Measured Bone Mineral Research Articles

191 Recovery of Growth and Body Composition in 10-kg Pigs after a 6-Week Growth Attenuation by Ammonium Chloride Additions to Feed

Abstract This project aimed to develop nutritional strategies to reduce pig growth > 50% for 2 to 6 weeks during crisis management. Previously growth was attenuated by 2.0% NH4Cl additions to hold growth (HG) diets. Compensatory growth was evident after withdrawal of NH4Cl. However, tissue composition was not quantified. The HG diets were formulated to reduce lysine, P, and K and increase Cl. Assumptions were that excess Cl interacts with limited K to create an “apparent” K deficiency, which limits protein accretion. The current experiment assessed body composition responses during recovery from HG diets with 2.0% NH4Cl (HGCL) by feeding control (Ctl) diets or Ctl diets fortified with 150% of lysine, P, and K requirements (+Lys+P+K). At 10 kg, 34 barrows were individually housed and randomly assigned to 1 of 4 dietary treatments with free access to assigned diets and water throughout the trial. During the HG phase pigs were fed either Ctl or HGCL diets until 25 kg; 6 weeks for pigs fed HGCl diets. An additional diet was included to validate K and Cl interactions (0.29:1 K:Cl ratio) in growth attenuation. Potassium bicarbonate was added to the HGCl diet (HGCl+K) to restore a 1.26:1 K:Cl ratio. At 25 kg BW, pigs were fed either Ctl or +Lys+P+K diets until 45 kg body weight (BW). Pig, feed weights, and body composition derived from whole-body DXA scans during the hold (HG, 10 to 25 kg) and recovery (Rec, 25 to 45 kg) phases allowed calculations of BW gain, nutrient intake, and measurements of whole-body bone mineral, fat, and lean gain. Growth of pigs fed HGCl diets was reduced (P < 0.01) by approximately 50% compared with Ctl pigs during the HG phase (Table 1). Pigs fed HGCl diets required 23 more days to grow from 10 to 25 kg. Similar reductions (P < 0.01) in bone mineral and lean gain, but not fat gain, were detected in pigs fed HGCl diets during the HG phase. Addition of K to the HGCl diet partially restored gain, bone, and lean gain (P < 0.01). Compensatory responses in weight, bone, fat, and lean gain were evident in HG pigs fed Ctl diets during Rec. Pigs previously fed HGCl diets compensated and only required 14 extra days to reach 45 kg compared with Ctl. Additions of lysine, P, and K allowed greater (P < 0.01) compensation in BW, bone, and lean, but not fat gain over a 20 kg recovery phase. These results confirm a successful strategy to hold pigs during crisis management with potential benefits of compensatory growth and improved body composition during recovery. Whether the improved lean gain was attributed to the additional lysine, P, or K was not determined in this experiment.

The Effect of Entecavir and Tenofovir Disoproxil on Bone Mineral Density in Chronic Hepatitis B Treatment

Background/Aim:Evaluation of the relationship between drugs and osteoporosis in patients receiving entecavir (ETV) or tenofovir disoproxil fumarate (TDF) treatment for chronic hepatitis B infection (CHB).
 Material and Method: The study included patients who received ETV or TDF treatment for at least 12 months between 2016 and 2021 and underwent bone mineral densitometry (BMD) measurement within 12 months after treatment. Demographic characteristics of the patients and the association of antiviral drug use with osteopenia/osteoporosis were retrospectively.
 Results: The study included 170 patients, 92 (54.1%) of whom were male, with a mean age at diagnosis of 36.57 ± 14.88 years. Of the patients, 24 (14.1%) were on ETV and 146 (85.9%) were on TDF. The mean age at BMD measurement was 48.62 ± 13.4 years. The median time from diagnosis to BMD was 138.5 (15-373) months. Osteopenia/osteoporosis was found in 14 (15.2%) of male patients and 25 (32.1%) of female patients. The frequency of osteopenia/osteoporosis was significantly higher in women (p=0.011). There was no significant difference in the frequency of osteopenia/osteoporosis between ETV and TDF (p=0.112). Lumbar spine (LS) BMD was significantly higher in TDF users (p=0.043). While no patient had a BMD within 12 months of treatment initiation, 6 (3.5%) of the patients had a BMD within 24 months, 8 (4.7%) within 36 months and 25 (14.7%) within 60 months of treatment initiation.
 Conclusion: There was no significant difference in the development of osteopenia/osteoporosis in patients using TDF and ETV. It was found that bone mineral measurements of patients with CHB were not performed regularly and appropriately.

