Dual X-ray Absorptiometry Scans Research Articles

Association of Neck Circumference with Anthropometric Indicators and Body Composition Measured by DXA in Young Spanish Adults

Background: Due to a clinical and public health interest of neck circumference (NC), a better understanding of this simple anthropometric measurement, as a valid marker of body composition is necessary. Methods: A total of 119 young healthy adults participated in this study. NC was measured over the thyroid cartilage and perpendicular to the longitudinal axis of the neck. Body weight, height, waist circumference (WC), and hip circumference were measured. A Dual X-ray absorptiometry (DXA) scan was used to determine fat mass, lean mass, and visceral adipose tissue (VAT). Additionally, body mass index (BMI) and triponderal mass index (TMI), the waist to hip and waist to height ratios, and the fat mass and lean mass indexes (FMI and LMI, respectively) were calculated. Results: NC was positively associated in women (W) and men (M), with BMI (rW = 0.70 and rM = 0.84, respectively), TMI (rW = 0.63 and rM = 0.80, respectively), WC (rW = 0.75 and rM = 0.86, respectively), VAT (rW = 0.74 and rM = 0.82, respectively), Waist/hip (rW = 0.51 and rM = 0.67, respectively), Waist/height (rW = 0.68 and rM = 0.83, respectively) and FMI (rW = 0.61 and rM = 0.81, respectively). The association between NC and indicators of body composition was however weaker than that observed by BMI, TMI, WC and Waist/height in both women and men. It is of note that in women, NC was associated with FMI, VAT and LMI independently of BMI. In men, adding NC to anthropometric variables did not improve the prediction of body composition, while slight improvements were observed in women. Conclusions: Taken together, the present study provides no indication for NC as a useful proxy of body composition parameters in young adults, yet future studies should explore its usefulness as a measure to use in combination with BMI, especially in women.

Unpicking observational relationships between hip shape and osteoarthritis: hype or hope?

To review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application. Recent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation being identified, such as a wider femoral neck and larger lesser trochanter, in association with HOA. Furthermore, this method has formed the basis of genetic studies identifying novel genetic influences on hip shape, several of which are shared with known genetic risk factors for HOA. Shared genetic influences of hip shape and HOA raise the possibility that hip shape plays a casual role in the development of HOA, justifying preventive approaches aiming to combat these adverse consequences.

Pathophysiology of growth hormone secretion disorders and their impact on bone microstructure as measured by trabecular bone score.

This article is focused on endocrine-mediated osteoporosis caused by growth hormone (GH) disorders; adult GH deficiency and acromegaly. GH and insulin like growth factor-1 (IGF-1) stimulate linear bone growth through complex hormonal interactions and activates epiphyseal prechondrocytes. GH, via receptor activator of nuclear factor-kappaB (RANK), its ligand (RANK-L), and the osteoprotegerin system, stimulates production of osteoprotegerin and its accumulation in bone matrix. Malfunction of this mechanism, could lead to specific bone impairment. However, the primary problem of bone disease in GH secretion disorders is the primary prevention of osteoporotic fractures, so it is important to determine bone quality that better reflects the patient's actual predisposition to fracture. A method estimating bone quality from lumbar spine dual X-ray absorptiometry (DXA) scans is trabecular bone score (TBS). TBS in addition to bone mineral density (BMD) is a promising predictor of the osteoporotic fracture risk in women with postmenopausal osteopenia. In acromegaly TBS better defines risk of fracture because BMD is normal or even increased. TBS helps to monitor the effect of growth hormone therapy. Despite these findings, TBS should not be used alone, but a comprehensive consideration of all fracture risk factors, BMD and bone turnover markers is necessary.

