History Of Bone Fractures Research Articles

Bone mineral density determinants in adolescents and young adults with congenital adrenal hyperplasia.

The effects of long-term glucocorticoid (GC) treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) remain controversial. This cross-sectional study aimed to evaluate BMD in relation to genotype, growth, vitamin D status, cumulative GC doses, and other relevant factors in youths with CAH. Thirty-two patients with classical CAH (13 males; mean age 26.0 ± 7.1 years) were compared with 32 healthy controls matched by age and sex. BMD was measured using dual-energy x-ray absorptiometry, and statistical analyses, including the Mann-Whitney U-test and Spearman's correlation coefficient, were performed to evaluate differences and associations. Median whole-body and lumbar BMD Z-scores were similar between CAH patients and controls (p = 0.27 and 0.15, respectively). Low bone density was observed in 12.5% of CAH patients and 18.75% of controls (p = 0.5), and osteoporosis was confirmed in 12.5% of CAH patients and 0% of controls (p = 0.04). BMD did not correlate with cumulative GC doses, estradiol, renin, phosphate, sodium levels, or anthropometric parameters in CAH patients. There was no significant difference in BMD between severe and non-severe genotypes of CAH. However, a positive correlation was found between the whole-body BMD Z-score and growth velocity during infancy (r = 0.776, p = 0.021) in CAH patients. Vitamin D deficiency was noted in 56.25% of CAH patients, although vitamin D levels did not correlate with BMD or genotype. No history of bone fractures was reported among study participants. CAH patients are at risk of developing osteoporosis, but in this study, BMD Z-scores were not associated with cumulative GC doses. The study did not identify an association between genotype and BMD. Poor growth during infancy was linked to decreased BMD in adulthood.

12372 A Rare Case Of Silicon Granulomatosis Induced Hypercalcemia In A Transgender Female

Abstract Disclosure: O.A. Aluko: None. I. Singh: None. Introduction: Hypercalcemia has been described in patients with most granulomatous disorders, of which sarcoidosis and tuberculosis are the most common. Granuloma formation is a rare, however well known complication of silicon implants and injections. We present a case of silicon granulomatosis induced hypercalcemia in a transgender female. Case Report 60-year-old transgender female, with past medical history of HIV on HAART was referred to Endocrinology for evaluation of hypercalcemia. She Bloodwork done a few weeks prior revealed elevated calcium 12.3 and low PTH of 9. Reported symptoms include worsening abdominal pain similar to prior gastritis flare, insomnia and significant weight loss. Denied any constipation, joint pain, mood changes, no history of bone fractures or kidney stones. Admitted to significant dairy intake - half a gallon of milk within 3 days and daily yogurt consumption. Endorsed inadequate daily fluid intake and she was not taking oral calcium or Vitamin D supplementation. Quit tobacco 9 years ago. Vitals were significant for tachycardia with HR 120/min, BP stable. Patient was referred to the ER for IV hydration and further evaluation with initial suspicion of malignancy. Repeat corrected calcium was 14.7, ionized calcium 6.8, PTHrP undetectable <2, borderline high 1,25 dihydroxyvitamin D 74.5, low vitamin D 17.9 and normal free T4 1.5. ACE, SPEP, UPEP levels within normal limits. Vitamin A low. CT chest/abdomen/pelvis revealed innumerable soft tissue foci in the subcutaneous adipose tissue of the flanks and lateral gluteal areas; nodular liver, suspected cirrhosis and portal hypertension. Imaging findings prompted further discussion regarding prior procedures. She endorsed history of silicone fillers in hips and breast implants 30 years ago. Images reviewed with radiology confirmed calcification around bilateral breast implants, with intracapsular rupture. Calcium improved with IV Fluids, bisphosphonates and steroids. The most probable cause of hypercalcemia was believed to be secondary to silicone granulomatosis. Innumerable granulomas were deemed irresectable, removal of the breast implants considered however not performed. She was later diagnosed with hepatitis B, cirrhosis and succumbed to sepsis and multiorgan failure. Conclusion Eliciting a detailed history, physical exam and correlating with imaging findings is imperative to establishing an uncommon diagnosis. PTHrP was low and there were no bony metastases making the possibility of malignancy related hypercalcemia less likely. FDG-PET if performed would reveal hypermetabolic nodules, often an initial indication to the underlying etiology. Presentation: 6/2/2024

Modelling the factors associated with quality of life in women with osteoporosis: A cross-sectional study

