Monitoring Of Bone Mineral Density Research Articles

Multicenter Study on the Frequency of Low Bone Mineral Density in Young Women With Breast Cancer and Associated Factors

IntroductionYoung women with breast cancer (BC) may experience bone mineral density (BMD) loss secondary to cancer treatment effects on estrogen levels. Studies assessing BMD in BC patients have had a limited representation of young women. This multicenter retrospective study analyzed the frequency of low BMD and associated factors in this age group. MethodsWomen diagnosed with stage 0-III BC at ≤40 years, treated with chemotherapy and/or endocrine therapy between 2010 and 2020 at 5 Mexican BC referral centers were eligible. Demographic, clinical and treatment data were collected, as well as bone dual-energy X-ray absorptiometry (DEXA) results. Low BMD was defined as lumbar or femoral neck T-score < -1.0 or Z-score ≤ -2.0. ResultsA total of 1259 patients were included; median age at diagnosis was 36 years (21-40). Overall, 93% received chemotherapy and 65% endocrine therapy (tamoxifen was received at some point by 61%, aromatase inhibitors by 17%, and GnRH agonists/bilateral oophorectomy by 21%). DEXA scans were documented in 254 (20%), of which 163 (64%; 95% confidence interval [CI] 58%-70%) had a low BMD report. Low BMD was associated with receiving aromatase inhibitors (Odds ratio [OR] 1.92; 95% CI 1.13-3.24), and GnRH agonists/bilateral oophorectomy (OR 2.25; 95% CI 1.21-4.21). ConclusionThe suboptimal frequency of BMD monitoring observed displays an alarming disregard for bone health in young patients. Thus, a high proportion of women with low BMD are potentially being missed and precluded from the opportunity to receive timely interventions. Particular focus should be put on BMD monitoring among patients treated with aromatase inhibitors, GnRH agonists or bilateral oophorectomy.

Longitudinal Assessment of Bone Mineral Density in Women Living With and Without HIV Across Reproductive Phases.

Women living with HIV commonly experience low areal bone mineral density (BMD), but whether this is affected by low ovarian hormonal states (prolonged amenorrhea or menopause) is unknown. We compared rates of BMD loss between women living with HIV and HIV-negative control women and investigated its association with low ovarian hormonal states. Women living with HIV were enrolled from Vancouver Canada and controls from 9 Canadian sites. This longitudinal analysis included age-matched women living with HIV in the Children and Women: AntiRetrovirals and Markers of Aging cohort and controls in the population-based Canadian Multicentre Osteoporosis Study. Rate of change/year in BMD at the total hip and lumbar spine (L1-L4) between 3 and 5 years was compared between groups, adjusting for sociodemographic and clinical variables. Ninety-two women living with HIV (median [interquartile range] age: 49.5 [41.6-54.1] years and body mass index: 24.1 [20.7-30.8] kg/m 2 ) and 278 controls (age: 49.0 [43.0-55.0] years and body mass index: 25.8 [22.9-30.6] kg/m 2 ) were included. Total hip BMD loss was associated with HIV (β: -0.003 [95% CI: -0.006 to -0.0001] g/cm 2 /yr), menopause (β: -0.007 [-0.01 to -0.005] g/cm 2 /yr), and smoking (β: -0.003 [-0.006 to -0.0002] g/cm 2 /yr); BMD gain was linked with higher body mass index (β: 0.0002 [0.0007-0.0004] g/cm 2 /yr). Menopause was associated with losing L1-L4 BMD (β: -0.01 [-0.01 to -0.006] g/cm 2 /yr). Amenorrhea was not associated with BMD loss. HIV and menopause negatively influenced total hip BMD. These data suggest women living with HIV require hip BMD monitoring as they age.

