Spinal Changes Research Articles

MODERN APPROACH TO THE DIAGNOSIS AND TREATMENT OF SPONDYLOLISTHESIS

Pain syndrome and a variety of neurological syndromes resulting from degenerative-dystrophic changes of the lumbar spine lead to significant violations of labor and social adaptation. According to many researchers, pain in the lumbar spine radiating to the leg observed in 1/3 of patients with degenerative-dystrophic lesions of the lumbar spine, which in 40% of cases is due to the presence of herniated protrusions of the intervertebral discs and spondylolisthesis. The frequency of spondylolisthesis in the lumbar spine occurs to 50 out of 100,000 population. Spondylolisthesis is more common among middle-aged men.

DXplorer: A Unified Visualization Framework for Interactive Dendritic Spine Analysis Using 3D Morphological Features.

Dendritic spines are dynamic, submicron-scale protrusions on neuronal dendrites that receive neuronal inputs. Morphological changes in the dendritic spine often reflect alterations in physiological conditions and are indicators of various neuropsychiatric conditions. However, owing to the highly dynamic and heterogeneous nature of spines, accurate measurement and objective analysis of spine morphology are major challenges in neuroscience research. Most conventional approaches for analyzing dendritic spines are based on two-dimensional (2D) images, which barely reflect the actual three-dimensional (3D) shapes. Although some recent studies have attempted to analyze spines with various 3D-based features, it is still difficult to objectively categorize and analyze spines based on 3D morphology. Here, we propose a unified visualization framework for an interactive 3D dendritic spine analysis system, DXplorer, that displays 3D rendering of spines and plots the high-dimensional features extracted from the 3D mesh of spines. With this system, users can perform the clustering of spines interactively and explore and analyze dendritic spines based on high-dimensional features. We propose a series of high-dimensional morphological features extracted from a 3D mesh of dendritic spines. In addition, an interactive machine learning classifier with visual exploration and user feedback using an interactive 3D mesh grid view ensures a more precise classification based on the spine phenotype. A user study and two case studies were conducted to quantitatively verify the performance and usability of the DXplorer. We demonstrate that the system performs the entire analytic process effectively and provides high-quality, accurate, and objective analysis.

The accuracy of computerized biophotogrammetry in diagnosing changes in the cervical spine and its reliability for the cervical lordosis angle.

Accuracy studies of biophotogrammetry protocols require standardization similar to radiography. To estimate the diagnostic accuracy of a biophotogrammetric assessment protocol for cervical hyperlordosis, compared to radiography, and its intra- and inter-examiner reliability for measuring the cervical lordosis angle. A study of diagnostic accuracy in women complaining of cervical pain. Two photos were taken using the CorelDraw biophotogrammetric protocol and one radiograph using the Cobb C1-C7 method. The Intra- and Inter-examiner reliability was calculated using the Kappa index and the intraclass correlation coefficient (ICC). The Bland-Altman plot and the ROC curve were presented. The sample consisted of 19 women. The accuracy of biophotogrammetry was 94.73% and the reliability between biophotogrammetry and radiography presented an ICC of 0.84 and a Kappa of 0.87. The excellent intra (ICC = 0.94) and inter-examiner (ICC = 0.86) reliability of the biophotogrammetry was confirmed. The area under the ROC curve was 93.5%. The Bland-Altman plot indicated differences between the two instruments close to the mean (1.5∘). The biophotogrammetric protocol proved to be accurate in diagnosing cervical hyperlordosis, with excellent reliability between the biophotogrammetric and radiographic assessments. It also demonstrated excellent intra- and inter-examiner reliability in measuring the cervical lordosis angle.

The effect of cage type on local and total cervical lordosis restoration and global spine alignment in single-level anterior cervical discectomy and fusion based on EOS® imaging: A comparison between standalone conventional interbody polyether ether ketone cage and integrated cage and plate (Perfect-C®).

There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.