BackgroundConsidering the important factors contributing to different health-related quality of life (HRQoL) subscales is essential for implementing preventive measures to increase the HRQoL among women with osteoporosis. We here evaluated the variables related to the mental and physical HRQoL in a sample of Iranian osteoporotic women. MethodsIn this cross-sectional study, the participants included 111 women with osteoporosis in 2013. Physical and mental of HRQoL were measured by the ECOS-16 questionnaire. Other variables included BMD t-score (Osteoporosis was diagnosed based on bone mineral density (BMD) with BMD t-score < −2.5), age, body mass index, educational level, marital status, duration of the disease, history of bone fracture in the past year, the number of pregnancies, and weekly walking hours. Final regression coefficients were obtained based on the total effects of estimations (decompositions of effects into direct, indirect and total effects) by structural equation model (SEM) analysis. ResultsThe mean scores of physical and mental domains of HRQoL were 54(21) and 54(25), respectively. The mean of BMD t-score was −3.2 (0.9). Based on the regression coefficients obtained in the SEM model, weekly walking hours(2.2), number of pregnancies (−1.2), and history of bone fracture in past year(−2.9) were the more important determinants of physical aspect of HRQoL than other included variables of this study. Furthermore, age over than 60 (−9.1), history of bone fracture in past year(−4.8), weekly walking hours(2.3), marital status(−5), and education level (3.9)influenced the mental aspect of HRQoL. ConclusionsSocial and life style factors tend to impact on physical and mental domains of HRQoL, a measure that is influenced by multiple factors among postmenopausal women. In this respect, these obtained factors should be considered for health planning to improve the physical and mental domains of HRQoL among postmenopausal women.

The relationship between serum monoterpene levels and bone health: a retrospective cross-sectional analysis from the National Health and Nutrition Examination Survey (NHANES) data.

Monoterpenes, a subset of the terpene family composed of two isoprene units, have garnered significant attention in research circles owing to their potential medicinal benefits. Recent experimental studies indicate that they might exert positive effects on bone health. Nevertheless, the impact of monoterpenes exposure on bone health remains unexplored in humans. We examined 748 adults (age ≥ 40 years) from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to explore the correlation between three monoterpenes (α-pinene, β-pinene, and limonene), bone mineral density (BMD) in the total lumbar spine and proximal femur, FRAX® scores, and prior bone fracture history. Our analysis unveiled a significant inverse association between a one-unit increase in the natural logarithm (ln) of α-pinene and limonene and total proximal femur BMD (ß = -0.027, S.E. = 0.008, P = 0.004 and ß = -0.019, S.E. = 0.007, P = 0.016, respectively). As serum α-pinene levels ascended across quintiles, there was a notable decrease in total proximal femur BMD (P for trend = 0.025). The inverse relationship between ln α-pinene levels and total proximal femur BMD was more pronounced in women, especially pre-menopausal women. Compared to subjects with α-pinene and limonene levels at or below the 50th percentiles, those exceeding this threshold exhibited the lowest mean value of total proximal femur BMD (0.8628 g/cm2, S.E. = 0.026, P = 0.009). However, the trend was not statistically significant (P = 0.070). Additionally, all three monoterpenes were linked to a higher prevalence of previous spine fractures, whereas β-pinene showed a reduced incidence of other types of fractures. In this comprehensive survey of American adults aged 40 and above, higher serum levels of α-pinene and limonene correlated with decreased total proximal femur BMD. Furthermore, our findings suggest a potential combined effect of α-pinene and limonene on total proximal femur BMD. Further investigation is essential to elucidate the clinical relevance and causative nature of our findings.

Bone fracture is associated with incident myocardial infarction in long-term follow-up

BackgroundThe association between bone fracture and cardiovascular diseases is examined in this study. While basic research has established a connection between fractures and heart attacks through the linkage between bones and arteries, population studies have not provided clear evidence. The aim of the present study is to investigate the association between bone fracture and the occurrence of myocardial infarction in a natural population during long-term follow-up.MethodsA total of 13,196 adult participants with bone fracture history at baseline from the China Health and Nutrition Survey (CHNS) prospective cohort were included in this study. Baseline investigation was performed in 1997–2009 and the outcome was followed up till 2015. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using Cox proportional hazards models.ResultsFrom 1997 to 2015, a total of 329 incident myocardial infarction cases were identified. In univariate and multivariate Cox regression analysis, a history of bone fracture was associated with an increased risk of myocardial infarction incidence in the total population (for the crude model: HR = 2.56, 95% CI 1.83–3.53, P < 0.001; for the multivariate model: HR = 1.43, 95% CI 1.02–1.99, P = 0.036). In the stratified analysis, bone fracture was not associated with an increased risk of incident myocardial infarction in subjects with age < 50 years (HR = 0.71, 95% CI 0.34–1.47, P = 0.356), but significantly associated with an increased risk of incident myocardial infarction in subjects with age ≥ 50 years (HR = 1.80, 95% CI 1.23–2.63, P = 0.003).ConclusionsIt is suggested by the present study that bone fracture may be associated with an increased risk of incident myocardial infarction in the elderly population during long-term follow-up.

