Bone Health Research Articles

Recent Advances in Biomaterial Design for Bone Regenerative Therapy: A Mini Review

Abstract: Longevity has been associated with morbidity and an increase in age-related illnesses, linked to tissue degeneration and gradual loss of biological functions. Bone is an important organ that gradually degenerates with increasing lifespan. The remodeling phase plays a huge role in maintaining the ability of bone to regenerate and maintain its stability and function throughout life. Hence, bone health represents one of the major challenges to elderly citizens due to the increase of injury associated with bone degeneration, such as fragility and risks of fractures. In the virtue of improving the regenerative function of bone tissues, a specialized field of bone tissue engineering (BTE) has been introduced to improve the current strategies in treating bone degenerative disorders. Most of the research performed in BTE focuses on the optimization of key components to generate new bone formation, including the scaffold. A scaffold plays a significant role in establishing the structural form that interconnects major elements of the tissue engineering triad. To date, many types of biomaterials have been explored in BTE, ranging from natural and synthetic materials to nanocomposites. However, ideal scaffolds that display excellent biocompatibility and mechanical properties, approved for clinical practices are yet available. This paper aims to describe the up-to-date advancements in scaffold for new bone generation, highlighting the essential elements and strategies in selecting suitable biomaterials for bone repair.

Nutraceuticals and Functional Foods: A Comprehensive Review of Their Role in Bone Health

Bone health is the result of a tightly regulated balance between bone modeling and bone remodeling, and alterations of these processes have been observed in several diseases both in adult and pediatric populations. The imbalance in bone remodeling can ultimately lead to osteoporosis, which is most often associated with aging, but contributing factors can already act during the developmental age, when over a third of bone mass is accumulated. The maintenance of an adequate bone mass is influenced by genetic and environmental factors, such as physical activity and diet, and particularly by an adequate intake of calcium and vitamin D. In addition, it has been claimed that the integration of specific nutraceuticals such as resveratrol, anthocyanins, isoflavones, lycopene, curcumin, lutein, and β-carotene and the intake of bioactive compounds from the diet such as honey, tea, dried plums, blueberry, and olive oil can be efficient strategies for bone loss prevention. Nutraceuticals and functional foods are largely used to provide medical or health benefits, but there is an urge to determine which products have adequate clinical evidence and a strong safety profile. The aim of this review is to explore the scientific and clinical evidence of the positive role of nutraceuticals and functional food in bone health, focusing both on molecular mechanisms and on real-world studies.

Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants.

Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69years at recruitment during 2006-2010. We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile. Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.

Metformin treatment prevents experimental metabolic syndrome-induced femoral bone marrow adiposity in rats.

Motivation for the study. Most research supports a negative association between metabolic syndrome and bone health, although there is an overall lack of consensus. Therefore, there is a need for research in this area to develop a better understanding. Main findings. Metabolic syndrome induced by a fructose-rich diet increases the adipogenic predisposition of bone marrow progenitor cells and femoral medullary adiposity in rats. Furthermore, this can be partially prevented by co-treatment with metformin. Implications. Experimental metabolic syndrome has negative effects on bone tissue and can be prevented by oral treatment with metformin as a normoglycemic drug. To determine the effect of metformin (MET) treatment on adipogenic predisposition of bone marrow progenitor cells (BMPC), bone marrow adiposity and bone biomechanical properties. 20 young adult male Wistar rats were sorted into four groups. Each of the groups received the following in drinking water: 100% water (C); 20% fructose (F); metformin 100 mg/kg wt/day (M); or fructose plus metformin (FM). After five weeks the animals were sacrificed. Both humeri were dissected to obtain BMPC, and both femurs were dissected to evaluate medullary adiposity (histomorphometry) and biomechanical properties (3-point bending). BMPC were cultured in vitro in adipogenic medium to evaluate RUNX2, PPAR-γ and RAGE expression by RT-PCR, lipase activity and triglyceride accumulation. The fructose-rich diet (group F) caused an increase in both triglycerides in vitro, and medullary adiposity in vivo; being partially or totally prevented by co-treatment with metformin (group FM). No differences were found in femoral biomechanical tests in vivo, nor in lipase activity and RUNX2/PPAR-γ ratio in vitro. DRF increased RAGE expression in BMPC, being prevented by co-treatment with MET. Metabolic syndrome induced by a fructose-rich diet increases femoral medullary adiposity and, in part, the adipogenic predisposition of BMPC. In turn, this can be totally or partially prevented by oral co-treatment with MET.

