Whole-body Bone Mineral Density Research Articles

Evidence of impaired bone quality in men with type 1 diabetes: a cross-sectional study.

ObjectiveType 1 diabetes (T1D) is associated with substantial fracture risk. Bone mineral density (BMD) is, however, only modestly reduced, suggesting impaired bone microarchitecture and/or bone material properties. Yet, the skeletal abnormalities have not been uncovered. Men with T1D seem to experience a more pronounced bone loss than their female counterparts. Hence, we aimed to examine different aspects of bone quality in men with T1D.Design and MethodsIn this cross-sectional study, men with T1D and healthy male controls were enrolled. BMD (femoral neck, total hip, lumbar spine, whole body) and spine trabecular bone score (TBS) were measured by dual x-ray absorptiometry, and bone material strength index (BMSi) was measured by in vivo impact microindentation. HbA1c and bone turnover markers were analyzed.ResultsAltogether, 33 men with T1D (43 ± 12 years) and 28 healthy male controls (42 ± 12 years) were included. Subjects with T1D exhibited lower whole-body BMD than controls (P = 0.04). TBS and BMSi were attenuated in men with T1D vs controls (P = 0.016 and P = 0.004, respectively), and T1D subjects also had a lower bone turnover. The bone parameters did not differ between subjects with or without diabetic complications. Duration of disease correlated negatively with femoral neck BMD but not with TBS or BMSi.ConclusionsThis study revealed compromised bone material strength and microarchitecture in men with T1D. Moreover, our data confirm previous studies which found a modest decrease in BMD and low bone turnover in subjects with T1D. Accordingly, bone should be recognized as a target of diabetic complications.

Genetically determined SCFA concentration modifies the association of dietary fiber intake with changes in bone mineral density during weight loss: The Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial

SCFAs are involved in regulation of body weight and bone health. We aimed to examine whether genetic variations related to butyrate modified the relation between dietary fiber intake and changes in bone mineral density (BMD) in response to weight-loss dietary interventions. In the 2-y Preventing Overweight Using Novel Dietary Strategies trial, 424 participants with BMD measured by DXA scan were randomly assigned to 1 of 4 diets varying in macronutrient intakes. A polygenic score (PGS) was calculated based on 7 genetic variants related to the production of butyrate for 370 of the 424 participants. SCFA PGS significantly modified the association between baseline dietary fiber intake and sex on 2-y changes in whole-body BMD (P-interaction=0.049 and 0.008). In participants with the highest tertile of SCFA PGS, higher dietary fiber intake was related to a greater increase in BMD (β: 0.0022; 95% CI: 0.0009, 0.0035; P=0.002), whereas no such association was found for participants in the lower tertiles. In the lowest tertiles of SCFA PGS, men showed a significant increase in whole-body BMD (β: 0.0280; 95% CI: 0.0112, 0.0447; P=0.002) compared with women. In the highest tertile, no significant difference was found for the change in BMD between men and women. Our data indicate that genetic variants related to butyrate modify the relations of dietary fiber intake and sex with long-term changes in BMD in response to weight-loss diet interventions.

Feasibility and effects of 6-month home-based digitally supported E-Fit program utilizing high-intensity interval exercises in girls with adolescent idiopathic scoliosis: a randomized controlled pilot study.

