Lower Spine Bone Mineral Density Research Articles

Low Bone Mineral Density as a Predictor of Mortality and Infections in Stroke Patients: A Hospital-based Study.

Low bone mineral density (BMD) has been linked to elevated risks of mortality and infections in the general population; however, its association with these outcomes in stroke patients remains unclear. This study aims to investigate the correlation between low BMD and risks of mortality and infections among stroke patients in a Taiwanese cohort. In this single-centered retrospective cohort study, 905 stroke patients from a Taiwanese database (2000-2022) were analyzed. Patients were divided based on BMD measurements of the femur and spine. The primary outcome was all-cause mortality, and secondary outcomes included urinary tract infection (UTI) and pneumonia. Accelerated failure time regression model analyses evaluated the association between BMD and these outcomes, while the Kaplan-Meier method and log-rank test assessed survival differences between groups. Among the participants (average age 76.1 years, 70.5% female), 33.82% had osteopenia and 55.25% had osteoporosis. Stroke patients with lower spine and right femur BMD had significantly reduced survival rates, especially when the BMD value fell below 0.842 g/cm2 (spine), and 0.624 g/cm2 (right femur), respectively. Regarding secondary outcomes, lower spine BMD was significantly associated with an increased risk of UTI. Low BMD, particularly in the femur and spine, is a significant predictor of mortality and UTI in stroke patients. These findings highlight the importance of assessing and managing BMD in stroke patients to improve outcomes and reduce complications.

Osteoporosis and osteoarthritis: a bi-directional Mendelian randomization study

ObjectiveTo investigate the causal relationship between low bone mineral density (BMD) and osteoarthritis (OA) using Mendelian randomization (MR) design.MethodsTwo-sample bi-directional MR analyses were performed using summary-level information on OA traits from UK Biobank and arcOGEN. Sensitivity analyses including MR-Egger, simple median, weighted median, MR pleiotropy residual sum, and outlier approaches were utilized in conjunction with inverse variance weighting (IVW). Gene ontology (GO) enrichment analyses and expression quantitative trait locus (eQTL) colocalization analyses were used to investigate the potential mechanism and shared genes between osteoporosis (OP) and OA.ResultsThe IVW method revealed that genetically predicted low femoral neck BMD was significantly linked with hip (β = 0.105, 95% CI: 0.023–0.188) and knee OA (β = 0.117, 95% CI: 0.049–0.184), but not with other site-specific OA. Genetically predicted low lumber spine BMD was significantly associated with OA at any sites (β = 0.048, 95% CI: 0.011–0.085), knee OA (β = 0.101, 95% CI: 0.045–0.156), and hip OA (β = 0.150, 95% CI: 0.077–0.224). Only hip OA was significantly linked with genetically predicted reduced total bone BMD (β = 0.092, 95% CI: 0.010–0.174). In the reverse MR analyses, no evidence for a causal effect of OA on BMD was found. GO enrichment analysis and eQTL analysis illustrated that DDN and SMAD-3 were the most prominent co-located genes.ConclusionsThese findings suggested that OP may be causally linked to an increased risk of OA, indicating that measures to raise BMD may be effective in preventing OA. More research is required to determine the underlying processes via which OP causes OA.

Interaction effects of significant risk factors on low bone mineral density in ankylosing spondylitis.

