Indices Of Bone Health Research Articles

The Short-Term Effect of Dried Plums on Inflammation and Indices of Bone Health in Osteopenic Men (P01-027-19)

ObjectivesOsteoporosis has significant public health importance for both women and men, where 54% of the U.S. population age 50 and older have low bone mineral density (BMD). Chronic inflammation alters bone remodeling, which is one contributor to bone loss; therefore, foods rich in antioxidants, such as dried plums (DP, Prunus domestica L.), are of great interest for preventing chronic inflammation. Previously, dietary intervention with DP has been shown to prevent orichidectomy-induced decreases in BMD, microstructure, and biomechanics in male rats; however, this has yet to be studied in a clinical setting in adult males. MethodsOne-hundred and sixty osteopenic men are being recruited from the greater Tallahassee, Florida area to examine the effects of DP on BMD, bone biomarkers, and inflammation after one year of regular consumption. The present analysis is of a subset of this population, documenting the effects of two doses of DP on biomarkers of inflammation and bone metabolism in men after three months of consumption. Twenty-seven men between the ages of 55 and 80 with moderate bone loss (T-score between –0.1 and –2.5 SD below the mean) were included. The men were randomized into one of three groups: 100 g DP, 50 g DP, or control group, with all three groups given a multivitamin containing 450 mg calcium and 800 IU vitamin D (Shaklee Corporation). Serum samples from the baseline and three-month time points were analyzed for C-reactive protein (CRP) and bone-specific alkaline phosphatase (BAP). DXA scans of the lumbar vertebrae alongside TBS iNnsight® software were used to generate trabecular bone score (TBS). ResultsThree months of DP consumption was associated with numerical increases in BAP in both the 100 g (6.5%, P = 0.14) and 50 g (6.3%, P = 0.3) DP groups, numerical decreases in CRP in both the 100 g (–8.8%, P = 0.75) and 50 g (–8.5%, P = 0.71) DP groups, and minimal change in TBS in both the 100 g (0.37%, P = 0.71) and 50 g (–0.55%, P = 0.44) DP groups. ConclusionsRegular consumption of either 100 g or 50 g DP for three months may contribute to increases in bone formation and decreases in inflammation, however not to an extent that affects bone quality. Three months of consumption may not be long enough to manifest changes in bone; therefore, further analysis of data after six months and one year of DP consumption in a larger number of men is warranted. Funding SourcesUSDA-NIFA, Shaklee Corporation, California Dried Plum Board.

Physical Activity and Health in Children Younger than 6 Years: A Systematic Review.

Physical activity is known to provide important health benefits in school-age youth. However, until recently, few studies have examined associations between physical activity and health in young children. The purpose of this study was to conduct a systematic review of the relationship between physical activity and selected health outcomes in children younger than 6 yr. A systematic search identified randomized controlled trials and prospective cohort studies examining the associations between physical activity and adiposity/weight status, bone health, cardiometabolic health, and cognition in children younger than 6 yr. Twenty-seven studies met inclusion criteria and served as the basis for this systematic review. For weight status/adiposity, 12 of 15 studies found negative associations between physical activity and one or more measures of the outcome. For bone health, 10 articles based on four studies were identified, and nine studies showed stronger bone in more active children. For cardiometabolic health, three studies were identified and findings were limited and inconsistent. For cognition, two systematic reviews were identified and findings were limited. For all four health outcomes, evidence of dose-response relationships and effect modification by demographic factors was very limited. There is strong evidence indicating that higher amounts of physical activity are associated with better indicators of bone health and with reduced risk for excessive increases in weight and adiposity in children 3 to 6 yr. Evidence was too limited to support conclusions regarding the effects of physical activity on cardiometabolic health and cognition.

