Bone Mineral Density In Individuals Research Articles

Bone pattern changes in post liver transplant patients using bisphosphonates.

To identify radiographic findings suggestive of drug-induced osteonecrosis and evaluate radiomorphometric patterns indicative of changes in bone mineral density in individuals transplanted for liver disorders using bisphosphonates. The study group included panoramic x-rays of liver transplant patients who are being monitored and who present a clinical status of osteoporosis and use bisphosphonates. The control group was made up of liver transplant patients who did not have osteoporosis. On panoramic radiographs, mental index (MI) and mandibular cortical index (MCI) and the presence of radiographic anomalies suggestive of osteonecrosis were evaluated. There were significant statistical results when comparing the groups in relation to the decrease in bone mineral density (BMD) with MCI-C3 (p=0.036), however, there were none in relation to MI (p=0.14). There were no valid statistical results when relating MCI (p=0.94) and MI (p=0.66) with reduced BMD and use of bisphosphonates. Liver transplant individuals using bisphosphonates present greater radiographic signs of bone sclerosis suggestive of a greater propensity to develop osteonecrosis of the jaw and an increased risk of presenting changes suggestive of reduced bone mineral density on panoramic radiographs when compared to liver transplant individuals not using bisphosphonates.

Cases with the H syndrome presenting with skin and bone findings.

The H syndrome is an autosomal recessive disease characterized by hyperpigmentation, hypertrichosis and sensorineural hearing loss. A mutation in the coding of the human equilibrative nucleoside transporter 3 (hENT3) within the SLC29A3 gene on chromosome 10q22 leads to the manifestation of this disease. In this report, we present two cases of H syndrome. The first patient exhibits hyperpigmentation, hypogonadism, Type 1 diabetes mellitus, arthritis and osteoporosis. The second patient experiences hyperpigmentation, hypertrichosis, osteopenia and hypogonadism. Our objective is to broaden the clinical spectrum of H syndrome, highlighting the involvement of arthritis, hyperinflammation and low bone mineral density in individuals with this disorder.

Bone manifestations in Snyder‐Robinson syndrome

PurposeSnyder-Robinson syndrome (SRS) is a rare, X-linked condition caused by loss of function variants in the SMS gene, which codes for spermine synthase, an enzyme essential for synthesis of the polyamine spermine [1]. It is speculated that polyamines are crucial for osteoblast activity [2]. While published cases of SRS have reported osteopenia or osteoporosis, the natural history of bone health in individuals with SRS has not yet been explored. It is hypothesized that the natural history of bone health in these individuals results in low bone density for age and increased fractures in the absence of intervention. It is important for healthcare providers to recognize bone manifestations in individuals with SRS so that an appropriate standard of care can be administered. MethodsCase histories of 40 males with SRS spanning various ages from birth through adulthood were obtained from the Global Snyder-Robinson Syndrome Natural History Study and previously published cases. The data described and summarized in this study included dual x-ray absorptiometry (DEXA) scan results, fractures, and bisphosphonate treatment histories. ResultsMost individuals experienced at least one fracture, which was most common in their lower extremities. A greater number of fractures was reported when individuals did not receive bisphosphonates. Favorable DEXA results showed improvements in Z-scores and bone mineral density in individuals on bisphosphonates. ConclusionSRS is associated with persistent low bone density for age or osteoporosis. Treatment with bisphosphonates and long-term use requires further evaluation. This review contributes to the knowledge of bone health in the SRS population.

Clinical efficacy of Gushukang Jiaonang in osteoporosis and its effects on bone metabolism in patients: A retrospective study

Purpose: To investigate the clinical efficacy of Gushukang Jiaonang in the prevention and treatment of osteoporosis, and its effect on patients' bone metabolism based on its use in traditional Chinese medicine.Methods: Retrospective analysis was conducted on 108 patients with osteoporosis discharged from the North Hospital Affiliated Hospital of Gansu University of Traditional Chinese Medicine, from January 2021 to January 2023. Patients were divided into study group (n = 54) and control group (n = 54). Control group received oral calcitriol and calcium tablets, while study group orally received calcitriol and calcium tablets and Gushukang Jiaonang capsules in addition. Clinical symptom improvement scores, bone mineral density, serum phosphorus and calcium, and blood alkaline phosphatase levels were compared between the groups.Results: After treatment, total amino terminal prolonging peptide of collagen I in the blood of study group was significantly higher than before treatment (p < 0.05). Osteocalcin was significantly increased before and after treatment in the two groups (p < 0.05). Vitamin D levels were significantly increased before and after treatment, and the difference was statistically significant (p < 0.05).Conclusion: Gushukang Jiaonang provides patients with efficient, comprehensive and precise prevention and treatment of osteoporosis. It also promotes positive disease regression, which in turn contributes to increase in bone mineral density in individuals. Long-term investigations with a larger population size, more indices as well as multicenter control should be carried out to provide sufficient theoretical basis for use in clinical practice.

