Bone Mineral Density Deterioration Research Articles

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency.

Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture. To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD. We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5. At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002). Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

Protective effects of electroacupuncture on senile osteoporosis in rats.

The objectives were to explore the protective effects of electroacupuncture (EA) on senile osteoporosis in aged rats and investigate the underlying mechanisms. This study included aged (24-month-old; n = 16) and young (3-month-old; n = 8) male Sprague-Dawley rats. Aged rats were further randomized 1:1 to an aged control group (Aged; n = 8) and an EA treatment group (EA; n = 8). The 3-month-old rats served as young controls (Young). EA rats received EA at ST36, SP6, GB34 and SP10 bilaterally for 30 min a day, 5 days a week, for 8 weeks. EA significantly increased serum markers of bone formation in Aged rats. There were no significant differences in serum markers of bone resorption between EA and Aged rats. Deterioration of bone mineral density (BMD) and trabecular bone architecture was observed in the Aged group, while EA significantly increased BMD of the left femur and L5 vertebral body in aged rats. Aging-induced deterioration of trabecular bone architecture was partially reversed in EA rats. Runx2 and Osterix mRNA and protein levels were significantly increased and peroxisome proliferator-activated receptor (PPAR)γ was significantly decreased in bone marrow cells in EA compared with Aged groups. The mRNA and protein levels of core constituents of the Wnt/β-catenin signaling pathway (Wnt3a, low-density lipoprotein receptor-related protein (LRP)5 and β-catenin) were significantly increased and Dickkopf 1 was significantly decreased in bone marrow cells in EA compared with Aged groups. EA may prevent bone loss and deterioration in aged rats by promoting osteogenesis via a mechanism that may involve activation of the Wnt/β-catenin signaling pathway. EA may represent a therapeutic option for senile osteoporosis.

Prediction Model of Spinal Osteoporosis Using Lumbar Spine X-Ray from Transfer Learning Deep Convolutional Neural Networks

Objective: Osteoporosis is highly prevalent among older adults and women. This condition leads to a deterioration in bone mineral density and microarchitecture, significantly increasing the risk of fractures. Additionally, osteoporosis commonly results in complications such as screw loosening and non-union during spinal surgery. Deep-learning algorithms have now achieved an accuracy comparable to the current human margin of error. Therefore, this study explored the potential of using transfer learning in deep learning algorithms to predict, diagnose, and screen for osteoporosis using commonly obtained sagittal spine X-rays from patients with spinal conditions.Methods: We retrospectively evaluated 2,300 consecutive patients who underwent dual energy X-ray absorptiometry (DXA) and lumbar sagittal plain X-ray exams between 2013 and 2021. The exclusion criteria included: (1) a gap of more than 1 year between the DXA and X-ray exams; (2) vertebrae that had undergone vertebroplasty; (3) lack of spine anterior-posterior DXA; and (4) images that were unassessable. Ultimately, 256 patients (images) were included in the study. Transfer learning was applied using convolutional neural network (CNN) techniques, specifically visual geometry group (VGG) 16, VGG 19, ResNet50, and Xception.Results: The most accurate CNN model in the training group was ResNet50, with an accuracy of 0.95. ResNet50 showed the best performance, with an accuracy of 0.82, precision of 0.80, recall of 0.86, and F1-score of 0.83. Additionally, its area under the curve (0.76) was higher than that other CNN models. The confusion matrix for ResNet50’s performance displayed the outcomes for images predicted as osteoporosis (n=12) among the test data osteoporosis images (n=14)Conclusion: Artificial intelligence (AI) technology employing deep learning techniques is significantly nearing human capabilities in the role of diagnostic assistance. The diagnosis of osteoporosis using bone mineral density is expected to evolve into a comprehensive diagnostic aid or decision-making tool with the integration of AI in the future.

Bone health in childhood cancer survivors, is there really a problem? Pitfalls of assessment, calculating risk and suggested surveillance and management for osteonecrosis and low and very low bone mineral density.

