083 ± 0,187, 45–59 років — 1,025 ± 0,248, 60–74 роки — 1,084 ± 0,170, 75–89 років — 0,951 ± 0,170) порівняно з контрольною групою (30–44 роки — 1,276 ± 0,121, 45–59 років — 1,226 ± 0,156, 60–74 роки — 1,150 ± 0,175, 75–89 років — 1,183 ± 0,174); F = 1,56; р < 0,001. МЩКТ на рівні поперекового відділу хребта (F = 1,52; р

Summary. The objective of the investigation — to study the changes of the vertebral bodies, intervertebral discs and their area in the lumbar spine in the reduction of bone mineral density (BMD) using magnetic resonance imaging (MRI). 81 patients underwent dual-energy X-ray densitometry (DEXA) and MRI of lumbar spine. Osteopenia was diagnosed in 33 patients (II group), osteoporosis — in 28 (group III), and control group consisted of 20 patients (I group) without signs of osteoporosis (according to DEXA). The average BMD parameters (g/cm2) in L1-L4 bodies were: in healthy people — 1.232 ± 0.060; in osteopenia — –1.032 ± 0.070; in osteoporosis — –0.757 ± ± 0.080. The average T-score in the control group was –1.27 ± 0.71; in the II group with osteopenia — –1.40 ± 0.11; in the III group with osteoporosis — –3.09 ± 1.73. The difference in BMD between I and II groups was 16.2 % (p, Цель исследования — изучение изменений тел позвонков, межпозвоночных дисков и их площадей в поясничном отделе позвоночника при уменьшении минеральной плотности костной ткани (МКП) с помощью магнитно-резонансной томографии (МРТ). 81 пациенту были проведены двухэнергетическая рентгеновская денситометрия (ДРД) и МРТ поясничного отдела позвоночника. Остеопения диагностирована у 33 больных (ІІ группа), остеопороз — у 28 (ІІІ группа), контрольную группу составили 20 пациентов (І группа) без признаков остеопороза (по данным ДРД). Cредние показатели МКП (г/см2) в телах L1-L4 составили: у здоровых — 1,232 ± 0,060; при остеопении — –1,032 ± 0,070; при остеопорозе — –0,757 ± 0,080. Средние показатели Т-критерия в группе сравнения составили –1,27 ± 0,71; во ІІ группе с остеопенией — –1,40 ± 011; в ІІІ группе с остеопорозом — –3,09 ± 1,73. Разница в МКП между I и II группами составила 16,2 % (р < 0,05), между I и III группами — 25 % (p < 0,01). При МРТ-морфометрии у больных с остеопенией и остеопорозом изменения тел позвонков поясничного отдела позвоночника сопровождались снижением средней высоты тел, незначительным снижением передней высоты тел позвонков; уменьшением индекса Барнетта — Нордина; выраженным увеличением средней высоты и площадей межпозвоночных дисков, более выраженными при остеопорозе. Установлено, что у больных с нарушением минеральной плотности костной ткани имеются и дегенеративные изменения межпозвоночных дисков, причем степень их дегенерации достоверно не отличается от группы контроля., Мета дослідження — вивчення змін тіл хребців, міжхребцевих дисків і їх площ у поперековому відділі хребта при зменшенні мінеральної щільності кісткової тканини (МЩК) за допомогою магнітно-резонансної томографії (МРТ). 81 пацієнту була проведена двохенергетична рентгенівська денситометрія (ДРД) і МРТ поперекового відділу хребта. Остеопенію діагностовано у 33 хворих (ІІ група), остеопороз — у 28 (ІІІ група), контрольну групу становили 20 пацієнтів (І група) без ознак порушення мінеральної щільності за даними ДРД. Середні показники МЩК (г/см2) у тілах L1-L4 становили: у здорових — 1,232 ± 0,060; при остеопенії — –1,032 ± 0,070; при остеопорозі — –0,757 ± 0,080. Середні показники Т-критерію в групі порівняння становили 1,27 ± 0,71; у ІІ групі з остеопенією — –1,40 ± 011; у ІІІ групі з остеопорозом — –3,09 ± 1,73. Різниця в МЩК між I і II групами становила 16,2 % (р < 0,05), між I і III групами — 25 % (p < 0,01). При МРТ-морфометрії у хворих на остеопенію та остеопороз зміни тіл хребців поперекового відділу хребта супрово­джувалися зниженням середньої висоти тіл, незначним зниженням передньої висоти тіл хребців; зменшенням індексу Барнетта — Нордіна; вираженим збільшенням середньої висоти та площ міжхребцевих дисків, більш вираженими при остеопорозі. Встановлено, що у хворих із порушенням мінеральної щільності кісткової тканини є і дегенеративні зміни міжхребцевих дисків, причому ступінь їх дегенерації вірогідно не відрізняється від групи контролю.

The article deals with the study of the quality index of trabecular bone tissue in patients with rheumatoid arthritis (RA). The study included 134 female patients with RA aged 31 to 78 years (mean age — 52.4 ± 12.7 years; height — 162.6 ± 6.4 cm; weight — 68.5 ± 13.8 kg; average duration of disease — 9.1 ± 7.6 years). In studying the effect of age on the structural and functional state of bone tissue, the examined patients were divided into five groups by decades. In order to evaluate the effect of glucocorticoids (GC) on the parameter of quality of trabecular bone and bone mineral density (BMD), the patients were divided into three groups: 1st group comprised 37 patients who did not take GC, 2nd group — 47 patients who had been prescribed with GC only at exacerbation, of the short, less than 6 months term, 3rd group — 50 patients who received systemically GC at a dose of ≥ 5 mg by prednisone for over 3 years. By the method of dual energy X-ray densitometry (Prodigy, GE Lunar, Madison, USA) we measured BMD at the lumbar spine, proximal femoral and radial bone. The index of the quality of trabecular bone tissue (TBS) of the lumbar spine was determined using the method of TBS iNsight (Med-Imaps, Pessac, France). It is established that starting from the age of 50 years, the indices of TBS L1-L4 (1.156 ± 0.140 vs. 1.318 ± 0.155 in women aged 30–39 years; t = 3.5; p = 0.001) and BMD of different parts of the skeleton in women with RA are significantly decreasing. GC administration is associated with the violation of the quality of the bone tissue. It was revealed that at the systemic administration of GC (in the 3rd group compared to the 1st group), rate of TBS L1-L4 (1.147 ± 0.168 vs 1.250 ± 0.135; t = –3.07; p = 0.003) was significantly lower, while significant changes in BMD parameters of the lumbar spine and femur hadn’t been detected. Over the year of follow-up the index TBS L1-L4 in 1st group decreased by 1.4 %, in 3rd group — by 5.8 %. Thus, the definition of TBS L1-L4 is a technique that can assess the impact of GC on bone tissue and dynamics of its loss as a result of treatment.

