Lumbar Spine Bone Mineral Density Research Articles

Impact of different antiretroviral therapy regimens on bone mineral density in people living with HIV: a retrospective and longitudinal study in China

BackgroundHIV infection and antiretroviral therapy (ART) are associated with bone loss of people living with HIV (PLWH), but limited studies exist on the impacts of ART regimens on bone mineral density (BMD) in China. This study evaluated BMD changes with three common ART regimens: tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + efavirenz (EFV), tenofovir alafenamide (TAF)-containing, and dolutegravir (DTG)-containing (non-TDF/non-TAF) therapies.MethodsIn this retrospective study, the prevalence of low BMD was analyzed in PLWH who underwent dual-energy X-ray absorptiometry (DXA) before ART initiation. BMD changes were assessed in participants who had follow-up DXA scans after ≥ 1 year of ART with TDF + 3TC + EFV, TAF-containing, or DTG-containing regimens. We used multivariate logistic regression to evaluate the impact of different ART regimens on > 3% BMD reduction, adjusting for demographic and clinical variables that were significant in univariate analysis (P < 0.10).Results22.99% (630/2740) of PLWH before ART initiation had low BMD. Among 571 individuals followed up for over 1 year, BMD at the femoral neck (FN) and total hip (TH) decreased significantly in the TDF + 3TC + EFV [FN: -0.03(-0.07, 0.00) g/cm2, TH: -0.02(-0.05, 0.00) g/cm2, P < 0.001 for both] and TAF-containing regimens [FN: -0.02(-0.05, 0.01) g/cm2, TH: -0.02(-0.04, 0.01) g/cm2, P < 0.001 for both]. Lumbar spine (LS) BMD decreased significantly only with TDF + 3TC + EFV [-0.02(-0.05, 0.01) g/cm2, P < 0.001]. TDF + 3TC + EFV caused greater BMD loss at the FN and LS than the TAF-containing regimen[FN: -3.66% (-8.05%, 0.34%) vs. -2.38% (-5.44%, 1.12%), P = 0.044; LS: -2.11% (-4.50%, 0.62%) vs.-0.06% (-2.05%, 2.57%), P < 0.001]. Compared to TDF + 3TC + EFV, DTG-containing regimens showed smaller BMD reductions across all sites [FN: -1.49% (-4.65%, 3.83%), TH: 0.00% (-3.98%, 3.18%), LS: 0.59% (-2.73%, 3.09%), P = 0.004, 0.008 and 0.004, respectively]. TAF-containing and DTG-containing regimens showed no significant differences in BMD changes. Multivariable logistic regression showed that TDF + 3TC + EFV, compared to DTG-containing regimens, had higher odds of > 3% FN and LS BMD reduction (FN: OR 2.91, 95% CI: 1.33 to 6.37, P = 0.009; LS: OR 2.93, 95% CI: 1.17 to 7.32, P = 0.022), while TAF-containing regimens were not independently linked to > 3% BMD loss (P > 0.05).ConclusionsTAF-containing and DTG-containing regimens caused less bone loss than TDF + 3TC + EFV, offering safer options for preserving bone health in Chinese PLWH.

Cumulative incidence and treatment effectiveness of low bone mineral density among people living with HIV in Iran (2021–2023)

BackgroundThe introduction of antiretroviral therapy (ART) has significantly improved the life expectancy of people living with HIV (PLHIV), leading to an increased prevalence of age-related comorbidities such as osteoporosis. This study investigates the incidence and characteristics of low bone mineral density (BMD) and the treatment effectiveness of low BMD participants among PLHIV in Kerman, Iran.MethodsA longitudinal study utilized dual-energy X-ray absorptiometry (DEXA) to screen 94 PLHIV in Kerman, Iran, for low BMD. Participants were aged 30 or older and had received antiretroviral therapy (ART) for at least 12 months. Those with low BMD were entered into a single-arm clinical trial and received the appropriate treatment. These people were checked to assess the treatment effectiveness 11 months after completion of the treatment. Those with normal BMD entered a cohort study and were checked to determine the cumulative incidence of low BMD. Data on demographics, medical history, and laboratory tests were collected. A chi-square test was used to assess the association between the categorical variables. A t-test (for normally distributed variables), or Mann-Whitney U (for non-normally distributed variables) was used to assess the differences of BMD between the two groups. Statistical significance was set at p ≤ 0.05, with analyses conducted in Stata 17.ResultsAmong 94 PLHIV at baseline, 48 participants (51%) had low BMD. During the follow-up, 11 participants (11.7%) missed the follow-up visits. In the follow-up, 83 PLHIV (40 with low BMD and 43 with normal BMD at baseline) were available. Among 40 participants who received treatment, 5 had normal BMD (treatment effectiveness: 12.5%). However, among 43 PLHIV with normal BMD at baseline, 7 PLHIV had low BMD at the follow-up visit (cumulative Incidence 16.3%). Those with lower body mass index (BMI) had a higher prevalence of low BMD than those with normal BMI during the follow-up (p-value: 0.003). Lumbar spine BMD increased modestly (0.005 g/cm2), while femoral neck and total hip BMD declined in total participants (0.011, 0.007 g/cm2, respectively). Osteocalcin and β-isomerized C-terminal telopeptides (β-CTx) levels were higher in the low BMD group in the follow-up, indicating increased bone turnover.ConclusionsThe study highlights the high cumulative incidence of 16.3% and treatment effectiveness of 12.5% of low BMD among PLHIV in Kerman, Iran, with implications for fracture risk. Despite a steady state in spine BMD decline, the risk of fracture remains elevated due to continued femoral neck and total hip BMD reduction. Gender-specific factors and BMI may influence susceptibility to low BMD.