Childhood cancer survivors are at increased risk of developing (long-term) skeletal adverse effects, such as osteonecrosis, impaired bone mineral density, and fractures. This paper provides an overview of the current understanding of bone health in these survivors, examining whether it represents a significant concern. It focuses on the challenges of assessing and managing bone health in childhood cancer survivors, highlighting diagnostic pitfalls, methods for accurately identifying those at high risk, and suggested strategies for surveillance and management of osteonecrosis and impaired bone mineral density. The need for improved surveillance strategies, particularly for high-risk survivors, alongside potential prevention and management options, including pharmacological and lifestyle interventions, is emphasised. Given the lack of consensus on optimal prevention and treatment strategies, the paper emphasises the need for further research to optimise care and improve long-term outcomes for childhood cancer survivors with bone health impairments.

Osteoporosis classification using VGG-16 and logistic regression: A radiograph and BMD data approach

Osteoporosis is an ailment associated with the bones, in which the bone resorption takes place at a much faster pace as compared to the formation of bones, eventually leading to the deterioration of bone mineral density (BMD). Ultimately, it adversely affects the strength of bones. To determine different diseases, deep learning is used in almost every sector of healthcare. In the context of Osteoporosis, there are numerous machine learning technologies that have been utilized for early detection of the disease. Certainly, these techniques provided great accuracy, but their scope of study was limited exclusively to individual factors. This paper proposes a model which studies multiple aspects leading to the early prognosis of disease, thus increasing the reliability. The aspects are Bone Density Measure, the X-rays of affected bone, lifestyle of the patient which may include medical history if any, fracture status and the specific bone. The dataset used for the research contains 2000 X-rays in total and 500 BMD reports of 500 distinct patients. in Logistic regression is used for the BMD based classification, where the accuracy achieved is 98.66%, with a recall of 97%, precision of 100% and f1-score of 98% for osteoporotic category. The VGG16 model used for the classification based on image dataset achieves the accuracy of 97.19% which is acceptable comparative to existing methods.

Chemotherapy effects on bone mineral density and microstructure in women with breast cancer.

Chemotherapy involves the administration of steroids to prevent nausea and vomiting; however, its effect on bone microstructure remains unknown. This study aimed to evaluate the changes in bone mineral density (BMD) and bone microstructure associated with chemotherapy using high-resolution peripheral quantitative computed tomography (HR-pQCT) in women with early breast cancer. This prospective single-arm observational study included non-osteoporotic, postmenopausal women with breast cancer. The patients underwent dual-energy X-ray absorptiometry (DXA), HR-pQCT, and tartrate-resistant acid phosphatase-5b (TRACP-5b) or procollagen type-I N-terminal propeptide (P1NP) measurements at baseline, end of chemotherapy, and 6months after chemotherapy. The primary endpoint was the change in total volumetric BMD at the distal tibia and radius. Eighteen women were included in the study (median age: 57years; range: 55-62years). At 6months after chemotherapy, HR-pQCT indicated a significant decrease in total volumetric BMD (median: distal tibia -4.5%, p < 0.01; distal radius -2.3%, p < 0.01), cortical volumetric BMD (-1.9%, p < 0.01; -0.8%, p = 0.07, respectively), and trabecular volumetric BMD (-1.1%, p = 0.09; -3.0%, p < 0.01, respectively). The DXA BMD also showed a significant decrease in the lumbar spine (median: -4.5%, p < 0.01), total hip (-5.5%, p < 0.01), and femoral neck (-4.2%, p < 0.01). TRACP-5b and P1NP levels were significantly increased at the end of chemotherapy compared to baseline. Postmenopausal women undergoing chemotherapy for early breast cancer experienced significant BMD deterioration in weight-bearing bone, which was further reduced 6months after chemotherapy.

Major Pancreatic Resection Increases Bone Mineral Density Loss, Osteoporosis, and Fractures.

