Bone Mineral Density In Women Research Articles

Steroid hormone levels and bone mineral density in women over 65 years of age

Previous studies using immunoassays for steroid measurements have focused on the association between steroid hormone levels and bone mineral density (BMD) in postmenopausal women, obtaining contradictory results. This study aimed to assess this association using a highly sensitive bioanalytical method. A total of 68 postmenopausal women, aged 65–89 years, were enrolled in a cross-sectional study. Measurements of the BMD of the hip and lumbar spine were performed using dual energy X-ray absorptiometry, and serum hormone levels were quantified by gas chromatography and tandem mass spectrometry. Associations between estradiol (E2), testosterone, dehydroepiandrosterone (DHEA), androstenedione and T score levels of the hip and lumbar spine were evaluated, after adjustment for confounding variables. The analysis revealed a statistically significant association between testosterone and the T score of the hip (p = 0.035), but not that of the lumbar spine. No statistically significant associations were found between E2, DHEA, androstenedione and the T scores of the hip and the lumbar spine. Using a highly sensitive hormone assay method, our study identified a significant association between testosterone and BMD of the hip in women over 65 years of age, suggesting that lower testosterone increases the risk of osteoporosis.

Effect of Nutrient Intake, Nutritional Status, Physical Activity and Sunlight Exposure on Bone Mineral Density in Women: A Systematic Review

Osteoporosis is a condition or disease that can cause bones to become brittle and break easily. The risk of osteoporosis in women is greater than in men, which is four times greater. Bone mineral density (BMD) or bone density is the total mineral present in bone. Measurement of BMD is important to show the degree of bone mineralization associated with osteoporosis. There are factors associated with reduced bone density. Thus, this systematic review aimed to analyze several factors related to BMD in women including nutrient intake, nutritional status, physical activity, and sunlight exposure. Studies in this systematic review were gathered by the (PRISMA) guidelines and identified through PubMed, Google Scholar, and ScienceDirect databases from 2017 until 2022. A total of 17 articles passed the eligibility and were analyzed in this systematic review. Studies found the effect of nutrient intake, BMI, physical activity, and sunlight exposure on BMD in women from different age groups. So it is necessary to make eating habits with good nutritional intake and have a lifestyle that routinely carries out sufficient physical activity and gets sufficient sunlight to improve and maintain bone health until old age.

Effect of Nutrient Intake, Nutritional Status, Physical Activity and Sunlight Exposure on Bone Mineral Density in Women: A Systematic Review

Effect of Nutrient Intake, Nutritional Status, Physical Activity and Sunlight Exposure on Bone Mineral Density in Women: A Systematic Review

Gut microbiota and plasma metabolites associated with bone mineral density in women with or at risk of HIV infection.

To evaluate gut microbiota (GMB) alterations and metabolite profile perturbations associated with bone mineral density (BMD) in the context of HIV infection. Cross-sectional studies of 58 women with chronic HIV infection receiving antiretroviral therapy and 33 women without HIV infection. We examined associations of GMB and metabolites with BMD among 91 women. BMD was measured by dual-energy X-ray absorptiometry (DXA), and T -scores of lumbar spine or total hip less than -1 defined low BMD. GMB was measured by 16S rRNA V4 region sequencing on fecal samples, and plasma metabolites were measured by liquid chromatography-tandem mass spectrometry. Associations of GMB with plasma metabolites were assessed in a larger sample (418 women; 280 HIV+ and 138 HIV-). Relative abundances of five predominant bacterial genera ( Dorea , Megasphaera , unclassified Lachnospiraceae, Ruminococcus , and Mitsuokella ) were higher in women with low BMD compared with those with normal BMD (all linear discriminant analysis (LDA) scores >2.0). A distinct plasma metabolite profile was identified in women with low BMD, featuring lower levels of several metabolites belonging to amino acids, carnitines, caffeine, fatty acids, pyridines, and retinoids, compared with those with normal BMD. BMD-associated bacterial genera, especially Megasphaera , were inversely associated with several BMD-related metabolites (e.g. 4-pyridoxic acid, C4 carnitine, creatinine, and dimethylglycine). The inverse association of Megasphaera with dimethylglycine was more pronounced in women with HIV infection compared with those without HIV infection ( P for interaction = 0.016). Among women with and at risk of HIV infection, we identified altered GMB and plasma metabolite profiles associated with low BMD.