NHANES data analysis of the cardiometabolic index in relation to lumbar spine bone mineral density.

to investigate the correlation between cardiometabolic index (CMI) and lumbar spine bone mineral density (LSBMD) in U.S. adults. the study selected eligible participants from the National Health and Nutrition Examination Survey (NHANES) database from 2011 to 2018. After adjusting for age, gender, race/ethnicity, body mass index (BMI), liver function markers, kidney function markers, blood routine indicators, metabolic markers, and chronic disease status, a logistic regression model combined with a restricted cubic spline model, smooth curve fitting, and threshold effect analysis was used to examine the association between CMI and LSBMD. Subgroup analysis was performed to verify the robustness of the results. among the 3,885 participants, for each unit increase in CMI, LSBMD decreased by 0.011 g/cm². Additionally, a turning point was identified at CMI = 0.797. When CMI was below 0.797, LSBMD decreased as CMI increased, showing a strong negative correlation (β = -0.077, 95 % CI: -0.097 to -0.058, p < 0.001). However, beyond this threshold, the relationship between CMI and LSBMD was no longer significant. Subgroup analysis revealed that the negative correlation between CMI and BMD was consistent across most subgroups (such as gender, BMI, hypertension, and high cholesterol), but instability was observed in subgroups such as individuals aged 51-59, Mexican Americans, non-Hispanic Blacks, and those with diabetes. there exists a non-linear inverse correlation with CMI and LSBMD, showing that CMI could be a potential contributing factor for decreased bone mineral density, with a more pronounced effect within a specific range.

Bone biochemical markers, bone mineral density, and the risk of osteonecrosis of the femoral head: a Mendelian randomization study

BackgroundAlterations in bone metabolism may play a significant role in the early stages of femoral head necrosis, yet the causal relationship remains unclear. This study utilizes a two-sample Mendelian randomization (MR) approach to explore the genetic causal links between biochemical markers of bone metabolism, bone mineral density, and the risk of femoral head necrosis.MethodsThis study utilizes publicly available genome-wide association study (GWAS) datasets, with exposure factors including biochemical bone markers (25OHD, calcium, and alkaline phosphatase) and bone mineral density (measured at the lumbar spine, heel, femoral neck, and total body). The outcome of interest is osteonecrosis of the femoral head. We selected validated single nucleotide polymorphisms that are strongly associated with the exposure factors as instrumental variables. Mendelian randomization analysis was conducted using inverse variance weighting(IVW), MR-Egger regression, and weighted median estimation. Additionally, we performed analyses for horizontal pleiotropy, heterogeneity, and sensitivity.ResultsA total of 934 SNPs were included in this study. The MR analysis results indicate that the IVW analysis of 25OHD, Ca, and ALP did not reach statistical significance (25OHD OR = 1.006, 95%CI: 0.69–1.47, P = 0.975; Ca OR = 0.856, 95%CI: 0.43–1.70, P = 0.657; ALP OR = 1.022, 95%CI: 0.86–1.21, P = 0.801). However, bone density, including heel, lumbar spine, and total body bone density, showed a protective causal relationship with the onset of ONFH, while the results for femoral neck bone density did not reach statistical significance (lumbar spine BMD OR = 0.662, 95%CI: 0.48–0.91, P = 0.010; heel BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; total body BMD OR = 0.726, 95%CI: 0.62–0.85, P < 0.001; femoral neck BMD OR = 0.748, 95%CI: 0.53–1.05, P = 0.096). Cochran’s Q statistic for IVW and MR-Egger methods indicated no intergenic heterogeneity for all exposure outcomes’ SNPs, and the tests for pleiotropy suggested a low likelihood of pleiotropy in all causal analyses.ConclusionsThe results of this study indicate that there is no genetically mediated causal relationship between serum levels of 25-hydroxyvitamin D, calcium, and alkaline phosphatase and osteonecrosis of the femoral head. However, heel, lumbar spine, and total body bone mineral density can be considered protective factors for the occurrence of ONFH. There is no genetic causality between femoral neck bone mineral density and ONFH development.