Study of Effects of Gender-Affirming Hormone Therapy on Bone Mineral Density in Individuals with Gender Dysphoria.

Gender affirming hormone therapy (GAHT) is the mainstay treatment in transitioning individuals and has positive physical and psychological effects. Among the things to monitor in transgender patients on long-term hormones, bone health is an essential consideration. As the calcium intake in the Indian population is less, and many gender-incongruent individuals may not take adequate calcium in their diet, we needed data on the bone health of Indians with gender dysphoria as the information available globally may not apply to our population. The study was performed to assess bone mineral density in individuals with gender dysphoria who were on gender-affirming hormonal therapy for at least 6 months. It was a hospital-based cross-sectional study of bone mineral density measured at two sites - hip and spine in individuals with gender dysphoria on GAHT for at least six months. A total of 30 individuals were included in this study. The mean age of individuals with Gender dysphoria was found to be 28.17 ± 6.15 years, and the age range was 19-42 years. Out of the 30 individuals, 14 were transgender males, and the remaining 16 were transgender females. Bone mineral density at the hip and spine in transgender males was 1.047 ± 0.124 g/cm2 and 1.065 ± 0.115 g/cm2, which was better compared to transgender females in whom the bone mineral density at hip and spine was 0.899 ± 0.873 g/cm2 and 0.854 ± 0.099 g/cm2 (P = 0.001 for hip; P = 0.000 for spine). The Z score at hip and spine were better in transgender males as compared to transgender females (P < 0.001 for hip; P < 0.001 for spine) when compared to genetic sex and at the spine (P = 0.001) when compared to affirmed sex. In this study, we observed that the transgender females who underwent orchidectomy had a lower mean Z score at spine compared to individuals who did not undergo the procedure. The current study results indicate that GAHT does have positive effects on bone health in transmen.

The association of nonalcoholic fatty liver disease with bone mineral density in type 2 diabetes

ObjectiveWe examined the association between nonalcoholic fatty liver disease and lumbar spine bone mineral density in individuals with and without type 2 diabetes.MethodsThe lumbar BMD of 1088 subjects was measured using dual-energy X-ray absorptiometry (DXA). Liver fat content was quantified via B-mode ultrasound. Multivariable linear regression was used to study the association between NAFLD and lumbar BMD in participants with and without T2DM.ResultsThe lumbar BMD in the T2DM group and the non-diabetes group was higher in the NAFLD group than in the non-NAFLD group (P < 0.001). Multivariate regression analysis in the T2DM group showed that after adjusting for confounders, the positive association between lumbar spine BMD and NAFLD remained (P = 0.027). In the non-diabetes group, after adjusting for confounders, the association between NAFLD and lumbar spine BMD disappeared.ConclusionsThe relationship between nonalcoholic fatty liver disease and lumbar bone mineral density may differ in individuals with and without diabetes. The effect of nonalcoholic fatty liver disease on bone mineral density needs to be evaluated in different clinical contexts.

Association of Metabolic Dysfunction-Associated Fatty Liver Disease and Liver Stiffness With Bone Mineral Density in American Adults.

