Linking bone and brain: Dysregulated bone metabolism exacerbates cognitive impairment in bipolar disorder.

Influence of body size on the accuracy of lumbar bone mineral density by dual-energy CT: A phantom study.

Diagnostic criteria for sarcopenia in patients undergoing vertebroplasty and kyphoplasty: a systematic review.

Early and Long-Term Changes in Adjacent Vertebral Body Bone Mineral Density Determined by DEXA After Posterolateral Fusion with Transpedicular Screw Fixation in Elderly Patients: A Retrospective Study.

Improving bone mineral density assessment in total shoulder arthroplasty: assessment of phantom-calibrated Hounsfield units in the glenoid and proximal humerus.

The effects of anti-Parkinsonian medications on bone mineral density: A systematic review.

Creatine supplementation modifies fat deposition in arm and leg tissues in individuals with Down syndrome.

Bone resorption around cementless short humeral stems is increasingly recognized after shoulder arthroplasty, but quantitative longitudinal data are lacking. We measured bone mineral density (BMD) around the humeral component after anatomical total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (RSA) using dual-energy X-ray absorptiometry (DEXA) and evaluated the time-course changes over two postoperative years. Additionally, we investigated the association between osteoporosis and clinical outcomes. The subjects were patients who underwent aTSA or RSA, and for whom DEXA evaluation was available at three weeks, six months, one year, and two years postoperatively. The area around the humeral component was divided into five zones, and the BMD of each zone was measured. To evaluate clinical outcomes, we investigated their association with osteoporosis and measured the postoperative American Shoulder and Elbow Surgeons (ASES) score using the minimal clinically important difference (MCID) as the reference. Overall, 94 RSAs and 43 aTSAs were observed. In RSA, BMD decreased significantly over time in zones 3 and 5 (both p < 0.05). In aTSA, BMD decreased in zones 2, 3, and 4 from three weeks to six months, with little sustained decrease thereafter. Additionally, in RSA, a decrease in zone 3 BMD was significantly associated with osteoporosis (both p < 0.05). Failure to achieve the MCID for the ASES score was also significantly associated with both zone 3 BMD loss and osteoporosis (both p < 0.05). Time-course changes in BMD around cementless short humeral components differed between aTSA and RSA. In RSA, BMD decreased over time in zones 3 and 5. Zone 3 BMD loss was significantly associated with osteoporosis, and both zone 3 BMD loss and osteoporosis were linked to failure to achieve the MCID for the ASES score. These findings suggest that patients undergoing RSA with osteoporosis may benefit from careful postoperative follow-up, including monitoring of periprosthetic bone loss and optimization of osteoporosis management.

Sagittal abdominal diameter (SAD), a measure of visceral adiposity, has been linked to major adverse cardiovascular events (MACE). However, the relationship between SAD and abdominal aortic calcification (AAC), a marker of subclinical vascular disease, and whether they independently and jointly predict MACE remains unclear. To investigate whether weight-normalized SAD and AAC scored using a validated machine learning algorithm (ML-AAC24) are independently and jointly associated with incident MACE. SAD and ML-AAC24 were measured from dual-energy X-ray absorptiometry (DXA) posteroanterior and lateral spine images, respectively, from the Manitoba Bone Density registry. Among 8806 individuals (mean age 75.1±6.6years, 93.9% women), 11.3% experienced MACE during a mean follow-up of 3.8years. SAD/weight and ML-AAC24 were positively correlated (Spearman r=0.11, P<0.001). Individuals with moderate and high ML-AAC24 had 1.1% and 3.0% higher mean SAD/weight, respectively, than those with low ML-AAC24. Both ML-AAC24 and SAD/weight were independently associated with higher risk of MACE. Adjusted hazard ratios [HRs] for MACE were 1.45, 95%CI 1.24-1.71 and 1.99, 95%CI 1.67-2.35 for moderate and high ML-AAC24, respectively, vs. low. The HR for the highest vs. lowest tertile of SAD/weight was 1.37, 95%CI 1.16-1.61. Individuals who had both high ML-AAC24 and were in the highest SAD/weight tertile had the highest MACE risk (HR 2.63, 95% CI 2.02-3.44). Higher baseline SAD/weight was associated with higher ML-AAC24 scores. Both measures independently and jointly associated with MACE. Their combined use may potentially help identify individuals at high risk for cardiovascular disease during routine bone density testing.

