Changes In Bone Health Research Articles

The potential effect of romosozumab on perioperative management for instrumentation surgery.

Age-related changes in bone health increase the risk for complications in elderly patients undergoing orthopedic surgery. Osteoporosis is a key therapeutic target that needs to be addressed to ensure successful instrumentation surgery. The effectiveness of pharmacological interventions in orthopedic surgery, particularly the new drug romosozumab, is still unknown. We aim to evaluate the effect of 3-month romosozumab treatment on biomechanical parameters related to spinal instrumentation surgery, using the Quantitative Computed Tomography (QCT)-based Finite Element Method (FEM). This open-labeled, prospective study included 81 patients aged 60 to 90 years, who met the osteoporosis criteria and were scheduled for either romosozumab or eldecalcitol treatment. Patients were assessed using blood samples, dual-energy absorptiometry (DXA), and QCT. Biomechanical parameters were evaluated using FEM at baseline and 3 months post-treatment. The primary endpoints were biomechanical parameters at 3 months, while secondary endpoints included changes in regional volumetric bone mineral density around the pedicle (P-vBMD) and vertebral body (V-vBMD). Romosozumab treatment led to significant gains in P-vBMD, and V-vBMD compared to eldecalcitol at 3 months. Notably, the romosozumab group showed greater improvements in all biomechanical parameters estimated by FEM at 3 months compared to the eldecalcitol group. Romosozumab significantly increased the regional vBMD as well as biomechanical parameters, potentially offering clinical benefits in reducing post-operative complications in patients with osteoporosis undergoing orthopedic instrumentation surgery. This study highlights the novel advantages of romosozumab treatment and advocates further research on its effectiveness in perioperative management.

A prospective study of changes in bone health in adult cancer patients treated with pelvic radiotherapy.

Cancer is a major health problem in today's world. Many patients of pelvic malignancies need treatment by radiation therapy. Post-treatment morbidity due to loss of bone health is less commonly studied. Our study aims at studying the impact of pelvic radiation therapy on bone health including bone mineral density and blood parameters and time of maximum change in Indian patients after pelvic radiotherapy. Patients suffering from histologically confirmed pelvic malignancies were included. Patients having metastasis, primary bone tumor or uncontrolled co-morbid conditions were excluded. Patients were treated with concomitant chemoradiation using conventional fractionation of external beam radiotherapy followed by brachytherapy where indicated. T score and Z score of bone mineral density, serum alkaline phosphatase, vitamin D3, phosphorus and calcium were measured before radiation therapy and 6 weeks, three months, and six months after completion of radiation therapy. A p-value ≤ 0.05 was considered statistically significant. We found that there was a significant decrease in mean Z score and a significant rise of mean serum alkaline phosphatase at three months post radiation therapy. This was associated with an insignificant changes of mean T score, vitamin D3, phosphorus and calcium after radiation therapy. No pelvic insufficiency fractures were detected. In Indian patients, alkaline phosphatase rises, and Z score falls significantly after radiation therapy at three months after treatment. This suggests maximum bone turnover at three months after treatment. Pharmacological intervention, when necessary, may be considered by careful monitoring of patients by this time.

Children with severe acute malnutrition have high rates of bone resorption: A cross-sectional comparative study

Malnutrition in under-5 children (i.e., children younger than age 5 years) remains a major public health problem. Because of the reductive adaptation in children with severe acute malnutrition (SAM), changes in bone health are often subtle. We hypothesized that children with SAM have higher rates of bone resorption than bone formation, which can be assessed using bone turnover markers. In this cross-sectional comparative study, we evaluated the status of bone turnover markers, serum osteocalcin and serum tartrate-resistant acid phosphatase-5b (TRAP-5b) in under-5 children with SAM. Thirty children (6-59 months) with SAM (defined as per World Health Organization criteria) were enrolled as cases and another 30 children (age and sex matched) with normal nutritional status (weight for height -1 standard deviation [SD] to +1 SD) were enrolled for comparison of bone turnover markers. Serum TRAP-5b concentrations were significantly higher in children with SAM compared with children with normal nutritional status (mean [SD] 22.6 [15.3] vs. 11.3 [9.6], P=.009), whereas serum osteocalcin concentrations were comparable between the 2 groups (mean [SD] 40.6 [17.9] vs. 36.0 [12.5], P=.344). Frequency of hypocalcemia and vitamin D deficiency were also significantly high in children with SAM (P < .05). An inverse correlation was found between serum calcium and serum osteocalcin (r=-0.383, P < .05). Our results indicate that children with SAM have a higher bone resorption rate than children with normal nutrition status indicating compromised bone health.

