Bone Mass In Adolescents Research Articles

Use of selective serotonin reuptake inhibitors and bone mass in adolescents: An NHANES study

ContextSelective serotonin reuptake inhibitors (SSRIs) are commonly prescribed medications to treat depression and anxiety. SSRIs exert their effects by inhibiting the serotonin transporter and modulating extracellular serotonin levels, a neurotransmitter that has been shown to affect bone metabolism in animals. Studies in adults suggest a negative association between SSRI use and bone mineral density (BMD), greater rates of bone loss with SSRI use and increased risk of fractures. However, the results on bone mass have been inconsistent. Furthermore, there is a dearth of studies examining an association between SSRI use and bone mass in the pediatric and adolescent age group. ObjectiveTo investigate associations between SSRI use and bone mass in adolescents. DesignCross-sectional analysis of data from the 2005–2010 National Health and Nutrition Examination Study (NHANES). Participants4303 NHANES participants aged 12–20years. The mean age was 15.65±2.42years. Main outcomesTotal femur, femoral neck and lumbar spine bone mineral content (BMC) and BMD assessed via dual-energy X-ray absorptiometry (DXA). Results62 out of 4303 subjects used SSRIs. SSRI use was an independent predictor of bone mass after adjusting for age, gender, height and weight Z score, socioeconomic status, physical activity, serum cotinine level and race/ethnicity. After multivariable adjustment, total femur BMC was 8.8% lower among SSRI users versus non-users (mean difference 2.98g, SE±0.105g, p=0.0006), while total femur BMD was 6.1% lower (mean difference 0.06g/cm2, SE±0.002g/cm2, p=0.016). Femoral neck BMC and BMD and lumbar spine BMC were similarly negatively associated with SSRI use. Compared to nonusers, lumbar spine BMC was 7% lower among SSRI users (mean difference 0.97g, SE±0.048g, p=0.02) and BMD was 3.2% lower (mean difference 0.03g/cm2, SE±0.015g/cm2, p=0.09). Sub-analysis of those individuals treated for more than 6months yield similar results. Finally, the association of SSRIs with bone mass persisted after excluding individuals with Body Mass Index (BMI) less than 5th percentile thus accounting for the possible confounding effect of anorexia nervosa, which can be treated with SSRIs. ConclusionIn this NHANES study, adolescents treated with SSRIs had lower DXA measurements of the total femur and lumbar spine compared to SSRI non-users. These findings support the need for future prospective studies to examine the effects of SSRI use on bone mass in adolescents.

Effect of a program of short bouts of exercise on bone health in adolescents involved in different sports: the PRO-BONE study protocol.

BackgroundOsteoporosis is a skeletal disease associated with high morbidity, mortality and increased economic costs. Early prevention during adolescence appears to be one of the most beneficial practices. Exercise is an effective approach for developing bone mass during puberty, but some sports may have a positive or negative impact on bone mass accrual. Plyometric jump training has been suggested as a type of exercise that can augment bone, but its effects on adolescent bone mass have not been rigorously assessed. The aims of the PRO-BONE study are to: 1) longitudinally assess bone health and its metabolism in adolescents engaged in osteogenic (football), non-osteogenic (cycling and swimming) sports and in a control group, and 2) examine the effect of a 9 month plyometric jump training programme on bone related outcomes in the sport groups.Methods/DesignThis study will recruit 105 males aged 12–14 years who have participated in sport specific training for at least 3 hours per week during the last 3 years in the following sports groups: football (n = 30), cycling (n = 30) and swimming (n = 30). An age-matched control group (n = 15) that does not engage in these sports more than 3 hours per week will also be recruited. Participants will be measured on 5 occasions: 1) at baseline; 2) after 12 months of sport specific training where each sport group will be randomly allocated into two sub-groups: intervention group (sport + plyometric jump training) and sport group (sport only); 3) exactly after the 9 months of intervention; 4) 6 months following the intervention; 5) 12 months following the intervention. Body composition (dual energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance), bone stiffness index (ultrasounds), physical activity (accelerometers), diet (24 h recall questionnaire), pubertal maturation (Tanner stage), physical fitness (cardiorespiratory and muscular), bone turnover markers and vitamin D will be measured at each visit.DiscussionThe PRO-BONE study is designed to investigate the impact of osteogenic and non-osteogenic sports on bone development in adolescent males during puberty, and how a plyometric jump training programme is associated with body composition parameters.