Bone Mineral Density Improvement After Resolution of Endogenous Cushing Syndrome: A Systematic Review and Meta-analysis.

We aimed to identify all evidence to evaluate bone mineral density (BMD) improvement after resolution of endogenous Cushing syndrome (eCS). Potentially eligible studies were identified from the EMBASE and PubMed databases from inception to February 2024, utilizing a search strategy incorporating terms related to "Bone mineral density" and "Cushing syndrome". Eligible studies must include patients diagnosed with eCS. These studies must present lumbar spine (LS) or femoral neck (FN) BMD measurements before and after resolution of eCS. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method. Meta-regression analysis was utilized to explore factors influencing BMD improvement. After systematic review, 5,085 records were identified. After systematic review, 12 studies (302 patients, mean age of 13 - 44 years, % female patients 57 - 92%, follow-up time 16 - 60 months) were eligible. The meta-analysis demonstrated that resolution of eCS resulted in improvements in LS BMD (pooled MD T-score: +0.86, I2 80.4 %; 95%CI 0.51 - 1.21; Z-score: +0.86, 95%CI 0.57 - 1.16, I2 75.9%) and FN BMD (pooled MD: T-score: +0.38, 95%CI 0.26 - 0.51, I2 0.0%; Z-score: +0.44, 95%CI 0.31 - 0.57, I2 20.3%). The meta-regression analysis identified factors potentially influencing LS BMD increases, including longer follow-up time, higher %female patients and lower mean baseline 24-hour UFC, while none of these factors were significantly associated with FN BMD changes. Our study presents the degree and influencing factors of BMD improvement following eCS resolution. These findings offer guidance for management of eCS-associated osteoporosis.

Effects of recreational artistic gymnastics on bone mineral density and content of school-age girls

Aims :This study aimed to evaluate whether Artistic Gymnastics (AG) practice has beneficial effects on Bone Mineral Density (BMD) and Bone Mineral Content (BMC) of young gymnasts.Methods : All girls involved in AG training from the city of Pelotas, aged 6 to 12 years were recruited. Control group participants could not be involved in any extracurricular sports activity. Predictive equations based on anthropometric and physical tests were used to assess bone mass (BMD and BMC).Results : When compared to control group, AG group showed higher Femoral neck (0.672 ± 0.147 vs 0.561 ± 0.172) and Upper limbs (1.482 ± 0.159 vs 1.289 ± 0.178) BMD. In addition, Lumbar spine BMD was higher in AG group regardless of the predictive equation used. When compared with girls not involved in extracurricular activities, AG practitioners presented higher upper limbs, femoral neck and lumbar spine BMD.Conclusion : However, caution is required when using predictive equations to assess BMD and BMC.

Association of serum alkaline phosphatase levels with bone mineral density, osteoporosis prevalence, and mortality in US adults with osteoporosis: evidence from NHANES 2005-2018.

The evidence regarding the association between serum T-ALP, BMD and osteoporosis prevalence in general population is incomplete, and limited evidence is available concerning its association with mortality among individuals with osteoporosis. The study investigated the association of serum T-ALP with BMD and osteoporosis prevalence in the general population, and examined its association with mortality in individuals with osteoporosis. All participants were adults from the NHANES (2005-2018), and mortality data were obtained from the National Death Index up to December 31, 2019. Firstly, the association of serum T-ALP with BMD and osteoporosis risk was assessed using linear regression model, subgroup analysis, analysis of covariance and weighted logistic regression model, respectively. Secondly, survival analysis including Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline regression models were utilized to analyze the relationship between serum T-ALP levels and mortality risk. The study included 13,724 participants aged 18 to 85years, and 944 were diagnosed with osteoporosis, among whom 221 died during a median of 133months follow-up. Totally, elevated serum T-ALP was significantly associated with low BMD in femoral neck and lumbar spine, and the results exhibited consistency across diverse age, genders, races, and BMI subgroups. Moreover, for each 1 SD increase in T-ALP, there was a 0.5% increase in the prevalence of osteoporosis [OR (95%CI): 1.005 (1.005, 1.005), p < 0.001]. Among individuals with osteoporosis, for every 1 SD increase in T-ALP, the all-cause mortality increased by 0.4% [HR (95%CI):1.004 (1.002, 1.006), p < 0.001]. Meanwhile, comparing participants with highest serum T-ALP levels (> 79IU/L) to those with lowest levels (< 53IU/L) further raised the prevalence of osteoporosis [OR (95%CI):1.292 (1.021, 1.636), p = 0.033] and all-cause mortality [HR (95% CI):1.232 (1.041, 1.459), p = 0.015]. Based on a representative sample of US adults, elevated serum T-ALP levels were found to be significantly associated with both reduced BMD and an increased risk of osteoporosis across all participants, as well as with a higher all-cause mortality in individuals with osteoporosis.

