Bone Density In Patients Research Articles

Loss of Bone Density in Patients with Anorexia Nervosa Food That Alone Will Not Cure

Background: Anorexia Nervosa is a highly lethal illness that is also associated with many medical complications. Food restriction and weight loss define this illness. Most of its physical complications are reversible with weight restoration, with the notable exception of the loss of bone density, which is commonly present in anorexia nervosa. Methods: A comprehensive scientific literature review was performed in order to explore bone disease in anorexia nervosa. Results: The pathophysiology of the loss of bone mineral density in anorexia nervosa was elucidated, along with the diagnosis and treatment of osteoporosis in patients with anorexia nervosa, including the nutritional approach to weight restoration. Conclusions: Loss of bone mineral density in anorexia nervosa is very aggressive. Nutritional rehabilitation is a cornerstone to treating this, along with medicinal considerations.

Exploring bone density analysis on routine CT scans as a tool for opportunistic osteoporosis screening

The primary aim of this study was to evaluate computed tomography (CT)-based bone density analysis at the level of thoracic vertebra 12 (Th12) as a screening method for decreased bone density in patients admitted to the intensive care unit (ICU). Interobserver variability was analyzed. Secondary aims were to assess the prevalence of CT-based low bone density upon ICU admission in a cohort of COVID-19 patients and to assess the potential effect of long-term ICU stay on bone density in these patients. Retrospective single-center cohort study. ICU of the Leiden University Medical Center (LUMC), the Netherlands. Patients admitted to the ICU of the LUMC between March 1st, 2020 and February 1st, 2022 with a diagnosis of COVID-19, and a length of ICU stay of ≥ 21 days. In the included patients both baseline chest CT scans (obtained upon ICU admission) and follow-up chest CT scans (obtained ≥ 21 days after ICU admission) were available for analysis. A total of 118 CT scans in 38 patients were analyzed. There was a good interobserver variability, with an overall mean absolute difference (between measurements of three observers) of 9.7 Hounsfield Units (HU) and an intraclass correlation coefficient (ICC) of 0.93 (95% CI 0.88–0.96). The effect of intravenous contrast administration on bone density measurements was small (+ 7.5 HU (95% CI 3.4–11.5 HU)) higher in contrast enhanced CT images compared to non contrast enhanced CT images). Thirty-seven percent of patients had a bone density < 140 HU, suggestive of osteoporosis. No significant difference was found between bone density upon ICU admission and bone density at follow-up (≥ 21 days after ICU admission). Vertebral CT-based bone density analysis using routine CT scans is an easily applicable method to identify ICU patients with decreased bone density, which could enable enrollment in osteoporosis prevention programs. A high prevalence of low bone density was found in our cohort of ICU patients. There were no changes observed in bone density between baseline and follow-up measurements.

Midregional Proatrial Natriuretic Peptide (MRproANP) is associated with vertebral fractures and low bone density in patients with chronic obstructive pulmonary disease (COPD)

BackgroundPatients with COPD are often affected by loss of bone mineral density (BMD) and osteoporotic fractures. Natriuretic peptides (NP) are known as cardiac markers, but have also been linked to fragility-associated fractures in the elderly. As their functions include regulation of fluid and mineral balance, they also might affect bone metabolism, particularly in systemic disorders such as COPD.Research questionWe investigated the association between NP serum levels, vertebral fractures and BMD assessed by chest computed tomography (CT) in patients with COPD.MethodsParticipants of the COSYCONET cohort with CT scans were included. Mean vertebral bone density on CT (BMD-CT) as a risk factor for osteoporosis was assessed at the level of TH12 (AI-Rad Companion), and vertebral compression fractures were visually quantified by two readers. Their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP), Mid-regional pro-atrial natriuretic peptide (MRproANP) and Midregional pro-adrenomedullin (MRproADM) was determined using group comparisons and multivariable analyses.ResultsAmong 418 participants (58% male, median age 64 years, FEV1 59.6% predicted), vertebral fractures in TH12 were found in 76 patients (18.1%). Compared to patients without fractures, these had elevated serum levels (p ≤ 0.005) of MRproANP and MRproADM. Using optimal cut-off values in multiple logistic regression analyses, MRproANP levels ≥ 65 nmol/l (OR 2.34; p = 0.011) and age (p = 0.009) were the only significant predictors of fractures after adjustment for sex, BMI, smoking status, FEV1% predicted, SGRQ Activity score, daily physical activity, oral corticosteroids, the diagnosis of cardiac disease, and renal impairment. Correspondingly, MRproANP (p < 0.001), age (p = 0.055), SGRQ Activity score (p = 0.061) and active smoking (p = 0.025) were associated with TH12 vertebral density.InterpretationMRproANP was a marker for osteoporotic vertebral fractures in our COPD patients from the COSYCONET cohort. Its association with reduced vertebral BMD on CT and its known modulating effects on fluid and ion balance are suggestive of direct effects on bone mineralization.Trial registrationClinicalTrials.gov NCT01245933, Date of registration: 18 November 2010.

