Dual-energy X-ray Absorptiometry In Patients Research Articles

Bioelectrical Impedance Analysis Demonstrates Reliable Agreement with Dual-Energy X-ray Absorptiometry in Identifying Reduced Skeletal Muscle Mass in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease and Hypertension.

Background/Objectives: Body composition (BC) affects the risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD) and hypertension (HTN). Currently, dual-energy X-ray absorptiometry (DEXA) is considered the gold standard for assessing BC, even though it has some limitations, including immobility, ionizing radiation, and patient weight restrictions. The aim of the study was to evaluate the correlations of BC parameters measured by bioelectrical impedance analysis (BIA) with those measured by DEXA in patients with MASLD and HTN. Methods: Overall, 78 patients with MASLD and HTN underwent the following study procedures: compilation of an anamnesis, physical examination of a patient, laboratory tests, abdominal ultrasound, BIA, DEXA, and anthropometric measurements. Results: The agreement between BIA and DEXA in diagnosing reduced skeletal muscle mass (SMM) in patients with MASLD and HTN was moderate (kappa values were 0.440 and 0.404 in males and females, respectively). Significant strong direct correlations were found between fat mass (FM) and body fat percentage measured by BIA with corresponding measurements by DEXA (p < 0.001 for both). The area under the receiver operating characteristic curves (AUC) of SMM to body weight ratios calculated using BIA data were 0.834 and 0.929 for reduced appendicular SMM determined by DEXA in males and females with MASLD and HTN, respectively. Conclusions: In conclusion, BIA is an easy-to-use and widely available tool for assessing SMM and FM in patients with MASLD and HTN, demonstrating reliable agreement with DEXA measurement results and completely free of its limitations.

Differences in the Evaluation of Malnutrition and Body Composition Using Bioelectrical Impedance Analysis, Nutritional Ultrasound, and Dual-Energy X-ray Absorptiometry in Patients with Heart Failure.

Although malnutrition is frequently observed in patients with heart failure (HF), this diagnosis should be performed carefully since HF itself is associated with increased inflammatory activity, which affects body weight, functionality, and some nutritional parameters; thus, its isolated interpretation can erroneously identify surrogate markers of severity as markers of malnutrition. In this context, we aimed to evaluate the prevalence of malnutrition using different classification systems and perform a comprehensive nutritional evaluation to determine the reliability of different diagnostic techniques. Eighty-three patients with a recent hospital admission due to HF were evaluated. GLIM diagnosis criteria and subjective global assessment (SGA) were performed; a comprehensive anthropometric, functional, and biochemical nutritional evaluation was performed, in which bioelectrical impedance analysis (BIA), nutritional ultrasound, and dual-energy X-ray absorptiometry (DXA) were performed. Additionally, mortality and additional admissions due to HF were determined after a mean follow up of 18 months. Malnutrition according to the GLIM criteria (54%) accurately distinguished patients with impaired functionality, lower lean mass, skeletal mass index, and appendicular muscle mass (BIA), as well as lower trunk fat mass, trunk lean mass, fat-free mass (DXA), and decreased albumin and increased C-reactive protein serum levels. According to SGA, there were significant changes in body composition parameters determined by BIA, muscle ultrasound, and functional tests between well-nourished patients and patients with risk of malnutrition (53.7%) or who had malnutrition (7.1%), but not when the last two groups were compared. BIA and DXA showed strong correlations when evaluating muscle and fat mass in HF patients, but correlations with nutritional ultrasound were limited, as well as functional tests. A multivariate analysis showed that no significant association was observed between body composition and mortality, but preperitoneal fat was associated with an increased risk of new hospital admissions (OR: 0.73). GLIM criteria identified a lower percentage of patients with HF and malnutrition compared with SGA; thus, SGA could have a role in preventing malnutrition in HF patients. Nutritional evaluation with BIA and DXA in patients with HF showed reliable results of body composition parameters in HF, and both help with the diagnosis of malnutrition according to the GLIM or SGA criteria and could provide complementary information in some specific cases.

Correlation between Vertebral Marrow Fat Fraction in MRI Using DIXON Technique and BMD in DXA in Patients of Suspected Osteoporosis.

