Lower Bone Mineral Density Values Research Articles

Assessment of bone health in pregnancy

We performed a review of the literature on the use of radiofrequency echographic multi spectrometry (REMS) technology in pregnancy, in order to assess bone mineral density (BMD) and objectively measure its reduction during pregnancy. In a prospective case-control observational study, 78 women at 39.1 ± 1.5 weeks of gestation were submitted to a sonographic examination of the proximal femur using REMS technology to quantify BMD. The study group, when compared with a control group of non-pregnant women, was found to have significantly lower BMD values (0.769±0.094 g/cm2 vs. 0.831±0.101 g/cm2, p = 0.0001) with a mean reduction of 8.1%. Lower BMD values were found in older women (p<0.0001), women with a lower BMI (p=0.0004), and Caucasian women (p<0.0001). In another study, 65 pregnant women underwent femoral BMD measurement in the first and the third trimester using REMS. A significant reduction in BMD (0.723±0.069 vs. 0.709±0.069 g/cm2; p<0.001) was noted, with a mean change of −1.9±0.6% between the first and the third trimester. On multivariable linear regression analysis, none of the population characteristics was independently associated with BMD changes. In conclusion, decreased BMD in pregnancy has been demonstrated using REMS technology. Further studies are needed to identify risk factors for decreased BMD in pregnancy. KEY WORDS: Bone mineral density, REMS, ultrasound technology, pregnancy.

Bone mineral density parameters and related nutritional factors in vegans, lacto-ovo-vegetarians, and omnivores: a cross-sectional study.

The growing prevalence of vegetarianism determines the need for comprehensive study of the impact of these diets on health and particularly on bone metabolism. We hypothesized that significant dietary differences between vegans, lacto-ovo-vegetarians, and omnivores also cause significant differences in their nutrient status, which may affect bone health. The study assessed dual-energy X-ray absorptiometry parameters in lumbar spine and femoral neck, average nutrient intake, serum nutrient concentrations, serum PTH levels, and urinary pH among 46 vegans, 38 lacto-ovo-vegetarians, and 44 omnivores. There were no differences in bone mineral density (BMD) between the groups. However, the parathyroid hormone (PTH) levels were still higher in vegans compared to omnivores, despite the same prevalence of hyperparathyroidism in all groups. These findings may probably be explained by the fact that each group had its own "strengths and weaknesses." Thus, vegans and, to a lesser extent, lacto-ovo-vegetarians consumed much more potassium, magnesium, copper, manganese, and vitamins B6, B9, and C. At the same time, the diet of omnivores contained more protein and vitamins D and B12. All the subjects consumed less vitamin D than recommended. More than half of vegans and omnivores had insufficiency or even deficiency of vitamin D in the blood. Low serum concentrations of manganese with its quite adequate intake are also noteworthy: its deficiency was observed in 57% of vegans, 79% of lacto-ovo-vegetarians, and 63% of omnivores. Currently, it is no longer possible to conclude that lacto-ovo-vegetarians have lower BMD than omnivores, as our research supported. Vegans in our study also did not demonstrate lower BMD values, only higher PTH blood concentrations, compared to omnivores, however, a large number of studies, including recent, show the opposite view. In this regard, further large-scale research is required. Vegans and lacto-ovo-vegetarians now have a variety of foods fortified with vitamins D and B12, as well as calcium. There is also a great diversity of ethically sourced dietary supplements. The found low concentrations of manganese require further investigation.

Effects of Antipsychotics on Bone Mineral Density in Schizophrenia

Abstract Previous researches have shown that patients with schizophrenia who were using antipsychotics in their treatment developed changes in Bone Mineral Density and body composition, leading to osteoporosis and modifications in weight, skeletal muscle mass index and percent of fat tissue. Results of many studies suggested that the use of antipsychotic causes hyperprolactinemia and consequently lower bone mineral density values were observed. Further, antipsychotics increase food intake and have possible effects on metabolism, causing changes in weight, glucose level and lipid status, all of which can be a risk for developing metabolic syndrome and result in changing of bone mineral density. Antipsychotics change cytokine profiles in patients with schizophrenia and on the other hand the influence of T cells, B cells and inflammatory cytokines on osteoclasts and on osteoblasts was also established. In assessing the effects of antipsychotic on bone metabolism very important is to consider the duration of the treatment and clinical course of the disease, but undeniable effect is careless life style and inadequate physical activity that patients with schizophrenia have. Our attempt is to give an overview of the newest findings in this field, regarding the direct effects of antipsychotics on the bone metabolism, but also through prolactine elevation, metabolic and immune changes. Better understanding of the underlying mechanisms of schizophrenia and changes in bone mineral density could improve our clinical practice: affect to choice of the individually most appropriate antipsychotic, point to the need to monitor possible immunmetabolic changes during the treatment and improvement of the life quality of this vulnerable population.