Femoral neck structural properties are altered in adults with type 1 diabetes

AimsTo determine differences in hip geometry in adults with type 1 diabetes (T1D) compared with healthy adults without diabetes. MethodsIn this cross-sectional study, 43 adults with T1D (mean age 56 years, 84 % female, 92 % White, mean duration of diabetes of 39 years, A1c of 7.8 %) and 40 adults without diabetes (mean age 60 years, 80 % female, 77 % white) who had hip dual-energy x-ray absorptiometry (DXA) scans from previous studies were included. Areal bone mineral density (aBMD) and measures of hip structural properties at the narrow neck, intertrochanteric and femoral shaft regions of the left proximal femur were analyzed between adults with T1D and controls using linear models controlled for age, sex, and body mass index. ResultsThere were no significant differences in DXA-based aBMD at the hip (0.769 ± 0.132 vs. 0.900 ± 0.139 g/cm2, p = 0.07) or femoral neck (0.722 ± 0.116 vs. 0.849 ± 0.114 g/cm2, p = 0.09) regions between adults with T1D and controls. When controlling for age, sex, and BMI, DXA-based aBMD at the hip (0.880 ± 0.022 vs. 0.943 ± 0.020 g/cm2, p = 0.02) and femoral neck (0.750 ± 0.021 vs. 0.812 ± 0.020 g/cm2, p = 0.02) regions were significantly lower in adults with T1D than controls. Cortical thickness was significantly lower in all three hip regions in adults with T1D than in controls (narrow-neck: 0.169 ± 0.005 vs. 0.186 ± 0.005 cm, p = 0.011; intertrochanteric: 0.388 ± 0.013 vs. 0.425 ± 0.012 cm, p = 0.017; femoral shaft: 0.529 ± 0.017 vs. 0.586 ± 0.016 cm, p = 0.006). Moreover, adults with T1D had a smaller cross-sectional area at the narrow-neck (3.06 ± 0.09 vs. 3.32 ± 0.08 cm2, p = 0.015), a higher femoral shaft endocortical diameter (2.23 ± 0.07 vs. 2.02 ± 0.06 cm, p = 0.011), and higher buckling ratios (an indicator of cortical instability) at the intertrochanteric (9.22 ± 0.34 vs. 8.23 ± 0.32, p = 0.016) and femoral shaft (3.32 ± 0.15 vs. 2.89 ± 0.14, p = 0.016) regions. ConclusionsAdults with T1D have several significant differences in proximal femur morphology compared with controls. These morphological differences may adversely affect the mechanical integrity of the proximal femur, thereby contributing to an increased risk of fracture in the event of a fall.

Using asynchronous quantitative computed tomography for opportunistic screening of osteoporosis

The aim – to determine the possibility of identifying individuals with osteoporosis using asynchronous computed quantitative tomography (CT) of the proximal femur by comparison with dual-energy X-ray absorptiometry (DХA).Materials and methods. The study included 40 postmenopausal women and 6 men over 50 years old (Me of age – 72.5 [65.3; 77.7] years) referred by the attending physician for densitometric examination. The patients signed an informed consent. The measurements were performed on a DXA with a narrow fan beam (Lunar Prodigy Advance, GE Healthcare, USA), and QCT on the Aquilion 64 (Canon Medical Systems, Japan). Correlation analysis and comparison of projected bone mineral density (BMD), bone mineral content (BMC), measurement area and T-score using the Blend – Altman method were carried out.Results. A statistically significant correlations were revealed between the indicators of DXA and asynchronous QCT: for femoral neck BMD r=0.93; for the T-score r=0.93; for the total hip – r=0.91 and r=0.91 respectively. When conducting the analysis using the Blend – Altman method, it was found that the QCT underestimated the value of the femoral neck BMC (bias –0.923 g), covered a smaller area of interest (bias 0.376 cm2 ), and therefore there was a shift in the values of BMD by –0.224 g/cm2 . The value of the T-score for the femoral neck had bias –0.29 standard deviations (SD), and for the total hip –0.72 SD, which were statistically significant.Conclusions. There was a high correlation between quantitative indicators of bone tissue of the proximal hip, assessed using QCT and DXA. The BMD and T-score values for the femoral neck and the total hip at QCT were lower compared to the values of the DXA results. Considering the conducted research, it is recommended that when introducing asynchronous QCT into clinical practice to identify people with osteoporosis, a synchronous phantom should be pre-scanned to compare the QCT and DXA results, followed by adjusting the BMD and T-score values for QCT by the average difference between them.