Prevalence and risk factors of osteoporosis in lupus nephritis patients in China: a cross-sectional study

BackgroundOsteoporosis is a significant concern among individuals with lupus nephritis (LN), with reported prevalence rates exhibiting considerable variation. This study investigates the prevalence and identifies risk factors contributing to osteoporosis in premenopausal and postmenopausal LN patients, addressing the paucity of data specific to the Chinese population.MethodsThis cross-sectional study enrolled patients with renal biopsy-proven LN, who underwent bone mineral density (BMD) measurements using dual X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. The study was conducted at Tongji hospital from May 2011 to June 2018.ResultsA total of 130 patients were evaluated, with a mean age of 46.2 ± 12.9 years, including 2 males and 128 females. A significant majority, 52.3% (n = 67) of the female patients, were identified as postmenopausal. BMD measurements revealed that 40.0% of patients had osteoporosis in at least one site. The spearman rank correlation of BMD with clinical characteristics indicated that age at menopause, weight, height, and body mass index were positively correlated with BMD, while age, age at diagnosis of LN, and menopause duration were negatively correlated with BMD in lumbar spine, total hip, and/or femoral neck. Multivariable linear regression analysis demonstrated that body mass index was positively associated with BMD, whereas disease duration and menopause duration were negatively associated with BMD in all and postmenopausal patients. Postmenopausal patients consistently had a higher prevalence of osteoporosis across all measured sites. Factors such as older age, lower weight, and the absence of bisphosphonates therapy were independently associated with an increased risk of osteoporosis in LN patients.ConclusionOur findings underscore a substantial prevalence of osteoporosis in LN patients, especially among postmenopausal individuals. The study identifies older age, lower weight, and absence of bisphosphonates treatment as risk factors for osteoporosis in this patient population.

Bone strain index for fracture risk assessment in older men-the prospective STRAMBO study.

Bone strain index (BSI) is a noninvasive index of bone strength assessed on lumbar spine and femur dual energy X-ray absorptiometry scans using the finite-element method. In this study, we assess the link of the lumbar spine and hip BSI with fracture risk in older men. Prospective cohort study. A cohort of 825 men aged ≥60 was followed up for 12 years. Lumbar spine and hip bone mineral density, BSI, Fracture Risk Assessment Tool (FRAX) for major osteoporotic fractures (MOPFx), and lumbar spine trabecular bone score (TBS) were assessed at baseline. Overall, 159 men had 198 incident fractures. After adjustment for FRAX and prior falls, a higher BSI was associated with a higher fracture risk, eg, trochanter BSI: (HR = 1.34 per standard deviation (SD) increase, 95% CI: 1.14-1.58, P < .001). Patterns were similar for MOPFx, vertebral, nonvertebral, and multiple fractures. The fracture risk was higher in the highest vs the lowest BSI quartiles. The associations were the strongest for the BSI of the lumbar spine and trochanter. When the TBS and BSI were analyzed jointly, their respective contributions to fracture prediction varied according to the fracture and the site of the BSI, eg, both the TBS and the trochanter BSI contributed to the MOPFx prediction (TBS: HR = 1.38/SD decrease, 95%CI: 1.04-1.84, P < .05; BSI: HR = 1.49/SD increase, 95% CI: 1.16-1.91, P < .005). The BSI at both the lumbar and the femoral sites was associated with a higher fracture risk independently of FRAX and prior falls in older men followed prospectively for 12 years.

Low geriatric nutritional risk index is associated with osteosarcopenia in older patients with type 2 diabetes mellitus

BackgroundThe association between the geriatric nutritional risk index (GNRI) and osteosarcopenia in older adults with type 2 diabetes mellitus (T2DM) is not clear.MethodsA total of 573 individuals with T2DM were included in this cross-sectional study. Osteosarcopenia was defined as the presence of both osteoporosis and sarcopenia. Appendicular skeletal muscle mass and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry to diagnose sarcopenia and osteoporosis. Multivariate analyses were used to assess the association between Geriatric Nutritional Risk Index (GNRI) and osteosarcopenia.ResultsThe patients were divided into four groups: robust (n = 367), osteoporosis alone (n = 154), sarcopenia alone (n = 29), and osteosarcopenia (n = 23). The GNRI was the lowest in osteosarcopenia group and was positively correlated with skeletal muscle index (SMI) (r = 0.122, p = 0.004), grip strength (r = 0.154, p < 0.001), gait speed (r = 0.123, p = 0.004), and BMD of lumbar spine 2–4, femoral neck, and total hip (r = 0.137, p = 0.002; r = 0.096, p = 0.028; r = 0.086, p = 0.049, respectively). In the logistic regression model low GNRI was significantly associated with an increased risk of osteosarcopenia (adjusted OR, 4.164; 95% CI, 1.283–13.514, p = 0.018). Age provided a discriminatory effect of osteosarcopenia with an area under the curve (AUC) of 0.764. When GNRI values were added to the model, the value of the ROC curve was further improved, with an AUC of 0.842.ConclusionLow GNRI was associated with an increased risk of osteosarcopenia in older adults with T2DM. Comprehensive clinical evaluation of nutritional status by a simple tool such as GNRI might be helpful for early identification of those at high risk for osteosarcopenia in older diabetic individuals.

