Dual-emission X-ray Absorptiometry Research Articles

Urinary calcium excretion and bone turnover in osteoporotic patients

It is well documented that patients with osteoporosis (OP) have high incidence of hypercalciuria (HC). However, the mechanism of HC in patients with OP is not well established. It is thought to be the result of high bone turnover (HBT) with excessive bone resorption. OP also frequently presents with low bone turnover (LBT). At this time, it is not clear whether OP with LBT is also associated with hypercalciuria. The purpose of this study is to evaluate urinary calcium excretion in osteoporotic patients with HBT and LBT. This is a retrospective study of 132 patients with osteoporosis who underwent bone biopsy at the University of Kentucky between January 2010 and December 2012. Based on bone biopsy results, patients were divided into HBT or LBT groups. Demographic data, medical history, bone mineral density, serum creatinine, calcium, phosphorus, estimated glomerular filtration rate (eGFR), filtered calcium load, fractional excretion of calcium and phosphorus, 25-hydroxy vitamin D levels, and 24-hour urinary calcium excretion and creatinine were obtained from the patients' medical records. Also, intact parathyroid hormone (iPTH), serum osteocalcin, bone-specific alkaline phosphatase, N-telopeptide of type I collagen, and urine pyridinium levels were measured. Hypercalciuria was present in approximately half of the patients in both the HBT and LBT groups. Patients with HBT OP were significantly younger than those with LBT OP (p=0.013). There was no difference between HBT and LBT patients in 24-hour urinary calcium excretion, serum creatinine, calcium, phosphorus, eGFR, filtered calcium load, and fractional excretion of phosphorus. Mean values of serum osteocalcin and serum N-telopeptide of type I collagen were significantly lower in the LBT compared to the HBT group (p=0.000 and 0.0152, respectively). There was a significant correlation between filtered calcium load and urinary calcium excretion in HBT patients but not in patients with LBT. Fractional excretion of calcium significantly correlated with urinary calcium excretion in both groups. There was no correlation between kidney function and 24-hour urinary calcium excretion. There was no correlation between dual-emission X-ray absorptiometry T-scores and 24-hour urinary calcium excretion. HC is frequently present in patients with OP regardless of the underlying bone turnover status. This may suggest the presence of a bone-derived renal calcium regulating factor(s). Further studies are needed to understand the exact mechanism and the potential consequences of HC in OP patients. .

Assessment of fracture risk in a cohort of Egyptian female Systemic Lupus erythematosus patients

Aim of the workTo assess the fracture risk in a cohort of Egyptian systemic lupus erythematosus (SLE) females in correlation to some disease variables. Patients and methodsSeventy female SLE patients ≥40years old were enrolled with detailed history taking, assessment of disease activity and damage index. Measurement of Serum calcium, phosphorus and alkaline phosphatase, bone mineral density (BMD) by dual emission X-ray absorptiometry (DEXA) at lumbar spine (LS) and femoral neck (FN), serum osteocalcin level and World Health Organization (WHO) fracture risk assessment tool (FRAX®). Results20% of the patients had LS osteoporosis, 35.7% LS osteopenia, 8.6% FN osteoporosis, and 42.9% FN osteopenia. Ten-year risk of major and hip fractures was high in SLE patients evidenced by FRAX-Major ≥20% in 10% of patients, and FRAX-Hip ≥3% in 27.1% of patients. Serum osteocalcin level was significantly decreased in SLE patients with lower BMD than those with normal BMD, and significantly decreased in patients with osteoporosis than those with osteopenia. A significant negative correlation was found between osteocalcin level and age of patients, disease duration, disease activity and damage index scores, current intravenous pulse and cumulative steroids, immunosuppressants, anticoagulants, but there was a positive correlation with antimalarials and calcium supplements. ConclusionTen-year risk of major and hip fractures was high in SLE patients. Increasing age, disease duration, high anti-DNA titres, higher disease activity and damage index were associated with a higher fracture risk. FRAX predicted fractures among SLE patients with normal and low bone mass not just those with frank osteoporosis. Physicians should be alerted to the higher risk of future fractures in SLE patients for periodic monitoring.