GBA1 as a risk gene for osteoporosis in the specific populations and its role in the development of Gaucher disease

BackgroundOsteoporosis and its primary complication, fragility fractures, contribute to substantial global morbidity and mortality. Gaucher disease (GD) is caused by glucocerebrosidase (GBA1) deficiency, leading to skeletal complications. This study aimed to investigate the impact of the GBA1 gene on osteoporosis progression in GD patients and the specific populations.MethodsWe selected 8115 patients with osteoporosis (T-score ≤ − 2.5) and 55,942 healthy individuals (T-score > − 1) from a clinical database (N = 95,223). Monocytes from GD patients were evaluated in relation to endoplasmic reticulum (ER) stress, inflammasome activation, and osteoclastogenesis. An in vitro model of GD patient’s cells treated with adeno-associated virus 9 (AAV9)-GBA1 to assess GBA1 enzyme activity, chitotriosidase activity, ER stress, and osteoclast differentiation. Longitudinal dual-energy X-ray absorptiometry (DXA) data tracking bone density in patients with Gaucher disease (GD) undergoing enzyme replacement therapy (ERT) over an extended period.ResultsThe GBA1 gene variant rs11264345 was significantly associated [P < 0.002, Odds Ratio (OR) = 1.06] with an increased risk of bone disease. Upregulation of Calnexin, NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) and Apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain (ASC) was positively associated with osteoclastogenesis in patients with GD. In vitro AAV9-GBA1 treatment of GD patient cells led to enhanced GBA1 enzyme activity, reduced chitotriosidase activity, diminished ER stress, and decreased osteoclast differentiation. Long-term bone density data suggests that initiating ERT earlier in GD leads to greater improvements in bone density.ConclusionsElevated ER stress and inflammasome activation are indicative of osteoporosis development, suggesting the need for clinical monitoring of patients with GD. Furthermore, disease-associated variant in the GBA1 gene may constitute a risk factor predisposing specific populations to osteoporosis.

Sex differences in the accuracy of vertebral bone quality score assessing bone density in patients undergoing lumbar spinal fusion.

Low bone mineral density (BMD) significantly increases the risk of complications in patients undergoing spinal fusion. Existing evidence indicates that traditional dual-energy x-ray absorptiometry (DEXA) and quantitative CT (QCT) screening are underutilized in spine surgery. The MRI-based vertebral bone quality (VBQ) score provides a tool for primary screening of bone density. The validity of this score as a predictor across sexes has not been investigated. This study aimed to explore the effect of sex on the diagnostic efficacy of the VBQ in predicting osteopenia/osteoporosis and whether a sex-specific threshold exists. In this retrospective cohort study, patients who underwent lumbar fusion at a tertiary care center were reviewed. VBQ was obtained by noncontrast T1-weighted MRI. Patients were stratified according to sex and bone density. Data were analyzed between the groups. Pearson correlation analysis and linear regression were used to analyze the correlation between the VBQ and DEXA T values. Receiver operating characteristic (ROC) curve analysis, including area under the curve (AUC) calculation, was used to evaluate the predictive performance of VBQ for low BMD in both sexes. A total of 271 patients (92 male, 179 female patients) were analyzed. The correlation coefficient between VBQ and the lowest T value was -0.40 for male and -0.554 for female patients. In comparing the bone density subgroups, among male patients a significant difference in the VBQ scores was observed only between the normal and osteoporosis subgroups (p = 0.012). VBQ demonstrated statistically significant differences among female patients across all three subgroups (p < 0.001). The ROC analysis revealed that the predictive performance of VBQ in detecting low BMD was more consistent with the gold-standard DEXA results in female than in male patients (AUC 0.647 vs AUC 0.823, p = 0.02). The optimal thresholds were similar in both sexes. Compared with male patients, VBQ has better discrimination between female patients with low BMD and those with normal bone density. Although the correlation between VBQ and bone density is weaker in male than in female patients, the optimal thresholds are similar in both sexes.