The Precision of Lumbar Spine BMD and TBS on Different Vertebral Combinations

OBJECTIVE The objective of this study is to compute the precision and LSC of BMD and TBS at the lumbar spine using dual-energy X-ray absorptiometry in different vertebral combinations. METHODS Thirty female participants (age 58.8 ± 4.0 years, height: 155.0 ± 5.2 cm, weight: 57.4 ± 8.6 kg and BMI: 23.9 ± 3.6) were scanned at the lumbar spine twice in the same day using DXA. The precision and LSC of BMD and TBS were computed in terms of the RMS-SD and %CV using the ISCD Advanced Precision Calculation Tool. RESULTS The precision and LSC of BMD of the 4 vertebrae combinations showed the best precision and also showed a similar trend (0.005 g/cm2 and 0.62%, 0.013 g/cm2 and 1.71%), respectively. For TBS, the precision and LSC followed a similar pattern as BMD but was inferior to those of BMD. The %CV LSC of BMD for all vertebrae combinations did not exceed 5.3% as recommended by ISCD (15). The %CV LSC of TBS for 2-4 vertebrae combinations were within 5.8% with the exception of the individual vertebra which was unacceptable (%CV range 6.17-8.98). CONCLUSIONS All vertebrae combinations had an acceptable level of precision and LSC for BMD monitoring. However, the precision and LSC of TBS were inferior to those of BMD, and individual vertebra were not appropriate for TBS monitoring. KEYWORDS precision, least significant change (LSC), bone mineral density (BMD), trabecular bone score (TBS)

Biological/targeted synthetic DMARDs do not arrest bone loss in patients with rheumatoid arthritis: a multicenter prospective observational study

Abstract Objective To elucidate the differential effects of biological/target synthesized DMARDs (b/tsDMARDs) on bone metabolism in patients with rheumatoid arthritis (RA) in a real-world cohort. Methods This was a multicentre prospective observational study of RA patients enrolled at the time of first b/tsDMARDs administration. Bone mineral density (BMD) and bone turnover markers (BTMs) were measured during the 52-week observation. The study was designed to enrol all eligible RA patients. The end-points were differences in changes in BMD according to b/tsDMARD type, and the correlation between BMD and BTMs. Results A total of 1164 patients were enrolled in this study. b/tsDMARDs improved RA disease activity from mean CDAI 25.5 at baseline to 4.5 at week 26. Patients not receiving anti-osteoporotic agents (anti-OP) at baseline with no history of fracture experienced a significant decrease in both femoral neck (F: mean 0.666–0.655 g/cm3) and radial (R: 0.518–0.514) BMD at week 26. Despite maintaining low CDAI levels during weeks 26–52 (5.3–4.4), there was a continued decline in BMD (F: 0.653, R: 0.509. Weeks 52). None of the b/tsDMARDs type preserved BMD. Conversely, patients receiving anti-OP at baseline maintained stable BMD throughout the study (Weeks 0/26/52. F: 0.551/0.551/0.555, R: 0.415/0.416/0.415). Although BTMs were changed by b/tsDMARDs, the changes were unrelated to those in BMD. Conclusion Our study suggested the progression of osteoporosis in RA patients during b/tsDMARDs treatment without anti-OP. BTMs may not reflect BMD change. Regular monitoring of BMD in RA should be considered for early management of osteoporosis.

The associations of alcoholic liver disease and nonalcoholic fatty liver disease with bone mineral density and the mediation of serum 25-Hydroxyvitamin D: A bidirectional and two-step Mendelian randomization.

Reduced bone mineral density (BMD) and osteoporosis are common in chronic liver diseases. However, the causal effect of alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) on BMD remains uncertain. This study uses a two-sample Mendelian randomization (MR) design to evaluate the genetically predicted effect of ALD and NAFLD on BMDs using summary data from publically available genome-wide association studies (GWASs). The GWAS summary statistics of ALD (1416 cases and 213,592 controls) and NAFLD (894 cases and 217,898 controls) were obtained from the FinnGen consortium. BMDs of four sites (total body, n = 56,284; femoral neck, n = 32,735; lumbar spine, n = 28,498; forearm, n = 8143) were from the GEnetic Factors for OSteoporosis Consortium. Data for alcohol consumption (n = 112,117) and smoking (n = 33,299) and serum 25-Hydroxyvitamin D (25-OHD) level (n = 417,580) were from UK-biobank. We first performed univariate MR analysis with the Inverse Variance Weighted (IVW) method as the primary analysis to investigate the genetically predicted effect of ALD or NAFLD on BMD. Then, multivariate MR and mediation analysis were performed to identify whether the effect was mediated by alcohol consumption, smoking, or serum 25-OHD level. The MR results suggested a robust genetically predicted effect of ALD on reduced BMD in the femoral neck (FN-BMD) (IVW beta = -0.0288; 95% CI: -0.0488, -0.00871; P = 0.00494) but not the other three sites. Serum 25-OHD level exhibited a significant mediating effect on the association between ALD and reduced FN-BMD albeit the proportion of mediation was mild (2.21%). No significant effects of NAFLD, alcohol consumption, or smoking on BMD in four sites, or reverse effect of BMD on ALD or NAFLD were detected. Our findings confirm the genetically predicted effect of ALD on reduced FN-BMD, and highlight the importance of periodic BMD and serum 25-OHD monitoring and vitamin D supplementation as needed in patients with ALD. Future research is required to validate our results and investigate the probable underlying mechanisms.