Spine trabecular bone scores and bone mineral density of postmenopausal Taiwanese women.

The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis. A total of 1,915 postmenopausal women with lumbar spine and hip bone mineral density (BMD) and spine TBS were enrolled from a single medical center into this study. The women's BMD and TBS were measured using dual x-ray absorptiometry (Discovery Wi; Hologic, Bedford, Mass) and iNsight software (Med-Imaps SASU, Merignac, France), respectively. The women's demographic characteristics; lumbar spine, total hip, and femoral neck BMD; and lumbar spine TBS were recorded, and correlations among the parameters were identified using a 2-tailed Pearson test, in which a P value less than 0.05 was considered statistically significant. We developed simple linear regression models to represent changes related to TBS and performed an analysis of variance on the selected variables. The average age of the women was 62.5 ± 9.1 years (range, 25.7-93.7 years). The mean TBS was 1.300 ± 0.086 (range, 1.015-1.596). The TBS was weakly and negatively correlated with body mass index ( r = -0.078) and moderately and positively correlated with the lumbar spine BMD ( r = 0.619). The patients' lowest BMD values among those measured at multiple sites revealed a higher rate of osteoporosis (32.5%) than those measured at individual sites. Degraded TBS were noted in 21.2% of the participants, and a combination of BMD and TBS results predicted more individuals (7.8%) at a high risk of fracture than did the BMD result only. The rates of both osteoporosis and degraded TBS increased with age. Bone mineral density and TBS can be used in combination to predict osteoporosis in a greater number of postmenopausal Taiwanese women. Because the incidence of osteoporosis is the highest among older women, clinicians should pay careful attention to TBS degradation among older patients without low BMD.

Effect of the pilates method on people with osteoporosis: a systematic review

Background: Aging process is a risk factor for the development of several diseases, including osteoporosis. Osteoporosis is a systemic skeletal disorder characterized by an increase in bone fragility that can result in fractures and considerably impact the lives of patients. As a means of preventing the onset of this disease or even reducing the impact of symptoms in cases where already exists, one can choose to practice physical exercises. The Pilates method was developed by Joseph Pilates with the aim of working mind, body awareness, postural control and movements through a single approach. Objectives: The aim of this study was to review in the available literature the effects of the Pilates method on people with osteoporosis. Methods: This is a systematic review of literature carried out through a comprehensive strategy in the databases PubMed, Cochrane, SciELO, Web of Science, Cinahl and Embase in August 2020. Results: Five studies, three clinical trials and 2 studies Observational studies, published between 2012 and 2020, were included in the review. Of a total of 210 participants, all were female and an average age of 61 years. The main factors evaluated in the studies were bone mineral density, pain, functionality and quality of life. Conclusion: The Pilates method was associated with pain relief, improved functionality and quality of life, and obtaining bone mineral density in women with osteoporosis.

Genetically Predicted Milk Intake Increased Femoral Neck Bone Mineral Density in Women But Not in Men.

BackgroundCow milk contains more calcium, magnesium, potassium, zinc, and phosphorus minerals. For a long time, people have believed that increasing milk intake is beneficial to increasing bone density. Many confounding factors can affect milk consumption, and thus the association described to date may not be causal. We explored the causal relationship between genetically predicted milk consumption and Bone Mineral Density (BMD) of the femoral neck and lumbar spine based on 53,236 individuals from 27 studies of European ancestry using the Mendelian randomization (MR) study. 32,961 individuals of European and East Asian ancestry were used for sensitivity analysis.MethodsA genetic instrument used for evaluating milk consumption is rs4988235, a locus located at 13,910 base pairs upstream of the LCT gene. A Mendelian randomization (MR) analysis was conducted to study the effect of selected single nucleotide polymorphisms (SNPs) and BMD. The summary-level data for BMD of the femoral neck and lumbar spine were obtained from two GWAS meta-analyses [‘Data Release 2012’ and ‘Data Release 2015’ in the GEnetic Factors for OSteoporosis Consortium (GEFOS)].Resultswe found that genetically predicted milk consumption was not associated with FN-BMD(OR 1.007; 95% CI 0.991–1.023; P = 0.385), LS-BMD(OR 1.003; 95% CI 0.983–1.024; P = 0.743) by performing a meta-analysis of several different cohort studies. High levels of genetically predicted milk intake were positively associated with increased FN-BMD in Women. The OR for each additional milk intake increasing allele was 1.032 (95%CI 1.005–1.059; P = 0.014). However, no causal relationship was found between milk consumption and FN-BMD in men (OR 0.996; 95% CI 0.964–1.029; P = 0.839). Genetically predicted milk consumption was not significantly associated with LS-BMD in women (OR 1.017; 95% CI 0.991–1.043; P = 0.198) and men (OR 1.011; 95% CI 0.978–1.045; P = 0.523).ConclusionOur study found that women who consume more milk have a higher FN-BMD. When studying the effect of milk consumption on bone density in further studies, we need to pay more attention to women.