Calculation of the Least Significant Change Value of Bone Densitometry Using a Dual-Energy X-ray Absorptiometry System

Purpose: The precision error of a bone density meter reflects the equipment and reproducibility of results by an examiner. Precision error values can be expressed as coefficient of variation (CV), CV%, and root mean square-SD (RMS-SD). The International Society for Clinical Densitometry (ISCD) currently recommends using RMS-SD as the precision error value. When a 95% confidence interval is applied, the least significant change (LSC) value is calculated by multiplying the precision error value by 2.77. Exceeding the LSC value reflects a significant difference in measured bone density. Therefore, the LSC value of a bone density equipment is an essential factor for accurately determining a patient's bone density. Accordingly, we aimed to calculate the LSC value of a bone density meter (Lunar iDXA, GE) and compare it with the value recommended by the ISCD. We also assessed whether the value measured by the iDXA equipment was below the LSC value recommended by ISCD. Material and Methods: The bone densities of the lumbar spine and thighs of 30 participants were measured twice, and the LSC values were calculated using the precision calculation tool provided by the ISCD (http://www.iscd.org). To check the reproducibility of the measurement, patients were asked to completely dismount from the equipment after the first measurement; the patient was then repositioned before proceeding with the second measurement. Results: The LSC values derived using the CV% values recommended by the ISCD were 5.3% for the lumbar spine and 5.0% for the thigh. The LSC values measured using our bone density equipment were 2.47% for the lumbar spine and 1.61% for the thigh. The LSC value using RMS-SD was 0.031 g/cm2 for the lumbar spine and 0.017 g/cm2 for the thigh. Conclusion: that the findings confirm that the CV% value measured using our bone density meter and the LSC value using RMS-SD were maintained very stably. This can be helpful for obtaining accurate measurements during bone density follow-up examinations.

Evaluation of multidetector CT Hounsfield unit measurements as a predictor of efficacy and complications in percutaneous vertebroplasty for osteoporotic vertebral compression fractures

IntroductionMore than 30 years after the initial experience of Galibert and Deramond with percutaneous vertebroplasty, the procedure has gone through countless refinements and clinical evaluations. Predictors for the success and failure of the procedure in the literature vary and are focused on the duration of complaints, type of fracture, presence of edema on MRI scans, etc. We propose using a quantitative method based on a standard CT examination of the thoracic or lumbar spine to assess the risks and potential success of performing vertebroplasty.Materials and methodsThis is a single-center prospective observational study on 139 patients treated with percutaneous vertebroplasty (pVPL) for a single symptomatic osteoporotic vertebral compression fracture (OVCF). We measured the levels of disability and pain preoperatively and again at the 3-, 6- and 12-month marks using the standardized VAS and ODI questionnaires. Every patient in the study was evaluated with postoperative multidetector CT (MDCT) to determine the presence, extent, and localization of vertebral cement leakage and to measure the adjacent vertebrae’s minimal and mean density in Hounsfield units (HUmin and HUmean, respectively).ResultsWe determined that a slight (r = −0.201) but statistically significant (p = 0.018) correlation existed between HU measurements taken from radiologically intact adjacent vertebrae and the procedure’s effect concerning the pain levels at the 3-month follow-up. This correlation failed to reach statistical significance at 12 months (p = 0.072). We found no statistically significant relationship between low vertebral cancellous bone density and cement leakage on postoperative scans (p = 0.6 for HUmin and p = 0.74 for HUmean).ConclusionWe have moderately strong data that show a negative correlation between the mean values of vertebral cancellous bone density in patients with OVCF and the effect of pVPL in reducing pain. Lower bone densities, measured this way, showed no increased risk of cement leakage.

