Bone Mineral Density Deterioration Research Articles

Osteopenia is associated with wasting in pancreatic adenocarcinoma and predicts survival after surgery.

Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest of all common malignancies. Treatment is difficult and often complicated by the presence of cachexia. The clinical portrait of cachexia contributes to the poor prognosis experienced by PDAC patients and worsens therapeutic outcomes. We propose that low bone mineral density is a component of cachexia, which we explore herein through a retrospective review of all patients at our facility that underwent surgery for PDAC between 2011 and 2018 and compared to sex‐, age‐ and comorbidity‐matched control individuals. Data were abstracted from the medical record and pre‐operative computed tomography scans. Muscle mass and quality were measured at the L3 level and bone mineral density was measured as the radiation attenuation of the lumbar vertebral bodies. Patients with PDAC displayed typical signs of cachexia such as weight loss and radiologically appreciable deterioration of skeletal muscle. Critically, PDAC patients had significantly lower bone mineral density than controls, with 61.2% of PDAC patients categorized as osteopenic compared to 36.8% of controls. PDAC patients classified as osteopenic had significantly reduced survival (1.01 years) compared to patients without osteopenia (2.77 years). The presence of osteopenia was the strongest clinical predictor of 1‐ and 2‐year disease‐specific mortality, increasing the risk of death by 107% and 80%, respectively. Osteopenia serves as a test of 2‐year mortality with sensitivity of 76% and specificity of 58%. These data therefore identify impaired bone mineral density as a key component of cachexia and predictor of postoperative survival in patients with PDAC. The mechanisms that lead to bone wasting in tumor‐bearing hosts deserve further study.

Housing Temperature Influences Atypical Antipsychotic Drug-Induced Bone Loss in Female C57BL/6J Mice.

ABSTRACTAtypical antipsychotic (AA) drugs, such as risperidone, are associated with endocrine and metabolic side effects, including impaired bone mineral density (BMD) acquisition and increased fracture risk. We have previously shown that risperidone causes bone loss through the sympathetic nervous system and that bone loss is associated with elevated markers of thermogenesis in brown and white adipose tissue. Because rodents are normally housed in sub‐thermoneutral conditions, we wanted to test whether increasing housing temperature would protect against bone loss from risperidone. Four weeks of risperidone treatment in female C57BL/6J mice at thermoneutral (28°C) housing attenuated risperidone‐induced trabecular bone loss and led to a low‐turnover bone phenotype, with indices of both bone formation and resorption suppressed in mice with risperidone treatment at thermoneutrality, whereas indices of bone resorption were elevated by risperidone at room temperature. Protection against trabecular bone loss was not absolute, however, and additional evidence of cortical bone loss emerged in risperidone‐treated mice at thermoneutrality. Taken together, these findings suggest thermal challenge may be in part responsible for bone loss with risperidone treatment and that housing temperature should be considered when assessing bone outcomes of treatments that impact thermogenic pathways. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Bone mineral density in pediatric heart transplanted patients: A retrospective single-center study at Skåne University Hospital in Lund 1988-2016.

Impaired bone mineral density (BMD) and osteoporosis are commonly found in patients who have undergone heart transplantation (HT), which increases the risk for bone fractures which is associated with increased morbidity and mortality in adults. However, the long-term evolution of BMD after HT in pediatric patients has not been thoroughly investigated. Bone mineral density up to 10years after HT was investigated in 30 patients who underwent HT at an age <20years at Skåne University Hospital in Lund 1988-2016. The total observed time was 235 person-years. Before HT, 86% had low BMD for chronologic age in the lumbar spine. In lumbar spine, BMD was significantly lower than normal for chronological age before HT (p=.034), but recovered at the 4th year (p=.009). In whole body, BMD was normal at the 4th annual check-up (p=.030) and remained so throughout the follow-up period. The median T score in the lumbar spine and femoral neck 10years after HT did not differ between the two groups based on age at HT (<20years vs 20years or older; p=.779 in the lumbar spine and p=.388 in the femoral neck). Patients who undergo HT at an age of <20years have low BMD for chronological age already before HT, but BMD may recover completely within the first 4years after HT. The results indicate no difference in BMD at 10years after HT between pediatric and adult patients.