To analyze individually and interactively critical risk factors, which are closely related to low bone mineral density (BMD) in patient with ankylosing spondylitis (AS). A total of 249 AS patients who visited China-Japan Friendship Hospital were included in this training set. Patients with questionnaire data, blood samples, X-rays, and BMD were collected. Logistic regression analysis was employed to identify key risk factors for low BMD in different sites, and predictive accuracy was improved by incorporating the selected significant risk factors into the baseline model, which was then validated using a validation set. The interaction between risk factors was analyzed, and predictive nomograms for low BMD in different sites were established. There were 113 patients with normal BMD, and 136 patients with low BMD. AS patients with hip involvement are more likely to have low BMD in the total hip, whereas those without hip involvement are more prone to low BMD in the lumbar spine. Chest expansion, mSASSS, radiographic average grade of the sacroiliac joint, and hip involvement were significantly associated with low BMD of the femoral neck and total hip. Syndesmophytes, hip involvement and higher radiographic average grade of the sacroiliac joint increases the risk of low BMD of the femoral neck and total hip in an additive manner. Finally, a prediction model was constructed to predict the risk of low BMD in total hip and femoral neck. This study identified hip involvement was strongly associated with low BMD of the total hip in AS patients. Furthermore, the risk of low BMD of the femoral neck and total hip was found to increase in an additive manner with the presence of syndesmophytes, hip involvement, and severe sacroiliitis. This finding may help rheumatologists to identify AS patients who are at a high risk of developing low BMD and prompt early intervention to prevent fractures.

239 Predictors of raised bone turnover markers after transitioning to Zoledronic acid from denosumab

Abstract Background Denosumab is a commonly used to treat osteoporosis though if stopped there is a rebound increase in bone turnover and vertebral fracture risk. Treatment with Zoledronic Acid (ZA) after denosumab discontinuation is recommended to reduce this risk, though in some patients a second ZA infusion may be required six months later to maintain adequate suppression of Bone Turnover Markers (BTM). We aimed to assess the proportion of patients with a sub-therapeutically suppressed BTM after a single dose of ZA post denosumab cessation and explore for predictors of this. Methods We identified patients at our bone health clinic who received ZA 6 to 9 months after the last and final denosumab injection. BTM measured was cross linked C-Telopeptide type I collagen (CTX). Sub-therapeutic BTM response was defined as a CTX >0.300 ng/ml. Logistic regression was used to explore for prectiors of CTX >0.300 including age, body mass index (BMI), denosumab duration and lumbar spine bone mineral density (BMD). Results There were 88 patients, 93% female with a mean age of 67 years. Median duration of denosumab therapy was 5.0 years and 44% had osteoporosis prior to transitioning to ZA. Mean CTX after ZA (median 127 days post ZA) was 0.252. However, 45% had a CTX >0.300 and in these patients the median value was 0.412. Older age (p = 0.045), longer denosumab duration (p = 0.010) and lower BMD at the spine (p = 0.008) were associated with a CTX >0.30. Conclusion A large proportion (45%) had subtherapeutic BTM suppression 3 to 6 months after receiving ZA post stopping denosumab and this was predicted by older age, lower spine BMD and longer denosumab duration. Guidelines suggest a second ZA infusion at 6 months in such patients. If transitioning to ZA, findings highlight the importance of optimising BMD first, especially in older adults with longer denosumab therapy.

Albuminuria, Disease Duration, and Glycated Hemoglobin Are Related With Bone Mineral Density in Type 1 Diabetes: A Cross-sectional Study

ObjectiveStudies have found a significant decrease in bone mineral density (BMD) in individuals with type 1 diabetes (T1D) compared to healthy controls. Factors associated with this phenomenon have yet to be defined; therefore, this study aimed to explore the association of glycated hemoglobin (HbA1c), disease duration, albuminuria, and glomerular filtration rate with BMD in adults with T1D. MethodsA cross-sectional study was carried out in tertiary care center. BMD analysis was performed by dual x-ray absorptiometry. Linear models were constructed considering variables associated with BMD. Approval from the ethics committees and informed consent were obtained. ResultsWe included 128 participants, of whom 59% were women, and 16% had menopause. The median age was 33 (26-42) years. The average age of diabetes diagnosis was 15.3 ± 6.3 years, and the median disease duration was 19.5 (12-27) years. In the adjusted analysis, higher albuminuria (P < .01) and disease duration (P < .05) were associated with a lower BMD in the femoral neck and total hip, independently of age, sex, and body mass index (BMI). Higher HbA1c (P < .01) was associated with a lower spine BMD after adjustment for age, sex, and BMI. ConclusionStudied factors specific to T1D, including albuminuria, disease duration, and HbA1c have an association with BMD regardless of BMI, age, and sex.