Sarcopenia is a muscle disease characterized by the progressive loss of muscle mass, strength, and function. Despite evolving definitions, validated diagnostic tools for younger individuals, especially those with cancer or chronic diseases, remain lacking. Oncological treatments can lead to severe muscle deconditioning. Many patients face limited follow-up and remain physically diminished in post-cancer period. We aimed to determine the prevalence of sarcopenia in post-cancer patients and to highlight its occurrence even in younger individuals and long after completion of oncological treatments. We performed prospective and standardized muscle assessment through: physical activity questionnaires (International Physical Activity Questionnaire [IPAQ] and Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls [SARC-F]); functional tests (grip strength, 6-minute walk, and 30-second chair stand tests); and appendicular lean mass (ALM) index measurement by dual-energy X-ray absorptiometry (DXA; ALM/height² in kg/m²). Ninety-eight patients (68 females) were included (age (mean±SD) 53.8±11.0 years and body mass index (BMI) 27.8±6.4 kg/m²). Fifty-five had solid tumors (41 metastatic) with a post-treatment duration of 20.3±21.75 months. SARC-F score was 1.5±1.6. Grip strength and ALM index were 27.3±11.7 kg and 6.4±1.4 kg/m² respectively. Considering cancer as a sarcopenia at risk status, we used European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and identified 27 (27.6%) patients with sarcopenia. Patients with sarcopenia were younger (50.2±11.6 vs 55.2±12.0 years; p=0.07), more frequently in remission and long after treatment, and had lower BMI (23.3±3.2 vs 29.5±6.5 kg/m²; p<0.0001) compared to patients without sarcopenia. When using SARC-F for screening, only 5 patients were detected, underlining its poor sensitivity in this setting. Sarcopenia is highly prevalent in post-cancer patients including younger individuals and those in long-term remission. The 2019 EWGSOP2 criteria, combining ALM and functional tests, effectively identified sarcopenia but screening with SARC-F may not be suitable in the post-cancer population.

This work examines potential links between lean tissue composition and prior occurrences of gestational diabetes mellitus (GDM) within a nationally representative cohort. This cross-sectional study included 1807 participants from the National Health and Nutrition Examination Survey (NHANES) (2011-2018). GDM history was self-reported. Body composition was assessed using dual-energy X-ray absorptiometry (DXA). Weighted multivariable logistic regression, adjusted for covariates, was used to assess the relationships between body composition distribution and GDM history. Nonlinear associations were evaluated using cubic spline functions, with subgroup and sensitivity analyses to assess robustness. The adjusted model revealed that a history of GDM was associated with higher android-to-gynoid lean mass ratio (AGLR), android lean mass index (ALMI), and android-to-gynoid fat ratio (AGFR). Multivariable restricted cubic spline (RCS) analysis showed a significant linear association between AGLR, AGFR, and GDM history (nonlinearity p > 0.05), while ALMI demonstrated a nonlinear relationship (nonlinearity p < 0.05). These associations were significantly influenced by economic status and blood pressure levels (p < 0.05). Sensitivity analysis excluding participants whose last live birth occurred > 10 years ago yielded results consistent with the primary analysis. Higher AGLR, ALMI, and AGFR are associated with increased odds of a history of GDM, with AGLR showing the strongest correlation. These findings underscore the importance of incorporating GDM history and regional lean mass distribution into risk assessment.

Survivors of childhood acute lymphoblastic leukemia (ALL) often exhibit early deficits in muscle and movement competence, which can compromise long-term health. Integrative neuromuscular training (INT), a multifaceted approach combining fundamental movement activities with strength exercises, may help address these deficits during critical developmental periods. Eight children treated for ALL (aged 6-12 years) completed a supervised INT intervention (2 sessions/week for 8 weeks). Primary outcomes were feasibility (recruitment, retention, adherence, compliance, and tolerance) and program acceptability. Secondary outcomes included muscle function (isometric midthigh pull [IMTP], countermovement jump, and handgrip strength), dual-energy x-ray absorptiometry (DXA)-derived body composition, peripheral quantitative computed tomography (pQCT)-derived muscle measures, and health-related quality of life assessed using the Pediatric Quality of Life Inventory (PedsQL). Pre- to post-intervention changes were evaluated using paired tests (paired t-tests or Wilcoxon signed-rank tests, depending on normality) and corresponding effect sizes (Cohen's d or rank-biserial correlation). Recruitment was 80%, retention was 100%, and adherence was 100%, although the intervention extended beyond 8 weeks. The program was well-tolerated and demonstrated high acceptability, with no adverse events reported. Exploratory analyses suggested improvements in muscle strength (IMTP and countermovement jump peak force, and left handgrip strength), modest increases in whole-body lean mass, and specific PedsQL domains (school functioning, general fatigue, cognitive fatigue), with limited changes in muscle power and pQCT-derived muscle measures. INT is feasible and acceptable for survivors of childhood ALL, though maintaining twice-weekly attendance was challenging. Preliminary results indicate potential benefits for muscle strength, mass, and specific quality-of-life domains, underscoring the need for strategies to support consistent participation in this population.

