Optimizing Women's Health Over the Lifespan: Why Body Composition, Bone Health and Fitness Matter.

BACKGROUND AND OBJECTIVES:The effects of vitamin D on bone mass remain to be understood. This study was conducted with the objective of evaluating the influence of 25-hydroxyvitamin D (25OHD) levels on bone mineral density (BMD) among Saudi nationals.DESIGN AND SETTING:Cross-sectional study carried out at university hospital from 1 February 2008 to 31 May 2008.SUBJECTS AND METHODS:Healthy Saudi men and women in the peak bone mass (PBM) age group and those aged ≥50 years were recruited from the outpatient department of King Fahd University Hospital, Al Khobar, Saudi Arabia, between February 1, 2008, and May 31, 2008. Patient age and sex were documented, and body mass index was calculated. Hematological, biochemical, and serum 25OHD tests were performed. BMD was determined by dual-energy x-ray absorptiometry of the upper femur and lumbar spine. Patients were divided into three groups, based on their 25OHD level.RESULTS:Data from 400 patients were analyzed. Among individuals with a normal 25OHD level, 50% of women and 7% of men in the PBM age group and 26.4% of women and 49.2% of men aged ≥50 years had low bone mass. In patients with 25OHD insufficiency, 84.2% of women and 88.9% of men in the PBM age group and 83.3% of women and 80% of men aged ≥50 years had low bone mass. Results for patients with 25OHD deficiency revealed that none of the men and women in the PBM age group or ≥50 years old had normal BMD. Significant positive correlations between 25OHD level and BMD and significant negative correlations with parathyroid hormone were shown in most of the groups.CONCLUSIONS:This study showed that the vitamin D level significantly influences BMD reading among Saudi individuals. Evaluation and treatment of hypovitaminosis D should be considered during management of low bone mass.

The significance of high bone density in children

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

Osteoporosis in Children: Implications for Nursing

No association between body composition and walking outcomes in multiple sclerosis

BackgroundAndrogen deprivation therapy (ADT) is a key component of therapy for patients with high-risk prostate carcinoma, but it may be deleterious for bone health. We sought to determine the frequency of dual energy x-ray absorptiometry (DXA) scanning in patients commencing adjuvant ADT for treatment of high-risk prostate cancer at a large integrated regional cancer centre.Material and methodsThe electronic medical records (EMR) of all patients with high-risk prostate carcinoma commenced on adjuvant ADT between January 1, 2016 and December 31, 2017 at the Mid-North Coast Cancer Institute, Coffs Harbour, Australia were reviewed. Patients commenced on neoadjuvant ADT and long-term suppressive ADT for metastatic disease were excluded. The following data were obtained: socio-demographic information, prostate cancer data, ADT details and DXA results.Results188 men (mean age ± SD, 75.4 ± 7 years) were commenced on adjuvant ADT for a total duration (mean ± SD) of 23.4 ± 7 months. Most (n = 155/188, 82%) were commenced on leuprorelin acetate. While only 26/188 (14%) had a DXA scan performed prior to ADT, another 133 (71%) had a DXA scan at a median of 20 days (interquartile range 7–98), later. Of the 159 men with DXA readings, 76 (48%) were osteopaenic and 38 (24%) were osteoporotic by DXA criteria.ConclusionA high level (85%) of DXA scanning in men commencing ADT for prostate cancer can be achieved at a regional centre. The high prevalence (72%) of low bone mass in our unselected cohort underscores the importance of routine DXA scanning to guide bone health management during ADT.

Accurate assessment of body composition is essential for evaluating the risk of chronic disease. 3D body shape, obtainable using smartphones, correlates strongly with body composition. We present a novel method that fits a 3D body mesh to a dual-energy X-ray absorptiometry (DXA) silhouette (emulating a single photograph) paired with anthropometric traits, and apply it to the multi-phase Fenland study comprising 12,435 adults. Using baseline data, we derive models predicting total and regional body composition metrics from these meshes. In Fenland follow-up data, all metrics were predicted with high correlations (r > 0.86). We also evaluate a smartphone app which reconstructs a 3D mesh from phone images to predict body composition metrics; this analysis also showed strong correlations (r > 0.84) for all metrics. The 3D body shape approach is a valid alternative to medical imaging that could offer accessible health parameters for monitoring the efficacy of lifestyle intervention programmes.