Aim Osteoporosis is a common metabolic bone disease accounting for low back pain (LBP). It is diagnosed by dual-energy X-ray absorptiometry (DXA). Magnetic resonance imaging (MRI), a routine investigation for LBP, is also sensitive to detect fat fraction (FF) of the vertebral body that increases with increasing age. This study aimed to correlate vertebral marrow FF using MRI and bone mineral density (BMD). Material and Methods Patients presenting with low backache and suspected osteoporosis were included. All patients underwent an MRI of lumbosacral spine and DXA. Patients were categorized into an osteoporotic and a nonosteoporotic group based on the T-score obtained from DXA. "T-scores" of < -2.5 on BMD were considered as osteoporotic spine. T-score of > -2.5 was considered as nonosteoporotic. The FF obtained from the DIXON sequence of MRI was correlated between the two groups. Result Thirty-one patients were included with a mean age of 54.26 ± 11.6 years. Sixteen patients were osteoporotic based on the defined criteria in the methods. The mean vertebral marrow FF was significantly higher in the osteoporotic patients (64.98 ± 8.8%) compared with the nonosteoporotic (45.18 ± 13.2%) ( p = 0.001). The mean FF of the vertebra having fracture (69.19 ± 7.73%) was significantly higher than that of patients without fracture (57.96 ± 5.75%) ( p = 0.03). Taking a cutoff value of vertebral marrow FF of 54.85, the sensitivity and specificity of diagnosing osteoporosis were 93 and 80%, respectively, with a confidence interval of 95%. The area under the curve was 0.925. Conclusion Increased vertebral marrow FF is noted in the osteoporotic spine. FF has an inverse correlation with the T-score obtained from BMD. MRI with FF measurement can provide indirect evidence of osteoporosis, which can be done under one roof, especially in young patients where we need to avoid ionizing radiation.

#6641 BONE MATERIAL STRENGTH INDEX AND DUAL ENERGY X-RAY ABSORPTIOMETRY IN EVALUATION OF BONE HEALTH IN AUTOSOMAL POLYCYSTIC KIDNEY DISEASE

Abstract Background and Aims Bone material strength measured with the use of impact microindentation technique (OsteoProbe®) has emerged recently as potentially beneficial tool in evaluating bone quality in metabolic bone disorders. Patients with autosomal polycystic kidney disease (ADPKD) carry an increased risk of skeletal complications, both due to deficiency of polycystins and development of chronic kidney disease-mineral bone disorder (CKD-MBD). In our preliminary study, we found that bone material strength index (BMSi) associated with bone mineral density (BMD) measured with the use of dual energy X-ray absorptiometry (DXA) in chronic kidney disese patients (CKD). The aim of the present study was to find if the same applies to patients with ADPKD. We evaluated bone health by measuring BMSi and performing DXA in patients with ADPKD. Method BMSi was measured (OsteoProbe®, Active Life Scientific, USA) in 64 adult patients (37 men, mean age 43 years) with ADPKD in CKD stages G1-4. The measurement of BMSi compared the resistance to impact of microindentation in bone and reference material. After applying local anaesthesia, we impacted the cortical bone in the midshaft tibia in 10 different points. BMD was measured using Hologic Discovery Wi densitometer in multiple sites: lumbar spine, hip, 1/3 distal non-dominant forearm and whole-body. Trabecular bone score (TBS) was calculated using Medimaps TBS iNsight software. Results Mean values of BMSi, TBS and BMD are presented in the Table 1. BMSi in ADPKD patients was lower than average value observed in healthy individuals (85 men and 80 women). A positive linear relationship between BMSi and BMD was found in all of the examined sites with the highest standardized regression coefficient for 1/3 distal forearm (R2 = 0.315, beta = 0.57, p &amp;lt; 0.001) and weakest for lumbar spine (R2 = 0.003, beta = 0.33, p = 0.003). There was no association between BMSi and TBS. Conclusion This is the first report on BMSi in ADPKD patients. In agreement with the notion of a distinct bone phenotype in ADPKD, we observed a median bone material strength index in patients with ADPKD that was lower than the reference value. BMSi associated with BMD, but not with TBS. However, the association with BMD overall is weak, with BMD explaining only 3 to 31% of the variability of BMSi. This observation suggests complementarity and warrants additional studies investigating whether BMSi associates with hard bone endpoints, independent of BMD.

