Differences In aBMD Research Articles

Co-morbid sarcopenia and low bone mineral density in young paediatric cancer survivors.

Sarcopenia and low areal bone mineral density (aBMD) are prevalent musculoskeletal complications after paediatric cancer treatment. However, their relationship has not been examined in young paediatric cancers survivors. This study aimed to evaluate aBMD differences according to sarcopenia status and the risk of low aBMD Z-score in young paediatric cancer survivors with sarcopenia confirmed/probable. This cross-sectional study included 116 paediatric cancer survivors (12.1±3.3years old; 42.2% female). Handgrip strength was used to assessed muscle strength. Dual-energy X-ray absorptiometry estimated aBMD (g/cm2) and appendicular lean mass index (ALMI, kg/m2). 'No sarcopenia' was defined when muscle strength was >decile 2. 'Sarcopenia probable' was defined when muscle strength was ≤ decile 2 and ALMI Z-score was > -1.5 standard deviation (SD). 'Sarcopenia confirmed' was defined when muscle strength was ≤ decile 2 and ALMI Z-score ≤ -1.5 SD. Analysis of covariance and logistic regression, adjusted for time from treatment completion, radiotherapy exposure, calcium intake, and physical activity, was used to evaluate aBMD and estimate the odds ratios (ORs) of low aBMD (aBMD Z-score < -1.0). Survivors with sarcopenia confirmed had significantly lower aBMD than those without sarcopenia at total body (-1.2 [95% CI: -1.5 to -0.8] vs. 0.2 [-0.2 to 0.6], P<0.001), lumbar spine (-0.7 [-1.1 to -0.3] vs. 0.4 [0.0 to 0.8], P<0.001), total hip (-0.5 [-0.9 to -0.2] vs. 0.4 [0.1 to 0.8], P<0.001), and femoral neck (-1.0 [-1.4 to -0.6] vs. 0.1 [-0.3 to 0.4], P=0.001). Compared with survivors with sarcopenia probable, survivors with sarcopenia confirmed had significantly lower aBMD Z-score at total body (-1.2 [-1.5 to -0.8] vs. -0.2 [-0.7 to 0.4], P=0.009), total hip (-0.5 [-0.9 to -0.2] vs. 0.5 [-0.1 to 1.0], P=0.010), and femoral neck (-1.0 [-1.4 to -0.6] vs. 0.1 [-0.5 to 0.7], P=0.014). Survivors with sarcopenia confirmed were at higher risk of low aBMD Z-score at the total body (OR: 6.91, 95% CI: 2.31-24.15), total hip (OR: 2.98, 1.02-9.54), and femoral neck (OR: 4.72, 1.72-14.19), than those without sarcopenia. Survivors with sarcopenia probable were at higher risk of low aBMD Z-score at the total body (OR: 4.13, 1.04-17.60) than those without sarcopenia. Young paediatric cancer survivors with sarcopenia present higher risk of low aBMD. Resistance training-based interventions designed to mitigate osteosarcopenia in this population should be implemented at early stages.

Development of in vitro osteoporosis model in minipig proximal humerus and femur: validation in histological and biomechanical study

BackgroundThe minipig has been used for research in various fields of medicine, even in orthopedics. Though previous studies have already suggested other methods to create osteoporotic bone, those methods had some disadvantages for taking time and efforts. Therefore, we aimed to generate osteoporotic proximal humerus and proximal femur of minipig using EDTA solution and validate their properties through dual energy X-ray absorptiometry (DEXA), micro-CT study, histological and biomechanical ways.MethodsSix minipigs were used. Out of a total of 12 proximal humerus (PH) and 12 proximal femurs (PF), 6 PH and 6 PF were used as the decalcified group and the opposite side as the non-decalcified group. In vitro decalcification with Ca-chelating agents (0.5 M EDTA solution, pH 7.4) was used. Area BMD (aBMD) was measured using DEXA, Volumetric BMD (vBMD), and microstructure were measured using micro-CT. Universal testing machine was used to measure ultimate load to failure (ULTF). Each group was compared using two types of suture anchors (all-suture anchor, ASA, and conventional screw type anchor, CA).ResultsThere was a significant difference in aBMD and cortical thickness (aBMD: decalcified, 0.433 ± 0.073 g/cm2, undecalcified, 0.962 ± 0.123 g/cm2, p < 0.001; cortical thickness: decalcified, 0.33 ± 0.34 mm, undecalcified, 1.61 ± 0.45 mm, p < 0.001). In the case of ASA, the ULTF was significantly lower in the decalcified group (decalcified: 176.6 ± 74.2 N, non-decalcified: 307.7 ± 116.5 N, p = 0.003). In the case of CA, there was no significant difference (decalcified: 265.1 ± 96.0 N, undecalcified: 289.4 ± 114.5 N, p = 0.578).ConclusionWe demonstrated that decalcification with EDTA solution significantly decreased aBMD, vBMD, and cortical thickness. Decalcified minipig bone using EDTA resulted in similar biomechanical properties as osteoporotic human bone with respect to anchor pull-out.

