Lower Spine Bone Mineral Density Research Articles

Association between prolonged breastfeeding and bone mineral density and osteoporosis in postmenopausal women: KNHANES 2010-2011.

This study showed that a negative correlation between duration of breastfeeding and bone mineral density (BMD) in the lumbar spine and prolonged breastfeeding is an independent risk for osteoporosis in postmenopausal women. The present study suggests that postmenopausal women with a history of prolonged breastfeeding require more careful screening for osteoporosis. Several studies suggest that breastfeeding and childbirth lead to maternal calcium loss and a decline in BMD. While the association between breastfeeding and BMD immediately after weaning is well-established, the effects of breastfeeding on postmenopausal women have been controversial. The aim of this study was to examine the effects of breastfeeding on bone mineral density (BMD) and the prevalence of osteoporosis in postmenopausal women. The present study was a cross-sectional survey based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 and 2011 data. The association between breastfeeding and BMD and osteoporosis was examined in 1222 postmenopausal women. The duration of breastfeeding and BMD in the lumbar spine showed a negative correlation. The association between duration of breastfeeding and BMD remained significant after adjustment for reproductive factors and other confounding factors (P = 0.008). However, the number of deliveries and age at the time of delivery did not correlate with BMD at any site after adjustment. Moreover, the prevalence of osteoporosis in postmenopausal women with a history of prolonged breastfeeding was significantly higher than that in women with a short history of breastfeeding (≥37 months, OR = 3.292; 95 % CI 1.485-7.299). The prevalence of lumbar spine fracture showed a significant increasing trend with the increase in the duration of breastfeeding. Prolonged breastfeeding was significantly associated with low BMD in the lumbar spine and higher prevalence of osteoporosis. However, the number of deliveries or age at the time of childbirth did not influence BMD.

Incident Vertebral Fractures in Children With Leukemia During the Four Years Following Diagnosis

The purpose of this article was to determine the incidence and predictors of vertebral fractures (VF) during the 4 years after diagnosis in pediatric acute lymphoblastic leukemia (ALL). Children were enrolled within 30 days of chemotherapy initiation, with incident VF assessed annually on lateral spine radiographs according to the Genant method. Extended Cox models were used to assess the association between incident VF and clinical predictors. A total of 186 children with ALL completed the baseline evaluation (median age, 5.3 years; interquartile range, 3.4-9.7 years; 58% boys). The VF incidence rate was 8.7 per 100 person-years, with a 4-year cumulative incidence of 26.4%. The highest annual incidence occurred at 12 months (16.1%; 95% confidence interval [CI], 11.2-22.7), falling to 2.9% at 4 years (95% CI, 1.1-7.3). Half of the children with incident VF had a moderate or severe VF, and 39% of those with incident VF were asymptomatic. Every 10 mg/m(2) increase in average daily glucocorticoid dose (prednisone equivalents) was associated with a 5.9-fold increased VF risk (95% CI, 3.0-11.8; P < .01). Other predictors of increased VF risk included VF at diagnosis, younger age, and lower spine bone mineral density Z-scores at baseline and each annual assessment. One quarter of children with ALL developed incident VF in the 4 years after diagnosis; most of the VF burden was in the first year. Over one third of children with incident VF were asymptomatic. Discrete clinical predictors of a VF were evident early in the patient's clinical course, including a VF at diagnosis.

Predictors of Bone Mineral Density in African-American and Caucasian College Aged Women

Research regarding risk factors and prevalence of low bone mineral density (BMD) among African-American and Caucasian college-aged women are limited. The objective of this cross-sectional study was to determine if selected predictors of BMD in African-American and Caucasian college-aged women differ by race. A total of 101 local African-American (n=50) and Caucasian (n=51) females, ages 18 to 30 years, were in this study. All data were collected in the Bone Density and Body Composition Laboratory. BMD was measured using DXA technology. Race, family history of osteoporosis, BMI, current physical activity, osteoporosis knowledge, length of time on oral contraceptives, age at menarche and calcium intake were included in the multiple regression analyses with spinal and femoral BMD as dependent variables. Overall, 38.6% had low spinal BMD and 7.9% had low femoral BMD. BMI (β=0.073, R(2) = .148, P = .001, 95% CI [0.030, 0.116]) and current physical activity (β=0.071, R(2) = .148, P = .017, 95% CI [0.013, 0.129]) were the only variables that were statistically significant in predicting spinal BMD. BMI (β=0.056, R(2) = .13, P = .010, 95% CI [0.014, 0.098]) and current physical activ-ity (β=0.078, R(2) = .13, P = .007, 95% CI [0.022, 0.134]) were also the only varia-bles that were statistically significant in predicting femoral BMD. Race was not a significant predictor of spinal or femoral BMD. It is imperative for both African-American and Caucasian women to engage in osteoporosis-preventive behaviors.