Review of Ca Metabolic Studies and a Model for Optimizing Gastrointestinal Ca Absorption and Peak Bone Mass in Adolescents

Purpose: The objective of this study is to review researches regarding factors that potentially affect adolescent calcium (Ca) metabolism, and to suggest a potential modeling approach for optimizing gastrointestinal Ca absorption and peak bone mass. Background: Optimal gastrointestinal Ca absorption is a key to maximizing peak bone mass in adolescents. Urine Ca excretion in adolescents rises only after bone accretion is saturated, indicating that higher intestinal Ca absorption and bone retention is necessary to ensure maximum bone accretion. Hence, maximizing peak bone mass is possible by controlling the factors influencing gastrointestinal Ca absorption and bone acc retion. However, a mechanism that explains the unique adolescent Ca metabolism has not yet been elucidated. Review: Dietary factors that enhance gastrointestinal Ca absorption may increase the available Ca pool usable for bone accretion, and a specific hormone may direct optimal Ca utilization to maximize peak bone mass. IGF-1 is an endocrine hormone whose levels peak during adolescence and increase fractional Ca absorption and bone Ca accretion. Prebiotics, generally obtained from dietary sources, have been reported to exert a beneficial effect on Ca absorption via microbiota activity. We selected and reviewed three candidates that could be used to propose a comprehensive Ca metabolic model for optimal Ca absorption and peak bone mass in adolescents. Modeling: Modeling has been used to investigate Ca metabolism and its regulators. Herein, we reviewed previous Ca modeling studies. Based on this review, we proposed a method for developing a comprehensive model that includes regulatory effectors of IGF-1 and prebiotics.

Major depressive disorder and bone mass in adolescents and young adults.

Depression has been associated with reduced bone mass in adults, but the mechanisms remain unclear. In addition, little is known about the association between depression and bone health during growth and development. To address this knowledge gap, we examined bone density and structure in 222 adolescents and young adults (69% females, mean ± SD age: 19.0 ± 1.5 years), enrolled within 1 month of starting a selective serotonin reuptake inhibitor (SSRI) or unmedicated. Psychiatric functioning was assessed with self-report and researcher-administered instruments, including the Longitudinal Interval Follow-up Evaluation for Adolescents (A-LIFE). Anthropometric and laboratory measures included dual-energy x-ray absorptiometry and peripheral quantitative computed tomography scans. Linear multivariable regression analysis tested the association between depression and bone mass, after accounting for relevant confounders. The presence of current depression was associated with a significant reduction in age-sex-height-race-specific bone mineral density (BMD) and content (BMC) of total body less head and lumbar spine. The findings varied by assessment method with self-report scales, capturing symptom severity over the prior week or two, yielding the weakest associations. Depression was also associated with reduced cortical thickness and a trend for increased endosteal circumference. In contrast, generalized anxiety disorder was not associated with bone deficits. In sum, depressive illness is associated with significantly lower bone mass in youths. Future investigations must examine whether bone recovery is possible following depression remission or whether remedial interventions are warranted to optimize bone mass in order to minimize the long-term risk of osteoporosis.

Bone health in eating disorders

Eating disorders (EDs) put adolescents and young adults at risk for impaired bone health. Low bone mineral density (BMD) with ED is caused by failure to accrue peak bone mass in adolescence and bone loss in young adulthood. Although ED patients diagnosed with bone loss may be asymptomatic, some suffer bone pains and have increased incidence of fractures. Adolescents with ED are prone to increased prevalence of stress fractures, kyphoscoliosis and height loss. The clinical picture of the various EDs involves endocrinopathies that contribute to impaired bone health. Anorexia nervosa (AN) is characterized by low bone turnover, with relatively higher osteoclastic (bone resorptive) than osteoblastic (bone formation) activity. Bone loss in AN occurs in both the trabecular and cortical bones, although the former is more vulnerable. Bone loss in AN has been shown to be influenced by malnutrition and low weight, reduced fat mass, oestrogen and androgen deficiency, glucocorticoid excess, impaired growth hormone-insulin-like growth factor 1 axis, and more. Bone loss in AN may not be completely reversible despite recovery from the illness. Treatment modalities involving hormonal therapies have limited effectiveness, whereas increased caloric intake, weight gain and resumption of menses are essential to improved BMD.

