Bone Mineral Density Estimation Research Articles

Bone quality in young adults with intellectual disability involved in adapted competitive football

ABSTRACTThe objective of this study was to analyse bone quality parameters of football players with intellectual disability (ID) participating in adapted competitive football. Sixty-seven male football players with ID were studied: 22 with Down syndrome (DS) and 45 without DS. The average age was 26 years (range: 16 ̶ 50 years). A group of 25 age-matched sedentary individuals with ID (11 DS and 14 non-DS) and another group of 20 healthy participants of the same age group not involved in competitive football were comparatively analysed. There were no differences in the bone quality parameters when the healthy sedentary individuals were compared with both the sedentary and the football players with ID. However, the speed of sound (SOS), T-score, and estimated bone mineral density (BMD) were of higher values in the football players with ID than in the sedentary ID group (p < 0.05). On comparing the football players with non-DS ID with the sedentary non-DS individuals, significant differences were noted in SOS (p < 0.01), T-scores (p < 0.01), and estimated BMD (p < 0.01). Four of the 45 non-DS (8.9%) and none of the football players with DS had T-scores less than −1.5. Two of the 14 sedentary non-DS participants (14.3%) had T-scores indicating osteoporosis. In summary, the ID population actively involved in football showed higher values of bone mass parameters than their sedentary ID and healthy peers. The participants with non-DS ID showed a higher prevalence of osteoporosis than the football players with DS. Participation in sports seems to prevent bone loss in individuals with ID.

Bone mineral density in comparison to anthropometric parameters and level of gross motor function in children with cerebral palsy

Background/Aim. Children with cerebral palsy (CP) grow at a slower rate relative to their peers. Their body height, body weight and bone mineral density are significantly below those measured for healthy children of corresponding age. The aim of this work was to estimate bone mineral density in relation to the anthropometric parameters and the level of gross motor function in the children with cerebral palsy. Methods. This cross-sectional pilot study included 23 children with CP, aged 6 to 17 years, in whom the gross motor function level was estimated according to the Gross motor function classification system- expanded and revised (GMFCS-E&amp;R), while the anthropometric parameters were established in relation to the developmental charts for healthy children as well as those pertaining to children with CP. Bone mineral density was measured by dual energy X-ray absorptiometry and the findings were interpreted in accordance with the International Society for Clinical Densitometry Official Positions of Adults &amp; Pediatrics. Mean values with interquartile deviations, along with frequencies and percentages were the descriptive statistical measures employed in the analyses. Differences between groups were ascertained through the Kruskal-Wallis test. Results. Our sample of 23 children comprised of 56.5% boys and 43.5% girls, aged 13.00 ? 3.56 years, of whom 3/4 had a severe form of gross motor dysfunction (GMFCS-E&amp;R levels IV and V). All subjects had lower bone density in both regions of interest [spinal Z-score -1.60 ? 1.40 standard devation (SD); hip Z-score -2.00 ? 3.00 SD], as well as lower anthropometric parameters [height Z-score -2.74 ? 4.28; body weight Z-score - 3.22 ? 6.96; body mass index (BMI) Z-score -2.64 ? 6.03]. In the observed sample, bone mineral density in the spine (p &lt; 0.01) and the hip (p &lt; 0.05) was reduced in all subjects, and all children had a lower body weight (p &lt; 0.01) and the BMI (p &lt; 0.01), but not body height, in relation to the existing developmental charts for the CP children adopted from the US. Children with the CP Level IV on the GMFCS-E&amp;R had a significantly lower bone density (spinal Z-score -1.90 SD; hip Z-score -3.40 SD), with the reduction even more pronounced at level V (spinal Z-score -3.80 SD; hip Z-score -2.30 SD). Conclusion. A significantly lower bone mineral density as well as the decreased values of all observed anthropometric parameters, were noted in the children with CP. In the observed sample, bone mineral density in both spine and hip was reduced in all subjects, all of whom also had lower body weight and the BMI, but not body height compared to the existing developmental charts for the children with CP adopted from the US. The children with severe forms of CP (GMFCS-E&amp;R levels IV and V) had significantly lower bone mineral density.

Impact of Body Weight Dynamics Following Intentional Weight Loss on Fracture Risk: Results from The Action for Health in Diabetes Study.