Idiopathic Juvenile Osteoporosis: Clinical Experience from a Single Centre and Screening of LRP5 and LRP6 Genes.

We report clinical findings, bone mineral density (BMD) and bone biopsy data in ten children with features of classic idiopathic juvenile osteoporosis (IJO). We also screened the patients for mutations in LRP5 and LRP6. We found low BMD in the lumbar spine, the hip and distal radius. In the spine and distal radius, the reduction in BMD was more marked in the trabecular compartment. Biopsy confirmed that the trabecular compartment is more severely involved with reduction in bone formation and increase in bone resorption. No mutations in LRP5 and LRP6 could be identified. IJO is likely to be a heterogeneous bone disorder, and next-generation genomic sequencing studies may help reveal causative genes.

Factors associated with bone mineral density in healthy African women.

There is a paucity of normative bone mineral density (BMD) data in healthy African women. Baseline total hip and lumbar spine BMD was measured in premenopausal women. BMD distribution was comparable to that of a reference population and was impacted by several factors including contraception and duration of lactation. Normative data on bone mineral density (BMD) and the cumulative impact of lactation, contraceptive use, and other factors on BMD in healthy African women have not been well studied. The objective of this study was to determine the factors associated with BMD in healthy premenopausal women in Uganda and Zimbabwe. Baseline total hip (TH) and lumbar spine (LS) BMD was measured by dual x-ray absorptiometry in 518 healthy, premenopausal black women enrolling in VOICE, an HIV-1 chemoprevention trial, at sites in Uganda and Zimbabwe. Contraceptive and lactation histories, physical activity assessment, calcium intake, and serum vitamin D levels were assessed. Independent factors associated with BMD were identified using an analysis of covariance model. The study enrolled 331 women from Zimbabwe and 187 women from Uganda. Median age was 29 years (IQR 25, 32) and median body mass index (BMI) was 24.8 kg/m(2) (IQR 22.2, 28.6). In univariate analyses, lower TH BMD values were associated with residence in Uganda (p < 0.001), lower BMI (p < 0.001), and any use of and duration of depot-medroxyprogresterone acetate. Use of oral contraceptives, progestin-only implants, and higher physical activity levels were protective against reduced BMD. Similarly, lower LS BMD values were associated with these same factors but also higher parity and history of breastfeeding. In a multivariable analysis, lower TH and LS BMD values were associated with enrollment in Uganda, lower BMI, and lower physical activity level; contraceptive use was associated with lower spine BMD, and breastfeeding contributed to lower total hip BMD. Among healthy premenopausal women, TH and LS BMD was higher in Zimbabwe than Uganda. Additional factors independently associated with BMD included BMI, physical activity level, contraceptive use, and lactation.