Total and regional body composition are important indicators of health and mortality risk, but their measurement is usually restricted to controlled environments in clinical settings with expensive and specialized equipment. A method that approaches the accuracy of the current gold standard method, dual-energy x-ray absorptiometry (DXA), while only requiring input from widely available consumer grade equipment, would enable the measurement of these important biometrics in the wild, enabling data collection at a scale that would have previously been prohibitive in time and expense. We describe an algorithm for predicting three-dimensional (3D) body shape and composition from a single frontal 2-dimensional image acquired with a digital consumer camera. Duplicate 3D optical scans, two-dimensional (2D) optical images, and DXA whole-body scans were available for 183 men and 233 women from the Shape Up! Adults Study. A principal component analysis vector basis was fit to 3D point clouds of a training subset of 152 men and 194 women. The relationship between this vector space and DXA-derived body composition was modeled with linear regression. The principal component 3D shape was then fitted to match a silhouette extracted from a 2D photograph of a novel body. Body composition was predicted from the resulting 3D shape match using the linear mapping between the principal component parameters and the DXA metrics. Accuracy of body composition estimates from the silhouette method was evaluated against a simple model using height and weight as a baseline, and against DXA measurements as ground truth. Test-retest precision of the silhouette method was evaluated using the duplicate 2D optical images and compared against precision of the duplicate DXA scans. Paired t-tests were performed to detect significant differences between the sets. Results were reported on a held-out set. Body composition prediction achieved R2 s of 0.81 and 0.74 for percent fat prediction of males and females, respectively, on a held-out test set consisting of 31 males and 39 females. Precision estimates for fat mass were 2.31% and 2.06% for males and females, respectively, compared to 1.26% and 0.68% for DXA scans. The t-tests revealed no statistically significant differences between the silhouette method measurements and DXA measurements, or between retests. Total and regional body composition measures can be estimated from a single frontal photograph of a human body. Body composition prediction using consumer level photography can enable early screening and monitoring of possible physiological indicators of metabolic disease in regions where medical imagery or clinical assessment is inaccessible.

Baptista, F, de Marco, RL, Zymbal, V, and Janz, KF. Reference standards for vertical jump power and handgrip strength for screening the risk of low bone and muscle mass for age in youth. J Strength Cond Res 39(8): e974-e981, 2025-This study examined the predictive validity of vertical jump power and handgrip strength to discriminate at-risk youth for low muscle mass and bone mass for age. The sample consisted of 529 subjects of ages 10-18 years. Handgrip strength and vertical jump power were assessed using a hand dynamometer and a countermovement jump performed on a force platform. Dual-energy X-ray absorptiometry was used to assess lean body mass normalized for body height (kg·m -2 ) and bone mineral density (g·cm -2 ) of the whole body less head. These variables were used to determine the risk of low bone and muscle mass, defined by a Z -score ≤ -1.0 for both variables. All variables were standardized by the lambda-mu-sigma method according to sex and age group, using the sample as a reference. By sex, the analysis included the area under the curve (AUC), sensitivity (Se), and specificity (Sp). The ability to discriminate the risk of low bone and muscle mass through the assessment of musculoskeletal fitness was good to exceptional for vertical jump power (AUCs ≥0.88, Se and Sp = 78-91%) and acceptable to good for handgrip strength (AUCs = 0.75-0.88, Se and Sp = 68-73%). Risk Z -scores for musculoskeletal fitness ranged from -0.5 to -0.8, depending on the test and sex. Handgrip strength and especially vertical jump power can be used to screen the risk of pediatric low bone and muscle mass. Slight decreases in musculoskeletal fitness can be an inexpensive and noninvasive indicator of muscle and bone health.