Age-related changes in the cervical spine of asymptomatic individuals: A magnetic resonance imaging-based study

Age-related changes in the cervical spine of asymptomatic individuals: A magnetic resonance imaging-based study

VESTIBULAR DYSFUNCTIONS IN CHRONIC BRAIN ISCHEMIA IN THE POST COVID PERIOD.

The aim: The aim of the study is the clinical-pathogenetic reasoning of vestibular dysfunctions (VD) development against the background of chronic brain ischemia in the presence of degenerative changes in the cervical spine (CS) in the post COVID period. Materials and methods: 82 patients, in the conditions of the clinical base of the Odessa National Medical University in 2019-2021 were examined. Group I with VD against the background of chronic brain ischemia (CBI) at the compensated phase; Group II with VD against the background of CBI at the subcom¬pensated phase (33 men; 49 women), aged from 18 to 55 years. The control group (CG) consisted of 20 patients of the corresponding gender and age. The condition of the state of the autonomic nervous system, vestibular functions, cervical spine, cerebral arteries and emotional condition were examined. Results: Vestibulo-ataxic disorders were higher compared to CG and increased along with the degree of brain damage. An important aspect of the development of VD is autonomic dysfunction against the background of pathological autonomic characteristics with predominant parasympathetic orientation of autonomic tone, especially in the case of insufficiency of autonomic recativity (AR) and pathological autonomic support of activity. Such changes significantly increased in the presence of subcompensation of CBI. The correlation between psychoemotional disorders and changes in autonomic characteristics with VD against the background of CBI with initial regularities depending on the degree of brain damage was defined. The progression of CBI is facilitated by coronavirus infection and manifested in autonomic and psychoemotional dysfunctions. A characteristic hemodynamic feature in groups with compensated and subcompensated CBI is the presence of reduced perfusion in basilar (BA) and vertebral (VA) arteries. Changes in cerebral vascular reactivity with a decrease in cerebrovascular reactivity indicators were characteristic of the subcompensated phase of CBI. Hyperactivity to rotational functional loads in both clinical groups has a high correlation with the presence of stair descent and, to a lesser extent, isolated instability in CS. Conclusions: 1. The occurrence of VD is facilitated by the presence of autonomic dysfunction and degenerative-dystrophic changes in the CS, especially in case of subcompensation of CBI. 2. Psychoemotional changes were a characteristic feature of patients with VD against the background of CBI and had certain regularities depending on the phase of CBI. 3. Suffered coronavirus infection contributes to the progression of VD and further decompensation of CBI due to direct damage to the autonomic and vascular systems of the brain. 4. Changes in cerebral hemodynamics in the form of reduced perfusion in BA and VA, a decrease in cerebrovascular reactivity, and an increase in reactivity to rotational functional load were determined in patients with VD against the background of subcompensated CBI.

Age- and gender-related radiological changes of the cervical spine: A study with largest magnetic resonance imaging database of 5672 consecutive patients.

The morphological features of the cervical spine are an essential issue. This retrospective study aimed to investigate the structural and radiological changes in the cervical spine. A total of 250 patients with neck pain but no apparent cervical pathology were selected from a database of 5672 consecutive patients undergoing magnetic resonance imaging (MRI). MRIs were directly examined for cervical disc degeneration. These include Pfirrmann grade (Pg/C), cervical lordosis angle (A/CL), Atlantodental distance (ADD), the thickness of transverse ligament (T/TL), and position of cerebellar tonsils (P/CT). The measurements were taken at the positions of T1- and T2-weighted sagittal and axial MRIs. To evaluate the results, patients were divided into seven age groups (10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70, and over). In terms of ADD (mm), T/TL (mm), and P/CT (mm), there was no significant difference among age groups (P > 0.05). However, in terms of A/CL (degree) values, a statistically significant difference was observed among age groups (P < 0.05). Intervertebral disc degeneration was more severe in males than in females as age increased. For both genders, cervical lordosis, decreased significantly as age increased. T/TL, ADD, and P/CT did not significantly differ with age. The present study indicates that structural and radiological changes are possible reasons for cervical pain at advanced ages.