Acai fruit extracts and anthocyanins alter osteoblast proliferation and the expression of HDAC1 and osterix/Sp7 in vitro and in vivo

Musculoskeletal injuries and disorders are the leading cause of disability in the United States and affect more than one out of every two persons in the United States age 18 and over, and nearly three out of four persons aged 65 and over. Bone health is critical to the overall health and quality of life for Americans, and greater efforts are needed to address the burdens associated with osteoporosis and related bone diseases. Evidence from a variety of studies strongly points to a positive link between fruit and vegetable consumption and indices of bone and joint health, although the mechanisms are not well understood. In this work we investigate the effects of Acai fruit extract (AFE) and anthocyanidins on osteoblastogenesis in vitro and in vivo. hFOB human osteoblasts were obtained from ATCC and cultured in 1:1 mixture of Ham's F12 Medium Dulbecco's Modified Eagle's medium, with 2.5 mM L‐glutamine (without phenol red). An extract of acai fruits (AFE) was prepared in methanol and purified cyanidin‐3‐glucoside were purchased. Double transgenic medaka (dT; osterix/Sp7:mCherry were maintained at UIC under protocol #17‐166. Larvae at 9–12 dpf were staged and then treated for 5 days with the extracts and compounds (1–10 mg/ml). Osteoblast formation and distribution were analyzed by fluorescence microscopy, bone mineralization was visualized by calcein. The results show that AE and cyanidin‐3‐glucoside (C3G) increased osteoblast proliferation and reduced apoptosis in hFOB 1.19 osteoblasts induced by serum and glucose starvation. Gene expression data showed that C3G increased HDAC1 expression, increased BCL‐2 and reduced BAX mRNA and caspase 3/7 in apoptotic hFOB cells. AFE increased the proliferation of osteoblasts in dT osx/Sp7:mCherry medaka by enhancing the expression of osx/Sp7. Osterix (also known as transcription factor Sp7) is an osteoblast‐specific transcription factor which activates a repertoire of genes during differentiation of preosteoblasts into mature osteoblasts and osteocytes. AFE and C3G enhanced proliferation of hFOB cells, reduced hFOB apoptosis induced by serum and glucose starvation by via epigenetic regulation of HDAC1, and by increasing BCl‐2 and reducing the expression of BAX and caspase 3/7. The AFE enhanced osteoblast proliferation in osx/Sp7:mCherry medaka, and increased osx/sp7 expression.Support or Funding InformationNCCIH at NIHThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Calcium and vitamin D supplementation and bone health in Marine recruits: Effect of season.

Stress fractures are common overuse injuries caused by repetitive bone loading. These fractures are of particular concern for military recruits and athletes resulting in attrition in up to 60% of recruits that sustain a fracture. Army and Navy recruits supplemented with daily calcium and vitamin D (Ca + D) demonstrated improved bone strength and reduced stress fractures. The aim of the current study was to evaluate whether Ca + D supplementation improves measures of bone health in recruits undergoing United States Marine Corps initial military training (IMT), and whether the effect of supplementation on indices of bone health varied by season. One-hundred ninety-seven Marine recruits (n = 107 males, n = 90 females, mean age = 18.9 ± 1.6 y) were randomized to receive either Ca + D fortified snack bars (2000 mg Ca and 1000 IU vitamin D per day) or placebo divided into twice daily doses during 12 weeks of IMT. Anthropometrics, fasted blood samples, and peripheral quantitative computed tomography (pQCT) scans of the tibial metaphysis and diaphysis were collected upon entrance to- and post-training (12 weeks later). Half of the volunteers entered training in July and the other half started in February. Time-by-group interactions were observed for vitamin D status (25OHD) and the bone turnover markers, BAP, TRAP and OCN. 25OHD increased and BAP, TRAP and OCN all decreased in the Ca + D group (p < .05). Training increased distal tibia volumetric BMD (+1.9 ± 2.8%), BMC (+2.0 ± 3.1%), and bone strength index (BSI; +4.0 ± 4.0%) and diaphyseal BMC (+1.0 ± 2.2%) and polar stress strain index (SSIp; +0.7 ± 2.1%) independent of Ca + D supplementation (p < .05 for all). When analyzed by season, change in BSI was greater in the Ca + D group as compared to placebo in the summer iteration only (T*G; p < .05). No other effects of supplementation on bone tissue were observed. When categorized by tertile of percent change in BSI, recruits demonstrating the greatest changes in BSI and 25OHD entered training with the lowest levels of 25OHD (p < .05). Over all, these results suggest that Ca + D supplementation reduced some markers of bone formation and resorption and the decline in 25OHD over training in volunteers that started training in the summer was prevented by supplementation. Baseline 25OHD and trajectory may impact bone responses to IMT, but little effect of Ca + D supplementation was observed at the investigated doses.