Bone Health Outcomes at 1 Year after Hematopoietic Stem Cell Transplantation in a Heterogeneous Pediatric Population

Impaired bone mineral density (BMD) is a known complication of hematopoietic stem cell transplantation (HSCT) in adults and may lead to increased fracture risk. Less is known in children about the risks for impaired BMD and fragility (low trauma) fractures after HSCT. In this study, we evaluated the incidence of fragility fractures in a large diverse pediatric HSCT recipient population and identified risk factors for both fracture and impaired BMD. We reviewed the records of 237 patients age ≤21 years at the time of transplantation who underwent HSCT at our institution between January 2015 and March 2018. The primary endpoint was the incidence of fragility fractures, and the secondary endpoint was assessment of BMD on dual-energy X-ray absorptiometry (DXA). DXA studies were available for analysis in 79 of 206 patients who were alive at 1 year after HSCT, and the median height-for-age adjusted z-score for spine BMD was 0.15. Among the 237 patients in this study, 25 (10.5%) had evidence of at least 1 fragility fracture on imaging. In the patients with at least 1 fragility fracture, 18 (72%) sustained spine fractures. The median time to fracture was 5.9 months after HSCT. Mortality at 1 year was proportionally higher, although not statistically significantly so (P=.11) in patients who had at least 1 fragility fracture (24%; 6 of 25) compared with patients without a fragility fracture (12%; 25 of 212). Vitamin D status at 1 year post-HSCT was sufficient (>20 ng/mL) in 94% of the patients assessed (160 of 171). There was no difference in the incidence of fracture between vitamin D-sufficient patients and vitamin D-insufficient patients (P=1.0). The incidence of fracture was significantly higher in patients with graft-versus-host disease (GVHD) compared with those without GVHD (15% vs 6%; P=.02). There was no significant difference in fracture occurrence between patients who received reduced-intensity conditioning and those who received myeloablative conditioning. The cumulative glucocorticoid dose was significantly associated with fracture in patients exposed to glucocorticoids for >3 months (P=.03). The incidence of fragility fractures, especially vertebral compression fractures, after pediatric HSCT is striking. Furthermore, there may have been additional, asymptomatic patients in our cohort with undetected, occult fractures. The high incidence of fragility fractures seen in this study advocates for establishing bone health screening protocols with attention to spinal imaging in pediatric patients undergoing HSCT.

Prenylated Isoflavonoids-Rich Extract of Erythrinae Cortex Exerted Bone Protective Effects by Modulating Gut Microbial Compositions and Metabolites in Ovariectomized Rats.

Flavonoids, found in a wide variety of foods and plants, are considered to play an important role in the prevention and treatment of osteoporosis. Our previous studies demonstrated that Erythrina cortex extract (EC) rich in prenylated isoflavonoids exerted bone protective effects in ovariectomized (OVX) rats. The present study aimed to investigate the interactions of gut microbiota with the EC extract to explore the underlying mechanisms involved in its beneficial effects on bone. Sprague-Dawley female rats of 3-months-old were ovariectomized and treated with EC extract for 12 weeks. EC extract reversed ovariectomy-induced deterioration of bone mineral density and bone microarchitecture as well as downregulated cathepsin K (Ctsk) and upregulated runt-related transcription factor 2 (Runx2) and alkaline phosphatase (ALP) in the tibia of OVX rats. Its protective effects on bone were correlated with changes in microbial richness and the restorations of several genera. EC increased the serum circulating levels of acetate and propionate in OVX rats. We conclude that the bone protective effects of EC extract were associated with the changes in microbial compositions and serum short chain fatty acids (SCFAs) in OVX rats.