Adolescent idiopathic scoliosis (AIS) patients have lower physical activities when compared with healthy controls, and are associated with lower bone mineral density (BMD), muscle strength and poorer quality of life (QoL). We aimed to assess the feasibility and effects of 6-month home-based digitally supported E-Fit comprised of high-intensity interval exercises for AIS patients. 40 AIS girls aged 11-14 were randomly assigned to E-Fit or control group. E-Fit group participated in an online 6-month home-based exercise program. At baseline, 6-months and 12-months follow-up, BMD using dual-energy X-ray absorptiometry, muscle functions, physical activity using Modified Baecke Questionnaire (MBQ), and QoL using Scoliosis Research Society-22 (SRS-22r) and feedback questionnaire were investigated. 14 in E-Fit and 16 in control group completed the study. Both groups had similar baseline characteristics. At 6-months, E-Fit group showed better improvement and significant interaction effect in left femoral neck bone mineral content (p=0.021) and isometric curl up test (p=0.04). Left arm lean mass showed better improvement between 6-months and 12-months follow-up (p=0.046) and whole-body areal BMD had significant interaction effect at 12-months follow-up (p=0.077). Improvement on self-image, work and sports participation were noted in E-Fit group across time. 70% of E-Fit participants were positive towards domestic application via online platform. E-Fit showed some benefits on bone health, muscle functions, physical activity and QoL measures. Current study indicated some potential physical and psychological benefits of E-Fit for AIS girls. E-Fit was feasible to conduct online at home and might have value of promoting exercise habits among relatively inactive AIS girls.

High bone mineral density in lifelong trained female team handball players and young elite football players.

Low bone mineral density (BMD) and fractures are a major concern in the female population and preventative strategies are needed. Whether team sports participation may reduce age-related bone loss in elderly women is still uncertain. One hundred and thirty healthy, non-smoking women participated in this cross-sectional study, i.e., elderly (60-80years) team handball players (EH, n = 35), elderly untrained controls (EC, n = 35), young (18-30years) elite football players (YF, n = 30) and young untrained controls (YC, n = 30). A whole-body and two regional dual-energy X-ray absorptiometry (DXA) scans were performed to evaluate BMD and a blood sample was collected for measurement of bone turnover markers (BTMs). EH had higher BMD in all regions of the lumbar spine, except for L1, compared to EC (8-10%), and higher BMD in the femoral Ward's triangle (9%) and trochanter (7%) of the left leg. Furthermore, EH had higher mean leg BMD (8%) and whole-body BMD (5%) than EC. EH and YC had similar BMD in femoral trochanter, L1-L4 and mean leg despite an age difference of ~ 40years. YF had higher BMD in all regions of the proximal femur (18-29%) and lumbar spine (12-16%) compared to YC, as well as higher mean leg BMD (20%) and whole-body BMD (13%). Sclerostin was 14% lower in EH compared to EC. YF showed higher PINP (98%), osteocalcin (57%), and CTX (83%) compared to YC. Lifelong team handball training and elite football training are associated with superior bone mineralization and changed bone turnover in elderly and young women.

Does the severity of obesity influence bone density, geometry and strength in adolescents?

Relationships between the severity of obesity and bone health remain underexplored. To compare whole-body and localized bone mineral content (BMC) and density (BMD), trabecular bone score (TBS) and hip geometry and strength between adolescents with obesity versus extreme obesity. This cross-sectional study included 154 adolescents (12-15 years, 62% females) who were classified as having obesity (OG, [95th-99th] percentile) or extreme obesity (EOG, >99th percentile). Fat mass (FM), lean mass (LM), BMC, BMD for total-body-less-head (TBLH), lumbar spine (LS), hip, TBS and geometric and strength indices at the narrow-neck (NN), femoral shaft (FS) and intertrochanteric regions (IT) were assessed by Dual-X-ray Absorptiometry (DXA). There was no significant sex-interaction. For both sexes, TBLH BMC and BMD were not different between groups. TBS was lower in EOG compared with OG in both sexes in univariate analysis and after adjustment with maturation and body weight (p < 0.05). Hip BMD was significantly higher in the EOG compared to OG only after adjustment with maturation and fat mass percentage (p < 0.05 for men, p < 0.01 for women). For both sexes, TBLH, LS and hip BMC and BMD positively correlated with weight, BMI, LM and FM. TBS negatively correlated with BMI-percentile in both sexes, with a negative correlation with FM for males alone. Hip BMC and BMD, BMD, ACT and CSA at the three hip sites positively correlated with BMI-percentile in males. Extreme obesity impacts bone health depending on anatomical sites, altering lumbar trabecular bone in both males and females adolescents.