Bone mineral density in egyptian children with juvenile idiopathic arthritis: possible correlation to serum RANKL / osteoprotegerin (OPG) ratio and OPG gene polymorphisms

BackgroundChildren with juvenile idiopathic arthritis (JIA) are at higher risk of decreased bone mineral density (BMD) compared with healthy children due to genetic, disease and medication-related causes. This study aims to investigate the possible effects of osteoprotegerin (OPG) gene polymorphisms and serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor κB-ligand (RANKL) and RANKL/OPG ratio on BMD in children with JIA.MethodsOPG gene rs2073617, rs3134069, serum RANKL, OPG and RANKL/OPG ratio were evaluated in 60 JIA children and 100 matched healthy controls. BMD was evaluated by lumbar dual energy X-ray absorptiometry (DEXA) according to which patients were classified in 2 groups (DEXA z-score above and below − 2). Composite disease activity was measured using the Juvenile Arthritis Disease Activity Score (JADAS) 27-joints. Articular damage was scored using the juvenile arthritis damage index (JADI).ResultsPatients aged 12.05 ± 3.2 years, included 38 females and 31% had BMD z-score below-2. Systemic-onset JIA was the most frequent phenotype (38%). Genotypes and alleles frequencies of the 2 studied polymorphisms did not differ between patients and controls (p > 0.05 for all) while serum RANKL and RANKL/OPG ratio were significantly higher in patients compared to controls (p = < 0.001 and 0.03 respectively). Patients with BMD < -2 had significantly greater frequencies of rs2073617 TT genotype and T allele (p < 0.001), higher serum RANKL, RANKL/OPG ratio (p = 0.01, 0.002), female predominance (p = 0.02), higher articular and extra-articular damage index (p = 0.008,0.009) and more frequent steroid usage (p = 0.02) compared to patients with BMD z-score >-2. Multivariate analysis showed rs2073617 TT genotype, RANKL/OPG ratio, long disease duration (above 36 months) and use of steroid to be associated with decreased BMD (p = 0.03,0.04,0.01,0.01 respectively) in JIA children.ConclusionsEgyptian children with JIA have decreased BMD. rs2073617 TT genotype and T allele, RANKL/OPG ratio are possible determinants of reduced BMD in JIA. Our results underline the importance of frequent monitoring of BMD in JIA children and trying to control disease activity to preserve long term bone health.

To repeat or not to repeat? Measuring bone mineral density during anti-resorptive therapy or a drug holiday.

An initial bone mineral density (BMD) measurement is used to diagnose osteoporosis and decide whether patients need treatment, but the utility of repeating this test in those on treatment or on a drug holiday (ie, during a pause in bisphosphonate treatment) is controversial. Here, we present evidence for and against the use of BMD monitoring in patients receiving antiresorptive therapy or on a drug holiday, and give our recommendations, arguing against a one-size-fits-all approach.

Bone turnover markers to monitor oral bisphosphonate therapy.

Bisphosphonates are widely used as first-line therapy to slow bone loss and decrease fracture risk in postmenopausal women with osteoporosis. Nonadherence to oral bisphosphonates diminishes the benefit of reduced bone loss and fracture risk of these medications. Strategies to enhance osteoporosis monitoring and adherence to therapy are crucial to improve outcomes. Dual-energy x-ray absorptiometry (DXA) is the gold standard for monitoring bone mineral density but is slow to detect change after initiation of oral bisphosphonate therapy. Bone turnover markers (BTMs) are by-products released during bone remodeling and are measurable in blood and urine. We review how the rapid change in BTMs can be a useful short-term tool to monitor the effectiveness of oral bisphosphonate therapy, which may ultimately improve adherence to therapy and outcomes.