A Nomogram for Predicting ADHD and ASD in Child and Adolescent Mental Health Services (CAMHS).

Objectives: To enhance the early detection of Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) by leveraging clinical variables collected at child and adolescent mental health services (CAMHS). Methods: This study included children diagnosed with ADHD and/or ASD (n = 857). Three logistic regression models were developed to predict the presence of ADHD, its subtypes, and ASD. The analysis began with univariate logistic regression, followed by a multicollinearity diagnostic. A backward logistic regression selection strategy was then employed to retain variables with p < 0.05. Ethical approval was obtained from the local ethics committee. The models' internal validity was evaluated based on their calibration and discriminative abilities. Results: The study produced models that are well-calibrated and validated for predicting ADHD (incorporating variables such as physical activity, history of bone fractures, and admissions to pediatric/psychiatric services) and ASD (including disability, gender, special education needs, and Axis V diagnoses, among others). Conclusions: Clinical variables can play a significant role in enhancing the early identification of ADHD and ASD.

Symptoms of anxiety and depression among osteoporotic women

IntroductionOsteoporosis (OP) prevalence is on the rise as a result of an ageing population and lifestyle factors such as inactivity. Previous research has reported OP in individuals with depressive symptoms. Furthermore, OP has been shown to be a risk factor for anxiety.ObjectivesIn this study, we aimed to describe anxiety and depression symptoms among osteoporotic women in a university hospital in Tunisia.MethodsA cross-sectional study was conducted between January and June 2023 in a university hospital in Tunisia. Women with postmenopausal OP in the rheumatology department were interviewed. A hospital anxiety and depressive scale was used to describe anxiety and depression symptoms among patients. It consists of seven items for depression (HADS-D) and seven items for anxiety (HADS-A). For each component a score ≤ 7 indicated the absence of symptomatology.ResultsSeventy-two women diagnosed with post-menopausal OP participated in the study. The mean age was 72.5 (±1.08). The median duration of menopause was 23 years (IIQ= [10.5-28.5]). All patients were receiving bisphosphonates. Fifty-eight women (80.5%) were identified with depressive symptoms. The median depression score was 17.5 (IIQ= [9-19]). Physical activity was significantly and inversely associated with the presence of depressive symptoms (r= -6.36; p=10-3). Those who were overweight or even obese had significantly more depressive symptoms than those who were not overweight (94%, 57%, p= 0.001).The median score of anxiety was 16 (IIQ= [9-17]). Sixty-three patients (87.5%) were identified with anxiety symptoms. Physical activity was significantly and inversely associated with the presence of anxiety symptoms (r= -4.89; p=10-3). Women who had bone fractures were significantly more anxious than those without a history of bone fractures (100%, 63%, p&lt;10-3). Patients who were overweight were significantly more anxious than those with normal weight (96%, 57%, p&lt;10-3).ConclusionsPhysical activity and obesity were associated with depression and anxiety among osteoporotic patients. These data are consistent with previous findings That’s why, promoting physical activity and weight loss is essential to preventing mental disorders among osteoporotic women.Disclosure of InterestNone Declared

Evaluation of the potential implications of following a vegan diet on bone health

