Maintain Bone Mineral Density Research Articles

Cultivating Vitality: Unveiling the Transformative Effects of Exercise on Menopausal Women's Well-being and Physiological Markers: A Meta-Analysis of Randomized Control Trial

Introduction: Menopause frequently coincides with age-related hormonal decline, elevated blood pressure, and unfavorable body composition changes, collectively heightening the risk of cardiovascular disease. Addressing the adverse effects of menopause is crucial through the integration of suitable lifestyle interventions, such as exercise. Nonetheless, there remains controversy within studies regarding the significance of exercise in improving Quality of Life (QoL), reducing Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Total Cholesterol (TC), and Low-Density Lipoprotein (LDL), as well as maintaining Bone Mineral Density (BMD). Thus, this review aims to determine and clarify the influence of exercise on patient outcomes. Materials/Methods: This meta-analysis followed the PRISMA statement guidelines, utilizing databases such as PubMed, ScienceDirect, and Google Scholar over the past ten years. Inclusion criteria adhered to the PICOS framework, and the literature quality assessment was based on the Risk of Bias 2.0 Tool. Results: Out of 14 included studies, the majority indicated no significant improvements in menopause women undergoing exercise regarding QoL [MD: -6.62 (95% CI: -16.90 – -3.66, I2=91%)], SBP [MD: -4.74 (95% CI: -10.54 – 1.05, I2=100%)], DBP [MD: -4.52 (95% CI: -8.59 – -0.46, I2=99%)], TC [MD: -4.06 (95% CI: -8.75 –0.64, I2=57%)], LDL [MD: -2.26 (95% CI: -7.37 – 2.86, I2=65%)], and BMD [MD: 0.06 (95% CI: -0.01 – 0.13, I2=86%)]. Significant improvements were seen only in DBP outcomes Conclusion: Menopause exercise women may effectively raise QoL, reduce SBP, DBP, TC, and LDL, also maintain BMD.

Vitamin D Maintains Growth and Bone Mineral Density against a Background of Severe Vitamin A Deficiency and Moderate Toxicity in a Swine Model.

Excessive vitamin A (VA) negatively impacts bone. Interactions between VA and vitamin D (VD) in bone health are not well-understood. This study used a traditional two-by-two factorial design. Pigs were weaned and randomized to four treatments (n = 13/group): -A-D, -A+D, +A-D, and +A+D for 3 and 5 wk. Serum, liver, kidney, adrenal glands, spleen, and lung were analyzed by ultra-performance LC. Growth was evaluated by weight measured weekly and BMD by DXA. Weights were higher in -A+D (18.1 ± 1.0 kg) and +A+D (18.2 ± 2.3 kg) at 5 wk than in -A-D (15.5 ± 2.1 kg) and +A-D (15.8 ± 1.5 kg). Serum retinol concentrations were 0.25 ± 0.023, 0.22 ± 0.10, 0.77 ± 0.12, and 0.84 ± 0.28 µmol/L; and liver VA concentrations were 0.016 ± 0.015, 0.0065 ± 0.0035, 2.97 ± 0.43, 3.05 ± 0.68 µmol/g in -A-D, -A+D, +A-D, and +A+D, respectively. Serum 25(OH)D3 concentrations were 1.5 ± 1.11, 1.8 ± 0.43, 27.7 ± 8.91, and 23.9 ± 6.67 ng/mL in -A-D, +A-D, -A+D, +A+D, respectively, indicating a deficiency in -D and adequacy in +D. BMD was highest in +D (p < 0.001). VA and the interaction had no effect on BMD. Dietary VD influenced weight gain, BMD, and health despite VA status.

Potential Metabolic Pathways Involved in Osteoporosis and Evaluation of Fracture Risk in Individuals with Diabetes.

