Lower TBS Research Articles

Bone mass, microarchitecture and turnover among young Indian women with non-alcoholic fatty liver disease.

To evaluate comprehensive bone health among young Indian women, including bone mass, microarchitecture, and turnover, in relation to their non-alcoholic fatty liver disease (NAFLD) status. This cross-sectional study (May 2018-November 2019) recruited women with a history of gestational diabetes mellitus (GDM) and normoglycemia in their index pregnancy, who were at least 6 months postpartum. All participants underwent abdominal ultrasonography for determination of NAFLD status (grades 2 and 3: severe NAFLD) and transient elastography (FibroScan) for hepatic fibrosis (LSM >6 kPa). Bone mass was assessed by DXA, bone microarchitecture with trabecular bone score {TBS} (low TBS ≤ 1.310) and bone turnover with markers of bone formation (osteocalcin and P1NP), and resorption (CTX). Bone mineral density (BMD) at femoral neck (p = 0.026) and total hip (p = 0.007) was significantly higher among women with NAFLD (n = 170) compared to those without (n = 124). There was no significant difference in bone turnover markers between the two groups. The presence of NAFLD [adjusted OR: 1.82 (1.07, 3.11)] was associated with low TBS, with a greater strength of association among women with severe NAFLD [adjusted OR: 2.97 (1.12, 7.88)]. However, these associations were attenuated and no longer significant after additionally adjusting for BMI. Women with NAFLD and hepatic fibrosis manifested significantly higher BMD at lumbar spine, femoral neck, and total hip (p < 0.001 for all) and significantly lower bone turnover markers (osteocalcin, p = 0.009 and CTX, p = 0.029), however, the association with low TBS was not observed. Among young Indian women, NAFLD is associated with increased bone mass and impaired bone microarchitecture, and hepatic fibrosis with increased bone mass and reduced bone turnover.

New Entity-Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement.

New Entity-Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement.

Post-Hatch Performance of Broilers Following Hypoxic Exposure During Incubation Under Suboptimal Environmental Temperature.

The modern broiler is selected to exploit its full genetic potential, to sustain a rapid growth rate, and to lower the feed conversion rate (FCR). Recently reported reductions in FCR have been associated with augmented tissue formation at the expense of physiological functions such as thermoregulation. In turn, modern broilers exhibit a relatively low capability to balance energy expenditure under suboptimal ambient temperature. Hypoxic conditions at late incubation stages play a role in reforming metabolic plasticity. This work examined the effect of exposure to 12-h hypoxia (12H; 17% O2) for three consecutive days (from E16 through E18), or continuous hypoxia exposure for 48 h (48H), from E16 through E17, as compared to standard incubation (21% O2) on post-hatch performance of broilers maintained under suboptimal ambient temperatures (cold, hot, and diurnal cyclic ambient temperature). 12H chicks kept under hot ambient temperature had significantly lower body temperature (Tb) as compared to the control chicks. On day 42, both 12H and 48H chicks grown in the cyclic temperature room had significantly lower Tbs than controls. In parallel, from week 4, onward, 12H chicks had a significantly lower FCR than controls, and the 48H chicks demonstrated a lower FCR from week 5 and on. 12H and 48H broilers maintained under diurnal cyclic ambient temperature, exhibited significantly greater relative breast muscle weight, and a similar pattern was found in hypoxic broilers raised under standard and hot ambient temperatures. Hypoxic manipulation affects and create an adaptive bias in allocating metabolic energy between maintenance and growth, thus resulting in improved broiler performance, thermoregulation, and rearing under suboptimal environmental temperature.

Effect of soft tissue noise on trabecular bone score in postmenopausal women with diabetes: A cross sectional study.