Comparison of human bone mineral densities in subjects on plant-based and omnivorous diets: a systematic review and meta-analysis

The increased consumption of plant-based diets has encouraged studies of bone mineral density (BMD). The present systematic review and meta-analysis compared the effects of plant-based and omnivorous diets on BMD. We searched the Cochrane Library, PubMed, EMBASE, and the Web of Science to July 1, 2020. We used the mean differences (MDs) with 95% CIs to compare group outcomes. We compared the lumbar spine, femoral neck, and whole-body BMDs of those on plant-based and omnivorous diets. We performed subgroup analyses by various clinical characteristics. Two reviewers independently assessed trial quality and extracted data. All statistical analyses were performed using Review Manager version 5.2. A total of 17 cross-sectional studies including 13,888 patients were identified. The pooled results indicated that those on plant-based diets (compared to omnivores) exhibited lower BMDs at the lumbar spine (MD - 0.04; 95% CI - 0.06 to - 0.02; P < 0.0001) and femoral neck (MD - 0.04; 95% CI - 0.05 to - 0.02; P < 0.00001), and a reduced whole-body BMD (MD - 0.03; 95% CI - 0.06 to - 0.01; P = 0.0009). Both vegetarians and vegans exhibited lower lumbar spine, femoral neck, and whole-body BMDs than omnivores. Plant-based diets were associated with lower BMDs than those of an omnivore population. Plant-based diets may compromise overall bone health; prospective research is required.

Accounting for Surgical Confounding Factors Affecting Dual-Energy X-ray Absorptiometry in a Large Clinical Trial

Joint replacements are among the most common orthopedic procedures performed in the U.S. and will continue to increase with the aging population. It is therefore necessary to account for these and other confounding factors, such as breast implants, when performing dual-energy X-ray absorptiometry (DXA) measurements. Whole-body DXA scans were performed in 771 participants (men ≥50 yr and women ≥55 yr) to assess bone mineral density (BMD) and body composition (fat and lean mass). In the DXA scan analyses of participants with internal metal, these affected regions of interest were replaced with measures from the unaffected, contralateral side, consistent with recommendations of the International Society for Clinical Densitometry. T-scores and Z-scores were recalculated using default sex and ethnicity-matched databases. We also explored effects of breast implants on bone density and body composition analyses. Approximately 13.1% of participants had internal metal artifacts at baseline. Replacing metal artifacts with the unaffected, contralateral side decreased the whole-body BMD by an average of 8.1% (SEM 0.84%; n = 67). In participants with unilateral hip (n = 17) and knee replacements (n = 20), BMD was decreased by an average of 14.1% (SEM 1.7%) and 11.2% (SEM 1.1%), respectively. Fat and lean mass were not significantly affected by metal artifacts, as differences between values with and without metal were within 1%. Two participants had bilateral breast implants, and in a separate trial, one participant had a unilateral breast implant. Bone mineral content (BMC) in the region with the breast implant was 5.8 times higher than the contralateral side, and whole-body BMC was increased by 4.7%. Metal artifacts and breast implants can confound DXA whole-body bone but not fat and lean results. It is therefore important in clinical studies to account for these factors to detect physiologically relevant differences in bone measures.

Sex differences in systemic bone and muscle loss following femur fracture in mice.

Fracture induces systemic bone loss in mice and humans, and a first (index) fracture increases the risk of future fracture at any skeletal site more in men than women. The etiology of this sex difference is unknown, but fracture may induces a greater systemic bone loss response in men. Also sex differences in systemic muscle loss after fracture have not been examined. We investigated sex differences in systemic bone and muscle loss after transverse femur fracture in 3-month-old male and female C57BL/6 J mice. Whole-body and regional bone mineral content and density (BMC and BMD), trabecular and cortical bone microstructure, muscle contractile force, muscle mass, and muscle fiber size were quantified at multiple time points postfracture. Serum concentrations of inflammatory cytokines (IL-1β, IL-6, and TNF-α) were measured 1-day postfracture. One day postfracture, IL-6 and Il-1B were elevated in fracture mice of both sexes, but TNF-α was only elevated in male fracture mice. Fracture reduced BMC, BMD, and trabecular bone microstructural properties in both sexes 2 weeks postfracture, but declines were greater in males. Muscle contractile force, mass, and fiber size decreased primarily in the fractured limb at 2 weeks postfracture and females showed a trend toward greater muscle loss. Bone and muscle properties recovered by 6 weeks postfracture. Overall, postfracture systemic bone loss is greater in men, which may contribute to sex differences in subsequent fracture risk. In both sexes, muscle loss is primarily confined to the injured limb and fracture may induce greater inflammation in males.