To assess whether long-term survivors of pancreatic surgery show increased risk to develop impaired bone mineral density, osteoporosis, and vitamin D deficiency. Pancreatic resection poses a risk for malabsorption of fat-soluble vitamins and other micronutrients essential for bone mineralization. Here, we evaluated the long-term effects of pancreatic resection on bone mineral density (BMD) and its clinical sequelae. This was a two-pronged analysis of post-pancreatectomy patients with a follow-up period greater than 3 years comprising (1) a large, propensity score-matched, cohort study based on a multinational federated research network (FRN) and (2) a retrospective single institution review of clinical and radiographic patient data. In the FRN analysis, an initial cohort of 8,423 post-pancreatectomy patients were identified and propensity score-matched with normal controls. The primary endpoint was the 10-year risk of developing osteoporotic pathological fractures and secondary endpoints included diagnosis of osteoporosis, vitamin-D deficiency, and related therapies. The single institution retrospective analysis identified 224 patients who underwent pancreatic resection between 2005 and 2019. BMD was quantified in CT images acquired before and after surgery. BMD trends and related factors were assessed in a time-series mixed effect linear regression model. A total of 8,080 propensity score-matched pairs were included in the FRN analysis. The analysis revealed a 2.4-fold increase in pathological fractures (P<0.0001) and 1.4-1.5 fold increase in osteoporosis/osteomalacia (P<0.0001) and vitamin-D deficiency (P<0.0001) in post-pancreatectomy patients. Vitamin-D supplements were more common in the pancreatectomy group (OR 1.4, 95% CI 1.28-1.53, P<0.0001), as were specific osteoporosis/osteomalacia treatments such as calcitonin, denosumab, romosozumab, abaloparatide, and teriparatide (OR 2.24, 95%CI 1.69-2.95, P<0.0001). Retrospective analysis of CT imaging revealed that BMD declined more rapidly following pancreatic resection compared to normal historical controls (P=0.015). Older age, pancreatic cancer, and pancreaticoduodenectomy were associated with increased rates of BMD loss (P<0.05, each). After pancreatic resection, patients are at higher risk for BMD loss and subsequent fractures. As the cohort of pancreatic resection survivorship grows, attention will need to be paid to focused prevention efforts to reduce BMD loss, osteoporosis, and fractures in these vulnerable patients, with specific attention to the pancreatic cancer population.

Impaired bone mineral density and microarchitecture in female adolescents with IgE-mediated cow's milk allergy.

Persistent immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) may impair bone parameters and increase the risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel methodology that not only assesses trabecular and cortical bone compartments and volumetric density measurements, but also evaluates bone microarchitecture and estimates biomechanical properties through finite element analysis (FEA). Both HR-pQCT and bone strength parameters derived from FEA have shown a strong correlation with fracture risk. To assess the bone density, microarchitecture, and bone strength of adolescents with persistent IgE-mediated CMA (IgE-CMA). This was an observational, cross-sectional study with female adolescents with persistent IgE-CMA and healthy control participants matched by female sex and sexual maturation. Bone parameters were assessed by areal bone mineral density (aBMD) through dual-energy X-ray absorptiometry (DXA), bone microarchitecture by HR-pQCT at the radius and tibia, and laboratory markers related to bone metabolism. The median age of adolescents with persistent IgE-CMA (n = 26) was 13.0years (interquartile range (IQR) 11.4-14.7) and of healthy control participants (n = 28) was 13.6years (IQR 11.9-14.9). Adolescents with IgE-CMA ingested 27.4% less calcium (p = 0.012) and 28.8% less phosphorus (p = 0.009) than controls. Adolescents with IgE-CMA had lower bone mineral content (BMC) (38.83g vs. 44.50g) and aBMD (0.796g/cm2 vs. 0.872g/cm2) at lumbar spine, and lower BMC (1.11kg vs. 1.27kg) and aBMD (0.823g/cm2 vs. 0.877g/cm2) at total body less head (TBLH) (p < 0.05). However, Z-scores BMC and Z-scores aBMD at lumbar spine and TBLH, when adjusted for Z-score height/age, were not significantly different between the groups. Moreover, CMA adolescents had lower bone strength at the distal tibia (S 169 kN/mm vs. 194 kN/mm; F Load 8030 N vs. 9223 N) (p < 0.05). Pairing of groups by the presence of menarche showed compromised parameters at the tibia-lower total volumetric BMD (Tt.vBMD) (293.9mg HA/cm3 vs. 325.9mg HA/cm3) and trabecular vBMD (Tb.vBMD) (170.8mg HA/cm3 vs. 192.2mg HA/cm3), along with lower cortical thickness (Ct.th) (1.02mm vs. 1.16mm) and bone strength (S 174 kN vs. 210 kN; F Load 8301 N vs. 9950 N)-and at the radius (S 61 kN/mm vs. 71 kN/mm; F Load 2920 N vs. 3398 N) (p < 0.05) among adolescents with IgE-CMA. Adolescents with IgE-CMA on a total exclusion diet (n = 12) showed greater impairment of bone features than those on a partial exclusion diet (n = 14), with lower lumbar spine Z-score BMC (- 0.65 vs. 0.18; p = 0.013), lumbar spine trabecular bone score (TBS) (1.268 vs. 1.383; p = 0.005), Z-score TBS (0.03 vs. 1.14; p = 0.020), TBLH Z-score BMC (- 1.17 vs. - 0.35; p = 0.012), TBLH Z-score aBMD (- 1.13 vs. - 0.33; p = 0.027), Tt.vBMD at the tibia (259.0mg HA/cm3 vs. 298.7mg HA/cm3; p = 0.021), Ct.th at the tibia (0.77mm vs. 1.04mm; p = 0.015) and Ct.th at the radius (0.16mm vs. 0.56mm; p = 0.033). Adolescents with persistent IgE-CMA had lower aBMD and compromised microarchitecture (impaired trabecular microarchitecture and lower bone strength). Adolescents on a partial exclusion diet had better bone parameters than those on a total exclusion diet.