Bone health in Norwegian female elite runners: a cross-sectional, controlled study

ObjectiveThe primary objective was to compare bone mineral density (BMD) in Norwegian female elite long-distance runners with a control group of inactive females. Secondary objectives were to identify cases of...

P568 Patients with ulcerative colitis after pouch surgery are at risk for low spinal bone mineral density: a cross sectional study

Abstract Background Low bone mineral density (BMD) is prevalent in patients with inflammatory bowel diseases (IBD), specifically Crohn’s disease (CD) due to multiple factors including active inflammation, use of corticosteroids, surgeries and nutritional deficiencies. Patients with ulcerative colitis (UC) who undergo total proctocolectomy and pouch surgery may develop small bowel inflammation (pouchitis) resembling CD. Data regarding their BMD are scarce. We assessed low BMD rates and risk factors in these patientsץ Methods Patients with UC-pouch ages 18-50 without BMD assessment in the past 5 years were recruited. BMD was assessed by dual-energy x-ray absorptiometry (DEXA). Clinical data, biochemical and inflammatory markers were detected and dietary patterns were assessed using validated questionnaires. Results Patients recruited-30: male/female 14/16; Median age 45 (IQR 31-51.7) years; median BMI 23.2 (IQR 21-26.5); median IBD duration 23 (IQR 15-30) years; median pouch age 17 (IQR 10-25) years. Low BMD detected in 16/30 (53.3%): 6/30 (20%) osteoporosis,10/30 (33.3%) osteopenia. Low L1-L4 T-scores correlated with younger age, lower BMI and shorter disease duration (p= 0.001; p= 0.001; p= 0.023, respectively). In univariate analysis patients with low and normal BMD were comparable in age, gender, BMI, smoking, past and current medical treatment. In multivariate analysis younger age and lower BMI remained significant (age SE= 0.22, β 0.422 p=0.043, BMI SE=0.06, β=0.531 p=0.006) independently of sex, years since IBD diagnosis, and smoking. Dietary patterns were comparable (p=0.715). Conclusion Abnormally low BMD was prevalent in over half of patients with UC-Pouch. Interestingly younger age and lower BMI were risk factors for low spinal BMD. Dietary patterns did not account for the findings. BMD should be routinely assessed in patients with UC-pouch and intervention to correct abnormally low BMD should be planned.

Evaluation of Bone Mineral Density in Juvenile Systemic Lupus Erythematosus.

The present study aimed to determine the prevalence of low bone mineral density (BMD) and low bone mineral content (BMC) as chronic complications of juvenile systemic lupus erythematosus (JSLE) and identify the associated variables and patient characteristics to investigate the relationship between BMD and influential factors. This cross-sectional study enrolled 54 patients with JSLE, including 38 females and 16 males. The BMD and BMC were assessed by dual-energy X-ray absorptiometry in the hip (femoral neck) and the lumbar spine. Low BMD was considered a Z-score < -2. The study investigated the association of BMC and Z-score with the current daily dose of corticosteroids, the daily dose of corticosteroids at disease onset, the duration of disease, the duration of steroid treatment, the time from the onset of symptoms to diagnosis, and renal involvement. The prevalence of low BMD in the lumbar spine and the femoral neck was 14.8% and 18.5%, respectively; the reduction of BMD was more significant in the femoral neck compared to the lumbar spine. Osteoporosis was detected in one patient. The multiple linear regression analysis found a significant association between a higher daily corticosteroid dose and lower BMC of the femoral neck and the lumbar spine. In addition, patients receiving higher doses of corticosteroids at disease onset showed better follow-up bone mineral densitometry results. Based on the findings of this study, JSLE more affects the femoral neck than the lumbar spine. Patients receiving a more robust treatment with higher doses of corticosteroids at disease onset (to control the inflammatory processes) showed better spinal BMC results. A higher dose of daily corticosteroid treatment during assessment was identified as a risk factor for low BMD.

Low bone mineral density and its related factors in adults with congenital heart disease in Vietnam: A cross-sectional study.