The comparable efficacy of denosumab on bone mineral density in rheumatoid arthritis patients with postmenopausal osteoporosis: A retrospective case-control study.

Little is known about differences in the therapeutic efficacy of denosumab in subjects with and without rheumatoid arthritis (RA). This study compares the changes in bone mineral density (BMD) between RA patients and controls without RA who had been treated with denosumab for 2 years for postmenopausal osteoporosis. A total of 82 RA patients and 64 controls were enrolled, who were refractory to selective estrogen receptor modulators (SERMs) or bisphosphonates and completed the treatment of denosumab 60 mg for 2 years. The efficacy of denosumab in RA patients and controls was assessed using areal BMD (aBMD) and T-score of the lumbar spine, femur neck, and total hip. A general linear model with repeated measures analysis of variance was used to determine differences in aBMD and T-score between 2 study groups. No significant differences in percent changes in aBMD and T-scores by denosumab treatment for 2 years at the lumbar spine, femur neck, and total hip were evident between RA patients and controls (P > .05 of all), except T-score of the total hip (P = .034). Denosumab treatment equally increased aBMD at the lumbar spine and T-scores at the lumbar spine and total hip between RA patients and controls without statistical differences, but RA patients showed less improvement in aBMD at the femur neck (ptime*group = 0.032) and T-scores at the femur neck and total hip than controls (ptime*group = 0.004 of both). Changes in aBMD and T-scores after denosumab treatment in RA patients were not affected by previous use of bisphosphonates or SERMs. Differences of T-score at the femur neck among previous bisphosphonate users and aBMD and T-score at the femur neck and T-scores at the total hip were evident. This study revealed that 2 years of denosumab treatment in female RA patients achieved comparable efficacy on BMD to controls at the lumbar spine, but showed somewhat insufficient improvement at the femur neck and total hip.

Sex-specific associations between markers of arterial stiffness and bone mineral density in Indian men and women.

Osteoporosis and cardiovascular disease (CVD) share common risk factors, yet both are usually underdiagnosed in the absence of major complications. We investigated associations between arterial stiffness, cardiac workload, carotid intima media thickness (CIMT) and areal bone mineral density (aBMD) in Indian adults. Men and women aged >45years from the Andhra Pradesh Children and Parents Study (APCAPS) were included for cross-sectional analysis (521 women and 696 men). Dual energy x-ray absorptiometry (DXA) measured aBMD at the whole body, total hip and lumbar spine. Supine blood pressure and heart rate were measured and used to calculate rate pressure product and pulse pressure; augmentation index, pulse wave velocity and CIMT were measured. Sex-interactions were tested (denoted as p-int); adjustments were made for confounders. Data were expressed as SD differences with 95% confidence intervals. There were significant negative associations between pulse pressure and aBMD at all sites in women only. In unadjusted analyses, for every 1SD increase in pulse pressure, women had greater negative differences in aBMD at the whole body (-0.13vs 0.007), total hip (-0.20 vs -0.05) and lumbar spine (-0.12 vs 0.05) compared with men. After adjustments, sex differences remained. Similar negative associations were seen between pulse wave velocity and augmentation index with aBMD in women only. There were no sex differences between CIMT and rate pressure product with aBMD. Markers of arterial stiffness are associated with poorer bone health in Indian women, but not in men. There is a need to identify the shared risk factors and markers of arterial stiffness and poor bone health to detect those who require co-management of these diseases to prevent cardiovascular events and fractures.