The Predictive Value of Vitamin D Serum Concentration for Osteopenia and Fractures in Children with Hematological Malignancies

Background -Impaired bone mineral density (BMD) is a frequently reported side-effect of patients with childhood cancer. Vitamin D deficiency is suggested to be a risk factor for diminished BMD and fractures during and after cessation of treatment of childhood hematological malignancies.Objective - The aim of our study was to assess the predictive value of a deficient vitamin D serum concentrations for osteopenia and fractures in children with hematological malignancies during and after cessation of treatment.Methods - An extensive literature search was conducted in PubMed, Embase and Cochrane databases. Studies with a prospective study design and written in English, Dutch, French or German, addressing children with hematological malignancies were considered eligible if vitamin D and bone mineral density and/or fractures were measured at baseline and during/after cessation of treatment.Results - A total of 923 articles were identified. After screening and critical appraisal, ten articles (n=16-43, mean/ median age 3.9-11.2 years) were eligible for quantitative analysis. Five studies showed deficient 25-OHD and/or 1,25(OH)2D levels, ranging from 8.5-46 ng/ml and 12.3-75 pg/ml, respectively. In all these cases, levels were already deficient at baseline.No studies adressed the predicitive value of vitamin D on fracture risk. All studies except one investigating BMD found decreased BMD Z-scores both at baseline and at follow-up, ranging from 0.70- -2.3 and -0.21- -2.4. Only four studies assessed the relation between vitamin D status and low BMD, of which just two corrected for possible confounders. Of these studies, one reported a positive correlation of serum 25-OHD at follow-up and subtotal body BMD (R=0.39-0.42, p<0.03), whereas the others found no relation.Conclusion - Based on the available evidence consisting of small studies, deficient vitamin D serum concentration cannot be conceived to be a predictor of impaired BMD and fractures during and after cessation of treatment in children with hematological malignancies. However, one studie reported a positive correlation and both vitamin D levels and BMD were often decreased, implying a relation. Larger studies addressing vitamin D as an independent risk factor should be conducted. DisclosuresNo relevant conflicts of interest to declare.

Estimating the Proportion of Bone Mineral Density Loss in Patients with Normal Kidney Function among South Indian Population

Background: Bone Mineral density (BMD) is considered as one of the golden tool to measure the bone quality in which two measurements namely T- Score and Z –score are used to report the BMD test results. Whenever there is deterioration of BMD it is associated with low skeletal mass. Creatinine is a chemical waste molecule that is generated from this muscle metabolism. Creatinine is a good marker for muscle mass. However, limited studies have been done which tell us the association between BMD loss and serum creatinine (SCr) levels.Methodology: 200 participants who were referred for CECT abdomen and pelvis were scanned using 128 slice Philips Brilliance CT. Using BMD software, four different vertebral bodies from L1-L4 were taken and ROI was placed at the central portion of the trabecular bone, two reference ROI’s, one in retro spinal muscle and one in fat tissue were also placed. To measure CT attenuation value, a ROI graphic tool was drawn at the trabecular bone. Average HU of BMD, T score and Z score values were taken from L1-L4.Statistical Analysis: The data was analysed using SSPS version 16.0. For assessment of normal BMD values, the results of measurements were averaged for age, creatinine level, T score and Z score and descriptive statistics was calculated. Spearman’s correlation coefficient was used to estimate the correlation between serum creatinine with T score and Z score.Results: T Score and SCr correlated negatively at -0.25. The correlation between Z Score and SCr was also negatively correlated at -0.187.Conclusion: It was evident from the study findings, that there is a non-association between SCr and T Score levels which showed that BMD of a person was not associated with normal kidney function. Thus, SCr levels cannot be used as a biomarker for osteoporosis or osteopenia.

Surveillance of Depleted Uranium-exposed Gulf War Veterans: More Evidence for Bone Effects.