OR05-5 Body Mass Index (BMI) as a Predictor of Bone Mineral Density (BMD) in Gender Diverse Youth

Abstract Objective GnRH agonists (GnRHa), used to prevent development of undesired secondary sex characteristics for gender diverse youth (GDY), may impede pubertal bone mineral accrual increasing the risk for osteopenia/osteoporosis during adulthood. Based on findings of low bone mineral density (BMD) scores (relative to natal sex) prior to GnRHa [1], we hypothesized BMD might be associated with body mass index (BMI) in GDY.Method: To test our hypothesis, we reviewed medical records for 27 GDY; 16 were designated female at birth (DFAB) and 11 were designated male at birth (DMAB). Age at presentation, gender identity, ages at initiation of GnRHa and gender affirming hormone treatment (GAHT), duration of GnRHa treatment prior to GAHT initiation, auxologic parameters including BMI, and lumbar spine BMD obtained from GE lunar IDXa dual-energy X-ray absorptiometry (DEXA) were extracted. Lumbar spine BMD was used for statistical analysis. Statistical analysis was performed with Microsoft Excel Analysis ToolPak. A linear regression model was used to determine significance of BMI and GnRHa as predictors of BMD Z-score using a significance level of 0.05. Legal gender marker was used to determine BMD Z-scores. Results BMI ranged from 16.93 kg/m2 to 35.79 kg/m2 (5th to the 99th percentile). DEXA scan results were available for 27 GDY with age range 10-25 years; mean age (±SD) was 17±3 years. BMD of the lumbar spine was obtained from 0-61 months (mean 30 ± 21 months) following initiation of GnRHa. Length of GnRHa treatment prior to GAHT initiation ranged from 0-53 months (mean 14 ± 12 months).Individuals were at different stages of the gender affirmation process including 1) No medical treatments, 2) GnRH agonist only, 3) GAHT only, and 4) combined GnRH agonist and GAHT. Using a linear regression model, length of GnRHa therapy and length of GnRHa without GAHT were not significantly associated with lumbar spine BMD in our sample (p = 0.44 and 0.29, respectively). Using a linear regression model, BMI was a significant positive predictor of higher lumbar bone mineral density (p = 0.03). Conclusion Sex hormone exposure during adolescence and young adulthood is essential for bone health. While GnRH agonists lower endogenous sex hormone exposure, in our sample, lower BMD was not associated with total duration of GnRHa therapy or duration of GnRHa treatment prior to GAHT. Rather BMD was positively associated with BMI regardless of gender affirming medical therapies. Limitations include small sample size, retrospective design, and the use of legal gender marker for normative values. The next step will be larger, prospective studies to identify predictors of low BMD in GD youth. This information will guide future management regarding BMD monitoring.

Inverse association between low-density lipoprotein cholesterol and bone mineral density in young- and middle-aged people: The NHANES 2011–2018

ObjectivesLow-density lipoprotein cholesterol (LDL-C) plays an essential part in bone metabolism. However, the correlation between LDL-C levels and bone mineral density (BMD) is still controversial. This study aimed to explore the relationship between LDL-C levels and lumbar BMD in young- and middle-aged people.MethodsWe conducted a cross-sectional study comprising 4,441 participants aged 20–59 from the National Health and Nutrition Examination Survey (NHANES). LDL-C levels and lumbar BMD were used as independent and dependent variables, respectively. We evaluated the correlation between LDL-C levels and lumbar BMD through a weighted multivariate linear regression model. We performed a subgroup analysis of the relationship between LDL-C levels and lumbar BMD based on age, gender, and body mass index (BMI).ResultsAfter adjusting for confounding factors, LDL-C levels were negatively correlated with lumbar BMD. In subgroup analyses stratified by gender, this negative association was statistically significant in men and women. In the subgroup analysis stratified by age, a negative connection existed in people aged 30–49 years. In the subgroup analysis divided by BMI, there was an inverse correlation in overweight people (25 ≤ BMI < 30).ConclusionsOur research observed an inverse association between LDL-C levels and lumbar BMD in young- and middle-aged people, especially in people aged 30–49 years and who are overweight. Close monitoring of BMD and early intervention may be required for these people.

Monitoring bone mineral density in patients with chronic intestinal failure on home parenteral nutrition – a national centre experience

Type 3 intestinal failure (IF) is known to negatively impact bone metabolism contributing to increased prevalence of osteoporosis and associated increases in morbidity and mortality. It has been challenging to appropriately monitor for these pathologies under the restrictions imposed by the ongoing COVID-19 pandemic.