BACKGROUND: We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B. METHODS: A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study. RESULTS: Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034). CONCLUSION: Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.

Recent studies have demonstrated the importance of bone as an endocrine organ that produces biologically active substances, which regulate both local bone metabolism and metabolic functions throughout the body. In the process of bone remodeling (formation/destruction), the active cells secrete specific biomarkers that help detect osteometabolic dysfunction. Among bone hormones, osteocalcin plays an important role as a coordinator of bone modeling processes, energy homeostasis, metabolism of glucose, lipids and minerals. Osteocalcin is a structural protein of the bone matrix, which is synthesized by osteoblasts and enters the bloodstream in the process of bone resorption. The level of osteocalcin in the serum is used as a specific marker of bone formation. Osteocalcin promotes pancreatic β-cell proliferation and insulin secretion, and also affects the insulin sensitivity of peripheral tissues. The inverse association of glycemia with the level of osteocalcin was revealed. Patients with type 2 diabetes mellitus usually have normal or even slightly elevated bone mineral density compared to age-appropriate controls. Decreased bone quality and increased risk of fractures are associated with changes in bone microarchitecture and local humoral environment. An imbalance in osteoblast/osteoclast activity may be due to oxidative stress and the accumulation of glycosylation end products, which contributes to chronic inflammation and bone resorbtion in patients with diabetes. It is shown that the level of osteocalcin in the blood serum is significantly reduced compared to healthy controls, both in patients with type 1 diabetes mellitus and, especially, in type 2 diabetes mellitus. Given the importance of developing new approaches to the diagnosis and correction of metabolic disorders in diabetic patients, the study of the influence of bone hormones on hormonal and metabolic parameters and bone status, including the risk of fractures, remains relevant in modern diabetology., Дослідження останнього часу продемонстрували значення кістки як ендокринного органа, що продукує біологічно активні речовини, які регулюють як місцевий кістковий метаболізм, так і метаболічні функції у всьому організмі. Під час кісткового ремоделювання (формування/руйнування) активні клітини виділяють специфічні біомаркери, які допомагають виявляти остеометаболічну дисфункцію. Серед гормонів кісткової тканини важлива роль належить остеокальцину як координатору процесів кісткового моделювання, енергетичного гомеостазу, метаболізму глюкози, ліпідів та мінеральних речовин. Остеокальцин — структурний білок кісткового матриксу, що синтезується остеобластами і надходить до кровотоку під час резорб­ції кісткової тканини. Рівень остеокальцину в сироватці крові використовується як специфічний маркер формування кісткової тканини. Остеокальцин сприяє проліферації β-клітин підшлункової залози та секреції інсуліну, а також впливає на інсуліночутливість периферичних тканин. Виявлено обернену асоціацію глікемії з рівнем остеокальцину. У хворих на цукровий діабет 2-го типу (ЦД2) зазвичай спостерігається нормальна або навіть трохи підвищена мінеральна щільність кісткової тканини порівняно з контролем відповідного віку. Зниження якості кісток та підвищений ризик переломів пов’язують зі змінами кісткової мікроархітектури та місцевого гуморального середовища. Дисбаланс активності остеобластів/остеокластів може бути зумовлений окиснювальним стресом та накопиченням кінцевих продуктів глікозилювання, що сприяє хронічному запаленню та резорбції кісток у пацієнтів із діабетом. Показано, що рівень остеокальцину в сироватці крові значно знижується порівняно зі здоровим контролем як у хворих на ЦД1, так і, особливо сильно, при ЦД2. З урахуванням важливості розробки нових підходів до діагностики та корекції метаболічних порушень у хворих на ЦД вивчення впливу кісткових гормонів на гормонально-метаболічні показники та стан кісткової тканини, включаючи ризик переломів, зберігає актуальність у сучасній діабетології.

Tumor-induced osteomalacia TIO is a rare paraneoplastic syndrome caused by excessive production of fibroblast growth factor 23 FGF23 by a tumor. Previous studies have revealed generalized mineralization defects and low areal bone mineral density aBMD in TIO. However, data on the bone microarchitecture in TIO are limited. In this study, we evaluated the microarchitecture in the peripheral distal radius and tibia and axial lumbar spine skeleton using high-resolution peripheral quantitative computed tomography HR-pQCT and trabecular bone score TBS and investigated related factors in a large cohort of Chinese patients with TIO. A total of 186 patients with TIO who had undergone dual-energy X-ray absorptiometry DXA or HR-pQCT scans were enrolled. Compared with age-, sex- and BMI-matched healthy controls, TIO patients n=113 had lower vBMD, damaged microstructure and reduced bone strength in the peripheral skeleton, especially at the tibia. The average TBS obtained from 173 patients was 1.15 ± 0.16. The proportion of patients with abnormal TBS