Alterações esqueléticas do eixo axial e de membros inferiores em crianças e adolescentes com excesso de peso

To evaluate the presence of axial skeletal deviations in children and adolescents and to relate them to body mass index (BMI), age and sex. 101 patients aged 7 to 17 years old were included in this study; exclusion criteria were primary orthopedic diseases and syndromes or treatments that affect growth. Patients were grouped according to their BMI Z-score: eutrophic (n=29), overweight (n=18) and obese (n=54). They underwent static clinical inspection was made by simetrographic technique. Intermaleolar distance was obtained, Adam's forward bend and tiptoe tests were performed. When comparing obese and eutrophic patients, changes in the cervical spine (p<0.01), spine (p<0.001), hip (p<0.01) and shoulders (p<0.001) were present in more than half of the obese patients (62.5%, 62.2%, 79.9% and 55.4%, respectively). Changes in the knees were more frequent among obese (p<0.001) when compared to eutrophic patients. There was no variation regarding age or sex (p>0.05). being overweight influences skeletal deviations in children and adolescents.

Neck pain association with modic changes of the cervical spine,prevalence, risk factors, and disc degeneration:a cross-sectional, large-scale population-based study

Neck pain association with modic changes of the cervical spine,prevalence, risk factors, and disc degeneration:a cross-sectional, large-scale population-based study

Ultrasound-guided subarachnoid block in kyphoscoliotic parturient posted for urgent caesarean section

Parturient with kyphoscoliosis poses a major challenge in the administration of spinal anaesthesia owing to changes in the anatomy of the spine and physiological changes associated with pregnancy. Recently, ultrasound guidance has proved to be a boon for regional anaesthesia techniques. We report the successful anaesthetic management of a 43 year-old primigravida with kyphoscoliosis who was posted for emergency caesarean section using an ultrasound-guided subarachnoid block.

The current state of radiodiagnostics of degenerative changes in the lumbar spine (literature review)

Examination of the spine using radiological methods remains the most frequently conducted study in the outpatient practice of almost any radiologist. In most cases, changes in the spine are degenerative and dystrophic in nature. These changes in the spine are the leading cause of loss of activity among adults and the elderly, and cover a wide range of age-related structural changes. It is of great importance to understand the possibilities and limitations of radiological methods of diagnostics. The description of morphological changes observed in degenerative and dystrophic changes requires the use of unified terminology and classifications among clinicians and radiologists.The aim. To present modern concepts in the assessment of degenerative changes of the spine using radiological methods. A description of the standardized international nomenclature of intervertebral disc pathology and current classifications of spinal canal stenosis are presented.Material and methods. For literature search, we used electronic databases MEDLINE (PubMed), eLibrary, EMBASE and Cochrane Library with a selection of sources published from 2000 to 2021. We analyzed the works devoted to the diagnosis of degenerative changes in lumbar spine and to degenerative stenosis.Conclusion. The key to productive communication between physicians is the uniformity or standardization of terminology and definitions used. It is important that the protocol of description, its terms, semantic expressions be uniform and understandable to specialists who are involved in the diagnosis and treatment of the spine. Magnetic resonance imaging is a valuable method in the diagnosis of degenerative changes of the spinal column, but it has its limitations.

Features of the influence of degenerative changes of the cervical spine in the V1 segment of the spinal artery on the character of extravasal compression