Обеспеченность витамином D и минеральная плотность костной ткани у больных ювенильным ревматоидным артритом

Актуальность. Мониторирование минеральной плотности костной ткани (МПКТ) у больных ювенильным ревматоидным артритом (ЮРА), дополненное определением сывороточного уровня кальцидиола (25(ОН)D) является индикатором системности процессов катаболизма и критерием успешности терапии. Цель. Оценка показателей денситометрии, уровня кальцидиола у больных ЮРА для определения остеопенического синдрома, целесообразности назначения дополнительных доз витамина D. Материалы и методы. Оценено значение 25(ОН)D и МПКТ у 65 больных ЮРА. Данные обработаны с применением xи-квадрата Пирсона и рангового корреляционного анализа по Спирмену. Результаты. У 92 % больных ЮРА определяется нарушение обеспеченности витамином D. При проведении двухэнергетической рентгеновской абсорбциометрии (DXA) выявлено, что 60 % больных имеют вторичный остеопенический синдром (Z-score ≤ –2 SD). У пациентов, которые получали иммунобиологические препараты в комплексном лечении, наблюдаются достоверно более высокие показатели МПКТ (р &lt; 0,01). Показатель МПКТ имеет сильную негативную корреляционную зависимость от степени активности болезни (коэффициент корреляции (r Spearman’s) равен –0,72), умеренную зависимость от уровня 25(ОН)D (r Spearman’s равный 0,39). Выводы. В процессе наблюдения и мониторинга лечения больных ЮРА необходимо контролировать уровень 25(ОН)D и МПКТ. 68 % больных ЮРА, которые в качестве базисной терапии получают плановое лечение иммунобиологическими препаратами, имеют нормальную МПКТ.

Bone mineral density and its influencing factors in Chinese children with spinal muscular atrophy types 2 and 3

BackgroundPatients with spinal muscular atrophy (SMA) are at risk of decreased bone mineral density (BMD). The bone health status of Chinese patients with SMA has been poorly studied. We aimed to evaluate the BMD of children with SMA types 2 and 3 in mainland China and investigate its influencing factors.MethodsForty patients with a mean age of 5.5 years affected by SMA types 2 and 3 (n = 22 and n = 18, respectively) were enrolled between September 2017 and May 2019. Total body less head (TBLH) BMD, lumbar spine (LS) BMD, and body composition were measured using dual-energy X-ray absorptiometry (DXA). Serum bone metabolism markers and complete spinal radiographs were assessed. We utilized a linear regression model to explore the correlations between BMD and its related factors.ResultsA total of 67.5% (27/40) of patients were diagnosed with low BMD and 2.5% (1/40) were diagnosed with osteoporosis. The TBLH BMD and LS BMD Z-scores in children with SMA type 2 were significantly lower than those with SMA type 3. Both TBLH and LS BMD Z-scores tended to increase with the change of SMA subtypes from 2a-3b. Vitamin D insufficiency and deficiency were found in 37.5% (15/40) of the patients. Serum Ca, phosphorus (P), alkaline phosphatase (ALP) and parathormone (PTH) levels were normal. There were no significant differences among the four subtypes in terms of all the serum bone metabolism markers. Phenotype was significantly associated with TBLH BMD and LS BMD Z-scores, and serum PTH levels were significantly associated with TBLH BMD Z-scores.ConclusionsLow BMD and osteoporosis were highly prevalent in mainland Chinese children with SMA types 2 and 3. Phenotype and serum PTH level might be the influencing factors of BMD. Regular monitoring of BMD by DXA scan and taking active interventions aim to SMA children with different types are important.

High-density Lipoprotein Cholesterol Is Negatively Correlated with Bone Mineral Density and Has Potential Predictive Value for Bone Loss