Bone mineral density & bone mineral content in Saudi children, risk factors and early detection of their affection using dual-emission X-ray absorptiometry (DEXA) scan

ObjectivesOptimization of bone health is a very important concern now a day. Achievement of optimal peak bone mineral mass is the best means of preventing osteoporosis in adulthood. Dual-energy X-ray absorptiometry (DXA) has become the basis for the evaluation of skeletal health in all ages. The aim of the workThis work aims to assess bone parameters in Alhasa children, Saudi Arabia. Patient & methodsA Cross-sectional survey study involves 126 healthy children (83) boys & (43) girls. Their ages range from (3–15years). ResultsThe mean of Bone mineral density (BMD) and bone mineral content (BMC) were (0.915±0.34 & 0.795±0.133) (43.93±29.4 & 37.63±11.2) in boys and in girls respectively. These values were lower than other areas in Saudi Arabia. BMD & BMC are statistically significant positive correlation with age in both sex, (r=0.567 P=0.000 & r=0.57 P<0.001) and (r=0.831, P=0.000 & r=0.818 P<0.001) respectively. Level of BMD & BMC acquisition were more in boys than girls in all age groups especially group (12–15years). The mean Z score shows significant steady decrease with age in both sexes. Height, Weight, BMI, showed significant positive correlations with changes in BMD & BMC. While Calcium level and Vitamin D level showed negative correlations. ConclusionThe average BMD & BMC in Saudi children is less than that of other races. It shows no significant difference with other Saudi population. Height, weight, BMI Calcium level and Vitamin D level can predict the changes in the BMC & BMD.

The biomechanical and cement leakage study of the different bone mineral density embalmed vertebral body after vertebroplasty

Objective To explore the differences of biomechanics and cement leakage among different bone mineral density (BMD) embalmed vertebral body after vertebroplasty. Methods Forty-five vertebral bodies were harvested from 9 embalmed cadavers. BMD of the vertebral body was measured using dual emission X-ray absorptiometry (DEXA). According to their BMD, vertebral bodies were divided into 3 groups: preferable bone mass group (A, n=10); general bone mass group (B, n=10), poor bone mass group (C, n=10). All specimens were selected to make into compression fracture model by the biomechanical machine for further test. After fracture vertebroplasty was performed, all vertebral bodies underwent unilateral vertabroplasty, with 2.5 ml bone cement injection for each vertebral body. The biomechanical testing was carried out before the fracture and after cement injection. The cement leakage rate and distribution of cement were assessed with the reference of postoperative CT scan (group A, 6 cases; group B, 5 cases; group C, 3 cases). Results In groups A, B and C the intensity and stiffness after cement injection were (5 178.43±903.17) N, (4 630.49±504.542) N, (3 476.67±757.29) N; (427.01±171.85) N/mm, (302.76±70.95) N/mm, (385.67±101.49) N/mm, respectively. After vertabroplasty the intensity was statistically significant among 3 groups (F=13.772, P=0.000), and the stiffness showed no significant difference (χ2=4.376, P=0.112). The leakage rate was higher in group A than in group B and C but have no statistically significant (P=0.534). Conclusion The BMD, maximum load strength and bone cement leakage rate were positively related after vertebroplasty. The recovery of stiffness was not influenced by BMD. Key words: Vertebroplasty; Bone mineral density; Biomechanics; Bone cement leakage

Periacetabular Bone Densitometry after Total Hip Arthroplasty with Highly Porous Titanium Cups: A 2-Year Follow-Up Prospective Study