Fracture patterns and bone mass in South African adolescent–mother pairs: the Birth to Twenty cohort

SummaryThe associations of fracture prevalence and bone mass in adolescents with maternal fracture history and bone mass have not been investigated previously in South Africa. Maternal bone mass has a significant inverse association with their adolescents' fracture rates and bone mass across all ethnic groups.IntroductionDifferences in fracture rates and bone mass between families and individuals of different ethnic origins may be due to differing lifestyles and/or genetic backgrounds. This study aimed to assess associations of fracture prevalence and bone mass in adolescents with maternal fracture history and bone mass, and sibling fracture history.MethodsData from 1,389 adolescent–biological mother pairs from the Birth to Twenty longitudinal study were obtained. Questionnaires were completed on adolescent fractures until 17/18 years of age and on sibling fractures. Biological mothers completed questionnaires on their own fractures prior to the age of 18 years. Anthropometric and bone mass data on adolescent–biological mother pairs were collected.ResultsAn adolescent's risk of lifetime fracture decreased with increasing maternal lumbar spine (LS) bone mineral content (BMC; 24 % reduction in fracture risk for every unit increase in maternal LS BMC Z-score) and increased if they were white, male, or had a sibling with a history of fracture. Adolescent height, weight, male gender, maternal bone area and BMC, and white ethnicity were positive predictors of adolescent bone mass. White adolescents and their mothers had a higher fracture prevalence (adolescents 42 %, mothers 31 %) compared to the black (adolescents 20 %, mothers 6 %) and mixed ancestry (adolescents 20 %, mothers 16 %) groups.ConclusionMaternal bone mass has a significant inverse association with their adolescent off-springs' fracture risk and bone mass. Furthermore, there is a strong familial component in fracture patterns among South African adolescents and their siblings.

Decreased levels of physical activity in adolescents with down syndrome are related with low bone mineral density: a cross-sectional study

BackgroundDown syndrome (DS) has been described as one of the main contributors for low bone mineral density (BMD). Physical activity (PA) is a key factor in skeletal health and thus, PA levels might be associated to the risk of developing osteoporosis. Therefore, the aims were (1) to describe PA patterns in adolescents with DS compared to their counterparts and (2) to determine the relationships between PA and the risk of having low bone mass in adolescents with DS.MethodsNineteen adolescents (10 girls) with DS and 14 without disabilities (7 girls) participated in the study. Minutes in different PA intensities were objectively assessed with accelerometers (ActiTrainer). Moreover adolescents with DS were classified into PA tertiles taking into account the amount of total minutes of PA at any intensity, resulting in those performing low, medium or high of PA (lowPA, medPA and highPA). BMD was measured at the whole body, hip and lumbar spine with dual-energy X-ray absorptiometry and the BMD Z-score was calculated for each region taking into account age- and sex-matched reference data. Student’s unpaired t-tests and analysis of covariance were used to compare variables between different conditions (DS vs. control) and PA levels (low, medium and high).ResultsNone of the adolescents with DS achieved the minimum of 60 min of daily moderate to vigorous PA (VPA) intensity recommended by PA guidelines; adolescents with DS group spent less time in sedentary and in VPA and more time in light PA than those without DS (p < 0.05). Adolescents with DS showed lower BMD Z-score values than those without (p < 0.05). Those adolescents with DS allocated in the lowPA tertile showed significant lower BMD Z-score at the hip and a general tendency towards lower BMD Z-score was found at whole body and lumbar spine compared to those in highPA tertile and (p < 0.05).ConclusionsAdolescents with DS in the highPA tertile showed lower risk of developing future osteoporosis by having higher BMD Z-score at the hip. This data provides an idea regarding the importance of accumulated minutes of PA, and not only moderate or vigorous in the bone health in adolescents with DS.

Fracture patterns and bone mass in South African adolescent-mother pairs: the Birth to Twenty Cohort

Summary The associations of fracture prevalence and bone mass in adolescents with maternal fracture history and bone mass have not been investigated previously in South Africa. Maternal bone mass has a significant inverse association with their adolescents' fracture rates and bone mass across all ethnic groups.