Beyond the lungs: The role of extrapulmonary manifestations in the quality of life of Indians with chronic airway diseases.

Down syndrome (DS) is the most common chromosomal abnormality associated with intellectual disabilities. Many metabolic issues begin in childhood, and children without DS are reported to have a high prevalence of metabolic syndrome (MS) according to various studies. However, our understanding of the risk of MS in children with DS is limited. A cross-sectional study assessed the prevalence of MS in DS children aged 10-18 during 2022-2024. Demographic details and anthropometric measurements were recorded for all participants. Fasting blood samples were collected for blood glucose, insulin, and lipid profile analysis. The modified NCEP-ATP III criteria were used to classify the MS. We also evaluated insulin resistance (IR) using HOMA-IR and body adiposity patterns with a DEXA scan in DS children aged 6-18. Seventy-six children aged 10-18 and 38 aged 6-9 were enrolled. The prevalence of MS was 18% in our cohort. Dyslipidemia (high triglycerides and low HDL) was observed in 21% and 15.8% of children aged 6-9 and 10-18, respectively. IR was observed in 27.6% and 7.8% of children aged 10-18 and 6-9, respectively. IR was positively correlated with BMI, whereas no correlation was observed with MS or dyslipidemia. Total body fat mass was positively correlated with MS. Our study observed a higher prevalence (18.0%) of MS than age-matched general population studies (pooled prevalence: 5.0%). Additionally, we observed a high prevalence of dyslipidemia and IR from 6 years of age. The results indicate the need to review the management guidelines and consider incorporating metabolic workups.

The use of a standard body mass index (BMI) cut-point (e.g., BMI ≥30 kg/m 2 ) to define obesity across the lifespan does not reflect our current understanding of changes in adiposity that occur throughout the aging process. The objective of the present study was to examine the validity of BMI-for-age percentiles as a measure of obesity in older adults, compared with an objective gold-standard measure of obesity status, total body fat percent (BF%) measured by dual energy X-ray absorptiometry scan. Using data from the Canadian Longitudinal Study on Aging (n = 28,764), sensitivity, specificity, positive predictive value, and negative predictive value were calculated for BMI ≥85th percentile and other thresholds against BF% ≥35%, 38%, and 40%, respectively. When comparing obesity defined by BMI percentile values (≥85th percentile) to BF% (≥40% BF) as a measure of true obesity status, sensitivity, specificity, positive predictive value, and negative predictive value values were 0.32 (0.31, 0.33), 0.98 (0.98, 0.98), 0.94 (0.93, 0.95), and 0.61 (0.60, 0.62) in women and 0.85 (0.81, 0.89), 0.86 (0.85, 0.86), 0.14 (0.13, 0.16), and 1.00 (0.99, 1.00) in men, respectively. Incorporating age and sex information, BMI-for-age percentile is a highly specific and moderately sensitive measure of obesity in older adults, with potential as a valuable screening tool. Further research on BMI-for-age percentiles could help develop more accurate obesity screening tools than the current standard BMI cut-points.

Elite male football players have high peak fat oxidation (PFO), and recently PFO was reported to increase following preseason (PS) training in semi-professional male players. Whether PFO increases from PS to competitive season (CS) in elite male football players remains unknown. This study investigated if PFO increases from PS to CS in elite male football players, and secondarily, it explored the interplay between PFO and running performance. Twenty-two elite male outfield football players reported to the laboratory during PS and CS. Testing included a resting blood sample, a dual-energy X-ray absorptiometry scan, and a graded treadmill running test. The players' load during training and matches was monitored between the test days. PFO, the intensity eliciting PFO (Fatmax) and peak oxygen consumption (V̇O2peak) did not change from PS to CS (mean difference with 95% confidence intervals: -1.0 mg·kg FFM-1·min-1 (95% CI: -2.4 to 0.3 mg·kg FFM-1·min-1), 1% V̇O2peak (95% CI: -4% to 6% V̇O2peak) and 0.2 mL·kg-1·min-1 (95% CI: -1.0 to 1.4 mL·kg-1·min-1), respectively). Intra-individual changes in PFO, Fatmax and V̇O2peak from PS to CS were not positively correlated with weekly distance covered during football training, or with changes in distance covered during matches, neither in total nor within intensity domains. Whole body fat-free mass increased by 1.2 kg (95% CI: 0.4 to 1.9 kg) and fat percentage decreased by 0.4% points (95% CI: 0.1% to 0.8% points) from PS to CS. In conclusion, PFO, Fatmax and V̇O2peak did not change from PS to CS, and PFO was not associated with training or match running performance of elite male football players.