Infancy is a period of rapid bone growth and mineral accretion; nonetheless, reference data remain scarce for this age group. The purpose of this report is to generate reference data for bone mass in breastfed vitamin D replete infants and investigate patterns of bone mineral accretion and sex differences. This is a secondary analysis from a double-blinded randomized controlled trial (NCT00381914). Healthy term breastfed (exclusively or mixed) infants were randomized to different doses of oral vitamin D supplementation (400-1600 IU/d) and followed prospectively from 1 to 12 mo. Plasma 25-hydroxyvitamin D (LC-MS/MS), bone mineral content (BMC; whole body (WB) and lumbar spine (LS)) and bone mineral density (BMD; LS) were measured at 1, 3, 6, 9, and 12 mo by dual-energy x-ray absorptiometry (Hologic Discovery 4500A) with no effect of supplementation on bone outcomes. For the purpose of this analysis, 63 infants with adequate plasma 25-hydroxyvitamin D ≥ 50 nmol/L at baseline, were included. Differences over time and between sexes were tested using mixed model repeated measures ANOVA. Infants (31 males, 32 females) were 39.5 ± 1.1 wk gestational age at birth and appropriate for gestational age. WB BMC, LS BMC, and LS BMD increased by 143.2%, 116.8%, and 31.1% respectively across infancy. WB BMC was higher (4.2% - 9.4%; p = 0.03) in males than in females across the study. After adjusting WB BMC for weight, length or head BMC, sex differences were not evident. LS BMC and LS BMD did not vary by sex. LS BMD growth charts for both sexes combined, were generated using LMS chartmaker. WB BMC more than doubles during the first year of life confirming the importance of skeletal growth and the need for age-specific reference data in infancy. Sex differences in BMC, if any, are mostly driven by differences in body size.

Objective Predominance of bone loss in cortical sites with relative preservation of trabecular bone, even in postmenopausal women, has been described in primary hyperparathyroidism (PHPT). The aim of this study was to evaluate bone microarchitectural differences using dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS), and DXA-based 3-dimensional (3D) modeling (3D-DXA) between postmenopausal women diagnosed with PHPT (PM-PHPT) and healthy postmenopausal controls. Methods This retrospective study included 44 women with PM-PHPT (9 of whom had fractures) and 48 healthy women matched by age, body mass index, and years since menopause treated at Hospital Universitario Fundacion Jimenez Diaz between 2008 and 2017. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck, total hip (TH), and 1/3 radius was assessed using DXA, and trabecular volumetric BMD (vBMD), cortical vBMD, integral vBMD, cortical thickness, and cortical surface BMD at TH were assessed using a 3D-DXA software and TBS at LS. Results The mean adjusted BMD values at LS, the femoral neck, and TH; TBS at LS; and TH 3D-DXA parameters (trabecular vBMD, integral vBMD, cortical thickness, and cortical surface BMD) were significantly reduced in women with PM-PHPT compared with those in the controls. However, differences in mean cortical vBMD were not statistically significant (P = .078). There were no significant differences in mean BMD, TBS, or the 3D-DXA parameters between patients with fractures and those without fractures. The 25-hydroxyvitamin D level appeared to be associated with TBS but not with DXA and 3D-DXA measurements. Conclusion PM-PHPT has significant involvement of the trabecular and cortical compartments of the bone, as determined by DXA, TBS, and 3D-DXA.

Introduction Conventional exercises could not prevent the deterioration of astronaut's bone and muscle effectively during space flight. On the ground, stretching is widely used to improve the joint range of motion (ROM) and muscle performance. However, study on how stretching affected bone mass and bone quality was rarely reported and the animal stretching modes were not ideal. Therefore, the aim of this study was to develop a device that stretching the hindlimb of rats to study the effects of stretching on bone in hindlimb unloading rats. Methods The ankle joint angel of conscious rat was kept at 30° for periodical stretching by this device. 32 Sprague Dawley rats were randomly divided into 4 groups (n = 8, each): control group (CON); CON plus stretching group (CONS); tail-suspension group (TS); TS plus stretching group (TSS). On the 29th day of the experiment, the bone mineral density (BMD) and trabecular microstructure were analyzed by μCT, the mechanical properties of tibia were determined by three-point bending test and the muscle performance was measured by multi-channel physiological signal tester. Results The data showed that the muscle strength and wet weight in TSS group were significantly higher than TS group. After stretching, the BMD, trabecular microstructure and mechanical properties of tibia in TSS group were also significantly better than TS group. In addition, these results of bone showed no significant difference between TSS group and CON group. Conclusions This device we developed could quantitatively stretch the hindlimb of rat and prevent the bone and muscle degeneration induced by tail-suspension. Our results suggested that stretching could be a useful exercise mode to keep bone and muscle healthy for astronauts or people who could not do conventional exercise.

Background/purpose Nasal obstruction leads to oral breathing and consequently hypoxia. The purpose of this study was to determine the influence of hypoxia on inflammatory response and the effect on alveolar bone development in a rat model in which mouth breathing was induced by nasal obstruction. Materials and methods Unilateral nasal obstruction was performed by injecting a Merocel sponge into the nasal cavity of 8-week-old Sprague Dawley (SD) rats. After 3 and 6 weeks of nasal obstruction, rats were sacrificed, the organs were weighed, and the changes in mandibular bone quality were examined by micro-computed tomography (μ-CT). The stereomicroscope was used for the morphological analysis of alveolar bone loss in response to nasal obstruction. Hematoxylin and Eosin (H&E) and immunohistochemical staining were employed to examine inflammation and bone remodeling induced by hypoxia. Results Nasal obstruction led to a delay in overall growth and organ development. The bone mineral density (BMD) and bone volume/total volume (BV/TV) of the mandible were reduced due to nasal obstruction, and the loss of the alveolar bone was confirmed morphologically. Our nasal obstruction method was observed to be successful in inducing hypoxia along with an increase in hypoxia-inducible factor 1-alpha (HIF-α). Oral hypoxia induced by nasal obstruction increased inflammatory response, and increased expression of receptor activator of nuclear factor kappa-Β ligand (RANKL) led to bone destruction. Conclusion This study demonstrated that nasal obstruction induced mouth breathing led to hypoxia in a rat model. Under hypoxic conditions, an increase in osteoclast differentiation induced by activation of the inflammatory pathway causes destructive changes in the alveolar bone.