A New Insight to Bone Turnover: Role of ω‐3 Polyunsaturated Fatty Acids

Background. Evidence has shown that long-chain polyunsaturated fatty acids (LCPUFA), especially the ω-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are beneficial for bone health and turnover. Objectives. This review summarizes findings from both in vivo and in vitro studies and the effects of LC PUFA on bone metabolism, as well as the relationship with the oxidative stress, the inflammatory process, and obesity. Results. Some studies in humans indicate that LCPUFA can increase bone formation, affect peak bone mass in adolescents, and reduce bone loss. However, the cellular mechanisms of action of the LCPUFA are complex and involve modulation of fatty acid metabolites such as prostaglandins, resolvins and protectins, several signaling pathways, cytokines, and growth factors, although in certain aspects there is still some controversy. LCPUFA affect receptor activator of nuclear factor κ β (RANK), a receptor found on the osteoclast, causing bone resorption, which controls osteoclast formation. Conclusions. Since fatty acids are an endogenous source of reactive oxygen species, free radicals alter the process of bone turnover; however, although there are clinical evidences linking bone metabolism and dietary lipids, more clinical trials are necessary to prove whether ω-3 PUFA supplementation plays a major role in bone health.

The association between breastfeeding, maternal smoking in utero, and birth weight with bone mass and fractures in adolescents: a 16-year longitudinal study

The aim of this birth cohort study was to determine whether early life factors (birth weight, breastfeeding, and maternal smoking) were associated with bone mass and fractures in 16-year-old adolescents. The results suggest that breastfeeding is associated with higher bone mass and lower fracture risk at age 16 but not in utero smoking or birth weight. There are limited data on early life influences on bone mass in adolescence but we have previously reported in utero smoking, breastfeeding, and birth weight were associated with bone mass at age 8. Birth weight, breastfeeding intention and habit, and maternal smoking during pregnancy were assessed at phase one in 1988-1999 and by recall during phase two in 1996-1997. Bone mineral density (BMD) was measured by dual-energy X-ray densitometry. Fractures were assessed by questionnaire. Subjects included 415 male and female adolescents from Southern Tasmania representing 29 % of those who originally took part in a birth cohort study in 1988 and 1989. Breastfeeding (assessed in a number of ways) was associated with a 2-3 % increase in BMD at all sites apart from the radius and around a one third reduction in fracture risk which persisted after adjustment for confounders. In univariate analysis, birth weight was associated with BMD at the hip, radius, and total body but this did not persist in multivariate analysis and there was no association with fracture. Smoking in utero had no association with BMD at any site or fracture. Breastfeeding is associated with a beneficial increase in bone mass at age 16 and a reduction in fracture risk during adolescence. The association previously observed at 8 years of age is no longer present for birth weight or smoking in utero.

Sedentary behaviours and its association with bone mass in adolescents: the HELENA cross-sectional study

BackgroundWe aimed to examine whether time spent on different sedentary behaviours is associated with bone mineral content (BMC) in adolescents, after controlling for relevant confounders such as lean mass and objectively measured physical activity (PA), and if so, whether extra-curricular participation in osteogenic sports could have a role in this association.MethodsParticipants were 359 Spanish adolescents (12.5-17.5 yr, 178 boys,) from the HELENA-CSS (2006–07). Relationships of sedentary behaviours with bone variables were analysed by linear regression. The prevalence of low BMC (at least 1SD below the mean) and time spent on sedentary behaviours according to extracurricular sport participation was analysed by Chi-square tests.ResultsIn boys, the use of internet for non-study was negatively associated with whole body BMC after adjustment for lean mass and moderate to vigorous PA (MVPA). In girls, the time spent studying was negatively associated with femoral neck BMC. Additional adjustment for lean mass slightly reduced the negative association between time spent studying and femoral neck BMC. The additional adjustment for MVPA did not change the results at this site. The percentage of girls having low femoral neck BMC was significantly smaller in those participating in osteogenic sports (≥ 3 h/week) than in the rest, independently of the cut-off selected for the time spent studying.ConclusionsThe use of internet for non-study (in boys) and the time spent studying (in girls) are negatively associated with whole body and femoral neck BMC, respectively. In addition, at least 3 h/week of extra-curricular osteogenic sports may help to counteract the negative association of time spent studying on bone health in girls.