Age-related trajectory of bone density in children with intestinal failure: A longitudinal retrospective cohort study.

Longitudinal changes in bone health in children with intestinal failure (IF) are unclear. We aimed to better understand the trajectory of bone mineral status over time in children with IF and identify clinical factors that influence the trajectory. Clinical records of patients attending the Intestinal Rehabilitation Center of Cincinnati Children's Hospital Medical Center between 2012 and 2021 were reviewed. Children diagnosed with IF before age 3 years with at least two lumbar spine dual-energy x-ray absorptiometry scans were included. We abstracted information on medical history, parenteral nutrition, bone density, and growth. We calculated bone density z scores with and without adjustment for height z scores. Thirty-four children with IF met inclusion criteria. Children were shorter than average with a mean height z score of -1.5 ± 1.3. The mean bone density z score was -1.5 ± 1.3 with 25 of the cohort having a z score < -2.0. After height adjustment, the mean bone density z score was -0.42 ± 1.4 with 11% below -2.0. Most dual-energy x-ray absorptiometry scans (60%) had a feeding tube artifact. Bone density z scores increased slightly with age and lower parenteral nutrition dependency and were higher in scans without an artifact. Etiologies of IF, line infections, prematurity, and vitamin D status were not associated with height-adjusted bone density z scores. Children with IF were shorter than expected for age. Deficits in bone mineral status were less common when adjusting for short stature. Etiologies of IF, prematurity, and vitamin D deficiency were not associated with bone density.

Association Between Combat-Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss Is Localized and Correlates With Altered Loading in Amputees: the Armed Services Trauma Rehabilitation Outcome (ADVANCE) Study.

The association between combat-related traumatic injury (CRTI) and bone health is uncertain. A disproportionate number of lower limb amputees from the Iraq and Afghanistan conflicts are diagnosed with osteopenia/osteoporosis, increasing lifetime risk of fragility fracture and challenging traditional osteoporosis treatment paradigms. The aim of this study is to test the hypotheses that CRTI results in a systemic reduction in bone mineral density (BMD) and that active traumatic lower limb amputees have localized BMD reduction, which is more prominent with higher level amputations. This is a cross-sectional analysis of the first phase of a cohort study comprising 575 male adult UK military personnel with CRTI (UK-Afghanistan War 2003 to 2014; including 153 lower limb amputees) who were frequency-matched to 562 uninjured men by age, service, rank, regiment, deployment period, and role-in-theatre. BMD was assessed using dual-energy X-ray absorptiometry (DXA) scanning of the hips and lumbar spine. Femoral neck BMD was lower in the CRTI than the uninjured group (T-score -0.08 versus -0.42 p=.000). Subgroup analysis revealed this reduction was significant only at the femoral neck of the amputated limb of amputees (p=0.000), where the reduction was greater for above knee amputees than below knee amputees (p < 0.001). There were no differences in spine BMD or activity levels between amputees and controls. Changes in bone health in CRTI appear to be mechanically driven rather than systemic and are only evident in those with lower limb amputation. This may arise from altered joint and muscle loading creating a reduced mechanical stimulus to the femur resulting in localized unloading osteopenia. This suggests that interventions to stimulate bone may provide an effective management strategy. © 2023 Crown copyright and The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.

The Role of Bone Cell Energetics in Altering Bone Quality and Strength in Health and Disease.

Bone quality and strength are diminished with age and disease but can be improved by clinical intervention. Energetic pathways are essential for cellular function and drive osteogenic signaling within bone cells. Altered bone quality is associated with changes in the energetic activity of bone cells following diet-based or therapeutic interventions. Energetic pathways may directly or indirectly contribute to changes in bone quality. The goal of this review is to highlight tissue-level and bioenergetic changes in bone health and disease. Bone cell energetics are an expanding field of research. Early literature primarily focused on defining energetic activation throughout the lifespan of bone cells. Recent studies have begun to connect bone energetic activity to health and disease. In this review, we highlight bone cell energetic demands, the effect of substrate availability on bone quality, altered bioenergetics associated with disease treatment and development, and additional biological factors influencing bone cell energetics. Bone cells use several energetic pathways during differentiation and maturity. The orchestration of bioenergetic pathways is critical for healthy cell function. Systemic changes in substrate availability alter bone quality, potentially due to the direct effects of altered bone cell bioenergetic activity. Bone cell bioenergetics may also contribute directly to the development and treatment of skeletal diseases. Understanding the role of energetic pathways in the cellular response to disease will improve patient treatment.