Gulf War I veterans who were victims of depleted uranium (DU) "friendly-fire" incidents have undergone longitudinal health surveillance since 1994. During the spring of 2019, 36 members of the cohort were evaluated with a monitoring protocol including exposure assessment for total and isotopic uranium concentrations in urine and a comprehensive review of health outcomes, including measures of bone metabolism and bone mineral density (BMD) determination. Elevated urine U concentrations were observed in cohort members with retained depleted uranium (DU) shrapnel fragments. In addition, a measure of bone resorption, N-telopeptide, showed a statistically significant increase in those in the high DU subgroup, a finding consistent with a statistically significant decrease in bone mass also observed in this high DU subgroup compared to the low DU subgroup. After more than 25 y since first exposure to DU, an aging cohort of military veterans continues to show few U-related health effects in known target organs of U toxicity. The new finding of impaired BMD in the high DU subgroup has now been detected in two consecutive surveillance visits. While this is a biologically plausible uranium effect, it is not reflected in other measures of bone metabolism in the full cohort, which have largely been within normal limits. However, ongoing accrual of the U burden from fragment absorption over time and the effect of aging further impairing BMD suggest the need for future surveillance assessments of this cohort.

Bone Mass in Young Patients with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Background: The effects of hyperandrogenism and steroid treatment on bone mineral density (BMD) in patients with congenital adrenal hyperplasia (CAH) are controversial. Objectives: The objectives of this study were to characterize BMD and fractures in patients with CAH and to identify whether there is an association between alterations in BMD, nutritional status, and variables related to the disease. Methods: A cross-sectional descriptive study was conducted to explore clinical, hormonal, dairy consumption, physical activity, and BMD variables in patients with CAH due to 21-hydroxylase deficiency and controls matched by age, gender, skin color, body mass index, and Tanner scale. Results: Fifty subjects (CAH n = 25; females n = 42 [84%]) with a mean age of 15.9 ± 5.8 years were included in the study. White skin color predominated in 34 subjects (68%), mestizo in 11 (22%), and black in 5 (10%). In patients with CAH, BMD lumbar spine was decreased compared to that in controls (0.83 ± 0.23 vs. 0.98 ± 0.26 g/cm³, p = 0.004). BMD femur was also decreased in patients with CAH; however, this was not significant (0.95 ± 0.20 vs. 1.04 ± 0.24 g/cm³, p = 0.17). There was a positive relationship between age at diagnosis, age of initiation of glucocorticoid treatment, and testosterone levels with all measurements of BMD. The daily glucocorticoid dose was negatively related to BMD. No fractures were found. Conclusions: Patients with CAH had decreased BMD, especially in lumbar spine. Increased androgen exposure seemed to improve, while increased glucocorticoid dose impaired BMD.

Bone structure assessed with pQCT in prepubertal males with delayed puberty or congenital hypogonadotropic hypogonadism

Congenital hypogonadotropic hypogonadism (CHH) is associated with impaired bone mineral density in adulthood, whereas the estimates on bone structure in adolescents with CHH has not been previously evaluated. This study describes bone structure in CHH patients and compares it to that in boys with constitutional delay of growth and puberty (CDGP). A cross-sectional study. Peripheral quantitative computed tomography (pQCT) of non-dominant arm and left leg were performed. Volumetric bone mineral density (BMD), bone mineral content, and area in trabecular and cortical bone compartments were evaluated, and bone age-adjusted Z-scores for the bone parameters were determined. The participants with CHH had more advanced bone age and were older, taller and heavier than the CDGP boys, yet they had lower trabecular BMD in distal radius (147.7mg/mm3 [95% CI, 128-168mg/mm3 ] vs. 181.2mg/mm3 [172-192mg/mm3 ], p=.002) and distal tibia (167.6mg/mm3 [145-190mg/mm3 ] vs. 207.2mg/mm3 [187-227mg/mm3 ], p=.012), respectively. CHH males had lower cortical thickness at diaphyseal tibia than the participants with CDGP (p=.001). These between-group differences remained significant in corresponding Z-scores adjusted for bone age and height (p=.001). In CDGP group, serum testosterone correlated positively with trabecular BMD (r=0.51, p=.013) at distal radius, and estradiol levels correlated positively with trabecular BMD at the distal site of tibia (r=0.58, p=.004). Five treatment-naïve male patients with CHH exhibited poorer trabecular BMD than untreated males with CDGP. We speculate that timely low-dose sex steroid replacement in CHH males may benefit skeletal health in adulthood.