The Impact of Hempseed Consumption on Bone Parameters and Body Composition in Growing Mice

ObjectivesThis study investigated the effect of a diet containing hempseeds (HS), which are rich in polyunsaturated fatty acids and polyphenols, on body composition, bone mineral measurements and epiphyseal plate osteoblast density. MethodsGroups (n = 8 each) of female C57BL/6 mice were fed one of three AIN-93G-based diets (15% HS by weight; 5% HS; 0% HS) from age 5 to 30 weeks. Diets contained ∼16, 18, and 60% total kcals from fat, protein and carbohydrate, respectively. In-vivo whole-body composition and bone mineral density and content were measured every 4 weeks using dual-energy x-ray absorptiometry. Ex-vivo humeri osteoblast density was determined by sectioning bone longitudinally, mounting the sections on slides and staining using alkaline phosphatase. Stain intensity at the epiphyseal plate was ranked independently by 5 evaluators. ANOVA was used to compare outcomes across groups. Linear regression was used to examine the relationship of end-point bone mineral measurements and osteoblast density. ResultsNo differences were seen in bone mineral measurements, lean mass or fat mass across diet groups. Body weight gain did not differ across groups yet mice fed the 15% HS diet consumed significantly more food than those fed the 0% and 5% HS diets (p = 0.0002). Humeri from both HS groups displayed significantly lower osteoblast densities compared to the control group (P < 0.0001). No relationship was seen between osteoblast density and body composition measurements. ConclusionsDiets enriched with 5% and 15% HS supported growth as well as the control diet without significant impacts on whole-body composition, including bone mineral density and content. At the cellular level, however, HS consumption resulted in reduced density of osteoblasts at the epiphyseal plate. These data invite closer examination of bone cell activity and microarchitecture to determine the effect of habitual HS consumption on bone integrity. Funding SourcesInstitute of Cannabis Research at Colorado State University, Pueblo; Idaho State University.

Longitudinal Changes in Bone Mineral Measurements Inside and Outside Radiation Fields Used for Cervical Cancer Treatment

PurposeWe compared the magnitude of changes in bone mineral density (BMD), within and outside the radiation field, among women who received pelvic radiation therapy (RT) with or without chemotherapy for cervical cancer. Methods and MaterialsIn this secondary analysis of a prospective study, we analyzed serial computed tomography scans and dual-energy x-ray absorptiometry scans from 78 patients who received definitive RT or chemoradiation therapy (CRT) for cervical cancer at a single institution from 2008 to 2015. BMD values at L1, L2, L3, and L4 were measured. We compared changes in BMD within the radiation field (ie, at L4) with those outside the field (ie, at L1). Linear mixed models were also used to examine the effect of RT on changes in BMD over time and covariate adjustment. ResultsThe median age of the 78 patients was 45.5 years (range, 23-88 years); all received RT and 76 (97%) received concurrent CRT. Treatment was associated with significant declines in BMD in all 4 lumbar vertebral bodies over time (P < .05), with nadir at 3 months for L4 and at 1 year for L1. Pairwise comparisons at 3 months and 2 years after treatment indicated that BMD in L4 (within the RT field) had improved (P = .037), but BMD in L1 (outside the RT field) was no different at 3 months and 2 years. ConclusionsSignificant BMD declines were observed in all lumbar vertebral bodies immediately after RT. However, in-field vertebral bodies reached nadir BMD earlier than those located outside the RT field. Our results suggest that treatment and patient-related factors other than RT may contribute to declines in BMD after treatment for cervical cancer. Routine bone density screening and post-RT therapy with hormones may be beneficial for selected patients who receive CRT for cervical cancer.

Types of vertebral fractures could influence the selection of clinical bone mineral measures to predict biomechanical properties