Serum and Urinary Osteocalcin in Healthy 7- to 19-Year-Old Finnish Children and Adolescents.

Children and adolescents have high bone turnover marker (BTM) levels due to high growth velocity and rapid bone turnover. Pediatric normative values for BTMs reflecting bone formation and resorption are vital for timely assessment of healthy bone turnover, investigating skeletal diseases, or monitoring treatment outcomes. Optimally, clinically feasible measurement protocols for BTMs would be validated and measurable in both urine and serum. We aimed to (a) establish sex- and age-specific reference intervals for urinary and serum total and carboxylated osteocalcin (OC) in 7- to 19-year-old healthy Finnish children and adolescents (n = 172), (b) validate these against standardized serum and urinary BTMs, and (c) assess the impact of anthropometry, pubertal status, and body composition on the OC values. All OC values in addition to other BTMs increased with puberty and correlated with pubertal growth, which occurred and declined earlier in girls than in boys. The mean serum total and carboxylated OC and urinary OC values and percentiles for sex-specific age categories and pubertal stages were established. Correlation between serum and urinary OC was weak, especially in younger boys, but improved with increasing age. The independent determinants for OC varied, the urinary OC being the most robust while age, height, weight, and plasma parathyroid hormone (PTH) influenced serum total and carboxylated OC values. Body composition parameters had no influence on any of the OC values. In children and adolescents, circulating and urinary OC reflect more accurately growth status than bone mineral density (BMD) or body composition. Thus, validity of OC, similar to other BTMs, as a single marker of bone turnover, remains limited. Yet, serum and urinary OC similarly to other BTMs provide a valuable supplementary tool when assessing longitudinal changes in bone health with repeat measurements, in combination with other clinically relevant parameters.

Bone Health Assessed by Calcaneal Quantitative Ultrasound among Cohort of Pregnant Egyptian Women.

Aim:The aim was to assess the risk of osteopenia and osteoporosis and to identify possible risk factors affecting bone density (BD) during pregnancy as parity, body mass index (BMI), Vitamin D, and calcium supplementation using quantitative ultrasound (QUS) of the calcaneus among first- and third-trimester pregnant women.Methods:It is a case–control study conducted at Ain Shams Maternity Hospital, Egypt, from May 7 to December 14, 2015. One hundred and thirty-two women in the third trimester and 33 matched controls in the first trimester were screened for BD at the calcaneus by QUS. Stiffness index (SI), QUS-T, and Z scores were measured.Results:Comparing both the groups regarding QUS-T score, Z score, and SI showed a statistically significant difference between both groups. Third-trimester participants had lower scores (−0.72 ± 1.0, −0.63 ± 0.99, and 88.53 ± 14.81, respectively) compared to their matched controls (1.05 ± 0.89, 1.16 ± 0.91, and 113.79 ± 12.49, respectively). According to QUS-T scores, 82 women (62.1%) in the third-trimester group were assessed as having normal BD, whereas 47 women (35.6%) were at risk of being osteopenic and 3 women (2.3%) were at risk of being osteoporotic. All women of the first trimester were assessed as having normal BD. Logistic regression was performed to identify possible risk factors affecting BD among third-trimester patients. BMI was the only statistically significant predictor for changes in bone health in those women (P = 0.001, odds ratio: 0.857, 95% confidence interval: 0.786–0.936).Conclusion:With one-unit rise in BMI, a 14% reduction in risk of decreased bone health is obtained.

Six-month table tennis training improves body composition, bone health and physical performance in untrained older men; a randomized controlled trial