Machine Learning Reveals Influence of Stool pH on Bone Mineral Density in a Healthy Multi-Ethnic U.S. Population

Abstract Objectives A variety of modifiable and non-modifiable factors such as ethnicity, age, and diet have been shown to influence bone health. Previous studies are usually limited to analyses focused on the association of a few a priori variables or on a specific subset of the population. The objective of this study was to use dietary, physiological, and lifestyle data to identify directly modifiable and non-modifiable variables predictive of bone mineral content (BMC) and bone mineral density (BMD) in healthy US men and women using machine learning models. Methods Ridge, lasso, elastic net, and random forest models were used to predict whole-body, femoral neck, and spine BMC and BMD in healthy US adults (n = 313) using non-modifiable anthropometric, physiological, and demographic variables, directly modifiable lifestyle (physical activity, tobacco use) and dietary (nutrient or food groups intake via food frequency questionnaire) variables, and variables approximating directly modifiable behavior (circulating vitamin D and stool pH). Model feature importances were used to identify variables useful for predicting BMC and BMD. Results Machine learning models using non-modifiable variables explained more variation in BMC and BMD (highest R2 = 0.750) compared to when using only directly modifiable variables (highest R2 = 0.107). Machine learning models had better performance compared to multivariate linear regression, which had lower predictive value (highest R2 = 0.063) when using directly modifiable variables only. BMI, body fat %, height, and menstruation history were predictors of BMC and BMD. For the directly modifiable features, betaine, cholesterol, hydroxyproline, menaquinone-4, dihydrophylloquinone, eggs, cheese, cured meat, refined grains, fruit juice, and alcohol consumption were predictors of BMC and BMD. Low stool pH, a proxy for fermentable fiber intake, was also predictive of higher BMC and BMD. Conclusions Machine learning models can be used to identify previously unforeseen variables that may contribute to bone health. Modifiable factors explained less variation in the data compared to other features. Low stool pH, which has been shown to be associated with fermentable fiber intake, short chain fatty acid production, and enhanced calcium absorption, was associated with higher BMC and BMD in a healthy US population. Funding Sources USDA-ARS

Association between calcium supplementation and bone mineral density in children: a systematic review and meta-analysis

Abstract Objective To evaluate the effects of calcium supplementation on bone mineral density in children. Methods The PubMed, Embase, and Cochrane library were systematically searched. The retrieve inception date was between October 2001 and October 2019. Two reviewers independently performed the data extraction and assessed methodology quality. Studies were limited to randomized clinical trials comparing calcium supplement with a placebo for bone mineral density in children. A meta-analysis was performed to calculate standard mean difference (SMD) and 95% confidence interval (CI). Results A total of 6 randomized controlled trials involving 408 participants (calcium supplementation group: 198; placebo group: 210) were finally included in this study. The meta-analysis revealed that, compared with placebos, calcium supplementation had no effect on the bone mineral densities [the whole-body: SMD with CI = 0.43 (−0.05–0.91), P=0.08, I 2 = 75%; the 2nd–4th lumbar vertebrae: SMD with 95% CI = 0.27 (−0.17 to 0.70), P = 0.07, I 2 = 0%)]. Sensitivity analysis revealed that the results of the whole-body bone mineral density were unstable and that the bone density of the 2nd–4th lumbar spine was robust. Conclusions The results of this meta-analysis suggested that calcium supplementation did not improve bone mineral density in children. However, there continues to be a need for more high-quality studies to verify this fact in the future.