Review of bone health in women receiving endocrine therapy because of breast cancer

Review of bone health in women receiving endocrine therapy because of breast cancer

Assessing the effects of probiotic supplementation, single strain versus mixed strains, on femoral mineral density and osteoblastic gene mRNA expression in rats.

Osteoporosis is a significant health concern characterized by weak and porous bones, particularly affecting menopausal women aged 50 and above, leading to increased risk of hip fractures and associated morbidity and mortality. We conducted a study to assess the efficacy of single-strain versus mixed-strain probiotic supplementation on bone health using an ovariectomy (OVX) rat model of induced bone loss. The probiotics evaluated were Lactobacillus helveticus (L. helveticus), Bifidobacterium longum (B. longum), and a combination of both. Rats were divided into five groups: SHAM (Control negative), OVX (Control positive), OVX +L. helveticus, OVX + B. longum, and OVX + mixed L. helveticus and B. longum. Daily oral administration of probiotics at 10^8-10^9 CFU/mL began two weeks post-surgery and continued for 16 weeks. Both single-strain and mixed-strain probiotic supplementation upregulated expression of osteoblastic genes (BMP- 2, RUNX-2, OSX), increased serum osteocalcin (OC) levels, and improved bone formation parameters. Serum C-terminal telopeptide (CTX) levels and bone resorption parameters were reduced. However, the single-strain supplementation demonstrated superior efficacy compared to the mixed-strain approach. Supplementation with B. longum and L. helveticus significantly reduces bone resorption and improves bone health in OVX rats, with single-strain supplementation showing greater efficacy compared to a mixed-strain combination. These findings highlight the potential of probiotics as a therapeutic intervention for osteoporosis, warranting further investigation in human studies.

A bone remodeling approach encoding the effect of damage and a diffusive bio-mechanical stimulus

AbstractThe paper focuses on the effect of damage on the bone remodeling process. This is a crucial, although complex, aspect. A one-dimensional continuous deformable body is employed to model living bone tissue. The model incorporates the bone functional adaptation through an evolution law for an effective elastic modulus driven by mechanical feedback via a mechano-transduction diffusive signal. This type of information transduction, i.e., diffusion, is essential for the model to take into account remodeling in the case of minor injury or pathology-affected regions where there is no signal production. In addition, the model is able to also take into account potential tissue damage that may evolve over time according to a suitable evolution law. To illustrate the capability of the model to describe the mentioned complex coupled phenomena, numerical tests have been performed encompassing high external loads causing the onset of damage and cyclic loading for healing. The numerical simulations carried out via finite-element analyses yield insights into the mechanisms of bone remodeling, with the final goal of aiding clinical decisions and implant designs for bone health and repair. Overall, a key aspect of the paper is to highlight the feasibility of modeling the evolution in bone elasticity arising from the combined effect of damage and remodeling.

Vasculoendothelial dysfunction and bone health in obese children: A connection with cancers

Obesity in children, a growing global epidemic, is not merely characterized by excessive body fat but also by a cascade of metabolic and functional derangements with significant musculoskeletal consequences. One of the key underpinnings of these detrimental effects is vasculoendothelial dysfunction (VED), a multifaceted pathological process characterized by impaired endothelial cell function. The endothelium, lining the vasculature, plays a pivotal role in regulating vascular tone, inflammation, and coagulation, and its dysfunction in obese children leads to a plethora of downstream complications with profound implications for musculoskeletal and bone health. Diagnosing VED in obese children remains a challenge. Traditional cardiovascular risk factors such as hypertension and dyslipidemia are often detected long after the occurrence of endothelial dysfunction. In the context of bone sarcoma, the interaction between cancer cells and vascular endothelium in the bone microenvironment is critical. The bone is a highly vascularized tissue, and the vascular endothelium plays a role in regulating bone homeostasis. In the presence of cancer cells, altered bone microenvironment provides a milieu favorable to tumor growth and invasion. The relationship between the vascular endothelium and cancer is complex and can vary depending on the type of cancer and its microenvironment. Understanding the interactions between vascular endothelium and bone sarcoma is crucial for developing targeted therapies. New molecular and cellular mechanisms involved in these interactions are awaiting to be uncovered, shedding light on potential therapeutic strategies for cancer treatment. On a relevant note, emerging vasculoendothelial markers hold promise for early detection and intervention. Early identification of VED, through the detection of vasculoendothelial markers, opens doors for timely interventions aimed at preventing its detrimental effects on musculoskeletal and bone health in obese children