In the present study, we aimed to investigate the effects of 6-month table tennis (TT) training on bone health, muscle mass, and physical performance in older men. Forty older men aged of ≥ 65 years were randomly assigned to an experimental group (EXP; n = 20) or control group (CON; n = 20). Before and after the intervention, dual-energy X-ray absorptiometry, a short physical performance test battery and one-leg balance tests were used to assess body composition and physical function. TT increased whole body and regional bone mineral density (range from 2.6% to 8.7%; p < 0.05), and lean mass (range from 2.2% to 11.1%; p < 0.05), while total and regional body fat mass decreased (range from 4.8% to 24.7%; p < 0.05). TT also improved the performance test score, 4-m walk, 5-chair stands, 400-m walk and balance (range from 4.0% to 13.7%; p < 0.05). This indicates that TT can effectively mitigate changes in bone health, muscle mass and physical performance associated with aging and a sedentary lifestyle. Dans la présente étude, nous avons cherché à étudier les effets de six mois d’entraînement au tennis de table (TT) sur la santé osseuse, la masse musculaire et les performances motrices d’hommes sédentaires de plus de 65 ans. Quarante hommes âgés de ≥ 65 ans ont été assignés de façon randomisée à un groupe expérimental (EXP ; n = 20) ou groupe contrôle (CON ; n = 20). Avant et après l’intervention, une absorptiométrie biphotonique, une batterie de test de performance physique et des tests d’équilibre sur une jambe ont été utilisés pour évaluer la composition corporelle et la performance motrice. TT a augmenté la densité minérale osseuse du corps entier et la densité minérale osseuse régionale (de 2,6 % à 8,7 % ; p < 0,05) ainsi que la masse maigre (de 2,2 % à 11,1 %; p < 0,05), tandis que la masse grasse corporelle totale et régionale a diminué (de 4,8 % à 24,7 %; p < 0,05). Le TT a également amélioré le résultat du test de performance de marche de 4 m, les supports de 5 chaises, la marche de 400 m et l’équilibre (de 4,0 % à 13,7 %; p < 0,05). Cela indique que le TT peut efficacement limiter le déclin de la masse osseuse, de la masse musculaire et de la performance physique du au vieillissement et à un mode de vie sédentaire.

Peripheral bone density measurement: An interdisciplinary initiative for improving health outcomes for people with learning disabilities.

Challenges exist in respect of people with intellectual disabilities who, with the increasing life expectancy, have a growing risk of age-related degenerative conditions. Changes in bone health are associated with increasing age and the bone health of people who have intellectual disabilities is well documented in the literature as being poor in comparison to the general population. A heel scan clinic was set up in an intellectual disability service as a service improvement initiative. There were 12 females and 17 males scanned using a heel scanner. Only 3 (10.3%) people with intellectual disabilities were in the normal bone mineral density (BMD) range. Peripheral BMD screening for people has been shown to provide important information about the bone health of people with intellectual disabilities which has prompted further treatment by general practitioners and has the potential to provide an accessible way to obtain information on the bone health of people with intellectual disabilities.

Evaluation the Sensitivity of Bone Natural Frequency as a Diagnosis Tool to Identify Bones Integrity

This study explain the reason behind the low sensitivity of the natural frequency for the changes in bone health. The mechanical properties of the bone were reduced by placing the bone in boiling water for 2 hours and the mass of the bone was reduced by placing the bone in diluted acidic medium for 24 hours. The natural frequency of the bone samples (10 samples) was calculated in three cases (fresh, after boiling, and after acidic treatment). The natural frequency was calculated theoretically by using finite element analysis based upon CT-Scan DICOME images and experimentally by using impulse test. The difference between the results in the two methods was less than 15%. The boiling process caused a reduction in the natural frequency while the acidic treatment caused an increase in the natural frequency compared with the natural frequency of the fresh condition. The mutual influence of these two component cannot be separated. This mutual influence will reduce the sensitivity of the natural frequency as diagnosis factor for the changes in the health condition of the bone.

Bone Mineral Density Responses to Obesity Reduction with Enhanced Protein: Short Term Results in Functionally Frail Older Adults (OR18-04-19)