The Effect of Bone Quality on Tibial Component Migration in Medial Cemented Unicompartmental Knee Arthroplasty. A Prospective Cohort Study Using Dual X-Ray Absorptiometry and Radiostereometric Analysis

BackgroundPeriprosthetic bone mineral density (BMD) may influence implant fixation and subsequent loosening. Unicompartmental knee arthroplasty (UKA) restores normal knee kinematics and load distribution to the surrounding bone. We studied the influence of systemic and periprosthetic BMD of the proximal tibia on migration of the tibial component of cemented medial UKA. MethodsThe cohort was dichotomized into a normal BMD group (T-score ≥ −1; n = 37) and a low BMD group (T-score < −1; n = 28) according to World Health Organization criteria. BMD of the proximal tibia and migration of the tibial component were measured with dual X-ray absorptiometry scans and stereoradiographs with 2-year follow-up. ResultsPatients with normal systemic BMD had an 11% to15% higher BMD in all regions of interest (ROIs) compared to patients with low systemic BMD throughout follow-up. Over time, a decrease in periprosthetic BMD in ROI 1-3 was seen for both groups. The operated knees and contralateral knees showed a similar reduction in BMD in all ROIs between preoperative and 24 months.Between 12 and 24 months, the normal BMD group migrated (maximal total point motion) 0.03 mm (95% confidence interval, −0.01, 0.08) and the low BMD group migrated 0.02 mm (95% confidence interval, −0.03, 0.07). Migration over time was not influenced by change in periprosthetic BMD. ConclusionMigration of cemented medial tibial UKA was low until 24 months and was neither affected by preoperative systemic BMD nor affected by postoperative change in periprosthetic BMD. This suggests good long-term fixation despite an index difference in proximal tibial BMD.

An Ultra-Short Femoral Neck-Preserving Hip Prosthesis: A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction.

Total hip arthroplasty (THA) with a diaphyseal stem may risk bone loss. In order to save proximal bone stock in young patients with a high activity level and a long life expectancy, the interest in short stems has evolved. The purpose of this prospective observational cohort study was to evaluate the fixation of, and bone remodeling around, the Primoris femoral neck-preserving hip implant. Fifty younger patients with end-stage osteoarthritis were managed with the Primoris hip implant. We evaluated bone mineral density (BMD) using dual x-ray absorptiometry (DXA) and implant migration using radiostereometric analysis (RSA). A region-of-interest (ROI) protocol for 4 ROIs was applied to assess BMD. The association between BMD and migration was evaluated to determine the fixation of the Primoris implant and bone remodeling in the proximal part of the femur. Follow-up evaluation was performed at regular intervals from day 1 (baseline) until 24 months after surgery. The major stem migrations were subsidence (Y axis; mean, 0.38 mm) at 6 weeks and varus tilt (rotation) (Z axis; mean, 0.93°) at 6 to 12 months. In ROI4 (the calcar area), a significant gain in bone was found with a mean difference of 4.1% (95% confidence interval [CI], 0.8% to 7.4%; p < 0.02) at 24 months postoperatively. Significant bone loss was found in ROI1 and ROI2, with a mean difference of -4.9% (95% CI, -7.4% to -2.4%; p = 0.0003) and -8.9% (95% CI, -11.5% to -6.2%; p = 0.0001), respectively. Linear regression and multivariate regression analysis showed a significant negative association between maximal total point motion and BMD (p = 0.02, R = 15%; and p < 0.05, R = 26%, respectively). The Primoris component showed satisfactory primary stability with promising results at the 24-month follow-up. DXA scans showed limited stress-shielding with the proximal loading pattern of the Primoris. Better bone quality was associated with less implant migration. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

SARCOPENIA IN OLDER ADULTS UNDERGOING CARDIAC SURGERY

Sarcopenia, defined as age-related loss of muscle mass and strength, is one of the biological hallmarks of frailty. In practice, muscle mass is typically measured using a dual x-ray absorptiometry (DXA) scan, while strength is measured using physical performance tests. However, DXA may be less accurate in acute cardiac patients due to the confounding effect of body edema, and strength alone may be a superior indicator of muscle quality in aging. A convenience sample of older adults referred for cardiac surgery were prospectively consented and enrolled at the Jewish General Hospital. After a structured questionnaire and physical performance battery, patients underwent a DXA scan (GE Lunar) to measure their appendicular muscle mass (AMM) – the sum of fat-free tissue in their arms and legs. Patients were categorized as sarcopenic based on the European Working Group guidelines if they had low AMM and low strength as measured by the timed chair rise test >15 seconds. Both non-indexed and height-squared-indexed cutoffs were explored for low AMM. A Cox proportional hazards model was used to test the association between sarcopenia (or its individual components) and all-cause mortality adjusting for age, sex, and cardiac surgery type. The cohort consisted of 134 patients with a mean age of 70.7 ± 10.2 years and 23% female. The cardiac surgery type was isolated coronary bypass in 58%, valve surgery in 30%, and decision not to proceed with surgery in 12%. The mean AMM was 24.2 ± 5.1 kg in men and 21.0 ± 5.2 kg in women. The prevalence of sarcopenia was 10% and 13% using non-indexed and indexed cutoffs, respectively, similar in men and women. In the multivariable model, sarcopenia was not associated with mortality (N=24) over 2 years of follow-up, and neither was AMM alone. Timed chair rise time alone was associated with mortality as a continuous variable and a dichotomous >15 second variable (HR 7.72, 95% CI 1.75 to 34.11). Lower-extremity muscle strength is more predictive than muscle mass or DXA-based sarcopenia in predicting survival after cardiac surgery.