Molecularly Imprinted Polymers: Shaping the Future of Early-Stage Bone Loss Detection-A Review.

Osteoporosis is the deterioration of bone mineral density (BMD) because of an imbalance between bone resorption and formation, which might happen due to lots of factors like age, hormonal imbalance, and several others. While this occurrence is prevalent in both genders, it is more common in women, especially postmenopausal women. It is an asymptomatic disease that is underlying until the first incidence of a fracture. The bone is weakened, making it more susceptible to fracture. Even a low trauma can result in a fracture, making osteoporosis an even more alarming disease. These fractures can sometimes be fatal or can make the patient bedridden. Osteoporosis is an understudied disease, and there are certain limitations in diagnosing and early-stage detection of this condition. The standard method of dual X-ray absorptiometry can be used to some extent and can be detected in standard radiographs after the deterioration of a significant amount of bone mass. Clinically assessing osteoporosis using biomarkers can still be challenging, as clinical tests can be expensive and cannot be accessed by most of the general population. In addition, manufacturing antibodies specific to these biomarkers can be a challenging, time-consuming, and expensive method. As an alternative to these antibodies, molecularly imprinted polymers (MIPs) can be used in the detection of these biomarkers. This Review provides a comprehensive exploration of bone formation, resorption, and remodeling processes, linking them to the pathophysiology of osteoporosis. It details biomarker-based detection and diagnosis methods, with a focus on MIPs for sensing CTX-1, NTX-1, and other biomarkers. The discussion compares traditional clinical practices with MIP-based sensors, revealing comparable sensitivity with identified limitations. Additionally, the Review contrasts antibody-functionalized sensors with MIPs. Finally, our Review concludes by highlighting the potential of MIPs in future early-stage osteoporosis detection.

P617 Persistent active inflammation may predict non-improvement in bone mass density in patients with Crohn's disease