Efficacy and safety of weekly liquid alendronate in Korean postmenopausal women with osteoporosis: a 12-month, multi-center, randomized trial

SummaryThis study compared liquid and tablet forms of alendronate for osteoporosis treatment. After 12 months, both forms increased bone density to a similar degree with no significant differences in side effects. New low-volume liquid alendronate is as effective as tablets, offering an alternative treatment option for postmenopausal women with osteoporosis.Purpose/IntroductionAlendronate, despite its significant efficacy, poses challenges due to complex administration protocols and patient compliance issues, underscoring the need for various formulations. This study compared the efficacy and safety of once-weekly low-volume liquid alendronate sodium trihydrate (ALN-S), an oral solution, to once-weekly alendronate sodium (ALN-T), an oral tablet, in Korean postmenopausal women with osteoporosis.MethodsIn a 12-month, multi-center, prospective, randomized, open-labeled, parallel trial conducted at two hospitals in Korea, 170 patients were randomized to alendronate solution (ALN-S) (N = 85) or alendronate tablet (ALN-T) (N = 85) groups. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN), and total hip (TH) was measured at baseline and after 12 months. Bone turnover markers (BTMs) were assessed at baseline, 6, and 12 months. The primary outcome was the percentage change in BMD of the LS, evaluated for non-inferiority.ResultsAfter 12 months, both ALN-S and ALN-T groups exhibited a significant increase in LS, FN, and TH BMD, with no significant intergroup differences (ALN-S: LS 5.0 ± 0.6%, FN 1.8 ± 0.6%, TH 2.2 ± 0.5%; ALN-T: LS 5.2 ± 0.6%, FN 1.6 ± 0.6%, TH 1.8 ± 0.5%). ALN-S was found to be non-inferior to ALN-T for BMD change at LS (treatment difference: − 0.22%, 95% CI: − 1.84 to 1.40%), excluding the predefined non-inferiority margin of − 2.29%. Changes in BTMs did not differ significantly between groups. The frequency of adverse events was similar between groups.ConclusionLiquid alendronate was non-inferior to tablet alendronate in increasing BMD in Korean postmenopausal women with osteoporosis, presenting a viable alternative when the tablet form is limited in various clinical scenarios.Clinical trial registrationThe trial was registered with ClinicalTrials.gov (NCT05387200).

Forearm bone mineral density as a predictor of adjacent vertebral refracture after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture: a retrospective analysis

BackgroundThe incidence of adjacent vertebral body re-fracture after percutaneous kyphoplasty (PKP) is associated with a number of variables, of which decreased bone mineral density is one of the major risk factors. Forearm bone mineral density (BMD) measurements are gaining attention because of their convenience and validity, but there is a lack of systematic research on the specific relationship between forearm BMD and the risk of adjacent vertebral re-fracture after PKP.PurposeTo investigate the correlation between forearm BMD and the risk of adjacent vertebral re-fracture after PKP in osteoporotic vertebral compression fractures (OVCF) patients.MethodsRetrospective evaluation of 198 OVCF patients receiving PKP was conducted in this study. The patients were divided into two groups: the no-fracture group and the re-fracture group, according to whether or not they had undergone vertebral re-fracture. Obtain basic information about the patient's age, sex, body mass index, bone cement leakage, smoking history, diabetes history, and surgical segmentation. Using computed tomography, the mean Hounsfield unit (HU) values for the BMD of the L1 lumbar spine were determined. For the dual-energy X-ray BMD test, the distal one-third lengths of the patient's nondominant forearm's radius and ulna were chosen. Receiver operating characteristic curves were utilized to evaluate the predictive value of forearm BMD versus lumbar CT values for vertebral re-fracture, and univariate and multivariate logistic regression analyses were employed to identify characteristics related with vertebral re-fracture following PKP.ResultsRe-fracture rate after PKP was 17.2% at a minimum 12-month follow-up. Significant differences were seen between the refracture and non-fracture groups in terms of hypertension, Cobb angle correction, vertebral height recovery rate, intradiscal cement leakage, forearm bone density, and vertebral HU values. In multifactorial logistic regression analysis, forearm bone density (OR 0.821; 95% CI 0.728–0.937, p = 0.008) and HU values (OR 0.815; 95% CI 0.733–0.906, p = 0.005) were independent risk factors for vertebral re-fracture. The area under the curve (AUC) for forearm BMD values and HU values predicting adjacent vertebral re-fracture were 0.956 and 0.967, respectively.ConclusionsForearm BMD is an independent risk factor for re-fracture of adjacent vertebrae after PKP. In addition, forearm BMD, as a valid indicator of postoperative re-fracture after PKP in patients with OVCF, and the HU value of lumbar spine CT were both powerful tools for predicting re-fracture.