The purpose of this study is to explore the impact of body weight change following intentional weight loss on incident fracture and bone mineral density (BMD) in overweight and obese adults with diabetes. A total of 1885 individuals with type 2 diabetes (baseline age: 58.5 ± 6.7 years, 58% women, body mass index: 35.7 ± 6.0 kg/m2) who participated in the Look AHEAD study and lost any weight 1 year after being randomized to an intensive lifestyle intervention were assessed. Body weight was measured annually and participants were categorized as weight regainers, weight cyclers, or continued losers/maintainers based on a ±3% annual change in weight from year 1 to year 4. Adjudicated overall fracture incidence was captured from years 4 through 13 (median follow‐up duration 11.5 years). Hip and spine BMD was assessed in a subset of participants at baseline, year 4 (n = 468), and year 8 (n = 354), using dual‐energy X‐ray absorptiometry. Cox proportional hazards and linear regression models, adjusted for relevant covariates, were performed for fracture and BMD outcomes, respectively. Fifty‐eight percent, 22%, and 20% of participants were classified as weight regainers, weight cyclers, and continued losers/maintainers, respectively; and 217 fractures (men n = 63; women n = 154) were recorded during the follow‐up period. There were no statistically significant differences in total incident fracture rates for weight regainers (HR [95% CI]: 1.01 [95% CI, 0.71 to 1.44]) or weight cyclers (HR [95% CI]: 1.02 [95% CI, 0.68 to 1.53]) when compared to continued losers/maintainers (p = 0.99). Similarly, follow‐up BMD estimates did not significantly vary by weight pattern group, although consistent trends for lowered BMD in the hip region were noted for continued losers/maintainers and weight cyclers compared with weight regainers. Patterns of weight change in the 3 years following 1 year of intentional weight loss were not associated with subsequent fracture or significantly reduced BMD in this cohort of overweight and obese adults with type 2 diabetes. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

A Novel Morphological Analysis of DXA-DICOM Images by Artificial Neural Networks for Estimating Bone Mineral Density in Health and Disease

One of the best methods for diagnosing bone disease in humans is site-specific and total bone mineral density (BMD) measurements by Dual-energy X-ray Absorptiometry (DXA) machines. The basic disadvantage of this technology is inconsistent BMD measurements among different DXA machines from different manufacturers due to different image analysis algorithms. The objective of the present study was to apply artificial neural networks (ANNs) to estimate total BMD for diagnosing a population of Egyptians with and without pathology, using extracted features from DXA-DICOM images based on the Histogram and Binary algorithms as compared to reference BMD measurements by DXA machine. The sample size comprised 3000 male and female participants with an age range 22–49 years, who were referred to us for diagnosis and/or treatment and for DXA total body scans in the period from January 2016 till December 2017. We constructed an entry computer data-logging visible unit, where we applied morphological operations to get a specific bone image, and used their extracted feature vectors as inputs to ANNs with cascade training, gathering, and testing for DXA-DICOM image processing. The multilayer feed-forward ANN set up its initial weights, carried out training and initiated the recall mode, and finally observed its decision and interaction based on estimated BMD. The ANN construction was carried out using a 3-layer architecture, with one hidden layer of 85 neurons. The input layer has neuron numbers equal to 256 for the Histogram and 77,365 for Binary algorithms, respectively. Total BMD estimation performance based on the Binary algorithm was capable of identifying all DXA-DICOM images with an accuracy of 100% for the training, cross-validation, and testing of the ANN phases. We believe this strategy will represent the means for standardizing bone measurements of all DXA machines, regardless of the manufacturer.

Ultrasonic backscatter evaluates the variability of bone in pregnant women

Pregnancy and lactation-associated osteoporosis (PLO) is characterized by the deterioration of bone tissue and the fractures during pregnancy without any underlying disorders. This study attempted to investigate the variability of bone in pregnant women. The ultrasonic backscatter experiments were performed in Shanghai Changning Maternity & Infant Health Hospital. A total of 896 subjects were divided into four groups gestational age from 11th to 39th week, calculated apparent integrated backscatter coefficients (AIB) and spectral centroid shift (SCS). The estimated bone mineral density (Est. BMD) was measured using a medical ultrasonic transmission instrument. The body mass index (BMI) was calculated basing on height and weight. The results showed that AIB preformed a decreasing trend with the increasing of gestational age, the mean value in 37-39th-week group decreased 2.07 dB comparing with the 11-13th-week group, p<0.001. The SCS mean value in 37–39th-week group shifted 21.66 kHz than the 11–13th-week group, p<0.001. The Est. BMD mean value in 37–39th-week group decreased 0.05 g/cm2 than the 11–13th-week group, p<0.001. The BMI increased with gestation age, the mean value in the 37–39th-week group was higher than the 11–13th-week about 4.19 kg/m2, p<0.001. One of the reasons for these results was that pregnant women provide nutrition for the fetus, resulting in decreased bone tissue along with gestational age increasing. These results suggest that ultrasonic backscatter method might have a potential to diagnosis PLO.