Lung volume reduction surgery continues to have a high morbidity despite National Emphysema Treatment Trial selection criteria. This study evaluated the association between analytic morphomics on chest computed tomography scans and outcomes after lung volume reduction surgery. In a retrospective review of 85 lung volume reduction surgery patients from 1998-2013, dorsal muscle group area, subcutaneous and visceral fat area, and bone mineral density were assessed using analytic morphomics. Lung density was divided into five levels of increasing density (Lung density 1, emphysema; 2, normal lung; 4-5, scarring). Outcomes including survival, hospital length of stay, readmission at 30 days, and pulmonary complications were analyzed using univariate and multivariable techniques. Pulmonary complications developed in 27.1% (23/85). Mortality at 90 days was 9.4% (8/85). On multivariable analysis, lower bone mineral density (Odds ratio 0.61; 95% confidence interval 0.39-0.95) was associated with decreased survival, longer length of stay (0.83; 0.77-0.89), and readmissions (0.39; 0.15-1.00). Higher lung density 5:lung density 2 volume (1.84; 1.05-3.23), possibly due to scarring, was associated with pulmonary complications and longer length of stay (1.32; 1.23-1.41) while lower subcutaneous fat area:height was associated with readmissions which may reflect decreased metabolic reserve (0.35; 0.13-0.93). Patients with signs of frailty including lower bone mineral density may be at increased risk of adverse outcomes including decreased survival after lung volume reduction surgery. The results of this hypothesis-generating study will need to be confirmed in larger, multicenter trials to determine whether analytic morphomics can improve risk stratification and patient selection.

Background/Aim. Skeletal muscles and bones are essential tissues that, in addition to supporting the body, are the primary site of postprandial glucose intake, which is significantly associated with insulin resistance. The aim of this study was to determine the effect of insulin resistance on bone mineral density (BMD) and fracture risk and re-evaluate the relationship between muscle properties and BMD and insulin resistance in postmenopausal women in Serbia. Methods. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated in postmenopausal women who were divided into two groups. The ?cut-off? value of insulin resistance for the group with ?Low HOMA-IR? was < 2, and for ?High HOMA-IR? > 2. Fat mass (FM), lean mass (LM), and BMD were measured on the hip and spine using a densitometer with dual-energy X-ray absorptiometry. Results. FM and LM had an evident impact on BMD. The decrease in LM and fat buildup was associated with a higher incidence of insulin resistance. A positive correlation was confirmed between HOMA-IR and BMD on the spine and hip, but there was no correlation between insulin resistance and fracture risk. Conclusion. LM and FM have significant effects on BMD. The association between LM, FM, BMD and the onset of insulin resistance in postmenopausal women is confirmed. However, women with higher insulin resistance levels and higher BMD do not have a lower fracture risk.

OBJECTIVE To investigate influences of spinopelvic parameters, such as lumbar lordosis (LL) angles, pelvic incidence, sacral slope, pelvic tilt, and sagittal vertical axis, on development of the proximal junctional failure fracture type after posterior instrumentation. METHODS This retrospective 1:3 matched case-control cohort study included 24 patients who developed proximal instrumented fracture in the study group and 72 patients without proximal junctional failure in the control group. Weighted Charlson Comorbidity Index and bone mineral density with T-score were recorded. In addition to spinopelvic parameters, proximal local kyphosis (PLK), which refers to a kyphosis angle between the upper end plate of upper instrumented vertebra plus 1 level and the lower end plate of upper instrumented vertebra; pelvic incidence-LL mismatch; and spinopelvic realignment score were calculated. RESULTS More comorbidities (Charlson Comorbidity Index, P = 0.002) and poorer bone density (T-score, P = 0.001) were noted in the study group. Before surgery, the study group had significantly lower LL (P = 0.046) and sacral slope (P = 0.043) and significantly higher PLK (P < 0.001) and pelvic tilt (P = 0.044) than the control group. Postoperatively, the study group had significantly higher PLK (P < 0.001) and lower LL (P = 0.031) than the control group; the degree of pelvic incidence-LL mismatch (P = 0.007) remained significantly higher in the study group. Preoperative (P = 0.026) and postoperative (P = 0.045) spinopelvic realignment scores was worse in the study group. Multivariate analysis revealed that postoperative PLK was the most significant radiographic factor to predict proximal instrumented fracture (P = 0.002, odds ratio 1.140, 95% confidence interval). CONCLUSIONS In our experience, appropriate LL and lower PLK should be obtained at surgery to prevent development of instrumented fracture.

After kidney transplantation, mineral and bone disorders are associated with higher risk of fractures and consequent morbidity and mortality. Disorders of calcium and phosphorus, vitamin D deficiency, and hyperparathyroidism are also common. The epidemiology of bone disease has evolved over the past several decades due to changes in immunosuppressive regimens, mainly glucocorticoid minimization or avoidance. The assessment of bone disease in kidney transplant recipients relies on risk factor recognition and bone mineral density assessment. Several drugs have been trialed for the treatment of post-transplant mineral and bone disorders. This review will focus on the epidemiology, effect, and treatment of metabolic and skeletal derangements in the transplant recipient.