The Impact of Aerobic Exercise on Female Bone Health Indicators.

Introduction:Females usually suffer from bone health problems, particularly with aging. Aerobic exercise has been shown to have health benefits for females.Aim:The main objective of this study was to investigate the impact of aerobic exercise on female bone health by measuring serum trace elements and bone metabolism markers.Methods:Prospective interventional study was conducted at rehabilitation clinics in Royal Medical Services, Jordan. A total of 65 female participants were included. Participants were assigned into three groups: control group (N = 20), osteopenic group (N = 22), and osteoporotic group (N = 23). A standard aerobic exercise protocol was followed for 12 weeks. Endurance exercise protocol involved three sessions weekly for 60 minutes each. At basal level and after the experiment, the following parameters were assessed: body mass index (BMI), bone-specific alkaline phosphatase (BAP), T-score, bone mineral density (BMD), and calcium. The analysis of data was carried out using SPSS version 21. The difference in means was computed based on t-test. Significance was considered at p < 0.05.Results:Aerobic training exercise improved the levels of all parameters in all groups for both sexes significantly, including BMI, BAP, T-score, BMD, and calcium (p < 0.05).Conclusion:Aerobic training exercise improves bone health and restores the hemostasis of bone tissue by restoring bone biomarkers, including BAP and calcium.

Undercarboxylated Osteocalcin: Experimental and Human Evidence for a Role in Glucose Homeostasis and Muscle Regulation of Insulin Sensitivity.

Recent advances have indicated that osteocalcin, and in particular its undercarboxylated form (ucOC), is not only a nutritional biomarker reflective of vitamin K status and an indicator of bone health but also an active hormone that mediates glucose metabolism in experimental studies. This work has been supported by the putative identification of G protein-coupled receptor, class C, group 6, member A (GPRC6A) as a cell surface receptor for ucOC. Of note, ucOC has been associated with diabetes and with cardiovascular risk in epidemiological studies, consistent with a pathophysiological role for ucOC in vivo. Limitations of existing knowledge include uncertainty regarding the underlying mechanisms by which ucOC interacts with GPRC6A to modulate metabolic and cardiovascular outcomes, technical issues with commonly used assays for ucOC in serum, and a paucity of clinical trials to prove causation and illuminate the scope for novel health interventions. A key emerging area of research is the role of ucOC in relation to expression of GPRC6A in muscle, and whether exercise interventions may modulate metabolic outcomes favorably in part via ucOC. Further research is warranted to clarify potential direct and indirect roles for ucOC in human health and cardiometabolic diseases.

P.14 - Testosterone therapy in patients with Duchenne muscular dystrophy and glucocorticoid-induced pubertal delay

Glucocorticoid therapy slows disease progression in Duchenne muscular dystrophy (DMD), but causes significant adverse effects, including delayed puberty or hypogonadism, obesity, insulin resistance and osteoporosis. Lack of puberty or hypogonadism further increases risk for osteoporosis and affects quality of life, but is not consistently addressed in DMD care. We sought to determine if testosterone therapy could induce puberty, and to examine the effects of testosterone therapy on body composition, bone health and metabolic indices, in glucocorticoid-treated patients with DMD. We reviewed medical records of boys with DMD on long-term glucocorticoid therapy, who were treated with testosterone for delayed (n = 31) or arrested (n = 2) puberty. Outcomes of interest were endogenous pubertal development; changes in body composition; bone mineral density and content of lumbar spine, whole body and lateral distal femur by dual-energy X-ray absorptiometry; and metabolic laboratory indices. Changes in bone health measures within 2.5 years prior to treatment were compared to changes up to 2.5 years after treatment initiation. Thirty-three male patients (median age 15.0 years, 27% ambulatory) on glucocorticoid therapy (median duration 7.7 years) were treated with testosterone therapy for a median of 37 (range 4.1 to 73.5) months. Endogenous puberty developed in 45% of previously pre-pubertal boys after starting testosterone. We observed increases in spine and whole body absolute bone mineral content (p = 0.03 and 0.0002 respectively), and stabilization of fat mass and percentage of total body fat accrual, when comparing post- to pre-testosterone treatment initiation. Although longer-term data are needed, testosterone therapy should be considered in the management of glucocorticoid-treated male patients with DMD who experience delayed puberty.