The difficulties of diagnosing and determining the tactics of treating osteoporosis in severe spinal scoliosis case

A female patient with early surgical menopause and severe S-shaped scoliosis was diagnosed with osteoporosis at the place of residence and treated with a bisphosphonate (zoledronic acid). Despite the deformity of the spine and chest, the patient had no complaints until recently and led an active lifestyle. During X-ray densitometry at the National Medical Research Center for Therapy and Preventive Medicine, in particular when examining the lumbar spine, there were difficulties with positioning the patient for correct scanning of the area of interest and, as a result, obtaining information about the true state of trabecular bone tissue. Bone mineral density (BMD) in the proximal femur was consistent with osteopenia. Additional laboratory and instrumental parameters, such as biochemical markers of bone remodelling (osteocalcin and C-terminal type 1 collagen telopeptide) and trabecular bone score (TBS), also did not allow to precise the risk of fractures and make an unambiguous conclusion about the necessity of continuing antiresorptive therapy. Given the low BMD values in lumbar spine (T-score -4.8 SD) and the possibility of developing vertebral compression fractures as a result of minimal trauma with further chest deformity progression and vital organs failure, it was decided to continue treatment with zoledronic acid. Further therapeutic tactics will be determined after the next scheduled examination in 1 year.

Fragility spinal fractures among cirrhotic liver transplant candidates in Croatia

IntroductionExisting data on fragility spinal fractures prevalence in liver transplant candidates are scarce and inconsistent. This may be due to other comorbidities, besides hepatic osteodystrophy (HO), that contribute to bone loss and fragility fracture prevalence in chronic liver disease (CLD). ObjectivesThe aim of this study was to investigate the prevalence of spinal thoracic and lumbar fragility fractures among cirrhotic, non-chronic kidney disease (CKD), non-diabetic liver transplant candidates and to explore their relationship with clinical characteristics, laboratory markers and dual-energy x-ray absorptiometry (DXA) results. Material and methodsThis cross-sectional observational study was conducted at Merkur University Hospital, Croatia, between February 2019 and May 2023. Adult patients with liver cirrhosis referred for liver transplantation were included. Patients with acute infection, CKD, diabetes mellitus, malignancies, inflammatory bone diseases and those on corticosteroid or antiresorptive therapy were excluded. Clinical, laboratory and radiological assessment was carried out and patients were accordingly allocated into non-fractured and fractured group for the purpose of statistical analysis. ResultsA total of 90 patients were included in the study. There was 123 fractures, 87 (70.7 %) in the thoracic and 36 (29.3 %) in the lumbar region. Eighty-nine (72.4 %) fractures were grade 1, 31 (25.2 %) were grade 2 and 3 (2.4 %) were grade 3. Patients in the fractured group were significantly older (p < 0.001). No significant differences between fractured and non-fractured group according to laboratory and DXA parameters were noted. Subgroup with lumbar fractures had significantly lower bone mineral density values at L1-L4 region. Statistically significant negative correlation between bone specific alkaline phosphatase (BALP) and hip total BMD (rho = -0.414, p < 0.001) and spine total BMD (rho = -0.258, p = 0.014) values was found. ConclusionPresent study confirmed detrimental impact of CLD and HO on bone strength. DXA measurement correlated with the presence of lumbar fragility fractures. A combination of standard X-ray imaging and DXA is needed for adequate bone evaluation in pretransplant period and BALP could be useful for detecting HO in CLD. Searching for other risk factors and implementing bone turnover markers and additional imaging techniques for bone loss evaluation in liver transplant candidates is needed.