Areal and volumetric BMD (aBMD and vBMD) measured by DXA and quantitative CT (QCT), respectively, are usually employed to predict vertebral fracture risks. In this study, we induced compression and wedge vertebral fractures to test if the types of fracture could influence the selection of bone mineral measures to predict biomechanical properties of vertebral bodies. DXA and QCT were employed to scan twenty-four male cadaveric vertebral bodies of humans for bone mineral content (BMC) and aBMD measures, and vBMD measures, respectively. We computed vBMD measures from three kinds of volumes of interest: intact structures (vertebral body, cortical compartment, and trabecular core), axially middle sections (1.250–1.875 cm height) of the intact structures, and clinically used elliptical regions of trabecular bone. We loaded vertebral bodies to failure for properties of strength (Pu), failure displacement (δu), and stiffness (K). Thirteen vertebral bodies sustained compression fractures and the remaining sustained wedge fractures. Linear and power regression models were used to test bone mineral predictions for Pu, δu, and K. We also did equality tests of correlation coefficients. Our results showed aBMD, BMC, and vBMD of the middle section of trabecular bone had the strongest correlations with Pu (R2 = 0.6420, p < 0.001), δu (R2 = 0.4619, p < 0.001), and K (R2 = 0.5992, p < 0.001) in power regression models, respectively when compression and wedge fractures were mixed. Considering compression fractures only, vBMD of the intact vertebral body displayed the strongest correlations with both Pu (R2 = 0.6529, p < 0.001) and K (R2 = 0.6354, p < 0.001) while BMC showed the strongest correlation with δu (R2 = 0.4376, p < 0.001) in linear regression models. When only wedge fractures were analyzed, vBMD of the elliptical regions of trabecular bone exhibited the strongest correlations with both Pu (R2 = 0.5845, p < 0.001) and K (R2 = 0.6420, p < 0.001) in power regression models, however, no bone mineral measure could significantly correlate with δu. These results may suggest the type of fracture could influence the determination of bone mineral measures to predict biomechanical properties of vertebral bodies.

Intensity Matters for Musculoskeletal Health: A Cross-Sectional Study on Movement Behaviors of Older Adults from High-Income Scottish and Low-Income South African Communities.

This study aimed to investigate differences in physical activity (PA) patterns and the associations between objectively measured 24-h movement behaviors and musculoskeletal measures (muscle strength, muscle mass, physical performance, and bone mineral density) in a high-income and a low-income community. This cross-sectional study recruited independent living older adults aged 60–85 years from high-income Scottish (n = 150) and low-income South African (n = 138) settings. Participants completed demographic and health questionnaires, and testing included body composition and bone mineral density (dual energy X-ray absorptiometry), physical performance (grip strength, gait speed), and PA (accelerometry). Participants accumulated similar amounts of weekly total PA, however, the Scottish cohort engaged in more moderate-to-vigorous intensity PA (MVPA) and sedentary behavior (SB), while the South African cohort spent more time sleeping and in light intensity PA (LPA). From compositional data analysis, more time spent in MVPA relative to the other movement behaviors was positively associated with higher muscle mass (p < 0.001) and strength (p = 0.001) in the Scottish cohort. Conversely, more time spent in MVPA was associated with faster gait speed (p < 0.001) and greater hip bone mineral density (p = 0.011) in the South African cohort. Our findings confirm the beneficial role of MVPA in both high- and low-income cohorts, however, the relationship MVPA had with components of musculoskeletal health in older adults differed between settings.

Bone health in young adult survivors born extremely preterm or extremely low birthweight in the post surfactant era.

Most infants born extremely preterm (EP; <28weeks' gestation) or extremely low birthweight (ELBW; <1000g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life. To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health. A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499g birthweight) were recruited into a longitudinal study from birth. At age 25years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight. Compared with controls (n=129), young adults born EP/ELBW (n=162) had lower areal bone mineral density (g/cm2) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength. Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.

LB4. A Phase 3, Randomized, Controlled Clinical Trial of Bictegravir in a Fixed-Dose Combination, B/F/TAF, vs. ABC/DTG/3TC in Treatment-Naïve Adults at Week 96