Persistent bone impairment despite long-term control of hyperprolactinemia and hypogonadism in men and women with prolactinomas

While prolactinoma patients have high bone turnover, current data are inconclusive when it comes to determining whether correction of hyperprolactinemia and associated hypogandism improves osteodensitometric data in men and women over the long term. In a large cohort of including 40 men and 60 women, we studied the long-term impact of prolactinoma treatment on bone mineral density (BMD) in men versus women, assessed adverse effects of a primary surgical or medical approach, and evaluated data for risk factors for impaired BMD at last follow-up using multivariate regression analyses. Median duration of follow-up was 79 months (range 13–408 months). Our data indicate that the prevalence of impaired BMD remained significantly higher in men (37%) than in women (7%, p < 0.001), despite the fact that hyperprolactinemia and hypogonadism are under control in the majority of men. We found that persistent hyperprolactinemia and male sex were independent risk factors for long-term bone impairment. Currently, osteoporosis prevention and treatment focus primarily on women, yet special attention to bone loss in men with prolactinomas is advised. Bone impairment as “end organ” reflects the full range of the disease and could become a surrogate marker for the severity of long-lasting hyperprolactinemia and associated hypogonadism.

Skeletal Abnormalities and VDR1 Gene Polymorphisms in Mucopolysaccharidosis Patients.

IntroductionArticular and bone damage, which is so disabling in Mucopolysaccharidosis (MPS), requires attention as to the explanatory bias of the pathogenetic mechanisms identified to date. The vitamin D receptor (VDR) has been investigated in many studies in correlation with bone metabolism, osteoporosis, and the impaired bone mineral density associated with certain polymorphisms of the VDR gene.AimThis study aims to observe whether there is an association between clinical features, phospho-calcium metabolism parameters and the VDR gene polymorphisms in patients with MPS.Patients and MethodWe evaluated six patients with MPS type I, 20 patients with MPS type II, two patients with MPS types IIIA and IIIB and three patients with MPS type IVB. In these patients, phospho-calcium metabolism, markers of bone formation, bone radiographs and bone densitometry were evaluated, as were four polymorphisms of the VDR gene (ApaI, BsmI, FokI and TaqI).ResultsThere was a deficiency in 25 hydroxy vitamin D in MPS type I patients at the final evaluation and in MPS type II patients, both at ERT initiation and at the last evaluation. The analysed polymorphisms were not associated with modified calcium-phosphor levels, but some differences were observed regarding the level of 25 OH vitamin D. Thus, in the case of AA polymorphism, all patients have a 25 OH vitamin D deficiency, and one patient with the AA genotype and three with Aa have a 25 OH vitamin D deficiency and secondary hyperparathyroidism due to this deficiency (four patients), all of them having the Bb phenotype.ConclusionIn MPS patients, vitamin D deficiency is observed, as it is in some patients with secondary hyperparathyroidism, which indicates vitamin D supplementation to protect bone metabolism. There are no obvious correlations between VDR polymorphism and bone metabolism in MPS patients.

Bone health in idiopathic inflammatory myopathies.