ContestThe relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and liver stiffness and bone mineral density (BMD) remains unclear.ObjectivesWe aimed to investigate the association between MAFLD and liver stiffness and BMD in the United States population.MethodsA cross-sectional study among 2031 participants over 50 years old in the National Health and Nutrition Examination Survey (NHANES) 2017-2018 was performed. All patients underwent vibration controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA). The linear and logistic regression model were used to analyze the association between the MAFLD and liver stiffness and osteoporosis, with adjustments for known covariates. Furthermore, the sensitive analyses were conducted to explore the relationship between MAFLD and liver stiffness and whole osteoporosis (include femoral and lumbar osteoporosis).ResultsMAFLD was prevalent in the study population, with a prevalence of 50.9% for men and 40.7% for women. The multiple linear models demonstrated positive associations between MAFLD and liver stiffness and total femur BMD, femur neck BMD, trochanter BMD, intertrochanter BMD. In multiple logistic regression models, both MAFLD and significant liver fibrosis were negatively associated with femoral osteoporosis (OR=0.41, 95% CI: 0.27 to 0.63; OR=0.67, 95% CI: 0.33-1.37, respectively). Nonetheless, when BMI was adjusted, the association between MAFLD and liver stiffness and osteoporosis became insignificant. Besides, as showed in the sensitive analyses, the relationship between MAFLD and liver stiffness and whole osteoporosis were stable.ConclusionsThese results suggest that MAFLD and liver stiffness were associated with higher femoral and lumbar bone mineral density in individuals aged over 50 years. But the results may be confounded by BMI.

Modulation of Bone and Joint Biomarkers, Gut Microbiota, and Inflammation Status by Synbiotic Supplementation and Weight-Bearing Exercise: Human Study Protocol for a Randomized Controlled Trial.

BackgroundThere is strong evidence suggesting that prebiotics and probiotics regulate gut microbiota, reducing inflammation and thereby potentially improving bone health status. Similarly, mechanistic evidence suggests that either low-impact or high-impact weight-bearing exercises improve body composition and consequently increase bone mineral density in individuals with osteoporosis and osteoarthritis.ObjectiveThis study aims to investigate the effects of a synbiotic (probiotic+prebiotic) supplementation, an exercise intervention, or a combination of both on gut microbiota, inflammation, and bone biomarkers in postmenopausal women.MethodsA total of 160 postmenopausal women from New Zealand will be recruited and randomized to one of four interventions or treatments for 12 weeks: control, synbiotic supplementation, exercise intervention, or synbiotic supplementation and exercise. The primary outcome measure is the bone and joint biomarkers at baseline and week 12, whereas the gut microbiota profile and inflammatory cytokine measurements will serve as the secondary outcome measures at baseline and week 12. Baseline data and exercise history will be used to assess, allocate, and stratify participants into treatment measures.ResultsRecruitment of participants will begin in September 2021, and the anticipated completion date is June 2022.ConclusionsTo the best of our knowledge, this will be the first randomized controlled trial to analyze the effects of both a synbiotic supplement and an exercise intervention in postmenopausal women. On the basis of the results obtained, a combination of synbiotic supplements and exercise might serve as a noninvasive approach to manage and/or improve body composition and bone health in postmenopausal women.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12620000998943p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380336&isClinicalTrial=False

Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury.

ObjectiveTo investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).MethodsPatients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.ResultsAmong 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.ConclusionThe duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

A Qualitative Assessment of Bone Mineral Density in Individuals With Hemifacial Microsomia: A Cone-Beam Computed Tomography Study.

The purpose of this study is to utilize cone-beam computed tomography (CBCT) to compare the bone mineral density (BMD) on the affected versus nonaffected side, among individuals with hemifacial microsomia (HFM). This retrospective study included 9 patients with HFM. Pretreatment CBCT volumes were imported into Invivo5 software, which was used to measure BMD through Hounsfield units (HU) in 3 regions of the mandible; inferior to the lower lateral incisors, inferior to the first molar and at the ramus inferior to the sigmoid notch. Each region was measured at the buccal cortical bone, lingual cortical bone, and cancellous bone. The densities on the right and left sides were compared by Wilcoxon signed-rank test. Overall, the BMD on the affected side tended to show slightly lower values when compared with the nonaffected side. Differences ranged from 14 HU at the lingual cortical plate of the first molar region to 234 HU at the buccal cortical plate of the ramus region. Differences were only statistically significant at the ramus region for the buccal (P = .002) and lingual (P < .001) cortical plates and at the lower incisor region at the buccal cortical plate (P = .016) and cancellous bone (P = .044). The differences, however, did not seem to be clinically significant. The current study shows that the quality of bone on the affected side may be slightly reduced but did not seem to be clinically significant. This should be accounted for during surgical and orthodontic planning for patients with HFM.