Type 2 diabetes (T2D) is associated with increased fracture risk, despite similar or greater BMD compared to nondiabetics. TBS predicts fracture risk in T2D and nondiabetics. However, increased abdominal thickness, a common feature in T2D, may reduce TBS values. To study the relationship among glycemic status, BMD and TBS, considering abdominal soft tissue thickness (STT) interference. Cross-sectional analysis of 493 women ≥65years, with simultaneous DXA scans and HbA1c measures. STT and TBS (iNsight Software, v3.0) were derived from lumbar spine (LS) scans. Subjects were divided according to HbA1c levels: 1 (≥6.5%; n=116), 2 (5.7-6.4%; n=217) and 3 (≤5.6%; n=160). Group 1 was further divided based on HbA1c and/or disease duration: 1a (HbA1c≥7.5%; n=42), 1b (HbA1c≥6.5% and disease duration ≥5years; n=63) and 1c (HbA1c≥7.5% and disease duration ≥5years; n=30). For the entire cohort, mean age, TBS, BMI and STT were 71.8±6.0years, 1.299±0.101, 26.9±4.1kg/m2, and 21.4±2.9cm, respectively. LS-BMD was similar among groups. BMD in hip sites and STT were higher in group 1. TBS was lower in patients with higher HbA1c (P=0.020), with a mean TBS in groups 1, 2, and 3 of 1.280, 1.299 and 1.314, respectively. This difference remained after adjusting for age, LS-BMD and BMI (P=0.010). After replacing BMI with STT, TBS differences were no longer significant (P=0.270). The same was observed when subgroups 1a and 1b were compared to group 3. However, for subgroup 1c, TBS remained lower compared to group 3, even after adjusting for age, LS-BMD and STT, with a borderline P-value (1.275 vs. 1.308; P=0.047). Higher HbA1c levels were associated with greater BMD in hip sites, higher abdominal STT and lower TBS values. However, after including the STT in the adjustment, TBS differences among groups disappeared, except in women with higher HbA1c levels and longer disease duration.

Bone Mineral Density and Trabecular Bone Score in Predicting Vertebral Fractures in Male Employees of the Electricity Generating Authority of Thailand.

Purpose Osteoporotic VF is frequently asymptomatic and affects not only women but also men. Identifying patients at risk is essential for early management and prevention. BMD and the TBS are measurements of bone strength and trabecular microarchitecture, respectively. Their role in VF prediction in men is less well-studied. We determined the BMD and TBS predictive ability for osteoporotic VF in men. Methods A total of 115 male participants of the Electricity Generating Authority of Thailand (EGAT) cohorts without a history of VF who completed the baseline BMD and TBS measurements in 2012 and a thoracolumbar spine radiograph in 2017 were recruited. The VF was assessed using the Genant semiquantitative method. Logistic regression analysis was performed to identify factors associated with the fracture. The area under the receiving operator curve (AUC) was analyzed to define VF predictive ability. Results Forty subjects (34.78%) had VFs. The unadjusted relative risks (95% confidence interval) for VF for one standard deviation decrease in the TBS and low TBS were 1.319 (1.157–1.506) and 2.347 (1.496–3.682), respectively, and remained significant after BMD and age adjustment. For VF prediction, combined models had a greater AUC than models predicted from a single variable. The use of low TBS, femoral neck BMD, and age provided the best AUC (0.693). Conclusion BMD and the TBS could predict osteoporotic VF in male EGAT employees. The use of both BMD and the TBS in the VF prediction process improved predictive ability.

Abstract 153: Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes

Background: Increased fracture risk is seen in T2DM despite higher bone mineral density (BMD) due to poor bone microarchitecture. Recent studies suggest bone health may be affected early in the natural history of diabetes and women with prior gestational diabetes mellitus (GDM) would be ideal population to study this as precise information on glycemic status in the near past is available.Objective: The aim of this cross-sectional study was to comprehensively assess bone health in women with prior gestational diabetes mellitus, including bone microarchitecture (TBS), bone mineral density (BMD) and bone turnover (osteocalcin).Results: A total of 240 women (mean age: 33.3 ± 5.0 years; median postpartum duration: 34 [interquartile range 13.0-54.5] months were evaluated. At the current visit, 115 (47.9%) and 36 (15%) women had prediabetes and diabetes, respectively. Women with dysglycemia (diabetes/prediabetes) had a higher BMD at all three sites, compared to those with normoglycemia; however, the difference was not statistically significant. Women with dysglycemia had a significantly lower TBS (1.32 ± 0.09 vs. 1.35 ± 0.09; p = .038). Women with dysglycemia had significantly lower serum osteocalcin levels (18.6 ± 8.5 ng/ml vs. 21.5 ± 9.7 ng/ml; p = .018). HOMA-IR (r = -.285, p < .001) was negatively correlated, while Matsuda index (r = .274, p < .001) and disposition index (r = .159, p = .016) were positively correlated with serum osteocalcin levels.Conclusions: Bone health is affected early in the natural history of diabetes and is associated with an overall low bone turnover state.