Comparison of the Lunar Prodigy and Stratos DR Dual-Energy X-Ray Absorptiometers to Assess Regional Bone Mineral Density

Purpose: The first objective of the study was to assess the agreement between the Stratos DR (DMS) and the GE Prodigy (GE) DXAs in determining femoral neck, total hip and lumbar spine aBMD. The second objective was to assess the potential impact of leg positioning (hip flexed at 90° or not) on lumbar spine aBMD. Methods: Forty-six individuals (n=42 women, 91.3%), with a mean age of 59.7 ± 13 years and mean BMI of 23.8 ± 4.7 kg/m², were scanned consecutively on the same day using the two devices. In a subgroup (n=30), two consecutive Stratos DR scans (with hip flexed at 90° or not) at the lumbar spine were conducted. Predictive equations for hip and lumbar spine aBMD were derived from linear regression of the data. Results: Correlation coefficients for aBMD measured with the two DXAs were characterised by an R² of 0.76 for the femoral neck, 0.89 for the total hip, and 0.86 for the lumbar spine. However, the derived equations for aBMD determination showed an intercept significantly different from 0 for hip aBMD, and a slope significantly different from 1 for lumbar spine aBMD. These results highlight a bias between the two measurements, thus requiring the determination of specific cross-calibration equations for hip and lumbar spine, femoral neck excepted. When compared with values on the Prodigy, mean aBMD on the Stratos DR was higher at the femoral neck (+4.8%, p<0.001) and total hip (+9.6%, p<0.001) and lower at L2-L4 (-8.8%, p<0.001). The coefficient of variation (CV%) for the two consecutive measures at lumbar spine (with different positioning) with the Stratos DR was 2.9%. Conclusions: The difference in aBMD measured with the two DXAs illustrates the need to define cross-calibration equations when comparing data across systems in order to avoid erroneous conclusions.

Risedronate use to attenuate bone loss following sleeve gastrectomy: Results from a pilot randomized controlled trial.

The purpose of this study was to explore the efficacy of 150 mg once monthly oral risedronate use in the prevention of sleeve gastrectomy (SG) associated bone loss. Twenty-four SG patients (56 ± 7 years, 83% female, 21% black) were randomized to risedronate or placebo for 6 months, with an optional 12-month assessment. Outcome measures included 6 (n = 21) and 12 (n = 14) month change in dual energy x-ray absorptiometry-acquired regional areal bone mineral density (aBMD). Six-month treatment effect estimates [mean (95% CI)] revealed significant between group aBMD differences at the femoral neck [risedronate: +0.013 g/cm2 (-0.021, 0.046) vs. placebo: -0.041 g/cm2 (-0.067, -0.015)] and lumbar spine [risedronate: +0.028 g/cm2 (-0.006, 0.063) vs. placebo: -0.029 g/cm2 (-0.054, -0.004)]; both p ≤ 0.02. When followed postoperatively to 12 months, differential aBMD treatment effects were observed at the total hip [risedronate: -0.035 g/cm2 (-0.061, -0.009) vs. placebo: -0.072 g/cm2 (-0.091, -0.052)] and lumbar spine [risedronate: +0.012 g/cm2 (-0.038, 0.063) vs. placebo: -0.052 g/cm2 (-0.087, -0.017)]; both p < 0.05. Preliminary treatment effect estimates signal 6 months of risedronate use may be efficacious in reducing aBMD loss at the axial skeleton post-SG, with benefit largely maintained throughout the 1-year postoperative period. Confirmatory data from an adequately powered trial are needed.

Bone Mass and Density in Youth With Type 2 Diabetes, Obesity, and Healthy Weight.

Youth-onset type 2 diabetes is an aggressive condition with increasing incidence. Adults with type 2 diabetes have increased fracture risk despite normal areal bone mineral density (aBMD), but the influence of diabetes on the growing skeleton is unknown. We compared bone health in youth with type 2 diabetes to control patients with obesity or healthy weight. Cross-sectional study of youth (56% African American, 67% female) ages 10-23 years with type 2 diabetes (n = 180), obesity (BMI >95th; n = 226), or healthy weight (BMI <85th; n = 238). Whole-body (less head) aBMD and lean mass as well as abdominal visceral fat were assessed via DXA. Lean BMI (LBMI) and aBMD SD scores (z scores) were computed using published reference data. We observed age-dependent differences in aBMD and LBMI z scores between the healthy weight, obese, and type 2 diabetes groups. In children, aBMD and LBMI z scores were greater in the type 2 diabetes group versus the obese group, but in adolescents and young adults, aBMD and LBMI z scores were lower in the type 2 diabetes group versus the obese group (age interactions P < 0.05). In the type 2 diabetes group and the obese group, aBMD was about 0.5 SDs lower for a given LBMI z score compared with healthy weight control patients (P < 0.05). Further, aBMD was lower in those with greater visceral fat (β = -0.121, P = 0.047). These results suggest that type 2 diabetes may be detrimental to bone density around the age of peak bone mass. Given the increased fracture risk in adults with type 2 diabetes, there is a pressing need for longitudinal studies aimed at understanding the influence of diabetes on the growing skeleton.

Zoledronic Acid Attenuates Early Bone Loss at Forearm in Patients with Acute Spinal Cord Injury.