Cow’s milk is the primary source of calcium in the NZ diet(1). The absence of dietary planning in a vegan diet can result in the individual unknowingly obtaining low intakes of calcium. Prolonged low calcium intakes can result in negative implications on bone mineral density by increasing the risk of osteoporosis later in life. The measurement of bone health parameters in NZ vegan adults have not been investigated. Therefore, we measured bone mineral density, markers of calcium homeostasis and assessed intake of essential nutrients for optimal bone health in vegans. This cross-sectional study included adults (&gt;18yrs), who followed a vegan diet for 2 years minimum. Demographic and lifestyle information was obtained from questionnaires including previous history of bone fractures and background of familial osteoporosis. A 4-day food record was completed for analysis of calcium, zinc, protein, magnesium, phosphorus and vitamin C intake and compared to the Estimated Average Requirement (EAR)(2). Weight, height and BMI were obtained, bone mineral density was measured at the hip and spine via dual x-ray absorptiometry (DXA) and reported as Z and T scores. Plasma calcium concentrations were corrected for albumin. All values are presented as mean and standard deviation. The study included 212 participants, aged 39 ± 12.38 years, 71% female. T scores at the lumbar spine and femoral neck were −0.63 ± 1.22 (Z score: −0.29 ± 1.12) and −0.66 ± 1.00 (Z score: −0.24 ± 0.89), respectively. Nine participants had a Z-score of &lt;-2.0 at the lumbar spine, and three at the femoral neck. Corrected calcium concentrations were 2.21 ± 0.33 mmol/L. Calcium intake was 917 ± 347.23 (range 195 to 2,429 mg/day) in all participants, which exceeded the EAR of 840 mg/day for adults aged 19-50 years. Men had higher intakes of calcium than women, 1,051 ± 363.7 mg/day (range 382 to 2,267 mg/day) vs. 867 ± 328.04 mg/day (range 194 to 2,428 mg/day), P-value &lt;0.001. The main source of calcium in the vegan diet was tofu. The intake of protein (77 ± 27.80) g/day, magnesium (569 ± 181.05) mg/day, and vitamin C (145 ± 96.94) mg/day met the EAR, excluding vitamin and mineral supplements. However, the intake of phosphorus (1,472 ± 459.98) mg/day and zinc (10.6 ± 4.01) mg/day were below the EAR. The findings of this study suggest that bone health of vegans are not negatively affected by the exclusion of dairy in the diet, provided that appropriate dietary planning is included to avoid nutrient deficiencies associated with poor bone health. Despite mean intake of calcium exceeding the EAR, very low intakes demonstrated significant variations between participants.

Efficacy and safety of alendronic acid in the treatment of osteoporosis in children

Objectivesto describe the efficacy and safety of the off-label use of alendronate in the treatment of osteoporosis in children and adolescents. Methoda retrospective study (2008-2014) of all patients under 18 years who were dispensed alendronate for this indication. The criteria for initiating treatment were: bone mineral density with a Z-score < -2.5 SD, a past history of bone fractures without a previous traumatism, and persistent pain. The variables collected were: demographic, treatment-related, clinical. and safety data. The treatment was considered to be effective when there was an increase in bone mineral density up to a Z-score > -2.5 SD. Resultsa total of 12 patients, 8 of them male, with a mean age of 11 years (± 3 SD), were treated with alendronate. After a mean time of treatment of 2.15 years (± 1.2 SD), there was an increase in bone mineral density in all patients, 9 of which achieved a Z-score > -2.5 SD, so the drug was considered effective in 75% of cases. No patient had bone fractures or expressed adverse effects during treatment. Conclusionsalendronate increased bone mineral density and was well tolerated in all patients, therefore it could be considered as a therapeutic option in the treatment of osteoporosis in children.

FRI453 Genetic Heterogeneity of Hypothalamic Hypogonadism DIsorders

Abstract Disclosure: C. Bheeman: None. O. Astapova: None. Title: Genetic Heterogeneity of Hypothalamic Hypogonadism disorders. Introduction: Hypothalamic hypogonadism (HH) can be defined as having inappropriately low serum concentrations of gonadotropins in the presence of low circulating concentrations of sex steroids. It represents a group of genetically and clinically heterogeneous disorders. Case A 32-year-old female who presented to the endocrine clinic for evaluation of infertility. Patient had menarche at age 12 but became amenorrhoeic at age 14. Her physical exam was notable for normal female secondary sexual characteristics and intact sense of smell. She had no history of bone fracture or menopausal symptoms. The patient had failed the progesterone withdrawal test twice, but had withdrawal bleeding with the birth control pill or with hormonal replacement therapy. She had failed ovulation induction with clomiphene citrate, but was able to conceive 3 pregnancies through in vitro fertilization. Patient’s labs off of hormonal replacement and birth control were: LH &amp;lt;0.3. FSH 0.6, Estradiol &amp;lt;5, Progesterone 0.4. Her prolactin level was within normal limits at 6.6 and her TSH was 1.08. MRI of the brain showed no abnormalities in the pituitary gland. Genetic testing showed that the patient was heterozygous for a duplication mutation in the ANOS1 gene. Conclusion The genotypic and phenotypic heterogeneity that can be seen in HH disorders is due to the numerous genes involved in hypothalamic hypogonadism and their intricate interactions. Mutations contributing to HH can be involved in either the neurodevelopmental or neuroendocrine pathways of the hypothalamic pituitary gonadal axis or in both. There are mutations that can be inactivating variants while some can play the role of the modifier genes. The later may be able to explain the incomplete penetrance and variable expressivity sometimes seen in HH. It is important to note that though &amp;gt; 60 genes have been implicated in HH 50% of the cases remain genetically undiagnosed. This case is particularly interesting as this patient is a female with a heterozygous mutation on the ANOS1 gene, the primary gene associated with Kallmann syndrome. Kallmann syndrome is a X-linked recessive disorder and therefore the patient having phenotypical expression of the mutation is unexpected. Through the presentation of this case we aim to explore different modes of genetic expression and the different mechanisms that could have led to this patient hypothalamic hypogonadism. Presentation Date: Friday, June 16, 2023

