Body Composition and Bone Status Through Lifespan in a Greek Adult Population: Establishing Reference Curves

Objectives: This study’s objective was to compare changes in body composition measurements (BCM) and bone mineral density (BMD) over 2 years between collegiate athletes following hip arthroscopy to treat labral tears due to femoral acetabular impingement syndrome (FAI) and matched uninjured collegiate athletes. Methods: A retrospective matched cohort study compared BCM and BMD of NCAA Division I athletes who underwent hip arthroscopy as a treatment for symptomatic FAI (scope group) with a control group of athletes who did not have hip arthroscopy over 24 months. The control group was matched to the scope group by sex and sport at a ratio of 2:1. Inclusion criteria for the scope group included arthroscopic hip surgery between January 1, 2017, and May 1, 2019, labral repair, femoral head-neck reshaping osteoplasty to address an alpha angle > 55 degrees, and available preoperative and postoperative outcomes. Athletes who had open hip surgery, surgery to address athletic pubalgia, other lower extremity surgery during the postoperative period, or failure to complete preoperative or postoperative testing were excluded. Incoming athletes beginning August 1, 2017 who did not have hip surgery, and had available BCM and BMD outcomes were included as controls. Dual Energy X-ray Absorptiometry scanning was used to measure BMD, lean mass, and fat mass. The regions of interest included the trunk (comprised of the pelvis, spine, and ribs), and bilateral lower extremities (Figure 1A). A mixed-effects linear regression model was used to compare differences in the change of BCM and BMD between the control and scope groups at baseline and at 1- and 2-years. The interaction of group and time was treated as a fixed effect, and the individual athlete was treated as a random effect. A p- value < 0.05 was set as the threshold for statistical significance and all tests were two-tailed. Results: A total of 20 athletes underwent hip arthroscopy during the study period. Three athletes were excluded due to insufficient pre- or postoperative data, and one athlete was excluded due to concomitant surgery to treat athletic pubalgia. Therefore, 16 NCAA Division I collegiate athletes (Figure 1B) were included in the scope group and 32 matched athletes were included as controls (Table 1). Relative to the control group, the scope group’s trunk BMD was significantly reduced at 1-year (β: - 0.052 grams/cm 2 [95% CI: -0.073 to -0.032]; p < 0.001; Figure 1C). At 2-years, the scope group’s trunk BMD change remained reduced compared to control, but this difference was no longer statistically significant (β: -0.020 grams/cm2; [ -0.051 to 0.011]; p = 0.20). No significant differences in the change in BMD of the legs were identified between groups at 1-year (β: -0.014 grams/cm 2 [-0.075 to 0.047]; p = 0.66) or 2-years (β: 0.057 grams/cm 2 [-0.038 to 0.155]; p = 0.24). Relative to control, the scope group demonstrated significant decreases in all of the regions comprising the trunk BMD at 1-year (Figure 1D), including the pelvis (β: -0.071 grams/cm 2 [-0.103 to -0.040]; p < 0.001), spine (β: -0.057 grams/cm 2 [- 0.092 to -0.023]; p = 0.002), and ribs (-0.027 grams/cm 2 [-0.053 to -0.002]; p = 0.035). Similarly, the trunk lean mass (Figure 1E) of the scope group decreased 1,903 grams relative to the control group (95% CI: -3052 to -746; p = 0.003) at 1-year, and 1,953 grams at 2-years (95% CI: -3009 to -892; p < 0.001). Lean mass estimates of the legs demonstrated a relative increase by 2-years in the scope group compared to controls (1196 grams [95% CI: 303 to 2090]; p = 0.011). Changes in fat mass of the trunk did not differ significantly compared to controls at 1-year (β: -394 grams [95% CI: -2417 to 1646]; p = 0.70) or 2-years (β: -1534 grams [95% CI: -3513 to 447]; p = 0.13). Similarly, changes in fat mass of the legs in the scope group did not differ significantly from the control group at 1-year (β: 582 grams [95% CI: -611 to 1780]; p = 0.34) or 2-years (β: -201 grams [95% CI: -1606 to 1217]; p = 0.78). Conclusions: Compared to matched control athletes, trunk BMD was significantly decreased 1-year after hip arthroscopy to treat FAI. BMD reductions were noted in the spine and ribs with the greatest reduction in BMD occurring in the pelvis. Similarly, a reduction in trunk lean mass was also noted in the scope group at 1 and 2 years. These same reductions in BMD and lean mass are not seen in the lower extremities of the scope group, however, suggesting postoperative rehabilitation restrictions alone are unlikely to account entirely for these findings. Taken together, the combination of the reduction in trunk BMD and the persistent reduction of trunk lean mass suggests significant alteration in the axial portion of the body following hip arthroscopy. These data may indicate a need for prioritizing early axial loading of the trunk through weight-bearing exercises, and incorporating core strengthening early postoperatively to improve lean mass. Ultimately, both bone health and lean mass are important considerations for hip arthroscopy, both when selecting patients preoperatively and managing them postoperatively. [Table: see text]