BACKGROUND. The peculiarity of the cervical spine (CS) is a complex movable musculoskeletal, ligamentous-articular apparatus that carries a significant static and dynamic load. X-ray research methods could not based on the definition of degenerative changes in bones and joints, explain compression-reflex and myotonic syndromes in the pathology of the CS.&#x0D; OBJECTIVE. To reveal the clinical, instrumental, and hemodynamic features of the course of vertebral artery compression syndrome (VACS) and their role in determining diagnostic and therapeutic tactics.&#x0D; MATERIALS AND METHODS. The features of diagnosis and treatment tactics of 1,118 patients with degenerative lesions of the CS and VACS were analyzed. X-ray examination made it possible to solve common tasks of diagnosis. During the analysis of X-ray examination in segment V1 showed degeneration of dystrophic changes.&#x0D; RESULTS AND DISCUSSION. Analyzing the expressiveness of VACS in compression scores, we obtained the following results for the identified variants of dystrophic changes of VACS in the projection of the V1 segment: variant I – 14.7±1.84; variant II – 15.3±1.72; variant III-A – 17.1±1.78; variant III-B – 16.2±1.67; variant IV-A – 16.8±1.69; variant IV-B – 15.9±1.48. The analysis of degenerative-dystrophic changes of the CS at the level of the maximum positional compression showed that the expressiveness of the extravasal positional compression in the V1 segment did not differ significantly in variants I, II, III.&#x0D; CONCLUSIONS. 1. Degenerative changes in CS occur long before the appearance of the clinical manifestation of VACS. 2. The expressiveness of the degenerative damage of the musculoskeletal system of the CS according to the X-ray examination does not correspond to the clinical course of VACS. 3. Character of radiological functional instability in CS is not reflected in the complex clinical symptoms of VACS. 4. A multimodal approach to analgesia guarantees full control over all links of the pain process.

Is spinal sagittal alignment of diffuse idiopathic skeletal hyperostosis relevant to thoracolumbar pain? A controlled study

ObjectivesThe extension of diffuse idiopathic skeletal hyperostosis (DISH) from the low thoracic spine to the lumbar spine result in adjustment of spinal sagittal alignment in surgical patients. The aim of this study was to investigate changes in sagittal alignment and back pain in the thoracolumbar spine in nonsurgical DISH and control participants selected from a radiological database.MethodsParticipants in the DISH and the control group were selected by searching for “DISH or degenerative changes in the thoracic spine” in the radiology database of Taizhou Hospital between 2018 and 2021 using Resnick and Niwayama’s criteria. The subjects with spinal tumors, previous spinal surgery, vertebral fractures, inflammatory diseases, poor-quality radiographs, or loss of follow-up were excluded. Demographic and clinical characteristics were recorded retrospectively via the hospital information system and telephone follow-up. Segmental disc angles (SDAs), lumbar lordosis (LL), and bridge scores were analyzed using images of three-dimensional CT.ResultsThe final participants consisted of 51 individuals with DISH (DISH group) and 102 individuals without DISH (control group). Depending on the presence of thoracolumbar pain, the DISH group was divided into the DISH group with thoracolumbar pain (DISH+Pain) and the DISH group without thoracolumbar pain (DISH-Pain). The LL and SDAs of T11-T12 and T12-L1 were significantly greater in the DISH group than in the control group. In addition, the SDA of L1-L2 was significantly smaller in the DISH+Pain group than in the DISH-Pain group, whereas there was no significant difference in lumbar lordosis between the DISH+Pain group and the DISH-Pain group. The bridge scores in DISH+Pain group was larger in T10-T11 (p = 0.01) and L1-L2 (p < 0.01) spine segments than those in DISH-Pain group.ConclusionThe extension of DISH from thoracic to lumbar spine may increase lumbar lordosis and SDAs in the thoracolumbar spine. The DISH patients with more bony bridging and small L1-L2 SDA may be more likely have thoracolumbar pain. Adjustment of sagittal alignment of the spine in the development of DISH may be of clinical importance.