ASSOCIATION OF INTERLEUKIN-1β GENE POLYMORPHISM WITH POSTMENOPAUSAL OSTEOPOROSIS IN WOMEN IN THE RUSSIAN POPULATION

Interleukin-1β (IL-1β) is a potential stimulant of bone resorption. IL-1β receptor antagonist (IL-1RA) is a natural inhibitor of the biological effects of IL-1β. Objective: to study the frequency distribution of polymorphisms in the IL-1β and IL-1RA genes and their association with bone mineral density (BMD) in women with primary osteoporosis (OP). Subjects and methods. The distribution of genotype frequency of IL-1β (-511C/T) polymorphism and that of IL-1RA 511C/T polymorphism that is associated with the number of variable tandem repeats (VTR), were investigated in 254 women with OP and 214 healthy women. Results and discussion. IL-1β (-511C/T) genotype carriers were encountered somewhat more frequently among the patients with OP (53.0%) than in the control group (43.4%); however, the differences were insignificant. In these carriers, the risk of OP was 1.5-fold higher than that in those of other genotypes (odds ratio, 1.49; confidence interval, 1.02–2.18; p = 0.041). The patients who were IL-1β T allele (CT- and TT-genotype) carriers had a significantly lower spine (LI–IV) BMD than those who had not this allele (CC-genotype; p = 0.011). The patients and the controls showed no differences in the frequency distribution of IL-1RA gene polymorphism associated with the number of VTR. In the OP group, the carriers of the rare genotype A1A3 in the IL-1RA gene (3.1%) had significantly higher femoral neck BMD (0.698±0.064 g/cm2) than those of the А1А1, А1А2 and А2А2 genotypes (0.613±0.078; 0.607±0.082. and 0.615±0.064 g/cm2; р = 0.003, р = 0.003, and р = 0.002, respectively). Conclusion. IL-1β (-511C/T) polymorphism is associated with lower spine BMD and IL-1RA A1A3 genotype polymorphism is related to higher femoral neck BMD.

Prevalence and associated factors of reduced bone mineral density in patients with idiopathic inflammatory myopathies

To determine the prevalence and identify the associated factors of reduced bone mineral density (BMD) in patients with idiopathic inflammatory myopathies (IIMs). Existing patients diagnosed to have IIMs were recruited for measurement of BMD by dual energy X-ray absorptiometry. Demographic, clinical and treatment variables of these patients were recorded. The prevalence of osteopenia and osteoporosis were calculated. Using multivariate analysis, the independent associated factors for reduced BMD were evaluated. Thirty-eight patients with IIMs completed the study with 32 (84.2%) being female. The mean age of the patients was 52.8±13.0years. Nine (23.7%) patients had osteoporosis and 18 (47.4%) had osteopenia. Multivariate analysis revealed female gender and low serum albumin levels at onset were associated with lower spinal BMD. For femoral neck, the factors associated with lower BMD were high Myositis Disease Activity Assessment Visual Analogue Scales (MYOACT) score and high cumulative prednisolone dose. Reduced BMD is prevalent in patients with IIMs. Female gender, low serum albumin level at onset, high disease activity and high cumulative corticosteroid dose appeared to be the independent associated factors. Regular assessment of BMD is advisable. The use of anti-osteoporotic and steroid-sparing agents should be encouraged.

Níveis séricos de homocisteína em crianças e adolescentes com comprometimento da saúde óssea

IntroductionAssociation between high serum homocysteine (S-Hcy) levels and low bone mineral density (BMD) and increased fracture risk in postmenopausal women has been documented. Data concerning S-Hcy and bone health in children are scarce. ObjectiveOur aim was to evaluate S-Hcy in children and adolescents with impaired bone health and look for correlations with clinical and laboratory data. Patients and methodsWe assessed S-Hcy levels in 37 children and adolescents (22 boys and 15 girls; mean age 13.9 ± 3.5 years) with prevalent low-energy trauma fractures (mean 3.3 ± 2.3 per patient) and/or low spinal L1-L4 BMD (below -2SD Z-score; DXA Lunar GE). We also evaluated S-ALP, serum CrossLaps, osteocalcin (S-OC), body height, weight, body mass index (BMI) and serum levels of folate and vitamin B12. At the time of assessment, the chil- dren were not taking any drugs known to influence bone metabolism. The age-dependent parameters were expressed as Z-scores ± SD. ResultsS-Hcy Z-score was significantly higher (1.3 ± 1.5; P < 0.0001) and L1-L4 BMD Z-score was significantly lower (-1.7 ± 1.3; P < 0.0001), respectively, in comparison with reference values. S-ALP did not differ from reference values (P = 0.88), while S-CrossLaps and S-osteo- calcin were higher (1.2 ± 1.8 and 0.4 ± 0.5; P = 0.0001 and P = 0.001, respectively). S-Hcy was inversely correlated to L1-L4 BMD (r = -0.33; P = 0.05) and S-ALP (r = -0.36; P = 0.04) and not related to number of prevalent fractures (r = 0.01), S-osteocalcin (r = -0.22) or S-CrossLaps (r = 0.003). ConclusionThese results suggest increased bone turnover and negative influence of elevat- ed S-Hcy on bone formation and BMD in children and adolescents with recurrent fractures.