Effect of Micronutrients on HIV-Related Clinical Outcomes Among Adults Living With HIV on Antiretroviral Therapy: Systematic Review and Meta-analysis.

Micronutrient deficiencies are common and frequently co-occurring among people living with HIV (PLHIV) globally, with consequences for their health and clinical outcomes. Previous reviews of the influence of micronutrient supplementation on HIV outcomes were conducted in the pre-highly active antiretroviral therapy (pre-HAART) era or included both HAART-naive and HAART-experienced individuals; thus, the evidence in the context of HAART is inconclusive. A systematic review and meta-analysis was conducted to evaluate the effect of micronutrient supplementation on important clinical outcomes among PLHIV on HAART. Original research articles published up to August 2022 in the following medical literature databases were identified and examined: PubMed/Medline, Embase, Web of Science, and Google Scholar. Randomized controlled trials (RCTs) and pre-post intervention studies that evaluated the relationship of micronutrient supplementation and HIV-related outcomes were included. A total of 32 studies investigating the effect of micronutrient supplementation on HIV outcomes in PLHIV on HAART were included. The main outcomes of interest were disease progression, CD4 lymphocyte count, viral load, weight, body mass index (BMI), hemoglobin, and anemia. The Cochrane Risk of Bias (RoB) 2 and ROBINS-I tools were used to assess the risk of bias in included studies, and GRADE was used to assess the certainty of the evidence. Vitamin D supplementation increased serum 25-hydroxyvitamin D concentration by 23.2 nmol/L (95% CI: 11.8 to 34.6; 6 RCTs, 567 participants; low-certainty evidence), but had little to no effect on CD4 lymphocyte counts (mean difference [MD]: 60 cells/µL; 95% CI: -35 to 155; 4 RCTs, 127 participants; low-certainty evidence). The effect of vitamin D on CD4 lymphocyte counts was greater among those with baseline CD4 count <350 cells/µL compared with counterparts with higher CD4 lymphocyte counts. Evidence from single RCTs suggests a beneficial effect of vitamin D on the incidence of sputum-smear-positive tuberculosis (hazard ratio = 0.54; 95% CI: 0.31, 0.92; 4000 participants; low-certainty evidence), and vitamin E (MD = 0.2 g/dL; 95% CI: 0.1, 0.3; 18 participants; moderate-certainty evidence) and selenium (MD = 0.30 g/dL; 95% CI: 0.29, 0.31; 97 participants; high-certainty evidence) on hemoglobin, and selenium on BMI (MD: -0.5; 95% CI: -0.51, -0.49; high-certainty evidence). Zinc supplementation had little to no effect on CD4 lymphocyte count overall, but for every 10-µg/dL higher serum zinc concentration, the predicted change in CD4 lymphocyte count from meta-regression was lower by 28 cells/µL (95% CI: -54, -3; 5 RCTs). Moderate- or high-certainty evidence indicates that there is probably no effect of zinc supplementation on log10 viral load, vitamin D on BMI and lumbar spine bone mineral density, and multiple micronutrient (MMN) supplementation on hemoglobin. The evidence is very uncertain about the effect of zinc supplementation on hemoglobin concentration and BMI, vitamin D supplementation on lumbar spine bone mineral density, vitamin E on CD4 lymphocyte count, and MMN supplementation on CD4 lymphocyte count. Zinc and vitamin D supplementation may promote immune recovery in a substantial proportion of PLHIV on HAART, and selenium and vitamin E supplementation may prevent anemia.

Serum IL-6 and TGF-β1 concentrations as diagnostic biomarkers in elderly male patients with osteoporosis.