Characterization and Function of Tumor Necrosis Factor and Interleukin-6-Induced Osteoclasts in Rheumatoid Arthritis.

ObjectiveWe have previously reported that stimulation of mouse bone marrow–derived macrophages with tumor necrosis factor (TNF) and interleukin‐6 (IL‐6) induces differentiation of osteoclast‐like cells. We undertook this study to clarify the characterization and function of human TNF and IL‐6–induced osteoclasts using peripheral blood collected from patients with rheumatoid arthritis (RA) and healthy donors.MethodsPeripheral blood monocytes were cultured with a combination of TNF and IL‐6, TNF alone, IL‐6 alone, or with RANKL, and their bone resorption ability was evaluated. Expression levels of NFATc1, proinflammatory cytokines, and matrix metalloproteinase 3 were analyzed. The effects of NFAT inhibitor and JAK inhibitor were examined. Furthermore, the relationship between the number of TNF and IL‐6–induced osteoclasts or RANKL‐induced osteoclasts differentiated from peripheral blood mononuclear cells (PBMCs) in patients with RA and the modified total Sharp score (mTSS) or whole‐body bone mineral density (BMD) was examined.ResultsPeripheral blood monocytes stimulated with a TNF and IL‐6–induced osteoclasts were shown to demonstrate the ability to absorb bone matrix. Cell differentiation was not inhibited by the addition of osteoprotegerin. Stimulation with a combination of TNF and IL‐6 promoted NFATc1 expression, whereas the NFAT and JAK inhibitors prevented TNF and IL‐6–induced osteoclast formation. Expression levels of IL1β, TNF, IL12p40, and MMP3 were significantly increased in TNF and IL‐6–induced osteoclasts, but not in RANKL‐induced osteoclasts. The number of TNF and IL‐6–induced osteoclasts differentiated from PBMCs in patients with RA positively correlated with the mTSS, whereas RANKL‐induced osteoclast numbers negatively correlated with the whole‐body BMD of the same patients.ConclusionOur results demonstrate that TNF and IL‐6–induced osteoclasts may contribute to the pathology of inflammatory arthritis associated with joint destruction, such as RA.

Body composition and bone mineral density in athletes with a physical impairment.

BackgroundThe impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI.MethodsForty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m2) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m2) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m2).ResultsOne-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm2 and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes.ConclusionsIn conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.

The frequency window effect of sinusoidal electromagnetic fields in promoting osteogenic differentiation and bone formation involves extension of osteoblastic primary cilia and activation of protein kinase A.

Electromagnetic fields (EMFs) have emerged as a versatile means for osteoporosis treatment and prevention. However, its optimal application parameters are still elusive. Here, we optimized the frequency parameter first by cell culture screening and then by animal experiment validation. Osteoblasts isolated from newborn rats (ROBs) were exposed 90 min/day to 1.8 mT SEMFs at different frequencies (ranging from 10 to 100 Hz, interval of 10 Hz). SEMFs of 1.8 mT inhibited ROB proliferation at 30, 40, 50, 60 Hz, but increased proliferation at 10, 70, 80 Hz. SEMFs of 10, 50, and 70 Hz promoted ROB osteogenic differentiation and mineralization as shown by alkaline phosphatase (ALP) activity, calcium content, and osteogenesis-related molecule expression analyses, with 50 Hz showing greater effects than 10 and 70 Hz. Treatment of young rats with 1.8 mT SEMFs at 10, 50, or 100 Hz for 2 months significantly increased whole-body bone mineral density (BMD) and femur microarchitecture, with the 50 Hz group showing the greatest effect. Furthermore, 1.8 mT SEMFs extended primary cilia lengths of ROBs and increased protein kinase A (PKA) activation also in a frequency-dependent manner, again with 50 Hz SEMFs showing the greatest effect. Pretreatment of ROBs with the PKA inhibitor KT5720 abolished the effects of SEMFs to increase primary cilia length and promote osteogenic differentiation/mineralization. These results indicate that 1.8 mT SEMFs have a frequency window effect in promoting osteogenic differentiation/mineralization in ROBs and bone formation in growing rats, which involve osteoblast primary cilia length extension and PKA activation.