Оцінка мікроархітектури хребта за допомогою TBS допомагає розрізнити пацієнтів з основними остеопоротичними переломами та контрольну групу залежно та незалежно від МЩКТ: Східноєвропейське дослідження TBS

Метою дослідження була оцінка клінічної ефективності моделі, що поєднує показники мінеральної щільності (МЩКТ) і мікроархітектури (TBS) кісткової тканини хребта, щодо виявлення остеопоротичних переломів. Східноєвропейське багатоцентрове дослідження (Сербія, Болгарія, Румунія, Україна) оцінювало роль TBS у рутинній клінічній практиці як доповнення до МЩКТ. Усі відскановані дані були отримані на денситометрах Hologic Discovery й GE Prodigy звичайним способом, що застосовується в клінічній практиці. Клінічні значення МЩКТ хребта і TBS для всіх типів остеопоротичних переломів (All-OP Fx) додатково були проаналізовані методом двохетапного дерева класифікації (МЩКТ супроводжувалось аналізом тертилів TBS). Були визначені чутливість, специфічність і точність виявлення переломів, а також був розрахований Net Reclassification Index (NRI). Дослідження включало 1031 жінку віком 45 років і старше з різних країн Східної Європи. Клінічні центри були перехресно відкалібровані за МЩКТ і TBS. Як і очікувалось, мінеральна щільність кісткової тканини хребта і TBS корелювали помірно (r2 = 0,19). Показник поширеності для всіх типів остеопоротичних переломів (All-OP Fx) становив 26%. Пацієнти з переломами мали значимо нижчі показники TBS і МЩКТ хребта, ніж особи без переломів (p = 0,01). Показник TBS асоціювався з наявністю переломів навіть після поправки на вік і МЩКТ хребта з OR (odds ratio) 1,27 [1,07–1,51]. Показники МЩКТ хребта за Т-критерієм –2,5 і нижче та TBS нижнього тертиля були подібні з погляду чутливості (35 проти 39%), специфічності (78 проти 80%) і точності (64 проти 66%). Комбінація МЩКТ хребта і TBS приводила до значного підвищення чутливості (+28%) і точності (+17%) порівняно з використанням тільки МЩКТ хребта, у той час як специфічність покращувалась помірно (+9%). Загальний коефіцієнт ефективності комбінації, визначений за допомогою NRI, становив 36%. Поєднане застосування МЩКТ хребта і TBS істотно зменшило кількість суб’єктів, які потребують додаткової діагностики МЩКТ, із 7 до 2. Ми показали, що в східноєвропейській когорті використання TBS як доповнення до МЩКТ хребта дозволяє правильно класифікувати більше ніж третину з усіх пацієнтів. Крім того, кількість осіб, які потребують додаткової діагностики, зменшилась до 2. Щоб оцінити вигоду використання TBS для системи охорони здоров’я, необхідно провести додаткові економічні дослідження.