Low rate of densitometric diagnosis and treatment in patients with severe osteoporosis in Colombia.

Osteoporosis is a systemic skeletal disease associated with an increased risk of fragility fractures and is a public health problem worldwide due to population aging. Early osteoporosis diagnosis and treatment is very important for reducing the incidence of fragility fractures and the resulting complications. Our study describes the clinical characteristics of patients with fragility fractures and their risk factors, evaluates the level of knowledge that patients have about osteoporosis, and follows-up on each case to establish if, after the fracture, a densitometric diagnosis was made and the patient received specific treatment in his outpatient follow-up through his health insurance plan. A descriptive cross-sectional study was carried out in a university hospital in Bogotá, Colombia. The data was collected by means of a questionnaire, administered to all patients admitted by the orthopedic emergency department with a diagnosis of fragility fracture. After discharge, a telephone follow-up was done every 3months for 1year, and patients were asked if they had already had the dual X-ray absorptiometry (DXA) scan and if they had begun osteoporosis treatment. A total of 111 patients with an average age of 74.4years (± 11.3years), of which 84 (75.6%) were women, all consulted for osteoporotic fracture at the orthopedic emergency department of the hospital. Hip fracture was the most frequent (51.4%), followed by vertebral (23.4%), wrist (22.5%), and humerus (4.5%) fracture. A total of 49.5% (n = 55) of the patients did not know what osteoporosis is; 58.6% (n = 65) did not know that fracture is the main complication of this disease, and 62.2% (n = 69) did not associate fractures with osteoporosis. All patients were educated about osteoporosis and the importance of diagnosing and treating it. Patients were given a medical order to have a DXA scan upon discharge; however, only 24.3% (n = 27) had the DXA scan in the first year of the fracture. A total of 33.3% (n = 37) received calcium plus vitamin D, and only 9.9% (n = 11) received osteoporosis treatment (7 bisphosphonate patients and 4 denosumab). No patient received osteoformative therapy. Our study shows that Colombian patients have little knowledge about osteoporosis and its relationship with fragility fractures. It also shows that densitometries are not done and, what is worse, patients with a diagnosis of fracture have limited access to treatment after discharge.

Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients

Pregnancy-associated osteoporosis (PAO) is a rare but painful disease. The current study aimed to investigate the demographic and clinical features, risk factors, treatment options, and outcomes of Turkish patients with PAO. In our retrospective, cross-sectional, and descriptive study the time to PAO diagnosis was 3.6 months. Pain and loss of height were detected in 78.6% and 28.6% of patients, respectively. As such, 60.6% of patients reported fractures at the thoracic area, 30.3% at the lumbar area, and 9.1% at the sacral area. While 14.3% of patients had optimal vitamin D status during pregnancy, 64.3% had vitamin D deficiency, and 21.4% had vitamin D insufficiency. Of the patients, 21.4% received anticoagulant therapy during their pregnancy. Dual X-ray absorptiometry scans revealed that osteoporosis was predominantly in the trabecular bone (L1–L4 Z-score –2.9, Femur Z score –2.19). Management options included supplements of calcium with vitamin D (93%), weaning the baby (79%), specific treatments for osteoporosis (64%), use of a supportive corset (50%), and exercise (21%), respectively. In addition, after delivery, 35.7% of patients were administered denosumab, 21.4% bisphosphonate, and 7.1% were given teriparatide. Data of the clinical features, treatments, and outcomes of PAO may contribute to early detection and management.

