Lumbar Spine L1-L4 Research Articles

The Association of Systemic and Mandibular Bone Mineral Density in Postmenopausal Females with Osteoporosis.

Background/Objectives: Osteoporosis is a common general disease that mostly affects the skeletal system, including the jawbone. There is a link between systemic and mandibular osteoporosis. This study aimed at assessing the association between systemic (lumbar spine L1-L4, femoral neck, total hip) bone mineral density (BMD) and mandible BMD sites in Romanian postmenopausal females. Methods: A total of 97 menopausal patients were studied, 62 with osteoporosis and 35 females with no osteoporosis. For each patient, dual-energy X-ray absorptiometry (DXA) assessments of BMD in the mandible, proximal femur, total hip, and lumbar spine (L1-L4) were performed. Mandibular measurements were performed using the distal forearm software, followed by manual analysis after the bone contour was defined in each case. Results: Comparing the osteoporosis and control groups, there were significant differences in BMD at each examined location. The mandibular BMD (1.125 ± 0.181506 g/cm2) in the osteoporosis group was considerably smaller than in the control group (1.35497 ± 0.244397 g/cm2). Correlations between the BMD at different sites were significant: lumbar spine and femoral neck (r = 0.738, p < 0.0001), lumbar spine and total hip (r = 0.735, p < 0.0001), lumbar spine and mandible (r = 0.506, p < 0.0001), femoral neck and total hip (r = 0.891, p < 0.0001), femoral neck and mandible (r = 0.482, p < 0.0001), and total hip and mandible (r = 0.466, p < 0.0001). Conclusions: There were correlations between mandible BMD and lumbar spine, femoral neck, and total hip BMD, suggesting that osteoporosis affects mandibular bone density. BMD assessments at common locations may help predict mandibular BMD and the probability of osteoporosis.

Effect of laparoscopic cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in post menopausal women

Background Laparoscopic cholecystectomy (LC) is the gold standard management for benign gallbladder diseases. It has been observed that there is alteration in vitamin D levels and bone mineral density after cholecystectomy due to altered enterohepatic circulation. With increase in average age expectancy of the population, low levels of vitamin D levels and osteoporosis after cholecystectomies might cause increased health care burden. Methods A prospective observational study was planned between 1 January 2022 and 30 June 2023 in the Department of General Surgery at PGIMER Chandigarh, a tertiary care hospital in north India. One hundred and three post-menopausal women who underwent LC and met the inclusion and exclusion criteria were included in the study. All participants underwent estimation of vitamin D and bone mineral density preoperatively and third-post operative month (POM). Results The mean age of the patients was 58.46 ± 7.44. Pain abdomen was present in 68(66%) patients, 18 had epigastric discomfort and 17 had dyspepsia. The mean levels of vitamin D decreased from 21.92 at the baseline to 20.12 at third POM (p < .001). There was a significant change in t score Femoral Neck (−1.12 vs −1.15, p < .001) and Lumbar spine L1–L4 − 1.98 vs −1.98 (p = .033). z-scores of the femoral neck were −0.34 vs −0.54 (p < .001) and of lumbar spine L1–L4 were −0.95 vs 1.02 (p < .001). The decrease in fracture risk for the femoral neck (p = .344) and the lumbar spine (p = .223) was not statistically significant. Conclusion There is a significant decrease in vitamin D and BMD levels after LC in post-menopausal females.

Development of the mineralisation of individual bones and bone regions in replacement gilts according to dietary calcium and phosphorus

Skeleton bones, distinguished by trabecular and cortical bone tissue content, exhibit varied growth and composition, in response to modified dietary calcium and phosphorus levels. The study investigated how gilts adapt their individual bone and bone region mineralisation kinetics in response to changing intake of Ca and P. A total of 24 gilts were fed according to a two-phase (Depletion (D) 60–95 and Repletion (R) 95–140 kg BW, respectively). During the D phase, gilts were fed either 60% (D60) or 100% (D100) of the estimated P requirement. Subsequently, during the R phase, half of the gilts from each D diet were fed either 100% (R100) or 160% (R160) of the estimated P requirement according to a 2 × 2 factorial arrangement. Bone mineral content (BMC) was assessed in the whole body, individual bones (femur and lumbar spine L2–L4), and bone regions (head, front legs, trunk, pelvis, femur, and hind legs) every 2 weeks using dual-energy X-ray absorptiometry (DXA). At 95 kg BW, gilts fed D60 showed reduced BMC and BMC/BW ratio in all studied sites compared to those fed D100 (P < 0.001). During the depletion phase, the allometric BW-dependent regressions slopes for BMC of D100 gilts remained close to 1 for all sites and did not differ from each other. In contrast, the slopes were lower in D60 gilts (P < 0.05), with an 18% reduction in the whole body, except for the front and hind legs, femur, and pelvis, which exhibited higher reductions (P < 0.05). At 140 kg BW, BMC and BMC/BW ratio of all studied sites were similar in gilts previously fed D60 and D100, but higher in R160 than in R100 gilts (P < 0.05), except for front and hind legs. During the repletion phase, the allometric BW dependent regressions slopes for BMC were lower (P < 0.05) in R100 than in R160 gilts (for whole body −10%; P < 0.01) except for front and hind legs, femur, and pelvis. In conclusion, bone demineralisation and recovery followed similar trends for all measured body sites. However, the lumbar spine region was most sensitive whereas the hind legs were least sensitive. These data suggest that using bone regions such as the head and forelegs that can be collected easily at the slaughterhouse may be a viable alternative to whole body DXA measurement.