Diabetes has a significant global prevalence. Chronic hyperglycemia affects multiple organs and tissues, including bones. A large number of diabetic patients develop osteoporosis; however, the precise relationship between diabetes and osteoporosis remains incompletely elucidated. The activation of the AGE-RAGE signaling pathway hinders the differentiation of osteoblasts and weakens the process of bone formation due to the presence of advanced glycation end products. High glucose environment can induce ferroptosis of osteoblasts and then develop osteoporosis. Hyperglycemia also suppresses the secretion of sex hormones, and the reduction of testosterone is difficult to effectively maintain bone mineral density. As diabetes therapy, thiazolidinediones control blood glucose by activating PPAR-γ. Activated PPAR-γ can promote osteoclast differentiation and regulate osteoblast function, triggering osteoporosis. The effects of metformin and insulin on bone are currently controversial. Currently, there are no appropriate tools available for assessing the risk of fractures in diabetic patients, despite the fact that the occurrence of osteoporotic fractures is considerably greater in diabetic individuals compared to those without diabetes. Further improving the inclusion criteria of FRAX risk factors and clarifying the early occurrence of osteoporosis sites unique to diabetic patients may be an effective way to diagnose and treat diabetic osteoporosis and reduce the risk of fracture occurrence.

The Microbial Revolution in the World of Joint Replacement Surgery.

The prevalence of revision surgery due to aseptic loosening and periprosthetic joint infection (PJI) following total hip and knee arthroplasty is growing. Strategies to prevent the need for revision surgery and its associated health-care costs and patient morbidity are needed. Therapies that modulate the gut microbiota to influence bone health and systemic inflammation are a novel area of research. A literature review of preclinical and clinical peer-reviewed articles relating to the role of the gut microbiota in bone health and PJI was performed. There is evidence that the gut microbiota plays a role in maintaining bone mineral density, which can contribute to osseointegration, osteolysis, aseptic loosening, and periprosthetic fractures. Similarly, the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to PJI. Emerging evidence supports the role of the gut microbiota in the development of complications such as aseptic loosening and PJI after total hip or knee arthroplasty. There is a potential for microbial therapies such as probiotics or fecal microbial transplantation to moderate the risk of developing these complications. However, further investigation is required. Modulation of the gut microbiota may influence patient outcomes following total joint arthroplasty.

Preventive effect of Total ethanolic extract of Butea monosperma on bone loss in osteopenic rats

Aim: The intent of the study was to assess the bone conserving effect of Butea monosperma total extract (BTE) prepared from the stem-bark, in ovariectomy (Ovx)-induced bone loss in Sprague Dawley (SD) rats.&#x0D; Methods: Sprague-Dawley rats were ovariectomized (Ovx) and BTE treatment with three different doses (100mg, 250mg and 500mg/kg body weight) commenced a day after Ovx and continued for 12 weeks. Skeletal parameters including trabecular and cortical bone microarchitecture, bone mineral density, bone mineral content, biomechanical strength, bone turnover markers (serum procollagen 1 N-terminal propeptide/ P1NP and cross-linked C-telopeptide of type I collagen/CTX-1), new bone formation rate (periosteal bone formation rate and mineral apposition rate), and expression of osteogenic genes were assessed. Estrogenicity of BTE was assessed by studying uterus at the end of the treatments.&#x0D; Results: Ovx rats treated with BTE prevented the alterations in trabecular and cortical microarchitecture, maintained bone mineral density, bone mineral content, and increased bone biomechanical strength in comparison with Ovx rats. Treatment of BTE also enhanced new bone formation rate, increased the serum bone formation marker (P1NP), decreased the serum bone resorption marker (CTX-1), and upregulated the osteogenic genes in bones. BTE was devoid of estrogen-like effect in uterus.&#x0D; Conclusion: BTE protects against Ovx-induced bone loss by inhibiting bone resorption and increasing new bone formation. The most effective bone conserving dose of BTE was 250mg/kg. This study demonstrates the potential of BTE in preventing/delaying osteoporosis development in postmenopausal women.&#x0D; Keywords: Butea total extract, ovariectomy, bone formation, bone mineral density.

Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999–2002

PurposeIt is known that muscle strength and muscle mass play a crucial role in maintaining bone mineral density (BMD). Despite this, there are uncertainties about how muscle mass, lower extremity muscular strength, and BMD are related. We examined the impact of lower extremity muscle strength and mass on BMD in the general American population using cross-sectional analysis.MethodsIn the study, we extracted 2165 individuals from the National Health and Nutrition Examination Survey 1999–2002. Multivariate logistic regression models were used to examine the association between muscle strength, muscle mass, and BMD. Fitted smoothing curves and generalized additive models were also performed. To ensure data stability and avoid confounding factors, subgroup analysis was also conducted on gender and race/ethnicity.ResultsAfter full adjustment for potential confounders, significant positive associations were detected between peak force (PF) [0.167 (0.084, 0.249) P < 0.001], appendicular skeletal muscle index (ASMI) [0.029 (0.022, 0.036) P < 0.001], and lumbar spine BMD. A positive correlation was also found between PF, ASMI, and pelvis and total BMD. Following stratification by gender and race/ethnicity, our analyses illustrated a significant correlation between PF and lumbar spine BMD in both men [0.232 (0.130, 0.333) P < 0.001] and women [0.281 (0.142, 0.420) P < 0.001]. This was also seen in non-Hispanic white [0.178 (0.068, 0.288) P = 0.002], but not in non-Hispanic black, Mexican American and other race–ethnicity. Additionally, there was a positive link between ASMI and BMD in both genders in non-Hispanic whites, and non-Hispanic blacks, but not in any other racial group.ConclusionPF and ASMI were positively associated with BMD in American adults. In the future, the findings reported here may have profound implications for public health in terms of osteopenia and osteoporosis prevention, early diagnosis, and treatment.

Litsea glutinosa extract promotes fracture healing and prevents bone loss via BMP2/SMAD1 signaling.

Estrogen deficiency is one of the main causes for postmenopausal osteoporosis. Current osteoporotic therapies are of high cost and associated with serious side effects. So there is an urgent need for cost-effective anti-osteoporotic agents. Anti-osteoporotic activity of Litsea glutinosa extract (LGE) is less explored. Moreover, its role in fracture healing and mechanism of action is still unknown. In the present study we explore the osteoprotective potential of LGE in osteoblast cells and fractured and ovariectomized (Ovx) mice models. Alkaline phosphatase (ALP), MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and mineralization assays revealed that LGE treatment increased osteoblast cell differentiation, viability and mineralization. LGE treatment at 0.01 μg increased the expression of BMP2, PSMAD, RUNX2 and type 1 col. LGE also mitigated RANKL-induced osteoclastogenesis. Next, drill hole injury Balb/C mice model was treated with LGE for 12 days. Micro-CT analysis and Calcein labeling at the fracture site showed that LGE (20 mg/kg) enhanced new bone formation and bone regeneration, also increased expression of BMP2/SMAD1 signaling genes at fracture site. Ovx mice were treated with LGE for 1 month. μCT analysis indicated that the treatment of LGE at 20 mg/kg dose prevented the alteration in bone microarchitecture and maintained bone mineral density and bone mineral content. Treatment also increased bone strength and restored the bone turnover markers. Furthermore, in bone samples, LGE increased osteogenesis by enhancing the expression of BMP2/SMAD1 signaling components and decreased osteoclast number and surface. We conclude that LGE promotes osteogenesis via modulating the BMP2/SMAD1 signaling pathway. The study advocates the therapeutic potential of LGE in osteoporosis treatment.

Recommendations for Improving Women's Bone Health Throughout the Lifespan.