Serum homocysteine levels in children and adolescents with impaired bone health

IntroductionAssociation between high serum homocysteine (S-Hcy) levels and low bone mineral density (BMD) and increased fracture risk in postmenopausal women has been documented. Data concerning S-Hcy and bone health in children are scarce. ObjectiveOur aim was to evaluate S-Hcy in children and adolescents with impaired bone health and look for correlations with clinical and laboratory data. Patients and methodsWe assessed S-Hcy levels in 37 children and adolescents (22 boys and 15 girls; mean age 13.9 ± 3.5 years) with prevalent low-energy trauma fractures (mean 3.3 ± 2.3 per patient) and/or low spinal L1-L4 BMD (below -2SD Z-score; DXA Lunar GE). We also evaluated S-ALP, serum CrossLaps, osteocalcin (S-OC), body height, weight, body mass index (BMI) and serum levels of folate and vitamin B12. At the time of assessment, the chil- dren were not taking any drugs known to influence bone metabolism. The age-dependent parameters were expressed as Z-scores ± SD. ResultsS-Hcy Z-score was significantly higher (1.3 ± 1.5; P < 0.0001) and L1-L4 BMD Z-score was significantly lower (-1.7 ± 1.3; P < 0.0001), respectively, in comparison with reference values. S-ALP did not differ from reference values (P = 0.88), while S-CrossLaps and S-osteo- calcin were higher (1.2 ± 1.8 and 0.4 ± 0.5; P = 0.0001 and P = 0.001, respectively). S-Hcy was inversely correlated to L1-L4 BMD (r = -0.33; P = 0.05) and S-ALP (r = -0.36; P = 0.04) and not related to number of prevalent fractures (r = 0.01), S-osteocalcin (r = -0.22) or S-CrossLaps (r = 0.003). ConclusionThese results suggest increased bone turnover and negative influence of elevat- ed S-Hcy on bone formation and BMD in children and adolescents with recurrent fractures.

Vertebral Fracture Assessment in Adolescents and Young Women With Anorexia Nervosa: A Case Series

Rates of vertebral fracture (VF) in young women with anorexia nervosa (AN) are not well understood. We sought to determine the rates of asymptomatic VF in patients suffering from AN, hypothesizing that VF rates would be higher in subjects with low bone mineral density (BMD) Z-scores. We recruited young women with AN (n = 80) for participation in a longitudinal trial. Dual-energy X-ray absorptiometry images of the lateral thoracic and lumbar spines were obtained for VF assessment at 0, 6, 12, and 18 mo. Thirteen subjects (16%) had a low spinal BMD at baseline (BMD Z-score ≤−2 standard deviation). Using the Genant semiquantitative technique, 2 of 80 subjects at baseline (2.5%) had evidence of a single Genant grade 1 deformity. One subject had a Genant grade 2 deformity. Over the 18-mo trial, 10 incident VFs occurred in 9 subjects (12.5%). Using quantitative techniques, only 2 subjects had a more than 15% loss in vertebral height. Neither anthropometric data nor markers of disease severity were associated with fracture. In conclusion, ill young women with AN were at low risk for asymptomatic VF in our cohort. VFs were not predicted by duration of illness, severity of malnutrition, or traditional measures of areal BMD at the lumbar spine.

Bone resorption and fracture across the menopausal transition: the Study of Women's Health Across the Nation.