Abstract Background Osteopenia and osteoporosis are associated with Crohn’s disease (CD). Diagnosis is made by dual-energy X-ray absorptiometry scan (DEXA). Pathophysiology of osteoporosis may reflect an interplay between persistent inflammation, steroid usage, as well as risk factors similar to general population. We aimed to identify factors associated with low or deteriorating bone mineral density (BMD) among patients. Methods A retrospective case-control study, included patients with CD followed at our IBD clinic from January 2000 to February 2023, with ≥ 2 DEXA scans. The observation started one year before the initial DEXA scan and extended until one year after the second scan. Demographic, clinical and laboratory data as well as medication exposure were collected before and during F/U. Patients were classified into three groups based on change in DEXA results: improved, worsened and no change. Multivariable proportional odds regression model was built to assess independent predictors of change in BMD. Results 121 patients [60 (49.6%) females, median age 33 years (IQR 23-43), median disease duration 5 years (IQR 0-35), median baseline BMI 22.4 kg/m2 (IQR 12.9-39.3), baseline CRP 1.4 ULN (IQR 0.5-4.5), baseline vitamin D 54.2 nmol/L (IQR 40.9-67.5)], were enrolled and followed for a median of 48 (IQR 29-71) months. At baseline, patients with osteoporosis had a lower BMI (18.5 kg/m2) than patients with normal BMD (26 kg/m2) and osteopenia (22.4 kg/m2), p&amp;lt;0.001. During F/U 63%, 59% and 66% of patients were exposed to high dose CS, anti-TNF and thiopurines respectively. At the end of F/U,19 (15.7%) patients had deterioration in BMD status while 78 (64.5%) remained unchanged, and in 24 (19.8%) BMD improved. Baseline vitamin D levels (in nmol/L) were higher in patients with improvement in BMD status at the end of the F/U compared to those with maintained or deterioration in BMD (66, 54.2, 41.2; p=0.001, Figure 1). Active smoking was associated with decline in BMD status (p=0.03). No correlation was found between different types of medication exposure and changes in BMD status. In multivariable analysis, elevated CRP was the only independent variable associated with lower odds of improvement in BMD (OR=0.45 (CI 0.2-1.0), p=0.05,Table 1). Conclusion Low BMI, low baseline vitamin D levels, and active smoking were found to be risk factors for low BMD status. Elevated CRP was associated with lack of improvement in BMD during the F/U. No correlation was found between different medications and changes in BMD status.

Marijuana-Provoked Hypoprolactinemia and Impaired Bone Mineral Density: Case Report and Review of Literature

Introduction: The incidence of concurrent hypoprolactinemia and impaired bone mineral density (IBMD) induced by marijuana abuse has not been observed among the general population. To the very best of our knowledge, none of these two rare conditions have previously been documented among Nigerians, within the existing literature. Case Report: Herein, is a rare case of concurrent hypoprolactinemia and IBMD triggered by marijuana abuse, in a 21-year-old undergraduate Nigerian male, who is a regular/heavy marijuana smoker of thirteen months duration. He had presented in our medical facility with complaints of recurrent excruciating lower back pain of three weeks duration which intensified with walking and while undertaking weight-bearing activities. He attested to having and seeking medical attention for, excessive sweating, and insomnia symptoms before the onset of current presenting symptoms. Results of investigations showed positive urine test for marijuana, hypoprolactinemia, distortions of biomarkers of bone metabolism, and radiologic features consistent with IBMD, Having found no other discernible cause of the low back/hip pain and hyoprolactinemia, he was diagnosed clinically with hypoprolactinemia and IBMD secondary to marijuana abuse. This warranted hospital admission where he obtained standardized specialist medical care and was subsequently discharged in good clinical condition with an uneventful follow-up period. Conclusion: This case highlights the dangers of metabolic aberrations due to marijuana abuse and the need to always maintain a high index of suspicion when confronted with it to avoid unnecessary medical protocols.

Gene Therapy for Alzheimer and Parkinson Diseases.

Alzheimer and Parkinson diseases are associated with cholinergic neuron loss and deterioration of bone mineral density. Gene therapy through either gene transfer, CRISPR gene editing, or CRISPR gene modulation holds the potential to cure Alzheimer and Parkinson diseases. The emerging role of weight-bearing exercise in the prevention of, and care for, osteoporosis, obesity, and diabetes has been previously recognized. Moreover, endurance exercise offers a viable alternative to reduce amyloid peptides deposits while increasing bone mineral density in Alzheimer and Parkinson patients. β-amyloid peptides, α-synuclein, and tau aggregates start building up two decades before the onset of Alzheimer and Parkinson diseases. Therefore, an early intervention program for the detection of these deposits is required to prevent or delay the onset of these diseases. This article spots light on the potential of gene therapy for Alzheimer and Parkinson diseases.

Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes.

Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. Cross-sectional. Clinical research center. 39 men (20 runners, 19 controls), ages 16-30 years. Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA <median had lower lumbar spine (-1.5 ± 0.7, P = .028), while runners with EA ≥median had higher hip (0.3 ± 0.7 vs -0.4 ± 0.5, P = .002), BMD Z-scores vs controls. After adjusting for calcium intake and running mileage, runners with EA <median had lower mean tibial total and trabecular volumetric BMD, trabecular bone volume fraction, cortical porosity, and apparent modulus vs controls (P < .05). Appendicular lean mass and serum estradiol (R ≥ 0.45, P ≤ .046), but not testosterone, were positively associated with tibial failure load among runners. Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.

No association between methotrexate and impaired bone mineral density in a cohort of patients with polymyalgia rheumatica, giant cell arteritis, granulomatosis with polyangiitis and other vasculitides—a cross-sectional analysis with dose–response analyses

ObjectiveTo investigate whether methotrexate (MTX) use is associated with bone mineral density (BMD) in patients with polymyalgia rheumatica (PMR) and various forms of vasculitis.MethodsRh-GIOP is a cohort study designed to evaluate bone health in patients with inflammatory rheumatic diseases. This cross-sectional analysis assessed the baseline visits of all patients with PMR or any kind of vasculitis. Following univariable analysis, multivariable linear regression analysis was performed. The lowest T-score of either the lumbar spine or the femur was chosen as the dependent variable to examine the relationship between MTX use and BMD. These analyses were adjusted for a variety of potential confounders, including age, sex, and glucocorticoid (GC) intake.ResultsOf 198 patients with PMR or vasculitis, 10 patients were excluded for very high GC dose (n = 6) or short disease duration (n = 4). The remaining 188 patients had the following diseases: PMR 37.2%, giant cell arteritis 25.0%, granulomatosis with polyangiitis 16.5%, followed by rarer diseases. The mean age was 68.0 ± 11.1 years, mean disease duration was 5.58 ± 6.39 years, and 19.7% had osteoporosis by dual x-ray absorptiometry (T-score ≤ −2.5). 23.4% were taking MTX at baseline with a mean dose of 13.2 mg/week (median: 15 mg/week). 38.6% of those used a subcutaneous preparation. MTX users had similar BMD compared to non-users (minimum T-scores −1.70 (± 0.86) versus −1.75 (± 0.91), respectively; p = 0.75). There was no statistically significant dose–response relationship: neither current nor cumulative dose were associated with BMD in unadjusted or adjusted models (current dose: slope −0.02; −0.14 to 0.09; p = 0.69; cumulative dose: slope −0.12; −0.28 to 0.05; p = 0.15).ConclusionIn the Rh-GIOP cohort, MTX is used in about a quarter of patients with PMR or vasculitis. It is not associated with BMD levels.

Peculiarities of the Ukrainian model of Fracture Risk Assessment (FRAX®) among patients with liver cirrhosis accompanied by impaired bone mineral density: its diagnostic and prognostic value