Osteoporosis is a common condition in which deteriorating bone tissue results in an increased risk of low trauma fracture. Influenced by the role of estrogen in building and maintaining bone mineral density, women have different patterns of bone accrual and loss compared with men, resulting in a lower peak bone mass and a greater lifetime fracture risk. Moreover, fracture risk increases significantly in postmenopausal women who have depleted estrogen levels. Osteoporotic fractures pose serious consequences-ranging from an inability to perform basic tasks and an increased risk of repeat fracture to the need for assisted living and even death. There is also a large economic toll associated with the health care costs required for post-fracture care. The Society for Women's Health Research (SWHR) convened an interdisciplinary Bone Health Working Group to review the current state of science and practice concerning women's bone health and osteoporosis care and to explore strategies to address gaps in screening, diagnosis, and treatment of bone disease in women. Women's bone health care must shift its paradigm from one of postmenopausal and post-fracture care to a preventive model that engages touchpoints throughout the lifespan. To achieve this paradigm shift, the Working Group recommends prioritizing efforts to build public awareness and clinical education of preventive bone health care for women, increase access to screening tools, improve patient-provider communication, and treat osteoporosis using a broader risk stratification approach.

Calsium Supplementation with Rasbora sp. to Prevent Loss of Bone Mineral Density during Gonadotropin-releasing hormone Agonis Long-term Treatment

Background. Gonadotropin-releasing hormone (GnRH) agonist widely used to induce hypoestrogenic climate overcoming any benign gynecologic abnormalities such as endometriosis, adenomyosis, or various cause of abnormal uterine bleeding. Hypoestrogenic cause some of adverse effect mainly loss of bone mineral density (BMD). Suplementation of calcium improve loss in BMD, hence prevent development of osteoporosis. Certain area of Indonesia shows specific biodiversity, for example South Borneo has its wetland biodiversity in swamp and river. Processed food from fishery like Rasbora sp. (locally called Seluang fish) is local favourite due to access and economical reason.&#x0D; Method. Studies included 24 reproductive age (15-49 years old) female on agonist GnRH leuprolide acetate 11,25 mcg regimen given subcutaneously. Measurement of bone mineral density was done twice within 3 months apart, before and after first agonist GnRH treatment. During observation, subject was divided to one of three daily supplementation belows, placebo containing saccharum lactis, grinded powder of 500 mg of calcium, or grinded powder of dried Rasbora sp containing 500 mg of calcium. Measurement pre- and post- supplementation was count using bone quality index with Osteosys of Sonost 3000.&#x0D; Result. Placebo supplementation group in GnRH agonist has bone mineral density loss of -22,7201 greater than 500 mg grinded powder of lactate calcium dan grinded powder of rasbora sp, respectively -4,4570 and -3,3634 after 3 months of trial. Homogeneity test shown p=0.031 level of significancy and ANOVA resulted a significant difference from three classes. Post Hoc resulted calcium lactate supplementation 18,26 + 3,20 greater (p = 0.001) and grinded powder of Seluang 19,36 + 3,20 greater (p = 0.000). Both form of calcium lactate and fish powder supplementation have no significant differences.&#x0D; Conclusion. Calcium supplementation in both of calcium lactate powder and natural resources help maintaining bone mineral density during GnRH agonist treatment. Seluang fish (Rasbora sp.), abundantly found along Indonesia people especially in South Borneo, has similar potency with pharmaceutical calcium lactate product in same weight. Fishery product, has beneficial trace element for bodies, 84 mg of calcium (Ca), 6,81 % of magnesium (Mg), 13,4 mg of iron (Fe), dan 3.97 % of zinc (Zn).&#x0D; Keyword: Bone mineral density, Calcium supplementation, Agonist GnRH, Rasbora Sp.

Zebrafish mutants reveal unexpected role of Lrp5 in osteoclast regulation.