The relationship of body mass index and T score in healthy and knee osteoarthritis women

Background: Osteoarthritis (OA) is a chronic, degenerative, slowly progressive disease common in women with multiple aetiology. Osteoarthritis occurs simultaneously with the reduction in bone mineral density (BMD)while a high bone mass index (BMI) value is one of the risk factors for OA. Objective: The purpose of this study was to determine the effect of BMI and BMD in healthy and knee OA women. Method: The study was conducted in an orthopaedic outpatient clinic in 2021. This is a quantitative descriptive study with accidental cross-sectional samplings. The Mann-Whitney test was used to analyse the data. Result: Subjects included in the inclusion criteria obtained 74 OA and 49 control groups. The largest subjects in the OA group were aged 56-65 years old (32, 43.24%), obese (51, 68.92%), and post-menopause (49, 66.22%). At the same time, the T score category was normal (14, 18.91%), osteopenia (22, 29.73%), and osteoporosis (38, 51.35%). Statistical analysis found a significant relationship between BMI and BMD (p = 0.002, p = 0.001) in controls and OA groups. Conclusion: Disorders of BMI and BMD are indicators of risk for OA. High BMI and low BMD values occur in women with knee OA. There is a relationship between BMI and BMD in healthy and knee OA women.

Prognostic Value of Diaphragm Diameter, Muscle Volume, and Bone Mineral Density in Critically Ill COVID-19 Patients.

Objective: We aimed to analyze the prognostic value of muscle volume (MV), bone mineral density (BMD), and diaphragm diameter (DD) in COVID-19. Method: The study included 498 patients admitted to the intensive care unit (ICU) with a positive polymerase chain reaction test for COVID-19 from March 11, 2020, through August 31, 2022. The patients' laboratory and demographic data of the patients at the time of ICU admission were recorded. MV, DD, and BMD measurements were performed using computed tomography examinations. Muscle index (MI) was calculated as MV/height2. Quartiles were determined for all 4 measurements. Patients in the lowest quartile were recorded as having low MV, MI, DD, and BMD values. The parameters were evaluated for the whole group and compared according to gender and mortality. The multiple regression analysis was performed for the prediction of mortality. Results: In the mortality group, the male and female patients had significantly statistically lower values in MV (P < .001 and P = .002, respectively), MI (P < .001 and P = .005, respectively), DD (P < .001 and P < .001, respectively), and BMD (P = .002 and P < .001, respectively). In the multiple regression analysis, low MI (OR: 2.03, 95% CI: 1.14-3.61, P = .016) and DD (OR: 10.47, 95% CI: 5.59-19.59, P < .001) values remained significant for the prediction of mortality. Conclusion: BMD is a risk factor for mortality in patients with severe COVID-19, but cannot be used as an independent predictor. However, MI and DD can be used as independent predictors of mortality even in severe cases.

Serum Intact Fibroblast Growth Factor 23 Levels Are Negatively Associated with Bone Mineral Density in Chronic Hemodialysis Patients

(1) Background: Fibroblast growth factor 23 (FGF23) is predominantly secreted from bone and plays an important role in mineral balance in chronic kidney disease. However, the relationship between FGF23 and bone mineral density (BMD) in chronic hemodialysis (CHD) patients remains unclear. (2) Methods: This was a cross-sectional observational study that involved 43 stable outpatients on CHD. A linear regression model was used to determine risk factors for BMD. Measurements included serum hemoglobin, intact FGF23 (iFGF23), C-terminal FGF23 (cFGF23), sclerostin, Dickkopf-1, α-klotho, 1,25-hydroxyvitamin D, intact parathyroid hormone levels and dialysis profiles. (3) Results: Study participants had a mean age of 59.4 ± 12.3 years, and 65% were male. In the multivariable analysis, cFGF23 levels showed no significant associations with the BMD of the lumbar spine (p = 0.387) nor that of the femoral head (p = 0.430). However, iFGF23 levels showed a significant negative association with the BMD of the lumbar spine (p = 0.015) and that of the femoral neck (p = 0.037). (4) Conclusions: Among patients on CHD, higher serum iFGF23 levels, but not serum cFGF23 levels, were associated with lower BMD values of the lumbar spine and femoral neck. However, further research is required to validate our findings.