Trabecular Titanium is an advanced cellular solid structure, composed of regular multiplanar hexagonal interconnected cells that mimic the morphology of the trabecular bone. This biomaterial demonstrated improved mechanical properties and enhanced osteoinduction and osteoconduction in several in vitro and in vivo studies. The aim of this study was to assess Trabecular Titanium osseointegration by measuring periacetabular changes in bone mineral density (BMD) with dual-emission X-ray absorptiometry (DEXA). 89 patients (91 hips) underwent primary total hip arthroplasty (THA) with acetabular Trabecular Titanium cups. Clinical (Harris Hip Score (HHS), SF-36) and radiographic assessment were performed preoperatively, and postoperatively at 7 days and at 3, 6, 12 and 24 months. DEXA analysis was performed only postoperatively, using the BMD values measured at 7 days as baselines. After an initial decrease from baseline to 6 months, BMD increased and progressively stabilised in all 3 regions of interest (ROIs). Median (IQR) HHS and SF-36 increased from 48 (39-62) and 49 (37-62) preoperatively to 99 (96-100) and 86 (79-92) at 24 months, indicating a considerable improvement in terms of pain relief, functional recovery and quality of life. BMD patterns and radiographic evaluation showed evident signs of periacetabular bone remodelling and osseointegration; all cups were stable at the final follow-up without radiolucent lines, loosening or osteolysis. No revisions were performed. After an initial reduction in periacetabular BMD, all 3 ROIs exhibited stabilisation or slight recovery. Although clinical outcomes and functional recovery proved satisfactory, longer follow-ups are necessary to assess this cup long-term survivorship.

The Risk of Fracture in Patients Undergoing Androgen Deprivation May Be Overstated: Analysis of an Unselected Cohort of Patients

Objective: In this study we examined the prevalence of fracture among men undergoing ADT for prostate cancer to determine if the fracture risk was increased among this population.Background: Androgen deprivation therapy (ADT) is a therapeutic approach for men with various prostate cancer disease states. Treatment-related side effects of ADT include rapid bone loss. Previous studies have found that the bone loss related to ADT leads to the development of fractures. Methods: This is a retrospective cohort study of patients treated with ADT in a radiation oncology and medical oncology practice at an urban academic medical center from 2005 to 2010. Patients with evidence of bone metastases responsive to ADT were included. Those with androgen-independent prostate cancer were excluded. Results: One hundred thirty patients met the inclusion criteria and among them only three fractures occurred during 373 person-years of follow-up. The fracture-free survival (FFS) rate at three years for all was 97.7%. Excluding fractures occurring within six months of ADT initiation, the FFS rate was 100% at three years. No significant difference was demonstrated in those screened with a pretreatment dual-emission X-ray absorptiometry (DEXA) scan; there was no relationship between the number of ADT cycles, recovery of testosterone to normal, or total time on ADT. Older patients, surprisingly, had a lower risk (p = 0.054). Patients with normal bone mineral density (BMD) had an FFS rate of 93.8% at three years, osteopenic patients had 94.7%, and patients with osteoporosis and hormone-responsive metastases had 100%. Conclusion: The prevalence of fracture among this group is significantly less than what has previously been reported for men receiving ADT, potentially suggesting an overstatement of risk in the literature to date. Further prospective study with a larger sample size is needed.

Interprofessional care for patients with osteoporosis in a continuing care retirement community

ObjectivesTo assess the quality of care provided to patients with osteoporosis in a continuing care retirement community (CCRC) after implementation of an interprofessional osteoporosis clinic (OPC). Specifically, quality measures were evaluated, including dual-emission X-ray absorptiometry (DXA) screening, calcium and vitamin D supplementation, and prescription treatment of osteoporosis and low bone mass in an ambulatory independent living community. SettingLarge family medicine teaching practice that provides primary care for residents in one main practice, 5 rural satellite practices, and 2 CCRCs. An interprofessional OPC was developed at the main practice in 2005. Patients at all of the organization's sites could be referred to the main practice for osteoporosis management. A needs assessment conducted at one of the CCRCs in 2011 revealed that rates of screening and treatment were suboptimal for its residents despite availability of an off-site OPC. Practice innovationIn 2012, a new interprofessional OPC including a physician, medical assistant, and pharmacist was replicated on-site at the CCRC so that residents had access to this service within their medical home. EvaluationQuality measures were evaluated after implementation of the team-based OPC on-site at a CCRC and included: 1) DXA screening; 2) calcium and vitamin D supplementation; and 3) prescription treatment of osteoporosis and low bone mass. ResultsTwenty-nine patients were seen in the new OPC from January 2012 to August 2013. Ninety-three percent had appropriate DXA testing after OPC implementation. Patients accepted pharmacist recommendations regarding calcium and vitamin D supplementation 90% and 86% of the time, respectively. All but 4 patients received appropriate treatment for osteoporosis or low bone mass. ConclusionProviding a team-based OPC on site in a CCRC improved quality measures for screening and treatment of osteoporosis and low bone mass.