Bone turnover markers (BTMs) predict fracture in older women, whereas data on younger women are lacking. To test the hypothesis that BTMs measured before and after menopause predict fracture risk, we performed a cohort study of 2,305 women. Women attended up to nine clinic visits for an average of 7.6 ± 1.6 years; all were aged 42 to 52 years and were premenopausal or early perimenopausal at baseline. Incident fractures were self-reported. Serum osteocalcin and urinary cross-linked N-telopeptide of type I collagen (NTX) were measured at baseline. NTX was measured at each annual follow-up. Interval-censored survival models or generalized estimating equations were used to test whether baseline BTMs and changes in NTX, respectively, were associated with fracture risk. Hazard ratios (HRs) or odds ratios were calculated with 95% CIs. Women who experienced fractures (n = 184) had about a 10% higher baseline median NTX (34.4 vs 31.5 nanomoles of bone collagen equivalents per liter per nanomole of creatinine per liter; P = 0.001), but there was no difference in osteocalcin. A 1-SD decrease in lumbar spine bone mineral density (BMD) measured premenopausally was associated with a higher fracture risk during menopause (HR, 1.50; 95% CI, 1.28-1.68). Women with a baseline NTX greater than the median had a 45% higher risk of fracture, multivariable-adjusted (HR, 1.46; 95% CI, 1.05-2.26). The HR of fracture among women with both the lowest spine BMD (quartile 1) and the highest NTX (quartile 4) at baseline was 2.87 (95% CI, 1.61-6.01), compared with women with lower NTX and higher BMD. Women whose NTX increased more than the median had a higher risk of fracture (odds ratio, 1.51; 95% CI, 1.08-2.10). Women who had baseline NTX greater than the median experienced greater loss of spine and hip BMD. A higher urinary NTX excretion measured before menopause and across menopause is associated with a higher risk of fracture. Our results are consistent with the pathophysiology of transmenopausal changes in bone strength.

Juvenile onset systemic lupus erythematosus: a possible role for vitamin D in disease status and bone health

In juvenile onset systemic lupus erythematosus (JoSLE), evidence for the association between vitamin D status, lupus activity, and bone health is very limited and not conclusive. The aim of this study was, therefore, to assess in JoSLE patients the possible relevance of vitamin D deficiency in disease and bone parameters. Fifty-seven JoSLE patients were initially compared to 37 age, race and body mass index (BMI) -matched healthy controls. The serum concentration of 25 hydroxyvitamin D (25OHD) was determined by radioimmunoassay. Patients with 25OHD deficiency (≤20 ng/mL) were compared to those with levels >20 ng/mL. Disease activity was evaluated by SLE Disease Activity Index (SLEDAI). Bone mineral density (BMD) and body composition (BC) were measured using dual-energy X-ray absorptiometry (DXA). 25OHD levels were similar in patients and controls (21.44 ± 7.91 vs 22.54 ± 8.25 ng/mL, p = 0.519), regardless of supplementation (65% of patients and none in controls). Thirty-one patients with 25OHD deficiency (≤20 ng/mL) were further compared to the 26 JoSLE patients with levels >20 ng/mL. These two groups were well-balanced regarding vitamin D confounding variables: age (p = 0.100), ethnicity (p = 1.000), BMI (p = 0.911), season (p = 0.502), frequency of vitamin D supplementation (p = 0.587), creatinine (p = 0.751), renal involvement (p = 0.597), fat mass (p = 0.764), lean mass (p = 0.549), previous/current use of glucocorticoids(GC) (p = 1.0), immunosuppressors (p = 0.765), and mean current daily dose of GC (p = 0.345). Patients with vitamin D deficiency had higher SLEDAI (3.35 ± 4.35 vs 1.00 ± 2.48, p = 0.018), lower C4 levels (12.79 ± 6.78 vs 18.38 ± 12.24 mg/dL, p = 0.038), lower spine BMD (0.798 ± 0.148 vs 0.880 ± 0.127 g/cm(2), p = 0.037) and whole body BMD (0.962 ± 0.109 vs 1.027 ± 0.098 g/cm(2), p = 0.024). JoSLE vitamin D deficiency, in spite of conventional vitamin D supplementation, affects bone and disease activity status independent of therapy and fat mass reinforcing the recommendation to achieve adequate levels.