Low Bone Mineral Density and Associated Risk Factors in Elite Cyclists at Different Stages of a Professional Cycling Career.

This study aimed to assess the prevalence of low bone mineral density (BMD) in male and female elite cyclists at different stages of a professional cycling career and to identify potential risk factors of low BMD. In this cross-sectional study, 93 male and female early career, advanced career, and postcareer elite cyclists completed dual-energy x-ray absorptiometry at the hip, femoral neck, lumbar spine, and total body; blood sampling; assessment of training history and injuries; and the bone-specific physical activity questionnaire. Backward stepwise multiple regression analyses were conducted to explore associations between BMD and its potential predictors in early and advanced career (i.e., active career) cyclists. With a mean Z -score of -0.3 ± 0.8, -1.5 ± 1.0, and -1.0 ± 0.9, low BMD ( Z -score < -1) at the lumbar spine was present in 27%, 64%, and 50% of the early, advanced, and postcareer elite male cyclists, respectively. Lumbar spine Z -scores of -0.9 ± 1.0, -1.0 ± 1.0, and 0.2 ± 1.4 in early, advanced, and postcareer elite female cyclists, respectively, indicated low BMD in 45%, 45%, and 20% of these female subpopulations. Regression analyses identified body mass index, fracture incidence, bone-specific physical activity, and triiodothyronine as the main factors associated with BMD. Low BMD is highly prevalent in elite cyclists, especially in early career females and advanced career males and females. These low BMD values may not fully recover after the professional cycling career, given the substantial prevalence of low BMD in retired elite cyclists. Exploratory analyses indicated that low BMD is associated with low body mass index, fracture incidence, lack of bone-specific physical activity, and low energy availability in active career elite cyclists.

Bone Mineral Density in Children with Congenital Adrenal Hyperplasia

Background: C Treatment in all forms of CAH includes lifelong replacement of steroids. Steroids have an impact on bone health in multiple ways and are known to cause osteoporosis when given in high doses or for a longer duration. Objective: To evaluate bone mineral density (BMD), using dual-energy X-ray absorptiometry (DEXA) scan in children with CAH taking long-term steroids presenting in the pediatric endocrinology ward of National Institute of Child Health, (NICH) Karachi, Pakistan. Materials and Methods: This cross-sectional study was performed at the Department of Pediatric Endocrinology, National Institute of Child Health, Karachi from October 2021 to July 2022. A total of 47 diagnosed cases of CAH taking steroids for more than 5 years were enrolled. Assessment of BMD was done using a DEXA scan. Lumbar spine BMD was done and Z-score was modified for height for age z-score. The dose of steroids and duration was calculated. Results: Out of 47 patients, low BMD was observed in 8 (17.02%) patients. Individuals with low BMD had significantly higher median duration, (p=0.017), dose (p=0.003), and median alkaline phosphate level (p=0.036),) but low median BMD value (p=0.009) and z score (p&lt;0.001) than normal BMD individuals. Although median bone age (p=0.009) was appropriate for chronologic age in low BMD patients. A moderate negative significant correlation was observed between z score and age (rho=-0.319, p=0.029), z-score and duration of steroid treatment (rho=-0.364, p=0.012), z score and alkaline phosphate (rho=-0.466, p=0.001), z score and bone age (rho=-0.378, p=0.009). Conclusion: Low BMD was observed in 17% of children on the DEXA scan. Moreover, these individuals had significantly higher median average duration and dose of hydrocortisone.

Osseous microarchitecture in frequent fracture zones of the distal clavicle.