Low-density Lipoprotein Receptor-related Protein 5 (LRP5) functions as a co-receptor for Wnt ligands, controlling expression of genes involved in osteogenesis. In humans, loss-of-function mutations in LRP5 cause Osteoporosis-Pseudoglioma syndrome, a low bone mass disorder, while gain-of-function missense mutations have been observed in individuals with high bone mass. Zebrafish (Danio rerio) is a popular model for human disease research, as genetic determinants that control bone formation are generally conserved between zebrafish and mammals. We generated lrp5- knock-out zebrafish to study its role in skeletogenesis and homeostasis. Loss of lrp5 in zebrafish leads to craniofacial deformities and low bone mineral density (total body and head) at adult ages. To understand the mechanism and consequences of the observed phenotypes, we performed transcriptome analysis of the cranium of adult lrp5 mutants and siblings. Enrichment analysis revealed upregulation of genes significantly associated with hydrolase activity: mmp9, mmp13a, acp5a. acp5a encodes Tartrate-resistant acid phosphatase (TRAP) which is commonly used as an osteoclast marker, while Matrix metalloprotease 9, Mmp9, is known to be secreted by osteoclasts and stimulate bone resorption. These genes point to changes in osteoclast differentiation regulated by lrp5. To analyze these changes functionally, we assessed osteoclast dynamics in mutants and observed increased TRAP staining, significantly larger resorption areas, and developmental skeletal dysmorphologies in the mutant, suggesting higher resorptive activity in the absence of Lrp5 signaling. Our findings support a conserved role of Lrp5 in maintaining bone mineral density and revealed unexpected insights into the function of Lrp5 in bone homeostasis through moderation of osteoclast function.

Nopal cladodes (Opuntia Ficus Indica): Nutritional properties and functional potential

Nopal pads at different maturity stages show changes in their chemical composition. They are an excellent nutritional source and should be included in human diets worldwide. Moreover, they can be considered a novel potential food resource and used for scientific studies when transformed into powders, to reduce product loss during harvest season. Their physicochemical properties in the maturity stage can be used to treat or prevent nutritional related diseases. The nopal pad powder at high maturity stages could help normalize the fiber intake, and the high amount of Ca and Mg could help maintain bone mineral density. Soluble fiber can be included in human diets by consuming f fresh young nopals. Authors considered it necessary to increase the studies of the nutritional properties of different varieties of nopal cladodes as a function of the maturity and select them according to the nutritional requirements.

Efficacy and safety of vitamin K2 for postmenopausal women with osteoporosis at a long-term follow-up: meta-analysis and systematic review.

Vitamin K2 supplementation has been revealed to be effective in the prevention and treatment of osteoporosis in Japan, but further proof for the effectiveness of this practice is still needed. To investigate whether vitamin K2 supplementation plays a role in maintaining bone mineral density (BMD) and reducing the incidence of fractures for postmenopausal women with osteoporosis at a long-term follow-up. We searched systematically throughout the databases of PubMed, Cochrane library, and EMBASE from the dates of their inception to November 16 2021 in this meta-analysis and systematic review, using keywords vitamin K2 and osteoporosis. Nine RCTs with 6853 participants met the inclusion criteria. Vitamin K2 was associated with a significantly increased percentage change of lumbar BMD and forearm BMD (WMD 2.17, 95% CI [1.59-2.76] and WMD 1.57, 95% CI [1.15-1.99]). There were significant differences in undercarboxylated osteocalcin (uc-OC) reduction (WMD -0.96, 95% CI [-0.70 to 0.21]) and osteocalcin (OC) increment (WMD 26.52, 95% CI [17.06-35.98]). Adverse reaction analysis showed that there seemed to be higher adverse reaction rates in the vitamin K2 group (RR = 1.33, 95% CI [1.11-1.59]), but no serious adverse events related to vitamin K2 supplementation. This meta-analysis and systematic review seemed to support the hypothesis that vitamin K2 plays an important role in the maintenance and improvement of BMD, and it decreases uc-OC and increases OC significantly at a long-term follow-up. Vitamin K2 supplementation is beneficial and safe in the treatment of osteoporosis for postmenopausal women.