Background and AimsRecent studies have highlighted the increased risk of low bone mineral density (BMD) in adults with cardiovascular disease. However, little is known about BMD in adults with congenital heart disease (CHD), particularly in developing countries. We hypothesized that factors related to BMD would lead to a high prevalence of low BMD in adults with CHD. This study aimed to determine the prevalence of low BMD and its related factors in Vietnamese adults with CHD.MethodsWe conducted a cross‐sectional study of 73 adults diagnosed with CHD in Vietnam. Low BMD was classified based on their site‐specific Z‐scores and T‐scores at the posteroanterior lumbar spine and left proximal femur. Logistic regression analyses were performed to evaluate factors related to low BMD.ResultsLow BMD was confirmed in one‐third of the adults with CHD. There were trends of more bone loss in certain parts of the body than in others, with the prevalence of low BMD at the sites of the lumbar vertebrae (L1‒L4) and left proximal femur (femoral neck, trochanteric femur, and intertrochanteric area) of 43.9%, 31.8%, 28.8%, 33.3%, 8.8%, 1.5%, and 6.1%, respectively. The prevalence of low BMD in the lumbar spine was significantly higher than that in the left proximal femur (34.3% vs. 2.9%, p < 0.001). Moreover, the prevalence of low BMD was significantly higher in adults with CHD than in those without polycythemia and vitamin D deficiency (55.6% vs. 20.9%, p = 0.001 and 46.2% vs. 19.4%, p = 0.002, respectively). A stratified multivariate logistic regression analysis revealed that low BMD was associated with polycythemia (odds ratio: 4.72; 95% confidence interval: 1.64–13.58, p = 0.004).ConclusionsLow BMD is common among adults with CHD in Vietnam and related to polycythemia.

Pharmacological treatment of osteoporosis: 2022 update

Background: Osteoporosis is a skeletal disorder characterized by compromised bone strength resulting in a predisposition to fracture. Osteoporosis-related fractures can lead to pain, disability, and increased healthcare costs. We aimed to explore the guidelines and criteria for selecting medications for osteoporosis.Current Concepts: Osteoporosis medications can be classified mainly as antiresorptive drugs and osteogenesis promoters. The former includes selective estrogen receptor modulators, bisphosphonates, and receptor activators of nuclear factor kappa-B ligand inhibitors, e.g., denosumab. The latter includes human parathyroid hormone, e.g., teriparatide, and the dual-action agent, romosozumab. Selective estrogen receptor modulators (raloxifene or bazedoxifene) can be considered suitable for younger postmenopausal women with low spine bone mineral density. It also can be used for patients with low glomerular filtration rates due to low excretion in urine and patients who need dental care. Bisphosphonate has a residual effect on bone; therefore, osteonecrosis of the jaw and atypical fractures should be considered as side effects for its long-term use. Presently, denosumab is the most potent antiresorptive agent, but its favorable skeletal effects can be reversed quickly after its cessation. Therefore, subsequent antiresorptive treatment is mandatory. Romosozumab is a dual-action agent that simultaneously stimulates bone formation and inhibits bone resorption. It also needs a subsequent antiresorptive treatment.Discussion and Conclusion: Tailored treatment is needed in a patient with osteoporosis. Even in the case of the same bone density, the risk of fracture and the fracture sites differ depending on age. After setting an achievable goal of bone density within a suitable period, the appropriate medication should be selected.

Investigation of the Factors Affecting Bone Mineral Density in Children with Celiac Disease.

PurposeChildren with celiac disease (CD) are at an increased risk of low bone mineral density (BMD) owing to malabsorption of fat-soluble vitamins, inflammation, and malnutrition. This study aimed to determine the prevalence and risk factors for low BMD in Iranian children with CD.MethodsThis prospective cohort study examined 149 Iranian children with CD between 2011 and 2018 at Zabol University of Medical Sciences. BMD was measured using dual-energy X-ray absorptiometry. Demographic, clinical, and laboratory data were collected from patients’ medical records. Logistic regression analysis was performed to identify the factors associated with low areal BMD (BMD-Z <−2) in the lumbar spine and femoral neck. Descriptive data were analyzed using the mean, standard deviation, and relative frequency. Data were analyzed using the chi-square test, t-test, and analysis of variance.ResultsOf the 149 children with CD, 27.5% had osteoporosis. The mean body mass index (BMI) Z score was −1.28±1.2. Lower BMI was associated with a higher likelihood of BMD-Z (odds ratio 2.17; p≤0.05).ConclusionOverall, the findings of this study showed that there was no correlation among Marsh classification, presence of specific human leukocyte antigens, and low BMD in Iranian children with CD. BMI can be a predictor of bone density in children with CD and may be applied clinically in early screenings to evaluate the bone health status in these children.