Background Distal radius fractures are often the first fractures experienced by adults with osteoporosis, and such fractures provide an opportunity for treatment to prevent a domino effect of future fractures. Most of these fractures result from falls, which may be related to the individual's limb muscle mass, strength, and exercise capacity. Active vitamin D3 positively affects muscle and bone mass. However, the effect of a bone resorption inhibitor is unknown. This study aimed to determine the effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mass, limb muscle mass, and exercise capacity of osteoporotic patients with distal radius fractures and to identify the preventive effects against future fractures. Methods Participants were postmenopausal women(n = 99) with distal radius fractures who visited the orthopedics outpatient department in a city general hospital from April 2015 to October 2017. Bone mass, limb muscle mass, skeletal muscle mass index, and muscle strength (grip strength and quadriceps muscle strength), walking speed, 2-step results, and timed up and go tests results were evaluated before and after 1 year of treatment. The instances of fall recurrence and refracture were investigated using a questionnaire. Results Eighty-five patients completed follow-up assessments for 1 year. After treatment, bone mass and bone mineral density were significantly improved in the lumbar spine and total proximal femur compared to before treatment. Furthermore, skeletal muscle mass index, grip strength on the unaffected side, quadriceps muscle strength, walking speed and 2-step test results after 1 year of treatment were significantly improved. Nineteen and 4 patients experienced fall recurrence and refracture, respectively. Conclusions Eldecalcitol alone or a bone resorption inhibitor with eldecalcitol improved bone mass and bone mineral density, and maintained skeletal muscle mass index, muscle strength, and exercise capacity of osteoporotic patients with distal radius fractures.

Background The relationship between serum creatinine (CR) and osteoporosis under normal renal function and the possible mediating effects mediated by physical activity (PA) are largely unknown. Methods A total of 4,137 elderly Chinese subjects were recruited. Three models including different covariates were established. Correlation analysis and multiple linear regression analysis were used to evaluate the relationship between CR and bone mineral density (BMD) and also under different PA pattern. Logistic regression was used to investigate the interaction between CR*PA with osteoporosis. PA was used as a moderating variable to investigate the relationship between CR and BMD. Results As we expected, the association between CR and BMD remained significant after adjusting covariates in all models. The relationship between CR and BMD showed changeable pattern in case of different physical activity. Specially, the moderating effects of PA on serum creatinine and BMD were significant for all models only in the case of medium physical activity (PA3). Conclusions In Chinese elderly under normal renal function, serum CR is positively correlated with BMD, and medium physical activity has mediation effect on such correlation.

OBJECTIVE The aim of this study was to compare the ability of 1) CT-derived bone lesion quality (classification of vertebral bone metastases [BM]) and 2) computed CT-measured volumetric bone mineral density (vBMD) for evaluating the strength and stiffness of cadaver vertebrae from donors with metastatic spinal disease. METHODS Forty-five thoracic and lumbar vertebrae were obtained from cadaver spines of 11 donors with breast, esophageal, kidney, lung, or prostate cancer. Each vertebra was imaged using microCT (21.4 μm), vBMD, and bone volume to total volume were computed, and compressive strength and stiffness experimentally measured. The microCT images were reconstructed at 1-mm voxel size to simulate axial and sagittal clinical CT images. Five expert clinicians blindly classified the images according to bone lesion quality (osteolytic, osteoblastic, mixed, or healthy). Fleiss’ kappa test was used to test agreement among 5 clinical raters for classifying bone lesion quality. Kruskal-Wallis ANOVA was used to test the difference in vertebral strength and stiffness based on bone lesion quality. Multivariable regression analysis was used to test the independent contribution of bone lesion quality, computed vBMD, age, gender, and race for predicting vertebral strength and stiffness. RESULTS A low interrater agreement was found for bone lesion quality (κ = 0.19). Although the osteoblastic vertebrae showed significantly higher strength than osteolytic vertebrae (p = 0.0148), the multivariable analysis showed that bone lesion quality explained 19% of the variability in vertebral strength and 13% in vertebral stiffness. The computed vBMD explained 75% of vertebral strength (p < 0.0001) and 48% of stiffness (p < 0.0001) variability. The type of BM affected vBMD-based estimates of vertebral strength, explaining 75% of strength variability in osteoblastic vertebrae (R2 = 0.75, p < 0.0001) but only 41% in vertebrae with mixed bone metastasis (R2 = 0.41, p = 0.0168), and 39% in osteolytic vertebrae (R2 = 0.39, p = 0.0381). For vertebral stiffness, vBMD was only associated with that of osteoblastic vertebrae (R2 = 0.44, p = 0.0024). Age and race inconsistently affected the model’s strength and stiffness predictions. CONCLUSIONS Pathologic vertebral fracture occurs when the metastatic lesion degrades vertebral strength, rendering it unable to carry daily loads. This study demonstrated the limitation of qualitative clinical classification of bone lesion quality for predicting pathologic vertebral strength and stiffness. Computed CT-derived vBMD more reliably estimated vertebral strength and stiffness. Replacing the qualitative clinical classification with computed vBMD estimates may improve the prediction of vertebral fracture risk.

Aims We aimed to explore the relationship between total BMD and prevalent fractures and the risk of CVD in a female population in the United States (US). Methods and Results We undertook cross-sectional analyses of a female population participating in the US National Health and Nutrition Examination Survey (NHANES). Generalized linear models and restricted cubic spline curves were used to examine the association between total BMD and CVD. Subgroup analyses were also undertaken. A total of 13707 women were enrolled. The restricted cubic spline curve revealed a linear and negative association between total BMD and CVD. The inflection point for the curve was identified at total BMD = 1.085 g/cm2. A negative relationship between total BMD and the prevalence of individual CVDs (angina and stroke) was noted (P Conclusions We revealed a reduced prevalence of CVD associated with increased total BMD in a female population in the US. CVD risk decreased significantly if total BMD >1.085 g/cm2. Additionally, fracture-free individuals had much reduced odds of developing CVD.