Factors Associated with Bone Health in Malaysian Middle-Aged and Elderly Women Assessed via Quantitative Ultrasound

Risk factors for osteoporosis may vary according to different populations. We aimed to investigate the relationship between risk factors of osteoporosis and bone health indices determined via calcaneal quantitative ultrasound (QUS) in a group of Malaysian women aged 50 years or above. A cross-sectional study was performed on 344 Malaysian women recruited from a tertiary medical centre in Kuala Lumpur, Malaysia. They answered a self-administered questionnaire on their social-demographic details, medical history, lifestyle, and physical activity status. Their height was measured using a stadiometer, and their body composition estimated using a bioelectrical impedance device. Their bone health status was determined using a water-based calcaneal QUS device that generated three indices, namely speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI). A T-score was computed from SI values using a reference database from a mainland Chinese population. Women with three or more lifetime pregnancies, who were underweight and not drinking coffee had a significantly lower BUA. Stepwise multiple linear regression showed that SOS was predicted by age alone, BUA and SI by years since menopause, body mass index (BMI), and number of lifetime pregnancies, and T-score by years since menopause and percentage of body fat. As a conclusion, suboptimal bone health in middle-aged and elderly Malaysian women as indicated by QUS is associated with old age, being underweight, having a high body fat percentage, and a high number of lifetime pregnancies. Women having several risk factors should be monitored more closely to protect their bones against accelerated bone loss.

Effects of a 20-week high-intensity strength and sprint training program on tibial bone structure and strength in middle-aged and older male sprint athletes: a randomized controlled trial.

High-load, high-speed and impact-type exercise may be an efficient way of improving bone strength even in old age. We evaluated the effects of combined strength and sprint training on indices of bone health in competitive masters athletes, who serve as a group of older people who are likely to be able to participate in vigorous exercise of this kind. Seventy-two men (age 40-85) were randomized into an experimental (EX, n=40) and a control (CTRL, n=32) group. EX participated in a 20-week program combining heavy and explosive strength exercises with sprint training. CTRL maintained their usual, run-based sprint training schedules. Bone structural, strength and densitometric parameters were assessed by peripheral QCT at the distal tibia and tibial midshaft. The intervention had no effects on distal tibia bone traits. At the mid-tibia, the mean difference in the change in cortical thickness (ThCO) in EX compared to CTRL was 2.0% (p=0.007). The changes in structure and strength were more pronounced in the most compliant athletes (training adherence >75%). Compared to CTRL, total and cortical cross-sectional area, ThCO, and the area and density-weighted moments of inertia for the direction of the smallest flexural rigidity (I minA , I minD ) increased in EX by 1.6-3.2% (p=0.023-0.006). Polar mass distribution analysis revealed increased BMC at the anteromedial site, whereas vBMD decreased (p=0.035-0.043). Intensive strength and sprint training improves mid-tibia structure and strength in middle-aged and older male sprint athletes, suggesting that in the presence of high-intensity loading exercise, the adaptability of the bone structure is maintained during aging.