To evaluate the occurrence of low bone mineral density (BMD) and its relationship with clinical and laboratorial characteristics in children and young adults with sickle cell anaemia living in Northeast-Brazil, and to assess the role of radiography in diagnosing low BMD. Bone mineral density of lumbar spine was measured by dual energy X-ray absorptiometry (DXA) in 27 patients with Sickle cell anaemia (SCA) aged 7-28years. Clinical history, calcium and calorie intake, laboratory measurements, anthropometrics and pubertal development were assessed, and X-rays were obtained. Z-scores and T-scores for weight, height, Body Mass Index (BMI) and BMD were calculated using age and gender matched reference data. Mean lumbar spine BMD Z-scores and T-scores were -1.81 SD in boys and -0.80 SD in girls. BMD Z-scores were below -2 SD in 33.3% of girls and in 46.7% of boys. Low BMD (<-2 SD) occurred significantly more in patients with low height-for-age (P=0.02), low weight-for-age (P=0.001) and low BMI-for-age (P=0.006). No significant relationships were found between BMD and other clinical and laboratory parameters. Radiography had a sensitivity of 75% and a specificity of 36% to detect low BMD, and was considered not useful in this context. Patients with low height and/or low weight-for-age seem to be at high risk for developing low BMD.

Whether lean soft tissue mass or fat mass is the major independent contributor to bone mineral density in postmenopausal women, especially when controlling for physical activity remains incompletely characterized. PURPOSE: To examine: 1) the associations between historical and recent physical activity and bone mineral density and 2) the relative strength of associations among lean soft tissue mass, fat mass and bone mineral density, controlling for historical and recent physical activity in postmenopausal women. METHODS: Using a cross-sectional design, middle-aged postmenopausal women (n = 67, mean age 58.1±3.8) were assessed for historical and recent physical activity and completed dual energy x-ray absorptiometry (DXA) scanning. Subjective physical activity was measured via the Bone Loading History Questionnaire, Bone-specific Physical Activity Questionnaire, and Global Physical Activity Questionnaire. Objective physical activity was measured via accelerometer (steps/day). Bone status (whole body and femoral neck) and body composition (lean soft tissue mass and fat mass) were assessed using DXA. RESULTS: No significant relationships were found between historical physical activity and current bone mineral density. Recent physical activity, as assessed using the Bone Loading History Questionnaire, was negatively associated with whole body and femoral neck bone mineral density (r range = -0.29 to -0.37; p<0.05). Whole body bone mineral density was negatively related to steps/day (r = -0.28; p<0.05). Regardless of the physical activity measure included in the regression analysis (i.e. steps/day or Bone Loading History Questionnaire), hormone replacement therapy and lean soft tissue mass were the only significant independent predictors (all p<0.05) of whole body and femoral neck bone mineral density. CONCLUSIONS: Lean soft tissue mass, not fat mass or recent physical activity, is a significant independent contributor to bone status at the whole body and femoral neck sites reinforcing the importance of lean mass maintenance in middle-aged postmenopausal women.