Randomized controlled trial. To study the magnitude of bone loss at forearm in persons with acute spinal cord injury (SCI) & the effect of early administration of Zoledronic acid on its' prevention. Sawai Man Singh Medical College,Jaipur, India. Sixty patients with acute SCI were randomized either to receive standard medical and nursing care or Zoledronic acid infusion in combination with standard medical and nursing care. Areal bone mineral density (aBMD) was measured at the forearm (radius + ulna) once patientswere medically stable using Dual Energy X-Ray Absorptiometry (DXA) at baseline and at 3, 6 and 12 months. Significant differences in aBMD was found between the control & Zoledronic acid group at 1/3 forearm (- 0.064; 95% CI - 0.092 to - 0.036, p = 0.001), mid forearm (- 0.059; 95% CI - 0.084 to - 0.034, p = 0.001), UD forearm (- 0.048; 95% CI - 0.097 to 0.001, p = 0.016) and total forearm (- 0.048; 95% CI - 0.088 to - 0.008, p = 0.021) at 1 year in the paraplegic patients with SCI. Similar significant difference was also observed at 1/3 forearm (- 0.046; 95% CI - 0.073 to - 0.019, p = 0.002), mid forearm (- 0.063; 95% CI - 0.088 to - 0.037, p < 0.0001), UD forearm (- 0.084; 95% CI - 0.101 to - 0.067, p < 0.0001) and total forearm (- 0.115; 95% CI - 0.132 to - 0.097, p < 0.0001) respectively at 1 year in the quadriplegic patients with SCI. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites in quadriplegic patients. [1/3 forearm - 0.022; 95% CI - 0.039 to - 0.005; p = 0.015, Mid forearm - 0.023; 95% CI - 0.042 to - 0.004; p = 0.019, UD forearm - 0.041; 95% CI - 0.055 to - 0.027; p < 0.0001 and Total forearm - 0.049; 95%CI - 0.062 to - 0.036; p < 0.0001]. Bone loss was reduced in the Zoledronic acid treated group compared to the standard treatment group in both paraplegic and quadriplegic patients. Single dose of 5mg intravenous Zoledronic acid is an effective treatment in preventing bone loss at the forearm for 12 months following acute spinal cord injury.

Distal radius bone microarchitecture: what are the differences between age 25 and old age?

Aging is strongly associated with bone loss, but little is known about magnitudes of differences in bone microarchitectures, aBMD, and vBMD from peak bone mass (PBM) to senescence. We aimed to describe differences in aBMD, vBMD, and bone microarchitecture parameters at the distal radius between older and young adults. We compared 201 participants, aged 62-89years (female 47%) and 196 participants, aged 24-28years (female 38%). Bone microarchitecture parameters at distal radius were measured using high-resolution peripheral computed tomography (HRpQCT). aBMD was measured using dual-energy X-ray absorptiometry (DXA). Unpaired t tests and chi-square tests were used to compare differences in means and proportions as appropriate. Older adults had thinner compact-appearing cortices with larger (cross-sectional area: outer 30.96mm2 vs. 28.38mm2, inner 36.34mm2 vs. 32.93mm2) and thicker (outer 0.57mm vs. 0.54mm, inner 0.71mm vs. 0.65mm) transitional zones compared with young adults (all p < 0.05). Cortical porosity was modestly higher in older adults than in young adults (54% vs. 49%, p < 0.001). The magnitude of the difference in hip aBMD between older and young adults was slightly lower than of total radial vBMD (- 0.51 SD vs. - 0.78 SD). Compared with young adults at the time of PBM, the transitional zones in older adults were enlarged at the expense of the compact-appearing cortex with a greater porosity in all cortical sub-compartments. The similar SD differences in aBMD and vBMD between older and younger groups suggest that the differences in bone area are not leading to major artefactual change in aBMD.

Bone-Loading Physical Activity and Alcohol Intake but not BMI Affect Areal Bone Mineral Density in Young College-Aged Korean Women: A Cross-Sectional Study.