Whole Body Vibration Increases Hip Bone Mineral Density in Road Cyclists

This study aimed to determine the effects of 10 weeks of whole body vibration training on the bone density of well-trained road cyclists. 15 road cyclists were assigned to either a vibrating group (n=8), who undertook 15 min of intermittent whole body vibration at 30 Hz, 3 times per week while continuing with their normal cycling training; or a control group (n=7), who continued with their normal cycling training for the 10-week period. Cyclists were age, body mass and height matched with 15 sedentary participants. At baseline, all participants underwent regional dual x-ray absorptiometry scans, where both cycling groups had lower pelvic (p<0.050) and higher head bone mineral density (p<0.050) than the sedentary participants with no other differences observed. After 10 weeks of training, vibrating cyclists showed a significantly greater increase in hip bone mineral density (0.020±0.010 g.cm - 2 (1.65%), p=0.024) while the control cyclists ( - 0.004±0.001 g.cm - 2 (0%)) showed no change (p>0.050). The control group had a significantly lower spine bone mineral density (1.027±0.140 g.cm - 2, p=0.020) compared to baseline (1.039±0.140 g.cm - 2). This loss was not observed in the vibrating group. 10 weeks of whole body vibration training increased hip and preserved spine bone mineral density in road cyclists.

Endocrine and Bone Metabolic Complications in Chronic Liver Disease and After Liver Transplantation in Children

With improved survival of orthotopic liver transplantation (OLT) in children, prevention and treatment of pre- and posttransplant complications have become a major focus of care. End-stage liver failure can cause endocrine complications such as growth failure and hepatic osteodystrophy, and, like other chronic illnesses, also pubertal delay, relative adrenal insufficiency, and the sick euthyroid syndrome. Drug-induced diabetes mellitus post-OLT affects approximately 10% of children. Growth failure is found in 60% of children assessed for OLT. Despite optimisation of nutrition, rarely can further stunting of growth before OLT be prevented. Catch-up growth is usually observed after steroid weaning from 18 months post-OLT. Whether growth hormone treatment would benefit the 20% of children who fail to catch up in height requires testing in randomised controlled trials. Hepatic osteodystrophy in children comprises vitamin D deficiency rickets, low bone mass, and fractures caused by malnutrition and malabsorption. Vitamin D deficiency requires aggressive treatment with ergocalciferol (D2) or cholecalciferol (D3). The active vitamin D metabolites alphacalcidol or calcitriol increase gut calcium absorption but do not replace vitamin D stores. Prevalence of fractures is increased both before OLT (10%-28% of children) and after OLT (12%-38%). Most fractures are vertebral, are associated with low spine bone mineral density, and frequently occur asymptomatically, but they may also cause chronic pain. Fracture prediction in these children is limited. OLT in children is also associated with a greater risk of developing avascular bone necrosis (4%) and scoliosis (13%-38%). This article reviews the literature on endocrine and skeletal complications of liver disease and presents preventive screening recommendations and therapeutic strategies.

Anemia as a risk factor for low bone mineral density in postmenopausal Turkish women

BackgroundWe investigated the association of bone mineral density (BMD) by detected dual-energy X-ray absorptiometric (DXA) method and hemoglobin (Hb) levels in a large sample. MethodsThe current study enrolled 371 postmenopausal women (82 anemic patients), who were screened for osteopenia or osteoporosis by DXA. Patients with osteopenia or osteoporosis (T score<−1.0 SD) were grouped as having low bone mass (LBM). ResultsAnemic patients were older and had significantly higher duration of menopause. When compared with subjects with normal Hb, anemic patients had significant lower femur t score, femur BMD, femur Z score, spinal t score, spinal BMD and spinal Z score (p<0.001). Additionally, the ratio of subjects with LBM in the femur and spine were significantly high in anemic patients (p<0.002, p<0.002, respectively). There were significant correlations between Hb values and femur t score, femur BMD, spine t score, and spine BMD values of the study population in bivariate correlation analysis (r=0.150, p=0.004, r=0.148, p=0.004, r=0.160, p=0.002, r=0.164, p=0.001, respectively). Furthermore, presence of anemia was found to be an independent predictor of LBM for spine [OR: 2.483 (95% CI: 1.309–4.712), p<0.005] in logistic regression analysis. Additionally, number of anemic patients was significantly high in low femur and spine BMD groups (56 vs. 26; p=0.01, 66 vs. 16; p=0.002, respectively). ConclusionWe have found that the presence of anemia was as an independent predictor of LBM for spine after adjusting for body mass index and other confounders in postmenopausal Turkish women.