Anti-osteoporotic medication and scleroderma

Scleroderma (systemic sclerosis) represents a challenging condition, usually requiring a multi-disciplinary team due to multi-organ involvement; it is mostly considered an autoimmune disease; the signature of the malady is the extensive fibrosis at the level of skin and multiple organs, associating endothelial/vessel damage and anomalies of immune response. We point out a few aspects concerning scleroderma-related osteoporosis. This is a literature review. Patients might associate low bone mineral density (the underling mechanisms are not entirely understood), thus an increased risk of fractures; so early recognition and treatment is mandatory for a better outcome. Some data showed that particularly vertebral fractures are prone to the condition. Almost half of individuals with the malady have osteoporosis (female prevalence, especially post-menopausal) and one third of them have an osteoporotic fracture. Older age and associated vitamin D deficiency increases the risk of fracture. Vitamin D has pleomorphic distribution, also targeting the immune modulation, cytokines puzzle, and the muscle-bone crosstalk in scleroderma. Hypovitaminosis D might be expected in these patients, while general D-supplementation has controversial benefits effects. Chronic inflammatory rheumatic conditions might benefit from the TBS use as fracture risk indicator through micro-architecture evaluation. It seems that patients with systemic sclerosis and malnutrition have lower TBS; high Dkk-1 serum levels (Dickkopf-1) is correlated with reduced TBS and advanced disease; TBS is correlated to the extent of microvascular complications; exposure to glucocorticoids (certain high-dose regimes) supplementary lowers TBS. Gastrointestinal complications are presented in 90% of patients with systemic sclerosis, involving fibrosis at any level which is a poor prognostic factor; malabsorption of nutrients and weight loss correlates with reduced bone formation while esophageal and gastric anomalies contraindicate the use of oral bisphosphonates for osteoporosis. Other abnormal elements of skeleton frame include: premature ovarian failure, serotonin system anomalies, chronic inflammation, potential side effects of immunosuppressant drugs. In patients with systemic sclerosis, the choices of medication targeting osteoporosis are limited; the use of intravenous bisphosphonates remains first line option (if renal function is adequate); the consideration of skin and esophageal anomalies is mandatory in the management of osteoporosis. Overall, the landscape of bone domain in systemic sclerosis is multi-leveled and some areas are still waiting for clear answers.

Bone microarchitecture, bone mineral density and bone turnover in association with glycemia and insulin action in women with prior gestational diabetes.

The aim of this cross-sectional study was to comprehensively assess bone health in women with prior gestational diabetes mellitus, including bone microarchitecture (TBS), bone mineral density (BMD, DXA) and bone turnover (osteocalcin). Study participants underwent a detailed anthropometric, biochemical and hormone assessment, including insulin and osteocalcin measurement. BMD was measured at lumbar spine, femur neck and total hip using DXA and TBS derived from lumbar spine DXA images using TBS iNsight software. A total of 240 women (mean age: 33.3 ± 5.0 years; median postpartum duration: 34 [interquartile range 13.0-54.5] months were evaluated. At the current visit, 115 (47.9%) and 36 (15%) women had prediabetes and diabetes, respectively. Women with dysglycemia (diabetes/prediabetes) had a higher BMD at all three sites, compared to those with normoglycemia; however, the difference was not statistically significant. Women with dysglycemia had a significantly lower TBS (1.32 ± 0.09 vs. 1.35 ± 0.09; p = .038). In the fully adjusted model, the odds ratio for association between diabetes and low TBS was 2.92 (95% confidence interval: 1.20, 7.08; p = .018). Women with dysglycemia had significantly lower serum osteocalcin levels (18.6 ± 8.5 ng/ml vs. 21.5 ± 9.7 ng/ml; p = .018). HOMA-IR (r = -.285, p < .001) was negatively correlated, while Matsuda index (r = .274, p < .001) and disposition index (r = .159, p = .016) were positively correlated with serum osteocalcin levels. Bone health is affected early in the natural history of diabetes and is associated with an overall low bone turnover state.

A simulation-based approach for removing the effect of water contamination on SMAP soil moisture retrieval over the Qinghai-Tibet Plateau

ABSTRACT L-band passive microwave remote sensing is currently the optimum tool for the large-scale soil moisture mapping. However, due to the coarse spatial resolution of passive microwave remote sensing, the existence and dynamic changes of water bodies in the field of view would affect the performance of soil moisture retrieval. The Qinghai-Tibet Plateau (QTP) is a densely populated area of lakes in China, and the correction of water contamination effect is much more challenging. In this letter, we proposed a simulation-based approach which utilizes a radiative transfer model to simulate the brightness temperature (TB) of water bodies to correct the Soil Moisture Active Passive (SMAP) data over the QTP, taking into account of wind speed, surface temperature and salinity of lakes. The simulated data and water area fraction obtained from a dynamic map of water bodies were applied to remove the effect of water contamination. Results showed that the relatively low SMAP TBs surrounding both small and large lakes could be eliminated and do not have correlation with the water area fraction after using the proposed approach. Validation results in the Naqu network demonstrated that the simulation-based approach can effectively remove the water contamination from SMAP data with improved soil moisture retrievals.