BackgroundBictegravir (B), a potent INSTI with a high barrier to resistance, is coformulated with emtricitabine (F) and tenofovir alafenamide (TAF) as the FDA-approved single-tablet regimen B/F/TAF. We report Week 96 results from an ongoing phase 3 study comparing B/F/TAF to coformulated dolutegravir, abacavir, and lamivudine (DTG/ABC/3TC) in treatment-naïve adults living with HIV-1. Primary outcome at W48 demonstrated noninferior virologic responses, similar bone and renal profiles, and no viral resistance.MethodsWe randomized 1:1 HLA-B*5701-negative adults, without HBV and with estimated glomerular filtration rate (eGFR) ≥50 mL/minute to receive blinded B/F/TAF (50/200/25 mg) or DTG/ABC/3TC (50/600/300 mg) with matching placebos QD. Primary endpoint was proportion with HIV-1 RNA <50 copies/mL at W48 (FDA snapshot), with secondary analyses at W96. Noninferiority was assessed with 95% confidence intervals (CI) (12% margin). Other secondary endpoints were safety (adverse events [AEs], laboratory abnormalities) and predefined analyses of bone mineral density (BMD) and measures of renal function (eGFR, proteinuria).ResultsA total of 629 adults were randomized/treated (314 B/F/TAF, 315 DTG/ABC/3TC). At W96, B/F/TAF was noninferior to DTG/ABC/3TC: 87.9% vs. 89.8%, respectively, achieved HIV-1 RNA <50 copies/mL (difference −1.9%; 95%CI −6.9% to 3.1%, P = 0.45). In per-protocol analysis, 99.6% on B/F/TAF vs. 98.9% on DTG/ABC/3TC achieved HIV-1 RNA <50 copies/mL (P = 0.33). Most common AEs overall were nausea (11% B/F/TAF, 24% DTG/ABC/3TC, P < 0.001), diarrhea (15%, 16%), and headache (13%, 16%). Through W96, no participant had emergent resistance to study drugs. No participant discontinued B/F/TAF due to AEs; five (2%) discontinued DTG/ABC/3TC due to AEs (one after W48). Treatment-related AEs occurred in 28% B/F/TAF vs. 40% DTG/ABC/3TC (P = 0.002); most common was nausea (6%, 17%. P < 0.001). At W96, mean percentage changes in spine and hip BMD were small and similar between groups (table); median change in eGFR was significantly less with B/F/TAF, while median % changes in proteinuria were similar.ConclusionAt W96, B/F/TAF was virologically noninferior to DTG/ABC/3TC, with no viral resistance or safety-related discontinuations. B/F/TAF was well tolerated with less nausea than DTG/ABC/3TC and similar bone and renal safety. Disclosures D. A. Wohl, Gilead: Grant Investigator and Scientific Advisor, Consulting fee and Research grant. Y. Yazdanpanah, AbbVie: Consultant, Consulting fee. Bristol-Myers Squibb: Consultant, Consulting fee. Gilead: Consultant, Consulting fee. MSD: Consultant, Consulting fee. Pfizer: Consultant, Consulting fee. Johnson & Johnson: Consultant, Consulting fee. ViiV Healthcare: Consultant, Consulting fee. A. Baumgarten, AbbVie: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. BMS: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Gilead: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. Janssen-Cilag: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. MSD: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. ViiV: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium. A. Clarke, GSK: Scientific Advisor, Consulting fee. Gilead: Conference attendence, Scientific Advisor and Speaker’s Bureau, Conference attendance support, Consulting fee and Speaker honorarium. BMS: Conference attendence, Conference attendance support. Janssen: Conference attendence, Conference attendance support. M. Thompson, Bristol Myers Squibb: Research Contractor, Research support. ViiV Healthcare: Research Contractor, Research support. C. Brinson, Gilead: Investigator, Scientific Advisor and Speaker’s Bureau, Research support and Speaker honorarium. Theratech: Investigator, Research support. BMS: Investigator, Research support. SlieaGen: Investigator, Research support. GSK ViiV: Consultant, Investigator and Scientific Advisor, Consulting fee, Research support and Speaker honorarium. Daiichi Sankyo: Sub Investigator, Research support. Novo Nordisk: Investigator, Research support. Sanofi: Investigator, Research support. Watson: Investigator, Research support. Salix: Investigator, Research support. Janssen: Investigator, Research support. Roche: Investigator, Research support. Colucid: Investigator, Research support. Eisai: Investigator, Research support. Shionogi: Investigator, Research support. Elcelyx: Investigator, Research support. Sangamo: Sub Investigator, Research support. D. Hagins, GlaxoSmithKline: Scientific Advisor and Speaker’s Bureau, Honoraria and Speaker honorarium. ViiV Healthcare: Scientific Advisor and Speaker’s Bureau, Honoraria and Speaker honorarium. Gilead: Scientific Advisor, Honoraria and Speaker honorarium. Bristol-Myers Squibb: Scientific Advisor and Speaker’s Bureau, Honoraria and Speaker honorarium. M. Ramgopal, Gilead: Grant Investigator, Research grant. A. Antinori, AbbVie: Consultant, Consulting fee. BMS: Consultant and Grant Investigator, Consulting fee and Research grant. Gilead: Consultant and Grant Investigator, Consulting fee and Research grant. Janssen-Cilag: Consultant and Grant Investigator, Consulting fee and Research grant. Merck: Consultant, Consulting fee. ViiV Healthcare: Consultant and Grant Investigator, Consulting fee and Research grant. X. Wei, Gilead: Shareholder, Salary and Stock. K. White, Gilead: Employee and Shareholder, Salary and Stock. S. Collins, Gilead: Employee and Shareholder, Salary and Stock. A. Cheng, Gilead: Employee and Shareholder, Salary and Stock. E. Quirk, Gilead: Employee and Shareholder, Salary and Stock. H. Martin, Gilead: Employee and Shareholder, Salary and Stock.