Bone mineral density and risk of breast cancer: A cohort study and Mendelian randomization analysis.

Estrogen is involved in both bone metabolism and breast cancer proliferation. However, evidence about the risk of breast cancer according to women's bone mineral density (BMD) is scarce, and little is known about their causal associations. Women participating in the UK Biobank cohort were used to investigate the association between BMD and the risk of breast cancer using Cox regression models. Instrumental variants associated with estimated BMD (eBMD) were extracted from genome-wide association studies with European ancestry. Logistic regression was used to calculate the genetic association with breast cancer in the UK Biobank and 2-sample Mendelian randomization (MR) analyses to assess their causal associations with breast cancer. Finally, the pleiotropic conditional false discovery rate (cFDR) method was conducted to further detect common genetic variants between BMD and breast cancer. Compared with the general population, postmenopausal women with BMD T scores <-2.5 had a lower risk of breast cancer (hazard ratio [HR], 0.77; 95% CI, 0.59-1.00), and this effect was stronger in women with fracture (HR, 0.31; 95% CI, 0.12-0.82). In MR analysis, no causal associations between eBMD and breast cancer were observed. The cFDR method identified 63 pleiotropic loci associated with both BMD and breast cancer, of which CCDC170, ESR1, and FTO might play crucial roles in their pleiotropy. An association between BMD and the risk of postmenopausal breast cancer in the UK Biobank was observed, whereas no evidence supported their causal association. Instead, their association could be explained by pleiotropic genetic variants leading to the pathology of osteoporosis and breast cancer.

The Correlation of Caffeine and Fizzy Drink Consumption and Bone Mineral Density in Women Fertilizer Age in Pekanbaru City

Osteoporosis is defined as a decrease in bone mass and is characterized by an increased risk of fracture due to bone fragility. Prevention of low bone density can be done by optimizing the formation of bone mass at the time of growth, namely the age of 20-35 years. Research on osteoporosis in Jakarta in 2011 on subjects aged 20-25 years, stated that 6.3% had osteoporosis and 51.1% had osteopenia (pre-osteoporosis). The aim of the study was to identify the correlation of caffeine and soft drinks consumption toward bone mineral density status in women of childbearing age. This study was a quantitative analytic study, with a cross sectional research design. The sample was women of childbearing age who were in the work area of Tampan District as many as 399 people. The Chi-Square test showed the effect of caffeine consumption and soft drinks on the status of bone mineral density in women of childbearing age with a P value of 0.000 &lt; Alpha 0.05 with a large OR of 24,330 (95% CI: 10,174- 58.182), meaning that respondents who consumed caffeine and soft drinks were 24 times more likely to suffer from osteoporosis. It is expected for women to avoid risk factors that can cause a decrease in bone mineral density and perform early detection of osteoporosis before the age of 30 years.

Association of androgen excess and bone mineral density in women with classical congenital adrenal hyperplasia with 21-hydroxylase deficiency.

This study aims to assess BMD and its association with androgen excess in women with CAH. We enrolled 92 women with CAH with 21-OH deficiency and retrospectively reviewed their clinical features, hormone concentrations, body composition, glucocorticoid (GC) dose, and BMD. BMD was not different according to the subtypes of CAH. BMD at the lumbar spine was lower in women with CAH with regular menstruation than those with irregular menstruation (1.081 vs. 1.165g/cm2, P < 0.05). BMD was lower in women with CAH with 17-hydroxyprogesterone (17-OHP) < 10ng/mL than in those with ≥ 10ng/mL (lumbar spine, 1.019 vs. 1.150g/cm2; femur neck, 0.806 vs. 0.899g/cm2; total hip, 0.795 vs. 0.943g/cm2; all P < 0.05). After adjusting for age and BMI in correlation analyses, testosterone concentrations were positively correlated with lumbar spine, femur neck, and total hip BMD (r = 0.46, r = 0.38, and r = 0.35, respectively; all P < 0.05), while 17-OHP was positively correlated with lumbar spine BMD (r = 0.38, P < 0.01). In subgroup analysis, 17-OHP was positively correlated with BMD (lumbar spine, r = 0.22; femur neck, r = 0.22; total hip, r = 0.24; all P < 0.05) only in the group with a total cumulative dose of GC ≥ 156.0g/m2. Androgen excess may have a protective effect on BMD in women with classic CAH and high cumulative doses of GC.