Rationale and study design of Randomized Controlled Trial of Dietary Supplementation with prune (dried plums) on bone density, geometry, and estimated bone strength in postmenopausal women: The Prune study

The use of non-pharmacological alternatives to pharmacological interventions, e.g., nutritional therapy, to improve or maintain bone mineral density (BMD) in postmenopausal women has gained traction over the past decade, but limited data exist regarding its efficacy. This paper describes the design of the Prune Study, a randomized controlled trial (RCT) that explored the effectiveness of a 12-month intervention of daily prune consumption on bone density, bone structure and strength estimates, bone turnover, various biomarkers of immune function, inflammation, and cardiovascular health, as well as phenolic and gut microbiota analyses. Postmenopausal women between the ages of 55–75 years were randomized into either control group (no prune consumption; n = 78), 50g prune (50g prune/day; n = 79), or 100g prune (100g prune/day; n = 78). All participants received 1200 mg calcium +800 IU vitamin D3 daily as standard of care. The Prune Study is the largest and most comprehensive investigation of a dose response of prune consumption on bone health, biomarkers of immune function, inflammation, and cardiovascular health, as well as detailed phenolic and gut microbiota analyses in postmenopausal women. 235 women were randomized and 183 women completed the entire study. The findings of this study will help expand our current understanding of clinical implications and mechanisms underlying the resultant health effects of prune as a functional food therapy.

The effect of maltobionic acid on bone metabolism markers in healthy Japanese postmenopausal women: A randomized double-blind placebo-controlled crossover study.

Osteoporosis is characterized by compromised bone strengthpredisposing to an increased risk of fracture and is a disease with a high incidence in postmenopausal women. Frequent estrogen deficiency, particularly in postmenopausal women, induces osteoclast activation and is a major contributor to reduced bone mineral density. Maltobionic acid (MB) reportedly promotes mineral resorption and maintains bone mineral density in human clinical trials, although no studies have confirmed that MB improves bone metabolism in humans. Therefore, this study aimed to investigate the effects of MB administration on bone‐resorption markers in healthy Japanese postmenopausal women. This was a randomized, double‐blind, placebo‐controlled, crossover trial. Twenty‐six healthy adult Japanese women who realized that they had passed through more than 1 year of natural menopause and were aged 40–69 years were categorized into three groups. The experimental groups were allowed to consume maltobionic acid syrup 4 g (MB syrup 4 g group), maltobionic acid syrup 2 g plus maltose syrup 2 g (MB syrup 2 g group), and maltose syrup 4 g (placebo group) for 4 weeks. All 26 participants completed the intervention. Continuous ingestion of MB syrup 2 g or 4 g for 4 weeks significantly reduced the levels of bone‐resorption markers deoxypyridinoline (DPD) and urinary N‐telopeptide (u‐NTx), and significantly increased the bone formation marker osteocalcin (OC) compared with the placebo group. Maltobionic acid (MB) intake may improve bone metabolism and reduce bone health problems, including osteoporosis, in postmenopausal, adult Japanese women. (UMIN‐CTR ID: UMIN000038627).

Drinking Natural Mineral Water Maintains Bone Health in Young Rats With Metabolic Acidosis