Effect of ACDF combined with different degrees of partial resection of uncovertebral joints on cervical stability and degeneration: a three-dimensional finite element analysis

BackgroundTo evaluate the influence of the resection of different amounts of the uncovertebral joints on the stability of the cervical spine by comparing and analyzing the stress distribution and peak displacement characteristics of the internal fixation structures and endplates.MethodsAfter obtaining the CT data of a 34-year-old male healthy cervical spine, a three-dimensional finite element model was established and verified. The three-dimensional finite element method was used to establish the models of anterior cervical compression fusion and internal fixation surgical implants and anterior cervical compression fusion and internal fixation combined with the partial resection of different amounts of the unilateral or bilateral uncovertebral joints. The models were tested under six working conditions: flexion, extension, left bending, right bending, left rotation, and right rotation. The surgical models were compared regarding the stress distribution of the titanium mesh, titanium plate and screw, and endplate, and the peak displacement of the vertebral body.ResultsThere were no significant differences in the stress distribution and peak displacement of the vertebral body of ACDF combined with different amounts of uncovertebral joint resection in the states of flexion and extension. However, there were significant increases in the stress distribution and peak displacement of the vertebral body in the states of left and right bending and rotation. In the states of left and right bending and rotation, the stress distribution and peak displacement of the vertebral body were significantly greater in the models with bilateral partial resection of the uncovertebral joints than in the models with unilateral partial resection of the uncovertebral joints. Bilateral resection of the uncovertebral joints by 30–40% and unilateral resection of the uncovertebral joints by 40–50% resulted in the greatest increases in the maximum stress distribution of the titanium plate and screw and the peak displacement of the vertebral body.ConclusionFinite element analysis of the biomechanical changes in the cervical spine showed that anterior cervical compression fusion and internal fixation combined with bilateral resection of less than 30% of the uncovertebral joints or unilateral resection of less than 40% of the uncovertebral joints had little effect on the stability of the cervical spine.

Management of Spine-Related Problems Following Sport Injuries: A Review Article

Context: Athletes have routine activity programs, and better physical health is expected among them. There is limited information about the connection between athletes' injuries during sports activity and their future health status. Objectives: The prevalence of spine changes related to sports activities and what risk factors were associated with these events in athletes. Method: SCOPUS, EMBASE, and Web of Science were used for article searching. Results: Sports injuries in sports happen frequently. Our data is limited to introducing sports with the highest risk of injury. A history of sports injury, an intense training program, and years of sports activities are factors predicting injury. It has been seen that former top male athletes have more activity than age-matched control individuals. Conclusions: Spinal injury management in athletes needs a proper diagnosis, work-up, and complex rehabilitation plans; otherwise, it can lead to spinal complaints in the future. Rest, appropriate analgesia, and rehabilitation are the three main primary treatments. The usage of orthoses is not recommended for these injuries in general.

Long-term examinations of the lumbal disc and facet joint changes in 5 German Shepard dogs

The purpose of this first-time long-term observational study was to evaluate the changes of the caudal lumbar spine at the locations L5/6, L6/7, and L7/S1 in 5 German shepherd dogs over a 6-year time period using computed tomography (CT) and magnetic resonance imaging (MRI). The dogs had a mean age of 26 months at the time of the first examination. In addition, it was evaluated whether a breeding examination, with regard to disc degeneration, is justified in young dog. The locations L7/S1, L6/7, and L5/6 were examined in more detail with regard to their signal intensity changes, the facet joint angle changes in dorsal (dors) and transverse (trans) planes, and disc surface changes in sagittal (sag) and transverse (trans) reconstruction planes with CT and MRT in 2015 and 2021. All data were collected computer-based and analyzed statistically. Subsequently, the results were compared to the measured signal intensity and to the subjective disc degeneration grading according to Seiler used in practice. Over the period of 6 years a significant loss of the measured signal intensity of the intervertebral discs in the transverse plane and an overall facet joint widening in the transverse plane of 0.54° as well as in the dorsal plane of 1.8° was evident. In addition, there was no evidence of a relationship between the size of the facet joint angle and the degree of disc degeneration. Furthermore, regardless of the initial degree of degeneration, the discs showed low signal intensity and higher Seiler grade during follow-up. The results of the present study group indicate that an inconspicuous condition of the lumbar intervertebral discs at the time of the initial breeding examination in the young dog does not allow an accurate prediction of the subsequent degree of degeneration and that there are ongoing remodeling processes at the facet joints even in healthy German shepherd dogs.