IgA rheumatoid factor is associated with bone mineral density preservation in rheumatoid arthritis

Autoantibodies such as IgM rheumatoid factor (RF) and anti-citrullinated proteins/peptides antibodies (ACPA) have previously been incriminated in systemic bone loss in rheumatoid arthritis (RA). There are, however, no data describing association of IgA RF and IgG RF with systemic bone loss. This study was aimed to investigate the association of RF isotypes with systemic bone loss among patients with RA. RF isotypes and ACPA were measured by enzyme-linked immunosorbent assay among 153 patients with RA. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. Ninety-four (61.4%) patients had positive IgA RF, 89 (58.2%) had positive IgG RF, 109 (71.2%) had positive IgM RF, whereas 122 (80.3%) RA patients tested positive for ACPA. Compared to the IgA RF-negative patients, IgA RF-positive patients exhibited higher disease activity and had higher RF titers. Seven (4.6%) patients had low BMD at femoral neck, 12 (7.8%) at total femur, and 47 (30.7%) at lumbar spine. IgA RF was found to be associated with protection against low BMD at spine (OR = 0.47, 95% CI = 0.23-0.95, p = 0.034). This association was further confirmed in the multivariate regression analysis taking into account several potential confounding factors(OR = 0.21, 95% CI = 0.06-0.65, p = 0.039). No association between low BMD and the presence of IgG RF or IgM RF or ACPA was found. IgA RF for the first time ever was shown to be associated with BMD preservation at spine in RA. Key points • IgA RF was associated with protection against low spinal BMD. • No association between low BMD and the presence of IgG RF or IgM RF was found.

Association of bone mineral density and depression in different bone sites and ages: A meta-analysis.

Major depressive disorder (MDD) is considered as a risk factor for osteoporosis. Bone mineral density (BMD), as the main tool for diagnosing osteoporosis, has been reported to have correlation with MDD in different cohorts. However, the information in causative link and etiology determinants of osteoporosis in MDD is still under investigation. The results are unclear. Thus, we perform a meta‐analysis to evaluate the association between altered BMD and MDD. We searched the electronic databases to find studies examining BMD in patients with MDD. Finally, 26 published studies were included in our meta‐analysis up from January 1990 to January 2019. All the data were pooled analysis using RevMan software. The association between altered BMD and MDD was assessed by std. mean difference (STD) and their 95% confidence intervals (CIs) for each study. Twenty‐six studies were included in this meta‐analysis. Pooled results showed a significant lower BMD in spine (STD=0.51, 95% CI=0.30–0.71, p < .00001), total hip (STD=0.41, 95% CI=0.16 to 0.66, p = .001), and femoral neck (STD=0.93, 95% CI=0.32 to 1.55, p = .003) in MDD compared with controls. After stratification by mean age, gender, recruitment, diagnostic criteria, and measuring methods, no significant difference of BMD was found in bone mineral density of male total hip between MDD and controls(p > .05). Moreover, adults appear to have lower BMD than old cohorts. This is an updated meta‐analysis to reveal the association of bone mineral density and depression, suggesting that BMD appears to be more susceptible to occur in spine, total hip, femoral neck in MDD, especially for adults and women. Our meta‐analysis may provide clinicians and public health administrators with an important screening tool for assessing depression and avoiding osteoporosis in adult subjects and female.

Early clinical effects, safety, and predictors of the effects of romosozumab treatment in osteoporosis patients: one-year study.