Evaluation of Trabecular Bone Microarchitecture and Bone Mineral Density in Young Women, Including Selected Hormonal Parameters.

The absence of non-invasive methods for assessing bone material and structural changes is a significant diagnostic challenge. Dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) testing is the gold standard for osteoporosis diagnosis. BMD and the trabecular bone score (TBS) have facilitated targeted osteoporosis prevention and treatment in clinical settings. The findings from this study indicate that BMD modulation in young women is influenced by various hormones, potentially compromising the diagnostic precision of BMD for subclinical bone demineralization. A total of 205 women aged 19 to 37 underwent anthropometric measurements and hormonal tests. BMD was determined using DXA, and TBS values were computed from the lumbar spine L1-L4 segment. The multivariate analysis findings suggest that BMD might not be determined by hormones. The relationship between TBS and TSH was statistically significant in the univariate analysis, which indicates the efficacy of further studies to determine the link between TBS and specific hormones. Analyzing the strength of the correlation between TBS and hormones in the univariate analysis shows which factors are worth considering in further analyses. This makes it possible to create better techniques that will help identify young women who are at a higher risk of developing osteoporosis.

The Interplay between Muscular Grip Strength and Bone Mineral Density with Consideration of Metabolic and Endocrine Parameters in Individuals with Turner Syndrome.

Patients with Turner syndrome (TS) often face skeletal and muscular challenges, including reduced bone mineral density (BMD) and muscle weakness. This comprehensive study sheds light on the complex interplay between muscle strength, BMD, and metabolic and endocrine parameters in TS and healthy subjects. A cross-sectional study involving 42 TS patients and 70 healthy women was conducted. All patients had their BMD determined in the L1-L4 lumbar spine section and in the whole skeleton as well as the parameters of body fat mass (BF), and visceral fat mass (VF) were also determined. The maximum gripping force was measured with a hydraulic manual dynamometer. In addition, a number of blood hormonal and metabolic parameters were determined. In the TS group, hand grip strength correlated positively with triglyceride levels but not with BMD. Healthy individuals had a positive link between hand grip strength and BMD, while patients with TS did not show a significant association between the two. A trend suggested that longer recombinant human growth hormone (rhGH) therapy might improve BMD in the L1-L4 region. Multiple linear regression analysis revealed that muscle strength assessment may be a potential exponent of reduced BMD, and also used clinically in young adult women but not in individuals with TS. The relationship between BMD variables and hand grip might differ between the two groups, potentially indicating distinct musculoskeletal characteristics in TS patients. Longer rhGH therapy in TS patients may have a positive effect on BMD in the L1-L4 region. Understanding the intricate relationships between these factors is important for optimizing clinical management strategies and improving the quality of life for TS patients.

Genetic variants of MTHFR gene in relation to folic acid levels and bone mineral density in Polish patients with inflammatory bowel disease

Lower bone mineral density (BMD) constitutes a common issue in inflammatory bowel disease (IBD). Studies often explore the association between BMD and folic acid level. The presented study aimed to evaluate the impact of MTHFR gene polymorphism and folic acid levels on BMD in patients with IBDs: Crohn’s disease (CD) and ulcerative colitis (UC). The study group comprised IBD patients and a healthy control group. BMD, T-score, and Z-score of the lumbar spine (L1-L4) and femoral neck (FN) were assessed using dual-energy X-ray absorptiometry. Folic acid level was determined using direct chemiluminescence, and the MTHFR 677C > T (rs1801133) and 1298A > C (rs1801131) genotyping were performed by HRMA. Our study found no significant differences in the folic acid levels between the groups. Patients with CD and UC presented a lower BMD, T-score, and Z-score of the FN and L1-L4 than the CG. UC patients who were homozygotes AA in loci c.1298A>C presented lower than controls lumbar spine L1-L4 BMD and T-score values. Regarding MTHFR 677 polymorphism, we found that IBD patients carrying CC genotype demonstrated lower than controls femoral neck Z-score, lumbar spine L1-L4 BMD, T-score and Z-score. MTHFR polymorphisms were found to have no impact on folic acid concentrations. IBD patients presented a higher risk of low BMD than the healthy controls, regardless of MTHFR 677 and 1298 genotypes. However, MTHFR polymorphism may influence on bone in IBD patients. Nevertheless, it appears essential to conduct further studies.