This research is intended to evaluate the correlations of serum IL-6 and TGF-β1 concentrations with bone density and turnover markers as well as their diagnostic value in elderly male patients with osteoporosis (OP). A retrospective analysis was conducted on 335 elderly men (≥ 60years; 90 with normal bone mass, 120 osteopenia cases, and 125 OP cases). Lumbar spine/femoral neck BMD values were measured using dual-energy X-ray absorptiometry. Correlations of serum IL-6 and TGF-β1 concentrations with bone density and bone turnover markers in OP patients were analyzed utilizing Pearson or Spearman correlation coefficients. Independent influencing factors for OP were identified by logistic multivariate regression analysis. The diagnostic value of serum IL-6 and TGF-β1 was assessed with ROC curves and MedCalc software. Smoking history, drinking history, lumbar spine BMD, femoral neck BMD, PINP, and β-CTX markedly differed among the normal bone mass, osteopenia, and OP groups. Elevated IL-6 and reduced TGF-β1 concentrations were observed in serum samples of OP. Serum IL-6 concentrations was inversely associated with bone density markers but positively lined to bone turnover markers. Conversely, serum TGF-β1 was positively related to bone density markers but negatively associated with bone turnover markers. Smoking history, PINP, and IL-6, were identified as independent risk factors while lumbar spine BMD, femoral neck BMD, and TGF-β1 were independent protective markers for OP. The combined assessment of serum IL-6 and TGF-β1 showed superior diagnostic performance for OP. Serum IL-6 in combination with TGF-β1 exhibits good diagnostic performance for OP. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

High prevalence of osteoporosis among virally suppressed older people (≥60 years) living with HIV.

Our objective was to evaluate bone mineral density (BMD) among older people living with HIV at the time of enrolment into a clinical trial in Kenya. The bictegravir/emtricitabine/tenofovir alafenamide (BFTAF) Elderly Study is a clinical trial among virally suppressed people living with HIV aged ≥60 years randomized to switch to BFTAF or continue their pre-enrolment regimen. At enrolment, dual-energy x-ray absorptiometry (DXA) of the lumbar spine, total hip, and femoral neck was performed and T-scores calculated for BMD. Osteoporosis was defined as T-score -2.5 or lower and osteopenia as T-score between -1 and -2.5. Fracture risk was calculated based on clinical risk factors (not including BMD), considering HIV as a secondary cause of osteoporosis, and the correlation between FRAX®-HIV and BMD assessed. Between February and May 2022, a total of 296 participants were enrolled. All were Black African, 147 (49.7%) were female, the median age was 64 years (range 60-77), and 280 (94.6%) were on tenofovir disoproxil fumarate. The median BMD of lumbar spine, total hip, and femoral neck was 0.87 g/cm2 (interquartile range [IQR] 0.78-0.99), 0.89 g/cm2 (IQR 0.79-1.01), and 0.75 g/cm2 (IQR 0.67-0.84), respectively, with median T-scores of -1.9 (IQR -2.8 to -0.7), -1.0 (IQR -1.9 to -0.3), and -1.5 (IQR -2.2 to -0.9), respectively. Osteoporosis and osteopenia were found in 37.5% and 47.3% of participants, respectively. Major osteoporotic fracture and hip fracture 10-year median probabilities using FRAX®-HIV were 3.4% (IQR 2.8-4.6) and 1.0% (IQR 0.7-1.3). Correlation coefficients between these FRAX®-HIV probabilities and femoral neck BMD were -0.204 for major osteoporotic fracture and -0.338 for hip fracture. The prevalence of osteoporosis is high among older people living with HIV in Kenya, where DXA is not readily available and risk calculation without BMD had low correlation with measured BMD values. Additional data are required on the impact of investment in fracture risk assessment and treatment, including population-specific risk calculators.

Sequential treatment from bisphosphonate to denosumab improves lumbar spine bone mineral density in postmenopausal osteoporosis patients: A meta-analysis of randomized controlled trials.

Bisphosphonates are effective in the treatment of postmenopausal osteoporosis. However, their prolonged use induces adverse events and may lead to a rapid decline in bone mineral density (BMD) after discontinuation. Denosumab, a human monoclonal antibody, is a widely used antiresorptive agent that is more effective than bisphosphonates in improving bone density. Whether sequential treatment with denosumab after bisphosphonate therapy can maintain or further increase BMD at all sites has not been conclusively demonstrated. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of this sequential therapy on BMD. We searched the PubMed, Embase, and Cochrane Library databases from December 1, 1986, to May 2, 2024, for all RCTs that assessed the efficacy of sequential therapy of bisphosphonate transition to denosumab in postmenopausal women with osteoporosis. BMD changes at the lumbar spine, femoral neck, and total hip were used as outcomes. We assessed methodological quality, extracted relevant data according to the Cochrane Handbook for Systematic Reviews of Interventions, applied random-effects models for meta-analyses, performed heterogeneity analyses, and assessed publication bias. A total of 3290 patients from 4 RCTs were included in the meta-analysis. Forest plot analysis showed that sequential treatment with bisphosphonate-denosumab was associated with higher lumbar spine BMD gain than continuous bisphosphonate treatment [mean difference (MD) = 5.50, 95% confidence interval (CI) = 5.26-5.75, I2 = 32.88%). No risk of bias was observed for the 4 trials, but there was an increase in femoral neck and total hip BMD. Moreover, analyses could not be performed because of high heterogeneity (femoral neck BMD: MD = 3.85, 95% CI = 2.84-4.85, I2 = 97.88%; total hip BMD: MD = 5.65, 95% CI = 4.28-7.02, I2 = 97.91%). Sequential therapy that involves a transition from bisphosphonates to denosumab had a positive effect on lumbar spine bone density, and this type of therapy may be a potential treatment option for increasing lumbar spine bone density in postmenopausal women.