ObjectivesWith soaring rates of geriatric obesity, a major shift in understanding of the relationship between body mass and bone health is unfolding. The premise that obesity is protective of bone runs counter to evidence that obesity factors like increased inflammation and reduced physical activity may increase fracture risk. MethodsObese (BMI ≥ 30 kg/m2) older (≥60 yrs) participants (female n = 42; male n = 12; 46% Black) with functional limitations (mean Short Physical Performance Battery score = 9.2 ± 1.4 out of 12) were randomized to an RDA level protein weight loss regimen (0.8 g/kg bw/d; Control; n = 25) or a higher protein arm (1.2 g/kg bw/d, with ≥30 g high quality protein [predominantly dairy] at each meal; Protein; n = 29). Both groups followed a hypo-caloric diet and participated in supervised low-intensity chair exercises, (three 30 min sessions/wk). Measurements at baseline and 6 months included body weight, body fat (BodPod), and bone mineral density (BMD by Dual X-ray Absorptiometry) lumbar spine (LS), total hip (TH) and femoral neck (FN) and bone condition classified as normal, osteopenia, or osteoporosis. ResultsMean baseline characteristics were BMI 34.3 ± 4.7 kg/m2 and age = 70.0 ± 6.1 yrs; 42 had normal BMD, 18 osteopenia and 4 osteoporosis. Compared to baseline, weight loss and body fat reduction were significant (P < 0.001) at 6 months in both Control (7.7%) and Protein (6.4%) with no group difference. Between 0 and 6 months, BMD was unchanged for TH or FN in either group but increased for LS (0.164 ± 0.293 g/cm2; P < 0.01) in Protein. BMD at LS was unchanged in Control (0.0111 ± 0.0497 g/cm2; P = 0.295) but there was no group difference in LS change. The number of participants with osteoporosis was unchanged at 6 months. ConclusionsStudy findings show no detrimental changes in bone health following a 6-month obesity intervention; this was the case for both groups and could result in part from the regular physical exercise during weight loss. Conclusions must take into account the interim nature of these preliminary findings, since bone turnover responses to a physiologic challenge can take a year or more to fully equilibrate. Long-term study of the influence of this obesity intervention on BMD is warranted. Funding SourcesNational Dairy Council and US Department of Veterans Affairs Rehabilitation Research and Development Service Program (CDA-2/IK2 RX002348).

Muscle strength and regional lean body mass influence on mineral bone health in young male adults.

The relationship between muscle strength and bone mineral content (BMC) and bone mineral density (BMD) is supposed from the assumption of the mechanical stress influence on bone tissue metabolism. However, the direct relationship is not well established in younger men, since the enhancement of force able to produce effective changes in bone health, still needs to be further studied. This study aimed to analyze the influence of muscle strength on BMC and BMD in undergraduate students. Thirty six men (24.9 ± 8.6 y/o) were evaluated for regional and whole-body composition by dual energy X-ray absorptiometry (DXA). One repetition maximum tests (1RM) were assessed on flat bench-press (BP), lat-pull down (LPD), leg-curl (LC), knee extension (KE), and leg-press 45° (LP45) exercises. Linear regression modelled the relationships of BMD and BMC to the regional body composition and 1RM values. Measurements of dispersion and error (R2adj and standard error of estimate (SEE)) were tested, setting ρ at ≤0.05. The BMD mean value for whole-body was 1.12±0.09 g/cm2 and BMC attained 2477.9 ± 379.2 g. The regional lean mass (LM) in upper-limbs (UL) (= 6.80±1.21 kg) was related to BMC and BMD for UL (R2adj = 0.74, p<0.01, SEE = 31.0 g and R2adj = 0.63, SEE = 0.08 g/cm2), and LM in lower-limbs (LL) (= 19.13±2.50 kg) related to BMC and BMD for LL (R2adj = 0.68, p<0,01, SEE = 99.3 g and R2adj = 0.50, SEE = 0.20 g/cm2). The 1RM in BP was related to BMD (R2adj = 0.51, SEE = 0.09 g/cm2), which was the strongest relationship among values of 1RM for men; but, 1RM on LPD was related to BMC (R2adj = 0.47, p<0.01, SEE = 44.6 g), and LC was related to both BMC (R2adj = 0.36, p<0.01, SEE = 142.0 g) and BMD (R2adj = 0.29, p<0.01, SEE = 0.23 g/cm2). Hence, 1RM for multi-joint exercises is relevant to BMC and BMD in young men, strengthening the relationship between force and LM, and suggesting both to parametrizes bone mineral health.

Comparative efficacy of parathyroidectomy and active surveillance in patients with mild primary hyperparathyroidism: a systematic review and meta-analysis.