Bone mass density in patients with rheumatoid qrthritis: Influence of disease activity

Rheumatoid arthritis (RA) can affect bone density. Given the significant risk of low bone mass density (BMD) in RA patients, the present study aims to investigate the BMD in these patients. The present cross-sectional study included 415 RA patients from the Rafsanjan Rheumatology Clinic. The patients were included in the study by census based on the inclusion criteria, which included a physician's diagnosis of RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, at least three months of disease history, and age between of 35 and 70 years. The BMD was measured using the dual-energy x-ray absorptiometry method in both the hip and the spine, and the RA severity was determined using the disease activity score-28 (DAS-28) index. The mean age of RA patients was 56.49 ± 11.73 years, with females accounting for 86.7% (300 people). The frequency of osteoporosis was 7.5% (26 people), and osteopenia was 43.6% (151 people) based on hip bone density, and 33% (137 people) and 38.1% (158 people) based on spine density, respectively. Age, fracture history, and DAS-28 score increased the probability of developing osteopenia or osteoporosis based on hip and spine bone density. According to the findings of a study in RA patients, increasing age, history of bone fracture, and DAS-28 score increase the probability of osteopenia or osteoporosis. Therefore, it is advised to pay close attention to the mentioned factors to prevent complications in these patients.

Metabolic activity of bone tissue osteoblasts in patients with chronic pancreatitis

Objective — to investigate the level and role of osteocalcin in patients with chronic pancreatitis, to determine the dependence of changes in this indicator on the vitamin D receptor gene. Materials and methods. Examinations involved 70 patients with chronic pancreatitis (CP), who formed the main group. Women (46 or 66.4%) prevailed in this group. The age of the patients was from 29 to 43 years, the mean age 33.2±2.1 years. Control group consisted of 78 practically healthy subjects. The groups were comparable in terms of age and gender ratio. The diagnostic search included the study of the polymorphism of vitamin D receptor (VDR) gene and the biochemical marker of bone tissue, osteocalcin. Their possible effects on the course of the disease and the formation of complications have been investigated. Results. In the process of determining the VDR gene polymorphism, the significant difference was found in the distribution of gene alleles (χ2=30.08, df=4; p &lt;0.01). According to the results of genetic testing, both groups of patients were divided into three subgroups: 1st subgroup (bb‑genotype carriers), 2nd subgroup (Bb‑genotype carriers), 3rd subgroup (BB‑genotype carriers). In the control group, the distribution was as follows: 27 (38.6%), 34 (48.6%) and 9 (12.8%) patients, in the main group — 13 (18.5%), 30 (42.8%) and 27 (38.7%) patients. With the presence of CP, there was a change in the distribution of alleles towards the BB genotype of the VDR gene, which was associated with a higher risk of osteoporosis. 35 (50.0%) patients with CP and 3 (3.8%) individuals from the control group had a history of bone fractures (p &lt;0.01). In CP, the average osteocalcin level was 22.20±2.53 ng/ml, 27 (38.6%) patients had normal levels, 15 (55.6%) of them had the Bb genotype, 7 (25.9%) — genotype BB, in 5 (18.5%) — genotype bb. A decrease in the level of osteocalcin below the norm (to 12.7±1.87 ng/ml) was registered in 4 (5.7%) patients, of which 2 (50.0%) had the BB genotype, 1 (25.0%) — Bb genotype, another 1 (25.0%) — bb genotype. A higher than normal level of osteocalcin (45.1±23.24 ng/ml) was recorded in 39 (55.7%) patients of the main group, of which 18 (43.6%) had the BB genotype, 14 (35.9%) — Bb genotype, 7 (20.5%) — bb genotype. Conclusions. The course of CP in most cases is accompanied by an increase in osteocalcin levels, which can be considered as an indicator of a violation of the mineral density of bone tissue. Changes in the ratio of genotypes of the VDR gene are registered in patients with CP, which gives reason to assume a violation of the absorption of vitamin D due to genetic aberrations. In the majority of patients with CP, in the presence of an unfavorable genotype (BB) of the VDR gene, an increase in the content of osteocalcin is observed, which can be explained by one of the ways of the formation of osteoporotic conditions — a violation of the differentiation of osteoblasts. Chronic pancreatitis can be considered as an unfavorable nosology that provokes interference in bone metabolism with a high probability of formation of osteoporotic conditions, which requires early diagnosis and prevention of complications.