DXA-Based Bone Strain Index: A New Tool to Evaluate Bone Quality in Primary Hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is associated with impaired bone quality and increased fracture risk. Reliable tools for the evaluation of bone quality parameters are not yet clinically available. Bone Strain Index (BSI) is a new metric for bone strength based on Finite Element Analysis from lumbar spine and femoral neck dual-energy x-ray absorptiometry (DXA) images. To assess the lumbar spine (LS), femoral neck (FN), and total hip (TH) BSI in PHPT patients compared with controls and to investigate the association of BSI with vertebral fractures (VFs) in PHPT. This case-control study enrolled 50 PHPT patients and 100 age- and sex-matched control subjects from an outpatient clinic. The main outcome measures were LS-BSI, FN-BSI, and TH-BSI. FN bone mineral density (BMD) and one-third distal radius BMD were lower in the PHPT group than in controls (FN 0.633 ± 0.112 vs 0.666 ± 0.081, P = 0.042; radius 0.566 ± 0.07 vs 0.625 ± 0.06, P < 0.001). PHPT group has significant lower TBS score compared with controls (1.24 ± 0.09 vs 1.30 ± 0.10, P < 0.001). BSI was significantly higher at LS (2.28 ± 0.59 vs 2.02 ± 0.43, P = 0.009), FN (1.72 ± 0.41 vs 1.49 ± 0.35, P = 0.001), and TH (1.51 ± 0.33 vs 1.36 ± 0.25, P = 0.002) in PHPT. LS-BSI showed moderate accuracy for discriminating VFs (AUC 0.667; 95% CI, 0.513-0.820). LS-BSI ≥ 2.2 and was a statistically significant independent predictor of VFs, with an adjusted odds ratio ranging from 5.7 to 15.1. BSI, a DXA-derived bone quality index, is impaired in PHPT and may help to identify PHPT subjects at high risk of fractures.

Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors: Impact on trabecular bone score and bone mineral density in primary fibromyalgia

Background: Fibromyalgia is a chronic musculoskeletal pain disorder characterized by widespread pain at multiple tender points, sleep disturbance and fatigue, which subsequently affect quality of life.The aim of our study is to determine the correlation between consumption of SSRIs and SNRIs in patients with primary fibromyalgia, and BMD and TBS. Methods and Findings: A cross-sectional study carried out on 150 Egyptian participants. Patients were divided into 2 main groups: treatment group including 100 patients (50 on SSRI, and 50 on SNRI) diagnosed with primary myelofibrosis, and control group including 50 age-matched subjects (25 healthy individual, and 25 with primary myelofibrosis but receiving medications other than SSRI and SNRI).BMD and TBS were significantly low in SSRI and SNRI treatment groups compared to healthy control. In older population, lumbar spine (L1-L4) BMD and TBS decreased significantly in SSRI group. Also, control patients with primary fibromyalgia showed low BMD. Conclusion: Our study showed that patients with primary myelofibrosis, especially old population, whose treatment involved SSRIs or SNRIs had low BMD and low TBS. Additionally, patients with primary fibromyalgia who neither received SSRI nor SNRI also experienced low BMD. Thus, primary myelofibrosis could be considered as a contributing factor for low BMD.