BackgroundLimb dominance is influenced by daily activity and muscle strength. Previous studies have demonstrated lateral differences in bone mineral density (BMD), bone mineral content (BMC), and lean mass as a result of asymmetric mechanical loading. Understanding these variations is crucial, especially in conditions with regional bone demineralization, where the contralateral limb can serve as a reference. We aimed to analyze side-to-side differences in BMD, BMC, and lean mass, as measured by dual energy X-ray absorptiometry (DXA), in healthy subjects.MethodsA cross-sectional study included 802 whole-body composition assessments in Spanish adults (20–80 years). Athletes and individuals with bone metabolism disorders were excluded. Hand and foot dominance were self-reported. BMD, BMC, and lean mass were measured using a DXA scanner (Lunar Prodigy).ResultsThe sample (57.1% women, 42.9% men; mean age, 53.0±16.7 years) showed strong correlations between dominant and non-dominant limbs (r>0.90). The dominant upper limb had significantly higher BMD (~4%), BMC (~5–6%), and lean mass (~3–4%) in both sexes. In women, the dominant lower limb showed slight differences (~1%), while in men, only lean mass was significantly higher. Aging led to BMD and BMC reductions after a peak in the fourth decade in women and the third in men. Lean mass showed a higher decline in men in both upper and lower limbs.ConclusionsLimb dominance affects body composition differently between sexes, primarily in the upper limb, potentially due to differences in physical activity or mechanical loading. This study provides insight into how laterality and aging influence body composition in healthy individuals.

Increasing body weight is associated both with higher bone mass and with lower rates of bone loss. Whether the effects of body weight are mediated by lean body mass (LBM) or fat body mass (FBM) is, however, uncertain because different studies have used different measures of bone mass and arrived at contradictory conclusions. The parameter actually measured is bone mineral content (BMC). Bone mineral density (BMD), bone mineral apparent density (BMAD), and the BMD/height attempt to "correct" BMC for differences in bone or body size, but these corrections may bias the analysis of the effects of body composition on the skeleton. To resolve this issue, we measured BMC at the total body, lumbar spine, proximal femur, and forearm using dual energy X-ray absorptiometry (DXA) in a population-based sample including 138 premenopausal women (age range 21-54 years, mean 35 years) and 213 postmenopausal women (age range 34-94 years, mean 68 years). BMD, BMAD, and BMD/ height were also calculated for each site. LBM and FBM were determined from the DXA whole body scan. In a multivariate analysis that included age and height, both LBM and FBM predicted total body BMC in pre- and postmenopausal women (p < 0.002 for LBM and FBM in both groups). LBM had a dominant effect on spine and forearm BMC in both groups (p < 0.004) and hip BMC in premenopausal women (p < 0.001), whereas both LBM and FBM predicted hip BMC in postmenopausal women (p < 0.001). However, as BMC was adjusted for bone or body size using BMD, BMAD, or BMD/height, FBM tended to become more important than LBM in the analysis. This was, in part, due to the fact that each of the correction factors in the BMD and BMAD calculations, as well as height, were highly correlated with LBM (r = 0.57 and 0.52 for height versus LBM in pre- and postmenopausal women, respectively [p < 0.001]), and weakly or not at all with FBM (r = 0.08 and 0.11, respectively). Therefore, dividing BMC by these correction factors tended to bias the analysis against potential effects of LBM on bone mass. Thus, the relationship between body composition and bone mass is critically dependent on which bone mass parameter is used in the analysis. Both LBM and FBM have important effects on bone mass, depending on the bone mass parameter used, the skeletal site measured, and menopausal status.

Report of a Muscular Dystrophy Campaign funded workshop Birmingham, UK, January 16th 2004. Osteoporosis in Duchenne muscular dystrophy; its prevalence, treatment and prevention

Too Tall for the DXA Scan? Contributions of the Feet and Head to Overall Body Composition

The significance of high bone density in children

Cross-Calibration of Prodigy and Horizon A Densitometers and Precision of the Horizon A Densitometer