Estimation of bone mineral density and breaking strength of laying hens based on scans of computed tomography for body composition analysis

ABSTRACT1. The objective of this study was to evaluate the prediction potential of a computer tomography (CT) data collection protocol for determining total body composition used for analysis of tibiotarsal bone quality features.2. The CT image acquisition was performed on 54 healthy TETRA SL genotype laying hens at 90 weeks of age as well as in the 69th week of the egg production period in vivo and their tibiotarsal bones, ex vivo.3. Breaking strengths and ash content of the tibiotarsal bones were estimated based on the calculated mineral density of skeletal and tibiotarsal bones by means of CT with an estimation accuracy R2 0.963 and 0.975, respectively.4. In conclusion, the current investigation demonstrated that the acquisition protocol of CT for total-body composition analysis has a good potential for measuring the mineral status and breaking strength of the reference bone in laying hen.

Evaluation of Osteoporosis by Bone Mineral Density in Men: A Retrospective Study in a Tertiary Care Centre

Background: Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and density and that leads to an increased risk of fractures. Osteoporosis is highly prevalent, with an estimated 30 million women diagnosed to have osteoporosis. A bone mineral density (BMD) test measures how much calcium and other types of minerals are present in a section of bone. The absolute amount of bone as measured by bone mineral density (BMD) testing generally correlates with bone strength and its ability to bear weight. Materials & Methods: Retrospective study was done in 320 male patients, department of Orthopedics at Govt. Medical College, Nagpur, India during the 6-month study. The BMD estimation of these patients was done by quantitative ultrasonography of the calcaneal bone and the analysis done on the basis of T–scores. Results: 320 patients were included in the study from department of Orthopedics, at Govt. Medical College, Nagpur, India. Patients were in the age group of 20-75 yrs. Among these 20.62% (n=66) were between 20-35yrs, 50.62% (n=162) between 36-50yrs and 24.37%(n=78) between 51-65 yrs. Commonest presenting symptom in the study population was Backache which was 61.87% (n=198). 32.81% (105) presented with generalized bone pain and 11.87% (38) patients had a history of fracture after trivial trauma. Of the 320 patients included in the study, 48.43% (n=155) were osteoporotic, 30.62% (n=98) were osteopenia and severe osteoporosis 11.25%. Majority of the osteoporotic patients fell in the age group of 36-50 yrs. Conclusion: Our study shows that the osteoporosis and osteopenia is more common in males in the age group of 36-50 yrs. Early detection and prompt treatment is required to prevent pathological fractures. Quantitative ultrasonography is a standout amongst the best apparatuses for early recognition of osteopenia and osteoporosis as this is practical, needs radiation introduction and yields great outcomes, tantamount to other indicative devices like DEXA check.

Deep learning for biomarker regression: application to osteoporosis and emphysema on chest CT scans.

Biomarker computation using deep-learning often relies on a two-step process, where the deep learning algorithm segments the region of interest and then the biomarker is measured. We propose an alternative paradigm, where the biomarker is estimated directly using a regression network. We showcase this image-to-biomarker paradigm using two biomarkers: the estimation of bone mineral density (BMD) and the estimation of lung percentage of emphysema from CT scans. We use a large database of 9,925 CT scans to train, validate and test the network for which reference standard BMD and percentage emphysema have been already computed. First, the 3D dataset is reduced to a set of canonical 2D slices where the organ of interest is visible (either spine for BMD or lungs for emphysema). This data reduction is performed using an automatic object detector. Second, The regression neural network is composed of three convolutional layers, followed by a fully connected and an output layer. The network is optimized using a momentum optimizer with an exponential decay rate, using the root mean squared error as cost function. The Pearson correlation coefficients obtained against the reference standards are r = 0.940 (p < 0.00001) and r = 0.976 (p < 0.00001) for BMD and percentage emphysema respectively. The deep-learning regression architecture can learn biomarkers from images directly, without indicating the structures of interest. This approach simplifies the development of biomarker extraction algorithms. The proposed data reduction based on object detectors conveys enough information to compute the biomarkers of interest.