Association of muscle health impairment and atherosclerosis with major osteoporotic fracture risk in Taiwanese Vegetarians

ABSTRACT Objectives: Despite the beneficial effects of “vegetarian style” diet on atherosclerosis, it is also proven potentially detrimental to bone health. The influence of muscle health or atherosclerosis on major osteoporotic fracture (MOF) risk in vegetarians has rarely been explored. This prospective study aimed to investigate an association of MOF risk with muscle health and atherosclerosis in vegetarians. Materials and Methods: We conducted a questionnaire survey with the Mini-Nutritional Assessment (MNA) on 39 vegetarians. The 10-year probability of MOF was determined using the Taiwanese Fracture Risk Assessment (FRAX®) calculator. Appendicular skeletal muscle (ASM) mass and bone mineral density were measured with dual-energy X-ray absorptiometry. Physical performance was evaluated using the 6-min walk test (6MWT). Common carotid artery intima–media thickness (ccIMT) was determined using sonography. Serum levels of parathyroid hormone (PTH), Vitamin D, adiponectin, and leptin were measured. Results: Eleven (28.2%) of 39 vegetarians had a moderate-high risk of MOF, defined by FRAX-calculated risk ≥10%. These subjects had lower ASM (P &lt; 0.005) and 6MWT distances (P &lt; 0.01) but greater ccIMT than those with low risk. The MOF risk was negatively correlated with ASM (r = −0.51, P &lt; 0.001) and 6MWT distances (r = −0.62, P &lt; 0.001) but positively correlated with ccIMT (r = 0.56, P &lt; 0.001). Linear regression analysis revealed that MOF risk scores were negatively associated with ASM and 6MWT distance while positively associated with ccIMT. There was no significant association of MOF risk with MNA scores, serum levels of PTH, Vitamin D, adiponectin, or leptin. Conclusion: Decreased ASM mass, reduced physical performance, and atherosclerosis are significantly associated with MOF risk in vegetarians.

#1443 Bone and mineral metabolism in patients with nephropathic cystinosis as a function of age and eGFR

Abstract Background and Aims Cystinosis-associated metabolic bone disease (CMBD) is a major challenge in the treatment of patients with infantile nephropathic cystinosis (NC). Study data are limited due to small case numbers, lack of adults or patients on renal replacement therapy and/or inadequate assessment of bone health. Method We investigated markers for CMBD in all age groups (1-44 years; 61% children) and CKD stages 1-5D/T in the largest NC cohort to date with 103 German and Austrian NC patients. Skeletal comorbidity and concentrations of fibroblast growth factor 23 (FGF23), the osteoblast marker bone-specific alkaline phosphatase (BAP), the bone remodeling inhibitor sclerostin, the osteoclast marker tartrate-resistant acid phosphatase 5b (TRAP5b), the soluble receptor activator of nuclear factor kappa B ligand (sRANKL), osteoprotegerin (OPG) and the sRANKL/OPG ratio as surrogates for the regulation of osteoclastogenesis by osteoblasts were determined by ELISA, converted into age- and sex-specific z-scores and compared as a function of eGFR. Multivariable regression analyses were used to identify specific influencing factors associated with biochemical and clinical findings in pre-transplant NC patients. Results Skeletal complications occurred in two-thirds of patients, with the risk being five times higher in adults than in children. Pediatric and adult NC patients with CKD stages 1-4 showed hypophosphatemia and hypocalcemia associated with suppressed FGF23 and PTH levels and elevated BAP concentrations. This was associated with age, eGFR and treatment with phosphate and active vitamin D, suggesting more vigorous treatment of Fanconi syndrome in pre-transplant patients. As indicated by the increased TRAP5b and decreased sRANKL/OPG ratio, osteoclast activity was increased despite counterregulation by osteoblasts, which in conjunction with increased sclerostin activity may have contributed to the progressive bone loss and skeletal comorbidity in our patient cohort. Conclusion Bone health in NC progressively deteriorates with age, largely due to persistent rickets/osteomalacia associated with inadequate treatment of Fanconi syndrome and increased osteoclast activity despite osteoblast counterregulation via OPG/RANKL. Our data suggest that a primary osteoclast defect in NC promotes increased bone resorption, limiting maximal bone mass and leading to progressive bone loss and increased skeletal comorbidity.