Calcium intake below the recommended dietary allowance is associated with lower tibia bone mineral content and strength in young adults entering initial military training

BackgroundCalcium (Ca), a critical micronutrient for bone health, has been deemed a nutrient of public health concern due to consumption at levels below the recommended dietary allowance (RDA). Stress fracture risk is elevated during initial military training (IMT) and supplemental Ca during IMT reduces stress fracture incidence.ObjectiveTo assess dietary Ca in young adults entering IMT and to determine whether habitual Ca intake is associated with indices of bone health at the tibia, a commonly fractured site.MethodsA retrospective analysis was performed using baseline data from 3 randomized control trials that assessed the efficacy of Ca and vitamin D supplementation for optimizing bone health during IMT in Army, Air Force, and Marine recruits. Ca intake was estimated from a semi‐quantitative food frequency questionnaire and adequacy was based on the age‐specific RDAs. Bone health was evaluated by peripheral quantitative computed tomography (pQCT) of the tibia at the metaphysis and diaphysis. The associations between pQCT parameters and Ca intake adequacy were assessed by multivariate regression (SPSS, v21) controlling for age, sex, race, self‐reported physical activity, BMI, smoking, education level, and use of Depo Provera.ResultsOf the 399 study participants (n=223 females, n=180 males), 251 (62%) did not meet the RDA for Ca. Adequate Ca intake was positively associated with total bone mineral content (BMC; B=.091, p=.005) and strength (B=.084, p=.020) at the metaphysis. When participants were stratified by sex, 70% of females and 52% of the males did not meet the RDA. In the female cohort, adequate Ca intake was positively associated with BMC (B=.169, p=.011) and strength (B=.142, p=.033) at the metaphysis and cortical BMC (B=.134, p=.042) at the diaphysis. There were no associations in the male cohort.ConclusionAdequate Ca intake in young adults is positively associated with measures of tibia BMC and strength. As recruits with Ca intake below the RDA at the start of training may experience diminished bone health potentially leading to greater injury susceptibility, adequate Ca intake should be emphasized prior to initiating military training.Disclaimer: The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or the U.S. Government.Support or Funding InformationResearch supported by USAMRMC, DHP, and in part by an appointment to the Postgraduate Research Participation Program administered by the Oak Ridge Institute for Science and Education.

Dietary and age influences on bone health indices in pre-menopausal Brazilian women: preliminary results of the D-SOL Study

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Bone Mineral Density in Celiac Disease.

To study bone mineral density (BMD) and standard serum biochemical indices among newly diagnosed and already diagnosed cases of Celiac Disease (CD) on gluten free diet for at least one year. This hospital based analytic, observational study was done at a tertiary care centre, from April 2013 through June 2014. Thirty six children (20 females) with untreated CD at diagnosis (Group A) and 36 age and sex matched children on gluten-free diet for at least one year (Group B) were studied. Serum measurements of biochemical bone health indices and BMD, assessed by dual X-ray absorptiometry, were obtained. BMD Z-score was significantly low in newly diagnosed celiac patients. Patients on gluten free diet had higher BMD Z-score as compared to newly diagnosed patients (-2.02 vs. -0.65 respectively, p<0.001). BMD Z-score was high in GI symptom patients as compared to non-GI symptom patients (-0.46+/-0.89 vs.-0.88=+/-0.94) in Group B. In female patients BMD Z-score was comparatively low as compared to male patients in both groups but difference was not significant. In Group A the mean serum calcium level was lower than the patients in Group B (8.72+0.73 vs. 9.34+0.65, p<0.001). S. calcium levels were not correlated with bone mineral density (BMD) in both groups (P value >0.05). Children with CD are at risk for reduced BMD. Strict gluten-free diet significantly improves bone mineralization. Early diagnosis and treatment of celiac disease during childhood may protect CD patients from osteoporosis.