Pulse-echo ultrasound method for detection of post-menopausal women with osteoporotic BMD.

We lack effective screening and diagnostics of osteoporosis at primary health care. In this study, a pulse-echo ultrasound (US) method is investigated for osteoporosis screening. A total of 1091 Caucasian women (aged 50-80years) were recruited for the study and measured with US in the tibia and radius. This method measures cortical thickness and provides an estimate of bone mineral density (BMD) and density index (DI). BMD assessment of the hip was available for 988 women. A total of 888 women had one or more risk factors for osteoporosis (OP susp ), and 100 women were classified healthy. Previously determined thresholds for the DI were evaluated for assessment of efficacy of the technique to detect hip BMD at osteoporotic range (T-score at or below - 2.5). In the OP susp group, the application of thresholds for the DI showed that approximately 32% of the subjects would require an additional DXA measurement. The multi-site ultrasound (US) measurement-based DI showed 93.7% sensitivity and 81.6% specificity, whereas the corresponding values for single-site US measurement-based DI were 84.7 and 82.0%, respectively. The ultrasound measurements showed a high negative predictive value 97.7 to 99.2% in every age decade examined (ages 50-59, 60-69, 70-79years). The study data demonstrate that a strategy of combining ultrasound measurement with added DXA measurements in cases with intermediate ultrasound results (about 30%) can be useful for identifying subjects at risk for a low bone mineral density in the osteoporotic range.

Screening for bone mineral density using distal radius ultrasound (quantitative ultrasound scan): A camp-based approach

BACKGROUND: Bone mineral density (BMD) is an indirect measure of bone strength. As per WHO criteria of osteoporosis, osteoporosis and osteopenia are two subclinical states of low level of BMD. Osteoporosis is a major silent public health problem in India but epidemiological data are scanty in our country. Public awareness can play a crucial role to prevent the consequences of osteoporosis, which is based on the estimation of the BMD as osteoporosis is symptomless until person sustains fracture with a trivial trauma. The purpose of this study was to screen the people for their BMD levels using the quantitative ultrasound scan (QUS) method.METHODOLOGY: A total of 215 individuals (125 males and 90 females) between 25 and 75 years of age were screened for their BMD levels in a camp held at Lyallpur Khalsa College of Jalandhar, Punjab. Their BMD was estimated using QUS on distal radius of dominating hand. Results were presented as distributive statistics.RESULTS: As per WHO criteria of BMD, 11.2% participants were osteoporotic (T-score <−2.5), 32.6% were osteopenic (T-score <−1.0–2.5) whereas approximately 56% had normal bone density (T-score >−1.0) There was a significant trend of decreasing bone density with an increase in age in both the gender groups. A significant association (χ2 = 18.64, P < 0.005) was reported between the T-score and age of participants.CONCLUSION: Although such as DEXA scan, QUS method is not considered to be a standard tool for estimation of BMD; however, it is effective and affordable in identification of subclinical cases having low level of BMD. In our country, a camp is the best setting to screen a large population and creating awareness about such health problem.

Patterns of Age- and Sex-Related Variations in Bone Mineral Density of Lumbar Spine and Total Femur: A Retrospective Diagnostic Laboratory-Based Study.