Exploring the impact of vitamin D on tendon health: a comprehensive review.

Tendons are vital components of the musculoskeletal system, facilitating movement and supporting mechanical loads. Emerging evidence suggests that vitamin D, beyond its well-established role in bone health, exerts significant effects on tendon physiology. The aim of this manuscript is to review the impact of vitamin D on tendons, focusing on its mechanisms of action, clinical implications, and therapeutic applications. A comprehensive search of scientific electronic databases was conducted to identify articles on the effects of vitamin D ontendon health. Fourteen studies were included in this review. Five studies were performed invitro, and nine studies were conducted invivo. Despite some conflicting results, the included studies showed that vitamin D regulates collagen synthesis, inflammation, and mineralization within tendons through its interaction with vitamin D receptors. Epidemiological studies link vitamin D deficiency with tendon disorders, including tendinopathy and impaired healing. Supplementation with vitamin D shows promise in improving tendon strength and function, particularly in at-risk populations such as athletes and the elderly. Future research should address optimal supplementation strategies and explore the interplay between vitamin D and other factors influencing tendon health. Integrating vitamin D optimization into clinical practice could enhance tendon integrity and reduce the burden of tendon-related pathologies.

#129 Impact of Ramadan fasting on bone mineral metabolism in hemodialysis: a multi-center prospective study

Abstract Background and Aims Fasting is fundamental in several major religions and cultural traditions worldwide. In Islam, Ramadan fasting is characterized by daily complete eating and drinking abstinence from the dawn to sunset for an entire lunar month. Sick patients, including patients with advanced chronic kidney disease are not required to fast, however the majority of them are still choose to fast. The Impact of Ramadan fasting on bone health has not been studied prospectively. This study aims to examine the effect of Ramadan fasting on parameters of bone mineral metabolism in patients on hemodialysis. Method : This is a multi-center prospective study on 138 patients with ESKD who are maintained on intermittent hemodialysis for at least six months. Ninety-three (67%) were fasting while 45 patients (33%) did not fast. All patients' demographics, clinical and laboratory parameters were compared before and after the holy month of Ramadan. Serum biochemical parameters included serum sodium, potassium, bicarbonate, chloride, albumin, calcium, phosphorus, magnesium, intact parathyroid hormone (iPTH), FGF23, klotho, sclerostin, bone-specific alkaline phosphatase (BSAP), and tartrate-resistant alkaline phosphatase 5b (TRAP5b). Results The two groups exhibited comparable demographics and clinical parameters at baseline, except for the mean age, which was significantly lower in the fasting group (45.5 vs. 54.4 years, p-value = 0.003) and the non-smoker habit was significantly higher in the fasting group (71% vs. 56%, p-value = 0.02). There was no change in the clinical parameters by the end of Ramadan in both groups including intra-dialytic hypotension, inter-dialytic weight gain, and hypoglycemia. The basic biochemical parameters did not change significantly at the end of Ramadan in both groups, except there was an increased serum albumin level (p-value = 0.04). The BSAP levels significantly went down by the end of Ramadan in the fasting group (p-value = 0.01). The other novel serum biomarkers (FGF23, klotho, sclerostin, and TRAP5b) did not change significantly in both groups. Conclusion This multi-center prospective study demonstrates that Ramadan fasting does not significantly alter the clinical and biochemical parameters in hemodialysis patients, highlighting its safety in this population. Moreover, our findings reveal a noteworthy reduction of the higher BSAP towards normal levels in fasting patients, suggesting a potential benefit of fasting in improving high bone turnover. Further research is warranted to elucidate this phenomenon's underlying mechanisms and long-term implications, which may hold promise for managing bone health in hemodialysis patients during Ramadan fasting.