Cumulative Effects of Strontium Ranelate and Impact Exercise on Bone Mass in Ovariectomized Rats.

OBJECTIVE: To explore the effect of physical exercise (EXE), strontium ranelate (SR), or their combination on bone status in ovariectomized (OVX) rats. DESIGN: Sixty female Wistar rats were randomized to one of five groups: sham (Sh), OVX (O), OVX+EXE (OE), OVX+SR (OSR), and OVX+EXE+SR (OESR). Animals in EXE groups were subjected to 10 drops per day (45 cm in height); rats in SR groups received 625 mg/kg/day of SR, 5 days/week for 8 weeks. Bone mineral density (BMD) and bone mineral content (BMC, dual-energy X-ray absorptiometry (DXA)), mechanical strength of the left femur (three-point bending test), and femur microarchitecture of (micro-computed tomography imaging, microCT) analyses were performed to characterize biomechanical and trabecular/cortical structure. Bone remodeling, osteocyte apoptosis, and lipid content were evaluated by ELISA and immunofluorescence tests. RESULTS: In OVX rats, whole-body BMD, trabecular parameters, and osteocalcin (OCN) levels decreased, while weight, lean/fat mass, osteocyte apoptosis, and lipid content all increased. EXE after ovariectomy improved BMD and BMC, trabecular parameters, cross-sectional area (CSA), moment of inertia, and OCN levels while decreasing osteocyte apoptosis and lipid content. SR treatment increased BMD and BMC, trabecular parameters, CSA, stiffness, OCN, and alkaline phosphatase (ALP) levels. Furthermore, fat mass, N-telopeptide (NTX) level, osteocyte apoptosis, and lipid content significantly decreased. The combination of both EXE and SR improved bone parameters compared with EXE or SR alone. CONCLUSION: EXE and SR had positive and synergistic effects on bone formation and resorption.

Association between body fat and bone mineral density in non-obese post-menopausal women over 60 years old.

Background:Loss of bone mineral density is one of the most important complications of menopause. The results of studies about the relation between body fat and bone mineral density are controversial. The aim of this study was to determine the association between fat mass and bone mineral density on non-obese post-menopausal elderly women.Methods:This cross-sectional study is a part of the second phase of the Amirkola Health and Ageing Project (AHAP) that has been done on 356 elderly women with BMI of 18.5-30. Bone mineral density (BMD) and total body fat were measured using the Hologic Horizon-WI densitometer. Statistical tests were ANOVA, Pearson’s correlation coefficient and multiple linear regression and a p- value less than 0.05 was considered significant.Results:The mean age of the participants was 70.22±7.34 and the mean age of menopause was 47.68±5.05. Women with highest fat mass had a greater spine, femur and whole-body BMD (p<0.0001). In this study, we observed a direct and positive significant correlation between body fat mass and BMD at spine (r=0.308), femur (r=0.420) and whole body (r=0.312) (p<0.0001). Adjusted linear regression showed positive effect of fat mass on BMD on all three anatomical sites especially in total femur (β=0.254, p<0.0001).Conclusion:This study showed a positive correlation between fat mass and bone mineral density at all sites in post-menopausal women.

Clinical Criteria Can Identify Children With Osteopenia in Newly Diagnosed Crohn Disease.