Background:Osteoporosis is a major public health problem and should be a priority for healthcare providers and policymakers as it is an important reason of morbidity, mortality, and high-cost incurred in the management of its complications such as hip fractures. This study is designed to assess the bone mineral density (BMD) variation with age, site, and sex. Study is based on diagnostic laboratory data of BMD.Methods:A retrospective analysis was conducted on a sample population of 935 persons (73.5% women, 26.4% men), who underwent dual-energy X-ray absorptiometry scan between 2015 and 2017 in a National Accreditation Board for Testing and Calibration Laboratories accredited Mumbai (Maharashtra, India) based diagnostic laboratory. Lumbar spine, right and left total femur, BMD were analyzed across age, sex, and sites. The prevalence of low BMD and osteoporosis at these sites has been estimated as per the World Health Organization criteria of osteoporosis diagnosis using T scores.Results:Overall the prevalence of osteoporosis was found to be 6.4%, 5.5%, and 16.4%, while the prevalence of low BMD was 32.6%, 32.8%, and 31.2% at right total femur, left total femur, and lumbar spine, respectively. The decline in BMD at lumbar spine is more among women and it was a consistent decline with age, while among men' decline rate was less at all three sites.Conclusion:Our study highlighted the variation of BMD at different sites of body and higher vulnerability of spine for fragility fractures. Our study has shown a sharp decline in BMD among women during transition from 5th to 6th decade which signifies association of menopause with osteoporosis. Major limitation of the study is unavailability of clinical profiles of the subjects because of which it is difficult to ascertain whether BMD estimation was a diagnostic or screening procedure. In addition, study is conducted in diagnostic lab settings, due to which it is possible to overestimate prevalence of low BMD and osteoporosis by extrapolating these findings to the community.

Decrease in bone mineral density during three months after diagnosis of early rheumatoid arthritis measured by digital X-ray radiogrammetry predicts radiographic joint damage after one year

BackgroundPeriarticular osteopenia is an early sign of incipient joint injury in rheumatoid arthritis (RA), but cannot be accurately quantified using conventional radiography. Digital X-ray radiogrammetry (DXR) is a computerized technique to estimate bone mineral density (BMD) from hand radiographs. The aim of this study was to evaluate whether decrease in BMD of the hands (BMD loss), as determined by DXR 3 months after diagnosis, predicts radiographic joint damage after 1 and 2 years in patients with early RA.MethodsPatients (n = 176) with early RA (<12 months after onset of symptoms) from three different Swedish rheumatology centers were consecutively included in the study, and 167 of these patients were included in the analysis. Medication was given in accordance with Swedish guidelines, and the patients were followed for 2 years. Rheumatoid factor and antibodies to cyclic citrullinated peptides (anti-CCP) were measured at baseline, and 28-joint Disease Activity Score (DAS28) was assessed at each visit. Radiographs of the hands and feet were obtained at baseline, 3 months (hands only) and 1 and 2 years. Baseline and 1-year and 2-year radiographs were evaluated by the Larsen score. Radiographic progression was defined as a difference in Larsen score above the smallest detectable change. DXR-BMD was measured at baseline and after 3 months. BMD loss was defined as moderate when the decrease in BMD was between 0.25 and 2.5 mg/cm2/month and as severe when the decrease was greater than 2.5 mg/cm2/month. Multivariate regression was applied to test the association between DXR-BMD loss and radiographic damage, including adjustments for possible confounders.ResultsDXR-BMD loss during the initial 3 months occurred in 59% of the patients (44% moderate, 15% severe): 32 patients (19%) had radiographic progression at 1 year and 45 (35%) at 2 years. In multiple regression analyses, the magnitude of DXR-BMD loss was significantly associated with increase in Larsen score between baseline and 1 year (p = 0.033, adjusted R-squared = 0.069).ConclusionDXR-BMD loss during the initial 3 months independently predicted radiographic joint damage at 1 year in patients with early RA. Thus, DXR-BMD may be a useful tool to detect ongoing joint damage and thereby to improve individualization of therapy in early RA.

Preliminary precision-error estimates of bone mineral density in children with cerebral palsy

Searchable abstracts of presentations at key conferences on calcified tissues ISSN 2052-1219 (online)

Soft-tissue thickness compensation for ultrasound transit time spectroscopy estimated bone volume fraction—an experimental replication study