Serum Periostin Levels are Significantly Higher in Patients with Primary Hyperparathyroidism and Closely Related to Osteoporosis.

Periostin is an emerging biomarker that plays a role in bone metabolism and may be associated with bone mineral density (BMD). This study is aimed to investigate serum periostin levels in patients with primary hyperparathyroidism (PHPT) and its correlation with BMD in these patients. Forty patients with newly diagnosed PHPT without co-morbidities and 30 healthy controls were included. Laboratory tests for the diagnosis of PHPT and serum levels of periostin were measured for all patients. BMD was measured on lumbar spines L1 and L4 by dual-energy X-ray absorptiometry (DEXA). Serum periostin levels were detected using an enzyme-linked immunosorbent assay (ELISA). Serum periostin levels were significantly higher in patients with PHPT than in healthy controls (p<0.001). Serum periostin levels were also significantly higher (mean 59.7±11.0 ng/mL) in PHPT patients with osteoporosis than those without osteoporosis (p=0.004). In logistic regression analysis, only serum periostin levels independently predicted the patients with osteoporosis. According to this analysis, every 1 ng/mL increase in serum periostin increased the risk of having osteoporosis by 20.6%. When the cut-off for serum periostin level was 49.75 ng/mL, the patients with osteoporosis were predicted with 71.4% sensitivity and 69.2% specificity. Multivariate regression analysis revealed a negative correlation between serum periostin levels and L1-L4 T scores on DEXA. This is the first study to determine that serum periostin levels are higher in PHPT patients than those without PHPT and to demonstrate a significant association between serum periostin levels and T scores on DEXA in patients with PHPT. These findings will aid in detecting osteoporosis in patients with PHPT and making the decision for surgery in PHPT patients with no need for DEXA imaging that involves radiation.

Evaluation of the 10 Years' Association Between DXA Screening and Mortality in Patients Who Received Vertebroplasty in the Taiwan Population.

BackgroundOsteoporotic fractures are a significant cause of morbidity and mortality affecting population worldwide. All guidelines recommended vertebral fracture assessment by dual-energy X-ray absorptiometry (DXA). This study aimed at evaluation of any associated benefits of screening with DXA in patients who had received vertebroplasty in Taiwan.MethodsData were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan. We retrospectively compared the data of patients, who were admitted for vertebroplasty, whether they received DXA screening or not. The outcomes of interest were recurrence of spinal fracture and mortality during a follow-up period of 10 years.ResultsFrom this Taiwan national database, the screening rate of osteoporosis in patient who received vertebroplasty was 11.7%. The mean age in the non-DXA screened cohort (n=32,986) was 74.03±12.21 years (71.98% female). In the DXA screened cohort (n=4361), the mean age was 76.43±9.19 years (79.91% female). During the 10-year follow-up period, after matching, non-DXA patients had significantly higher mortality rates than their DXA counterparts, which were 42.37% and 37.73% (p-value < 0.0001), respectively. The re-fracture rates between non-DXA and DXA patients were not significantly different at 17.26% and 16.89% (p-value = 0.1766), respectively.ConclusionThe rate of DXA screening before patients receiving vertebroplasty was extremely low, at 11.7%. Our results showed that DXA screening before vertebroplasty in spinal fractures patients had lower mortality. From this national retrospective cohort study, routine screening of osteoporosis in spinal fracture patients can lead to reduction in mortality.

POS1111 DIAGNOSIS OF OSTEOPOROSIS USING RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) AT THE LUMBAR SPINE IN PATIENTS WITH DIFFERENT BODY MASS INDEX