The Effect Of Robotic Gait Training On Spinal Cord Transected Rat Femurs

Robotic locomotor training has been shown to be effective for significantly improving body composition and making some moderate, but not significant, changes in bone mineral density in individuals with spinal cord injury (Karalis et al., 2017). The effect of the training on other important mechanical properties of bone is unknown. PURPOSE: To determine the effects of 8 weeks of robotic locomotor training on mechanical properties of rat bones. METHODS: Twelve female Sprague-Dawley rats received spinal cord transections at 5 days old. At 3 weeks old, half of them were randomly assigned to a Training group and half to a Control group. The Training group received 5 minutes of robotic gait training with 90% body support for 5 days a week for 8 weeks. The Control group received no exercise. At the conclusion of the 8 weeks, the animals were euthanized and the right femurs were harvested for testing. Anthropometric measures and 3-point bending tests using an Instron material testing system (Norwood, MA) were performed. Independent t-tests were used to determine differences between the two groups (p < 0.05). RESULTS: There was no difference in body mass between the two groups prior to group assignments, but after 6 weeks of training the Control group had greater mass (p = 0.035) and at the end of training this difference continued (mass = 210.3 ± 36.0 g vs. 166.7 ± 14.5 g; p = 0.012). The Control group’s femur mass was significantly larger (p = 0.041), but when considered as a percentage of body mass, the Training group’s femur mass was larger (p = 0.014). Peak load and rupture loads were not different between the two groups, but when normalized for body mass the Training group had larger load values than the Control group (59.0±2.7% and 53.3±12.1% for the Training and 52.4±2.0% and 41.6±8.7% for Control; p = 0.001 and p = 0.035, respectively). The deflection at rupture was greater for the Control group (0.75 ± 0.09 mm vs. 0.59 ± 0.14 mm; p = 0.025), as was the energy absorbed (57.0 ± 6.1 mJ vs. 39.6 ± 12.1 mJ; p = 0.009). There were some differences in midshaft diameters, but the cross-sectional areas were not different between the two groups. CONCLUSION: Rats who experienced training had stronger and more massive femurs than those who experienced no training. This work was supported by NSF 0850516.

Improvement in Bone Mineral Density after a Distal Weight-Bearing Implant in a Series of 13 Cases

ABSTRACT Introduction The amputation of lower limbs and the subsequent use of a prosthesis require the adoption of new biomechanical patterns of load and gait by the patient, which may favor the onset of local or generalized bone mineral density loss. Osseo-anchored implants that allow distal weight bearing of the residuum may be able to mitigate bone mineral density loss related to amputation. The objective of this study is to determine the effect of the use of a distal weight-bearing implant on the bone mineral density of the amputated limb in relation to the nonamputated limb. Materials and Methods An interrupted time series clinical trial carried out in the Outpatient Department of Rehabilitation of the five participant hospitals. Thirteen patients with previous transfemoral amputations of traumatic, oncologic, and vascular etiology were enrolled. These patients underwent surgical implantation of an osseo-anchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using dual-energy x-ray absorptiometry of the femur neck. Results The mean increase in bone mineral density for the amputated limb was 0.020 g/cm2, which represented a mean percentage increase of 3.0%. For the nonamputated limb, the mean increase in bone mineral density was 0.005 g/cm2 and the mean percentage increase was 0.5%, with eight patients showing improvements in bone mineral density. The mean percentage of bone mineral density of the amputated limb in comparison with the nonamputated limb was 70.6% preimplantation and 73.2% postimplantation, with an average increase of 2.6%. Conclusions The results of this study show an improvement in bone mineral density in individuals with transfemoral amputation 14 months after having received a distal weight-bearing implant.

Calcaneal quantitative ultrasound has a role in out ruling low bone mineral density in axial spondyloarthropathy.