Revised reference curves of bone mineral density according to age and sex for Iranian children and adolescents.

Bone health evaluation requires an appropriate reference database that can identify the bone deficit according to age, sex, puberty, and race. The aim of this study was to determine bone mineral density Z-scores in Iranian children and adolescents and their comparability with other reference data. A sample of 476 healthy children and adolescents, aged 9-18years, from Kawar (an urban community, 50km east of Shiraz, Iran) was selected and bone mineral measurements of the lumbar spine, femoral neck, and total body (less head) were done. Sex-specific height-for-age, weight-for-age, and BMI-for-age Z-scores, as well as bone mineral density Z-scores, were calculated. Extended reference curves for bone mineral content (BMC) and areal bone mineral density (aBMD) of the total body less head, lumbar spine, and femoral neck, for ages 9-18years were constructed relative to sex and age. We found that median, - 2SD, and + 2SD curves for the lumbar spine aBMD were higher in Iranian subjects than in the American participants, but the curves of the femoral neck and total body were lower. Also, we showed that subjects with a lower height-for-age Z-score had a lower BMC and aBMD Z-score in the lumbar spine, femoral neck, and total body (p < 0.001). Relevant differences in bone mineral density and its curves exist between Iranian children and adolescents and other databases, revealing a significant potential for misdiagnosis. However, our results can be used to provide reference databases to assist clinicians in interpreting, assessing, and monitoring bone densitometry.

Associations of fluoride intake with children's cortical bone mineral and strength measures at age 11.

There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424). Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height. The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant. In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.

A novel dual energy method for enhanced quantitative computed tomography

Accurate assessment of bone mineral density (BMD) is critically important in clinical practice, and conveniently enabled via quantitative computed tomography (QCT). Meanwhile, dual-energy QCT (DEQCT) enables enhanced detection of small changes in BMD relative to single-energy QCT (SEQCT). In the present study, we aimed to investigate the accuracy of QCT methods, with particular emphasis on a new dual-energy approach, in comparison to single-energy and conventional dual-energy techniques. We used a sinogram-based analytical CT simulator to model the complete chain of CT data acquisitions, and assessed performance of SEQCT and different DEQCT techniques in quantification of BMD. We demonstrate a 120% reduction in error when using a proposed dual-energy Simultaneous Equation by Constrained Least-squares method, enabling more accurate bone mineral measurements.

High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial.

Optimal osteogenic mechanical loading requires the application of high-magnitude strains at high rates. High-intensity resistance and impact training (HiRIT) applies such loads but is not traditionally recommended for individuals with osteoporosis because of a perceived high risk of fracture. The purpose of the LIFTMOR trial was to determine the efficacy and to monitor adverse events of HiRIT to reduce parameters of risk for fracture in postmenopausal women with low bone mass. Postmenopausal women with low bone mass (T-score < -1.0, screened for conditions and medications that influence bone and physical function) were recruited and randomized to either 8 months of twice-weekly, 30-minute, supervised HiRIT (5 sets of 5 repetitions, >85% 1 repetition maximum) or a home-based, low-intensity exercise program (CON). Pre- and post-intervention testing included lumbar spine and proximal femur bone mineral density (BMD) and measures of functional performance (timed up-and-go, functional reach, 5 times sit-to-stand, back and leg strength). A total of 101 women (aged 65 ± 5 years, 161.8 ± 5.9 cm, 63.1 ± 10.4 kg) participated in the trial. HiRIT (n = 49) effects were superior to CON (n = 52) for lumbar spine (LS) BMD (2.9 ± 2.8% versus -1.2 ± 2.8%, p < 0.001), femoral neck (FN) BMD (0.3 ± 2.6% versus -1.9 ± 2.6%, p = 0.004), FN cortical thickness (13.6 ± 16.6% versus 6.3 ± 16.6%, p = 0.014), height (0.2 ± 0.5 cm versus -0.2 ± 0.5 cm, p = 0.004), and all functional performance measures (p < 0.001). Compliance was high (HiRIT 92 ± 11%; CON 85 ± 24%) in both groups, with only one adverse event reported (HiRIT: minor lower back spasm, 2/70 missed training sessions). Our novel, brief HiRIT program enhances indices of bone strength and functional performance in postmenopausal women with low bone mass. Contrary to current opinion, HiRIT was efficacious and induced no adverse events under highly supervised conditions for our sample of otherwise healthy postmenopausal women with low to very low bone mass. © 2017 American Society for Bone and Mineral Research.