Effectiveness of anthocyanin-rich foods on bone remodeling biomarkers of middle-aged and older adults at risk of osteoporosis: a systematic review, meta-analysis, and meta-regression.

Current osteoporosis pharmacological treatment has undesirable side effects. There is increasing focus on naturally derived food substances that contain phytonutrients with antioxidant effects in promoting health and regulating immune response. This review aims to systematically evaluate the effectiveness of anthocyanin-rich foods on bone remodeling biomarkers in middle-aged and older adults (≥40 y old) at risk of osteoporosis. Randomized controlled trials were searched on 8 bibliographic databases of PubMed, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Food Science and Technology Abstracts, Cochrane Library, and ProQuest. Thirteen studies were included in the meta-analysis. Receptor activator of nuclear factor kappa-B ligand (RANKL) is exhibited from osteoblastic cells that gathered osteoclasts to bone sites for bone resorption, accelerating bone loss. Anthocyanin-rich food consumption showed statistically nonsignificant effects, with no substantial heterogeneity on bone remodeling biomarkers. However, there was a significant increase in lumbar spine L1-L4 bone mineral density. Mild-to-small effects were seen to largely favor the consumption of anthocyanin-rich foods. Berries (d = -0.44) have a larger effect size of RANKL than plums (d = 0.18), with statistically significant subgroup differences. Random-effects meta-regression found body mass index, total attrition rate, total energy, and dietary carbohydrate and fat intake were significant covariates for the effect size of RANKL. All outcomes had low certainty of evidence. Anthocyanin-rich foods may improve bone health in middle-aged and older adults at risk of osteoporosis. This review contributes to the growing interest in nutrient-rich foods as a low-cost and modifiable alternative to promote human health and reduce disease burden. Future high-quality studies with larger sample sizes and longer treatment durations are required to fully understand the effect of anthocyanin-rich foods on bone health. PROSPERO registration no. CRD42022367136.

Correlation Between Hounsfield Units Measured by Diagnostic Noncontrast Enhanced CT in Lumbar Spine and Femoral Neck With Bone Mineral Density Measured by Dual-Energy X-Ray Absorptiometry

Background: Computed tomography (CT) is widely available and measurement of Hounsfield unit (HU) is easy and reproducible. Can this measurement predict osteoporosis? Objective: To evaluate correlation between HU of the lumbar spine and femoral neck and bone mineral density T-score (BMD T-score), and to assess the cutoff HU values at the lumbar spine and femoral neck to predict osteoporosis. Methods: This retrospective study reviewed 237 patients who underwent both dual-energy x-ray absorptiometry (DXA) and CT within an interval of 1 year from January 2014 to August 2022. HU at the L1-L4 lumbar spine and femoral neck, as well as BMD T-score for the same regions were determined. Correlation of BMD T-score and HU was evaluated using Pearson correlation. Receiver operating characteristic (ROC) curves were generated to determine the cutoff HU values for predicting osteoporosis and its sensitivity, specificity, positive, and negative predictive values. Results: Among 205 patients included, 64 (31.2%) had osteoporosis. At the lumbar spine, the average HU was moderately correlated with the BMD T-score (r = 0.639; 95% CI, 0.550 - 0.714), whereas at the femoral neck, the average HU had a good correlation with BMD T-score (r = 0.756; 95% CI, 0.691 - 0.809). Cutoff values for predicting osteoporosis were 155 HU at the lumbar spine and 130 HU at the femoral neck. Conclusions: HU and BMD T-score were more strongly correlated at the femoral neck than at the lumbar spine. A cutoff HU value of 130 at the femoral neck was used for predicting osteoporosis in Thai people.

Serum Irisin is Associated with Bone Mineral Density in Postmenopausal T2dm Patients Complicated with Osteoporosis and in Mice with Diabetic Osteoporosis.