Background:In recent years, the technology based on the analysis of raw ultrasound signals, Radiofrequency Echographic Multi Spectrometry (REMS), has been validated against Dual-energy X-ray Absorptiometry (DXA) for the diagnosis of osteoporosis and risk fracture prediction.Objectives:The aim of this multicenter observational study was to evaluate the diagnostic performance of REMS with respect to DXA in patients with different body mass index (BMI) categories.Methods:The inclusion criteria were: Caucasian women; age between 30 and 90 years; referral by their clinician for spinal DXA assessment; absence of significant walking impairment; signed informed consent.Patients underwent DXA and REMS scans at the lumbar spine, according to the procedures described in Di Paola et al. [1], including an a-posteriori quality check of the examinations in order to guarantee the maximum reliability of the diagnostic outputs.Three groups of patients were considered according to BMI:: underweight (BMI&lt;18.5 kg/m2), normal weight (BMI≥18.5 kg/m2 and &lt;25 kg/m2), and overweight/obese (BMI≥25 kg/m2). DXA and REMS BMD values were also stratified in 3 diagnostic categories: osteoporotic, osteopenic, or healthy.The degree of correlation between DXA and REMS BMD values was quantified by calculating Pearson’s correlation coefficient (r). The diagnostic concordance between REMS and DXA was assessed by Cohen’s K considering the 3 diagnostic categories. REMS´s sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for discriminating patients with and without osteoporosis were also calculated using DXA outcomes as reference. The same statistics were calculated accepting a 0.3 T-score tolerance on T-score values of borderline cases [1].Results:Overall, 4282 patients were enrolled and, after the quality check, 3501 couples of scans were included in the analyses. Of these patients, 122 (3.5%) were underweight, 1964 (56.1%) were normal weight, and 1415 (40.4%) were overweight. The results of the diagnostic performance in patients after BMI stratification are reported in Table 1.Conclusion:We observed an excellent correlation between REMS-based diagnosis with respect to the osteoporosis diagnosis performed by DXA in patients from each BMI category. These results indicate that lumbar spine REMS analysis is a suitable and accurate diagnostic tool for patients with different BMI.

Optimal Skeletal Muscle Mass Index Cut-Off Values for Presarcopenia Evaluated by Computed Tomography against Dual-Energy X-ray Absorptiometry in Patients with Chronic Liver Disease.

Although dual-energy X-ray absorptiometry (DXA) and body impedance analysis are commonly used to measure skeletal muscle mass (SMM), a computed tomography (CT) scan is preferred in clinical practice. We aimed to propose the cut-off values of skeletal muscle mass index (SMI) calculated using CT scans, using DXA as the reference method. We retrospectively assessed 589 patients with chronic liver disease. The SMI was assessed using appendicular SMM by DXA and total muscle area at the level of the third lumbar vertebra (L3) calculated by CT. The cut-off value was determined with reference to the Asian Working Group for Sarcopenia criteria. DXA identified 251 (42.6%) patients as having presarcopenia. In men, the cut-off value of SMI for presarcopenia was determined to be 45.471 cm2/m2, with an area under the curve (AUC) of 0.863 (95% confidence interval (CI): 0.823 to 0.903), and in women, this value was determined to be 35.170 cm2/m2, with an AUC of 0.846 (95% CI: 0.800 to 0.892). Cohen’s kappa coefficient was 0.575 (95% CI: 0.485–0.665) in men and 0.539 (95% CI: 0.438–0.639) in women.

Usefulness of new technologies based on dual-energy x-ray absorptiometry in patients with growth hormone deficiency or acromegaly

Usefulness of new technologies based on dual-energy x-ray absorptiometry in patients with growth hormone deficiency or acromegaly

Hounsfield units value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases.

To compare the performance of using Hounsfield units (HU) value derived from computed tomography and T-score of dual-energy X-ray absorptiometry (DXA) to predict pedicle screw loosening. We reviewed 253 patients aged ≥ 50years undergoing pedicle screw fixation for lumbar degenerative diseases (LDD). The evaluation of screw loosening: radiolucent zones of ≥ 1mm thick in X-ray. The criterion for osteoporosis: the lowest T-score ≤ - 2.5. The average HU value of L1-L4 was used to represent lumbar bone mineral density (BMD). The area under receiver operating characteristics curve (AUC) was used to evaluate the performance of predicting screw loosening. One patient underwent reoperation for screw loosening at 9months follow-up. At 12months follow-up, the loosening rate was 30.6% (77/252) in the remaining 252 patients. Osteoporotic patients had higher loosening rate than non-osteoporotic patients (39.3% vs. 25.8%, P = 0.026). The T-score showed no significant difference between loosening group and non-loosening group (- 2.1 ± 1.5 vs. - 1.7 ± 1.6, P = 0.074), and so is the lowest lumbar BMD of DXA (0.83 ± 0.16g/cm2 vs. 0.88 ± 0.19g/cm2, P = 0.054). The HU value was lower in the loosening group (106.8 ± 34.4 vs. 129.8 ± 45.7, P < 0.001). The HU value (OR, 0.980; 95%CI 0.968-0.993; P = 0.002) was the independent influencing factor of screw loosening. The AUC of predicting screw loosening was 0.666 (P < 0.001) for HU value and 0.574 (P = 0.062) for T-score. HU value is a better predictor of pedicle screw loosening than T-score of DXA in patients aged ≥ 50years with LDD. We should not only focus on the DXA measurements when making surgical plans concerning lumbar fixation. These slides can be retrieved under Electronic Supplementary Material.