Chronic inflammation of Crohn disease (CD) is associated with reduced bone mineral density (BMD). As bone mass is almost exclusively accrued during childhood, early recognition of osteopenia is especially important in pediatric CD. We aimed to identify variables associated with osteopenia to guide dual-energy X-ray absorptiometry (DXA) scan screening to those who most need it. This was a retrospective inception cohort study of children newly diagnosed with CD, and routinely referred to DXA scans. Demographic and explicit clinical data were recorded along with whole-body less head BMD, adjusted for age, sex, and height by z-scores. Of the 116 included children (mean age 13 ± 3.1 years, 67 [58%] boys, mean body mass index [BMI] 16.7 ± 2.6), 63 (54%) had normal BMD (z-score > -1) or borderline osteopenia (-1 ≥ z-score > -2) and 53 (46%) had osteopenia (z-score ≤ -2). Osteopenia was associated with lower BMI z-score (-0.8 ± 1.2 vs -1.8 ± 1.1, P < 0.001) and higher PCDAI (33.7 ± 15.2 vs 25.7 ± 16.5; P = 0.009) than those with BMD z-score >-2. In total, 59% of children with BMI z-score <-0.5 had moderate-severe osteopenia and only 18% of those with higher z-scores. Multivariate logistic regression identified BMI z-score as the sole risk factor (OR 1.28 [95% CI 1.08-1.52], P = 0.005). BMI z-score ≥-0.5 excludes osteopenia with a sensitivity 87%, specificity 49%, NPV 82%, and PPV 59%. Osteopenia was found in nearly half of children with newly onset CD. BMI z-score <-0.5 should prompt referral to DXA screening.

An investigation into the association of bone characteristics and body composition with stress fracture in athletes.

The aim of the study was to establish the bone and body composition characteristics of high-level athletes with and without a history of stress fracture injury. Overall, 279 high-level athletes (212 men, 67 women) (age 28.0±9.2 years; body mass 75.0±17.4 kg; height 1.78±0.10 m) and 112 non-athletic controls (60 women, 52 men) 36.2±15.0 years; 70.9±12.9 kg; 1.71±0.10 m) were assessed by DXA to establish their bone mineral density and content, body fat and lean mass. Athletes completed a questionnaire detailing their stress fracture history. There were no differences in whole-body bone mineral density (men 1.41±0.12 g/cm2, women 1.19±0.09 g/cm2), bone mineral content (men 3709±626 g, women 2263±290 g), body fat (men 16.3±5.0%,women 23.0±4.6%) and lean mass (men 65.4±9.9 kg, women 38.7±3.6 kg) between athletes with a history of stress fracture (34 men, 16 women) and those without (176 men, 40 women). DXA derived bone and body composition characteristics were not independent risk factors for stress fracture injury in high-level athletes. This study in a large cohort of high-level athletes provides normative bone and body composition values that can be used as a benchmark for researchers and applied practitioners.

Do avanafil and zaprinast exert positive effects on bone tissue via the nitric oxide/cyclic guanosine monophosphate/protein kinase-G signaling pathway in rats with ovariectomy-induced osteoporosis?

Phosphodiesterase-5 inhibitors (PDE-5Is) exert positive effects on bone healing and mineralization by activation the nitric oxide/cyclic guanosine monophosphate/protein kinase-G (NO/cGMP/PKG) signaling pathway. In this study, the effects of zaprinast and avanafil, two PDE-5Is, on the NO signaling pathway, estrogen levels, selected bone formation and destruction marker levels, whole-body bone mineral density (WB-BMD), right femur trabecular bone thickness (RF-TBT) and epiphyseal bone width, angiogenesis in the bone-marrow, and selected oxidative stress parameter levels were investigated in rats with ovariectomy-induced osteoporosis. Twenty four adult rats (8 months old) were equally divided into four groups. The first group was the sham operated group. Groups 2, 3 and 4 included ovariectomized rats. At six months after ovariectomy, the 3rd and 4th groups were administered 10 mg/kg zaprinast and avanafil daily as a single dose for 60 days, respectively. Increases in the activity of the NO/cGMP/PKG signalling-pathway, C-terminal collagen peptide levels, angiogenesis in the bone marrow, RF-TBT, epiphyseal bone width and WB-BMD were observed compared to the ovariectomized positive control group (OVX), while the pyridinoline and deoxypyridinoline levels were decreased in the OVX+zaprinast and OVX+avanafil groups (p<0.05). The malondialdehyde, ubiquinone10/ubiquinol10 and 8-hydroxy-2-deoxyguanosine/106deoxyguanosine levels were also increased in the ovariectomized groups compared to the sham group (p<0.05). Based on these results, the levels of bone atrophy and some markers of oxidative stress were increased due to acute estrogen deficiency induced by ovariectomy, but zaprinast and avanafil administration significantly prevented these changes

Relationship between Osteoporosis, Multiple Fractures, and Egg Intake in Healthy Elderly.