To review the extant literature relating to bone health in the idiopathic inflammatory myopathies (IIM) including both adult and juvenile patients. A PubMed search® identified relevant studies from 1966 to 2020 in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts, and a third author was consulted in the case of disagreement. We identified 37 articles (3 review articles, 2 RCTs, 9 cross-sectional, 16 cohort and 7 case-control studies). The prevalence of osteopenia (n=7) ranges from 7 to 75% and osteoporosis (n=7) between 13% to 27%. The prevalence of vertebral fractures ranged from 11 to 75%. Systemic inflammation likely contributes to reduced bone mineral density (BMD) in children with IIM but data is currently lacking in adult patients. Association between with impaired BMD and Vitamin D or calcium intake and physical activity has not been demonstrated in IIM. There is no clear consensus regarding the impact of age, menopause or BMI on bone health. Gender, smoking status, disease activity and inflammatory markers are not obvious independent predictors of low BMD. Several studies have demonstrated that glucocorticoids are associated with an increased risk of low BMD. There are no specific guidelines relating to the management of bone health in adult and juvenile patients with IIM. Both adult and juvenile patients with IIM are at high risk of impaired bone health and fracture. The mechanisms behind this are likely multifactorial including systemic inflammation, glucocorticoid treatment, reduced mobility and impaired calcium/vitamin D homeostasis. There are a lack of guidelines and studies relating to the screening, prevention and treatment of impaired bone health in adult and juvenile patients with IIM. Future research is required to understand the complexity of bone health in IIM including to develop much needed disease-specific management recommendations.

Ethanol Extract of Amomum tsao-ko Ameliorates Ovariectomy-Induced Trabecular Loss and Fat Accumulation.

In Asia, Amomum tsao-ko has long been used as a spice or seasoning in food to stimulate digestion. In the present study, we evaluated the effects of ethanol extract of Amomum tsao-ko (EEAT) on menopausal osteoporosis and obesity. After the administration of EEAT in ovariectomy (OVX) mice models for five weeks, microcomputed tomography and a histological analysis were performed to assess, respectively, the trabecular structure and the fat accumulation in adipose, liver, and bone tissues. We also examined the effects of EEAT on a bone marrow macrophage model of osteoclastogenesis by in vitro stimulation from the receptor activator of nuclear factor-kappa Β ligand (RANKL) through real-time PCR and Western blot analysis. In addition, ultrahigh performance liquid chromatography–tandem mass spectrometry (UHPLC–MS/MS) with authentic standards was applied to characterize the phytochemical profiling of EEAT. We found that EEAT significantly decreased OVX-induced body weight gain and fat accumulation, significantly prevented OVX-induced deterioration of bone mineral density and microstructure of trabecular tissues, and significantly inhibited osteoclast differentiation by downregulating NF-κB/Fos/NFATc1 signaling in osteoclasts. Furthermore, UHPLC–MS/MS identified eight beneficial phytochemicals in EEAT. Collectively, these results suggest that EEAT might be an effective nutraceutical candidate to attenuate menopausal osteoporosis by inhibiting osteoclastogenesis and to prevent obesity by suppressing fat accumulation.

Optimization of the nutritional composition of the food mixture, taking into account the individual restrictions of consumers

The paper considers the problem of optimizing the composition of food mixtures intended for feeding individuals with a predisposition to diseases associated with impaired bone mineral density (BMD) by selecting the ratio of the main and additional raw materials in the mixture. The mathematical formulation of the problem was carried out and the result of its solution was obtained using a computer program. The formation of the optimal composition of the mixture was calculated taking into account two criteria - restrictions on the ratio of the main and additional raw materials and taking into account the specified requirements of the standard for the amount of basic nutrients that will provide nutritional support for people with a predisposition to BMD impairment.