#2418 Effects of correction of acidosis on body composition and biochemical parameters in CKD patients on maintenance hemodialysis

Abstract Background and Aims Metabolic acidosis is a common problem in patients of chronic kidney disease and patients on maintenance hemodialysis. In resource poor countries, due to financial constraints frequency of dialysis and compliance to medication is adversely affected. This leads to worsening of clinical condition of patient and requirement of in hospital care, many times intensive care, further increasing cost of treatment. Metabolic acidosis has implications on bone and muscle health. Aim of our study was to assess the changes in body composition (fat percentage and lean body mass), changes in third space fluid, biochemical parameters, number of admissions and requirement of blood transfusions before and after correction of metabolic acidosis. Method This was a prospective, observational study. 25 patients on maintenance hemodialysis at our center were included in the study. Bio-impedance analysis (BIA), biochemical parameters (Complete blood counts, renal function tests, serum calcium and phosphorous, liver function tests, Blood gas analysis) were done at baseline before starting bicarbonate supplementation. Number of admissions and blood transfusions in 3 months prior to initiation of bicarbonate supplementation were noted. The oral bicarbonate supplementation was increased from baseline, based on the baseline blood gas analysis. The same parameters were assessed after 3 months and analyzed. Results At the end of 3 months we observed that there was significant reduction (p &amp;lt; 0.05) in total leucocyte counts (mean 8100/cumm to 6800/cumm), urea (mean 113.7 mg/dL to 83.72 ng/dL), creatinine (mean 7.87 mg/dL to 6.68 mg/dL), phosphorous (mean 5.18 mg/dL to 4.43 mg/dL), SGOT (mean 56.52 IU to 25.2 IU) and SGPT (mean 46.48 IU to 22.88 IU) with a trend of decrease (p ≤ 0.1) in percentage of extra cellular water (27.31% to 25.03%), lean body mass (44.27 kg to 43.0 kg) and trend of increase (p ≤ 0.1) in body fat composition (15.62 kg to 18.82 kg) and body fat percentage (26.924% to 31.90). There was a reduction in third space fluid (0.88 lit to 0.43 lit). The number of hospitalizations reduced (15 three months prior to initiation of therapy to 7 after initiation of therapy) and number of blood transfusions required also reduced (21 before initiation to 10 after initiation of therapy). Conclusion We concluded that correction of acidosis probably reduces the inflammation in patients of CKD on maintenance hemodialysis. This could be seen from the reduced total leucocyte counts, liver enzymes, urea and creatinine values. Changes in body composition with increased total fat mass, fat percentage and decreased lean mass was also noted. There was also a significant reduction in hospitalizations and number of blood transfusions.

#849 Association between types of phosphate binders and fragility fractures in patients on hemodialysis

Abstract Background and Aims Fractures that affect life expectancy and quality of life are an important outcome in patients undergoing hemodialysis. In older patients on dialysis, osteoporosis is particularly associated with fractures. Therefore, management of calcium, parathyroid hormone and phosphorus is essential to promote bone health. However, no effective treatment against osteoporosis has been established in patients with advanced chronic kidney disease Some reports have suggested that the use of calcium-based phosphate binder was favorable in bone metabolism; however, its effect on fragile fractures remains unclear. In this study, we aimed to investigate the relationship between the use of Ca-containing phosphate binders (CPB) or non-Ca-containing phosphate binders (NCPB) and fractures in patients on hemodialysis. Method A retrospective cohort study was conducted including 556 patients who started hemodialysis at our hospital between March 2004 and March 2023, and could be followed up for at least 3 months. To assess the association of the use of phosphate binders CPB or NCPB with fragile fractures, a multivariate analysis was performed using the Cox proportional hazard model with factors related to fractures as covariates. Results The mean age of the patients was 66 years, with women accounting for 28%. For up to 3 years from hemodialysis initiation, CPB, NCPB, vitamin D receptor activators (VDRA), and calcimimetics were prescribed in 35%, 52%, 72%, and 18% of patients, respectively. Of the 556 patients, 72 developed fragile fractures. A univariate analysis of factors associated with fractures revealed that the hazard ratio (HR) for fragile fractures was 0.39 [0.22-0.64] in CBP users and 0.81 [0.31-0.81] in NCPB users and both were statistically significant fracture suppressors. Multivariate analysis adjusted for significant factors in univariate analysis (age; history of fractures; BMI; levels of serum phosphorus, C-reactive protein, serum magnesium, and hemoglobin; and use or non-use of VDRA) as the covariates, demonstrated that the use of CPB and NCPB was not significantly associated with fractures (HR: 0.58 [0.31–1.05], HR: 0.58 [0.33–1.03]). However, the use of any phosphate binders was a significant fracture preventive factor with an HR of 0.43 [0.24-0.77]. Conclusion Regarding fragile fractures in patients on hemodialysis, no superiority was observed among CPB and NCPB; however, the use of either phosphate binders could reduce the risk of fragility fracture occurrence.