Angiotensin II receptor blockers and bone fracture in chronic kidney disease patients: the Fukuoka kidney disease Registry Study.

Angiotensin II receptor blockers (ARBs) reportedly reduce the risk of developing bone fractures; however, this association remains unclear among patients with chronic kidney disease (CKD). This was a cross-sectional study of 3380 CKD patients enrolled in the Fukuoka Kidney disease Registry Study, a multicenter prospective observational cohort study of non-dialysis-dependent CKD patients. The patients were divided into two groups, those taking ARBs and those who were not. Logistic regression models were used to examine the association between ARBs and bone fracture. Approximately 67.0% of the participants were on ARBs, and 6.3% had a history of bone fracture. The history of bone fracture was significantly lower in patients with prescribed ARB and remained significant even after multivariable adjustment (odds ratio, 0.68; 95% confidence interval, 0.51-0.93). Other antihypertensive drugs, such as thiazide diuretics, which were reportedly helpful in preventing fractures, did not alter the bone fracture history and did not change among ARB users and non-users. The present study showed that administering ARB was significantly associated with a lower frequency of bone fracture history.

Determinant of Osteoporosis Preventive Behaviors among Perimenopausal Women: A Cross-Sectional Study to Explore the Role of Knowledge and Health Beliefs.

Osteoporosis is a silent chronic disease, and many people did not discover it until they were diagnosed with a fracture. Therefore, regular scanning and appropriate Osteoporosis Preventive Behaviors (OPB) are the management cornerstone. OPB is strongly affected by personal knowledge and health beliefs. This study explores the role of knowledge and health beliefs as determinants of OPB among perimenopausal women. This cross-sectional study was performed on 1075 perimenopausal women in Najran City, Saudi Arabia, from January 2023 to March 2023. The data collection instrument is a self-reported questionnaire consisting of basic data, the OPB scale, an osteoporosis knowledge assessment tool, and the osteoporosis health belief scale. The current study results showed that approximately one-quarter (27.8%) of the study participants had high OPB with an overall mean of 20.83 ± 5.08 grade. The group practicing high OPB demonstrated a higher knowledge mean (11.37 ± 2.99) than the low OPB group (9.93 ± 3.51). In addition, all health beliefs constructs significantly differed among the low and high OPB groups (p ˂ 0.05). The participant's age, occupational status, educational level, attendance of training courses, and history of bone fractures were significantly associated with high OPB. Osteoporosis knowledge, perceived susceptibility, perceived seriousness, exercises' perceived benefits, and health motivations are positive predictors of high OPB (p ˂ 0.05). The study concluded that osteoporosis-related knowledge and health beliefs-especially perceived susceptibility, perceived seriousness, exercises' perceived benefits, and health motivations-are positive predictors of high OPB. The health belief model can be an effective tool used to determine high-risk groups who practice low OPB and build need-based educational interventions.

Female athlete triad cross-sectional study of soccer players by level of competition.

[Purpose] To determine the actual status of the Female Athlete Triad (low energy availability, menstrual dysfunction, and bone mineral density loss) in soccer players. [Participants and Methods] The survey was conducted between February 1 and March 1, 2022. It included 115 females between the ages of 12 and 28 registered with the Japan Football Association, from teams at different levels. [Results] Players in the top league did not differ in height and weight but were older and had a better understanding of caloric intake. There were no differences in amenorrhea or history of bone fractures based on league. [Conclusion] Of the female soccer players in the four different levels of competition, only the players in the top league had a better understanding of available energy and took preventive measures against the Female Athlete Triad.

OPG/RANK/RANKL Axis in Egyptian Children With Acute Lymphoblastic Leukemia After Maintenance Therapy: Relationship to Bone Mineral and Vitamin D Status.