Context:The role of dietary patterns in the prevention of osteoporosis has been investigated in many studies, but few have examined the association between consumption of specific food and whole-body (WB) bone mineral density (BMD). Recent evidence suggests that whole eggs contain bioactive compounds that could have beneficial effects on BMD. BMD is also expressed as the T-score, which is used for the clinical diagnosis of osteoporosis and to evaluate the effectiveness of drugs.Aims:We conducted a study to assess the association between eggs consumption and bone density in a population of the elderly.Settings and Design:This cross-sectional study included 176 individuals of both genders and aged ≥65 years.Subjects and Methods:Egg intake was ascertained by a combination of dietary intake assessment, and a dual X-ray absorptiometry scan was performed to measure WB T-score.Results:In our study, among all the food groups and nondietary factors evaluated, we find a positive association between the WB T-score and egg consumption (B = 0.02; P = 0.02), gender (B = 0.85; P < 0.001), and body mass index (B = 0.04; P = 0.03). Multiple fractures were associated with the daily intake of eggs (B = ‒0.26; P = 0.02) and high-density lipoprotein-cholesterol (B = 0.09; P = 0.03).Conclusions:This study provides novel evidence of a positive link between whole egg consumption and bone health. If results observed in this study will be confirmed through future randomized controlled trials, whole eggs may represent a viable strategy to prevent osteoporosis and reduce the risk of fractures in the elderly.

Tibial Macrostructure and Microarchitecture Adaptations in Women During 44 Weeks of Arduous Military Training.

Bone adapts to unaccustomed, high-impact loading but loses mechanosensitivity quickly. Short periods of military training (≤12 weeks) increase the density and size of the tibia in women. The effect of longer periods of military training, where the incidence of stress fracture is high, on tibial macrostructure and microarchitecture in women is unknown. This observational study recruited 51 women (age 19 to 30 years) at the start of 44 weeks of British Army Officer training. Tibial volumetric bone mineral density (vBMD), geometry, and microarchitecture were measured by high-resolution peripheral quantitative computed tomography (HRpQCT). Scans of the right tibial metaphysis (4% site) and diaphysis (30% site) were performed at weeks 1, 14, 28, and 44. Measures of whole-body areal bone mineral density (aBMD) were obtained using dual-energy X-ray absorptiometry (DXA). Blood samples were taken at weeks 1, 28, and 44, and were analyzed for markers of bone formation and resorption. Trabecular vBMD increased from week 1 to 44 at the 4% site (3.0%, p < .001). Cortical vBMD decreased from week 1 to 14 at the 30% site (-0.3%, p < .001). Trabecular area decreased at the 4% site (-0.4%); trabecular bone volume fraction (3.5%), cortical area (4.8%), and cortical thickness (4.0%) increased at the 4% site; and, cortical perimeter increased at the 30% site (0.5%) from week 1 to 44 (p ≤ .005). Trabecular number (3.5%) and thickness (2.1%) increased, and trabecular separation decreased (-3.1%), at the 4% site from week 1 to 44 (p < .001). Training increased failure load at the 30% site from week 1 to 44 (2.5%, p < .001). Training had no effect on aBMD or markers of bone formation or resorption. Tibial macrostructure and microarchitecture continued to adapt across 44 weeks of military training in young women. Temporal decreases in cortical density support a role of intracortical remodeling in the pathogenesis of stress fracture. © 2021 Crown copyright. Journal of Bone and Mineral Research © 2021 American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.