BackgroundMany studies have shown that lipids play important roles in bone metabolism. However, the association between high-density lipoprotein cholesterol (HDL-C) and bone mineral density (BMD) is unclear. Therefore, this study aimed to investigate the linear or nonlinear relation between HDL-C levels and BMD and addressed whether the HDL-C levels had the potential values for predicting the risk of osteoporosis or osteopenia.MethodsTwo researchers independently extracted all information from the National Health and Nutrition Examination Survey (NHANES) database. Participants over 20 years of age with available HDL-C and BMD data were enrolled in the final analysis. The linear relationship between HDL-C levels and BMD was assessed using multivariate linear regression models. Moreover, the nonlinear relationship was also characterized by fitted smoothing curves and generalized additive models. In addition, the odds ratio (OR) for osteopenia and osteoporosis was evaluated with multiple logistic regression models.ResultsThe weighted multivariable linear regression models demonstrated that HDL-C levels displayed an inverse association with BMD, especially among females and subjects aged 30 to 39 or 50 to 59. Moreover, the nonlinear relationship characterized by smooth curve fittings and generalized additive models suggested that (i) HDL-C levels displayed an inverted U-shaped relationship with BMD among women 30 to 39 or over 60 years of age; (ii) HDL-C levels exhibited a U-shaped association with BMD among women 20 to 29 or 50 to 59 years of age. In addition, females with high HDL levels (62-139 mg/dL) had an increased risk of osteopenia or osteoporosis.ConclusionThis study demonstrated that HDL-C levels exhibit an inverse correlation with BMD. Especially in females, clinicians need to be alert to patients with high HDL-C levels, which may indicate an increased risk of osteoporosis or osteopenia. For these patients, close monitoring of BMD and early intervention may be necessary.

142P Bone mineral density (BMD) after three years of adjuvant zoledronic acid (ZA) in postmenopausal oestrogen receptor positive (ER+) early breast cancer (EBC): An observational single centre study

Adjuvant bisphosphonate therapy is recommended in postmenopausal women with intermediate or high risk EBC. Bisphophonates improve breast cancer outcomes and also protect against bone loss from adjuvant aromatase inhibitors (AI). The increasing use of extended adjuvant AIs beyond 5 years has implications for bone health. There is currently no specific guidance for BMD monitoring in patients on extended endocrine therapy.

Diminishing Value from Multiple Serial Bone Densitometry in Women Receiving Antiresorptive Medication for Osteoporosis

The value of serial bone mineral density (BMD) monitoring while on osteoporosis therapy is controversial. We determined the percentage of women classified as suboptimal responders to therapy with antiresorptive medications according to 2 definitions of serial BMD change. This was a cohort study using administrative databases at a single-payer government health system in Manitoba, Canada. Participants were postmenopausal women aged 40 years or older receiving antiresorptive medications and having 3 sequential BMD measures. Women stopping or switching therapies were excluded. The percentage of women whose spine or hip BMD decreased significantly during the first or second interval of monitoring by BMD was determined. Suboptimal responder status was defined as BMD decrease during both monitoring intervals or BMD decreased from baseline to final BMD. There were 1369 women in the analytic cohort. Mean BMD monitoring intervals were 3.0 (0.8) and 3.2 (0.8) years. In the first interval, 3.2% and 6.5% of women had a decrease in spine or hip BMD; 8.0% and 16.9% had decreases in the second monitoring interval; but only 1.4% showed repeated losses in both intervals. Considering the entire treatment interval, only 3.2% and 7.4% showed BMD loss at spine or hip. Results may not apply to situations of poor adherence to antiresorptive medication or anabolic therapy use. Among women highly adherent to antiresorptive therapy for osteoporosis, a very small percentage sustained BMD losses on repeated measures. The value of multiple serial BMD monitoring to detect persistent suboptimal responders should be questioned.

Effect of inhaled corticosteroids on bone mineral density in asthmatic children

Background: There is a rise in prevalence of asthma world-over. This study was undertaken as there are controversies regarding the effect of long term inhaled-corticosteroids (ICS) on bone mineral density (BMD).Methods: Asthmatic children belonging to 5-18 year age-group as per the global initiative for asthma guidelines (GINA) guidelines, who were on ICS for a minimum period of 6 months were studied. This study was conducted at a tertiary-care teaching hospital in Mysuru. 60 asthmatic children were compared with 60 non-asthmatic controls. Dual-energy x-ray absorptiometry at 6 sites was used for estimating the BMD and vitamin D levels were measured.Results: 0.771±0.114 g/cm2 was the mean total BMD among children on low dose ICS, while it was 0.613±0.192 and 0.564±0.104 g/cm2 respectively for those on medium and high dose ICS, with p value of 0.026. Children on low dose ICS did not have any impact on BMD, while 18.9% of those on medium and high dose ICS had a reduced total BMD. Trochanteric region was a useful predictor site for monitoring BMD in children on long term ICS with 38.7% and 68.9% being affected when on ICS for 6-12 months and more than 12 months respectively (p=0.018).Conclusions: The ICS of medium and high dose, for a duration of more than 6 months had a reduced total BMD. However, no effect was seen with low dose. Trochanter is a useful site for long term monitoring of BMD in children. There was no correlation between vitamin D levels and control of asthma.