Policies to maximize peak bone mass in survivor's children of acute lymphoblastic leukemia (ALL) have been recognized as a priority area for research. The present study aimed to evaluate the relationship between osteoprotegerin (OPG)/receptor activator of nuclear factor kappa-B (RANK)/RANK ligand (RANKL) axis, vitamin D status, and serum magnesium in ALL survivors. Sixty ALL survivors treated with chemotherapy and 60 age and sex-matched controls were included. Vitamin D and parathyroid hormone, RANK, RANKL, and OPG levels were immunoassayed, in addition to serum calcium, phosphorus, magnesium levels, and alkaline phosphatase activity assessment. Furthermore, standard anthropometric measurement, history of fractures since treatment and clinical assessment were recorded. History of bone fractures after the start of therapy was detected in 17 ALL subjects (28.33%). Significantly lower vitamin D, magnesium, calcium, and OPG levels, meanwhile, significantly higher serum parathyroid hormone, RANK, and RANKL levels were detected in survivors compared with the control group. Vitamin D level was significantly positively correlated with magnesium, calcium, and OPG levels. Meanwhile, negatively correlated with RANK and RANKL levels. ALL survivors had a high prevalence of impaired vitamin D status, decreased Mg, and altered OPG/RANK/RANKL axis with impaired bone remodeling. The results herein may open the door for new interventional actions in ALL survivors to protect against bone resorption.

ODP075 A Rare Case of Intrathymic Parathyroid Adenoma

Abstract BACKGROUND: Parathyroid adenomas are the main cause of primary hyperparathyroidism (PHPT). PHPT most often affects adults between ages 50-60 and is considered rare in children and adolescents, representing less than 5% of cases1. It is more common among females than among males in the proportion 3 to 1. During embryogenesis, both the superior and inferior parathyroid glands detach from their pharyngeal origin and migrate towards their final location, posteriorly to the thyroid gland. Migration can be faulty and ectopic glands can appear along the path of embryologic descent2. We present a case of an adolescent male who presented with symptomatic PHPT in the setting of an intrathymic parathyroid adenoma. CASE PRESENTATION: 17-year-old male with no significant past medical history developed symptoms of anxiety, nausea and fatigue. Laboratory values revealed calcium 14.3 mg/dL (8.6-10.3), PTH 227 pg/mL (15-65), 25-dihydroxyvitamin D (vit-D) 8.31 ng/mL (30-100), and phosphorus 1.5 mg/dL (2.5-5. 0). He denied any personal history of bone fractures or nephrolithiasis. CT parathyroid scan showed an enhancing oblong 1.7×0.6 cm lesion in the left upper mediastinal space suggestive of a parathyroid adenoma. Focal sestamibi uptake confirmed a 1.7×0.6 cm enhancing nodule in the left upper anterior mediastinum within the thymus. He was instructed to take 2,000 IU of vit-D daily. Repeat blood work one month later showed that his serum calcium decreased to 13.4 mg/dL and PTH decreased to 122 pg/mL. Additional labs revealed vit-D 16.81 ng/mL, 1,25-dihydroxyvitamin D (calcitriol) 160 pg/mL (19.9-79.3) and 24-hour urine calcium excretion of 409 mg (0-320). Patient underwent successful excision of an intrathymic hyperplastic parathyroid gland adenoma with a &amp;gt;50% drop in peak PTH levels intraoperatively at 10 minutes post excision, later confirmed by pathology. CONCLUSION: This case highlights an adolescent with symptomatic primary hyperparathyroidism due to an intrathymic parathyroid adenoma. Ectopic adenomas have been reported in approximately 4 to 16% of patients with hyperparathyroidism2. When embryological development of the parathyroid glands is defective, it can predispose to the formation of ectopic glands, which is an important cause of failed parathyroid exploration. Unfortunately, PHPT has greater morbidity in the younger age group since most of these patients develop complications from the hypercalcemia, such as kidney stones, hypercalciuria, bone disease and symptoms of abdominal pain/vomiting. This case emphasizes the importance for clinicians to be aware of ectopic parathyroid adenoma in adolescents who present with symptoms and labs consistent with primary hyperparathyroidism.

Pharmacological management, and potentially inappropriate prescriptions in patients with osteoporosis