Sex differences in the effects of 12 weeks sprint interval training on body fat mass and the rates of fatty acid oxidation and VO2max during exercise

BackgroundThe purpose of this study was to examine whether very short duration, very high intensity sprint interval training (SIT) leads to loss of body fat mass in association with improvements...

Reduced bone mineral density in glycogen storage disease type III: evidence for a possible connection between metabolic imbalance and bone homeostasis

IntroductionGlycogen storage disease type III (GSDIII) is an inborn error of carbohydrate metabolism caused by deficient activity of glycogen debranching enzyme (GDE). It is characterized by liver, cardiac muscle and skeletal muscle involvement. The presence of systemic complications such as growth retardation, ovarian polycystosis, diabetes mellitus and osteopenia/osteoporosis has been reported. The pathogenesis of osteopenia/osteoporosis is still unclear. ObjectivesThe aim of the current study was to evaluate the bone mineral density (BMD) in GSDIII patients and the role of metabolic and endocrine factors and physical activity on bone status. MethodsNine GSDIII patients were enrolled (age 2–20years) and compared to eighteen age and sex matched controls. BMD was evaluated by Dual-emission-X-ray absorptiometry (DXA) and Quantitative ultrasound (QUS). Clinical and biochemical parameters of endocrine system function and bone metabolism were analyzed. Serum levels of the metabolic control markers were evaluated. Physical activity was evaluated by administering the International Physical Activity Questionnaire (IPAQ). ResultsGSDIII patients showed reduced BMD detected at both DXA and QUS, decreased serum levels of IGF-1, free IGF-1, insulin, calcitonin, osteocalcin (OC) and increased serum levels of C-terminal cross-linking telopeptide of type I collagen (CTX). IGF-1 serum levels inversely correlated with AST and ALT serum levels. DXA Z-score inversely correlated with cholesterol and triglycerides serum levels and directly correlated with IGF-1/IGFBP3 molar ratio. No difference in physical activity was observed between GSDIII patients and controls. DiscussionOur data confirm the presence of reduced BMD in GSDIII. On the basis of the results, we hypothesized that metabolic imbalance could be the key factor leading to osteopenia, acting through different mechanisms: chronic hyperlipidemia, reduced IGF-1, Insulin and OC serum levels. Thus, the mechanism of osteopenia/osteoporosis in GSDIII is probably multifactorial and we speculate on the factors involved in its pathogenesis.

Prediction of percent body fat measurements in Americans 8 years and older.

Although numerous equations to predict percent body fat have been published, few have broad generalizability. The objective of this study was to develop sets of equations that are generalizable to the American population 8 years of age and older. Dual-emission X-ray absorptiometry (DXA) assessed percent body fat from the 1999-2006 National Health and Nutrition Examination Survey (NHANES) was used as the response variable for development of 14 equations for each gender that included between 2 and 10 anthropometrics. Other candidate variables included demographics and menses. Models were developed using the Least Absolute Shrinkage and Selection Operator (LAASO) and validated in a ¼ withheld sample randomly selected from 11 884 males or 9215 females. In the final models, R(2) ranged from 0.664 to 0.845 in males and from 0.748 to 0.809 in females. R(2) was not notably improved by development of equations within, rather than across, age and ethnic groups. Systematic over or under estimation of percent body fat by age and ethnic groups was within 1 percentage point. Seven of the fourteen gender-specific models had R(2) values above 0.80 in males and 0.795 in females and exhibited low bias by age, race/ethnicity and body mass index (BMI). To our knowledge, these are the first equations that have been shown to be valid and unbiased in both youth and adults in estimating DXA assessed body fat. The equations developed here are appropriate for use in multiple ethnic groups, are generalizable to the US population and provide a useful method for assessment of percent body fat in settings where methods such as DXA are not feasible.