Correlation between bone mineral density, isokinetic peak torque and postural balance in postmenopausal women

Background: Postmenopausal women typically present loss of bone mineral density (BMD), muscular strength, and postural balance. However, there is no consensus in the literature on the correlation between these variables. Objectives: Our objective was to verify the correlation between BMD, isokinetic peak torque of knee extensors and flexors, and static postural balance in postmenopausal women. Methods: Fifty-one postmenopausal women underwent BMD evaluation through dual-energy X-ray absorptiometry (DXA) for four bone regions (lumbar spine, femoral neck, total hip, and trochanter). Muscular strength of knee extensors and flexors was evaluated in an isokinetic dynamometer at 60 and 180 degrees per second in the dominant lower limb. Static postural balance was evaluated on a force platform during five different tasks (bipodal eyes open, bipodal eyes closed, semi-tandem eyes open, semi-tandem eyes closed, and unipodal). Statistical analysis involved Spearman’s correlation coefficient (rho). Results: There was no significant correlation between BMD and isokinetic peak torque of knee extensors and flexors. Approximately half (27 of 60) of the postural balance variables presented significant inverse correlations (p &lt; 0.05) with BMD and of these, the majority (22 of 27) presented moderate correlation (rho between -0.49 and -0.30). Most correlations were for bipodal support tasks with eyes open and eyes closed. Conclusion: Greater postural oscillation in different balance tasks was correlated with lower BMD in postmenopausal women. Therefore, it is suggested that intervention protocols for women with impaired BMD, especially osteoporotic, consider balance training as part of rehabilitation.

Viburnum opulus L. Juice Phenolic Compounds Influence Osteogenic Differentiation in Human Osteosarcoma Saos-2 Cells.

Bone mass loss occurs with a decrease in osteoblast proliferation and differentiation, or the enhancement of bone resorption, which further leads to the impairment of bone mineral density and increase in bone fracture. Recent studies suggest that some phenolic compounds found in food play positive role in bone metabolism. High content of phenolic compounds with potential beneficial effects on bone metabolism have been identified in the Viburnum opulus fruit. The aim of the study was to determine the influence of V. opulus fresh juice (FJ) and juice purified by solid phase extraction (PJ) on osteogenesis processes with osteosarcoma Saos-2 cell lines. V. opulus purified juice revealed stronger potential as an inducer of Saos-2 osteogenic differentiation. Saos-2 cells matrix mineralization was evaluated with alkaline phosphatase (ALP) activity measurement and alizarin red S staining. Gene expression analysis showed the elevation of the mRNA levels of Runt-related transcription factor 2 (RUNX2), ALP, collagen type 1 and osteonectin, whereas the nuclear factor-κB ligand and osteoprotegerin ratio (RANKL/OPG) decreased. Furthermore, V. opulus was able to diminish the secretion of pro-inflammatory cytokines Il6 and TNFα, however had no effect on vascular endothelial growth factor (VEGF). It decreased intracellular oxidative stress and induced DNA repair, but had no effect on the growth inhibition of lactic acid beneficial microorganisms.

Bone Mineral Density in Male Hospital Physicians over the Age of 65 Years

Hospitalists are at risk for vitamin D deficiency during their active years due to indoor working conditions and insufficient sunlight exposure. The impairment of bone mineral density (BMD) in this group has not been studied. A total of 50 male hospitalists aged ≥ 65 years were enrolled. Their BMD was measured at the femoral neck (FN), lumbar spine (LS), and distal radius (DR), and their medical history and risk factors were assessed through a detailed questionnaire. The FRAX® (Fracture risk assessment tool) score was calculated for each participant. The mean age was 71 ±5.3 years. They worked as hospital physicians for a mean duration of 38.8 ±6.9 years. According to the BMD measurement, 15 (30%) had osteoporosis, and 29 (58%) had osteopenia. We also analyzed bone density excluding DR, since the clinical significance of low bone density of DR alone is debatable. In this analysis, 7 doctors (14%) had osteoporosis, and 33 (66%) had osteopenia. According to AACE/ACE 2016 guidelines, 48% of the participants would require specific treatment for fracture prevention. However, using only FN and LS BMD, 40% would require treatment. Hospitalists were found to have a high prevalence of osteoporosis and osteopenia, and 40% required specific treatment according to international guidelines.