Patients with end-stage kidney disease have markedly abnormal cortical hip parameters by dual-energy X-ray absorptiometry.

Patients with end-stage kidney disease (ESKD) have higher fracture rates and post-fracture mortality than the general population, but bone mineral density by dual-energy X-ray absorptiometry (DXA) is less predictive of fracture in this patient group. Bone biopsy and high-resolution imaging indicate that cortical thickness (CT) is reduced and cortical porosity is increased in ESKD. The aim of this study was to assess cortical parameters using DXA in patients with ESKD. It was hypothesized that these parameters would show deterioration and be associated with fracture. Using advanced hip analysis, normal age-related ranges were determined from 752 female and 861 male femur scans and were compared with scans of 226 patients with ESKD at the time of transplantation. Compared with controls, female patients had lower mean±SD CT (mms) at the femoral neck (FN) (2.59 ± 1.42 versus 5.23 ± 1.85), calcar (3.46 ± 1.07 versus 5.09 ± 1.30) and shaft (4.42 ± 1.21 versus 7.44 ± 2.07; P < 0.001 for each), and buckling ratios were higher (8.21 ± 4.6 versus 3.63 ± 1.42; P < 0.001), indicating greater FN instability. All findings were similar for men. Prevalent fracture was documented in 28.8% of patients; 12.4% vertebral only, 8.4% non-vertebral only and 8% vertebral plus non-vertebral. In adjusted models, each 1 SD reduction in FN CT and increase in the buckling ratio was associated with a respective 1.73 (1.22-2.46)- and 1.82 (1.49-2.86)-fold increase in the risk of prevalent vertebral fracture. In patients with ESKD, DXA-derived cortical parameters are markedly abnormal compared with age- and sex-matched controls. These parameters should be assessed for incident fracture prediction and targeting treatment.

SC172 - Preliminary result of a pilot phase IV study to evaluate variations in bone mineral density and lean and fat body mass, measured by dual-energy X-ray absorptiometry in patients with prostate cancer without bone metastases treated with degarelix

SC172 - Preliminary result of a pilot phase IV study to evaluate variations in bone mineral density and lean and fat body mass, measured by dual-energy X-ray absorptiometry in patients with prostate cancer without bone metastases treated with degarelix

Is the trabecular bone score useful for assessing bone quality in patients with axial spondyloarthritis and syndesmophytes?

Introduction and objectivesSyndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyze the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. Material and methodsFrom January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. ResultsThe study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7±10.27 years and 44.36±11.85 years, respectively (p<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345±0.14 and 1.41±0.11, respectively (p<.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. ConclusionTrabecular bone scores do not appear to be masked by the presence of syndesmophytes.

¿Es útil la puntuación de hueso trabecular en la valoración de la calidad ósea en pacientes con espondiloartritis axial y sindesmofitos?

Introduction and objectivesSyndesmophytes appear to falsely raise lumbar bone mineral density values, thereby hindering the diagnosis of osteoporosis by dual-energy X-ray absorptiometry in patients with axial spondyloarthritis. The objective of the study was therefore to analyse the influence of syndesmophytes at the lumbar level on trabecular bone scores and lumbar and femoral neck bone mineral density values and to assess the clinical and analytical factors associated with trabecular bone scores in axial spondyloarthritis. Material and methodsFrom January 2017 to June 2018, a cross-sectional study consecutively included patients with axial spondyloarthritis according to Assessment in Ankylosing Spondylitis criteria. We assessed the trabecular bone scores and bone mineral density values and recorded clinical, demographic, disease-related and laboratory variables. ResultsThe study included 82 patients with axial spondyloarthritis (38 with syndesmophytes and 44 without syndesmophytes). The mean age of the patients with and without syndesmophytes was 55.7±10.27years and 44.36±11.85years, respectively (P<.001). The mean trabecular bone score for the patients with and without syndesmophytes was 1.345±0.14 and 1.41±0.11, respectively (p < 0.05). There was an association between higher body mass index, erythrocyte sedimentation rate, disease duration and the number of levels affected by syndesmophytes and a greater risk of fracture as measured by the trabecular bone score. ConclusionTrabecular bone scores do not appear to be masked by the presence of syndesmophytes.