Background:Tenofovir disoproxil fumarate (TDF) is included in first-line antiretroviral treatment (ART) for adolescents living with HIV (ALWH). Associated toxicities remain a concern. Objective:We evaluated bone and renal safety outcomes in virologically suppressed South African ALWH after switching to TDF. Method:We recruited virally suppressed (< 100 copies/mL) adolescents, aged 15–20 years, who switched from an abacavir (ABC)-based to a TDF-based efavirenz regimen. Bone mass and renal function were assessed at Week 0 and at Week 24 after the switch to TDF using dual-energy X-ray absorptiometry (DXA) and serum renal markers. A change in the lumbar spine (LS) and the whole-body less head (WBLH) bone mineral density (BMD) Z-scores and the estimated glomerular filtration rate (eGFR) between the two measures were compared (pairedt-tests) and stratified by sex. Results:Fifty participants (48% male), with a median duration of prior ART of 11.4 years, were enrolled. Among 47 participants with 24-week DXA results, 15 (32%) had either no change or a decreased LS-BMD after the switch, with a mean change of –1.6%. Overall, more female participants experienced this outcome: 58% versus 4%,P< 0.0001. The mean change (standard deviation) in the LS-Z-score was –0.03 (0.25) and in the WBLH-Z-score was 0.02 (0.24). A decrease in the eGFR from 132.2 to 120.4 was observed (P= 0.0003); however, the levels remained clinically acceptable. Conclusion:South African ALWH switching from abacavir to TDF-based ART experienced statistically significant decreases in eGFR but not in LS and WBLH BMD. Female ALWH were more likely to experience a decrease in LS-BMD and may require closer monitoring.

Objective: The aim was to describe the anthropometry, bone mineral content (BMC), bone mineral density (BMD), dietary calcium intake and 25(OH)D3 levels in 11- and 12-year-old children in a peri-urban area. Design: A cross-sectional, descriptive study in the quantitative domain was undertaken. Setting: Bronkhorstspruit, Gauteng, South Africa. Subjects: Children, conveniently selected, were assessed in two groups. The first group comprised 70 children. From the 70 children, 20 children were conveniently selected to form a sub-sample (n = 20). Outcome measures: Anthropometric data (weight, height) and dietary data (three quantified /multi-pass 24-hour recalls). Children in the sub-sample additionally underwent body composition assessment (dual-energy X-ray absorptiometry; DXA scan) and a finger prick for 25(OH)D3. Results: BMI and body composition data (body fat mass and lean fat mass) showed that the girls exceeded the boys in all measurements. The girls had a non-significantly higher BMD and BMC than the boys. The mean and median values for 25(OH)D3 were lower than the reference range values. Dietary intake results showed that the children had a sufficient macronutrient intake, but a deficient intake of calcium, phosphate and vitamin D. The sub-sample had a mean vitamin D intake of 3.2 mcg. Conclusion: The girls exceeded the boys in all the anthropometric and body composition measurements. The calcium and vitamin D intake of the children were of concern. There were no significant differences or relationships in the bone measurements and vitamin D status between the boys and girls.

Background Inhaled corticosteroids (ICS) are a safe treatment for asthma. However, at higher doses, ICS use has been reported to inhibit adrenocortical function. Objective This study aimed to evaluate the effect of ICS on bone mineral density (BMD) in adult patients with asthma. Methods Ultrasonic bone densitometry was performed in 40 patients (14 men, 26 women, mean age 61.2 years, mean duration of asthma 6.19 years) who were receiving ICS for asthma, and the whole bone density, thickness of cortical bone, and density of cancellous bone of the radius was measured. The age-matched mean was set as 100%. Lifetime cumulative dose of ICS was calculated using all past prescriptions. Results No significant correlations were observed between lifetime cumulative ICS dose and whole bone density (r² = 0.011), cortical bone thickness (r² = 0.022), and cancellous bone density (r² = 0.004). No significant differences were observed between lower and higher lifetime cumulative ICS dose among these BMD parameters (104% vs 97%, 103% vs 99%, and 106% vs 91%, respectively). No significant correlations or differences in lifetime cumulative ICS dose were observed by asthma severity, asthma duration, and pulmonary function. Also, serum markers of bone metabolism showed no significant correlations or differences with lifetime cumulative ICS dose. Conclusions In the entire study population, long-term ICS use was safe and was not associated with an increased risk of osteoporosis.

Background: The currently available bone turnover markers are mostly derived from osteoblasts or osteoclasts. Protein markers derived from osteocytes, the most abundant bone cells that can regulate bone turnover activities by other cells, are less explored. Objective: This study aimed to compare the circulating markers of osteocytes and calcium homeostasis between Malaysian postmenopausal women with and without osteoporosis. Method: Postmenopausal women with (n=20) or without osteoporosis (n=20) as determined by dual- energy X-ray absorptiometry were randomly drawn from a bone health cohort. Their fasting blood was collected and assayed by a multiplex immunoassay panel. Results: The results showed that osteoprotegerin and sclerostin levels were significantly lower among postmenopausal women with osteoporosis than the normal control. No significant differences in other markers were observed between the two groups. Sclerostin level correlated positively with spine Bone Mineral Density (BMD), while 25-hydroxyvitamin D correlated negatively with hip BMD in the control group. No significant correlation was observed between other markers with spine or hip BMD. Conclusion: These data provide an insight into the possible roles of osteocyte markers, especially osteoprotegerin and sclerostin, in classifying subjects with osteoporosis. However, the lack of association between these markers and BMD indicates that osteoporosis is a complex and multifactorial condition.