Quantitative Analysis of Bone Mineral Measurements in Different Types of Dual-energy Absorptiometry Systems: Comparison of CT vs DEXA

Quantitative Analysis of Bone Mineral Measurements in Different Types of Dual-energy Absorptiometry Systems: Comparison of CT vs DEXA

Bone loss with antiepileptic drug therapy: a twin and sibling study.

To investigate the longitudinal associations of bone mineral measures with antiepileptic drug (AED) use, including enzyme-inducing (EIAED) and non-enzyme-inducing (NEIAED) types, and other predictors of bone loss in a study of 48 same-sex twin/age-matched sibling pairs (40 female, 8 male) discordant for AED use. Using dual-energy X-ray absorptiometry (DXA), areal bone mineral density (aBMD) and content (BMC) at the hip regions, forearm, lumbar spine, and whole body were measured twice, at least 2years apart. The mean within-pair difference (MWPD), MWPD%, and mean annual rate of aBMD change were adjusted for age, weight, and height. Predictors of bone loss were evaluated. AED users, compared to non-users, at baseline and follow-up, respectively, had reduced aBMD at the total hip (MWPD% 3.8, 4.4%), femoral neck (4.7, 4.5%), and trochanter regions (4.1, 4.6%) (p<0.05). For the whole cohort, the annual rate of change in all aBMD/BMC (p>0.05) regions did not differ within pairs. Nevertheless, EIAED users had greater aBMD loss than non-users (n=20 pairs) at the total hip (1.7 vs. 0.3%, p=0.013) and whole body regions (0.7% loss vs. 0.1% BMD gain, p=0.019), which was not found in NEIAED-discordant pairs (n=16). AED use >20years predicted higher aBMD loss at the forearm (p=0.028), whole body (p=0.010), and whole body BMC (p=0.031). AED users had reduced aBMD at the hip regions. Prolonged users and EIAED users had greater aBMD loss, predicting a higher risk of bone fragility. Further prospective studies of AED effects on bone microarchitecture are needed.

Bone histomorphometric changes in children with rheumatic disorders on chronic glucocorticoids.

BackgroundRheumatic diseases are associated with an increased fracture risk. The tissue level characteristics of the bone involvement in children have not been well elucidated. Our objectives were to describe the bone micro-architectural characteristics in children with rheumatic diseases on chronic glucocorticoids, and to determine associations between micro-architectural findings with clinical and radiological variables.MethodsChildren on chronic glucocorticoids for an underlying rheumatic disease were referred for evaluation of bone fragility given the presence of vertebral compression fractures. A trans-iliac bone biopsy was performed as part of the clinical assessment. Histomorphometric analysis and quantitative backscattered electron imaging (qBSE) of the biopsy samples were undertaken.ResultsData of 15 children (14.0 ± 3.2 years) with a duration of glucocorticoid exposure of 6.2 ± 4.1 years and average prednisone dose of 14.1 ± 6.2 mg/m2/day were assessed. Histomorphometric analyses demonstrated significant decrease in trabecular thickness (p = 0.01), osteoid thickness (p < 0.01), osteoblast surface (p = 0.02) and increase in trabecular separation (p = 0.04) compared to published age-matched normative data. Severity of the trabecular deficit was correlated to glucocorticoid dose, height and body mass index Z score, but not bone mineral density or measures of disease activity. Using qBSE to measure bone mineralization, the subjects were shown to have a heterogeneous and hypermineralized profile, with higher cumulative glucocorticoid dose being associated with greater mineralization (p < 0.01).ConclusionsIn children with rheumatic diseases presenting with vertebral fractures, there is evidence of abnormal bone matrix mineralization and impairments of bone micro-architecture that correlate to glucocorticoid dose.

Vitamin D Status, Bone Mineral Density and Mental Health in Young Australian Women: The Safe-D Study.