Nutritional Intake and Bone Health Among Adults With Probable Undiagnosed, Untreated Celiac Disease: What We Eat in America and NHANES 2009–2014

Objective: The aim was to evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic indices of these nutrients; and bone health among adults with and without probable, undiagnosed celiac disease (CD).Method: Cross-sectional data from What We Eat in America and the National Health and Nutrition Examination Survey 2009–2014 including self-reported dietary and supplement intake from one day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry scans were analyzed in adults with probable undiagnosed CD, who tested positive on the immunoglobulin A endomysial antibody assay (n = 48) and controls (n = 13,634). Statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio.Results: The prevalence of probable undiagnosed CD was 1 in 285. Probable CD status was associated with a 251.6 mg (95% confidence interval [CI], 72.3–432.9) higher daily total calcium intake. The total dietary and supplement intake of those with probable CD was significantly higher in calcium density (103.4 mg/1,000 kcal; 95% CI, 25.6–181.1) and phosphorus density (46.7 mg/1,000 kcal; 95% CI, 3.1–90.3). Probable CD status was associated with higher dairy consumption by 0.7 cups per day (95% CI, 0.2–1.2) and higher serum phosphorus concentrations (4.0 mg/dL vs 3.8 mg/dL, p = 0.011). No differences in serum calcium, vitamin D, or alkaline phosphatase levels were observed between groups. Probable CD status was also associated with a −0.1 g/cm2 (95% CI, −0.2 to −0.0) lower femur bone mineral density (BMD) and a −0.1 g/cm2 (95% CI, −0.1 to −0.0) lower femoral neck BMD. No differences in total spine BMD were observed.Conclusions: Adults with probable undiagnosed CD had lower bone density than adults without CD, despite also reporting higher total calcium intake and nutritional density of both calcium and phosphorus.

Diagnostic Value of Mid-Thigh and Mid-Calf Bone, Muscle, and Fat Mass in Osteosarcopenia: A Pilot Study.

Osteosarcopenia is defined as the concomitant occurrence of osteoporosis and sarcopenia. Current lack of consensus on sarcopenia definitions, combined with the low sensitivity andspecificity of screening methodologies, has resulted in varying prevalences of sarcopenia, and consequently osteosarcopenia diagnosis. Previous research indicates that mid-thigh is a potential surrogate region for the assessment of bone, muscle, and fat mass in a single,efficient and low-radiation dual x-ray absorptiometry (DXA) scan. We hypothesized that muscle and bone mass measurements in the mid-thigh region can be used to evaluate bone and muscle health and function. A retrospective study was conducted on community-dwelling older subjects (> 65 y.o., n = 260) who were at risk of falls and fractures. Mid-thigh and mid-calf bone, lean muscle, and fat masses, as well as their association with muscle function, falls, and fractures were compared against conventional measures (hip/spine bone, appendicular lean, and gynoid/android fat masses). Mid-thigh bone, lean, and fat masses showed strong correlation with conventional measures. Mid-thigh lean mass showed similar associations with grip strength, gait speed, and timed up and go (TUG) test as appendicular lean mass. Appendicular, mid-thigh and mid-calf lean masses corrected for body mass index (BMI) showed stronger associations than when corrected for height2. None of the indices were associated with fractures; but fat mass was invariably associated with falls. Those with falls and fractures history had lower bone and muscle mass at mid-thigh. Mid-thigh is a potential new surrogate to study bone, muscle, and fat mass in older people, with comparable ability in predicting muscle performance and falls.

Effects of an Acute Strength and Conditioning Training Session on Dual Energy X-ray Absorptiometry Results

In the use of dual x-ray absorptiometry (DXA) scans to obtain reliable measures of body composition, athletic staff must be aware of acute factors that may alter scan estimates, such as hydration status. PURPOSE: The purpose of this study was to determine if a strength and conditioning (S&C) training session, based upon what athletes regularly engage in, will alter body composition estimates (lean mass, fat mass, and bone mineral content) of a DXA scan. METHODS: The S&C session lasted ~ 90 minutes and consisted of upper and lower body resistance exercises and interval running. Twenty-two strength-trained subjects (15 men, 7 women, age 24 ± 2 yrs, height 174.2 ± 8.5 cm, weight 83.5 ± 15.0 kg) volunteered to participate in the study. Each subject completed two standard DXA scans on the same day, before and after the S&C session. Following the consumption of a free-living meal prior to the first scan, subjects avoided all food intake until completing the second scan. Throughout the S&C session, subjects were encouraged to drink water ad libitum. RESULTS: The results of this study were analyzed via correlated t-test (p < 0.05 considered significant) and significant values are listed in Table 1 below. CONCLUSION: The acute physiological effects of a S&C session alter body composition measures obtained by DXA scan. Thus, athletic staff should consider the timing of DXA scans in relation to S&C sessions.Table 1