Prevalence of osteoporosis and osteopenia in a cohort of HIV positive women with a history of treated neoplasms

Introduction:Higher prevalence of osteopenia and osteoporosis in HIV positive patients compared to non-infected population has been recognized. However, cancer patients have a higher risk of bone loss and fractures that is multifactorial. The aim of the study was to describe the prevalence of osteopenia and osteoporosis in HIV positive women with history of treated cancer.Methods:Between January 2018 and December 2019, women aged >40 years, HIV+ with a history of cancer diagnosis, who attended the AIDS Cancer Clinic at Instituto Nacional de Cancerología, Mexico City, and who had a dual X-ray absorptiometry performed during the study period were included. Two control groups (CG)—HIV negative women with history of cancer (CG1) and non-HIV, non-cancer women (CG2)—were matched by age 1:1.Results:Forty-eight patients in each group were included; the mean age was 51.1 ± 8.1 years. Osteopenia was found in femoral neck in 54.2% (HIV+), 37.5% (CG1), and 27.1% (CG2), p = 0.02; in spine was 35.7%, 47.9%, and 31.2%, respectively, p = 0.442. Osteoporosis in femoral neck was documented in 12.5%, 2.1%, and 0% in HIV+, CG1, and CG2 (p = 0.03), and in the spine was 47.9%, 16.7%, and 14.6%, respectively (p = 0.002).Conclusion:HIV patients with a history of treated cancer have a much higher prevalence of osteoporosis when compared with same-aged HIV-uninfected women with and without cancer. It is necessary to monitor Bone Mineral Density periodically, and all patients should be encouraged to make lifestyle changes, such as avoid tobacco and alcohol, and to increase exercising.

Effect of Lumbar Epidural Steroid Injections on Osteoporotic Fracture and Bone Mineral Density in Elderly Women with Diabetes Mellitus.

The incidence of osteoporosis and diabetes mellitus (DM) is known to increase with aging. DM is associated with osteoporotic fractures and decreased bone mineral metabolism. However, no studies have compared the effects of DM on the changes in bone mineral density (BMD) and osteoporotic fracture after epidural steroid injections (ESIs). The present study aimed to analyze the relationship between ESI and BMD changes in elderly women with and without DM. The medical records of elderly women who underwent ESI were retrospectively analyzed. All patients had radiographic and BMD assessments performed before and after receiving lumbar ESIs. A total of 172 patients were divided into two groups according to the presence of DM. The duration of BMD monitoring was 16.1 and 16.8 months in the non-DM and DM groups, respectively. The mean total number of ESIs was 3.4 and 3.2, and the mean cumulative administered dose of glucocorticoids (dexamethasone) was 17 and 16 mg in the non-DM and DM groups, respectively. There were no significant differences between baseline and posttreatment BMD in the lumbar spine, total femur, and femoral neck region in either group. The incidence of osteoporotic fractures at the hip joint and thoracolumbar spine was not significantly different in both groups. ESIs could be used without concerns regarding osteoporosis and fractures in elderly women with DM if low doses of glucocorticoids are used.

Vitamin-D status and bone mineral density in asthmatic children on long-term inhaled corticosteroids

Asthma is the most common chronic respiratory illness affecting children. Inhaled corticosteroids (ICS) form the main treatment modality in asthma. Reduction in bone mineral density (BMD) is an important adverse effect of steroid usage. This side effect is an established entity with oral corticosteroids but minimal with ICS therapy. However, there are reports regarding the detrimental effect of chronic therapy with ICS. Long-term high-dose budesonide more than 800 μg/day has been shown to reduce the BMD. However, this effect was not consistently seen with moderate doses of 400–800 μg/day. Anticipating the impact of steroids on bone metabolism and monitoring for it is essential. Annual monitoring of Vitamin-D levels and BMD in children on chronic therapy is beneficial for the early detection and management of steroid-induced osteopenia. Judicious ICS use at the lowest effective dose should be tailor-made for every individual.