Bone density in patients with nonfunctional adrenal incidentaloma

Aims: Adrenal incidentalomas (AI) are adrenal masses that are detected incidentally in imaging studies performed for different reasons in people who do not have any complaints suggestive of adrenal gland disease. The overall prevalence, approximately just over 4%, increases with age. AI is detected in approximately 10% of people over the age of 70. In this context, we thought that CT imaging, which is already used in the diagnosis and follow-up of AI, can contribute to the evaluation of muscle and bone mass without creating additional costs. Methods: In this retrospective study, 39 patients who were followed up with NFAI by the endocrinology department and 30 healthy individuals with normal adrenal imaging in the abdominal CT examination as the control group were included. Patients with chronic diseases or drug use that may affect bone and muscle mass, and individuals in the postmenopausal period were excluded in this study. Endocrine tests performed to exclude autonomous cortisol secretion, pheochromocytoma and primary hyperaldosteronism; VMA and fractionated metanephrines in 24-hour urine, cortisol values after 1 mg dexamethasone suppression test, baseline serum dehydroepiandrosterone sulfate (DHEAS) levels and plasma aldosterone (ng/dl)/renin (ng/ml/hour) ratio were measured. Autonomous cortisol production was excluded in patients with serum cortisol below 1.8 mcg/dl after 1 mg dexamethasone suppression. Results: 39 patients with NFAI and 30 healthy volunteers participated in the study. In the NFAI group, 69.2% (n= 27) were female and 30.8% (n=12) were male. In the healthy control group 63.3% (n=19) of the people were female and 37.7% (n=11) were male. There was no statistically significant difference between the two groups in terms of gender (p=061). The mean age of the NFAI group is 43 and the mean age of the control group is 49, and there was no statistically significant difference in age between the two groups (p=0.06) Conclusion: No decrease was found in BMD and paravertebral muscle mass values in the measurements made at L1-3 vertebral level with CT in NAFI patients. Further studies are needed in a larger patient population where the results are evaluated together with the femur and vertebral BMD measurements by DXA method, and muscle strength and performance are evaluated in addition to muscle mass in terms of sarcopenia.

Increased spine bone density in patients with chronic hepatitis B switched to tenofovir alafenamide: A prospective, multinational study.

Data on patients switched to tenofovir alafenamide (TAF) from nucleos(t)ide analogues (NUCs) other than tenofovir disoproxil fumarate are limited. To assess the treatment and renal/bone safety outcomes following the switch to TAF. We prospectively enrolled adult patients with chronic hepatitis B (CHB) who switched from any NUC to TAF at 14 centres in Japan, Korea, Taiwan and the U.S. Study outcomes were viral suppression (VR; HBV DNA < 20 IU/mL), biochemical response (BR; alanine aminotransferase normalisation), and changes in estimated glomerular filtration rate (eGFR) and T-scores (L-spine) by bone absorptiometry by 24 months after switch to TAF. We enrolled 270 eligible patients. Mean age was 58.1; 58.2% were male; 12.2% had cirrhosis and 73.3% previously received entecavir monotherapy. VR rate increased significantly from 95.2% to 98.8% by 24 months after the switch to TAF (p = 0.014). Between the switch and 24 months later, the mean spine T-score improved significantly from -1.43 ± 1.36 to -1.17 ± 1.38 (p < 0.0001), while there was no significant change in mean eGFR (88.4 ± 16.9-89.5 ± 16.3 mL/min/1.73 m2 , p = 0.13). On multivariable analysis adjusted for age, sex, baseline spine T-score and prior TDF or adefovir dipivoxil use, male sex was significantly associated with lower risk of worsening spine T-score (odds ratio: 0.29, p = 0.020), while age was significantly associated with a higher risk of worsening chronic kidney disease stage (OR: 1.07, p = 0.019). At 24 months after the switch to TAF, VR rates and spine bone density improved significantly while renal function remained stable.

Relationship between parameters of subclinical atherosclerosis and osteoporosis and their prognostic significance: data from the prospective studies

We analyzed modern publications on the relationship between cardiovascular diseases (CVDs) and osteoporosis and, in particular, their preclinical manifestations. Most of the papers on this issue are observational, cross-sectional, or study associations of preclinical markers with disease risk or outcomes. However, the results of these studies do not always coincide and are contradictory. Therefore, it is not possible to define cause-effect relationship between vascular changes and decreased bone mass, as well as persistence of its relationship. Due to the difficulties in management of prospective studies, in the last decade only a few studies have appeared with long-term follow-up of patients without symptoms with subsequent assessment of preclinical manifestations. A strong relationship has been demonstrated between intima-media thickness, plaque presence, coronary artery calcification and low bone density of the spine and proximal femur, as well as between vascular stiffness (pulse wave velocity) and proximal femur bone density. The data obtained indicate combined disorders of vascular wall morphology and bone tissue, not only in postmenopausal women, but also in elderly men, and can be used to justify indications for screening for decreased bone density in patients with CVD. At the same time, larger-scale prospective studies to explore associations between markers of preclinical manifestations of CVD and decreased bone mass, including in the Russian population, are required.