The purpose of this cross-sectional study was to determine the differences in areal bone mineral density (aBMD) based on alcohol consumption behaviors, bone-loading history as assessed by a bone-specific physical activity questionnaire (BPAQ), and the body mass index (BMI). College-aged female students (N = 112) were recruited from the universities in Seoul and Gyeonggi province, South Korea. The aBMD of the lumbar spine and non-dominant side of the proximal femur (total hip, TH; femoral neck, FN; femoral trochanter, FT) were measured using dual energy X-ray absorptiometry (DXA). Alcohol consumption was determined by the frequency and amount of alcohol intake during the past 12 months using a self-reported questionnaire. The X-scan plus II was used to measure height (cm), body mass (kg), fat-free mass (FFM, kg), and % body fat. Drinking two or more times alcohol per week was associated with greater aBMD of the TH (p = 0.04–0.002) and FN (p = 0.043) compared to a lower frequency of alcohol consumption and 2–4 times per month, respectively. Based on the drinking amount per occasion, there were no significant group differences (p > 0.05) in aBMD at any of the sites. The highest group of total BPAQ had greater aBMD of the TH, FN, and FT versus the lowest (p = 0.023–0.009) and mid of total BPAQ groups (p = 0.004–0.009). Additionally, the highest group had greater aBMD of the lumbar spine compared to the mid group (p = 0.001). No significant group differences in aBMD at any of the sites were noted based on the BMI (p > 0.05). Young college-aged women with greater bone-loading physical activity showed greater aBMD at the TH, FN, FT, and lumbar spine, while a moderate alcohol intake was associated with greater aBMD of the TH and FN. These findings have clinical implications for young women who may not participate in high-impact physical activity and are binge drinkers.

Periostin and sclerostin levels in individuals with spinal cord injury and their relationship with bone mass, bone turnover, fracture and osteoporosis status.

Spinal cord injury (SCI) induces an acute alteration in bone metabolism. Although the aetiology of the bone disturbances is not precisely known, immobilisation reduces mechanical loading and the morphology of osteocytes, which are the primary mechanosensors. Periostin and sclerostin are secreted mostly by osteocytes and are involved in bone's mechanical response. The present study was conducted to determine whether individuals with SCI present alterations in serum periostin and sclerostin and to assess their relationships with bone mineral density, bone turnover markers, fracture status, time since injury, densitometric osteoporosis and paraplegic vs. tetraplegic status. One hundred and thirty-one individuals with SCI (96 males and 35 females; 42.8 ± 13.7 yr old) with a mean 14.2 ± 12.1 years since the time of injury were evaluated and compared with 40 able-bodied controls in a cross-sectional study. Periostin and sclerostin were assayed by ELISA from Biomedica® (Vienna, Austria), and bone turnover markers and areal bone mineral density (aBMD) were concomitantly analysed. Compared with controls, individuals with SCI presented higher periostin (p < 0.01), lower sclerostin (p < 0.001), similar markers of bone turnover levels and lower aBMD at the hip. Compared with chronic individuals, bone turnover markers, sclerostin excepted, values were higher as well as aBMD at hip in individuals with acute SCI. Moreover, the aBMD differences were more marked in tetraplegic than paraplegic individuals. Bone mineral density, fracture status, densitometric osteoporosis and paraplegia vs. tetraplegia did not seem to substantially influence the values of biological markers, sclerostin excepted. This study showed for the first time that individuals with SCI presented higher periostin levels than healthy controls only during the acute phase. Conversely, sclerostin levels are lower whatever the post-injury time. Fractures and densitometric osteoporosis were not associated with differences in these two biological markers, whereas paraplegia vs. tetraplegia and fragility fracture status seemed to influence sclerostin levels only.

Impact Versus Resistance Training For Bone In Young Women: Preliminary Findings Of The OPTIMA-Ex Trial

PURPOSE: The OPTIMA-Ex (Osteoporosis Prevention Through Impact and Muscle-loading Approaches to Exercise) trial aims to compare bone responses to two known osteogenic stimuli - impact exercise and resistance training in young women with lower than average bone mass. METHODS: The trial is a three-arm, single-blind, single-centre, randomised controlled exercise intervention targeting healthy but sedentary women aged 18-30 years with lower than average bone mass (T-score ≤ 0). Participants were randomised to a 10 month, twice-weekly, either supervised high intensity impact training (IT), high intensity resistance training (RT) or home-based low intensity exercise (active control) (CON). Preliminary DXA (Medix DR) outcomes for lumbar spine (LS), dominant (D) and non-dominant (ND) femoral neck (FN); D and ND distal 1/3 radius (RAD) areal bone mineral density (aBMD) have been examined per-protocol, using repeated-measures ANCOVA adjusted for compliance, age, height, weight, total lifetime physical activity, dietary calcium and baseline values. DXA results are reported as mean difference ± SE, statistical significance set at p ≤ 0.05. RESULTS: A total of 51 women (age=22.2±3.6 years; height=1.64±0.62 m; weight=58.1±8.7 kg) have been randomised (IT=17, RT=17, CON=17) with no between-group differences at baseline. Follow-up data is available for 22 participants (IT=6, RT=8, CON=8). Compliance currently differs between groups (IT=66.5±17.2%, RT=67.3±12.3%, CON=87.5±13.7%; p=0.011). There are no between-group differences in aBMD at any site. However, there are significant within-group differences in our primary outcome of LS aBMD for both IT (0.046±0.020 g/cm2; p=0.044) and RT (0.049±0.018 g/cm2; p=0.019). Additional within-group differences are present for ND FN (0.031±0.012 g/cm2; p=0.027) and ND RAD (0.047±0.020 g/cm2; p=0.036) aBMD for RT. A significant within-group difference is evident for ND (0.057±0.023 g/cm2; p=0.027) and D (0.061±0.024 g/cm2; p=0.029) RAD aBMD for CON. CONCLUSIONS: Although minimal statistical power limits the conclusions that can be drawn from these preliminary data, results indicate both RT and IT improve spine bone mass, while RT may provide a broader osteogenic stimulus in young adult women with lower than average bone mass. Data collection is ongoing.

Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury: a randomized controlled trial.

Randomized controlled trial. To determine the effect of zoledronic acid on bone loss in people with acute spinal cord injury (SCI) SETTINGS: Sawai Man Singh Medical College, India. Sixty patients with acute SCI were randomized to receive either standard treatment alone or standard treatment with zoledronic acid within 3 months after injury. Areal bone mineral density (aBMD) was measured at the hip using dual-energy X-ray absorptiometry (DXA) at baseline 3, 6, and 12 months. Significant differences in aBMD were found between the standard treatment alone and standard treatment plus zoledronic acid group at the femoral neck (-0.13; 95% CI, -0.18 to -0.09, p < 0.0001), and total hip (-0.16; 95% CI, -0.19 to -0.12, p < 0.0001), respectively, at 1 year and bone loss was reduced in the zoledronic acid treated group as compared to the standard treatment group. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites. [Femoral neck -0.08; 95% CI, -0.12 to -0.03; p = 0.002 and total hip -0.12; 95% CI, -0.15 to -0.08; p < 0.0001] CONCLUSION: A zoledronic acid 5 mg infusion given within 3 month significantly reduces bone loss at the hip after 6 months post infusion in patients with acute SCI.

Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA

Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these regions diverge from those defined by the dual-energy X-ray absorptiometry manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA). The participants were 134 young adults divided into 2 groups according to the impact of PA performed in the last 12 mo: high-impact PA and low-impact PA. The aBMD of the proximal femur was assessed by dual-energy X-ray absorptiometry at the standard femoral neck, intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck and intertrochanteric region. The bone-specific physical activity questionnaire was used to estimate the impact load of PA. Comparisons between groups were adjusted for body height and body lean mass. Interaction analysis between sex and PA groups were conducted with analysis of variance. Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures analysis of variance. In the high-impact PA group, men benefit more than women at all bone regions, except the aBMD at intertrochanteric region. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs specific) and PA groups (low vs high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.

The effect of a previous created distal arteriovenous-fistula on radial bone DXA measurements in prevalent renal transplant recipients.

BackgroundAccelerated bone loss occurs rapidly following renal transplantation due to intensive immunosuppression and persistent hyperparathyroidism. In renal transplant recipients (RTRs) due to the hyperparathyroidism the non-dominant forearm is often utilized as a peripheral measurement site for dual-energy x-ray absorptiometry (DXA) measurements. The forearm is also the site of previous created distal arteriovenous fistulas (AVF). Although AVF remain patent long after successful transplantation, there are no data available concerning their impact on radial bone DXA measurements.MethodsIn this cross-sectional study we performed DXA in 40 RTRs with preexisting distal AVF (RTRs-AVF) to assess areal bone mineral density (aBMD) differences between both forearms (three areas) and compared our findings to patients with chronic kidney disease (CKD, n = 40), pre-emptive RTRs (RTRs-pre, n = 15) and healthy volunteers (n = 20). In addition, we assessed relevant demographic, biochemical and clinical aspects.ResultsWe found a marked radial asymmetry between the forearms in RTRs with preexisting AVF. The radial aBMD at the distal AVF forearm was lower compared to the contralateral forearm, resulting in significant differences for all three areas analyzed: the Rad-1/3: median (interquartile range) in g/cm2, Rad-1/3: 0.760 (0.641–0.804) vs. 0.742 (0.642, 0.794), p = 0.016; ultradistal radius, Rad-UD: 0.433 (0.392–0.507) vs. 0.420 (0.356, 0.475), p = 0.004; and total radius, Rad-total: 0.603 (0.518, 0.655) vs. 0.599 (0.504, 0.642), p = 0.001). No such asymmetries were observed in any other groups. Lower aBMD in AVF forearm subregions resulted in misclassification of osteoporosis.ConclusionsIn renal transplant recipients, a previously created distal fistula may exert a negative impact on the radial bone leading to significant site-to-site aBMD differences, which can result in diagnostic misclassifications.

Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women.

Fermented dairy products (FDP), including yogurts, provide calcium, phosphorus, and proteins together with prebiotics and probiotics, all being potentially beneficial for bone. In this prospective cohort study, we investigated whether FDP, milk, or ripened cheese consumptions influence age-related changes of bone mineral density (BMD) and microstructure. Dietary intakes were assessed at baseline and after 3.0 ± 0.5years with a food frequency questionnaire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography, in addition to areal (a) BMD and body composition by dual-energy X-ray absorptiometry, at the same time points. At baseline, FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia. Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption. In the longitudinal analysis, FDP consumption (mean of the two assessments) was associated with attenuated loss of radius total vBMD and of Ct vBMD, area, and thickness. There was no difference in aBMD and at the tibia. These associations were independent of total energy, calcium, or protein intakes. For other dairy products categories, only milk consumption was associated with lower decrease of aBMD and of failure load at the radius. In this prospective cohort of healthy postmenopausal women, age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes. ISRCTN11865958 ( http://www.isrctn.com ).

Skeletal Characteristics of Competitive Female Rowers

Weight-supported activities, such as rowing, are not commonly prescribed for fracture prevention. However, rowing requires large magnitudes of internal loading, thus it has potential to induce positive skeletal adaptations, especially in the hip and radius, two common fracture sites. PURPOSE: To examine skeletal health and body composition in college aged competitive female rowers. METHODS: In this cross-sectional study, 24 rowers and 24 age and body mass (±2yrs and 5lbs) matched physically active controls were compared. DXA was used to measure body composition and areal BMD (aBMD) of the total body, lumbar spine, hips and forearms, and hip structural analysis variables. pQCT was used to assess bone characteristics and bone strength of the tibiae (4%, 38%, 66%) and radii (4%, 66%) sites. RESULTS: Age- and height-adjusted aBMDs were not significantly different between groups (p>0.05), but rowers had greater hip cross-sectional moment of inertia (p≤0.05). Rowers had greater tibiae 4% total area, trabecular area, and periosteal circumference (PeriC) (p≤0.05). Also, total bone content and area, cortical area, PeriC, iPolar and SSI were greater at the tibiae 38% and 66% sites for rowers (p≤0.05). Controls had significantly greater 38% tibiae cortical density than rowers (p≤0.05). Rowers had significantly greater forearm muscle cross sectional area (p≤0.01) at the 66% radial site, and greater PeriC at the 4% radial site (p≤0.05). CONCLUSIONS: Rowers had greater tibiae bone area and strength compared to controls, but there were no group differences in aBMD or most radial bone variables. Our findings suggest that competitive rowing has osteogenic potential and may be particularly beneficial for improving bone quality at the tibiae even when compared to physically active controls.Table 1: Group comparisons of mean bilateral skeletal characteristics (means±SE)

Type 2 Diabetes Mellitus Is Associated With Better Bone Microarchitecture But Lower Bone Material Strength and Poorer Physical Function in Elderly Women: A Population-Based Study.

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fractures according to several studies. The underlying mechanisms remain unclear, although small case-control studies indicate poor quality of the cortical bone. We have studied a population-based sample of women aged 75 to 80 years in Gothenburg, randomly invited from the population register. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (Hologic Discovery A), bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT; ExtremeCT from Scanco Medical AG), and reference point indentation was performed with Osteoprobe (Active Life Scientific). Women with T2DM (n = 99) had higher aBMD compared to controls (n = 954). Ultradistal tibial and radial trabecular bone volume fraction (+11% and +15%, respectively), distal cortical volumetric BMD (+1.6% and +1.7%), cortical area (+11.5% and +9.3%), and failure load (+7.7% and +12.9%) were higher in diabetics than in controls. Cortical porosity was lower (mean ± SD: 1.5% ± 1.1% versus 2.0% ± 1.7%, p = 0.001) in T2DM in the distal radius but not in the ultradistal radius or the tibia. Adjustment for covariates (age, body mass index, glucocorticoid treatment, smoking, physical activity, calcium intake, bone-active drugs) eliminated the differences in aBMD but not in HR-pQCT bone variables. However, bone material strength index (BMSi) by reference point indentation was lower in T2DM (74.6 ± 7.6 versus 78.2 ± 7.5, p < 0.01), also after adjustment, and women with T2DM performed clearly worse in measures of physical function (one leg standing: -26%, 30-s chair-stand test: -7%, timed up and go: +12%, walking speed: +8%; p < 0.05-0.001) compared to controls. In conclusion, we observed a more favorable bone microarchitecture but no difference in adjusted aBMD in elderly women with T2DM in the population compared to nondiabetics. Reduced BMSi and impaired physical function may explain the increased fracture risk in T2DM. © 2016 American Society for Bone and Mineral Research.