Role of Nutrition in the Management of Patients with Multiple Endocrine Neoplasia Type 1

Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome caused by inactivating mutations in the MEN1 tumor suppressor gene. The three main clinical manifestations of MEN1 are primary hyperparathyroidism (PHPT), duodenal–pancreatic neuroendocrine tumors (DP-NETs) and anterior pituitary tumors. Endocrine tumors in patients with MEN1 differ from sporadic tumors because of their younger age at onset, common multiple presentations and the different clinical course. MEN1 is characterized by a complex clinical phenotype; thus, patients should be followed by a multidisciplinary team of experts that includes an endocrinologist, a surgeon, a oncologist, a radiotherapist, and not least, a nutritionist. It is important to remember the fundamental role that diet plays as a primary prevention tool, together with a healthy and active lifestyle in preventing osteoporosis/osteopenia and reducing the risk of developing kidney stones due to hypercalciuria, two frequent clinical complications in MEN1 patients. Is very important for MEN1 patients to have an adequate intake of calcium, vitamin D, magnesium and phosphate to maintain good bone health. The intake of foods containing oxalates must also be kept under control because in combination with calcium they concur to form calcium oxalate crystals, increasing the risk of nephrolithiasis. Another aspect to consider is the management of patients with pancreatic neuroendocrine tumors undergoing major surgical resections of the pancreas that can lead to alterations in digestion and absorption mechanisms due to partial or total reduction in pancreatic enzymes such as amylase, lipase, and protease, resulting in malabsorption and malnutrition. Therefore, the nutritionist’s aim should be to devise a dietary plan that takes into consideration each single patient, educating them about a healthy and active lifestyle, and accompanying them through various life stages by implementing strategies that can enhance their quality of life.

#1128 Accuracy of shorter iohexol glomerular filtration rate measurement protocols in individuals with preserved kidney function

Abstract Background and Aims Measuring glomerular filtration rate (mGFR) using exogenous tracers is recommended in a number of settings with plasma one-compartment multi-sample protocols (MSP) being the most commonly used and iohexol being the dominant tracer. The accuracy of MSP protocols has mostly been evaluated in the setting of reduced GFR where delayed initial and final samples are recommended. Much less is known about MSPs when GFR is not decreased and the default protocol tends to include initial sampling at 120 minutes and final sampling at 240 minutes post iohexol injection. The objective of this study was to assess the performance of shorter MSPs with earlier initial (60 and 90 minutes) and final (150, 180, and 210 minutes) sampling times in individuals with preserved GFR. Method Participants were recruited from a 4-year prospective, observational study evaluating the cardiovascular, renal, and bone health profile of young adults with Type 1 Diabetes. The reference mGFR was calculated using a plasma iohexol clearance one compartment slope intercept method with 5 samples collected between 120-240 minutes post iohexol injection. Four different combinations of shorter sampling strategies were investigated: 60-150 min, 60-180 min, 90-180 min and 90-210 min. Performance was evaluated using measurements of bias, precision, and accuracy (P2, P5, and mean absolute error). Results Mean age of the 43 participants was 23.9 ± 1.9 yrs with a mean eGFRCKiD-1 of 95.5 ± 15.9 ml/min/1.73 m2 and mean reference mGFR (120-240 min) of 102.3 ± 13.7 ml/min/1.73 m2. All exploratory shorter mGFRs performed well, with median biases less than 1 ml/min/1.73 m2 and mean absolute error less than 1.6 ml/min/1.73 m2. All shorter mGFRs were within 5% of the reference mGFR and the majority were within 2%. Conclusion These results demonstrate that shortening the mGFR procedure in individuals with preserved GFR provided very similar results to the current standard while significantly decreasing procedure time. The cost savings and improved feasibility of these shortened protocols should reduce some of the barriers to more widespread adoption of GFR measurement.

Discussion on protein recommendations for supporting muscle and bone health in older adults: a mini review

Discussion on protein recommendations for supporting muscle and bone health in older adults: a mini review

Dietary inclusion of phytase and stimbiotic decreases mortality and lameness in a wire-ramp challenge model in broilers.