SUN-362 Bone Involvement in Adult Patients Affected with Ehlers-Danlos Syndromes

INTRODUCTION: The Ehlers-Danlos syndrome (EDS) is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility, bone involvement is an emerging manifestation. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of clinical fractures and morphometric vertebral fractures (mVFx) in a large group of adult EDS patients. METHODS: Two-hundred and sixty-six consecutive Caucasian patients, aged ≥18 years (38.3±11.8) (190 females, 76 males) 58% with classical, 34.9% with hypermobility, 4.5% with vascular and 4.8% undefined EDS were enrolled. We had genetic information of 117 patients (74 patients showed no mutations, 2 COL2 mutations, 8 COL3 mutation, 28 COL5 mutations and 5 other genes mutations). In all subjects’ calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and radius and TBS by dual-energy X-ray absorptiometry were assessed. Moreover, we evaluated the history of clinical fragility and the mVFx presence by spine radiograph. RESULTS: The 20.6% of patients showed a Z-score BMD ≤-2.0, the 29.8% ≥1 mVFx and the 24.5% ≥1 clinical fractures. Male patients showed a higher prevalence of reduced BMD (31.9 vs 15.6%; p=0.007) and mVFx (41.4% vs 24.8%; p=0.026). Patients with ≥1 mVFx were older (43.2±12 vs 35.6±12; p=0.0001), showed a lower TBS z-score (-1.4±1.7 vs -0.8±1.2; p=0.013) and lower phosphate levels (3.3±0.6 vs 3.5±0.5; p=0.032) with an higher prevalence of hypophosphatemia (24.5% vs 8.8%; p=0.014). No difference was found in prevalence of EDS subtypes or gene mutations. In EDS patients, the VFx presence was significantly associated with TBS and age, even after adjusting for sex and hypophosphatemia. CONCLUSIONS: EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of clinical and mVFx associated with age and TBS.

Influence of Cleaning Methods on Resin Bonding to Contaminated Translucent 3Y-TZP ceramic.

To evaluate the influence of different cleaning methods on the resin bond strength to contaminated translucent 3Y-TZP ceramic. A total of 133 airborne-particle abraded (0.1 MPa) zirconia specimens were divided into 7 groups. Uncontaminated zirconia specimens were either not cleaned (UN) or cleaned with cleaning paste (Ivoclean) (UP1). After contamination by saliva and blood immersion, zirconia specimens were cleaned using either distilled water rinsing (CW), 99% isopropanol in an ultrasonic bath (CI), cleaning paste according to manufacturer's instructions (CP1), cleaning paste with additional rubbing (CP2), or additional airborne-particle abrasion at 0.1 MPa (CA). Three specimens from each group were examined by x-ray photoelectron spectroscopy (XPS). For each group, sixteen Plexiglas tubes filled with composite resin (Clearfil FII, Kuraray Noritake) were bonded to the zirconia specimens using a primer (Clearfil Ceramic Primer Plus, Kuraray Noritake) and luting composite (Panavia V5, Kuraray Noritake). Before measuring tensile bond strength, specimens were stored in distilled water for 3 or 150 days plus 37,500 thermal cycles. After 3 days, no group showed significantly different TBS compared to the control group UN (p > 0.05). However, groups CW and CI showed significantly lower TBS than all other groups after 150 days (p ≤ 0.05). XPS analysis revealed more organic residue on zirconia surfaces of groups CW and CI than on the other groups. Cleaning with the cleaning paste and airborne-particle abrasion were effective in removing saliva and blood contamination and enhancing bond strength.

Postmenopausal women with osteoporosis consume high amounts of vegetables but insufficient dairy products and calcium to benefit from their virtues: the CoLaus/OsteoLaus cohort.