Osteoporosis is a systemic bone disease with low bone mass, destruction of bone microstructure, and increased bone fragility. Gender and metabolic status are well-known risk factors for osteoporosis. Irisin is a newly discovered myokine that is secreted by skeletal muscle and adipose tissue. Serum Irisin was reported to be decreased in type 2 diabetes mellitus (T2DM) and/or osteoporosis patients, and it is correlated with bone mineral density (BMD) of neck bone, but its role in postmenopausal T2DM with osteoporosis remains largely unknown. Postmenopausal T2DM patients with or without osteoporosis were recruited, and 50 agematched healthy postmenopausal women were employed as healthy control. C57BL/6J mice were intraperitoneally injected with 65 mg/kg Streptozotocin (STZ) daily for consecutive 5 days to induce diabetes, and 1 mg/kg recombinant Irisin protein was injected into diabetic mice through the tail vein once a week for 4 months. Compared to that of healthy control, serum Irisin levels and BMD in L1-L4 lumbar spine, femoral neck, total hip, and Wards were decreased in postmenopausal T2DM patients and further decreased in T2DM patients with osteoporosis. Moreover, serum Irisin levels were also correlated with BMD in the above body parts in T2DM patients. Furthermore, recombinant Irisin protein improved diabetic osteoporosis and inflammation in STZ-induced diabetic mice with osteoporosis. Serum Irisin levels in postmenopausal T2DM patients with osteoporosis were significantly decreased, which may be related to the decreased BMD and the occurrence of osteoporosis in postmenopausal T2DM patients. The combined measurement of serum Irisin levels and BMD in patients with T2DM in the early stage has a certain effect on the diagnosis and treatment of osteoporosis.

Osteoporosis Detection in Lumbar Spine L1-L4 based on Trabecular Bone Texture Features

Osteoporosis Detection in Lumbar Spine L1-L4 based on Trabecular Bone Texture Features

PTHR1 Genetic Polymorphisms Are Associated with Osteoporosis among Postmenopausal Arab Women.

The parathyroid hormone 1 receptor (PTHR1) plays a crucial role in calcium homeostasis and bone metabolism. However, its genetic role in regulating bone turnover markers (BTMs) in postmenopausal osteoporosis (PMO) remains unclear. Herein, we explored parathyroid hormone (PTH) and PTHR gene variant susceptibility to osteoporosis and their association with various circulating BTM and inflammatory markers in postmenopausal women of Arab ethnicity. In total, 600 postmenopausal Arab women (300-PMO and 300-control) were genotyped for selected SNPs in PTH (rs1459015, rs307253, rs6054, rs307247, rs10500783 and rs10500784), PTHR1 (rs6442037, rs1138518, and rs724449 SNPs) and PTHR2 (rs9288393, rs10497900, and rs897083). Anthropometrics, BTMs, and inflammatory markers were measured. Bone mineral density (BMD) was measured at the lumbar spine L1–L4 and the femoral neck using dual-energy X-ray absorptiometry (DXA). PTHR1 rs1138518 genotype C/T was found to be a significant risk factor for PMO (OR = 1.49, 95% CI 1.0-2.1, P = 0.03). The genotypes C/T and T/T of PTHR1 rs1138518 were associated with 25-hydroxy-vitamin D (25(OH)D) regulation. In the PMO group, carriers of the C/T genotype had significantly lower 25(OH)D levels than carriers of the same genotypes in the control group (59.9 (36.7-92.4) nmol/l and 66.4 (43.5-87.8) nmol/l, respectively; P = 0.048]. Our study concludes that the PTHR1 rs1138518 genotype could be a potential risk factor for osteoporosis and 25(OH)D regulation in Arab women with PMO.

P013 Serum osteoprotegerin and RANKL in patients with Juvenile Idiopathic Arthritis and their correlation with bone mineral density