Quantitative ultrasound offers a reliable means to predict osteoporotic fracture risk, although to date it has not been generally used within routine clinical management since it does not provide a direct estimate of bone mineral density (BMD), and hence, the associated WHO criteria for osteopenia and osteoporosis. Langton has proposed that ultrasound propagation through cancellous bone may be considered as an array of parallel sonic-rays, the transit time of each determined by the corresponding proportion of bone and marrow propagated. This concept has led to the development of ultrasound transit time spectroscopy (UTTS) to estimate solid (bone) volume fraction (SVF). However, within the real-world clinical environment, a bone, such as the calcaneus, has overlying soft-tissues that would result in a significantly time-extended transit time spectrum (TTS), and hence, an underestimated SVF. The aims of this experimental replication study were firstly, to investigate the effect of overlying soft-tissues upon UTTS derived SVF (UTTS-SVF) estimation, and secondly, to develop and evaluate a method to compensate for this, thereby providing a more accurate estimation of SVF. Four 3D-cylindrical replica cancellous bone samples, with flat-parallel cortex discs on opposite faces, were studied; with varying thicknesses of water-replicating overlying soft-tissues. Through-transmission ultrasound signals were recorded, from which the apparent TTS was derived via deconvolution. Pulse-echo signals were utilised to measure the thickness of water overlying the replica cortices. The TTS was then corrected for the ultrasound transit time associated with the overlying water. UTTS-SVF was then calculated, and compared with the SVF value measured with microcomputed tomography (μCT-SVF). The results demonstrated that varying water-thicknesses for each sample provided very similar formats of ultrasound transit time spectra, but with significant extended time shifts. Compensation for overlying water thickness provided an accurate estimate of SVF for all samples; the overall of agreement between UTTS-SVF with μCT-SVF being 92.68%. It is therefore suggested that UTTS has the potential to provide a reliable in vivo estimate of BMD and hence application of the established WHO T-score for routine clinical assessment of osteoporosis.

Partial proximal tibia fractures.

Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component.High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density.Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient.Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects.A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments.Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org

A Portable Ultrasonic Bone Densitometer For The Measurement Of Multiple Sites

The purpose of this study was to develop a new ultrasound device to estimate bone mineral density (BMD) at the multiple sites (radius and tibia). The device is entirely portable and handheld and permits evaluation of the BMD by computing a parameter known as speed of sound of first arriving signal (SOSFAS). The SOSFAS was achieved by the so-called time of flight (TOF) of ultrasonic propagation. Two parameters calledSOSFAS-radius andSOSFAS-tibia were measured by temperature correction and be evaluated the correlation with the lumbar spine BMD. The correlation coefficient of SOSFAS-radius and SOSFAS-tibia with BMD was r=0.68 (p&lt;0.001), and r=0.77 (p&lt;0.001), respectively. Although X-ray methods are effective in bone mass assessment, osteoporosis remains one of the largest undiagnosed and under-diagnosed diseases in the world today. The research described here, in conjuction with the fact that the devices are designed to be manufactured at low cost, should enable the significant expansion of diagnosis to be manufactured at low cost, should enable the significant expansion of diagnosis and monitoring of osteoporosis.

Low bone mineral density in juvenile idiopathic arthritis: Prevalence and related factors

Abstract Introduction Height adjustment is currently recommended for Z -score bone mineral density (BMD) assessed by dual energy X-ray absorptiometry. At present there are no studies that evaluate the prevalence of low BMD in paediatric patients with juvenile idiopathic arthritis (JIA) in Spain following current recommendations. Objectives To evaluate low BMD in JIA in paediatric patients with JIA in Spain following the latest recommendations, as well as to assess associated factors. Methods Observational cross-sectional study of Spanish JIA patients from 5 to 16 years-old, followed-up in a Paediatric Rheumatology Unit between July 2014 and July 2015. Anthropometric, clinical and treatment data were recorded. Dual energy X-ray absorptiometry, and bone metabolism parameters were collected, and a completed diet and exercise questionnaire was obtained. Results A total of 92 children participated. The population prevalence estimation of low BMD was less than 5% (95% CI). A significant positive correlation was found in the multiple linear regression analysis between the body mass index percentile ( B : 0.021; P B : 0.0002; P = .012), and BMD Z -score adjusted for height ( Z -SAH). A significant negative correlation was found between fat mass index ( B : −0.0001; P = .018) and serum type I collagen N-propeptide ( B : −0.0006; P = .036) and Z -SAH. Conclusions Low BMD prevalence in JIA patients in our population is low. An adequate nutritional status and the prevalence of lean over fat mass seem to promote the acquisition of bone mass. Those JIA patients with lower BMD could be subjected to an increase of bone turnover.