Analysis of the use of transosseous osteosynthesis in the treatment of patients with diabetic osteoarthropathy complicated by chronic osteomyelitis

Relevance Diabetic neuroosteoarthropathy (DNOAP) complicated by chronic osteomyelitis (CO) is one of the most common complications (up to 7.5 %) in patients with diabetes mellitus. Treatment failure of such patients leads to amputation of the segment, and in some cases, to death. The use of the method of transosseous osteosynthesis is the only alternative method in the struggle for the limb salvage.Purpose Based on X-ray morphological criteria for assessing bone quality, to determine the optimal assembly of the external fixation device (EFF), which provides favorable conditions for restoring limb weight-bearing capacity in the treatment of patients with DNOAP complicated by infection.Materials and methods The analysis of radiographs and the clinical course of the reparative process in 49 patients (mean age 55.5 ± 9.4 years) with DNOAP complicated by chronic osteomyelitis was carried out. Two groups were distinguished based on the Ilizarov apparatus assembly: wire-based (WB) used in 25 patients; hybrid construct (HC) in 24 patients. The X-ray obtained in Jpeg format were analyzed using specialized Hi-scene software. The density of the bones of the foot was studied by MSCT.Results Comparison of the indicators of bone optical density in both study groups showed that there was an insignificant increase in the postoperative period Od of the calcaneus by 25 % after treatment in patients from the HC group, and in the WB group by 43 % in the distal tibia. At the same time, we noted a significant increase in the Od values of the tibia in the postoperative period in patients from the HC group and in the body of the calcaneus in patients from the WB group. MSCT showed that the density of the calcaneus before treatment in patients with DNOAP in the region of the calcaneal tubercle was 194.37 ± 49.05 HU, in the region of the body it was 205.47 ± 38.36 HU, in the region of the distal tibia 280.00 ± 40.30 HU. The analysis of the results of bone osteosynthesis of the affected segment showed that the rate of satisfactory outcomes after dismantling the device in patients from the HC group was significantly higher than in the WB group (56 %) and amounted to 75 %.Discussion As is known, pronounced osteoporosis of the bones of the lower leg and foot is often characteristic of patients with diabetes mellitus complicated by DNOAP and chronic osteomyelitis. A possible arsenal of treatment methods that allow solving the problems of stable arrest of the osteomyelitic process and restoring limb support in such patients is very limited. The optimal choice of the Ilizarov apparatus assembly type has an impact on the outcome of treatment of patients with this pathology.Conclusion Based on X-ray morphological criteria for assessing bone quality, our study showed a decrease in optical and densitometric bone density in patients with DNOAP complicated by chronic osteomyelitis compared to the norm. The use of wire-based assembly of the apparatus does not provide sufficient conditions for the solution of the set of the surgical tasks in this category of patients. The introduction of half-pins into the apparatus system provides the necessary fixation time with the possibility of functional load on the operated segment in patients in the postoperative period.

Factors Related to Reduced Bone Density in β-Thalassemia Major Patients: Mazandaran Thalassemia Registry

Introduction: OsteoPenia and osteoPorosis are known to be one of the main comPlications of β-thalassemia major (β-TM). The aim of this study was to determine the factors associated with decreased bone density of these Patients.&#x0D; Methods: Lumbar and femoral neck bone mineral density (BMD) in β-TM Patients characterized via Dual-energy X-ray absorPtiometry (DXA) to PinPoint the association of iron chelators, diabetes mellitus, serum ferritin above 3000 ng/mL, hemoglobin below 8 gr/dl, using hydroxyurea, liver siderosis and moderate to severe hePatic and cardiac siderosis with BMD. The information was collected from the thalassemia registry in 2019 and statistical analysis was Performed by STATA-13 software.&#x0D; Results: Out of 1959 ParticiPants with β-thalassemia major registered in the registry, 139 ones (7.09%) had bone mineral density (53 males and 86 females). The Prevalence of abnormal bone density in the lumbar and femoral neck was (52.48 to 47.66) 57.5 and (40.18 to 57.52) 48.85 Percent, resPectively. After adjusting for the effects of Possible interventions, the odds ratio of abnormal bone density in the Patients consuming hydroxyurea and deferasirox were 0.24 (0.03 to 1.73) and 0.25 (0.03 to 1.69), resPectively. The highest odds were 8.21 (0.18 to 360.22), and 6.72 (0.60 to 74.83) for moderate to severe cardiac and hePatic dePosition, resPectively.&#x0D; Conclusion: The Prevalence of osteoPenia and osteoPorosis is high among thalassemia major Patients. ConsumPtion of hydroxyurea and deferasirox is the most imPortant Protective factor and moderate to severe cardiac and hePatic siderosis are the most imPortant risk factors for abnormal bone density.