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic arthropathy of childhood and is associated with low bone mass, and may hasten the onset of osteoporosis later in life1. Bone loss occurs because of an imbalance between osteoclasts-activating factors like receptor activator of nuclear factor-κB ligand (RANKL) and its inhibitor osteoprotegerin (OPG) 2. Dual energy X-ray absorptiometry (DXA) is the preferred method for measuring bone mineral density (BMD) in children and to identify and follow individuals at risk for fracture 3. The objective is the Evaluation of serum levels of osteoprotegerin and RANKL and their correlation with BMD in JIA patients. Methods Forty JIA patients (according to the revised classification criteria of ILAR) and 40 healthy children individually matched for age, sex and race were included in this study. Children excluded from the study were those with primary and secondary causes of osteoporosis (such as chronic illness). All patients were assessed clinically by: age, sex, body mass index, type of JIA, disease duration and disease activity (by Juvenile Arthritis Disease Activity Score; JADAS 10). The functional disability was assessed by the Childhood Health Assessment Questionnaire (CHAQ). Blood samples were collected from JIA patients and healthy controls to determine serum levels of OPG and RANKL by ELISA. DXA scans were done using GE Healthcare Lunar DPX, Madison, Wisconsin. Bone mineral density of the L1-L4 lumbar spine and total body less head (TBLH) was evaluated in g/cm2 and expressed as Z score for age, sex according to the reference data given for this equipment. Results The study included 40 patients (25 females) with a mean age of 11.14 years and median disease duration of 2.5 years. As regard JIA type, 45% of patients were oligoarticular, 32.5% were polyarticular, and 22.5% were systemic JIA. Median JADAS 10 was 13.95. Patients (especially polyarticular JIA) had significantly higher serum RANKL levels and lower serum OPG and OPG/RANKL ratio when compared with controls (with p-value &amp;lt;0.001, 0.032 and &amp;lt;0.001 respectively). A diagnosis of low BMD (BMD Z-score ≤ -2) was given in 25% of patients (15% polyarticular and 10% systemic) by DXA of lumbar spine, and 20% (10% polyarticular and 10% systemic) by DXA of TBLH. On the other hand, no patient was given a diagnosis of osteoporosis (BMD Z-score ≤ -2 and a significant fracture history). Low BMD at lumbar spine and TBLH was negatively correlated with serum RANKL while positively correlated with OPG/RANKL ratio. Moreover, low BMD at lumbar spine was positively correlated with serum OPG level Conclusion High RANKL and low OPG levels appear to be associated with low bone mass in JIA patients. Patients with JIA (especially polyarticular and systemic subtype) are at increased risk of low bone mineral mass. Disclosure of Interests None declared

Evaluation of mandibular condyle trabecular structure in patients with rheumatoid arthritis using fractal analysis

The aim of this study was to compare the fractal dimension (FD) of trabecular structure of the mandibular condyles in patients with rheumatoid arthritis (RA) to patients without RA. Correlations between condylar FD and bone mineral density T-scores in the femoral neck and lumbar spine were also examined. The RA study group patients were divided into 3 categories (33 normal, 33 osteopenic, and 34 osteoporotic) according to T-scores. The control group without RA was sex- and age-matched with the study group. FD was calculated from panoramic radiographs and compared between the study and control groups. The relationships between FD values and femoral neck and L1-L4 lumbar spine T-scores were investigated for study and control groups. Significance was established at P < .05. The mean FD values of the entire study group and of each category in the study group were significantly lower than those of the control group (P < .001). There were no significant differences in FD values among the 3 RA categories (P > .05). No significant correlations appeared between FD and femoral neck or lumbar spine T-scores (P ≥ .063). Fractal analysis of the condyles on panoramic radiographs can distinguish RA from healthy condyles, even if the patients with RA have normal bone mineral density T-scores.

Is there an association of bone mineral density and risk of breast cancer in postmenopausal Saudi women?

Several studies revealed an association between high bone mineral density (BMD) and the increased risk for developing breast cancer (BC). Aim: Explore if there is an association between BMD and BC risk in postmenopausal Saudi (PMS) women. Material and Method: In a retrospective cohort study of 1145 PMS women age range from 46 – 85 year (mean = 55 year). The average time period of menopause 4 years.We reviewed BMD of all patients performed between October 2012 and November 2018. All patients had BMD measurements of lumbar spine L2-L4 and right femoral neck in gm/cm². Results: The T-score was used for analysis of the results. Among the total patient studied 195 (17%) were found to have BC group 1 (G1) while 950 (93%) without BC group 2(G2). Analysis of lumbar spine T-score in G1 showed that: 29 % had osteoporosis, 37% osteopenia and 34% had normal BMD and in G2 40% had osteoporosis, 31% osteopenia and 29 had normal values. Results showed prevalence of osteoporosis in G1 was significantly lower than in G2 (p =0.002) while there was no significant difference between the two groups with osteopenia and normal BMD results (p = 0.06 and 0.205 respectively). Conclusion: PMS women with BC had higher BMD at time of diagnosis compared to their counterpart without BC.