SummaryRomosozumab is an effective treatment for spine osteoporosis because it reduces the incidence of new fractures and significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications.IntroductionRomosozumab appeared as a new osteoporosis medication in Japan in 2019. It is an anti-sclerostin antibody, which increases bone formation and suppresses bone resorption. The aim of our study was to elucidate the clinical effects, safety, and predictors of the effects of one-year romosozumab treatment.MethodsThis study was an observational study designed as a pre–post study in 262 patients. Romosozumab (210 mg) was administered subcutaneously once every 4 weeks during 12 months. We focused on incidence of new fractures, safety, bone mineral density (BMD) at the spine and total hip, and bone metabolism markers.ResultsThere were five cases of new fractures during one-year romosozumab treatment. There were no fatal adverse events. Percent changes from baseline in the spine and total hip BMD after 12 months of romosozumab treatment were 10.67% and 2.04%, respectively. Romosozumab had better effects in cases of severe osteoporosis with low spine BMD, high TRACP-5b, and high iP1NP at the start of romosozumab treatment. The percent change in the spine BMD at 12 months was significantly lower in the group transitioning from bisphosphonates than in the group not previously treated with other anti-osteoporosis medications.ConclusionRomosozumab is an effective treatment for spine osteoporosis because it significantly increases the percent change in the spine BMD at 12 months. The percent change in the spine BMD is higher in patients not previously treated with other anti-osteoporosis medications.

An Unanticipated Role for Sphingosine Kinase-2 in Bone and in the Anabolic Effect of Parathyroid Hormone.

Sphingosine-1-phosphate (S1P) is an anabolic clastokine. Sphingosine kinase (SPHK) is the rate-limiting enzyme in S1P production and has 2 isoforms. To evaluate the roles of SPHK1 and SPHK2 in bone, we examined the skeletal phenotype of mice with selective deletion of SPHK1 in osteoclasts (SPHK1-Oc-/-) and mice in which the SPHK2 gene was deleted in all tissues (SPHK2-/-). SPHK1-Oc-/- had normal bone mass. By contrast, SPHK2-/- female mice had a 14% lower spinal bone mineral density (BMD; P < 0.01) and males a 22% lower BMD at the same site (P < 0.001). SPHK2-/- and control mice were subsequently treated either with daily parathyroid hormone [PTH](1-34) or vehicle for 29 days. The response to PTH was significantly attenuated in the SPHK2-/-mice. The mean femoral bone volume to total volume fraction (BV/TV) increased by 24.8% in the PTH-treated female control animals vs 10.6% in the vehicle-treated female controls (P < 0.01). In contrast, in the SPHK2-/- female mice the difference in femoral trabecular BV/TV at the end of treatment was not significant (20.5 vs13.3%, PTH vs vehicle, P = NS). The anabolic response to PTH was significantly attenuated in the spine of male SPHK2-/- mice (29.7% vs 23.1%, PTH vs vehicle, in controls, P < 0.05; 26.9% vs 19.5% PTH vs vehicle in SPHK2-/- mice, P = NS). The spine responded normally in the SPHK2-/- female mice. Interestingly, suppression of sclerostin was blunted in the SPHK2-/- mice when those animals were treated with an anabolic PTH regimen. We conclude that SPHK2 has an important role in mediating both normal bone remodeling and the anabolic response to PTH.

Association between Body Mass Index and Bone Mineral Density in Patients Referred for Dual-Energy X-Ray Absorptiometry Scan in INMAS, Sylhet