Study Design: Cross-sectional study using radiological measurements.Purpose: To analyze the relationship between type 2 diabetes mellitus (DM) and bone mineral density (BMD) in postmenopausal women and to assess risk factors of osteoporotic vertebral compression fracture (OVCF) in postmenopausal diabetic women.Overview of Literature: Type 2 DM has negative effects on the quality of bone. Patients with type 2 DM have increased risk of hip and other fractures, but their vertebral fracture risk is controversial. There is a positive correlation between body mass index (BMI) and BMD. At the same time, obesity is the most important risk factor for type 2 DM.Methods: Consecutive patients whose BMD had been checked using dual-energy X-ray absorptiometry at Gwangmyung Sungae Hospital were recruited. Patients were divided into two groups according to the presence of type 2 DM. Risk factors of OVCF including age, BMI, current smoking status, current alcohol consumption, and presence of osteoporosis were analyzed separately in the type 2 DM group and control group.Results: A total of 1,130 patients were enrolled in this study. The mean age was 63.2 years. BMI was positively correlated with lumbar BMD in the control group (r =0.284) and in the diabetic group (r =0.302). In subgroup analysis, BMI and age were significant risk factors of OVCF in the type 2 DM group. In multiple linear regression analysis, type 2 DM (β =0.035; 95% confidence interval [CI], 0.005–0.065; p =0.024) and BMI (β =0.015; 95% CI, 0.012–0.018; p

Children with thalassemia major (TM) are prone to growth failure and micronutrient deficiency. Thus, this study aimed to evaluate nutritional status, anthropometrics, and bone mineralization defects in patients with regular blood transfusion.Data obtained were analyzed by evaluating laboratory tests, anthropometric measures, and bone mineral density.This study included 29 patients (62% male and 38% female) with a mean age of 12.26±4.74 years, mean pre-transfusion hemoglobin of 8.64±1.01 g/dL, and mean serum ferritin of 1158.6±556.8 ng/ mL. Vitamin D (72.4%), selenium (72.4%), and folate (37.9%) deficiencies were most frequent. Hypocalcemia was observed in 17.2%, hypomagnesemia in 3.5%, and decreased ceruloplasmin in 10.3% of patients. Folate was higher between 2 and 6 years old (p=0.028). Ceruloplasmin was higher between 6 and 10 years old (p=0.018). Selenium was significantly higher in patients with a ferritin of ≥1,500 (p=0.008). No significant ferritin-related differences were found in other micronutrients (p0.05). Body mass index (BMI) were5 percentile (p) in 31% of patient, whereas none was95 p. Height in 24.5% and weight in 20.7% of patients were3 p, whereas none with97 p. BMI of patients aged 10-18 years was significantly higher (p=0.001). Anthropometric percentiles did not significantly differ in the mean serum ferritin and micronutrient levels. Hypoparathyroidism was observed in 13.8% and hypothyroidism in 3.5% of patients. Low bone density was detected in 14.8% (2 osteopenic and 2 osteoporotic) of patients. Bone mineral density did not significantly differ in the ferritin and micronutrient levels.Nutritional support and deficiency prevention are important to minimize the burden of complications and increase the life expectancy and quality in patients with TM.Talasemi majör (TM) tanılı çocuklar büyüme geriliğine ve mikrobesin eksikliklerine yatkındırlar. Bu çalışmada, düzenli transfüzyon uygulanan hastalarda mikro besin seviyelerini, antropometrik ölçümleri, kemik mineralizasyon defektlerini değerlendirmeyi amaçladık.Laboratuvar testlerini, antropometrik ölçümleri ve kemik mineral yoğunluğunu değerlendirerek elde edilen verileri analiz ettik.Çalışmaya ortalama yaşı 12,26±4,74 yıl, ortalama transfüzyon öncesi hemoglobin 8,64±1,01 g/dL, ortalama serum ferritin 1158,6±556,8 ng/mL olan 29 hasta (%62’si erkek, %38’i kız) alındı. En sık vitamin D (%72,4), selenyum (%72,4) ve folat (%37,9) eksikliği saptandı. Hastaların %17,2’de hipokalsemia, %3,5 hipomagnesemi, %10,3 seruloplazmin düşüklüğü saptandı. Folat 2≤ ile6 yaş arasında, seruloplazmin 6≤ ile10 yaş arasında daha yüksek saptandı (sırasıyla p=0,028, p=0,018). Selenyum, ferritin ≥1.500 olan hastalarda anlamlı olarak yüksekti (p=0,008). Diğer mikrobesin düzeylerinde ferritin düzeyi ilişkili anlamlı farklılık saptanmadı (p0,05). Hastaların %31’inin vücut kitle indeksi (VKİ) 5. Persentilin (p) altındaydı. VKİ 95. p’nin üzerinde olan hasta saptanmadı. Hastaların %24,5’inin boyu, %20,7’sinin vücut ağırlığı 3. p’nin altındaydı. Boy ve vücut ağırlığı açısından 97. p’nin üzerinde olan hasta saptanmadı. Antropometrik ölçümlerin, hastaların kan mikrobesin ve ferritin düzeyleri ile anlamlı bir ilişkisi saptanmadı. On-18 yaş arasındaki hastaların VKİ anlamlı olarak daha yüksek bulundu (p=0,001). Antropometrik ölçümler, ortalama ferritin ve mikrobesin düzeyleri açısından anlamlı farklılık göstermedi. Hastaların %20,8’de endokrinolojik bozukluklar (hipoparatiroidi %13,8, hipotiroidi %3,5) gözlendi. Hastaların %14,8’inde (2 osteopenik, 2 osteoporotik) düşük kemik yoğunluğu saptandı. Kemik mineral yoğunluğunun mikrobesin ve ferritin düzeyleriyle anlamlı ilişkisi saptanmadı.TM hastalarında nütrisyonel eksikliklerin önlenmesi ve beslenme desteğinin sağlanması kemik mineralizasyon bozuklukları ve büyüme geriliği gibi komplikasyonların gelişiminin en aza indirilmesi açısından önemlidir.