Bone Mineral Density, Fracture, and Vitamin D in Adolescents and Young Women Using Depot Medroxyprogesterone Acetate

Study Objective To evaluate bone mineral density (BMD) in adolescents and young adults treated with depot medroxyprogesterone acetate (DMPA). Design, Setting, Participants Eighty-three healthy subjects, 13-20 years old, who received at least 3 DMPA injections in an urban adolescent clinic and underwent dual energy x-ray absorptiometry (DXA) were evaluated by chart review. Main Outcome Measures Anthropometric data, DMPA use, BMD of the spine and hip, fracture history, and vitamin D status were collected. Results Subjects were a median age of 16.4 years old (range 13-20 years) when DMPA was initiated. The median number of DMPA injections was 5 (range 3-18) before the first DXA. At the spine and hip, respectively, BMD was normal (Z-score > −1.0 SD) for most subjects (79%, 86%). Subjects who received > 5 injections were more likely to have low spinal BMD (Z-score ≤ −2.0 SD) at first DXA ( P = .018). In 15 subjects with repeat DXA measurements, after an additional median 6 injections, spinal BMD Z-score decreased by −0.33 ± 0.10 (mean ± SD, P = .004), as did absolute BMD at the hip (−0.019 ± 0.007 g/cm 2, P = .014). History of fracture was not associated with initial or subsequent BMD measurements. Most (12/13, 92.3%) subjects with vitamin D measurements were deficient (25-hydroxy vitamin D < 20 ng/mL). Conclusions Most subjects on DMPA had normal BMD at first DXA. Low spinal BMD was associated with longer DMPA use, and some BMD measurements declined with prolonged use. Fracture history is not an absolute contraindication to DMPA use in this population. Studies are needed to determine possible benefits of vitamin D supplementation in DMPA users.

Computer‐aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis

To develop a computer-aided diagnosis system to continuously measure mandibular inferior cortical width on dental panoramic radiographs and evaluate the system's efficacy in identifying postmenopausal women with low-skeletal bone mineral density. Mandibular inferior cortical width was continuously measured by enhancing the original X-ray image, determining cortical boundaries, and evaluating all distances between the upper and lower boundaries in the region of interest. The system's efficacy in identifying osteoporosis at the lumbar spine and the femoral neck was evaluated for 100 women (≥50 years): 50 in the development of the tool and 50 in its validation. The sensitivity and specificity of the cortical measurements for identifying the development patients were 90% (95% confidence interval shown in parentheses) (63.0-87.0) in women with low spinal bone mineral density, and 81.8% (70.1-91.8) and 69.2% (56.2-81.8) in those with low femoral bone mineral density, respectively. Corresponding values in the validation patients were 93.3% (85.9-100) and 82.9% (71.4-92.7) at the lumbar spine, and 92.3% (84.5-99.5) and 75.7% (63.0-87.0) at the femoral neck, respectively. Our new computer-aided diagnosis system is a useful procedure in triage screening for osteoporosis.

Association of the A1330V and V667M polymorphisms of LRP5 with bone mineral density in Greek peri- and postmenopausal women

Wnt signaling through low-density lipoprotein receptor-related protein 5 (LRP5) is an important determinant of bone mass regulation. Objective To explore the influence of two LRP5 single nucleotide polymorphisms (SNPs) A1330V and V667M on bone mineral density (BMD) and serum levels of osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL) and bone metabolic markers in a Greek female population. Study design Two hundred and nine postmenopausal and twelve perimenopausal women aged 40–63 years were enrolled. All participants underwent spinal BMD evaluation. Genotyping of A1330V and V667M polymorphisms was performed by real-time polymerase chain reaction. Levels of OPG, soluble RANKL (sRANKL) and bone metabolic markers were measured. Results As regards A1330V SNP, women carrying CT/TT genotypes had lower spinal BMD than women with CC ( p < 0.0001). Regarding V667M SNP, spinal BMD was lower in women with GA/AA than in women with GG genotypes ( p < 0.0001). These differences remained significant after adjustment for age, years since menopause and body mass index. The A1330V and V667M polymorphisms were in strong linkage disequilibrium. A significant interaction between A1330V and V667M SNPs on spinal BMD was revealed. The haplotype with both risk alleles of the two SNPs (AT) conferred more risk for low BMD than the haplotypes with one risk allele (GT or AC) or the haplotype-reference (GC) ( p = 0.046, p = 0.045, and p = 0.010, respectively). No effect was observed on circulating OPG, sRANKL levels and bone metabolic markers. Conclusions These findings demonstrate that the A1330V and V667M polymorphisms are associated with low BMD in peri- and postmenopausal Greek women.