Analysis of the content of mineral elements in connective tissues in patients with bisphosphonate osteonecrosis

BACKGROUND: The presence of a large number of pathological studies and a significant amount of literature on high bone density in patients with bisphosphonate osteonecrosis determined the conduct of this study.&#x0D; AIM. To monitor micro- and macronutrients in patients with bisphosphonate osteonecrosis of the jaws, to detail their role in the pathological process.&#x0D; MATERIALS AND METHODS. In 184 patients with bisphosphonate necrosis, after sequestrectomy, the micro- and macronutrient composition of bone fragments removed from the lesion was analyzed.&#x0D; RESULTS. Deviations from reference values were found in such elements as sulfur (S2-), chlorine (Cl-), potassium (K+), calcium (Ca2+), phosphorus (P3+). The dynamics of micro and macro elements correlated with the clinical picture of the pathological process under study and the number of sessions or courses of adjuvant therapy.&#x0D; CONCLUSIONS. It is assumed that violations of cascade physiological reactions that develop as a result of violations of the mineral composition in the connective tissue are due to the pharmacokinetic properties of bisphosphonate preparations. The study of a number of micro and macro elements is predetermined by their role in the life and functional activity of amino acids, enzymatic systems, importance in the structure of cells and tissues.&#x0D; Keywords&#x0D; Bisphosphonate-Associated Osteonecrosis of the Jaw, micro and macro elements, sequestrations, bone fragments.

Clinical significance of drug cessation on medication-related osteonecrosis of the jaw in patients with osteoporosis

Suspending bisphosphonates (BPs) to reduce the risk and severity of medication-related osteonecrosis of the jaw (MRONJ) remains controversial. In this study, we quantitatively evaluated the clinical significance of BP suspension before surgery in osteoporosis patients with MRONJ. We analyzed 24 osteoporosis patients with MRONJ who were treated from 2012 to 2020 at Seoul National University Dental Hospital and compared the treatment outcomes of those who suspended BPs with those who did not. The number of surgical interventions, follow-up panoramic radiographs for relative bone density measurement, and laboratory blood tests including white blood cells, erythrocyte sedimentation rate, absolute neutrophil count, hemoglobin, hematocrit, and alkaline phosphatase were analyzed. ANOVA, Student's t -test, and Mann-Whitney U tests were used to compare results. Fisher's exact test was used to discover the association between treatment outcome and BP suspension, and Pearson's correlation test was used to measure the statistical relationship between the changes in serum inflammatory markers. The number of interventions was significantly higher in the non-drug suspension group due to recurrence (p<0.05). The relative bone density in patients who suspended BPs was significantly different over time (p<0.05), with the highest density at one-year follow-up. Fisher's exact test shows an association between successful treatment outcomes and BP suspension. The alkaline phosphatase and erythrocyte sedimentation rate levels decreased significantly in the BP-suspended group, and a positive correlation was found between these elevated markers. A significant increase in bone density throughout follow-up and a lower number of interventions were found in the BP suspension group compared to the non-drug suspension group. Also, BP suspension decreased inflammatory markers in the serum after surgery, resulting in good treatment outcomes. BP suspension is a prognostic factor for MRONJ and should be implemented before surgery.

A Randomized Controlled Trial to Assess the Effects of Oral Alkali Therapy in Patients with Diabetic Kidney Disease

Background: To analyze the effects of oral alkali therapy on renal function, nutritional status and bone density in patients of diabetic kidney disease. Material &amp; Methods: A randomized controlled trial was conducted on 60 patients of age&gt;18 years with diabetic kidney disease who were not on dialysis and had plasma bicarbonate levels between 16 and 20 mmol/l. Patients were randomly divided into two groups: Test group (n=30) which received oral alkali therapy as sodium bicarbonate and control group (n=30) who did not receive oral alkali therapy. The patients were followed for 12 months to compare the improvement. Results: In comparison to controls, test group showed a significant improvement in the Hb (0.7 vs. 0.25, P =0.003), significantly less decrease in eGFR (-2.25 vs. -2.9, P=0.049), non-significant less increase in creatinine (-0.26 ± 0.4 vs. -0.43 ± 0.33, P=0.09), significant improvement in bicarbonate levels (7.5 vs. 1, p&lt;0.0001), significant restoration of albumin (0.32 vs. 0.05, P&lt;.0001), significant fall in iPTH levels (50 vs. 25, p=0.007) and ALP levels (32 vs. 12, p=0.015). Bone density (0.28 ± 0.17 vs. 0.01 ± 0.13, P&lt;.0001) and clinical well-being VAS scores improved significantly among the cases (9.83 ± 5.65 vs. -1.67 ± 7.11, P&lt;.0001). Conclusion: In conclusion, oral alkali therapy slows the rate of decline of renal function and the development of end stage renal disease in patients with advanced stages of CKD. This cheap and simple strategy, which is in line with current renal consensus documents, also improves the nutritional status of patients and bone density.