Diet plays a significant role in the prevention of osteoporosis (OP). We evaluated the associations between nutrients, dietary patterns or compliance (expressed in odds of meeting) to dietary Swiss guidelines and bone health (T score < - 2.5 SD, TBS < 1230) among postmenopausal women. One thousand two hundred fifteen women (64.3 ± 7.5 years) from the CoLaus/OsteoLaus cohort (Lausanne, Switzerland) had their dietary intake assessed using a validated food frequency questionnaire. Bone mineral density (BMD), trabecular bone score (TBS) and vertebral fractures were evaluated with DXA. OP risk factors, calcium supplements (> 500 mg) and prevalent major OP fractures were assessed by questionnaire. One hundred eighty of 1195 women had OP according to BMD, 87/1185 a low TBS and 141/1215 prevalent major OP fractures. In multivariate analysis (adjusted for total energy intake, age, antiosteoporotic treatment, educational level, BMI, sedentary status and diabetes), OP women consumed more vegetable proteins (21.3 ± 0.4 vs 19.6 ± 0.2 g/day), more fibres (18.2 ± 0.5 vs 16.5 ± 0.2 g/day), less animal proteins (40.0 ± 1.1 vs 42.8 ± 0.4 g/day), less calcium (928 ± 30 vs 1010 ± 12 mg/day) and less dairy products (175 ± 12 vs 215 ± 5 g/day), all p ≤ 0.02. According to guidelines, OP women had a tendency to higher compliance for vegetables (OR (95% CI) 1.50 (0.99-2.26)) and a lower compliance for dairy (OR (95% CI) 0.44 (0.22-0.86)) than those without OP. Women taking calcium supplements consumed significantly higher amounts of dairy products. No association was found between TBS values or prevalent OP fractures and any dietary components. Postmenopausal women with OP consume a high amount of vegetables but insufficient amount of dairy products and calcium. TBS does not seem to be influenced by diet.

Fish thermoregulation and the promotion of cellular antimicrobial defenses

Despite being ectotherms, reptiles have an ability to thermoregulate which is enhanced by adopting a variety of behavioural mechanisms. Different behavioural postures, the use of retreat sites and selection of microhabitats enable reptiles to maintain their core body temperatures (Tb) above that of ambient temperatures (Ta) in winter or below Ta maximum in summer. This study describes the daily activity patterns of leopard tortoises (Stigmochelys pardalis) in relation to Tb and Ta, and the extent to which leopard tortoises can manipulate their Tb in response to seasonal changes in Ta. Ten and nine leopard tortoises were radio-tracked in 2002 and 2003, respectively and cloacal Tb and behaviours observed. Core Tbs were measured using Thermocron iButtons™ surgically implanted into the body cavities of 4 and 5 adult telemetered tortoises for summer and winter 2003, respectively. There were seasonal differences in the extent to which certain behaviours were practiced and the time of day that these occurred. Leopard tortoises generally had unimodal activity patterns in winter and bimodal ones in summer. In winter tortoises were active at lower Tbs, and at lower Ta, than in summer. Tortoises maintained their core Tb well below Ta minimum profiles in summer and well above these in winter. Core Tb closely followed the increase in Ta minimum profiles in the mornings, however tortoises exhibited an extended thermal lag when Ta minimum profiles cooled overnight. By using different behavioural mechanisms in summer and winter, leopard tortoises maintained their core Tb at different levels compared with Ta minimum and maximum profiles. Consequently although they are ectotherms, they maintained their core Tb independent of Ta.

VITamin D and OmegA-3 TriaL (VITAL) bone health ancillary study: clinical factors associated with trabecular bone score in women and men.

We investigated whether TBS differs by sex, race, body mass index (BMI), and other clinical variables. The VITamin D and OmegA-3 TriaL (VITAL) is determining effects of vitamin D3 and/or omega-3 fatty acid (FA) supplements in reducing risks of cancer and cardiovascular disease. In the VITAL: Effects on Bone Structure/Architecture ancillary study, effects of these interventions on bone will be investigated. Here, we examine the associations of clinical risk factors with TBS assessments at baseline in the bone health sub-cohort, comprised of 672 participants (369 men and 303 women), mean (± SD) age 63.5 ± 6.0years; BMI ≤ 37kg/m2, no bisphosphonates within 2years or other bone active medications within 1year. TBS was greater in men than women (1.311 vs. 1.278, P < 0.001) and lower with elevated BMIs (P < 0.001), higher age (P = 0.004), diabetes (P = 0.008), SSRI use (P = 0.044), and high alcohol intake (P = 0.009). There was a trend for history of fragility fractures (P = 0.072), and lower TBS. TBS did not vary when analyzed by race, smoking, history of falls, and multivitamin or caffeine use. Lower TBS was associated with female sex, aging, BMI ≥ 25kg/m2, SSRI use, alcohol use, and presence of diabetes; there was a trend between lower TBS and history of fragility fractures. TBS may be useful clinically to assess structural changes that may be associated with fractures among patients who are overweight or obese, those on SSRIs, or with diabetes. Ongoing follow-up studies will clarify the effects of supplemental vitamin D3 and/or FA's on TBS and other bone health measures. NCT01747447.