With an aging population, osteoporosis is increasingly becoming a public health concern. Bangladesh has a high incidence of osteoporosis and occurs among a relatively younger age group than in the developed world. There are several factors that could be associated with bone mineral density (BMD). We are keen to determine the association with BMD and BMI. The study was carried out on 152 patients who were referred to INMAS for dual energy X- ray absorptiometry (DEXA) measurement of bone mineral density (BMD) during the periods of January 2018 to July 2019. BMD was measured at right femoral neck and lumbar spines. Data about age and sex, BMI were recorded. Reporting was done according to the T score following WHO criteria. Prevalence were compared using chi-squared tests. Among 152 patients, 84.9% were females and 15.1% were males. Results showed for right femur that normal bone density in 91 (59.1%), osteopenia in 54 (35.1%), osteoporosis in 9 (5.8%) and BMD in spine was normal in 57 (37.0%) osteopenia in 44 (28.6%), osteoporosis in 53 (34.4%). About 60% of the study population was normal weight and others were underweighted or overweighed. Status of BMD was associated with BMI in the lumbar spine and femur. In this study group, total 61.2% and 26.3%were found low BMD in spine and right femur respectively. In age group ≥ 60 years, low BMD in spinewas 72.0% that is 42.29% higher compare to below 60 years’ group (50.6%).Correlation of BMI with lumbar spine T score, right femur and left femur T score were measured by Pearson’s correlation coefficient test. Positive significant Pearson’s correlation was observedbetween BMI with spine T score (r = 0.397; p = &lt;0.001), BMI with right femur T score (r = 0.347; p = &lt;0.001) and BMI with left femur T score (r = 0.382; p = &lt;0.001).&#x0D; Bangladesh J. Nuclear Med. 22(2): 108-113, Jul 2019

Bone health in HIV-infected children on antiretroviral therapy: An Indian study.

Aim:The aim of this study is to determine the bone health in HIV-infected children on antiretroviral therapy (ART).Materials and Methods:This cross-sectional study was carried out in 31 HIV-infected children aged 5–18 years. Each patient underwent testing for serum calcium, phosphorous, alkaline phosphatase, and 25(OH) Vitamin D. Bone mineral density (BMD) was done using a DXA scanner. Patients' z scores for BMD of the lumbar spine and left femoral neck were noted. The factors associated with low BMD were analyzed.Results:Seven (22.6%) children had a low spinal BMD and 6 (19.4%) had low femoral neck BMD. Low serum calcium was seen in 6 (19.4%) patients and high alkaline phosphatase was seen in 15 (48.4%) patients. Low serum 25 (OH) Vitamin D levels were present in 30 (96.8%) patients, whereas all the patients had normal serum phosphorous. Duration of ART in those with low spinal BMD was 4.6 ± 3.4 years as compared to 6.4 ± 3.2 years in those with normal spinal BMD (P = 0.235) and for low left femoral neck BMD was 3.9 ± 2 years as compared to 6.5 ± 3.4 years for those with normal femoral neck BMD (P = 0.031). Mean 25(OH) Vitamin D levels were 8.4 ± 2.8 ng/ml in those with low femoral neck BMD as compared to 13.6 ± 8.3 ng/ml in those with normal femoral neck BMD (P = 0.015). Type of ART did not have any association with low BMD.Conclusion:Over 95% of HIV-infected children have low 25(OH) Vitamin D levels which affect the appendicular BMD. BMD is affected more in children who have been on ART for a shorter time. No particular ART regimen is associated with low BMD.

Bone mineral density in Canadian children with severe haemophilia A or B: a cross-sectional study