Circulating platelet concentration is associated with bone mineral density in women.

Platelets play an important role in bone metabolism. However, the association between circulating platelet counts and bone mineral density (BMD) has been inconsistently reported. We aimed to investigate the relationship between platelet counts and osteoporosis in Chinese women. In this cross-sectional study, a total of 818 female adults who underwent BMD assessment during the health examination were enrolled. Blood cell counts and biochemistry data were recorded. Subjects with osteoporosis had the lowest platelet counts (238 ± 59 × 109/L) compared with subjects with osteopenia (256 ± 64 × 109/L) and a normal BMD (269 ± 76 × 109/L, P < 0.001). The circulating platelet concentration was positively correlated with the BMD of the lumbar spine (r = 0.195, P < 0.001), left hip (r = 0.145, P < 0.001), and right hip (r = 0.149, P < 0.001). According to the receiver operating characteristic curve, the cutoff platelet concentration for differentiating osteoporosis was 260 × 109/L. A high platelet concentration had significantly low odds of osteoporosis after adjusting for other covariates (odds ratio = 0.574, 95% confidence interval: 0.346‒0.953, P = 0.032). The circulating platelet concentration was significantly correlated with BMD in Chinese women.

Bone mineral density in women newly diagnosed with breast cancer: a prospective cohort study

Estrogen may have opposing effects on health, namely increasing the risk of breast cancer and improving bone health by increasing bone mineral density (BMD). The objective of this study was to compare dual-energy X-ray absorptiometry (DXA) BMD between women newly diagnosed with breast cancer and matched controls without breast cancer. Women newly diagnosed with breast cancer treated between April 2012 and October 2017 were prospectively enrolled. A control group was established of women with negative mammography or breast ultrasound, matched 1:1 by age, body mass index, parity, and the use of hormone replacement therapy. All those included had DXA BMD, and lab assessments at enrollment. Of 869 women with newly diagnosed breast cancer, 464 signed informed consent. Of the 344 who completed the study protocol, 284 were matched to controls. Overall, the mean age was 58 years. Compared to the control group, for the breast cancer group, the mean vitamin D level was lower (48.9 ± 19.0 vs. 53.8 ± 28.8 nmol/L, p = 0.022); and mean values were higher of total hip BMD (0.95 ± 0.14 vs. 0.92 ± 0.12 g/cm2, p = 0.002), T score (−0.38 ± 1.17 vs. −0.68 ± 0.98, p = 0.002), and Z score (0.32 ± 1.09 vs. 0.01 ± 0.88, p < 0.001). Among the women with breast cancer, no correlations were found of baseline BMD with tumor size or grade, nodal involvement, or breast cancer stage. We concluded that women with newly diagnosed breast cancer tend to have higher BMD than women with similar characteristics but without breast cancer. This implies that BMD might be considered a biomarker for breast cancer risk.

Comparing estrogen-based hormonal contraceptives and hormone therapy on bone mineral density in women with premature ovarian insufficiency: a systematic review.