Background/Aims Dual-energy X-ray absorptiometry (DXA) scans are routinely performed to assess bone mineral density (BMD), diagnose osteoporosis, refine fracture risk assessment and inform osteoporosis medicine decisions. The INDEX (understandINg bone DEnsity [dXa] scans) study aimed to explore patient and clinician understanding of DXA scans and results to identify opportunities to optimise DXA understanding. Methods Semi-structured think-aloud interviews with patients attending DXA scans across 3 NHS sites and primary and secondary care clinicians who refer to, and receive results from, DXA services. Interviews were transcribed verbatim and analysed using framework analysis, sensitised by the common-sense model of illness self-regulation, to explore how patients and clinicians perceive, interpret, and respond to DXA scan results. Results Interviews were completed with 38 patients (84% female; mean age of 66 years; 89% high health literacy), 12 primary care clinicians (11 General Practitioners, 1 First Contact Practitioner), and 10 secondary care clinicians. Four overarching themes related to (1) the importance of DXA scans; (2) (un)met information needs and (3) the impact of these; and (4) barriers and facilitators to addressing information needs. Perceived importance of DXA scans was influenced by individual and system-level factors. Patient and clinician attitudes towards osteoporosis and DXA scans varied, with some describing it as a low priority condition, particularly if ‘higher priority’ comorbidities were present. The reported opportunistic model of osteoporosis care coupled with the disconnect between primary and secondary care means that some patients may not receive adequate care. Patients had unmet information needs about the (1) purpose of a DXA scan, their DXA scan result, and what it means for their bone health and (2) the need for osteoporosis medicines and future scans. These unmet information needs impacted whether patients felt prepared for their DXA scan and anxiety caused by (mis)interpreting their DXA result. Unmet information needs impacted patient decisions about taking osteoporosis medicines. Clinicians also described unmet information needs regarding (1) who to refer for a DXA scan, (2) interpretation of DXA reports, and (3) drug treatment options and management. Barriers to meeting information needs included in DXA result format and content, including technical information. Patients and clinicians reflected that written results (e.g. texts, clinical reports) were insufficient to meet their information needs, particularly in absence of clinical interpretation. Some clinicians described potential clinical risk associated with misreading DXA reports. Opportunities for clinicians to explain DXA results and for patients to ask questions facilitated patient understanding, however time and resource constraints limited this. Conclusion The INDEX study highlights unmet information needs about DXA among patients and clinicians, revealing opportunities to optimise understanding. Findings will inform the coproduction of recommendations and resources to enhance DXA understanding, with the aim of supporting clinical and shared decision-making, osteoporosis care, and medicine uptake. Disclosure C. Kettle: None. F. Manning: Grants/research support; funded by the NIHR Applied Research Collaboration South West Peninsula. B. Henderson: None. J. Griffin: None. K. Knapp: None. J. Butterworth: Grants/research support; funded by a NIHR Doctoral Fellowship award (2017-10-005). C. Jinks: Grants/research support; part funded by NIHR Applied Research Collaboration (ARC) West Midlands. L. Bullock: None. Z. Paskins: Consultancies; received consultancy fees from UCB Pharma. Grants/research support; funded by the National Institute for Health and Care Research (NIHR) [Clinician Scientist Award (CS-2018-18-ST2-010)/NIHR Academy].

The menopause transition is a critical period marked by significant physiological adaptations. Data on the dynamic changes in body composition and metabolism during this transition are limited. The purpose was to determine body composition and metabolic changes over a 2-year follow-up in a cross-sectional sample of premenopausal (PRE), perimenopausal (PERI), and postmenopausal (POST) females. Twenty-three females who previously participated in a cross-sectional study returned for a 2-year follow-up visit were classified as PRE, PERI, or POST based on menstrual history and a Menopause Health Questionnaire. Muscle size [muscle cross-sectional area (mCSA)] and muscle quality [echo intensity, (EI)] were evaluated in the vastus lateralis with ultrasound. Bone mass and body composition were assessed using dual-energy X-ray absorptiometry, and metabolic flexibility through submax exercise with indirect calorimetry. At the 2-year follow-up, POST females had an increase in EI (change: 26.93 ± 12.82 a.u., group×time p-adjusted = 0.001) with no change in mCSA (change: -2.03 ± 2.40 cm², group×time p = 0.980). PERI compared to PRE females had lower total bone mass (group×time p-adjusted = 0.029) with an even lower bone mass in POST compared to PERI females (group×time p-adjusted = 0.023). No differences in metabolic flexibility at any exercise intensity were observed between groups over time (group×time p = ≥ 0.05). This study highlights a decline in muscle quality and total bone mass despite stable muscle size, emphasizing the need for targeted exercise and nutrition interventions to support muscle and bone health in females around the menopause transition.