1052-P: Clinical Characteristics of Osteoporosis in Postmenopausal Women with Type 2 Diabetes Mellitus

Objective: To investigate clinical characteristics and risk factors of osteoporosis in postmenopausal women with type 2 diabetes mellitus. Method: A total of 410 postmenopausal women with type 2 diabetes of natural menopause with no history of fracture were collected from outpatients of Beijing Hospital (Oct 2017 - Nov 2019). Bone mineral density (BMD) at lumbar spine L1-L4 and hip was measured using dual-energy X-ray absorptiometry. Biochemical markers of bone and glucose metabolism were evaluated. Patients were divided into three groups based on BMD: A (osteoporosis): T ≤-2.5 SD; B (osteopenia) -2.5 &amp;lt; T ≤ -1 SD; C (normal bone mineral density) T &amp;gt; -1 SD. Statistical differences of age, menopausal age, diabetes age, BMI and biochemical indexes were compared between groups. Result: 1. Case number based on lumbar spine BMD: 189 in A (46.1%), 147 in B (35.9%), and 74 in C (18.0%). ANOVA analysis showed group A patients had the highest age (F 5.698, p 0.004), age of diabetes onset (F 7.596, p 0.001), ALP (F 3.231, p 0.041) and menopausal duration (F 7.596, p 0.001), but the lowest BMI (F 11.456, p 0.000). Logistic multivariate regression showed body mass index is an independent risk factor for osteoporosis in postmenopausal women with type 2 diabetes [A vs. C: OR1.224 (95% CI 1.106-1.355, p 0.000); A vs. B: OR1.172 (95% CI 1.079-1.274, p 0.000].2. Case number based on femoral neck BMD: 159 in A (38.8%), 188 in B (45.9%), 63 in C (15.3%). ANOVA analysis showed group A patients had the highest age (F 21.484, p 0.000), age of diabetes onset (F 10.125, p 0.000) and PTH (F3.691, 0.026), but the lowest BMI (F 11.456, p 0.000). Logistic multivariate regression showed body mass index is an independent risk factor for osteoporosis in postmenopausal women with type 2 diabetes [A vs. C: OR1.267 (95% CI 1.120-1.433, p 0.000); A vs. B: OR1.195 (95% CI1.099-1.301, p 0.000)]. Conclusion: Osteoporosis in postmenopausal women with type 2 diabetes is associated with older age, longer menopause duration, older age of diabetes onset and lower BMI. Disclosure Y. Wang: None. Z. Lina: None. L. Guo: Consultant; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., BD, Eli Lilly and Company, Merck &amp; Co., Inc., Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk, Sanofi China.

Unusual Case of Pelvic Osteomyelitis Revealing Osteoporosis

Pelvic osteomyelitis is an uncommon and challenging condition to treat. Pressure ulcers, spinal injuries, contiguous sources of tracking infections, pelvic surgical procedures, traumatic injuries and open fractures all serve as nidi for developing pelvic osteomyelitis. We present a case of pelvic osteomyelitis suspected to be caused by insufficiency fractures due to osteoporosis in an anorexic adult.51 year old postmenopausal Caucasian female with undiagnosed anorexia presented to the hospital for severe right-sided pelvic pain and nausea. She denied fevers, vomiting, trauma, surgical procedures, history of pelvic infections, abnormal vaginal discharge, travel, prolonged steroid therapy. She disclosed a strict vegetarian diet, excessive daily exercise, low dairy intake and over 100lb intentional weight loss over the past 30 years. She reported normal menses, used oral contraceptives between ages of 25 to 30, and reached menopause at 49 years. For many years, she denied medical care including age-appropriate cancer screenings. She is employed in academia and denies tobacco, alcohol or drug use. On admission, height 153cm and weight 43kg, BMI 16.7kg/m2. Examination was notable for frail body habitus, moderate RLQ and pelvic tenderness, prominent PSIS and SI joints with decreased RLE range of motion. Laboratory results showed calcium 9.5mg/dL (n 8.6–10.4), phosphorus 4.1mg/dL (2.5–4.5), ALP 181IU/L (45–115), PTH 23pg/dL (n 9–76), Vitamin D 35ng/dL (n 25–80), 24-hour urinary calcium 285mg/24h (n 50–400). Abdominopelvic CT scan showed chronic right pubic ramus and bilateral sacral insufficiency fractures confirmed on MRI with septic arthritis of the pubic symphysis, osteomyelitis of pubic bodies and intramuscular abscess extending to the right adductor muscle. Wound culture was positive for Streptococcus viridans and pelvic bone biopsy showed degenerative changes. The patient completed IV Ceftriaxone therapy and underwent DXA scan confirming osteoporosis (T-scores:-3.8 lumbar spine L1-L4, -3.6 left femoral neck, -3.3 right femoral neck). Alendronate 10mg daily and calcium citrate-vitamin D 1000mg-800IU twice daily was prescribed. Diagnostic workup for secondary causes of severe osteoporosis was unremarkable except for hypercalciuria, for which calcium supplement was held with a plan to repeat in the future. Concern for her cachectic appearance and severity of her illness also elicited a dietician referral. Pelvic osteomyelitis and septic arthritis are seldom found without inciting insults. We report an atypical cause of presumed anorexia induced osteoporosis resulting in pelvic osteomyelitis. Untreated osteoporosis may lead to fracture, resulting in inflammation and predisposing patients to infections. Thus, early recognition and evaluation of osteoporosis in patients at high risk for fracture, such as patients with anorexia, is critical for prevention.