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency.

Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture. To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD. We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5. At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002). Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

Pilot study of the effect of surgical menopause on bone mineral density and quality in patients with gynecological malignancies.

To investigate the effects of surgical menopause on bone mineral density and bone quality because bilateral salpingo-oophorectomy for the treatment of gynecological malignancies is common even in premenopausal patients. This study is prospective one of bone mineral density and quality measurements after surgery for perimenopausal gynecologic malignancies. In 50 women who underwent surgical menopause for a diagnosis of gynecological malignancies, bone mineral density (BMD), blood levels of tartrate-resistant acid phosphatase 5b (TRACP-5b) and bone-specific alkaline phosphatase (BAP) as bone metabolism markers, and urinary pentosidine level as bone quality marker were measured before surgery and at multiple points up to 24 months after surgery. In a group of 22 patients who did not undergo hormone replacement therapy (HRT) (HRT- group), BMD of the lumbar spine and total hip continued to decrease significantly from 6 months postoperatively. Percentages of changes in BMD progressively increased over time after surgery. TRACP-5b and urinary pentosidine levels significantly increased 6 months postoperatively compared with preoperative levels. Comparisons between 10 patients who underwent HRT (HRT+ group) and the HRT- group revealed significant reductions in the percentage of change in lumbar spine BMD only and TRACP-5b and urinary pentosidine levels 12 months postoperatively in the former group. In this pilot study, we showed that BMD and bone-related markers are altered in patients with surgical menopause. It also suggested that HRT may reduce these influences on bone metabolism.

Trabecular bone score as an assessment tool to identify the risk of vertebral fractures in SAPHO syndrome.

To investigate the impact of bone artifacts on trabecular bone score (TBS) and lumbar spine (LS) bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and analyze the clinical utility of TBS evaluation for vertebral fracture (VF) risk assessment in SAPHO patients compared with BMD assessment. Seventy SAPHO patients (mean age 50.1 (10.7) years, 81% women) and an equal number of age- and sex-matched controls were enrolled. TBS and BMD were assessed using DXA. Bone artifacts and VF of the spine were evaluated using whole-spine CT. Univariate logistic regression analysis was performed to identify factors associated with VF. Odds ratios (ORs) per standard deviation decrease in TBS and BMDs were estimated from logistic regression models with adjustment for age. In patients with bone artifacts, TBS, but not LS BMD, was lower than matched controls, and in those without bone artifacts, both BMDs and TBS were lower than controls. After adjustment, LS BMD was significantly lower in the SAPHO group than in controls. TBS and LS BMD (OR [95% confidence interval], 12.0 [3.6, 40.4] and 4.7 [2.0, 10.9]) showed statistically significant ORs but the others did not. For evaluating VF in SAPHO patients, TBS showed the greatest AUC in the ROC curve, with a value of 0.920 compared with 0.777, 0.690, and 0.652 for LS, FN, and TH BMD, respectively. TBS seems not to be influenced by bone artifacts in opposition to LS BMD and has a better discriminatory value than BMD for VF in SAPHO patients.

Causal effects of Parkinson's disease on the risk of osteoporosis: A two-sample Mendelian randomization study.

Employing a two-sample Mendelian randomization (MR) analysis, we aimed to investigate the potential causal effect of Parkinson disease (PD) on osteoporosis. We conducted an in-depth MR analysis by leveraging extensive genome-wide association study datasets from the International Parkinson Disease Genomics Consortium and the Genetic Factors for Osteoporosis Consortium. We meticulously selected instrumental variables based on strict criteria, including significance thresholds, linkage disequilibrium, and the exclusion of confounding single-nucleotide polymorphisms. Our investigation utilized diverse MR methods, including inverse variance weighted, MR Egger regression, weighted median, and MR-PRESSO, to robustly evaluate the causal relationship. Our comprehensive analysis revealed noteworthy associations between PD and distinct measures of bone mineral density (BMD) (forearm BMD, femoral neck BMD, lumbar spine BMD). Specifically, the inverse variance weighted method underscored potential significant relationships between PD and forearm BMD (P = .037; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00-1.09), femoral neck BMD (P = .034; OR, 1.02; 95% CI, 1.00-1.05), and lumbar spine BMD (P = .043; OR, 1.03; 95% CI, 1.00-1.06). The consistency of results across various methods and sensitivity analyses indicated both robustness and minimal pleiotropy concerns. Through a two-sample MR approach, this study establishes a plausible causal relationship between PD and decreased BMD. The outcomes underscore the urgency of targeted interventions to mitigate bone loss and manage osteoporosis in individuals with PD.