Counseling for patients with primary hyperparathyroidism (PHPT) and mild hypercalcemia without indications for surgical intervention requires accurate estimates of the potential benefits of parathyroidectomy. We aim to summarize the available evidence regarding the benefits of parathyroidectomy that patients with mild PHPT without indications for surgery experience compared to observation. We searched multiple databases from inception to August 2015. We included randomized controlled trials (RCT) and observational studies that evaluated changes in bone health, quality of life or neuropsychiatric symptoms, or in the risk of nephrolithiasis, cardiovascular events, or death between patients undergoing parathyroidectomy or active surveillance. Eight studies were eligible. Risk differences were not significant, in part due to lack of events (fractures, nephrolithiasis, cardiovascular events, or deaths). No significant differences were observed across measures of bone health, quality of life, and neuropsychiatric symptoms. A single RCT evaluating bone mineral density (BMD) changes at 5years found a small statistically significant effect favoring parathyroidectomy. Patients with mild PHPT without indications for surgery experience a limited number of adverse consequences during short-term follow-up limiting our ability to estimate the benefit of surgery during this timeframe. This information is helpful as these patients consider surgery versus active surveillance. Long-term data is warranted to determine who benefits in the long run from surgical intervention and the extent to which this benefit affects outcomes that matter to patients.

Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia.

BackgroundOsteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia.MethodsA cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices.ResultsThe prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05).ConclusionA significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.

Changes in Bone Health During the First Year of Cancer Treatment in Children

This study aimed to evaluate longitudinal changes in bone mineral density (BMD) and bone mineral content (BMC) in children with cancer during the first year of treatment. Thirty pediatric cancer patients (median age 11.2 [range 3.8–17.4] yr; 21 boys, 9 girls; 19 hematologic malignancies, 11 solid tumors) and 30 healthy controls were enrolled. Dual energy X-ray absorptiometry was performed at baseline and at 1, 6, and 12 mo for each pediatric cancer patient. There were no significant differences in age, sex, body weight, height, body mass index, serum vitamin D levels, BMD, and BMC among children with hematologic malignancies, those with solid tumors, and the controls at baseline. When the medians of BMD Z-scores were compared between different time intervals, whole-body BMD Z-score significantly decreased during the first year of cancer treatment (p = 0.001) in children with hematologic malignancies, especially during the first month (p = 0.002), and between 1 and 6 mo (p = 0.006). In children with solid tumors, whole-body BMD Z-score changed significantly only between 6 and 12 mo after treatment (p = 0.043). Generalized estimation equations for the analysis of trends in the whole-body BMD Z-scores revealed that there were significant downward trends between BMD Z-scores at baseline and those at 12 mo in children with hematologic malignancies and those with solid tumors. Cancer treatment significantly affects the bone health status at least during the first year, causing a significant decrease in BMD, especially during the first 6 mo for patients with hematologic malignancies and during the last 6 mo for those with solid tumors. Better strategies for treating changes in BMD based on the underlying cancer are necessary during cancer treatment in children.

Systemic lupus erythematosus, bone health, and osteoporosis.

This manuscript will provide a review of recent publications, examining the correlation of systemic lupus erythematosus (SLE) with changes in bone health and associated osteoporosis, highlighting prevalence, etiology, diagnosis, and treatment. Studies suggest that bone loss and fractures are associated with SLE, related not only to the disease itself, but also with low vitamin D and treatment side-effects. Understanding the mechanisms of glucocorticoids on bone and the immunologic relationship of vitamin D, as well as recognizing the role of chronic inflammation on bone, allows for better understanding of skeletal side-effects. Further awareness of the association of poor bone health has led to an increased need for prevention and treatment. New imaging and treatment are emerging, although not recommended currently. Loss of bone density culminating in osteoporosis and fracture is a frequent comorbidity in SLE patients at any age and is multifactorial in etiology. Awareness and diagnosis is crucial because of its prevalence and morbidity. Prevention is safe and effective in this high-risk population where diagnostic measures and interventions are underutilized and guidelines are lacking.

The effects of long (C20/22) and short (C18) chain omega-3 fatty acids on keel bone fractures, bone biomechanics, behavior, and egg production in free-range laying hens