Nasal salmon calcitonin blunts bone microstructure alterations in healthy postmenopausal women

In healthy postmenopausal women, nasal salmon calcitonin blunted distal radius and tibia bone microstructure degradation. Nasal salmon calcitonin (NSC) has been reported to lower vertebral fracture risk by 33%, but to modestly increase spine areal bone mineral density (aBMD) by 1.5%. Thus, NSC may also influence bone microstructure, another known determinant of bone strength. In a randomized, double-blind, placebo-controlled trial, we investigated the effects of 200 IU/day NSC on distal radius and tibia bone microstructure (by high-resolution 3-dimensional peripheral quantitative computerized tomography), aBMD (by dual-energy X-ray absorptiometry), and serum bone turnover markers in healthy postmenopausal women. Mean age was 57.6 ± 0.8 (±SEM) and 57.4 ± 0.7 in NSC (n = 45) and placebo groups (n = 45), respectively. Mean femoral neck T-score was in the osteopenic range; prevalent vertebral fracture was 4% in each group. There was no observed between-group difference in the primary outcome distal radius BV/TV (-2.8 ± 0.6% vs. -4.3 ± 1.0%, NS). By 2 years, the decrease in distal radius total density vs. baseline was 4.4 ± 0.7% in controls and 2.1 ± 0.6% in NSC-receiving patients (p < 0.05). Distal radius and tibia cortical thickness decreased by 3.7 ± 1.0 and 2.4 ± 0.5% in placebo (p < 0.05 vs. baseline for both), respectively, but not in the NSC group. Distal radius total density and cortical thickness changes were lower in NSC group than in placebo (p < 0.05 for both) in the subgroup with baseline C-terminal telopeptides (CTX) above the median. By 6 and 12 months, serum CTX decreased by 17.3 ± 6.2 and 19.1 ± 6.6% (both p < 0.05 vs. baseline), respectively, in NSC, but remained stable in controls (NS vs. baseline). There was no difference in aBMD. NSC was well tolerated, with less arthralgia than the placebo group (14 vs. 26, p < 0.05). Nasal salmon calcitonin blunted the degradation of distal radius and tibia bone microstructure in healthy postmenopausal women.

Density, structure, and strength of the distal radius in patients with psoriatic arthritis: the role of inflammation and cardiovascular risk factors.

We investigated the densitometric and microstructural features of the distal radius in psoriatic arthritis (PsA) patients using high-resolution peripheral quantitative computed tomography. PsA patients have unique bone microstructural deficits, manifested as lower cortical bone density and higher cortical porosity, which are associated with a propensity to bone fragility. The aim of this study was to investigate the densitometric, geometric, microstructural, and biomechanical features of the distal radius in psoriatic arthritis (PsA) patients. This study cohort consisted of 53 PsA patients (24 males and 29 females), with an average age of 53.1 years and 53 gender- and age-matched controls. Areal bone mineral density (aBMD) of the hip, lumbar spine, and ultradistal radius was measured by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the distal radius to obtain measures of volumetric BMD (vBMD), microstructure, and derived biomechanical indices. There were no significant between-group differences in aBMD at the femoral neck, total hip, and ultradistal radius, while aBMD at the lumbar spine was significantly higher in patients. The only indices indicating compromised bone quality in PsA patients were related to cortical bone quality. Cortical vBMD were -3.8% significantly lower, while cortical pore volume, porosity index, and pore diameter were 108, 79.5, and 8.6%, respectively, significantly higher in patients. Cortical stress was marginally lower (-1.3%, p = 0.077) in patients with stress significantly more unevenly distributed (4.9%, p = 0.035). Endocortical perimeter and cortical pore volume were significantly higher in patients with vertebral fracture. Deficits in cortical bone quality were associated with indices of disease activity/severity and were more prominent in patients with type 2 diabetes mellitus or hypertension. There is an intertwined relationship between chronic inflammation, cardiovascular risk factors, and bone loss in PsA. PsA patients seem to have unique bone microstructural deficits which are associated with a propensity to bone fragility.