Background.Vitamin D deficiency has been associated with both poor bone health and mental ill-health. More recently, a number of studies have found individuals with depressive symptoms tend to have reduced bone mineral density. To explore the interrelationships between vitamin D status, bone mineral density and mental-ill health we are assessing a range of clinical, behavioural and lifestyle factors in young women (Part A of the Safe-D study).Design and methods.Part A of the Safe-D study is a cross-sectional study aiming to recruit 468 young females aged 16-25 years living in Victoria, Australia, through Facebook advertising. Participants are required to complete an extensive, online questionnaire, wear an ultra-violet dosimeter for 14 consecutive days and attend a study site visit. Outcome measures include areal bone mineral measures at the lumbar spine, total hip and whole body, as well as soft tissue composition using dual energy x-ray absorptiometry. Trabecular and cortical volumetric bone density at the tibia is measured using peripheral quantitative computed tomography. Other tests include serum 25-hydroxyvitamin D, serum biochemistry and a range of health markers. Details of mood disorder/s and depressive and anxiety symptoms are obtained by self-report. Cutaneous melanin density is measured by spectrophotometry.Expected impact.The findings of this cross-sectional study will have implications for health promotion in young women and for clinical care of those with vitamin D deficiency and/or mental ill-health. Optimising both vitamin D status and mental health may protect against poor bone health and fractures in later life.Significance for public healthVitamin D deficiency, depression and osteoporosis are all major public health issues. Vitamin D deficiency has been associated with both reduced bone mineral density and depressive symptoms. Moreover, cohort studies have found that subjects with depression have lower bone mineral density when compared to healthy controls. Early adulthood is a critical time in young woman’s lives as their independence, behaviours and lifestyle choices are established. These choices made as a young adult lay down the foundation for future health trajectories for not only for themselves but also for their potential partners and families. Addressing vitamin D deficiency, poor bone health and mental ill-health at a younger age may ultimately improve their wellbeing, productivity and long-term health outcomes. This study is of particular significance as the interplay between vitamin D, depression and bone health is currently uncertain and such knowledge is crucial for understanding, prevention and treatment of these conditions.

Bone Mineral Measurements.

The accurate measurement of bone mineral density using noninvasive methods can be of value in the detection and evaluation of primary and secondary causes of decreased bone mass. This includes primary osteoporosis and secondary disorders, such as hyperparathyroidism, osteomalacia, multiple myeloma, diffuse metastases, and glucocorticoid therapy or intrinsic excess.By far, the largest patient population is that encompassed by primary osteoporosis with increased susceptibility to fractures in the absence of other recognizable causes of bone loss.Primary osteoporosis is a common clinical disorder and a major public health problem because of the significant number of related bone fractures occurring annually. Because the risk of vertebral and femoral neck fractures rises dramatically as bone mineral density falls, fracture risk in individual patients may be estimated. Furthermore, in estrogen-deficient women, bone mineral density values may be used to make rational decisions about hormone replacement therapy, or other bone mineral therapies, and as follow-up in assessing the success of such treatment.In this article, we discuss different methods of bone densitometry and will focus on dual-energy x-ray absorptiometry (DXA) with discussing the factors which should be considered for interpretation of DXA scan.

A Healthier Lifestyle Pattern for Cardiovascular Risk Reduction Is Associated With Better Bone Mass in Southern Chinese Elderly Men and Women.

Lifestyle factors have been linked to bone health, however little is known about their combined impact on bone. Cardiovascular disease (CVD) and osteoporosis are 2 major public health problems that share some common pathophysiology. We aimed to assess whether higher adherence to American Heart Association diet and lifestyle recommendations (AHA-DLR) was associated with better bone health in Chinese elderly.This was a cross-sectional study using data from the largest population-based study on osteoporosis in Asia (Mr and Ms Os, Hong Kong). The study recruited 4000 independent walking Chinese men and women aged ≥65 year. Information on demographic, health, and lifestyle factors was obtained by standardized questionnaires. An overall lifestyle score was estimated based on a modified adherence index of AHA-DLR. Bone mineral measurements of the whole body, total hip, lumbar spine, and femoral neck were made by dual-energy X-ray absorptiometry.Most lifestyle factors alone were not significantly associated bone mass. Overall lifestyle score in the highest quartile compared with the lowest quartile had significantly better bone mass at all sites in a dose-response manner. Every 10-unit of lifestyle score increase was associated with 0.005, 0.004, and 0.007 g/cm increases of bone mineral density (BMD) at whole body, femur neck, and total hip, respectively (all P < 0.05), and 13.2% (odds ratio 0.868; 95% CI 0.784, 0.961) decreased risk of osteoporosis at total hip after adjustment for potential covariates.Our study suggested that greater adherence to an overall healthy lifestyle for CVD risk reduction was associated with better bone mass among Chinese elderly.