Keel fractures in the laying hen are the most critical animal welfare issue facing the egg production industry, particularly with the increased use of extensive systems in response to the 2012 EU directive banning conventional battery cages. The current study is aimed at assessing the effects of 2 omega-3 (n3) enhanced diets on bone health, production endpoints, and behavior in free-range laying hens. Data was collected from 2 experiments over 2 laying cycles, each of which compared a (n3) supplemented diet with a control diet. Experiment 1 employed a diet supplemented with a 60:40 fish oil-linseed mixture (n3:n6 to 1.35) compared with a control diet (n3:n6 to 0.11), whereas the n3 diet in Experiment 2 was supplemented with a 40:60 fish oil-linseed (n3:n6 to 0.77) compared to the control diet (n3:n6 to 0.11). The n3 enhanced diet of Experiment 1 had a higher n3:n6 ratio, and a greater proportion of n3 in the long chain (C20/22) form (0.41 LC:SC) than that of Experiment 2 (0.12 LC:SC). Although dietary treatment was successful in reducing the frequency of fractures by approximately 27% in Experiment 2, data from Experiment 1 indicated the diet actually induced a greater likelihood of fracture (odds ratio: 1.2) and had substantial production detriment. Reduced keel breakage during Experiment 2 could be related to changes in bone health as n3-supplemented birds demonstrated greater load at failure of the keel, and tibiae and humeri that were more flexible. These results support previous findings that n3-supplemented diets can reduce fracture likely by increasing bone strength, and that this can be achieved without detriment to production. However, our findings suggest diets with excessive quantities of n3, or very high levels of C20/22, may experience health and production detriments. Further research is needed to optimize the quantity and type of n3 in terms of bone health and production variables and investigate the potential associated mechanisms.

304P - Assessment of Bisphosphonates Use As Adjuvant Therapy in Breast Cancer

ABSTRACT Aim: Breast cancer is the most frequently diagnosed cancer in females. It is the leading cause of cancer deaths in females ranking as the first malignancy affecting females in Egypt and accounts for 30% of female cancers, 39.5% are postmenopausal. Adjuvant aromatase inhibitors (AI) alone or sequentially after tamoxifen increases disease free survival in postmenopausal women compared with tamoxifen alone, but at the expense of increased bone loss. Bisphosphonates including zoledronic acid have been shown to reduce cancer treatment-induced bone loss. Methods: This is a prospective randomized phase III study where 120 postmenopausal females with non-metastatic hormone-receptor-positive breast cancer completed initial therapy with baseline ECOG performance status ≤ 2, baseline lumbar spine (LS) and total hip (TH) T-score≥ -2 were included. Patients received letrozole 2.5 mg orally daily till disease progression with or without zoledronic acid 4 mg IV over 15 minutes every 6 months for 2 years . Evaluation of bone health was done by measuring bone mineral density (BMD) using Dual energy X-ray absorptiometry (DEXA) at base line, at 12 months and 24 months, also N-telopeptide Ntx was measured at baseline and at 12 months. Toxicity was analyzed according to NCI-CTC, with the primary end point to evaluate changes in bone health by measuring BMD, changes in the bone turnover marker urinary (Ntx) at 12 months, and evaluating disease-free survival (DFS). Results: Patients' clinicopathological characteristics were evenly matched, at 12 months evaluation the zoledronic acid arm had increased BMD in LS&TH with mean% change (+2.7%) and (+2.1%) compared with (-6.84%) and (-4.24%) in the other arm (p Conclusions: Adding zoledronic acid to adjuvant letrozole in postmeopausal breast cancer patients improves bone health as shown by BMD and Ntx. Disclosure: All authors have declared no conflicts of interest.

Quantitative Ultrasound and bone's response to exercise: A meta analysis

The utility of Quantitative Ultrasound (QUS) for assessing and monitoring changes in bone health due to exercise is limited for lack of adequate research evidence. Restrictions to bone density testing and the enduring debate over repeat dual energy absorptiometry testing spells uncertainty over clinical and non-clinical evaluation of exercise for prevention of osteoporosis. This study, via systematic review and meta-analysis, aimed to paint a portrait of current evidence regarding QUS' application to monitoring bone's adaptive response to exercise interventions. MethodsStructured and comprehensive search of databases was undertaken along with hand-searching of key journals and reference lists to locate relevant studies published up to December 2011. Twelve articles met predetermined inclusion criteria. The effect of exercise interventions for improving bone health, as measured by QUS of the calcaneum, was examined across the age spectrum. Study outcomes for analysis: absolute (dB/MHz) or relative change (%) in broadband ultrasound attenuation (BUA) and/or os calcis stiffness index were compared by calculating standardised mean difference (SMD) using fixed- and random-effects models. ResultsQuality of included trials varied from low to high on a scale of one to three. Four to 36months of exercise led to a significant improvement in calcaneum BUA (0.98 SMD, 95% CI 0.80, 1.16, overall effect Z-value=10.72, p=0.001) across the age spectrum. ConclusionThe meta-analysis attests to the sensitivity of QUS to exercise-induced changes in bone health across the age groups. QUS may be considered for use in exercise-based bone health interventions for preventing osteoporosis.