Baja densidad mineral ósea en artritis idiopática juvenil: prevalencia y factores relacionados

IntroductionHeight adjustment is currently recommended for Z-score bone mineral density (BMD) assessed by dual energy X-ray absorptiometry.At present there are no studies that evaluate the prevalence of low BMD in paediatric patients with Juvenile Idiopathic Arthritis (JIA) in Spain following current recommendations. ObjectivesTo evaluate low BMD in JIA in paediatric patients with JIA in Spain following the latest recommendations, as well as to assess associated factors. MethodsObservational cross-sectional study of Spanish JIA patients from 5 to 16 years-old, followed-up in a Paediatric Rheumatology Unit between July 2014 and July 2015.Anthropometric, clinical and treatment data were recorded. Dual energy X-ray absorptiometry, and bone metabolism parameters were collected, and a completed diet and exercise questionnaire was obtained. ResultsA total of 92 children participated. The population prevalence estimation of low BMD was less than 5% (95% CI).A significant positive correlation was found in the multiple linear regression analysis between the body mass index percentile (B: 0.021; P<.001) and lean mass index (B: 0.0002; P=.012), and BMD Z-score adjusted for height (Z-SAH). A significant negative correlation was found between fat mass index (B: –0.0001; P=.018) and serum type I collagen N-propeptide (B: –0,0006; P=.036) and Z-SAH. ConclusionsLow BMD prevalence in JIA patients in our population is low.An adequate nutritional status and the prevalence of lean over fat mass seem to promote the acquisition of bone mass. Those JIA patients with lower BMD could be subjected to an increase of bone turnover.

Assessment of Regional Bone Density in Fractured Vertebrae Using Quantitative Computed Tomography.

Study DesignCohort study.PurposeThe aim of this study is to propose and evaluate a new technique to assess bone mineral density of fractured vertebrae using quantitative computed tomography (QCT).Overview of LiteratureThere is no available technique to estimate bone mineral density (BMD) at the fractured vertebra because of the alterations in bony structures at the fracture site.MethodsForty patients with isolated fracture from T10 to L2 were analyzed from the vertebrae above and below the fracture level. Apparent density (AD) was measured based on the relationship between QCT images attenuation coefficients and the density of calibration objects. AD of 8 independent regions of interest (ROI) within the vertebral body and 2 ROI within the pedicles of vertebrae above and below the fractured vertebra were measured. At the level of the fractured vertebra, AD was measured at the pedicles, which are typically intact. AD of the fractured vertebral body was linearly interpolated, based on the assumption that AD at the fractured vertebra is equivalent to the average AD measured in vertebrae adjacent to the fracture. Estimated and measured AD of the pedicles at the fractured level were compared to verify our assumption of linear interpolation from adjacent vertebrae.ResultsThe difference between the measured and the interpolated density of the pedicles at the fractured vertebra was 0.006 and 0.003 g/cm3 for right and left pedicle respectively. The highest mean AD located at the pedicles and the lowest mean AD was found at the anterior ROI of the vertebral body. Significant negative correlation exist between age and AD of ROI in the vertebral body.ConclusionsThis study suggests that the proposed technique is adequate to estimate the AD of a fractured vertebra from the density of adjacent vertebrae.

Correlates of Calcaneal Quantitative Ultrasound Parameters in Patients with Diabetes: The Study on the Assessment of Determinants of Muscle and Bone Strength Abnormalities in Diabetes

Objective Quantitative ultrasound (QUS) provides an estimate of bone mineral density (BMD) and also evaluates bone quality, which has been related to increased fracture risk in people with diabetes. This study aimed at assessing the correlates of calcaneal QUS parameters in diabetic subjects encompassing various degrees of micro and macrovascular complications and a wide-range of peripheral nerve function. Methods Four hundred consecutive diabetic patients were examined by QUS to obtain values of broadband ultrasound attenuation (BUA), the speed of sound (SOS), quantitative ultrasound index (QUI), and BMD. Results Among surrogate measures of complications, sensory and motor nerve amplitude and heart rate response to cough test and standing correlated with QUS parameters at univariate analysis, together with age, body mass index (BMI), waist circumference, lipid profile, and renal function. Multivariate analysis revealed that BUA, SOS, QUI, and BMD were independently associated with age, male gender, hemoglobin A1c, BMI (or fat, but not fat-free mass), and somatic and autonomic nerve function parameters. Conclusions These data indicate that peripheral nerve dysfunction is associated with worse QUS parameters, possibly contributing to increased fracture risk in diabetes. The positive relation of QUS measures with adiposity needs further investigation. This trial is registered with ClinicalTrials.gov (NCT01600924).