Comparison of matrix metalloproteinase-13 and tissue inhibitor of metalloproteinase-1 levels and alveolar bone density in chronic periodontitis before and after scaling and root planning

Periodontitis is typically associated with disorders characterized by compromised tooth-supporting tissue. Damage to periodontal tissue is caused by an imbalance between matrix metalloproteinases and their inhibitors. Decreased tissue inhibitor and elevated matrix metalloproteinase levels result in collagen connective tissue and bone degradation. Several studies have shown that high levels of matrix metalloproteinase-13 (MMP-13) and low levels of tissue inhibitor of metalloproteinase-1 (TIMP-1) are also found in gingival crevicular fluid and saliva of patients with periodontitis. The purpose of this study was to determine the comparison of MMP-13 levels, TIMP-1 levels of saliva and bone density in patients with chronic periodontitis before and after scaling and root planning (SRP). The study samples were selected from patients who came for treatment at the Periodontics Installation of Universitas Sumatera Utara. A total of 16 patients were selected (n = 16) with a diagnosis of chronic periodontitis. The result showed that salivary MMP-13 levels in chronic periodontitis patients before SRP were higher than salivary MMP-13 levels after SRP and the difference was statistically significant (p &lt; 0.05). It was also revealed that salivary TIMP-1 levels and alveolar bone density in chronic periodontitis patients before SRP were lower than that after SRP and the difference was statisticallysignificant (p &lt; 0.05). There was a positive correlation between clinical parameters and salivary MMP-13 levels in patients with chronic periodontitis before and after SRP, but it was not statistically significant (p &gt; 0.05). There was a negative correlation between clinical parameters and salivary TIMP-1 levels in patients with chronic periodontitis before and after SRP, but it was not statistically significant (p &gt; 0.05).

LBSAT141 Bone Health In Patients With Adrenal Disorders

Abstract Introduction Limited data suggest low bone density in patients with adrenal adenomas. However, most studies are retrospective, single-center, and none were conducted in the United States. We aimed to determine the impact of cortisol and aldosterone excess on bone density. Methods We conducted a preliminary analysis of data from our multicenter, prospective observational study of adult patients with adrenocortical hormone excess and referent subjects without adrenal disorders (January 2019 - March 2022). Patients were diagnosed with non-functioning adenomas (NFA), adenomas with mild autonomous cortisol secretion, MACS (defined as cortisol following an overnight 1-mg dexamethasone suppression test (DST)&amp;gt;1.8 mcg/dL), adrenal or pituitary Cushing syndrome (CS), primary aldosteronism (PA), and concomitant PA-MACS. Referent subjects were patients undergoing cross-sectional imaging for reasons other than adrenal disease. All participants were interviewed about their bone health, and had bone density measurements at the spine, hips, and/or radius. Bone disease was defined as osteopenia (T-score -1.1 to -2.4), or osteoporosis (T-score &amp;lt; -2.5). Results A total of 417 participants included 156 referent subjects (88, 56% women, median age 65, range 2-95 years) and 261 patients (190, 73% women, median age 59, range 21-88 years). Patients were diagnosed with NFA (51, 19%), PA (46, 17%), MACS (122, 47%), PA-MACS (12, 5%), and CS (30,12%). When compared to referent subjects, sex- and age-adjusted analysis demonstrated an increased prevalence of bone disease only in patients with CS (OR 4.8, 95%CI 1.7-13), but not in other adrenal disorders. After excluding patients with CS, those with post-DST cortisol &amp;gt;5 mcg/dL demonstrated a higher prevalence of bone disease when compared to patients with post-DST cortisol between 1.8-5 mcg/dL (OR 2.8, 95%CI 1.2-6.5) and those with post-DST cortisol &amp;lt;1.8 mcg/dL (OR 2.7, 95% CI 1.1-6.7). Patients with MACS and post-DST cortisol between 1.8-5 mcg/dL did not demonstrate increased sex and age-adjusted prevalence of bone disease compared to those with post-DST &amp;lt;1.8 mcg/dL or referent subjects. However, using post-DST cortisol as a continuous variable, we found that after adjusting for sex and age, the risk of bone disease in patients increased by 13% (OR 1.13, 95%CI 1.6-1.2) for every 1 mcg/dL increase in post-DST cortisol. Conclusions The prevalence of osteopenia and osteoporosis increases proportional to the increase in post-DST cortisol concentrations. Patients with CS, and those with MACS and post-DST cortisol &amp;gt; 5mcg/dL have the highest prevalence of bone disease. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Експериментальне дослідження щільності кісткової тканини у хворих з уродженим псевдоартрозом кісток гомілки до та після операції за даними комп’ютерної томографії