The aim of this study was to investigate the role of quantitative ultrasound (QUS) of the calcaneus in screening for osteoporosis in adults with axial spondyloarthropathy (axSpA). Postmenopausal women and men over 50years with axSpA were recruited for this observational cross-sectional study. Dual-energy x-ray absorptiometry (DXA) assessed bone mineral density (BMD) of the spine and hip. QUS of the calcaneus produced broadband ultrasound attenuation (BUA), speed of sound (SOS), stiffness index (SI), and T-scores. Receiver-operating characteristics (ROC) curve analysis determined the ability of QUS to discriminate between low and normal BMD. Thresholds were identified to (1) out rule low BMD, (2) identify osteoporosis, and (3) identify low BMD. The number of DXAs which could be avoided using this approach was calculated. 56 participants were analyzed. BUA, SI, and T-score QUS parameters correlated with BMD by DXA; SOS did not. All QUS parameters had the ability to discriminate between low and normal BMD (area under the curve varied from 0.695 to 0.779). QUS identified individuals without low BMD with 90% confidence, with BUA performing best (sensitivity 93%, negative predictive value 86%). Using QUS as a triage tool, up to 27% of DXA assessments could have been avoided. QUS could not confidently identify individuals with osteoporosis. QUS of the calcaneus confidently out ruled low BMD in individuals with axSpA, reducing the need for onward DXA referral by up to 27%. QUS is promising as a non-invasive triage tool in the assessment of osteoporosis in adults with axSpA.Key Points• Osteoporosis is common in axial spondyloarthropathy (SpA), but evaluation of bone health is suboptimal in this population.• Quantitative ultrasound (QUS) of the calcaneus can out rule low bone mineral density in individuals with axial SpA, reducing the need for DXA assessment.• QUS is a promising non-invasive triage tool in the assessment of bone health in axial SpA.

Low Energy Availability, Menstrual Dysfunction, and Low Bone Mineral Density in Individuals with a Disability: Implications for the Para Athlete Population.

Low energy availability, functional hypothalamic amenorrhea, and low bone mineral density are three interrelated conditions described in athletic women. Although described as the female athlete triad (Triad), males experience similar health concerns. The literature suggests that individuals with a disability may experience altered physiology related to these three conditions when compared with the able-bodied population. The goal of this review is to describe the unique implications of low energy availability, low bone mineral density, and, in females, menstrual dysfunction in individuals with a disability and their potential impact on the para athlete population. A literature review was performed linking search terms related to the three conditions with six disability categories that are most represented in para sport. Few articles were found that directly pertained to athletes, therefore, the review additionally characterizes literature found in a non-athlete population. Review of the available literature in athletes suggests that both male and female athletes with spinal cord injury demonstrate risk factors for low energy availability. Bone mineral density may also show improvements for wheelchair athletes or athletes with hemiplegic cerebral palsy when compared with a disabled non-athlete population. However, the prevalence of the three conditions and implications on the health of para athletes is largely unknown and represents a key gap in the sports medicine literature. As participation in para sport continues to increase, further research is needed to understand the impact of these three interrelated health concerns for athletes with a disability, accompanied by educational initiatives targeting athletes, coaches, and health professionals.

Nephrolithiasis and Risk of Incident Bone Fracture

Higher urine calcium is a common feature of calcium nephrolithiasis and may be associated with lower bone mineral density in individuals with kidney stones. However previous population based studies of kidney stones and the risk of bone fracture demonstrate conflicting results. We examined independent associations between a history of kidney stones and incident fracture. We performed prospective studies using data from the Nurses' Health Study of 107,001 women with 32 years of followup and the Health Professionals Follow-up Study of 50,982 men with 26 years of followup. We excluded premenopausal women, men younger than 45 years and individuals who reported osteoporosis at baseline. Study outcomes were incident wrist (distal radius) or incident hip (proximal femur) fracture due to low or moderate trauma. Cox proportional hazards regression was used to adjust for multiple factors, including age, race, body mass index, thiazide use, supplemental calcium and dietary intakes. There were 4,940 wrist and 2,391 hip fractures in women, and 862 wrist and 747 hip fractures in men. All fractures were incident. The multivariable adjusted relative risk of incident wrist fracture in participants with a history ofkidney stones compared to participants without kidney stones was 1.18 (95%CI1.04-1.34) in women and 1.21 (95% CI 1.00-1.47) in men. The pooled multivariable adjusted relative risk of wrist fracture was 1.20 (95% CI1.08-1.33). The multivariable adjusted relative risk of incident hip fracture in participants with kidney stones was 0.96 (95% CI 0.80-1.14) in women and 0.92(95% CI 0.74-1.14) in men. The pooled multivariable adjusted relative risk of hip fracture was 0.94 (95% CI 0.82-1.08). Nephrolithiasis is associated with a significantly higher risk of incident wrist but not hip fracture in women and men.

Longitudinal assessment of bone growth and development in a facility-based population of young adults with cerebral palsy.