Fracture classifications of the distal clavicle are based on ligamentous integrity. The influence of osseous microarchitecture on fracture occurrence, morphology, and the lesion's stability has not yet been investigated. We aimed to characterize osseous microarchitecture according to common fracture classification systems based on ligamentous integrity and investigated the possible effects of age, gender, and osteoporosis in distal clavicle fractures. N=20 human cadaveric distal clavicles were scanned using XtremeCT with an isometric voxel size of 82 μm. In the sagittal plane, each data set was evaluated in 11 sections of approximately 7 mm thickness. Three topographic regions were defined: the bone lateral to the trapezoid (LTR), intertubercular (ITR), and medial to the conoid (MCR) ligament. Cortical bone mineral density (BMD) [mgHA/cm3] and cortical porosity (1- (BV/TV) [%]) were determined and evaluated relative to age and gender. Along the mediolateral axis, there was an >20-fold increase in median cortical porosity (P≤.001). There were significant differences in cortical porosity between LTR and ITR (P≤.001) but not between ITR and MCR (P=.09). In ITR, cortical porosity was significantly greater in >60-year-old compared to younger donors (P=.01). For BMD, there was an >2-fold decrease toward the distal apex (P≤.001). BMD was significantly greater in ITR compared to LTR (P≤.001) and in MCR compared to ITR (P=.02). In ITR and MCR, clavicles of >60-year-old donors had significantly lower BMD values compared to younger donors (P<.01). Across all 3 regions, frequency distribution of low bone mass did not significantly differ between <60-year-olds and >60-year-olds (P>.6). The distal clavicle features a characteristic bony microarchitecture. The present study revealed a significant difference in bone quality of lateral, intertubercular, and medial zones of the distal clavicle and could specify target areas and strategies for surgical treatment of unstable fractures. Age, gender, and osteoporosis have a limited effect on bone quality and fracture genesis. In contrast, ligamentous quality is supposed to exert a substantial influence on fracture characteristics, especially in ITR. Fracture morphology of the distal clavicle is determined by a bony-ligamentous conjunction, which remains to be characterized.

Bone mineral density and other risk factors in children and adolescents with low-energy fractures of long bones

Background. There are an increasing number of children and adolescents with reduced age-related rate of bone mass accumulation, low bone mineral density (BMD) and low-energy fractures. This problem is widely discussed in the scientific literature. Purpose of the study was to assess the BMD in children and adolescents with low-energy fractures of long bones and to investigate some biochemical parameters of bone metabolism. Materials and methods. Body mass index (BMI), bone densitometry, levels of vitamin D, calcium, phosphorus and alkaline phosphatase in blood serum of 230 children and adolescents with low-energy fractures of long bones, aged 6 to 17 years, who underwent treatment due to the fractures were studied. Results. Fractures occurred predominantly in 41.3% of the humerus and 43% of the forearm bones. 20% of children and adolescents had abnormal BMI values. Low BMD values in 86 of 230 examinees were detected in the lumbar spine, of which only 66 (76.7%) had BMD abnormalities in the hip. In assessing vitamin D status, 19.3% of the girls and 9.2% of the boys had normal vitamin D values. A decrease in calcium level and an increase in alkaline phosphatase in blood serum were found. In terms of BMD and vitamin D status, the dependence of boys was statistically significant in the elementary and high school groups, while in girls it was only in the elementary school group. A direct link between low BMD and vitamin D has been established. Conclusions. Low BMD, vitamin D, impaired calcium-phosphorus metabolism and obesity in children and adolescents may be considered predictors of fracture occurrence.

Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study

BackgroundThe surgical treatment of inferior patellar pole fractures can be a challenge, especially in geriatric patients, who are particularly frequently affected by osteoporosis. The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density.MethodsTwelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew® FT 4.5 mm) or transosseous suture (TS; #2 FiberWire®). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90° flexion to almost full extension (5°) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired t-tests, and correlations were calculated with Pearson’s correlation coefficient.ResultsThe suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0 ± 465.6 cycles, TS: 1000 ± 0 cycles, P = 0.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson’s r = 0.60, P = 0.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1 ± 2.6 mm, TS: 6.5 ± 2.6 mm, P = 0.19); 500 cycles (SA: 6.4 ± 6.1 mm, TS: 9.6 ± 3.8 mm, P = 0.39); and 1000 cycles (SA: 4.0 ± 0.4 mm, TS: 11.0 ± 4.5 mm, P = 0.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4 ± 212.2 N, TS: 825.7 ± 189.3 N, P = 0.04).ConclusionsSuture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.

Spine trabecular bone scores and bone mineral density of postmenopausal Taiwanese women.