Background The treatment of osteoporosis involves medications that reduce the risk of fractures, but some medications can decrease bone density. The aim of this study was to identify the treatments, comorbidities, and prescriptions related to reducing bone mineral density in patients with osteoporosis. Research design and methods A cross-sectional study that identified patterns of anti-osteoporotic drug prescriptions for outpatient use and potentially inappropriate prescriptions for patients with osteoporosis based on the drug-dispensing database (Audifarma SA) of 8.5 million people affiliated with the Colombian Health System and six health insurance companies. All patients ≥65 years with a diagnosis of osteoporosis were included. A multivariate analysis was performed to identify variables related to potentially inappropriate prescriptions for ≥3 months (glucocorticoids, proton pump inhibitors, among others). Results A total of 16,362 patients with osteoporosis were identified. They had a median age of 74.4 years, and 47.9% received anti-osteoporotic therapy, especially diphosphonates (41.6%), and 86.5% received calcium and/or vitamin D supplement. 41.6% of those who had a history of bone fractures were prescribed anti-osteoporotic drugs. Potentially inappropriate prescriptions, especially glucocorticoids at doses greater than 5mg prednisolone equivalent (4.4%), were found in 41.4% of cases for ≥3 months and were more common in older patients (OR:1.31;CI95%:1.18-1.46) and those with a history of fractures (OR:1.14;CI95%:1.04-1.25) or with cardiovascular (OR:2.23;CI95%:2.07-2.40), digestive (OR:3.09;CI95%:2.80-3.41), neurological (OR:1.49;CI95%:1.34-1.64), psychiatric (OR:2.71;CI95%:2.42-3.03) or neoplastic comorbidities (OR:1.94;CI95%:1.59-2.36). In addition, synthetic (OR:3.62;CI95%:3.21-4.07) and biological rheumatic disease-modifying drugs (OR:2.14;CI95%:1.15-4.01) also increased the likelihood of having potentially inappropriate prescriptions. Conclusions A significant proportion of patients with osteoporosis are not treated according to clinical practice guidelines. Potentially inappropriate prescriptions were common, especially in older patients, with certain comorbidities, and those receiving comedication with antirheumatic drugs.

Real-world data on vitamin D supplementation and its impacts in systemic lupus erythematosus: Cross-sectional analysis of a lupus registry of nationwide institutions (LUNA).

BackgroundAlthough vitamin D concentration is reportedly associated with the pathogenesis and pathology of systemic lupus erythematosus (SLE), benefits of vitamin D supplementation in SLE patients have not been elucidated, to our knowledge. We investigated the clinical impacts of vitamin D supplementation in SLE.MethodsA cross-sectional analysis was performed using data from a lupus registry of nationwide institutions. We evaluated vitamin D supplementation status associated with disease-related Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) as a parameter of long-term disease activity control.ResultsOf the enrolled 870 patients (mean age: 45 years, mean disease duration: 153 months), 426 (49%) received vitamin D supplementation. Patients with vitamin D supplementation were younger (43.2 vs 47.5 years, P < 0.0001), received higher doses of prednisolone (7.6 vs 6.8 mg/day, P = 0.002), and showed higher estimated glomerular filtration rates (79.3 vs 75.3 mL/min/1.73m2, P = 0.02) than those without supplementation. Disease-related SDI (0.73 ± 1.12 vs 0.73 ± 1.10, P = 0.75), total SDI, and SLE Disease Activity Index (SLEDAI) did not significantly differ between patients receiving and not receiving vitamin D supplementation. Even after excluding 136 patients who were highly recommended vitamin D supplementation (with age ≥ 75 years, history of bone fracture or avascular necrosis, denosumab use, and end-stage renal failure), disease-related SDI, total SDI, and SLEDAI did not significantly differ between the two groups.ConclusionsEven with a possible Vitamin D deficiency and a high risk of bone fractures in SLE patients, only half of our cohort received its supplementation. The effect of vitamin D supplementation for disease activity control was not observed.

Bisphosphonate Use Is Not Associated With Tuberculosis Risk Among Patients With Osteoporosis: A Nationwide Cohort Study.

Bisphosphonates are considered an effective inhibitor of glutamine synthetase and thus can be used for treating tuberculosis (TB). However, its clinical benefit in TB remains unknown. We conducted a population-based cohort study by using the Taiwan National Health Insurance Research Database and TB databases of the Taiwan Centers for Disease Control. Patients with osteoporosis and a history of bone fracture from 2007 to 2014 were identified. Among them, bisphosphonate users and propensity score-matched nonusers were selected. A stratified multivariable Cox proportional hazard regression model was employed to investigate the independent predictors of TB. Among 218908 patients with osteoporosis and bone fracture, 46842 bisphosphonate users and 46842 propensity score-matched nonusers were selected. Within the 2-year follow-up, 723 patients-348 in the user group and 375 in the nonuser group-developed TB. Bisphosphonate use was not an independent predictor of TB in the multivariable Cox proportional hazard model (adjusted hazard ratio, 0.86; 95%CI, 0.71-1.04); however, male sex, older age, being bedridden, and steroid use were independent risk factors. The real-world data revealed that bisphosphonate use did not protect patients with osteoporosis against TB.