Modic Changes of the Cervical and Lumbar Spine and Their Effect on Neck and Back Pain: A Systematic Review and Meta-Analysis.

Systematic Review. To systematically review the current literature and perform a meta-analysis on patients with cervical or lumbar spine Modic changes to determine if their baseline axial back pain and disability are comparable to patients without Modic changes. A systematic review of the PubMed database was conducted in accordance with PRISMA guidelines. A meta-analysis was performed to compare the mean differences in back pain, leg pain, and disability based on the presence of cervical or lumbar spine Modic changes. A subgroup analysis of the different types of Modic changes was conducted to determine if Modic type affected back pain or disability. - After review of 259 articles, 17 studies were included for meta-analysis and ten studies were included for qualitative synthesis. In the lumbar spine, 10 high-quality studies analyzed Visual Analog Scale (VAS) back pain, 10 evaluated VAS leg pain, and 8 analyzed Oswestry Disability Index. VAS back pain (mean difference (MD), -.38; 95% CI, -.61 - .16) and Oswestry disability index (MD -2.52; 95% CI, -3.93 - -1.12) were significantly lower in patients without Modic changes. Modic change subtype was not associated with differences in patient-reported outcomes. Patients with cervical spine Modic changes did not experience more severe pain than those without MC. Modic changes in the lumbar spine are not associated with clinically significant axial low back pain severity or patient disability. Similar to the lumbar spine, Modic changes in the cervical spine are not associated with symptom severity, but they are associated with pain duration.

Glucocorticoid regulation of diurnal spine plasticity in the murine ventromedial prefrontal cortex.

The ventromedial prefrontal cortex (vmPFC) regulates fear acquisition, fear extinction, mood, and HPA axis function. Multiple brain regions exhibit time-of-day dependent variations in learning, long term potentiation (LTP), and dendritic morphology. Glucocorticoids have been implicated in the regulation of dendritic structure in the context of stress. Glucocorticoids are also known to regulate molecular clock entrainment via upregulation of Per1 transcription. In the present study, C57BL/6 N mice were sacrificed at three distinct times of day (ZT3, ZT12, and ZT16, lights off at ZT12) and Per1 mRNA expression was measured in the infralimbic and prelimbic vmPFC subregions using droplet digital (dd) PCR after recovering from adrenalectomy or sham surgery for 10 days. Sham mice showed Per1 rhythmicity in both infralimbic (IL) and prelimbic (PL) cortex, with peak expression occurring at ZT12. Adrenalectomized mice showed reductions in Per1 amplitude at ZT12 in both IL and PL, suggesting that the vmPFC molecular clock is entrained by diurnal glucocorticoid oscillations. Thy1-eGFP mice were used to visualize and quantify dendritic spine density on deep layer pyramidal dendrites at ZT 3, 12, and 16. Spine density in both PL and IL exhibited changes between the light (inactive) and dark (active) phases, with peak spine density observed at ZT16 and trough spine density observed at ZT3. These changes in spine density were restricted to changes in long thin and stubby type spines. To determine if changes in spine density is regulated by glucocorticoid oscillations, the 11β-hydroxylase inhibitor metyrapone was administered 2h prior to the onset of the active phase (ZT10) daily for 7 days. Metyrapone administration blocked both the diurnal peak of plasma corticosterone and peak spine densities in the IL and PL at ZT16. These results suggest that vmPFC molecular clock gene and dendritic spine diurnal rhythms depend on intact diurnal glucocorticoid oscillations.