Introduction. The problem of osteoporotic fractures and the evaluation thresholds for intervention in patients with liver cirrhosis (LC) remains obscure so far. Ukrainian model of fracture risk assessment (FRAX®) has never been implemented among patients with LC in Ukraine. The aim of the study. To find out the peculiarities of the Ukrainian model of Fracture Risk Assessment, its diagnostic and prognostic value for implementation among patients with liver cirrhosis accompanied by impaired bone mineral density. Materials and methods. 90 patients with LC (27 women and 63 men aged 18 to 66 years) were randomly assigned into the study. Stratification into groups was based on information about bone condition. 72 patients were included into an experimental group (EG, patients with impaired bone mineral density (IBMD), which was divided into two subgroups – EG A (patients with osteopenia, 46) and EG B (patients with osteoporosis, 26). Control group (CG) included 18 patients without IBMD. The peculiarities of the fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model (2019) amoung patients with LC with bone disorders were established (significant differences between frequency of features in groups and substantial stochastic associations of features with IBMD or its manifestations were investigated). The diagnostic characteristcs (diagnostic value, predictive value, likelihood ratio) of the detected features for IBMD in general, osteopenia and osteoporosis in particular, were revealed, and after that the post-test probability of certain bone disorders was determined among all patients with LC in the case of applying the identified features. The results. It was found that although most of the risk factors occurred more often in patients with bone disorders, significant differences were detected only between the frequency of previous fractures in EG and CG, including EG B and CG, and EG A and EG B; between the frequency of cases of normal body weight, as well as overweight in EG and CG, including EG B and CG. The evaluation thresholds according to the Ukrainian FRAX® model also differed significantly: the values above the upper evaluation threshold – in EG B and CG and in EG A and EG B; the intermediate values of fracture risk – in EG A and CG; the values below the lower evaluation threshold – in EG and CG, as well as in EG A and CG and in EG B and CG, including. Bone disorders had a substantial direct stochastic association in the following cases: IBMD in general – with the previous fractures, normal body weight and values above the upper evaluation threshold; osteopenia – with the previous fractures, normal body weight and intermediate values of fracture risk; osteoporosis – with the previous fractures, normal body weight and values above the upper evaluation threshold. All manifestations of bone disorders had substantial negative stochastic association with overweight and values below the lower evaluation threshold, as well as osteoporosis with short height (indicates that features are inherent for normal bone mineral density). It was found out that fracture risk factors and evaluation thresholds according to the Ukrainian FRAX® model are mainly single-vector markers, since they can confirm the disease being detected, or deny it in the case they are absent. The previous fractures are highly specific for IBMD, especially for osteoporosis, and can be useful for confirming these disorders being present in patient with LC. The normal body weight is medium-specific for IBMD and for osteoporosis, but can be more useful for indicating IBMD if it is present, and excluding osteoporosis being absent. The values above the upper evaluation threshold according to the Ukrainian FRAX® model are highly specific for osteoporosis and can confirm osteoporisis being present. The intermediate values of fracture risk according to the Ukrainian FRAX® model are medium-specific for osteopenia, but can be more useful for excluding osteopenia if they are absent. The overweight, especially the values below the lower evaluation threshold, will most likely indicate normal bone mineral density. Conclusions. The use of the Ukrainian model of Fracture Risk Assessment (FRAX®) has certain peculiarities and can be valuable tool for detecting or excluding impaired bone mineral density in patients with liver cirrhosis.

ОСТЕОСИНТЕЗ ПЕРЕЛОМОВ МАЛОБЕРЦОВОЙ КОСТИ: ОТ НАКОСТНОГО К ИНТРАМЕДУЛЛЯРНОМУ

Fibula plays important role in the stability of the ankle joint. Precise restora-tion of its length, axis and rotation is critically important in intraarticular malleo-lar and distal tibia fractures. Open reduction and internal fixation with plate is widely accepted method of treatment of the fractures of lateral malleolus and fib-ular shaft. Nevertheless, substantial number of complications accomplishes this treatment modality. Danger of wound complications is associated with borderline blood supply in the zone of surgery and with wide surgical exposure performed on swollen soft-tissues. Risk of secondary displacements is associated with ad-vanced osteoporosis. Both factors lead to significant increase of number of com-plications in the elderly patients with impaired bone mineral density and altered nutrition of the soft-tissues. These dangers has led to the development of less in-vasive methods of intramedullary fixation in the lateral malleolus and fibular shaft. This article provides data on evolution of the methods of surgical fixation of these fractures.

Adverse effects of the cancer therapy on osteoclast-mediated bone loss in patients with cancers: a challenge

It is well-known that cancer therapies, including chemotherapy drugs, aromatase inhibitors and gonadotropin-releasing homone analogues, commonly contribute to remarkably reduce the bone mineral density, subsequently increase the rate of bone loss. For instance, in the patients with prostate cancer treated with androgene deprivation therapy (ADT), or chemotherapy drugs such as doxorubicin and cisplatin the calcicum levels were significantly decreased in the body, thereby leading to bone loss. Besides, the aromatase inhibitors widely used to treat breast cancer, and antiresorptive agents targeting the receptor activator of nuclear factor кB ligand can also trigger bone loss. Osteoclasts (OCs), derived from monocyte/macrophage lineage, are deifferentiated into mature, multinucleated OCs (a process also known as osteoclastogenesis) via a series of osteoclastogenic signaling pathways, are responsible for resorbing bone. This review article characterizes and summarizes the adverse effects of chemotherapy drugs on accelerating OC-induced bone defects such as the increased bone resorption and the impaired bone mineral density (BMD) in the patients with cancers.