Associations Of Sleep Metrics, Body Composition, And Cardiorespiratory Fitness In Older Women

Sleep duration and quality have been associated with obesity risk. Most previous studies used body mass index (BMI) as a proxy of obesity and subjectively evaluated sleep. Older adults often suffer from poor sleep quality, high body fat, and low cardiorespiratory fitness (CRF), especially women after menopause. PURPOSE: To investigate if sleep duration and quality are associated with BMI, body composition, and CRF in older women. METHODS: Older women (n= 115; age: 65.61±4.32) wore an actigraph monitor for 7 days to measure sleep metrics. Total sleep time and sleep quality, which included wake after sleep onset, activity counts during sleep, sleep onset latency, and number of awakenings, were determined using manufacturer provided software. BMI was calculated, and a dual x-ray absorptiometry scan was performed to assess body composition. A graded exercise test was used to measure CRF. Data was collected in two locations (n=89 and 26, respectively). Pearson product correlations were used to determine associations and study location was controlled for. RESULTS: Total sleep time negatively associated with lean mass and fat free mass (r= -0.28, p=0.012; r= -0.28, p=0.012), but positively associated with percent body fat (r=0.26, p=0.025). There were no associations between sleep metrics and CRF. CONCLUSIONS: Our data indicates longer total sleep time was associated with less lean mass but greater body fat in older women. This suggests in older women longer total sleep time may be linked with less physical function and worse health condition. Further examination of the association between sleep with physical function and biomarkers in this population is recommended.

VO2max and Dual Energy X-Ray Absorptiometry Results in NCAA Division I Tennis Players

PURPOSE: Describe VO2max and body compositions using dual x-ray absorptiometry (DXA) in NCAA Division I male tennis players. METHODS: Nine (9) male NCAA Division 1 tennis players (age 19.6 ± 1 yr, height 183.6 ± 5.9 cm, weight 75.6 ± 5.3 kg) who were in pre-season were tested as part of their athletic training program. Each subject underwent a DXA scan two weeks prior to their VO2max test. VO2max tests were conducted using the Bruce protocol (mL/kg/min). On the day of the test, athletes were instructed to consume their normal free-living breakfast and not engage in strenuous activity including team workouts prior to the test. Subjects ran to volitional exhaustion and peak exercise times and VO2max numbers were recorded. Blood pressures were monitored according to the ACSM guidelines before, during, and after the exercise. After the completion of the test, data were analyzed to determine VO2max, max heart rate (HR) which was recorded using a 12-lead ECG, and ventilatory threshold during exercise. RESULTS: Results shown in Table 1. CONCLUSION: With respect to published norms for men that are matched to age, the players’ measured VO2max average would be ranked in the 90th percentile and deemed excellent for VO2max based on the ACSM guidelines. The highest recorded VO2max from the study is ranked in the 95th percentile and deemed superior. Based off the ACSM guidelines, the average for the body fat percentage falls in the 55th percentile and is deemed fair. The leanest player of the group is in the 80th percentile and deemed excellent.

Assessing Agreement of Lateral Leg Muscle and Bone Composition Using Dual X-ray Absorptiometry