Lumbar spine bone mineral density in US adults: demographic patterns and relationship with femur neck skeletal status

This analysis examines lumbar spine bone mineral density (BMD) of US adults from NHANES 2005-2008 by age, sex, and race/ethnicity. Prevalence of low spine BMD and agreement between the prevalence of low BMD at the spine and femur neck in older adults are also assessed. Lumbar spine BMD data from a representative sample of the US population have not been previously available. We used data from the National Health and Nutrition Examination Survey 2005-2008 to examine demographic patterns in lumbar spine BMD among US adults age ≥20 years and the prevalence of low lumbar spine BMD in adults age ≥50 years. Agreement between the prevalence of low BMD at the femur neck and spine in older adults was also assessed. Dual-energy X-ray absorptiometry was used to measure lumbar spine and femur neck BMD. World Health Organization definitions were used to categorize skeletal status as normal, osteopenia, or osteoporosis. Compared to non-Hispanic whites, non-Hispanic blacks had higher and Mexican Americans had lower lumbar spine BMD. Lumbar spine BMD declined with age in women, but not in men. Approximately 4.7 million (10%) older US women and 1 million (3%) older men had lumbar spine osteoporosis in 2005-2008. Roughly one third of them differed in skeletal status at the spine and hip but most were normal at one site and osteopenic at the other. Only 3-10%, depending on sex, had osteoporosis at one skeletal site but not at the other skeletal site. Between 76% and 87% with discordant skeletal status had lumbar spine T-scores within 1 unit of the category threshold. These findings suggest that measuring either the femur neck or the lumbar spine will correctly classify the majority of individuals who present for care as osteoporotic or not.

REMEDY: Impact of Menstrual Status on Musculoskeletal and Hormonal Health

The prevalence of exercise-induced menstrual dysfunction (ExMD) is high (6-79%) in active women and may result from low energy availability (EA). ExMD increases the risk for musculoskeletal injuries and is associated with hormonal imbalances. Currently, a non-pharmacological treatment does not exist for ExMD. PURPOSE: To determine if improvements in EA in endurance-trained women, using a daily Carbohydrate-Protein supplement (CHO-PRO), will restore menstrual function and improve musculoskeletal health. METHODS: Active women with menstrual dysfunction (n=8; 7 amenorrheic, 1 oligomenorrheic, age=23±3y, VO2max =49±6 ml/kg/min, body fat=22±4%) participated in a 6-mo intervention, where they consumed 325ml of CHO-PRO drink/d (360kcal/d). Menstrual status was confirmed by measuring reproductive hormones. Energy intake and expenditure were assessed at baseline (0-mo) and post-intervention (6-mo) using 7-d weighed food and physical activity records and accelerometer. Lower body strength and power, bone mineral density (BMD), and blood hormonal levels were determined. Comparisons were made using multiple linear regression, blocking on participants. RESULTS: All women resumed menses (2.6±2.2 mo to 1st menses, 3.5±1.9 cycles during intervention). Women with longer duration of ExMD took longer to resume menses. No differences were detected in BMD (p>0.05), but improvements were observed in women with low BMD at the spine. Two women had low hip BMD at 0-mo and had no change in status at 6-mo. Two women had low spine BMD at 0-mo, and one improved status to normal at 6-mo. One women had osteoporosis of the spine at 0-mo and improved status to low BMD at 6-mo. Knee extension was higher at 6-mo vs. 0-mo (p=0.002), but no other strength differences were detected (p >0.05). CONCLUSION: Increasing daily energy intake using a CHO-PRO supplement was effective in resuming menses in active women. Although all participants did resume menses, improvements in muscle strength were only observed in knee extension. Improvements in BMD were only observed in women with low BMD. More time may be required after the resumption of menses before improvements in muscle strength and BMD are realized. Supported by Gatorade Sports Science Institute.