BackgroundOsteoporosis, characterized by reduced bone mass and increased fracture risk, is a major global health burden. Nonhuman primates, particularly female cynomolgus monkeys, are critical preclinical models due to their skeletal and hormonal similarity to humans. Dual-energy X-ray absorptiometry (DXA) is the gold standard for measuring bone mineral density (BMD) and body composition. However, data on age-related changes in these metrics in cynomolgus monkeys are inconsistent, and the relationship between body composition and BMD remains debated and understudied in this model. The objectives of this study were to delineate the age-dependent trends in bone mass and body composition and to evaluate the impact of body composition on bone mass. This study aims to furnish a data reference for experiments involving bone mass and body composition in cynomolgus monkeys as a disease model.MethodsA cohort of 112 healthy female cynomolgus monkeys was stratified into four age-based groups. DXA scans were conducted to ascertain total body bone mass, subcranial bone mass, spine BMD (BMDs), central region-of-interest bone mineral density (BMDCROI), and body composition metrics. A generalized additive model (GAM) was utilized for non-linear regression analysis of the aging trends in bone mass and body composition parameters. Spearman’s rank correlation and multiple linear regression analyses were conducted to investigate the interplay between body composition and bone mass.ResultsIn female cynomolgus monkeys ≤10 years of age, bone mass parameters showed a significant increase with age. Beyond the age of 10 years, BMDs remained stable with age, while total body BMD (BMDTB) and subcranial BMD exhibited a slight increasing trend in advanced age. A relative decline in BMDCROI was observed in the elderly cohort, with a higher cumulative bone loss rate compared to BMDs (−10.0% vs. 1.8%). BMDTB demonstrated a strong positive correlation with subcranial BMD, with correlation coefficients ranging from 0.947 to 0.990 (P<0.001). Similarly, total body bone mineral content (BMCTB) was highly correlated with subcranial BMC, with correlation coefficients ranging from 0.961 to 0.996 (P<0.001). In the correlation analysis of bone mass and body composition in female cynomolgus monkeys prior to peak age (≤10 years old), both lean mass (LM) and fat mass (FM) positively influenced BMD, with LM contributing more significantly. Post-peak age (>10 years), FM had a more pronounced effect on total body bone mass.ConclusionsThe bone mass and body composition data of female cynomolgus monkeys across different age groups serve as a valuable reference for studies employing female cynomolgus monkeys as animal models. BMDCROI is a sensitive indicator for detecting spinal bone mass loss, minimizing the confounding effects of osteoarthritis (OA). The variable contributions of LM and FM to bone mass in female cynomolgus monkeys at different ages offer significant insights for investigating the etiological factors of osteoporosis.

The role of trunk region body composition in lumbar spine bone mineral content and density.

Body composition phenotypes and bone health in young adults: A cluster analysis

Recent studies suggest conflicting findings regarding association between obesity and adolescent bone mineral content (BMC) and bone mineral density (BMD).AimTo determine the impact of being obese on whole-body (WB) BMC...

Background: Maternal gestational diabetes mellitus (GDM) and overweight are associated with an increased risk of obesity and the metabolic syndrome in the adult offspring. We studied the influence of maternal GDM on prepubertal children’s body composition and bone mineral biochemistry. Methods: A total of 134 prepubertal Caucasian children (age range 4.4–9.7 years) were studied in a controlled cross-sectional study. Seventy-six children had been exposed to maternal GDM and 58 children born after a normal pregnancy served as controls. The outcome variables were body fat %, android fat %, gynoid fat %, android/gynoid fat ratio, bone mineral density (BMD), bone mineral content (BMC), muscle mass, lean mass (LM) and serum 25-hydroxyvitamin D, ionized calcium, phosphate, and alkaline phosphatase concentrations. Results: There were no differences in body fat %, android fat %, BMD, BMC, muscle mass, or LM between the study groups. Gynoid fat % was higher in the GDM than control children (p = 0.03). Android fat %, gynoid fat %, and android/gynoid fat ratio were higher in the GDM boys than control boys (p = 0.046, 0.037, and 0.038) respectively, but no differences were found between the GDM and control girls. Conclusions: Boys exposed to maternal GDM presented with more unfavorable fat distribution than their controls, whereas no difference was found between the girls. Otherwise, the differences in body composition were minimal between prepubertal GDM and control children.

DXA body composition corrective factors between Hologic Discovery models to conduct multicenter studies.