Bone health measures in glucocorticoid-treated ambulatory boys with Duchenne muscular dystrophy

Osteoporosis is a major problem in boys with Duchenne Muscular Dystrophy (DMD), attributable to muscle weakness and glucocorticoid therapy. Consensus regarding bone health assessment and management is lacking. Lumbar spine areal bone mineral density (defined as bone mass per area of bone) by dual-energy X-ray absorptiometry (DXA) is frequently the primary measure used, but has limitations for boys with DMD. We retrospectively studied 292 ambulant glucocorticoid-treated boys with DMD categorized by functional mobility score, FMS 1, 2 or 3. We assessed DXA whole body and lumbar spine areal bone mineral density and content Z-scores adjusted for age and height, lateral distal femur areal bone mineral density Z-scores, frequency of fractures, and osteoporosis by International Society for Clinical Densitometry 2013 criteria. Whole body and femoral DXA indices decreased, while spine fractures increased, with declining motor function. Lumbar spine areal bone mineral density Z-scores appeared to improve with declining motor function. Bone mineral content Z-scores were consistently lower than corresponding bone mineral density Z-scores. Our findings highlight the complexity of assessing bone health in boys with DMD. Bone health indices worsened with declining motor function in ambulant boys, but interpretation was affected by measure and skeletal site examined. Whole body bone mineral content may be a valuable measure in boys with DMD. Lumbar spine areal bone mineral density Z-score as an isolated measure could be misleading. Comprehensive management of osteoporosis in boys with DMD should include vertebral fracture assessment.

Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia.

BackgroundOsteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia.MethodsA cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices.ResultsThe prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05).ConclusionA significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.

Current and past menstrual status is an important determinant of femoral neck geometry in exercising women

Menstrual status, both past and current, has been established as an important determinant of bone mineral density (BMD) in young exercising women. However, little is known regarding the association between the cumulative effect of menstrual status and indices of bone health beyond BMD, such as bone geometry and estimated bone strength. PurposeThis study explores the association between cumulative menstrual status and indices of bone health assessed using dual-energy x-ray absorptiometry (DXA), including femoral neck geometry and strength and areal BMD (aBMD), in exercising women. Methods101 exercising women (22.0±0.4years, BMI 21.0±0.2kg/m2, 520±40min/week of self-reported exercise) participated in this cross-sectional study. Women were divided into three groups as follows based on their self-reported current and past menstrual status: 1) current and past regular menstrual cycles (C+P-R) (n=23), 2) current and past irregular menstrual cycles (C+P-IR) (n=56), 3) and current or past irregular cycles (C/P-RIR) (n=22). Current menstrual status was confirmed using daily urinary metabolites of reproductive hormones. DXA was used to assess estimates of femoral neck geometry and strength from hip strength analysis (HSA), aBMD, and body composition. Cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), strength index (SI), diameter, and section modulus (Z) were calculated at the femoral neck. Low CSMI, CSA, SI, diameter, and Z were operationally defined as values below the median. Areal BMD (g/cm2) and Z-scores were determined at the lumbar spine, femoral neck, and total hip. Low BMD was defined as a Z-score<−1.0. Chi-square tests and multivariable logistic regression were performed to compare the prevalence and determine the odds, respectively, of low bone geometry, strength, and aBMD among groups. ResultsCumulative menstrual status was identified as a significant predictor of low femoral neck CSMI (p=0.005), CSA (p≤0.024), and diameter (p=0.042) after controlling for confounding variables. C+P-IR or C/P-RIR were four to eight times more likely to exhibit low femoral neck CSMI or CSA when compared with C+P-R. Lumbar spine aBMD and Z-score were lower in C+P-IR when compared with C+P-R (p≤0.003). A significant association between menstrual group and low aBMD was observed at the lumbar spine (p=0.006) but not at the femoral neck or total hip (p>0.05). However, after controlling for confounding variables, cumulative menstrual status was not a significant predictor of low aBMD. ConclusionIn exercising women, the cumulative effect of current and past menstrual irregularity appears to be an important predictor of lower estimates of femoral neck geometry, as observed by smaller CSMI and CSA, which may serve as an another means, beyond BMD, by which menstrual irregularity compromises bone strength. As such, evaluation of both current and past menstrual status is recommended to determine potential risk for relatively small bone geometry at the femoral neck.

Effects of recreational soccer on physical fitness and health indices in sedentary healthy and unhealthy subjects.