Disease progression associated with low bone mass in axial spondyloarthropathy patients.

We investigated the relationship between bone mineral density (BMD), vitamin D, and computed tomography (CT)-based progression of disease grades of the sacroiliac joint (SIJ), and sought to identify parameters predicting low BMD in patients with axial spondyloarthropathy (axSpA). We collected the ankylosis spondylitis disease activity score (ASDAS), the course of the disease, HLA-B27 status, and vitamin D and C-reactive protein (CRP) levels of 98 axSpA patients. Lumbar spine and femoral BMD were assessed by dual-energy X-ray (DXA), and SIJ grade was determined by CT. The axSpA patients (71 men, 27 women) with a mean age of 31.9 years (range 18-57 years) and body mass index 21.8 kg/m2 (range 15.6-30.6 kg/m2), with disease duration 4.5 years (range 0.3-30 years) were included. A longer disease course, higher CRP level, and lower femoral and lumbar spine BMD were independently related to a higher CT grade. Older age, longer disease course, elevated CRP, and high SIJ CT grade were independently related to lower BMD (femur and/or lumbar spine L1-L4 T scores ≤ -1). Older age, elevated CRP, low vitamin D levels, and high CT grade were independently associated with low femur and lumbar spine BMD. However, a longer disease course was independently related to low femur BMD, but not low lumbar spine BMD. Thus, inflammation and low femoral and lumbar spine BMD were strongly correlated with a high SIJ CT grade, and inflammation, low vitamin D levels, and a longer disease course within a certain time range influenced bone loss in axSpA.

The comparative efficiency of denosumab treatment in patients with postmenopausal osteoporosis, primary hyperparathyroidism and glucocorticoid-induced osteoporosis in real clinical practice

Background: Denosumab is a highly effective and safe first-line treatment for osteoporosis. Primary hyperparathyroidism is a prevalent condition found in patients with osteoporosis. However, data regarding effectiveness of denosumab treatment in patients with PHPT are scarce. Aims: To estimate the comparative effects of denosumab to treat postmenopausal osteoporosis (PMO) and osteoporosis caused by primary hyperparathyroidism (PHPT) or glucocorticoid-induced osteoporosis (GIOP) in postmenopausal women in routine clinical practice. Materials and methods: Retrospective study based on the medical card records. Patients over 50 years of age with verified osteoporosis (based on bone mineral density (BMD) T-score ≤ -2.5 SD and/or low-trauma fracture), who had at least 3 denosumab injections were included in the study. Results: 162 patients were included and divided into three groups according to the etiology of osteoporosis. The first group consisted of postmenopausal women with osteoporosis (PMO) [(n=85); median age 70 [64;78]]. Patients with glucocorticoid-induced osteoporosis (GIOP) were enrolled in the second group [(n=16); male to female ratio =1:15; median age 60 [57,8; 66,3]]. The third group consisted of patients with PHPT and osteoporosis [(n=61); male to female=2:59; median age 68 [63; 75]]. Among all patients, denosumab treatment significantly increased BMD and decreased serum levels of calcium and CTx compared with baseline. PMO: the median increase in BMD according to the T-score was L1-L4 0,6 (p&lt;0,001), femoral neck 0,2 (p&lt;0,001); serum calcium -0,04 (p=0,004). PHPT: the median increase in BMD according to the T-score was L1-L4 0,6 (p&lt;0,001), femoral neck 0,2 (p&lt;0,001); radius 33% 0,25 (p=0,002), serum calcium -0,04 (p&lt;0,001). In patients with GIOP, denosumab increased BMD in the lumbar spine L1-L4 0,5 (p=0,004). There was no difference in BMD increase or in levels of bone turnover suppression between the groups. A marked decline in levels of serum calcium was noted among patients with GFR less than 60 ml / min / 1.73 m2 (median Δ Са serum=0,24 p&lt;0,001), compared to patients without CKD (median Δ Са serum=0,08 p&lt;0,001).Conclusion: Denosumab treatment is similarly effective for increasing BMD and decreasing bone turnover markers in patients with PMO and PHPT among postmenopausal women. The hypocalciemic effect of denosumab is most significant in subjects with PHPT.