Comparison of laboratory and imaging methods associated with bone metabolism in patients with or without renal failure under the age of 45 years with elevated parathyroid hormone levels

Objectives: Although bone biopsy is considered the gold standard for the definitive diagnosis of renal osteodystrophy; it is not suitable for routine clinical practice due to its invasive nature. The present study was aimed to evaluate and compare the bone mineral status using dual energy X-ray absorptiometry of patients with or without chronic kidney disease in young population with elevated parathyroid hormone levels. Methods: This was a single center, cross-sectional, retrospective study conducted in patients younger than 45 years of age. The study was performed in the outpatient clinic of a university hospital. Patients with elevated parathyroid hormone levels were included. Results: Among them, 29 had renal insufficiency, 158 had normal renal function. Measured bone mineral density with dual energy X-ray absorptiometry and laboratory values were collected from patient files. The primary end point was to assess the efficiacy of dual energy X-ray absorptiometry in patients with or without renal failure. Except Z score at Ward’s triangle, all of the T and Z scores at lomber, femur neck, trochanteric, and intertrochanteric areas were found significantly lower in patients with chronic kidney disease compared to those without (p &amp;lt; 0.001). Conclusion: Dual energy X-ray absorptiometry seemed to be a reliable method for detection of osteoporosis in premenopausal female and male patients younger than 45 years of age with or without renal failure with elevated parathyroid hormone levels.

Risk of fracture and low bone mineral density in adults with inflammatory bowel diseases. A systematic literature review with meta-analysis

Inflammatory bowel diseases (IBDs) are associated with a decreased bone mineral density, but the impact on fractures is unknown. In our study, global risk of fracture is increased for patients with IBDs versus controls. This result will help to determine the appropriate assessment with early screening and management of osteoporosis. Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD) and ulcerative colitis (UC), are associated with a decreased bone mineral density (BMD). However, the impact on fracture risk is unknown and data are contradictory across studies. In this systematic review and meta-analysis, we aimed to assess the risk of fracture and presence of low BMD in patients with IBDs compared to healthy controls. A systematic search of literature was conducted of MEDLINE, EMBASE, the Cochrane library and abstracts from appropriate scientific congresses. Studies were selected if they compared the incidence of fractures and/or BMD measurement by dual-energy X-ray absorptiometry in patients with IBDs and healthy sex- and age-matched controls. Data were extracted by two independent investigators. Meta-analysis was performed with the inverse variance approach to estimate pooled odds ratios (ORs) and risk ratios (RRs) with their 95% confidence intervals (CIs). Twenty-four studies met the inclusion criteria. On the basis of nine studies, global risk of fracture was increased for patients with IBDs versus controls (RR = 1.38, 95% CI 1.11-1.73; p = 0.005). Fracture risk with IBDs was significantly increased for vertebral fractures (OR = 2.26, 95% CI 1.04-4.90; p < 0.001), but not for any other site. The analysis of 16 studies evaluating BMD showed a significant decrease in mean BMD and Z-scores for IBD patients versus controls at all sites. In our meta-analysis, patients with IBDs have an increased risk of fractures, especially in the spine, and significant decreased BMD at all sites, which suggests the need for identifying high-risk individuals among this population.

Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population

BackgroundThe risk of osteoporosis in patients with psoriatic arthritis (PsA) still remains unclear. The aim of this study was to investigate bone mineral density (BMD) at the hip and lumbar...