Background: Recently, a lateral-view dual X-ray absorptiometry (DXA) scanning method for measuring leg total, lean, and fat masses demonstrated accuracy vs the standard whole-body frontal DXA scanning view on the GE Lunar iDXA. The current study examined the lateral scanning method's agreement using a Hologic Horizon A DXA scanner. Methodology: Thirty healthy college-age participants (16 female; X̅age = 21.5 ± 1.7 yr) received 3 DXA scans (1 whole-body, 2 lateral leg scans) to quantify leg composition in the frontal and lateral plane. To mark regions of interest for postscan analysis, metallic markers were placed at 60% of the length above and below each leg's lateral epicondyle. Using lateral subject positioning, leg composition was measured with participants lying on their right and left sides. Paired t tests examined the lateral DXA scanning method's agreement when quantifying total, fat, and lean masses, bone mineral content, and bone mineral density compared to measurements of equal area in the whole-body frontal scanning view. Results: Comparisons of frontal and lateral view DXA scan measurements for right leg total mass (7.12 ± 0.91kg vs 6.39 ± 0.85kg), fat mass (1.70 ± 0.44kg vs 1.36 ± 0.33kg), lean mass (5.14 ± 1.05kg vs 4.77 ± 0.92kg), bone mineral content (0.28 ± 0.06kg vs 0.23 ± 0.05kg), and bone mineral density (1.39 ± 0.14g/cm2vs 1.36 ± 0.15g/cm2), respectively, were significantly different (p < 0.001–0.028). Similarly, comparisons of frontal and lateral left leg total mass (7.12 ± 0.97kg vs 6.38 ± 0.92kg), fat mass (1.70 ± 0.44kg vs 1.39 ± 0.36kg), lean mass (5.15 ± 1.12kg vs 4.76 ± 0.97kg), bone mineral content (0.28 ± 0.06kg vs 0.24 ± 0.06kg), and bone mineral density (1.39 ± 0.15g/cm2vs 1.36 ± 0.17g/cm2), respectively, were significantly different (p < 0.001–0.046). Conclusion: Unlike a previous study in which agreement of lateral vs frontal leg composition measurements of equal area was reported utilizing the GE Lunar iDXA, agreement was not observed using the Hologic Horizon A DXA scanner. Therefore, lateral view assessment may not be reliably performed on DXA scanner models produced by different manufacturers.

Dolutegravir plus rilpivirine as dual regimen in virologically suppressed HIV-1 infected patients in a clinical setting

Objectives: There are scarce data on the combination of dolutegravir (DTG) plus rilpivirine (RPV) in the real world, including patients with hepatitis C virus (HCV) coinfection, toxicity or previous failure, or at risk for severe drug–drug interactions (DDIs).Methods: Prospective cohort study of virologically suppressed HIV-1 infected patients, without resistance to DTG or RPV, switched to this dual regimen because of toxicity or risk of DDIs (NCT02491242).Results: Overall, 102 patients (mean age 54 years, 28% women) were included. Fifty-seven were coinfected with HCV (fibrosis grade 4 in 27 cases, 1 liver transplantation). Seven patients had chronic kidney disease (1 renal transplantation). At week 48, only 1 virologic failure occurred (<1%), and 6 patients (6%) left the regimen (3 with central nervous system adverse events, 1 each due to pregnancy, metformin interaction, and lost to follow up). Thus, the overall treatment success rates were 93% (95% CI, 88%–98%; ITT-e, snapshot analysis) and 96% (95% CI, 92%–99%; per protocol analysis). The CD4/CD8 ratio increased slightly (median, +0.03). Triglycerides levels improved significantly (−18.8%, p < 0.01). The creatinine-based estimated glomerular filtration rate decreased by a mean of −8.4 ml/min/1.73 m2, but tubular renal parameters improved. A paired dual X-ray absorptiometry scan showed a mild improvement in spine (mean, +1.15%; −0.57 to +3.3%) and in femoral neck bone mineral density (mean, +0.4%; −3.3% to +2.57%).Conclusions: In the clinical setting, switching to the combination of DTG plus rilpivirine in virologically suppressed HIV-1 patients is effective and safe, and improves lipid, renal and bone evolution.Trial registration: ClinicalTrials.gov identifier: NCT02491242.