ПРИМЕНЕНИЕ ДЕНОСУМАБА ДЛЯ ЛЕЧЕНИЯ ОСТЕОПОРОЗА РАЗЛИЧНОГО ГЕНЕЗА В РЕАЛЬНОЙ КЛИНИЧЕСКОЙ ПРАКТИКЕ

Background: Denosumab is a highly effective and safe first-line treatment for osteoporosis. Primary hyperparathyroidism is a prevalent condition found in patients with osteoporosis. However, data regarding effectiveness of denosumab treatment in patients with PHPT are scarce. Aims: To estimate the comparative effects of denosumab to treat postmenopausal osteoporosis (PMO) and osteoporosis caused by primary hyperparathyroidism (PHPT) or glucocorticoid-induced osteoporosis (GIOP) in postmenopausal women in routine clinical practice. Materials and methods: Retrospective study based on the medical card records. Patients over 50 years of age with verified osteoporosis (based on bone mineral density (BMD) T-score ≤ -2.5 SD and/or low-trauma fracture), who had at least 3 denosumab injections were included in the study. Results : 162 patients were included and divided into three groups according to the etiology of osteoporosis. The first group consisted of postmenopausal women with osteoporosis (PMO) [(n=85); median age 70 [64;78]]. Patients with glucocorticoid-induced osteoporosis (GIOP) were enrolled in the second group [(n=16); male to female ratio =1:15; median age 60 [57,8; 66,3]]. The third group consisted of patients with PHPT and osteoporosis [(n=61); male to female=2:59; median age 68 [63; 75]]. Among all patients, denosumab treatment significantly increased BMD and decreased serum levels of calcium and CTx compared with baseline. PMO: the median increase in BMD according to the T-score was L1-L4 0,6 (p<0,001), femoral neck 0,2 (p<0,001); serum calcium -0,04 (p=0,004). PHPT: the median increase in BMD according to the T-score was L1-L4 0,6 (p<0,001), femoral neck 0,2 (p<0,001); radius 33% 0,25 (p=0,002), serum calcium -0,04 (p<0,001). In patients with GIOP, denosumab increased BMD in the lumbar spine L1-L4 0,5 (p=0,004). There was no difference in BMD increase or in levels of bone turnover suppression between the groups. A marked decline in levels of serum calcium was noted among patients with GFR less than 60 ml / min / 1.73 m2 (median Δ Са serum=0,24 p<0,001), compared to patients without CKD (median Δ Са serum=0,08 p<0,001). Conclusion : Denosumab treatment is similarly effective for increasing BMD and decreasing bone turnover markers in patients with PMO and PHPT among postmenopausal women. The hypocalciemic effect of denosumab is most significant in subjects with PHPT.

The Application Value of Interleukin-10 and Interleukin-15 in Osteoporosis

Objective: To investigate the effects of cytokines IL-10 and IL-15 in osteoporosis, and to provide a basis for the prevention and treatment of osteoporosis. Methods: A total of 101 subjects who underwent bone density testing in Linyi People’s Hospital from January 2018-December 2019 were selected and divided into normal bone density group, osteopenia group and osteoporosis group according to their bone density. At the same time, the peripheral serum IL-10 and IL-15 levels of subjects were detected. Results: The serum IL-10 and IL-15 levels of subjects with normal bone density were significantly higher than those of subjects with bone loss (t = 5.31, P < 0.001) (t = 6.87, P < 0.001) and osteoporosis. In the subjects (t = 5.38, P < 0.001) (t = 5.30, P < 0.001), the bone mineral density of the lumbar spine L1-L4 was positively correlated with serum IL-15 levels (r = 0.216, P = 0.030), but with IL-10 No correlation (r = ?0.025, P = 0.801). Femoral neck bone mineral density was positively correlated with serum IL-10 levels (r = 0.209, P = 0.036), and femoral neck bone mineral density was positively correlated with serum IL-15 levels (r = 0.405, P < 0.001). Stepwise regression analysis shows that IL-15 is closely related to bone density. Conclusion: Serum IL-10 and IL-15 have a protective effect on bone mass. Two anti-inflammatory cytokines play an important role in the occurrence and development of osteoporosis. Low levels of serum IL-10 and IL-15 have a protective effect on bone mass. Bone loss and osteoporosis have certain evaluation value, which can be used to prevent the occurrence of osteoporosis, reduce the risk of fracture, and reduce the difficulty and burden of nursing.