Surgical treatment of congenital pseudarthrosis of the tibia bones is accompanied by a significant percentage of complications and refractions. One of the main reasons for the unsatisfactory results of treatment is the violation of the quality of bone tissue in the area of pseudoarthrosis, which is an obstacle to the normal process of fusion of the shin bones. Рurpose - use computed tomography to examine bone density in patients with congenital pseudoarthrosis of the tibia before and after surgery. Materials and methods. CT scans of the tibia of three patients with congenital pseudoarthrosis of the tibia, aged 5 to 7 years. The density in the Hounsfield units of the cortical layer above and below the nonunion zone was determined. Results. Prior to treatment, a significant decrease (p=0.001) in the density of the cortical layer of the tibia of the injured limb along its entire length was determined. One year after surgery, a statistically significant difference in the density of the cortical layer of the tibia remains. The optical density of the cortical layer of the damaged tibia is statistically significantly less than healthy (p=0.001). One year after surgical treatment by osteosynthesis with an intramedullary rod with axial mobility, the difference in the density of the cortical layer of the tibia of the healthy and operated limbs remains statistically significant (p=0.001) less than the bone density of the healthy limb. On the unoperated limb, a significant (p&lt;0.05) increase in optical density of bones was observed in all studied areas. Conclusions. As a result of surgical treatment of congenital pseudoarthrosis of the tibia, there is a statistically significant increase in the density of the cortical layer. The density of the cortical layer of the bones of the operated shin a year after surgery is close to the density of the bones of a healthy limb. The increase in bone density of the operated limb is due not only to the growth of patients, but also occurs due to the possibility of loading the operated limb. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Analysis for Predictors of Failure of Orthodontic Mini-implant Using Patient-Specific Finite Element Models.

In this study, we analyzed the clinical factors and mechanical parameters for predicting orthodontic mini-implant (OMI) failure in the mandible, which has different properties from the maxilla. A patient-specific finite element analysis was applied to 32 OMIs (6 failures and 26 successes) implanted between the mandibular second premolars and first molars used for anchorage. The peak stress and strain parameters were calculated for each sample. A logistic regression of the failure (vs. success) of OMIs on the mechanical parameters in the models was conducted. In addition, the influence of clinical factors on the mechanical parameters considered to be related to OMI failure was examined by a regression analysis. The mechanical parameter which best predicts OMI failure in the mandible was found to be a minimum principal strain of between 0.5 to 1.0mm from the OMI surface (R2 = 0.8033). The results indicate the patient's bone density, distance between the OMIs and adjacent root, and vertical implantation angle of the OMIs are potential clinical predictors of OMI failure in the mandible.

Prevalence of delayed puberty and low bone density in patients with epidermolysis bullosa: Insight from a large single center's experience.

Epidermolysis bullosa (EB) is a group of rare genetic skin conditions that result in skin fragility. EB can be quite severe with chronic inflammation and malnutrition impairing growth and pubertal development. These factors have potential consequences for skeletal health. We aimed to determine the prevalence of delayed puberty and low bone mineral density (BMD) for age in children and young adults with EB. Electronic medical records (EMR) of patients with confirmed EB <30 years of age at time of initial encounter at Cincinnati Children's Hospital Medical Center between January 1, 2010 and September 30, 2020 were reviewed. Natural language processing software was used to categorize pubertal status of patients with EB as early, normal or delayed. BMD was measured by dual energy x-ray absorptiometry and categorized as low if height adjusted Z-score was <-2.0 using age, sex and race specific reference ranges. 29% of individuals with EB had low BMD with most cases occurring prior to 10 years of age. Of patients who reached adolescence, 23% failed to develop any signs of puberty in the normal range (before age 13 in females or 14 in males) and BMD Z-scores further declined in these individuals. Delayed puberty is an under-recognized comorbidity of individuals with EB, especially in those with recessive dystrophic EB, and can have a significant impact on BMD.