Evaluation of the need for a fracture liaison service in a patient-centered medical home

ObjectivesTo evaluate the need for a fracture liaison service (FLS) based on postfracture care in a patient-centered medical home (PCMH). MethodsPatients in a PCMH who presented to a local 763-bed community teaching hospital with fragility fracture of the hip, spine, or forearm between January 1, 2013, and December 31, 2014, were identified using ICD-9 codes. A retrospective chart review of inpatient and outpatient medical records 2 years before the fracture and 1 year afterward was conducted. The primary outcome was dual X-ray absorptiometry (DXA) scan utilization or pharmacotherapy for osteoporosis 6 months after fracture. ResultsOne hundred eighty-two patients were identified, and 75 patients were included in the analysis. The median age of the cohort was 84 years, and 70.7% of patients were white women. Fragility fractures included hip fracture (42.7%), vertebral fracture (40.0%), and forearm fracture (17.3%). Six months after fracture, 30.7% of patients were prescribed prescription therapy for osteoporosis, and 6.7% had received a DXA scan. Although nearly all patients had a follow-up visit in the PCMH during the year after fracture, only 8.3% were seen in an established osteoporosis clinic. Twenty-three percent of patients were deceased at 1 year. ConclusionsMore patients in this PCMH received a DXA scan or pharmacotherapy, or both, for osteoporosis 6 months after fragility fracture than observed nationally. However, approximately 70% of patients were undertreated. Incorporating principles of an FLS into an existing osteoporosis clinic is warranted.

Secondary prevention of minor trauma fractures: the effects of a tailored intervention-an observational study.

Minor trauma fractures (MTF) in the elderly are associated with an increase in mortality, morbidity, and the risk of subsequent fractures. Often, these patients who sustain MTF have an underlying bone disease, such as osteopenia or osteoporosis. Osteoporosis is known to be underdiagnosed and undertreated, and adequate treatment is essential to reduce the occurrence of MTFs. At our hospital, this has led to the implementation of Osteofit, a patient-education-based intervention targeted at improving screening and prevention of osteoporosis, with the goal to reduce the rate of subsequent MTF. The aim of this study was to assess the efficacy of Osteofit in improving osteoporosis screening and treatment in patients after an initial MTF episode. The study is a prospective, single-center, cohort study of MTF patients aged 50years or older. A standardized questionnaire and telephone interview were used to collect 1-year follow-up data. The primary outcome was the rate of patients undergoing Dual X-ray Absorptiometry (DXA) scanning. Secondary outcomes were the rate of patients with a diagnosis of osteoporosis or osteopenia, the rate of patients treated with anti-osteoporotic medication, and the rate of patients with a subsequent fracture. DXA scanning rate, the prevalence of a diagnosis (osteoporosis/osteopenia), and data on medical treatment for osteoporosis were compared to the results of a previous study in the same hospital, published in 2004. Between 2012 and 2015, 411 of 823 eligible patients consented to participate and were included in this study. The mean age was 72 ± 9.3years. Sixty-three percent (63.3%, n= 252) of the patients received a DXA scan, compared to 12.6% reported in our previous study. Of all patients who received a DXA scan, 199 (82.9%) were diagnosed with osteoporosis or osteopenia. A total of 95 patients (23.1%) received specific medical treatment for osteoporosis and 59.8% reported the intake of any unspecific medication (vitamin D, calcium, or both). Fifteen patients (3.9%) had a subsequent fracture as a result of a minor trauma fall. The implementation of a MTF secondary prevention program with dedicated health professionals improved the rate of patients who underwent DXA screening by fivefold. Despite this improvement, DXA screening was missed in over a third of patients, with only 23% of eligible patients receiving specific medical treatment for osteoporosis at 1-year follow-up. Consequently, this tailored intervention is a promising first step in improving geriatric fracture care. However, further work to improve the rate of osteoporosis screening and medical treatment initiation for the long-term prevention of subsequent MTF is recommended. We believe osteoporosis screening and adequate osteoporosis medication should be integrated as standard procedure in the aftercare of MTF. II.

Use of bone age for evaluating bone density in patients with Duchenne muscular dystrophy: A preliminary report.

Patients with Duchenne muscular dystrophy (DMD) exhibit low bone mineral density and increased fracture risk. Because glucocorticoid therapy results in delayed puberty and short stature, it is important to account for delayed skeletal development when interpreting patients' bone mineral density. Twelve glucocorticoid-treated patients with DMD were evaluated by dual x-ray absorptiometry scans and wrist x-rays to estimate bone density and bone age, respectively. Z-scores were determined on the basis of chronological age. Each patient was assigned a "corrected" birth date that was calculated according to bone age, and a bone-age-corrected z-score was determined. Z-scores adjusted for chronological age were lower than those adjusted for bone age. We suggest the use of bone age as an alternative to chronological age for analysis of bone mineral density in glucocorticoid-treated patients with DMD. Additional research is required to determine the optimal method to predict fracture risk in this patient group. Muscle Nerve 59:422-425, 2019.