The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis. A total of 1,915 postmenopausal women with lumbar spine and hip bone mineral density (BMD) and spine TBS were enrolled from a single medical center into this study. The women's BMD and TBS were measured using dual x-ray absorptiometry (Discovery Wi; Hologic, Bedford, Mass) and iNsight software (Med-Imaps SASU, Merignac, France), respectively. The women's demographic characteristics; lumbar spine, total hip, and femoral neck BMD; and lumbar spine TBS were recorded, and correlations among the parameters were identified using a 2-tailed Pearson test, in which a P value less than 0.05 was considered statistically significant. We developed simple linear regression models to represent changes related to TBS and performed an analysis of variance on the selected variables. The average age of the women was 62.5 ± 9.1 years (range, 25.7-93.7 years). The mean TBS was 1.300 ± 0.086 (range, 1.015-1.596). The TBS was weakly and negatively correlated with body mass index ( r = -0.078) and moderately and positively correlated with the lumbar spine BMD ( r = 0.619). The patients' lowest BMD values among those measured at multiple sites revealed a higher rate of osteoporosis (32.5%) than those measured at individual sites. Degraded TBS were noted in 21.2% of the participants, and a combination of BMD and TBS results predicted more individuals (7.8%) at a high risk of fracture than did the BMD result only. The rates of both osteoporosis and degraded TBS increased with age. Bone mineral density and TBS can be used in combination to predict osteoporosis in a greater number of postmenopausal Taiwanese women. Because the incidence of osteoporosis is the highest among older women, clinicians should pay careful attention to TBS degradation among older patients without low BMD.

SCREENING OF OSTEOPOROSIS IN MEN

Underestimation of the disease osteoporosis in men is a serious problem, as osteoporotic fractures among men are frequent and they are accompanied by serious complications. Conducting DXA scans in men in Bulgaria is important to determine the state of their bone health.&#x0D; The aim of the study was to assess the bone mineral density (BMD) and T-score of the lumbar spine and of the hip through dual-energy X-ray absorptiometry (DXA) in men and to compare their values ​​in different age groups.&#x0D; Object of the study. Height, weight, body mass index (BMI) were assessed in 359 men with a mean age of 56 years (yrs.) ± 14 yrs., BMD and T-score of the lumbar spine and femoral neck were also examined.&#x0D; Methodology. Men are divided into the following age decades: 20-29 yrs., 30-39 yrs., 40-49 yrs., 50-59 yrs., 60-69 yrs., 70-79 yrs. and ≥80 yrs. Statistical program SPSS version 19.0 was used to access the data. The ANOVA test analyzes was applied to investigate if there are any statistically significant differences in BMD and T-score of the lumbar spine and femoral neck between the different age decades.&#x0D; Results and conclusions. 264 men were evaluated for total BMD of the lumbar spine and 95 men had results for BMD of the femoral neck. The mean total BMD of the lumbar spine differed significantly between the individual age decades in men (p = 0.000). The mean BMD values ​​of the femoral neck did not differ significantly in the different age decades in men (p = 0.07). 34 of 264 men (12.9%) were diagnosed with lumbar spine osteoporosis and 13 out of 93 men (14%) were diagnosed with femoral neck osteoporosis. The data obtained show a widespread prevalence of osteoporosis among men with a predominance of low values ​​of BMD on the axial skeleton in the age range between 60 and 79 years.

Thyroid Hormones Are Not Associated with Plasma Osteocalcin Levels in Adult Population with Normal Thyroid Function.

Thyroid hormones (THs) play an indispensable role in skeletal development and bone remodeling. Some studies have reported associations of THs with serum osteocalcin (OC) levels, but the results are quite inconsistent and the molecular mechanism of their simultaneous or interdependent activity on bone is almost unknown. Therefore, the aim of this study was to determine the possible associations of plasma THs with plasma OC levels and the possible mediating effect of OC on the relationship between THs and bone mineral density (BMD). For this purpose, out of the initial 1981 participants, we selected healthy euthyroid participants controlled for available confounding factors that can affect thyroid function and bone metabolism (N = 694). Given our results, we could not confirm any associations of THs with plasma OC levels nor the mediating effect of OC on the relationship between THs and BMD in euthyroid population. In the group of women controlled for menopause status (N = 396), we found a significant negative association of body mass index (BMI) with OC levels (β = −0.14, p = 0.03). We also found a negative association of free triiodothyronine (fT3) (β = −0.01, p = 0.02) and age (β = −0.003, p < 0.001) with BMD, and a positive association of BMI (β = 0.004, p < 0.001) and male gender (β = 0.1, p < 0.001) with BMD. In addition, we found significantly higher plasma OC levels and lower values of BMD in postmenopausal euthyroid women compared with premenopausal euthyroid women. In our opinion, the results of previous studies suggesting an association between circulating THs and serum OC levels may be influenced by an inconsistent selection of participants and the influence of confounding factors.