AbstractLameness due to bacterial chondronecrosis with osteomyelitis (BCO) is an infection of weak bone by opportunistic bacteria that infiltrate the circulation as a result of immune suppression or gastrointestinal deterioration. One mitigating strategy is the dietary inclusion of products to support overall broiler robustness and bone health. To test the ability of phytase and stimbiotic supplements to alleviate lameness, broilers were reared for 56 days on either litter flooring or wire ramps to induce BCO and fed one of 6 diets: positive control (PC); negative control (NC, Ca and P deficient); PC plus stimbiotic; PC plus stimbiotic and phytase; NC plus phytase; NC plus stimbiotic and phytase. Stimbiotic was added at 100 g/tonne, and phytase at 3000 FTU/kg. Birds were scored for BCO on d56, or when culled for lameness. All-cause mortality was higher on ramp as compared to litter, regardless of treatment. Lameness was significantly induced by wire ramps, with the greatest incidence in the NC diet. Importantly, the addition of stimbiotic and phytase to the NC diet reduced lameness by ∼50%. Femur BCO scores were similarly reduced, with ∼60% of femurs scored ≥1 in the NC group compared to 30-37% in stimbiotic and phytase supplemented groups, indicating that these supplements can impact the onset/progression of lameness in poultry. There was no correlation between plasma and bone inositol levels; however, wire flooring reduced bone inositol, regardless of diet. Additionally, blood pH was greater and circulating PCO2, HCO3, BE, TCO2, K, hematocrit, and hemoglobin were lower on ramp compared to litter flooring.

Osteoporosis screening in Australian community pharmacies: A mixed methods study.

Osteoporosis and poor bone health impact a large proportion of the Australian population, but is drastically underdiagnosed and undertreated. Community pharmacies are a strategic location for osteoporosis screening services due to their accessibility and the demographic profile of customers. The aim of this study was to develop, implement and evaluate a community pharmacy health promotion service centred on encouraging consumers to complete an anonymous osteoporosis screening survey called Know Your Bones. The implementation process was documented using the REAIM (reach, effectiveness, adoption, implementation, maintenance) framework. Uptake of the Know Your Bones screening tool was monitored anonymously with website traffic. Surveys and interviews were designed to capture consumer outcomes after screening. Semi-structured interviews were conducted with Australian community pharmacy stakeholders during design and implementation phases to explore their perspectives of the barriers and facilitators. The service was implemented in 27 community pharmacies. There were 448 visits to the screening website. Interviews were conducted with 41 stakeholders. There were a range of factors that appeared to influence implementation of the service. Perceived acceptability was critical, which depended on staff training, pharmacists' altruism, and remuneration. Staff relied heavily on their existing close relationships with consumers. No consumers completed non-anonymous surveys or agreed to participate in interviews post-screening. Using an implementation science approach, a community pharmacy osteoporosis screening service for the Australian context was designed and found to be acceptable to pharmacy staff and effective in reaching the target population. SO WHAT?: This low-cost and non-invasive health promotion has potential to sustainably increase national screening rates for osteoporosis.

Perioperative Nutritional, Functional, and Bone Health Optimization in Spine Surgery: A National Investigation of Spine Surgeons' Perceptions and Practices.

While perioperative nutritional, functional, and bone health status optimization in spine surgery is supported with ample evidence, the implementation and surgeon perception regarding such efforts in clinical practice remain largely unexplored. This study sought to assess the current perception of spine surgeons and implementation regarding the nutritional, functional status, and bone health perioperative optimization. An anonymous 30-question survey was distributed to orthopaedic spine fellowship and neurosurgery program directors identified through the North American Spine Society and American Association of Neurological Surgeons contact databases. The questionnaire was completed by 51 surgeon survey respondents. Among those, 62% reported no current formal nutritional optimization protocols with 14% not recommending an optimization plan, despite only 10% doubting benefits of nutritional optimization. While 5% of respondents perceived functional status optimization as nonbeneficial, 68% of respondents reported no protocol in place and 46% noted a functional status assessment relying on patient dependency. Among the respondents, 85% routinely ordered DEXA scan if there was suspicion of osteoporosis and 85% usually rescheduled surgery if bone health optimization goals were not achieved while 6% reported being suspicious of benefit from such interventions. While most responding spine surgeons believe in the benefit of perioperative nutritional and functional optimization, logistical and patient compliance challenges were noted as critical barriers toward optimization. Understanding surgeon perception and current practices may guide future efforts toward advancement of optimization protocols.