Recreational soccer (RS) is becoming a popular alternative to the classical continuous exercise mode used for the improvement of cardiovascular and metabolic fitness in untrained people. The objective of this paper was to conduct a detailed systematic review of the literature, identifying the physiological responses to RS and the training effects of RS on aerobic fitness and health in untrained healthy individuals and clinical patients. PubMed, Google Scholar and ScienceDirect databases were searched using terms related to recreational soccer. Inclusion criteria were randomized controlled trials (RCT) that assessed acute physiological responses to RS or the training effects of RS on physical fitness and health in sedentary, untrained subjects of any age or health status. All studies were assessed for methodological quality using the PEDro scale. Thirty-five articles met the inclusion criteria; seven examined the acute response to RS, and 28 assessed training effects. Clear evidence was found that RS had positive effects on many health-related indices and variables, including VO2max (gains of 7-16%), blood pressure (reductions of 6-13 mmHg), body composition (decreased fat mass and improved indices of bone health), and metabolic and cardiac function. These positive effects were observed in both healthy individuals and clinical patients, irrespective of age or sex. Although this review provides clear evidence of the positive effects of RS on health, most studies had limitations of methodology (an average PEDro score < 6). Furthermore, many of the training studies were from a small number of research groups. Future studies should be extended to other countries and institutions to ensure generality of the results. Regular RS training leads to significant cardiovascular and muscular adaptations and gains of health both in sedentary individuals and clinical patients at all ages, suggesting that RS is a potentially highly motivational method to enhance population health.

Handgrip strength as a predictor of bone mineral density in outpatients with cirrhosis.

Osteoporosis is well recognized as a cirrhosis complication; however, most studies assessing this condition included only patients on liver transplantation lists with an elevated rate of bone diseases. While general population studies show that handgrip strength is clearly associated with bone mineral density, until now this tool has not been applied to patients with cirrhosis in relation to their bone condition. This study aimed to evaluate whether handgrip strength, bone, and liver tests may be useful as predictors of bone disease in outpatients with cirrhosis. One hundred twenty-nine subjects were included (77 men and 52 women). Dual-energy X-ray absorptiometry was applied to evaluate lumbar-spine and femoral-neck T scores. Osteoporosis/osteopenia rates were 26.3%/35.6% in the lumbar spine and 6.9%/41.8% in the femoral neck, respectively. Model selections were based on backward procedures to find the best predictors of low T scores. For lumbar spine, only low handgrip strength and high parathyroid hormone levels were clearly related to low T scores. For femoral neck, only age was associated with low T scores. Handgrip strength may serve as an effective predictor of low lumbar spine T score among outpatients with cirrhosis. As cirrhosis affects the lumbar spine more than the femoral neck, these results suggest that handgrip strength should be tested in all patients with cirrhosis as a first indicator of bone health.

The effect of hyperinsulinaemic-euglycaemic clamp and exercise on bone remodeling markers in obese men.

Bone remodelling markers (BRMs) are suppressed following a glucose load and during glucose infusion. As exercise increases indices of bone health and improves glucose handling, we hypothesised that, at rest, hyperinsulinaemic-euglycaemic clamp will suppress BRMs in obese men and that exercise prior to the clamp will prevent this suppression. Eleven obese nondiabetic men (age 58.1±2.2 years, body mass index=33.1±1.4 kg m(-2) mean±s.e.m.) had a hyperinsulinaemic-euglycaemic clamp (HEC) at rest (Control) and 60 min post exercise (four bouts × 4 min cycling at 95% of hazard ratiopeak). Blood samples were analysed for serum insulin, glucose, bone formation markers, total osteocalcin (tOC) and procollagen type 1 N-terminal propeptide (P1NP), and the bone resorption marker, β-isomerised C-terminal telopeptides (β-CTx). In the control trial (no exercise), tOC, P1NP and β-CTx decreased with HEC by >10% compared with baseline (P<0.05). Fasting serum glucose, but not insulin, tended to correlate negatively with the BRMs (β range -0.57 to -0.66, p range 0.051-0.087). β-CTx, but not OC or P1NP, increased within 60 min post exercise (∼16%, P<0.01). During the post-exercise HEC, the glucose infusion rate was ∼30% higher compared with the no exercise trial. Despite this, BRMs were only suppressed to a similar extent as in the control session (10%). HEC suppressed BRMs in obese men. Exercise did not prevent this suppression of BRMs by HEC but improved glucose handling during the trial. It remains to be tested whether an exercise intervention of longer duration may be able to prevent the effect of HEC on bone remodelling.