Остеопороз у пацієнтів із хронічним панкреатитом – особливості діагностики

The purpose of the study was to determine the features of the development of osteoporotic bone changes in patients with fibrotic changes of the pancreas against the background of chronic pancreatitis. Materials and methods. 55 patients with chronic pancreatitis were examined. 30 examined were women, 25 were men. The average age of the patients was 47.3±3.5 years. To be included in the study, all patients were excluded from the presence of concomitant diseases. For female patients, preservation of menstrual function was a mandatory condition for inclusion in the study. The degree of fibrotic changes of the pancreas was established on the basis of conducting 2D shear wave elastometry with transcutaneous access by the shear wave method in the SWE mode. Determination of bone mineral density was carried out using a DEXXUM T X-ray densitometer by the method of dual-energy absorptiometry. Results and discussion. The severity of fibrotic changes in the pancreatic parenchyma also affected the prevalence of osteoporosis and osteopenia. Among patients with parenchyma density indicators corresponding to grade 3-4 of fibrotic changes, a decrease in bone mineral density was observed in 83% of examined patients, while among patients with grade 1-2 of such changes, osteoporosis and osteopenia were found in 34% (p = 0.003). In patients with fibrotic changes in the parenchyma of the pancreas, osteoporotic changes in the area of the lumbar vertebrae were noted in 55% of cases with reduced bone mineral density, an isolated decrease in the mineral density of the lumbar spine was diagnosed in 11 patients (28.2% of patients with a decrease in bone mineral density), 5 patients (12.8%) had a combination of a decrease in the mineral density of the spine with a decrease in the mineral density of the hip, the average T criterion of the vertebrae was -2.4±0.5, the average T criterion of the femoral neck was -2.6±0.36. In patients with fibrosis of the parenchyma of the pancreas of 1-2 stages bone mineral density decreased mainly to the level of osteopenia, with a combination of osteopenic changes in the lumbar spine and a decrease in hip mineral density. The average T criterion of vertebrae was -1.6±0.15, femoral neck -1.76±0.18 Conclusion. Patients with chronic pancreatitis are characterized by a high prevalence of osteoporosis and osteopenia. Patients with stages 3-4 of pancreatic fibrosis have a greater risk of developing this complication. The reduction of bone mineral density in patients with chronic pancreatitis is influenced not only by population risk factors, but also by the duration of pancreatitis. The severity of fibrotic changes in the pancreas affects the localization of changes in bone tissue

Longitudinal associations of insulin resistance with change in bone mineral density in midlife women.

BACKGROUNDThe effects of insulin resistance on bone mineral density (BMD) are unclear.METHODSIn Study of Women's Health Across the Nation (SWAN) participants, we used multivariable regression to test average insulin resistance (homeostatic model assessment of insulin resistance, HOMA-IR) and rate of change in insulin resistance as predictors of rate of change in lumbar spine (LS) and femoral neck (FN) BMD in 3 stages: premenopause (n = 861), menopause transition (MT) (n = 571), and postmenopause (n = 693). Models controlled for age, average BW, change in BW, cigarette use, race and ethnicity, and study site.RESULTSThe relation between HOMA-IR and BMD decline was biphasic. When average log2HOMA-IR was less than 1.5, greater HOMA-IR was associated with slower BMD decline; i.e., each doubling of average HOMA-IR in premenopause was associated with a 0.0032 (P = 0.01, LS) and 0.0041 (P = 0.004, FN) g/cm2 per year slower BMD loss. When greater than or equal to 1.5, average log2HOMA-IR was not associated with BMD change. In women in whom HOMA-IR decreased in premenopause, the association between the HOMA-IR change rate and BMD change rate was positive; i.e, slower HOMA-IR decline was associated with slower BMD loss. In women in whom insulin resistance increased in premenopause, the association was negative; i.e, faster HOMA-IR rise was associated with faster BMD decline. Associations of average HOMA-IR and HOMA-IR change rate with BMD change rate were similar in postmenopause, but weaker during the MT.CONCLUSIONWhen it decreases, insulin resistance is associated with BMD preservation; when it increases, insulin resistance is associated with BMD loss.FUNDINGThe SWAN has grant support from the NIH of the Department of Health and Human Services (DHHS) through the NIH National Institute on Aging (NIA), National Institute of Nursing Research (NINR), and Office of Research on Women's Health (ORWH) (grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495, and U19AG063720).