Abstract Background Previous research has shown that bone mineral density (BMD), a measure of bone strength, may be lower among people with haemophilia. However, the majority of this research has been done in adults and in countries where the treatment for haemophilia differs from the standard of care in Canada, and there is a lack of paediatric data. Aims The primary objective of this study was to determine whether Canadian children and youth with severe haemophilia A and B have BMD similar to healthy controls matched for height, age and weight (HAW-score). Secondary objectives included the exploration of any association between BMD and the following variables: factor replacement regimen, Hemophilia Joint Health Score (HJHS), bleeding history, physical activity level, and dietary intake of calcium, vitamin D, vitamin K and protein. Methods A cross-sectional observational study was designed to determine the BMD of children with severe haemophilia A and B in Canada. Ethical approvals were obtained from participating institutions. Thirty-eight participants aged 3–18 with severe haemophilia A and B were recruited from two treatment centres in Canada. Subjects underwent dual-energy X-ray absorptiometry (DXA) scan, and data was collected from regular clinic visit to identify factor replacement regimen, HJHS, and number of joint bleeds over the lifespan. Physical activity level and dietary intake of calcium, vitamin D, vitamin K and protein were identified using self-report questionnaires. Results Participants showed a mean spine BMD Z-score and HAW-score higher than controls, with no participants showing a spine Z-score or HAW-score of &lt;0. Hip BMD score was within normal range, and 2 participants had a Z-score and HAW-score of &lt;−2. Total body BMD score was lower than controls, with 6 participants having a Z-score of &lt;−2.0, and 3 participants having a HAW-score of &lt;−2.0. Factor replacement regimen, HJHS, calcium intake, and physical activity level had no relationship to BMD Z-score or HAW-score. Low intake of vitamin D was associated with a low hip and spine BMD Z-score and HAW-score. Participants with a HJHS joint score greater than 0 had a higher total body HAW-score than those who had a joint score of 0. Conclusion Canadian children with severe haemophilia A and B demonstrate differences in spine and total body BMD from height-, age-, and weight-matched controls, where spine BMD is higher than controls and total body BMD is lower than controls. Studies with a larger sample size are needed to clarify the status of BMD in children with haemophilia treated with primary prophylaxis.

Early clinical effects, safety, and appropriate selection of bone markers in romosozumab treatment for osteoporosis patients: a 6-month study.

Romosozumab appeared as a new osteoporosis medication in Japan in 2019. It is an anti-sclerostin antibody which increases bone formation and suppresses bone resorption. In this study, we analyzed the actual clinical effects, adverse effects, and the optimal way to evaluate the treatment. Romosozumab was administered as subcutaneous injection of 210mg once every 4weeks. We conducted pre-post study in 185 patients treated for 6months. We focused on the incidence of new vertebral fractures, safety, bone mineral density (BMD) at the spine and total hip, and bone metabolism markers. We evaluated BMD before romosozumab treatment and after 4 to 6months and performed the serum analysis before romosozumab treatment, after 1, 3, and 6months. There was no new fracture during treatment, and there was no fatal adverse event including cardiovascular disease. Since percent changes from baseline of the spine and total hip BMD were 6.34% and 1.53% after 4- to 6-month treatment, the treatment was effective for spine osteoporosis. Tartrate-resistant acid phosphatase 5b (TRACP-5b) and intact type I procollagen N-terminal propeptide (iP1NP) had significant changes during romosozumab treatment (p < 0.05). Percent change from baseline of TRACP-5b and iP1NP after 1month correlated with percent change from baseline of BMD after 4 to 6months of treatment. Romosozumab is effective in preventing fractures and useful for increasing the spine BMD. Also, romosozumab is relatively safe to use. It is especially effective in patients with low baseline spine BMD, high TRACP-5b, and high iP1NP.

A correlative study of liver fat content and bone mineral density in middle-aged and elderly people

Objective To investigate the quantitative relationship between liver fat content and bone mineral density (BMD) in middle-aged and elderly people. Methods Totally 184 middle-aged and elderly community residents were recruited from March to June 2016, including 68 males and 116 females. MRI mDIXON-Quant and quantitative CT (QCT) examinations were performed to determine the content of liver fat and L1-L3 vertebral BMD. The subjects were divided into four groups according to the quartiles of liver fat content, and the baseline characteristics and other variables of different groups were were identified by using one-way analysis of Variance. The relationship between liver fat content and lumbar vertebral BMD was assessed with Spearman correlation and partial correlation analysis. Result Subjects with higher hepatic fat content had lower spine BMD and higher body mass index (BMI), waist circumference. Liver fat content was negatively correlated with BMD (r=-0.203, P=0.003). After age and body weight were controlled, the negative correlation between liver fat content and BMD was still significant (r=-0.291, P<0.001), in males (r=-0.283, P=0.021) and in females (r=-0.210, P=0.025). Conclusion Liver fat content is negatively correlated with lumbar vertebral BMD in middle-aged and elderly people. Key words: Fatty liver; Bone density; Tomography, X-ray computed; mDIXON-Quant technique