The Risk of Low Energy Vertebral Body Compression Fracture Can be Predicted by CT Hounsfield Units

Introduction Vertebral compression fractures (VCF) are an increasingly common spinal pathology in the older adult population. Dual emission X-ray absorptiometry (DEXA) is frequently used to assess bone mineral density. Unfortunately, the sensitivity of DEXA in predicting fracture risk has been shown to be relatively poor, leading some to suggest the need for additional diagnostic studies that more accurately predict fracture risk. The objective of this study was to define the CT parameters that could be used to predict the risk of VCF. Materials and Methods A total of 100 consecutive patients undergoing CT scans for the workup of new onset axial back pain were enrolled in this study. CT scans utilized slice thickness of 0.5 mm. Tube voltage was 120 kV, current 300 mA, auto mAs range 180 to 400, 1.0 second/3.0 mm/0.5 × 32, and helical-pitch 21.0. Patients with a history of high-energy trauma or neoplasm were excluded. Bone density measurements were obtained in Hounsfield units (HU) at the T10–L5 levels from the cancellous portion of the vertebral body in the midsagittal, midcoronal, and axial planes and the average value was calculated. The presence of a single-level or multilevel VCF was identified by CT. Multilevel degenerative changes were characterized and recorded. Logistic regression was utilized to assess the relationship between the variables of bone density in HU, single- or multilevel VCF, and the presence of degenerative changes. Results HU were found to have a strong correlation to the risk of VCF. HU of less than 101 were associated with a significant increase in the rate of VCF, the parameters of logistic regression were В0 = 2.6254, p = 0.0013; B1 = − 0.0387, p &lt; 0.0001. Goodness of fit: chi-square = 37.1180; p &lt; 0.0001, percent of correctly predicted 81%. HU of less than 82 were associated with a significant increase in the rate of multilevel VCF, the parameters of logistic regression were В0 = 1.5934, p = − 0.0338; B1 = 0.0355, p = 0.00013. Goodness of fit: chi-square = 27.21870; p &lt; 0.0001, percent of correctly predicted 86%. The analysis of graphs using third derivatives of estimated regression functions showed that bone density of 101 HU or less is associated with an increased risk of VCF, and bone density of less than 82 HU is associated with an increased risk of multilevel VCF. Hypertrophic degenerative changes were found to be associated with a decreased rate of VCF, the parameters of logistic regression were chi-square = 8.976428, p = 0.0027; В0 = 0.3514, р = 0.2434 (not significant); B1 = 1.3978, p = 0.0050, odds ratio = 4.04 [1.54–10.62]. Conclusion CT data can accurately define the risk of VCF and, therefore, presents a useful clinical tool to support the need for prophylactic medical therapies for osteoporosis or to provide information useful in counseling patients at risk for VCF. Although highly predictive, routine use of CT as a screening tool for osteoporosis is unsuitable because of the associated radiation exposure and cost of the study; however, when CT scans are obtained for other clinical indications, they offer the clinician a unique opportunity to easily obtain useful data that can be used to direct treatment and counsel patients with regard to fracture risk.

EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both...

The presence and impact of diastolic dysfunction on physical function and body composition in hemodialysis patients.