Bone Densitometry in a Cohort of Egyptian Children with Steroid Sensitive Nephrotic Syndrome.

Introduction Nephrotic syndrome is one of the most frequent glomerular diseases among children. Steroid therapy is still the standard treatment of this disease. Aim of the Study This study aims to assess bone density in children with steroid sensitive nephrotic syndrome (SSNS) and to correlate the degree of bone density affection to steroid dose and duration. Methods Fifty children with SSNS [25 steroid dependent/ frequent relapsing (SDNS/FRNS) and 25 infrequently relapsing (IFRNS) patients] were assessed clinically and laboratory. Bone mineral density (BMD) was measured to all included patients by Duel energy X-ray absorptiometry. Results BMD abnormality is significantly increased in SDNS/FRNS group than IFRNS group (p = 0.0001). BMD Z score negatively correlated with relapse frequency-/year [p = 0.001 and correlation coefficient (CC) = -0.586]. Bone ache was the only significant complaint in patients with abnormal BMD (p = 0.004). Significant negative correlation was found between BMD Z score and each of serum alkaline phosphatase (ALP) level and Levamisol therapy duration (p 8329.4 mg/m2 with sensitivity of 85% and specificity of 96.67% and area under curve (AUC) of 0.92. Conclusion Impaired BMD in SSNS children significantly correlates with frequency of relapses, serum alkaline phosphatase level, Levamisol therapy duration, steroid doses and duration. At a cumulative steroid dose > 8329.4 mg/m2, BMD impairment is predicted with sensitivity 85% and specificity 97%.

SUN-065 Bone Health Outcomes in a Large, Diverse Pediatric Cohort Undergoing Hematopoietic Stem Cell Transplant

Background:Impaired bone mineral density (BMD) is a known complication of hematopoietic stem cell transplantation (HSCT) in adults and may lead to increased fracture risk. Little is known in pediatrics about the risks for impaired BMD and fragility (low trauma) fractures after HSCT. Factors that may influence the risk of bone disease include underlying diagnosis, glucocorticoid exposure, and HSCT complications (e.g. graft versus host disease (GVHD)). Our study aims to describe the incidence of fragility fractures in a large diverse pediatric HSCT population and to identify risk factors of both fracture and impaired BMD.Methods:We reviewed the records of 237 patients (age ≤ 21 years at time of transplant) who underwent HSCT at our institution between January 2015 and March 2018. The primary endpoint was incidence of fragility fractures and the secondary endpoint was assessment of BMD on dual-energy X-ray absorptiometry (DXA). We analyzed DXA results at one-year post-HSCT in 72 out of 206 patients alive at 1 year.Results:There were 25/237 (10.5%) patients with evidence of fragility fracture on x-ray. Of those, 18/25 (72%) were spine fractures. For patients who had fractures, median time to fracture was 5.9 months after BMT. Mortality at one-year was proportionally higher, though not significant (p=0.11) in patients who had at least one fragility fracture (24%; 6/25) compared to patients without fragility fracture (12%; 25/212). Vitamin D status at one-year post transplant was sufficient (>20ng/mL) in 94% (160/171) of patients measured. There was no difference in incidence of fracture between vitamin D sufficient and insufficient patients. The median height-for-age adjusted Z-score (HAZ) for spine BMD at one-year post transplant was 0.13 in all patients. The median HAZ spine BMD Z-score in patients with fragility fracture was -1.64, though data was available for only 5 patients.Conclusions:The incidence of fragility fractures, especially vertebral compression fractures, after pediatric HSCT is striking and is higher than in adult populations. Furthermore, there are likely additional asymptomatic patients with occult fractures not detected in out cohort. Additional analysis will assess the associations between underlying medical diagnosis, GVHD, and chronic glucocorticoid exposure on fragility fracture risk. The high incidence of fragility fractures seen in this study advocates for establishing bone health screening protocols with attention toward spinal imaging in pediatric patients undergoing HSCT.