Utility of radius bone densitometry for the treatment of osteoporosis with once-weekly teriparatide therapy

ObjectivesAs clinics that treat patients with osteoporosis do not usually have central dual-energy X-ray absorptiometry (DXA), bone density is often measured with radial DXA. However, no long-term evidence exists for radius bone density outcomes following treatment with once-weekly teriparatide in actual medical treatment. MethodsWe evaluated changes in bone density at 6-, 12-, and 18-month intervals using radial DXA in patients treated with once-weekly teriparatide for more than 6 months. ResultsA significant increase in bone mineral density (BMD) was observed at the 1/3 and 1/10 radius sites 12 months after the initiation of once-weekly teriparatide. We also observed that the rate of change in BMD was greater at the distal 1/10 radius than at the 1/3 radius. ConclusionsConsidering these points, the effect of once-weekly teriparatide therapy can be observed at the radius. In clinics that do not have central DXA, but instead have radial DXA, these findings can help to evaluate the effect of once-weekly teriparatide treatment on osteoporosis.

Vertebral fractures assessed with dual-energy X-ray absorptiometry in patients with Addison's disease on glucocorticoid and mineralocorticoid replacement therapy.

to assess bone damage and metabolic abnormalities in patients with Addison's disease given replacement doses of glucocorticoids and mineralocorticoids. A total of 87 patients and 81 age-matched and sex-matched healthy controls were studied. The following parameters were measured: urinary cortisol, serum calcium, phosphorus, creatinine, 24-h urinary calcium excretion, bone alkaline phosphatase, parathyroid hormone, serum CrossLaps, 25 hydroxyvitamin D, and 1,25 dihydroxyvitamin D. Clear vertebral images were obtained with dual-energy X-ray absorptiometry in 61 Addison's disease patients and 47 controls and assessed using Genant's classification. Nineteen Addison's disease patients (31.1%) had at least one morphometric vertebral fracture, as opposed to six controls (12.8%, odds ratio 3.09, 95% confidence interval 1.12-8.52). There were no significant differences in bone mineral density parameters at any site between patients and controls. In Addison's disease patients, there was a positive correlation between urinary cortisol and urinary calcium excretion. Patients with fractures had a longer history of disease than those without fractures. Patients taking fludrocortisone had a higher bone mineral density than untreated patients at all sites except the lumbar spine. Addison's disease patients have more fragile bones irrespective of any decrease in bone mineral density. Supra-physiological doses of glucocorticoids and longer-standing disease (with a consequently higher glucocorticoid intake) might be the main causes behind patients' increased bone fragility. Associated mineralocorticoid treatment seems to have a protective effect on bone mineral density.

Comparison of Body Mass Index and the Index of Adiposity in Patients with Juvenile Systemic Lupus Erythematosus

Objective: Compare the ability of body adiposity index (BAI), body mass index (BMI) and abdominal and hip circumferences to estimate body fat composition using the percentage of body fat measured by dual energy X-ray absorptiometry (DXA) as gold standard in patients with Juvenile Systemic Lupus Erythematosus (jSLE). Methods: Sixty four patients with jSLE and 64 controls matched for sex and age were included. Anthropometric data, BMI and BAI were obtained for all subjects. Clinical and laboratory data of patients with jSLE, including disease activity index, cumulative damage, and current and cumulative dose of corticosteroids were assessed from medical records. Fat mass, lean mass and fat percentage were obtained by DXA in patients with jSLE. Results: There were increased abdominal-hip circumferences ratios in patients with jSLE when compared to controls (p !0.001). There was no difference in the classification of obesity by BMI and BAI in patients with jSLE and controls. Using DXA as gold standard method, it was observed that all indirect measures of body fat correlated with total fat mass. In total body analysis there was correlation between lean mass and damage index (r 5 -0395, p 5 0.019); fat percentage and activity of disease calculated over time (r 5 0.402, p 5 0.008) and with duration of disease (r 5 -0370, P 5 0.012). In trunk composition analysis, there was correlation between lean mass and damage index (r5 -0.319, p5 0.042); fat percentage and calculated disease activity calculated over time (r 5 0.402, p 5 0.005), and also with the duration of disease (r 5 -0.408, p 5 0.005). Conclusion: Indirect estimations of body fat and clinical parameters correlated moderately with total body fat assessed by DXA. This study shows that there is no need to replace the BMI by BAI in the evaluation of body fat in jSLE. Considering the importance of obesity in cardiovascular disease genesis, it is recommended to use both anthropometric indexes and DXA in order to improve the prognosis of patients with jSLE.