The Association of Fasting Insulin, Glucose, and Lipids with Bone Mass in Adolescents: Findings from a Cross-Sectional Study

It is unclear whether variation in insulin resistance mediates the positive association of fat mass with bone mass in children/adolescents. Our objective was to examine whether markers linked to insulin resistance [fasting insulin, glucose, triglycerides, and high-density lipoprotein cholesterol (HDLc)] are associated with bone mass in adolescents, and if they are, to examine whether they mediate the fat mass-bone mass association. We conducted a cross-sectional analysis in participants from the Avon Longitudinal Study of Parents and Children. Participants included 2305 (1100 male) individuals of mean age 15.5 yr. We evaluated total body less head bone mineral content (BMC) (grams), bone area (BA) (square centimeters), and bone mineral density (BMD) (grams per square centimeter) from a dual-energy x-ray absorptiometry scan. Fat mass, fasting insulin, and triglycerides were positively associated with BMD, BMC, and BA; HDLc was inversely associated with these outcomes. For example, the adjusted mean difference in BMC per 1 sd fasting insulin was 45 g (95% confidence interval = 17-73 g) in males and 50 g (95% confidence interval = 28-72 g) in females. When the associations of fat mass with outcomes were adjusted for markers of insulin resistance, they were largely unchanged. Associations of triglycerides and HDLc with outcomes were attenuated to the null when they were adjusted for fat mass, whereas those of insulin changed direction; i.e. with adjustment for fat mass, higher fasting insulin was associated with lower BMD, BMC, and BA. Fasting insulin, glucose, and lipids do not appear to mediate the positive association of fat mass with bone mass in children/adolescents. The inverse association of fasting insulin with BMD, BMC, and BA once fat mass has been controlled for needs further study.

Neuroendocrine dysregulation and the growth hormone–IGF-1 axis in anorexia nervosa

Anorexia nervosa is a common psychiatric disorder characterized by extreme, self-induced starvation and is associated with a number of medical complications, including significant loss of bone mass. Disruption of the hypothalamic–pituitary axis has been demonstrated in anorexia nervosa and contributes to both loss of established bone mass in adults and failure to accrue normal bone mass in adolescents. Anorexia nervosa is associated with the development of a state of acquired growth hormone (GH) resistance, characterized by low IGF-1 and elevated GH levels, which may be mediated in part by FGF-21. Administration of supraphysiologic recombinant human GH does not result in an increase in markers of bone formation. However, treatment with recombinant human IGF-1, in combination with an oral contraceptive, increases markers of bone formation as well as bone mineral density, and may be a novel way to treat the bone loss associated with anorexia nervosa.

Vitamin D status and physical activity interact to improve bone mass in adolescents. The HELENA Study

The effects of vitamin D concentrations on bone mineral content in adolescents are still unclear. Vitamin D and physical activity (PA) may interact to determine bone mineral content (BMC) in two possible directions; 25(OH)D sufficiency levels improve BMC only in active adolescents, or PA increases BMC in individuals with replete vitamin D levels. The effects of suboptimal 25-hydroxycholecalciferol (25(OH)D) concentrations on BMC in adolescents are still unclear. The main aim of this study was to evaluate the influence of 25(OH)D on BMC in adolescents, considering the effect of body composition, sex, age, Tanner stage, season, calcium and vitamin D intakes, physical fitness and PA. Serum 25(OH)D concentrations, anthropometric measurements, dual energy X-ray absorptiometry measurements, calcium and vitamin D intakes, PA and physical fitness were obtained in 100 Spanish adolescents (47 males), aged 12.5-17.5years, within the framework of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Relations were examined using ANCOVA and regression analyses including BMC as dependent variable. Linear regression of BMC suggested that 25(OH)D concentrations independently influenced total and leg BMC after controlling for age, sex, lean mass, seasonality and calcium intake (B = 0.328, p < 0.05, and B = 0.221, p < 0.05, respectively) in the physically active group. No significant influence of 25(OH)D concentrations on BMC was observed in the inactive group. Significant effect was shown between the interaction of 25(OH)D and PA on BMC for the total body and legs (both p < 0.05). Vitamin D and PA may interact to determine BMC. 25(OH)D sufficiency levels improve bone mass only in active adolescents, or PA has a positive influence on BMC in individuals with replete vitamin D levels.