Objectives: This study aimed to assess the frequency of hypovitaminosis D in patients with Ankylosing Spondylitis (AS) compared to healthy controls and evaluate its association with disease activity, structural damage and Bone Mineral Density (BMD). Methods: Serum 25(OH) D in 30 AS male patients was compared to 30 matched healthy controls. AS disease activity was assessed using AS Disease Activity Score and C - reactive protein (ASDAS- CRP). Bath AS Functional Index (BASFI) and Bath AS Metrology Index (BASMI) were used to assess the functional impairment and the spinal mobility, respectively. Radiological damage was scored according to modified Stoke AS Spine Score (mSASSS) and BMD was measured in the lumbar spine and femoral neck. Results: The mean serum 25(OH)D levels in AS patients were significantly lower compared to healthy controls (27.73 ± 14.27 vs. 38.46 ± 8.11ng/ml, P Conclusions: Hypovitaminosis D is prevalent among AS patients and is associated with increased risk of active disease, impaired function, radiographic severity and bone mineral loss. Future studies with a larger sample size are recommended to assess the impact of vitamin D deficiency on radiological progression in AS and to address whether or not vitamin D supplementation will help control the active disease.

Aim To assess the influence of gender and age on different parameters of alveolar bone loss using orthopantomogram. Materials and methods Eighty subjects were enrolled in the study (20 dentulous and 60 completely edentulous), fulfilling the inclusion and exclusion criteria. Completely edentulous subjects were divided into four groups (15 males and 15 females above 60 years) and (15 males and 15 females below 60 years). Dentulous group comprised 20 subjects (10 males and 10 females) between 41 and 75 years. After taking panoramic radiographs, vertical as well as horizontal reference lines were drawn. The parameters used for evaluation included mandibular cortical index (MCI), inferior mandibular cortical width (MCW), panoramic mandibular index (PMI), alveolar bone loss (ABL), and height of bone at first premolar (Hp) and first molar (Hm) of the mandible. Results There was significant association between MCI and age for females with C2 and C3 categories being more common with advancing age. MCW was stable in all groups, except in females above 60 years of age. PMI and ABL were nonsignificant for age and gender. Although the average values of bone height (Hm and Hp) for males were higher than those of females, the results were statistically insignificant. Conclusion Panoramic radiographic measurements could provide much valuable information and could help in evaluating patients with a low bone mineral density (BMD) with a few limitations. Clinical significance Dental professionals could screen the patients through panoramic radiographs taken during routine clinical examination, which could help in identifying patients with a low BMD so that further treatment could be initiated early and thus to prevent a pathologic fracture.

У роботі встановлені популяційні чинники ризику, що беруть участь у генезі порушень кісткового метаболізму у хворих на автоімунний тиреоїдит (АІТ). Наведені результати дослідження мінеральної щільності кісткової тканини у хворих на АІТ. Вивчено значення популяційних чинників ризику (жіноча стать, менопауза у жінок, дефіцит маси тіла, вік) у генезі розвитку остеопенії та/або остеопорозу у хворих на АІТ.

Objective Bone health in older individuals with HIV infection has not been well studied. This study aimed to compare bone mineral density (BMD), trabecular bone score (TBS), and bone markers between HIV-infected men and age- and body mass index (BMI)-matched HIV-uninfected men aged ≥60 years. We investigated the associations of risk factors related to fracture with BMD, TBS, and bone markers in HIV-infected men. Methods This cross-sectional study included 45 HIV-infected men receiving antiretroviral therapy and 42 HIV-uninfected men. Medical history, BMD and TBS measurements, and laboratory tests related to bone health were assessed in all the participants. HIV-related factors known to be associated with bone loss were assessed in the HIV-infected men. Results The mean BMD, TBS, and osteopenia or osteoporosis prevalence were similar among the cases and controls. The HIV-infected men had significantly higher mean N-terminal propeptide of type 1 procollagen and C-terminal cross-linking telopeptide of type I collagen levels. Stepwise multiple linear regression analysis demonstrated that low BMI (lumbar spine, P = .015; femoral neck, P = .018; and total hip, P = .005), high C-terminal cross-linking telopeptide of type I collagen concentration (total hip, P = .042; and TBS, P = .010), and low vitamin D supplementation (TBS, P = .035) were independently associated with low BMD and TBS. Conclusion In older HIV-infected men with a low fracture risk, the mean BMD and TBS were similar to those of the age- and BMI-matched controls. The mean bone marker levels were higher in the HIV group. Traditional risk factors for fracture, including low BMI, high C-terminal cross-linking telopeptide of type I collagen level, and low vitamin D supplementation, were significant predictors of low BMD and TBS.

Objectives The purpose of this study is to investigate the stage of chronic kidney disease (CKD) in adenine-induced CKD model rats by serum analyses, and to examine bone mineral density (BMD), bone strength, and microstructure of trabecular and cortical bone in these rats. Methods Eight-week-old, male Wistar rats (n = 42) were divided into 2 groups: those fed a 0.75% adenine diet for 4 weeks until 12 weeks of age to generate CKD model rats (CKD group); and sham rats. The CKD and sham groups were sacrificed at 12, 16, and 20 weeks of age (n = 7 in each group and at 12, 16, and 20 weeks), and various parameters were evaluated, including body weight, renal wet weight, muscle wet weight, renal histology, biochemical tests, BMD, biomechanical testing, and micro-computed tomography (CT). The parameters were compared between the 2 groups at the various time points. Results In the CKD model rats, at 20 weeks of age, serum creatinine, phosphorus, and intact-PTH levels were elevated, and serum calcium levels were normal, indicating that the CKD was stage IV and associated with secondary hyperparathyroidism. Decreased BMDs of the whole body and the femur were observed as bone changes, and micro-CT analysis showed deterioration of bone microstructure of the cortical bone that resulted in decreased bone strength in the cortical and trabecular bone. Conclusions These CKD model rats showed stage IV CKD and appear appropriate for evaluating the effects of several treatments for CKD-related osteoporosis and mineral bone disorder.