Cardiovascular (CV) diseases are the main cause of death in maintenance hemodialysis (MHD) patients. Muscle wasting and physical function decline are common in MHD patients, and significantly impair their quality of life. These can result from abnormalities in cardiac function, which can be further worsened by physical deconditioning. Left ventricular diastolic function parameters were recently shown to be a better predictor of exercise capacity than systolic measures in patients with CV complications. But little is known about the relationship between cardiac function and physical function in MHD patients. In 82 MHD patients, left ventricular systolic dysfunction (LVSD) was assessed by ejection fraction and fractional shortening with echocardiography, and left ventricular diastolic dysfunction (LVDD) was assessed by pulse wave and tissue Doppler indices. Physical function was assessed by gait speed, performance on a shuttle walk test, and leg muscle strength. Dual-emission X-ray absorptiometry (DXA) was used to measure whole body lean mass (WBLM). The prevalence of LVDD and LVSD was 48.8 and 12.2%, respectively. Gait speed, shuttle walk time, leg strength, and WBLM% were significantly higher in the group without LVDD than with LVDD (p < 0.05 for all). However, there was no significant difference in any measure of physical function or body composition between patients with and without LVSD. These data suggest that LVDD is more closely related to physical function and body composition than LVSD in MHD patients, and hence that LVDD may be an important therapeutic target.

Irisin levels in LMNA-mutated lipodystrophic syndromes

Sarcopenia is defined by decreased muscle mass and impaired muscle function, which may be associated with frailty and eventually higher mortality rates. It is physiologically induced by aging but also related to obesity by different mechanisms such as 1) diminished physical activity; 2) elevated oxidative stress; 3) inflammatory cytokines; 4) increased catabolic state, through hypothalamo-pituitary axis; 5) muscle insulin resistance; 6) abnormal muscle progenitor cells differentiation to an adipocyte-like phenotype as a result of paracrine signals from (adipo)cytokines. Adipose tissue is classified as white adipose tissue (WAT), the major energy storing tissue, brown adipose tissue (BAT), which mediates non-shivering thermogenesis and brite adipocytes (brown in white). Increasing BAT and energy expenditure in adult humans could be a therapeutic strategy to combat obesity. Brown adipocytes are thought to originate from a precursor shared with skeletal muscle that expresses Myf5-Cre, while white adipocytes originate from a Myf5-negative precursors. This provides a rational explanation to why BAT is more metabolically favorable than WAT, even if the situation is more complex because subsets of white adipocytes also arise from Myf5-Cre expressing precursors. Differences in origin between adipocytes could explain metabolic heterogeneity between depots and/or influence body fat patterning particularly in lipodystrophic disorders. Irisin is a newly discovered myokine, associated with ‘browning’ of the WAT. It displays a day-night rhythm, is correlated with lean body mass, and increases after exercise in healthy young individuals, despite an association with major adverse cardiovascular events and polycystic ovary disease[1]. Deficiency of myostatin, and thus stimulation of muscle growth, has also been reported to induce irisin and its precursor FNDC5 expression in muscle and drive the browning of WAT in mice. Familial partial lipodystrophy, Dunnigan variety (FPLD2), an autosomal dominant disorder caused by LMNA mutations, is characterized by fat loss from the extremities and apparent muscular hypertrophy. However, it is unclear whether these patients appear muscular because of a lack of subcutaneous fat or have an actual increase in muscle mass[2]. Moreover adipose tissue mitochondrial dysfunction triggers a lipodystrophic syndrome with insulin resistance, hepatosteatosis, and cardiovascular complications[3,4]. Therefore, our objective was to identify the status of lean mass in LMNA-mutated lipodystrophic syndromes and to determine simple biomarkers to differentiate LMNA-mutated and acquired lipodystrophies. To do so, we assessed the lean (as a surrogate of muscle mass) and fat mass with absorptiometry in FPLD2 patients, non-diabetic obese and control subjects using dual-emission x-ray absorptiometry and magnetic resonance imaging, and measured the myokine irisin and the adipokine leptin blood levels . Our hypothesis is that the rupture of balance between physiological lean and fat mass in lipodystrophic syndromes could explain the evolution towards insulin-resistance (Trial registration: Clin.gov2009-AO-1169-48/PHRC2009 09/094).