Osteoporosis is a significant clinical problem in persons with moderate to severe cerebral palsy (CP), causing fractures with minimal trauma. Over the past decade, most studies examining osteoporosis and CP have been cross-sectional in nature, focused exclusively on children and adolescents and only involving one evaluation of bone mineral density (BMD). The purpose of this study was to assess BMD in a group including adults with CP, and changes in each individual's BMD over a 5- to 6-year period. The study group included 40 residents of a long-term care facility aged 6 to 26years at the time of their initial evaluation. Twenty-one patients (52.5%) were male, 35 (88%) were white, and 38 (95%) were in Gross Motor Function Classification System level V. BMD was assessed by dual-energy X-ray absorptiometry on the right and left distal femurs for three distinct regions of interest. Five residents had a fracture that occurred during the study period; this represented a fracture rate of 2.1% per year in the study group. Longitudinally, annualized change in the median BMD was 0.7% to 1.0% per year in the different regions of the distal femur, but ranged widely among the study group, with both increases and decreases in BMD. Increase in BMD over time was negatively correlated with age and positively correlated with change in weight. Changes in BMD over time in profoundly involved persons with CP can range widely, which is important to recognize when evaluating potential interventions to improve BMD. Age and changes in body weight appear the most relevant factors.

Influences of nutrition and adiposity on bone mineral density in individuals with chronic spinal cord injury: A cross-sectional, observational study

BackgroundDietary inadequacy and adiposity, both prevalent in the chronic spinal cord injury (SCI) population, are known to influence bone turnover and may be potential modifiable risk factors for the development of sublesional osteoporosis following SCI. This pilot study in an SCI cohort aimed to assess measures of nutrition and obesity, to determine if these measures were associated with bone mineral density (BMD), and to compare these measures to a non-SCI control cohort. MethodsIn a cross-sectional observational study, volunteers with chronic SCI (>1year post-injury, lesions from C1 to T12 and severity category A–D by the American Spinal Injury Association Impairment Scale) were assessed, and 8 non-SCI individuals were recruited as a comparison group. BMD at the femoral neck (FN) and lumbar spine (LS), and an estimate of visceral adipose tissue (VAT) from lumbar vertebrae 1 through 4 were measured using dual energy X-ray absorptiometry (DXA); nutrient intake of calcium, vitamins D & K, and protein were estimated using a food frequency questionnaire; plasma 25-hydroxyvitamin D (25(OH)D) was analyzed using ultra-high performance liquid chromatography/tandem mass spectroscopy; and serum leptin, adiponectin and insulin were analyzed using a multiplex assay. ResultsA total of 34 individuals with SCI (n=22 tetraplegic; n=12 paraplegic; 94% male) who averaged 12.7 (9.0) years post-injury, age 40.0 (10.9) years and % body fat of 28.4 (7.3) were assessed. Multiple linear regression analyses in the SCI cohort showed significant associations between BMD at the FN and LS with leptin (FN: r=0.529, p=0.005; LS: r=0.392, p=0.05), insulin (FN: r=0.544, p=0.003; LS: r=0.388, p=0.05), and VAT percent (FN: r=0.444, p=0.02; LS: r=0.381, p=0.05). Adiponectin was only correlated with LS BMD (r=0.429, p=0.03). No significant relationships were found between BMD and serum 25(OH)D, or intakes of calcium, vitamins D & K, and protein. Intake of vitamin D was adequate in 69% of participants with SCI, where 91% of those persons consumed either vitamin D and/or multivitamin supplements. Vitamin D status was similar between SCI and non-SCI groups as was sub-optimal status (25(OH)D<75nmol/L) (60% of SCI compared to 50% of non-SCI). Participants with SCI had significantly lower FN BMD in comparison to non-SCI controls (p=0.001). ConclusionsCompromised BMD among individuals with SCI was not associated with a deficiency of vitamin D or other bone nutrients. The observed positive associations between BMD and leptin, insulin, adiponectin and VAT provide a framework to evaluate links between adiposity and bone health in a larger SCI cohort.

Risk of fracture in urolithiasis: a population-based cohort study using the health improvement network.