Premature ovarian insufficiency (POI) is a condition associated with estrogen deficiency which leads to decreased bone mineral density and an increased risk of osteoporosis and fractures. Estrogen-based hormone therapy is an integral component of treatment; however, to date the ideal hormone formulation for optimizing bone health has not been established. To assess the effects of estrogen-based oral contraceptives (OCP) versus hormone therapy (HT) on bone mineral density (BMD) in women with POI. A systematic review of Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science databases was conducted from conception until December 2020. Randomized controlled trials (RCTs) and observational studies that met inclusion criteria were included in the analysis. Risk of bias was assessed with the Newcastle-Ottawa Quality Assessment Scale for cohort studies and the Cochrane Risk of Bias for RCTs. The study protocol was registered with the International Prospective Register of Systematic Reviews and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Our search yielded 1,227 studies; 3 RCTs and 2 observational cohort studies met inclusion criteria and were included in our study. The largest subpopulation was Turner Syndrome (n = 625), followed by idiopathic POI (n = 146). Of the four studies that assessed changes in BMD, two studies reported a significant increase in lumbar spine BMD with HT compared with OCP (+0.050 g/cm2, P < 0.025; +0.019 g/cm2, P < 0.01), one study found similar improvement in lumbar spine BMD across treatments (HT -0.003 g/cm2, P = 0.824), and one study did not directly compare treatments. Effects on bone turnover markers were inconsistent across three studies that evaluated this outcome. This is the first systematic review to include studies that directly compared OCP and HT on bone outcomes in POI. While two studies reported increased lumbar spine BMD with HT, this result was not consistently found across studies. There were important differences in POI etiology, treatment regimens and formulations, and risk of bias was high in many of the studies. These results indicate future, larger-scale trials are needed to further understand the optimal hormone therapy for bone density in POI.

USP25 Expression in Peripheral Blood Mononuclear Cells Is Associated With Bone Mineral Density in Women.

Osteoporosis is the most common metabolic bone disease in postmenopausal women. As precursors of osteoclasts, peripheral blood mononuclear cells are accessible and considered suitable models for studying osteoporosis pathology. Ubiquitination is a crucial protein degradation system in bone metabolism. The aim of this study was to identify potential ubiquitination-related genes in PBMCs that are related to osteoporosis pathogenesis. Therefore, we performed an integrated analysis of osteoporosis-related microarray datasets. With the obtained ubiquitination-related gene set, weighted gene coexpression network analysis was performed. The results showed that genes in the turquoise module were correlated with menopause, and 48 genes were identified as hub genes. A differential expression analysis revealed 43 differentially expressed genes between pre- and postmenopausal samples. After integrating the information on differentially expressed menopause-related genes, we found that several members of the ubiquitin-specific protease (USP) family (USP1, USP7, USP9X, USP16, and USP25) were highly expressed in samples from postmenopausal female and that, USP25 expression was significantly higher in low-BMD samples than in high-BMD samples among samples from premenopausal subjects (p = 0.0013) and among all samples (p = 0.013). Finally, we verified the protein expression of USP25 in PBMCs by performing Western blot analysis, which yielded results consistent with the aforementioned results. Moreover, by assessing GTEx datasets, we found that USP25 expression was highly correlated with TRAF6 expression in whole blood (p < 0.001). We also tested the protein expression levels of TRAF6 in PBMCs and found that it was positively correlated with USP25 expression (p = 0.036). Our results reveal that the ubiquitin-specific protease family may play important roles in menopause and that USP25 is related to osteoporosis pathogenesis.

Correlation between homocysteine and osteoprotegerin (OPG) serum with bone mineral density in women with systemic lupus erythematosus

Correlation between homocysteine and osteoprotegerin (OPG) serum with bone mineral density in women with systemic lupus erythematosus

Assessment of the frequency of hormonal disorders of the gonads and bone mineral density among women treated for anorexia nervosa in adolescence.

There are very few studies evaluating the activity of gonads in women treated for anorexia nervosa (AN) in adolescence, and reports on the bone mineral density in such patients are divergent. Objective Assessment of the incidence of gonadal hormonal function disorders and reduction of bone mineral density in women treated for AN in adolescence. Out of 97 women who had participated in a survey study, 56 reported personally to the clinic. Their somatic condition, body weight, and BMI were evaluated, as well as levels of oestradiol, LH, FSH in blood serum were determined and DEXA scans were performed. The average period of hospitalisation until the time of the study was 7.08 ±4.47 years. BMI was as follows: 20.01 ±3.6 kg/m2. 25% women were still sick, 75% were considered cured. In 17.9% of the study subjects hypogonadotropic hy-pogonadism was diagnosed. Abnormal results of the densitometric scan were confirmed in 85.7% of the study subjects. In the group of women with normal body weight only 19% had normal levels of bone mineral density. 1. In almost 18% of women treated for AN in adolescence, disorders of the hormonal function of gonads persist, despite normal body weight in 50% of them. 2. Bone mineral density is reduced in most women treated for AN, which indicates the need to monitor the condition of the bones, an early introduction of prevention of osteopenia and osteoporosis since the onset of AN in order to prevent bone fractures in adulthood.