Associations of prenatal exposure to impaired glucose tolerance with eating in the absence of hunger in early adolescence.

Exposure to impaired gestational glucose tolerance has been shown to have sex-specific associations with offspring obesity risk, perhaps by affecting the development of appetite regulation. We examined the extent to which prenatal exposure to impaired glucose tolerance was associated with eating in the absence of hunger (EAH) in early adolescent offspring, and in turn, whether EAH was cross-sectionally associated with body composition. We included data from 1097 adolescents participating in Project Viva, a pre-birth longitudinal cohort. We obtained the results of two-stage prenatal glycemic screening (50 g glucose challenge test, followed if abnormal by 100 g oral glucose tolerance test) at 26-28 weeks of gestation, and categorized mothers as having normal glucose tolerance, isolated hyperglycemia (IH, n = 92, 8.4%), impaired glucose tolerance (IGT, n = 36, 3.3%), or gestational diabetes mellitus (GDM, n = 52, 4.7%). At a median age of 13 years, offspring reported on two modified items of the Eating in the Absence of Hunger in Children and Adolescents questionnaire, we measured height and weight, and performed dual X-ray absorptiometry scans to assess fat and fat-free mass. We used multivariable linear regression analyses adjusted for sociodemographic and prenatal covariates, including maternal pre-pregnancy BMI. On a ten-point scale, the mean (SD) EAH score was 4.4 points (SD = 1.5) in boys and 4.4 (SD = 1.4) in girls. In girls, prenatal exposure to both IH and IGT was associated with more EAH compared with normal glucose tolerance (e.g., for IH: 0.56 points, 95% CI: 0.17, 0.96), whereas in boys, prenatal exposure to IGT was associated with less EAH (-0.81 points, 95% CI: -1.41, -0.21). We did not observe an association between exposure to GDM and EAH, nor did we observe associations between EAH and body composition in early adolescence. These findings suggest sex-specific associations of exposure to impaired gestational glucose tolerance with offspring EAH in early adolescence.

STRONG-D: Strength training regimen for normal weight diabetics: Rationale and design

BackgroundCurrently, there is a lack of data on effective lifestyle recommendations for normal-weight diabetics (NWD), who can represent up to 1 in 5 individuals with Type II Diabetes Mellitus (T2DM). NWD is especially prevalent in Asian populations and the elderly. Specific exercise treatment recommendations are needed for patients with normal-weight diabetes (NWD), as those in this category face higher mortality rates than overweight and obese diabetics. Standard T2DM treatment recommends aerobic training; however, performing aerobic training alone may not be appropriate for NWD and strength training may be a more effective treatment recommendation. ObjectiveWhile it is known that strength and aerobic training are beneficial in obese diabetics, there is currently insufficient evidence to recommend this regimen in NWD. The Strength Training Regimen for Normal Weight Diabetics (STRONG-D) study aims to determine the best exercise regimen for NWD and address the current lack of appropriate physical activity recommendations for this population. The primary goal of this study is to determine whether strength training aids glycemic control better than aerobic training in NWD. Study designSTRONG-D is a three-arm randomized controlled trial designed to compare the clinical effectiveness of structured strength training only, aerobic training only, and combination (strength + aerobic) training sessions, modeled after the intervention in the Health Benefits of Aerobic and Resistance Training in T2DM patients (HART-D) study. Potential participants meeting eligibility criteria of HbA1c values of 6.5% to 13.0% and BMI of 18.5 kg/m2 to 25 kg/m2 will be enrolled. After randomization, participants will begin a 9-month exercise intervention. The primary outcomes will be HbA1c levels. The secondary endpoints will include physical fitness, body composition measured by Dual X-Ray Absorptiometry (DXA) scans, and leg strength and endurance measured by Biodex testing. Initial follow-up visits will occur at 3 months, 6 months, and 9 months. To determine the long-term effects of the exercise intervention, passive follow-up will continue via electronic health records (EHR) until a 24-month follow-up visit. A total of 282 participants will be randomized into the three study arms determine the clinically significant differences between strength-only, aerobic-only and combination regimens.