P131 Adult coeliac disease and bone mineral density at the femoral neck, total hip and lumbar spine: an age- and sex-matched case-control study

Abstract Background/Aims Coeliac disease (CD) is characterised by intestinal villous atrophy causing malabsorption. Decreased bone mineral density (BMD) has been reported in CD. To the best of our knowledge, no published paper has documented BMD comparisons in detail at different sites. We aim to determine the prevalence of osteoporosis and BMD values at multiple locations in a group of adult CD patients, and compare them to those of age and sex matched controls. Methods We analysed data of adult patients referred for BMD estimation at a district scanner from 2004 to 2018. Dual-energy x-ray absorptiometry was used for all subjects. Patients diagnosed with CD (cases) were age- and sex-matched with subjects referred with no reason for scanning (controls). Additional FRAX(TM) risk factors for osteoporosis were recorded. Comparison was made using chi-squared for categorical values, student's T test for continuous variables, then a univariate followed by a multivariate stepwise logistic model, adjusting for height, weight and body mass index (BMI), were fitted. Results 645 (474 female) patients in the coeliac group were matched with 645 (474 female) controls. There was no significant difference in the mean age (years) at scan: cases 56.24 (SD 14.79) vs controls 56.24 (SD 14.80), p-value 1.00. The coeliac group had a significantly higher proportion of osteoporotic (T-score ≤-2.5 SD) patients at all locations compared to the control group. Cases had significantly lower mean BMD (gcm-2) and mean Z-scores at all locations than the controls. In the multivariate stepwise model, adjusted for height, weight and BMI, only the total hip, lumbar spine and their sub-sites revealed significant associations between having CD and a BMD (gcm-2) in the lowest tertile for the whole cohort. Key results are summarised in Table 1. Conclusion We confirmed that adult CD patients have higher prevalence of osteoporosis and lower BMD values compared to controls. Bone impairment was pronounced at the L1 and L2 vertebrae; least pronounced at the femoral neck. This might be due to CD preferentially damaging trabecular bone, which is predominant in the lumbar spine than femoral neck. Disclosure P. Shtarbanov: None. M. Bukhari: None.

Prevalence of Triad-RED-S symptoms in high-level Kenyan male and female distance runners and corresponding control groups.

This study examined and compared select Triad-RED-S components/risk factors in high-level Kenyan male and female distance runners to corresponding control groups; focusing on examining energy intake (EI), bone indices, and hormonal markers. A cross-sectional, observational design was used in which Kenyan male and female (n = 30 and n = 26, respectively) middle- and long-distance runners and corresponding male and female control groups (n = 29 and n = 29, respectively) were examined. The participant's bone mineral density (BMD) at the lumbar spine, right femur, and total body were measured using a dual-energy X-ray absorptiometry analysis. Complete blood counts (CBC) were done on the whole blood specimens and hormonal measurements were performed on plasma specimens. In addition, athletes completed metabolic testing to determine maximal oxygen uptakes and 7-day dietary diaries. Overall daily EI across runners and controls within each sex were low, but not significantly different (p > 0.05). Prevalence of low BMD values (Z score < -2.0) was comparable across groups in each sex (p > 0.05). CBC measures suggested that both runners and controls were healthy. Finally, slight hormonal differences between runners and their respective controls existed (p < 0.05), but were not clinically meaningful or observed in typical Triad-RED-S-related parameters. High-level Kenyan male and female runners had low daily EI, but no tendency toward a higher prevalence of low BMD, or Triad-RED-S-related hormonal abnormalities. The occurrence of low EI was not a major risk factor in our athletes; this calls into question whether the current criteria for Triad-RED-S are entirely applicable for athletes of African ethnicity.