Effect of consuming hi-oleic peanuts on adiposity and cardiometabolic health

Effect of consuming hi-oleic peanuts on adiposity and cardiometabolic health

FRI0127 Eular Recommendations for the Use of Imaging in Spondyloarthritis in Clinical Practice

ObjectivesTo develop evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis.MethodsThe task force comprised an expert group of 21 rheumatologists, radiologists and...

SP0142 Developing Eular Recommendations for the Use of Imaging in Spondyloarthritis Clinical Practice: Background and Process

Reflecting the perceived need for developing evidence-based recommendations on the use of imaging of the joints in the clinical management of spondyloarthritis (SpA) a European League Against Rheumatism (EULAR) convened...

SP0143 Ten Eular Recommendations for Use of Imaging in Spondyloarthritis Clinical Practice

A task force convened by the European League Against Rheumatism (EULAR) comprising rheumatologists, radiologists and methodologists from 11 countries developed 10 recommendations, based on both evidence obtained through systemic literature...

Adiposity distribution influences circulating adiponectin levels

Thirty percent of obese individuals are metabolically healthy and were noted to have increased peripheral obesity. Adipose tissue is the primary source of adiponectin, an adipokine with insulin-sensitizing and anti-inflammatory properties. Lower adiponectin levels are observed in individuals with obesity and those at risk for cardiovascular disease. Conversely, higher levels are noted in some obese individuals who are metabolically healthy. Our objective was to determine whether abdominal adiposity distribution, rather than body mass index (BMI) status, influences plasma adiponectin level. A total of 424 subjects (female, 255) of Northern European ancestry were recruited from "Take Off Pounds Sensibly" weight loss club members. Demographics, anthropometrics, and dual-emission x-ray absorptiometry of the whole body, and computed tomography scan of the abdomen were performed to obtain total body fat content and to quantify subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT), respectively. Laboratory measurements included fasting plasma glucose, insulin, lipid panel, and adiponectin. Age- and gender-adjusted correlation analyses showed that adiponectin levels were negatively correlated with BMI, waist circumference, triglycerides, total fat mass, and VAT. A positive correlation was noted with high-density lipoprotein cholesterol and fat-free mass (P < 0.05). SAT-to-VAT ratios were also significantly associated with adiponectin (r = 0.13, P = 0.001). Further, the best positive predictors for plasma adiponectin were found to be SAT-to-VAT ratios and gender by regression analyses (P < 0.01). Abdominal adiposity distribution is an important predictor of plasma adiponectin and obese individuals with higher SAT-to-VAT ratios may have higher adiponectin levels.

Bone quality assessment in type 2 diabetes mellitus

The increased risk for fractures in type 2 diabetes mellitus (T2DM) despite higher average bone density is unexplained. This study assessed trabecular bone quality in T2DM using the trabecular bone score (TBS). The salient findings are that TBS is decreased in T2DM and low TBS associates with worse glycemic control. Type 2 diabetes mellitus is a risk factor for osteoporotic fractures despite high average bone mineral density (BMD). The aim of this study was to compare BMD with a noninvasive assessment of trabecular microarchitecture, TBS, in women with T2DM. In a cross-sectional study, trabecular microarchitecture was examined in 57 women with T2DM and 43 women without diabetes, ages 30 to 90years. Lumbar spine BMD was measured by dual-emission x-ray absorptiometry (DXA), and TBS was calculated by examining pixel variations within the DXA images utilizing TBS iNsight software. Mean TBS was lower in T2DM (1.228 ± 0.140 vs. 1.298 ± 0.132, p = 0.013), irrespective of age. Mean BMD was higher in T2DM (1.150 ± 0.172 vs. 1.051 ± 0.125, p = 0.001). Within the T2DM group, TBS was higher (1.254 ± 0.148) in subjects with good glycemic control (A1c ≤ 7.5%) compared to those (1.166 ± 0.094; p = 0.01) with poor glycemic control (A1c > 7.5%). In T2DM, TBS is lower and associated with poor glycemic control. Abnormal trabecular microarchitecture may help explain the paradox of increased fractures at a higher BMD in T2DM. Further studies are needed to better understand the relationship between glycemic control and trabecular bone quality.