Relationships between hormonal parameters, body fat distribution and bone mineral density in women with psychogenic functional hypothalamic amenorrhea.

Available evidence implies that unfavorable changes in the distribution of adipose tissue resulting from hormonal imbalance associated with ovarian insufficiency might influence bone mineral density (BMD). The purpose of our study was to verify if volumes of visceral (VAT), female (FAT) and android (AAT) body fat as determined by densitometry determined influence BMD in women with functional menstrual disorders, and if these correlates some endocrine factors. We examined 293 women (mean age 26.7 ± 4.4 years) who have had psychogenic type of functional hypothalamic secondary amenorrhea for at least three months (mean 5.82 ± 0.94). A variety of hormonal tests, determination of BMD and both distribution and volume of adipose tissue were performed. Volume of adipose tissue in all analyzed body regions indicated a positive correlation with BMD in lumbar spine (VAT: R = 0.277, FAT: R = 0.345, AAT: R = 0.336) and entire skeleton (VAT: R = 0.453, FAT: R = 0.527, AAT: R = 0.529). BMD in both the lumbar spine and entire skeleton had positive correlation with body mass index (R = 0.380 and R = 0.599, respectively) and free androgen index values (R = 0.150 and R = 0.279). It showed a negative correlation with sex hormone-binding globulin (R = -0.191 and R = -0.326). We did not find a parameter that could be an independent predictor of BMD. Distribution of body fat is only one of numerous determinants of BMD in women with functional menstrual disorders and should not be treated as the only predictor for bone mass deficiency. Determination of adipose tissue distribution in these patients has probably minor clinical impact.

Sequential Therapy With Recombinant Human IGF-1 Followed by Risedronate Increases Spine Bone Mineral Density in Women With Anorexia Nervosa: A Randomized, Placebo-Controlled Trial.

Anorexia nervosa is complicated by low bone mineral density (BMD) and increased fracture risk associated with low bone formation and high bone resorption. The lumbar spine is most severely affected. Low bone formation is associated with relative insulin-like growth factor 1 (IGF-1) deficiency. Our objective was to determine whether bone anabolic therapy with recombinant human (rh) IGF-1 used off-label followed by antiresorptive therapy with risedronate would increase BMD more than risedronate or placebo in women with anorexia nervosa. We conducted a 12-month, randomized, placebo-controlled study of 90 ambulatory women with anorexia nervosa and low areal BMD (aBMD). Participants were randomized to three groups: 6 months of rhIGF-1 followed by 6 months of risedronate ("rhIGF-1/Risedronate") (n= 33), 12 months of risedronate ("Risedronate") (n= 33), or double placebo ("Placebo") (n= 16). Outcome measures were lumbar spine (1° endpoint: postero-anterior [PA] spine), hip, and radius aBMD by dual-energy X-ray absorptiometry (DXA), and vertebral, tibial, and radial volumetric BMD (vBMD) and estimated strength by high-resolution peripheral quantitative computed tomography (HR-pCT) (for extremity measurements) and multi-detector computed tomography (for vertebral measurements). At baseline, mean age, body mass index (BMI), aBMD, and vBMD were similar among groups. At 12 months, mean PA lumbar spine aBMD was higher in the rhIGF-1/Risedronate (p= 0.03) group and trended toward being higher in the Risedronate group than Placebo. Mean lateral lumbar spine aBMD was higher, in the rhIGF-1/Risedronate than the Risedronate or Placebo groups (p< 0.05). Vertebral vBMD was higher, and estimated strength trended toward being higher, in the rhIGF-1/Risedronate than Placebo group (p< 0.05). Neither hip or radial aBMD or vBMD, nor radial or tibial estimated strength, differed among groups. rhIGF-1 was well tolerated. Therefore, sequential therapy with rhIGF-1 followed by risedronate increased lateral lumbar spine aBMD more than risedronate or placebo. Strategies that are anabolic and antiresorptive to bone may be effective at increasing BMD in women with anorexia nervosa. © 2021 American Society for Bone and Mineral Research (ASBMR).