Studies have shown decreased bone mineral density in individuals with urolithiasis, but their burden of fracture remains unclear. This study sought to determine whether urolithiasis is associated with increased fracture risk across the lifespan and to delineate sex effects. A population-based retrospective cohort study using The Health Improvement Network was performed. The median calendar year for the start of the observation period was 2004 (1994-2012). This study identified 51,785 participants with ≥1 of 87 diagnostic codes for urolithiasis and 517,267 randomly selected age-, sex-, and practice-matched participants. Cox regression was used to estimate the hazard ratio (HR) for first fracture. Fractures identified using diagnostic codes were classified by anatomic site. Median age was 53 years, and 67% of participants were men, confirming their greater urolithiasis burden. Median time from urolithiasis diagnosis to fracture was 10 years. The HR for fracture associated with urolithiasis differed by sex and age (P for interactions, P≤0.003). In men, the adjusted HR was greatest in adolescence (1.55; 95% confidence interval [95% CI], 1.07 to 2.25) with an overall HR of 1.10 (95% CI, 1.05 to 1.16). Urolithiasis was associated with higher fracture risk in women aged 30-79 years (HR, 1.17-1.52), and was highest in women aged 30-39 years (HR, 1.52; 95% CI, 1.23 to 1.87). Peak background fracture rates were highest in boys aged 10-19 years and in women aged 70-79 years. The incidence per 10,000 person-years in participants with versus without urolithiasis was 392 versus 258 in male participants aged 10-19 years, and 263 versus 218 in women aged 70-79 years. Distribution of fracture site within sex did not differ between participants with versus without urolithiasis. Urolithiasis was associated with higher incident fracture risk. The significantly higher risk at times of peak background fracture incidence in adolescent boys and elderly women has profound public health implications.

Optimization of Physical Activity as a Countermeasure of Bone Loss: A 5-Year Study of Bikram Yoga Practice in Females

Over the last decade, the number of people diagnosed with osteoporosis has increased dramatically due to many factors. While it has been asserted that one variable associated with preserving bone health is participation in high-impact exercises, those same exercises are also well documented to damage the hip and knee joints. Therefore, the goal of the present study was to evaluate the potential benefits of a highly regimented, low impact weight-bearing exercise, Bikram Yoga. Specifically, the bone mineral content was measured using DEXA analysis of the proximal femur and lumbar spine of nine female Bikram Yoga instructors between the ages of 30 and 59, who not only participated in a minimum of 3 classes (4.5 hours) a week, but also actively taught Bikram Yoga classes. These same participants, who remained active as instructors and practitioners, were rescanned five years later. The results of the study, which focused on the percent change in individual bone mineral density over the five-year period were as follows: the premenopausal subjects showed a mean increase in BMD of 6.6% at the femoral neck, 2.0% for the total hip, and 1.0% for the total lumbar spine. In contrast, post-menopausal subjects revealed a mean decrease in bone mineral density (BMD) of ﹣6.0%, ﹣8.1%, and ﹣5.6% in the femoral neck, total hip, and total lumbar spine, respectively. Consequently, the results of this study suggest that performing Bikram Yoga may preserve, or even perhaps, increase bone mineral density in pre-menopausal women and hence, may be an effective countermeasure for preventing osteoporosis.

Assessing the Impact of Osteoporosis on the Burden of Hip Fractures

The aim of the study was to determine the number of hip fractures within defined countries for 2010 and the proportion attributable to osteoporosis. The number of incident hip fractures in one year in countries for which data were available was calculated from the population demography in 2010 and the age- and sex-specific risk of hip fracture. The number of hip fractures attributed to osteoporosis was computed as the number of hip fractures that would be saved assuming that no individual could have a femoral neck T-score of less than -2.5 SD (i.e., the lowest attainable T-score was that at the threshold of osteoporosis (=-2.5 SD). The total number of new hip fractures for 58 countries was 2.32 million (741,005 in men and 1,578,809 in women) with a female-to-male ratio of 2.13. Of these 1,159,727 (50 %) would be saved if bone mineral density in individuals with osteoporosis were set at a T-score of -2.5 SD. The majority (83 %) of these "prevented" hip fractures were found in men and women at the age of 70 years or more. The 58 countries assessed accounted for 83.5 % of the world population aged 50 years or more. Extrapolation to the world population using age- and sex-specific rates gave an estimated number of hip fractures of approximately 2.7 million in 2010, of which 1,364,717 were preventable with the avoidance of osteoporosis (264,162 in men and 1,100,555 in women). We conclude that osteoporosis accounts for approximately half of all hip fractures. Strategies to prevent osteoporosis could save up to 50 % of all hip fractures.