ABSTRACTBackgroundVitamin D promotes bone and muscle growth in non-athletes, suggesting supplementation may be ergogenic in athletes. Our primary aim was to determine if modest Vitamin D supplementation augments favorable body composition changes (increased bone and lean mass and decreased fat mass) and performance in collegiate basketball players following 12 weeks of standardized training.MethodsMembers of a men’s and women’s NCAA D1 Basketball team were recruited. Volunteers were randomized to receive either a weekly 4000 IU Vitamin D3 supplement (D3) or placebo (P) over 12 weeks of standardized pre-season strength training. Pre- and post-measurements included 1) serum 25-hydroxy vitamin D (25(OH)D); 2) body composition variables (total body lean, fat, and bone mass) using dual-energy X-ray absorptiometry (DXA) scans and 3) vertical jump test to assess peak power output. Dietary intake was assessed using Food Frequency questionnaires. Main outcome measures included changes (∆: post-intervention minus pre-intervention) in 25(OH)D, body composition, and performance.ResultsEighteen of the 23 players completed the trial (8 females/10 males). Eight received the placebo (20 ± 1 years; 3 females) while ten received Vitamin D3 (20 ± 2 years; 5 females). Weekly Vitamin D3 supplementation induced non-significant increases (∆) in 25(OH)D (2.6 ± 7.2 vs. −3.5 ± 5.3 ng/mL; p = 0.06), total body bone mineral content (BMC) (73.1 ± 62.5 vs. 84.1 ± 46.5 g; p = 0.68), and total body lean mass (2803.9 ± 1655.4 vs. 4474.5 ± 11,389.8 g; p = 0.03), plus a non-significant change in body fat (−0.5 ± 0.8 vs. −1.1 ± 1.2%; p = 0.19) (Vitamin D3 vs. placebo supplementation groups, respectively). Pre 25(OH)D correlated with both Δ total fat mass (g) (r = 0.65; p = 0.003) and Δ total body fat% (r = 0.56; p = 0.02). No differences were noted in peak power output ∆ between the D3 vs. P group (−127.4 ± 335.4 vs. 50.9 ± 9 W; NS). Participants in the D3 group ingested significantly fewer total calories (−526.2 ± 583.9 vs. −10.0 ± 400 kcals; p = 0.02) than participants in the P group.ConclusionsModest (~517 IU/day) Vitamin D3 supplementation did not enhance favorable changes in total body composition or performance, over 3 months of training, in collegiate basketball players. Weight training provides a robust training stimulus for bone and lean mass accrual, which likely predominates over isolated supplement use with adequate caloric intakes.

Body Composition and Its Relationship to Growth and Bone Mass in Patients with Thalassemia

Background: The purpose of this pilot study was to compare body composition metrics obtained by two portable bioelectrical impedance analysis (BIA) devices with dual-energy X-ray absorptiometry (DXA) among adolescents with cystic fibrosis (CF) before and after a resistance exercise training program. Methods: Participants with CF were assessed using DXA, single-frequency BIA (SFBIA), and multiple-frequency BIA (MFBIA) to quantify percent body fat (%Fat), fat mass (FM), and fat-free mass (FFM) at baseline and after a home-based resistance training intervention comprised of 36, 1 h sessions completed in 12–14 weeks. Repeated measures analysis of variance, paired samples t-tests, Cohen’s d effect sizes, and Pearson’s correlations were used to compare differences between and within methods at baseline and post-intervention. Results: Ten participants (15.8 ± 2.2 yr, 60.1 ± 15.1 kg) completed the assessments. At baseline, both SFBIA and MFBIA scales significantly underestimated %Fat and FM and overestimated FFM, with small to moderate effect sizes. Post-intervention, small, non-significant differences were found between DXA and both BIA scales for all body composition metrics. Significant changes in %Fat and FFM were observed with DXA. MFBIA displayed less constant error than SFBIA when compared to DXA for pre- and post-intervention assessments for %Fat (MFBIA: pre and post −2.8 and −0.8 vs. SFBIA: −4.6 and −2.0), FM (−0.4 and −0.4 vs. −3.0 and −1.1), and FFM (+0.8 and +0.6 vs. +3.1 and +1.3). Near-perfect correlations were observed at both time points between DXA and each BIA scale. Conclusions: Portable BIA results should be interpreted with caution, and further validation studies in CF patients are needed prior to clinical use.

IntroductionThe use of dual-energy x-ray absorptiometry (DEXA) scanning is instrumental in better management of osteoporosis. This study aimed to assess the level of knowledge about DEXA scanning and bone health in the women of Karachi, as well as to analyze their practices concerning the scan and increase their knowledge and awareness regarding the same.Methodology The sample size for this cross-sectional study was 384. Data were collected using a self-devised and validated questionnaire, consisting of four sections: social demographics, general knowledge about DEXA scanning, practices regarding DEXA, and knowledge about bone health. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23 and associations between multiple variables calculated, using independent sample t-test and Pearson’s chi-squared test.ResultsOnly one-third of our sample population had heard about DEXA scanning and amongst them, nobody had complete knowledge about it. The mean score of general knowledge of DEXA (5.3±2.0) was higher than that of knowledge about the conditions in which DEXA scanning is recommended (2.7±2.1). The knowledge score showed a significant correlation with education (p=0.007) and employment (p=0.001). Only 7.6% of the sample population had taken a DEXA scan and knowledge and employment status were found to have significant associations with practices (p value=0.000 and 0.001, respectively).ConclusionsThe awareness levels regarding DEXA scans and bone health should be evaluated amongst similar and other groups of people and effective measures be put into application to educate the public and to guide them towards better prevention and management of osteoporosis.