Decreased bone mineral density, Vitamin K and Vitamin D in ulcerative colitis patients

Background & ObjectiveUlcerative colitis (UC) is an inflammatory bowel disease, usually begins in the rectum and can involve the entire colon. Damage done by this condition can lead to several intestinal and extraintestinal manifestations (EIMs). Due to malnutrition, malabsorption and medications used in UC patients, bone mineral loss seems to happen at a higher pace, compared to healthy population. In this study, we aim to investigate bone mineral density (BMD) and its related biomarkers like Vitamin K, Vitamin D and Calcium in patients with UC. MethodOne hundred and one documented UC patients with at least one year of treatment entered our study. BMD was measured with dual X-ray absorptiometry. Lab tests were done to examine Vitamin K, Vitamin D, Calcium and Magnesium levels in patients’ serum. ResultsAmong 101 patients, 32 (31.7%) were men and 69 (68.3%) were women. The mean age of participants was 32.15±9.46 years. The mean duration of the disease was 6.24±3.30 years. Based on the femoral T-score index, 75 (74.3%) patients had normal femoral density, 24 (23.8%) were osteopenic and (2%) 2 patients had osteoporosis. Bone loss significantly correlated with age and disease. Patients with lower BMI tend to have lower BMD values. The data analysis revealed lower levels of Vitamin K, Vitamin D and Calcium in UC patients significantly decreased bone density indexes, except for lumbar T-score which did not showed a clear relationship with serum Vitamin K. Also, the cumulative dose of prednisolone significantly reduced all BMD indicators, especially in patients with longer disease durations. ConclusionBMD in UC patients seems to decrease at a higher pace and it's associated with lower levels of Vitamin K, Vitamin D and Calcium in serum as well as corticosteroid consumption. Close follow-ups, dietary supplements and corticosteroid usage limitations could be beneficial for UC patients and decrease the risk of developing osteoporosis.

Total, Free and Bioavailble 25 OH D and Bone Disease in Primary Hyperparathyroidism

Background: Low levels of vitamin D 25OHD are frequently described in PHP patients. The aim of this study was to evaluate bone parameters and vitamin D status in PHP patients and controls. Methods: Prior to surgery, 64 PHP patients and 63 healthy matched control subjects regarding age, gender and body mass index were enrolled in this study along 18 months. 25OHD and PTH were measured using Roche® Immunoassays. Bone mineral density (BMD) by dual X-ray absorptiometry (DXA) (Hologic QDR 4500) and TBS (InSight™) were determined in all patients and controls. Distribution of total, bioavailable and free (calculated) 25OH and its correlation with TBS and DXA in both groups was evaluated. DBP (vitamin D binding protein) SNPs genetic analysis was performed by ABI 7500 real time PCR System. None of the patients and controls were taking vitamin D supplements before the study. Results: PHP patients had lower BMD values than controls in all sites (p<0.01). TBS measurements were also reduced in PHP patients compared to controls, as expected (1233 vs 1280, p=0.04). There was no statistical difference in free, total and bioavailable 25OHD measurements between the PHP and the control group, mean±SD: 3.4±1.7 vs 3.1±1.7 pg/mL (p=0.44), 22.6± 6.1 vs 20.6± ng/dL (p=0.13) 1.53±0.66 vs 1.41±0.61 ng/mL (p=0.28), respectively. Likewise, there was no statistical difference in DBP haplotypes 1s/1s, 1f/1f, 1s/1f, 2/2, 1s/2, 1f/2 analysis between groups. There was no correlation with 25OHD and DXA measurements in both groups. However, total 25OHD presented statistical significant correlation with TBS measurements in the PHP group (r=0.28; p=0.02) and total, free and bioavailable 25OHD measurements with TBS in the control group (r=0.42; r=0.42; r=0.43; p<0.01). Conclusion: Vitamin D status correlates with TBS, but not with DXA, highlighting the relation of the vitamin D with the microarchitecture bone parameters in both PHP patients and controls. However, this correlation was more evident among controls than in PHP patients, spotlighting the primary hyperparathyroidism effects in bone.