The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease.

Declining renal function carries increased fracture risks, but BMD is less predictive of fracture for dialysis patients than the general population. The TBS, obtained from lumbar spine dual-energy X-ray absorptiometry (DXA) images, provides information on microarchitectural integrity not captured by BMD. The aim of this study was to assess associations of the TBS to clinical, DXA, radiological, and laboratory measures in patients with ESKD undergoing kidney and simultaneous pancreas kidney (SPK) transplantation. A total of 147 patients with ESKD underwent pre-transplant laboratory testing, DXA, lateral spine X-ray, and structured history within 4weeks of transplantation. Associations of the TBS to demographic data, prevalent fracture, BMD, and laboratory variables were assessed. Of 147 patients (60% male, mean age 48±13years), 36% had diabetes mellitus (DM) and 54 patients had fractures: 21 prevalent vertebral fractures only, 22 non-vertebral fractures only, and 11 had both. The mean TBS (1.345±0.125) was lower in patients undergoing SPK than kidney-only transplants (1.292 vs. 1.364, p=0.001). The TBS correlated to spine and total hip BMD, body mass index and inversely to parathyroid hormone, alkaline phosphatase and procollagen 1 N-propeptide. By multivariable logistic regression, lower TBS was significantly associated to prior non-vertebral fracture (p=0.026). A lower TBS, suggestive of increased microarchitectural damage, was associated with type 1 DM, markers of higher bone turnover, and prevalent fracture. These data support the need for prospective studies to evaluate whether TBS inclusion improves fracture prediction in patients with ESKD.

Fracture risk assessment in postmenopausal women with diabetes: comparison between DeFRA and FRAX tools

This study aimed to compare the performance of Fracture Risk Assessment Tool (FRAX) with that of Derived FRAX (DeFRA) in estimating fracture risk in a cohort of type-2 diabetes mellitus (T2DM) postmenopausal women. One hundred nineteen T2DM postmenopausal women and 118 consecutive healthy postmenopausal women were enrolled. Fracture risk was assessed with FRAX (adjusted or non- for trabecular bone score, TBS) and DeFRA. Bone mineral density (BMD) and TBS were evaluated by dual-energy X-ray absorptiometry (DXA). The outcome was the presence of vertebral/non-vertebral fragility fractures (FFs). T2DM women showed higher spinal BMD T-score (p < .05), but lower TBS (p < .05), than controls. Diabetic patients had higher prevalence of FFs compared to controls (p < .05), but no significant difference were found in the scores of any of the predictor tools. Differently, in the T2DM group, the scores of DeFRA, FRAX and adjusted-FRAX were significantly (p < .01 for all) higher in fractured compared with non-fractured women. DeFRA showed the best discriminative power among all fracture risk predictor tools (area under curves: DeFra: 0.89; adjusted FRAX: 0.80; non-adjusted FRAX: 0.73). In summary, all fracture risk assessment tools appeared to be effective in predicting bone fractures in T2DM postmenopausal women, with DeFRA showing a slightly better diagnostic accuracy.

Bone involvement in adult patients affected with Ehlers-Danlos syndrome.

The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients. The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients. Fifty consecutive Caucasian patients, aged 30-50years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects' calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed. Patients showed reduced BMD (Z-scores LS -0.45 ± 1.00, FN -0.56 ± 1.01, FT -0.58 ± 0.92) and TBS (1.299 ± 0.111) and increased prevalence of morphometric VFx (32%) than controls (Z-scores LS 0.09 ± 1.22, FN 0.01 ± 0.97, FT 0.08 ± 0.89; TBS 1.382 ± 0.176; VFx 8%, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245 ± 0.138 vs 1.325 ± 0.086, p < 0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency. EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.