Effects of anthropometric parameters on bone mineral density in women: from perimenopause to old age

Aim To analyze the influence of body components on bone mineral density (BMD) in women from perimenopause to old age. Material and Methods A total of 117 women were allocated into three groups according to the reproductive stage (STRAW): perimenopausal (PEM, N = 28, mean age 44.8 ± 3.6), early postmenopausal (EPM, N = 36, mean age 51.4 ± 2.8) and late postmenopausal (LPM, N = 53; mean age 64.0 ± 1.7). Total body mass, body mass index (BMI), lean mass (LM), fat mass (FM), fat percentage (FP) and BMD at the lumbar spine (lBMD) and femoral neck (fBMD) were assessed. Results BMI, FM, LM and BMD values decreased from PEM to LPM. The total effect of FM on fBMD and lBMD was of 42% and 8% for PEM, 28% and 33% for EMP and 9% and 1% for LPM respectively. Additionally, the total effect of LM on fBMD and lBMD was 48% and 3% for PEM, 54% and 53% for EMP and 9% and 11% for LPM women respectively. Conclusion BMI, LM, and FM decreased with aging. All these components had great influence on both fBMD and lBMD in EMP women. Conversely, in PEM these parameters only had influence on femoral BMD, but not on lumbar spine. These data suggests that LM is the most important component in BMD for women older than 50 years old, particularly in the hip.

Sequential Therapy With Recombinant Human IGF-1 Followed by Risedronate Increases Spine Bone Mineral Density in Women With Anorexia Nervosa

Anorexia nervosa is complicated by low bone mineral density (BMD) and increased fracture risk associated with low bone formation and high bone resorption. The spine, particularly its trabecular component as measured by lateral spine dual-energy x-ray absorptiometry (DXA), is most severely affected. Low BMD and bone formation are associated with relative insulin-like growth hormone-1 (IGF-1) deficiency. Our objective was to determine whether bone anabolic therapy with off-label recombinant human (rh)IGF-1 followed by antiresorptive therapy with risedronate would increase BMD more than risedronate alone or placebo in women with anorexia nervosa. We conducted a 12-month, randomized, placebo-controlled study of 90 ambulatory women with anorexia nervosa and low areal BMD (aBMD) (Z- or T-score <-1.0). Participants were randomized to 1 of 3 groups: 6 months of rhIGF-1 (starting dose 30 mcg/kg SQ BID) followed by 6 months of risedronate (35mg PO weekly) (“rhIGF-1/Risedronate”) (n=33), 12 months of risedronate (35mg PO weekly) (“Risedronate”) (n=33), or double placebo (“Placebo”) (n=16). Participants received calcium 1200 mg and vitamin D 800 IU daily. rhIGF-1 was titrated to maintain IGF-1 levels within the age-adjusted normal range. Main outcome measures were aBMD at the spine [1° endpoint: postero-anterior (PA) spine BMD], hip, and radius by DXA, and vertebral, tibial, and radial volumetric BMD (vBMD) and estimated strength by multi-detector computed tomography (MDCT) or high-resolution peripheral quantitative CT (HR-pQCT). At baseline, mean age [28 ± 7 y (mean ± SD)], BMI (18.5 ± 1.9 kg/m2), and BMD were similar among groups. At 12 months, mean PA spine aBMD was higher in the rhIGF-1/Risedronate (p=0.03), and trended towards being higher in the Risedronate (p=0.08), group than the Placebo group. Mean lateral spine aBMD was higher in the rhIGF-1/Risedronate than either the Risedronate (p=0.002) or Placebo (p=0.04) groups. From baseline to 12 months, mean PA and lateral spine aBMD increased by 1.9 ± 0.6% and 4.2 ± 1.0% in the rhIGF-1/Risedronate (p<0.05), 1.7 ± 0.8% and 1.7 ± 1.0% in the Risedronate (p=NS), and decreased by 0.3 ± 0.8% and 1.1 ± 1.3% in the Placebo (p=NS), groups, respectively. Areal BMD Z-scores did not normalize in any group. At 12 months, vertebral vBMD by MDCT was higher (p<0.05), and vertebral strength trended towards being higher, in the rhIGF-1/Risedronate than Placebo group. Neither hip or radial BMD, nor radial or tibial estimated strength, by HR-pQCT differed among groups. rhIGF-1 was well tolerated. In conclusion, sequential therapy of 6 months of rhIGF-1 followed by 6 months of risedronate increased lateral spine aBMD, the site most severely affected in women with anorexia nervosa, more than risedronate or placebo. These data suggest that strategies that are anabolic and antiresorptive to bone may be most effective in increasing BMD in women with anorexia nervosa.