Body composition phenotypes, and specific adiposity and lean mass indicators, and their lifestyle determinants among adult childhood cancer survivors - The iBoneFIT adult study.

To examine whether the combined assessment of low handgrip strength (HGS) and low adductor pollicis muscle thickness (APMT) represents a simple and integrated risk stratification approach for identifying adult women at increased likelihood of low muscle mass and low bone mass. In this cross-sectional study, 296 adult women aged 24-59 years were evaluated. HGS and APMT were measured using a manual dynamometer and anthropometric calipers, respectively. Muscle mass, bone mineral density, and femoral geometry were assessed through dual-energy x-ray absorptiometry. Low muscle mass and low bone mass were defined using established criteria. Low HGS and low APMT were categorized using data-derived cutoffs obtained through receiver operating characteristic curve analysis. Associations were examined using adjusted linear and logistic regression models. Both HGS and APMT were independently associated with muscle mass (P < 0.001) and femoral bone outcomes (P = 0.001 and P = 0.005, respectively). When categorized, the combination of low HGS and low APMT showed stronger associations with reduced muscle mass and low bone mass (OR: 7.52, 95% CI: 2.88-19.63; P < 0.001), including the femoral neck (OR: 7.20, 95% CI: 2.34-22.16; P < 0.001), lumbar spine (OR: 3.28, 95% CI: 1.02-10.56; P = 0.047), and at least one site (OR: 4.47, 95% CI: 1.62-12.36; P = 0.004). The combined assessment of HGS and APMT captures complementary dimensions of musculoskeletal health and may serve as a practical approach for preliminary risk stratification, particularly in resource-limited settings where access to standard diagnostic methods, such as dual-energy x-ray absorptiometry, remains limited.

Denosumab is increasingly used to treat osteoporosis in patients with advanced kidney disease, but clinically significant disturbances in calcium homeostasis remain a major concern. We report a peritoneal dialysis (PD) case in which denosumab administration was followed by pronounced calcium fluctuations requiring medication management. A 56-year-old woman with end-stage kidney disease due to lupus nephritis, receiving prednisolone (5mg/day), had been on continuous ambulatory PD (1.5-L exchanges three times daily) for 5years. Baseline intact parathyroid hormone was 176pg/mL. Osteoporosis was confirmed by dual-energy X-ray absorptiometry (lumbar spine 68% and femoral neck 58% of the young adult mean [YAM]). Denosumab 60mg was administered, and BMD increased within 10months to 78% YAM at the lumbar spine and 77% YAM at the femoral neck (same facility, identical DXA equipment). To mitigate hypocalcemia, dialysate calcium was pre-emptively increased to two 3.5-mEq/L and one 2.5-mEq/L bags per day (albumin-corrected calcium 9.5mg/dL at dosing). Nonetheless, symptomatic hypocalcemia developed (nadir 7.8mg/dL on day 7), prompting escalation to three 3.5-mEq/L bags with intensified vitamin D therapy and calcium supplementation. Serum calcium then overshot, peaking at 13.8mg/dL on day 29; therapy was de-escalated and calcium stabilized. This case highlights that while daily dialysate calcium exposure in PD may buffer early hypocalcemia, concurrent escalation of dialysate calcium, vitamin D therapy, and calcium supplementation can precipitate overshoot hypercalcemia. Frequent monitoring and staged, stepwise prescription changes during the first month after denosumab are essential. Standardized PD-specific post-denosumab calcium management protocols are urgently needed.

Bone fragility is a major cause of morbidity and reduced quality of life among adult solid organ transplant (SOT) recipients. Despite guideline recommendations, bone health screening and posttransplant treatment remain inconsistent, and optimal therapeutic strategies are not well standardized. We reviewed the relevant literature, along with professional society guidance, and integrated institutional clinical experience to develop a streamlined multidisciplinary care pathway and define key performance indicators for transplant and bone health specialist teams. All non-kidney SOT candidates should undergo spine and hip dual-energy X-ray absorptiometry (DXA) with vertebral fracture assessment at listing, whereas kidney transplant candidates should undergo DXA only when the results are expected to influence management. High-risk patients, defined by a fragility fracture or a T-score ≤-2.5, should be referred for specialist care. After transplantation, non-kidney SOT recipients should receive osteoporosis therapy within 2 to 4 months if they have not been treated in the prior year, with treatment guided by renal function and bone turnover status. Kidney transplant recipients should undergo DXA, with referral and treatment tailored to fracture risk, bone turnover, and renal function. Bone biopsy should be considered when the underlying bone disease is unclear. Early risk stratification, standardized assessment, and coordinated multidisciplinary management are essential for fracture prevention and improved outcomes in SOT recipients.