Habitual Levels of Vigorous, But Not Moderate or Light, Physical Activity Is Positively Related to Cortical Bone Mass in Adolescents

Habitual Levels of Vigorous, But Not Moderate or Light, Physical Activity Is Positively Related to Cortical Bone Mass in Adolescents

Levels of Physical Activity That Predict Optimal Bone Mass in Adolescents: The HELENA Study

Levels of Physical Activity That Predict Optimal Bone Mass in Adolescents: The HELENA Study

Habitual Levels of Vigorous, But Not Moderate or Light, Physical Activity Is Positively Related to Cortical Bone Mass in Adolescents

Habitual Levels of Vigorous, But Not Moderate or Light, Physical Activity Is Positively Related to Cortical Bone Mass in Adolescents

Are early growth and nutrition related to bone health in adolescence? The Copenhagen Cohort Study of infant nutrition and growth

It is generally accepted that peak bone mass affects later fracture risk in the elderly. The extent to which early nutrition and growth can program later bone health has been examined in only a few studies. In the Copenhagen Cohort Study we showed that breastfed infants had significantly higher serum (s)-osteocalcin concentration than did formula-fed infants. We investigated whether early nutrition and early growth are associated with later bone mass in adolescence. Participants were examined at birth; at ages 2, 6, and 9 mo (n = 143); and at age 17 y (n = 109) with anthropometric and s-osteocalcin measures and whole-body dual-energy X-ray absorptiometry (DXA) scanning (age 17 y only). Total body (T) and lumbar spine (LS) DXA values were used. The duration of exclusive breastfeeding was positively correlated with the sex-adjusted LS bone mineral content (BMC), LS bone area (BA), and LS bone mineral density (BMD) (all P < 0.03) and with size-adjusted LS-BMC (P = 0.075) at 17 y of age. s-Osteocalcin at 6 mo was positively correlated with sex-adjusted LS-BMC and LS-BMD (both P < 0.04) and with size-adjusted LS-BMC (P = 0.047) at 17 y of age. Weight and length at 9 mo and increase in weight and length during the first 9 mo of life were positively correlated with sex-adjusted T-BMC and T-BA at age 17 y (all P < 0.04). Early body size and growth in infancy are related to bone mass in late adolescence. Furthermore, the duration of exclusive breastfeeding and the markers of bone turnover at 6 mo seem to be positively related to LS bone mass at age 17 y.

Socioeconomic Status and Bone Mass in Spanish Adolescents. The HELENA Study

Socioeconomic status (SES) has been frequently associated with body composition, particularly fat mass and obesity. However, the SES-bone mass association is not clear. We aimed to evaluate the associations between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mineral content in Spanish adolescents. Participants were 322 adolescents (164 boys and 158 girls, 12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence study. The social background of the adolescents was self-reported using an SES questionnaire, and the bone variables were measured using dual-energy x-ray absorptiometry. Physical activity was measured using accelerometers. Calcium intake was estimated from two nonconsecutive 24 hours recalls. One-way analysis of covariance was performed to examine the relationships between SES indicators and bone mass using different sets of confounders: basic model (sex + sexual maturation), model 1 (basic model + height), model 2 (basic model + lean mass), and model 3 (basic model + calcium intake + average physical activity). Adjusted results showed no association between SES indicators and whole-body or total hip bone mineral content. Additional analyses were performed in lumbar spine, pelvis, and hip subregions (femoral neck, trochanter, and intertrochanter), and no significant associations were observed at these sites either. Our data do not support a link between different SES indicators (Family Affluence Scale, parental education, and occupation) and bone mass in adolescents.

Longitudinal evaluation of bone mass in adolescents and young adults with juvenile idiopathic arthritis: the role of bone mass determinants in a large cohort of patients

significantly increased levels of fat CSA than controls (p < 0.0001). Finally, JIA patients presented a significantly reduced AD-SoS (p < 0.001), and QUS z-score (p < 0.005). These data were confirmed also in longitudinal evaluation. However, evaluating different treatments, we showed a significant negative correlation among aBMD value (p < 0.005), TrabBMD (p < 0.005), AD-SoS (p < 0.005), and systemic corticosteroids exposure or intraarticular corticosteroids injections, and a positive correlation among TNF-alpha-blocking agents and aBMD (p < 0.005), TrabBMD (p < 0.005), and AD-SoS (p < 0.005).