Bone status in glucocorticoid-treated men and women.

We recorded the results of areal bone mineral density (aBMD) and microarchitecture of the bone measured by trabecular bone score (TBS) in 416 glucocorticoid-treated men and women aged 40 years and older with or without fracture to 1104 controls. TBS better discriminated those with fracture compared to aBMD. These differences were the greatest in men. The aim of this study is to evaluate glucocorticoid (GC)-induced effects on areal bone mineral density (aBMD) and bone microarchitectural texture measured by trabecular bone score (TBS). TBS and aBMD were evaluated at L1-L4 postero-anterior (PA) spine by dual X-ray absorptiometry (DXA) in 1520 men and women aged 40 years and over. Four hundred sixteen subjects who received GCs (≥5 mg/day, for ≥3 months) were matched with 1104 sex-, age-, and BMI-matched control subjects. Clinical data, osteoporotic fractures (OPF), and dietary habits were documented in the medical report. GC-treated patients were characterized by a significant decrease of TBS (1.267 vs. 1.298, p < 0.001) compared with control-matched subjects while no change in BMD was observed at any sites. These decreases were even more pronounced when fracture status was taken into account (1.222 vs. 1.298, p < 0.001). The odds ratio (OR) for TBS was 1.44 (1.095-1.89) for OPF, whereas no association was found for BMD at any sites (all p > 0.3). A similar effect on microarchitecture measured by TBS was seen by the presence of fracture as by the use of glucocorticoids. An influence on TBS by sex was also noted with a decrease in TBS of greater magnitude in men. GC-treated individuals have a significant deterioration of bone microarchitectural texture as assessed by TBS which is more marked in those with OPF and in men. TBS seems to be more sensitive than aBMD for GC-related fracture detection and should be a good surrogate indicator of bone health in such secondary osteoporosis.

Relationship between physical function, disease activity, spinal mobility and bone parameters (trabecular bone score and bone mineral density) in ankylosing spondylitis patients

This study aimed to evaluate the relationship between physical function, disease activity, spinal mobility and bone parameters in ankylosing spondylitis (AS) patients. Fifty patients (27 men and 23 women) were examined. The clinical assessment included Bath AS Disease Activity Index, AS Disease Activity Score, Bath AS Functional Index, Bath AS Metrology Index (BASMI). Lumbar spine and femoral neck bone mineral density (BMD), spinal trabecular bone score (TBS) and the TBS T-score were calculated by dual-energy X-ray absorptiometry. Prevalence rates for osteoporosis and osteopaenia were 14% and 36%, respectively and for partially and fully degraded microarchitecture – 34% and 16%, respectively. A similar inverse correlation was observed between BASMI and TBS, TBS T-score and femoral BMD bone parameters, which were significantly lower in patients ≥45 years of age. No significant correlations were detected between any bone parameter and indicators of disease activity and physical function. Patients with a disease duration of ≥10 years tended to exhibit either normal or elevated spine BMD. Femoral BMD was lower in men. The higher BASMI was associated with an increased likelihood of TBS < 1.350 (odds ratio (OR) = 1.44, 1.05–1.97, p = 0.024) and TBS T-score < –1.00 (OR = 1.55, 1.11–2.16, p = 0.01). In summary, lumbar spine BMD can be erroneously influenced by osteoproliferation, unlike the TBS and TBS T-score. The limitations in spinal mobility predicted abnormal results for these two TBS parameters. TBS may be a better indicator of bone health than BMD in AS.