The nature of changes in cell renewal and apoptosis of gingival epithelium in postmenopausal patients with chronic generalized periodontitis

Objective: to identify the nature of proliferation and apoptosis process disorders in the gingival epithelium in postmenopausal women with varying degrees of bone mineralization for early diagnosis and optimization of combination therapy. Materials and Methods. We examined 80 women aged 55–60 years with chronic generalized periodontitis (CGP) and reduced bone mineral density (BMD). All patients underwent a standard dental examination, including an index assessment of periodontal tissues. BMD was quantified via a densitometric analysis of the bone tissue condition. The investigation of periodontal epithelial cell renewal was performed using immunohistochemical studies. Results. We discovered that in postmenopausal patients with CGP and BMD disorders, there was a reduction in the proliferation of gingival epithelial cells with activation of their apoptosis (Iapt=0.73±0.03%, Iki-67=11.77±0.27%) vs. the patients with intact periodontium (Iapt 0.29±0.04%, Iki-67=9.88±0.09%), p=0.04. Conclusion. We discovered that CGP in postmenopausal women occurs with enlarged activity of apoptosis of gingival epithelial cells against the background of their reduced proliferation. The activity of inflammatory destructive processes in periodontal tissues is higher in patients with osteopenia vs. those without BMD impairment.

The Dietary and Non-Dietary Management of Osteoporosis in Adult-Onset Celiac Disease: Current Status and Practical Guidance.

Impaired bone mineral density (BMD) is a frequent complication of adult-onset celiac disease (CeD). This is usually due to malabsorption of nutrients, changes in bone metabolism in association with inflammation, and to a lesser extent, decreased overall physical health and mobility. This review aims to highlight the current status concerning surveillance, prevention, and treatment strategies for bone disease in CeD. A practical guidance on these matters is suggested. The available published research on the prevention and treatment of decreased BMD in relation to CeD is scarce. In general, publications were based on expert opinions or extrapolation from studies on postmenopausal women or inflammatory bowel disease. Optimal dietary treatment and an adequate supply of calcium and vitamin D are the cornerstones for the reduction in fracture risk in patients with CeD. In adults with low BMD or fragility fractures, CeD needs to be considered and specifically approached. When osteoporosis is documented, start treatment with an antiresorptive agent; these agents are proven to result in a long-term reduction in fracture risk in high-risk individuals. However, there are some important differences between the management of male and female patients, particularly premenopausal women, that need to be addressed. In patients with persisting diarrhea and malabsorption, parenteral medications may be preferable. Future research specifically focusing on celiac disease and the associated disorders in bone mineralization is mandatory to provide evidence-based recommendations in this field.

Flexible Sensor Suite Integrated Into Textile for Calcium Ion and Fall Detection

Studies show that excessive loss of sweat calcium is associated with the deterioration of bone mineral density in young athletes during vigorous intensity exercise. Low levels of bone mineral density cause a higher risk of bone fracture, meaning that a single fall can be devastating. This letter reports a smart compression sock that detects calcium levels in sweat and simultaneously scans for a fall and alerts the user accordingly. The sock is washable, and the device is removable using a Velcro pad attached to the inner side of the sock. An electrochemical sensor detects the calcium levels, while a triaxial accelerometer detects a fall event. When paired with a fall detection algorithm, the accelerometer quickly determines if a fall has occurred based on the differential acceleration. The calcium and fall detection units are interfaced with a microcontroller that sends the information to a user interface platform via the Blynk Internet of Things cloud. If the calcium level is above/below the critical value or a fall is detected, a notification along with the user's GPS location is sent to authorized emergency contacts so that the user can be attended to immediately. In addition, the electronic components were soldered onto a flexible printed circuit board. Such an integrated flexible system will allow the continuous monitoring of athletes to drive just-in-time intervention.