IntroductionMetabolic acidosis affects bone health. It remains unclear whether drinking natural mineral water is better for maintaining bone health in the youth with metabolic acidosis.Materials and MethodsSixty young female rats (3-weeks-old) were randomly divided into three groups and drank purified water (PW, as control), bicarbonate-rich natural mineral water (Bic-NMW), or sulfate-rich natural mineral water (Sul-NMW), which, respectively, contained calcium (0.17, 155, and 175 mg/L), bicarbonate (0.1360, and 139 mg/L) and sulfate (0, 35.6, and 532 mg/L), for 16 weeks. In the last 3 weeks, metabolic acidosis was induced in 10 rats per group by adding NH4Cl (0.28 mM) to drinking water. The rats' blood, urine, and femur were collected for assessing acid-base status, calcium metabolism, bone microstructure, and strength. The difference between the three groups was determined using one-way ANOVA followed by the Student–Newman–Keuls test or Dunnett's T3 test.ResultsCompared with the PW rats, the Bic-NMW rats and the Sul-NMW rats had less urine net acid excretion (−1.51, 0.20 vs. 10.77, EQ/L), higher bone mineral density (442.50, 407.49 vs. 373.28, mg/mm3), growth cartilage width (271.83, 283.83 vs. 233.27, μm) and cortical trabecular area (9.33, 9.55 vs. 5.05, mm2), and smaller cortical marrow cavity area (5.40, 5.49 vs. 7.27, mm2) in the femur (P < 0.05). Besides, the Bic-NMW rats had less serum calcium (2.53 vs. 2.68, mmol/L) and C-terminal cross-linked telopeptide of type-I collagen (1.35 vs. 1.93, ng/mL), and higher serum calcitonin (0.61 vs. 0.39, μg/L), femoral trabecular thickness (0.10 vs. 0.09, μm), bone volume/total volume (0.42 vs. 0.34, %), cortical bone area (15.91 vs. 12.80, mm2), and ultimate stress (35.12 vs. 29.32, MPa) (P < 0.05). The Sul-NMW rats had more osteoclasts (22.50 vs. 11.54, cells/field) (P < 0.05).ConclusionsDrinking natural mineral water, especially bicarbonate-rich natural mineral water, is effective in improving bone health in young rats with metabolic acidosis. These benefits include maintaining bone mineral density, and improving bone microstructure and biomechanical properties via moderating metabolic acidosis.

Abstract P1-13-04: Evaluation of the impact Vitamin D and Calcium supplementation on bone mineral density in breast cancer patients using or not taking Aromatase Inhibitors: 5-year follow-up

Abstract Introduction: Breast cancer is the most common among women worldwide. Approximately 67% of women with breast cancer are hormone receptor (RH) positive, so adjuvant endocrine therapy is often used. However, the impact of aromatase inhibitors on maintaining bone mineral density is discussed. Objective: Verify whether Vitamin D and Calcium supplementation impacted the progression to osteopenia and osteoporosis in the evaluated groups. Methodology: Comparative prospective cohort study with 140 women, divided into 2 groups; IAG (RH+ in treatment with aromatase inhibitors) and CG (triple- or HER-2 positive in another type of treatment). After approval of the project by the ethics committee, the mineral density of the lumbar spine, femoral neck and total femur (T-score) was analyzed by imaging before, after 6 months and 5 years of treatment. Blood tests to measure serum calcium, ionic calcium, vitamin D and parathyroid hormone (PTH) were performed before and after 5 years, where results less than 30ng/mL vitamin D were treated with 7,000UI per day (dose of attack), for eight weeks followed by daily maintenance of 1000UI, in the presence of Osteopenia they received calcium and Osteoporosis received zoledtobic acid (4mg), 6/6 months. Data were initially analyzed by the KS test to determine the normality of the sample, later by the Anova Test, considering p≤0,05. Results: Regarding vitamin D, before treatment, 45 (64%) and 56 (71%); after 5 years, 12 (17%) and 11 (16%) were respectively insufficient in the IAG and CG. In the progression to osteopenia, the changes were statistically significant in the femoral neck (4-12%,12-17%/9-12%,11-15%) and in the femur (7-10%,18-25%/6-8%,17-24%) after 6 months and 5 years, respectively in the IAG and CG. In the lumbar spine, despite showing progression to osteoporosis, it was not statistically significant, as well as in the comparison of groups. Both, IAG and the CG showed statistically significant loss of bone mass in the femur and femur neck when compared before treatment with 6 months and 5 years (p≤0,05). In the spine, the statistically significant loss occurred comparing before treatment with 6 months only in the IAG (p=0,05). When comparing the groups with each other, we found no statistically significant diferences. Conclusion: Vitamin D and calcium supplementation appears to have generated a protective factor in bone loss in both groups. Table 1.T-score values at the evaluated times (n=140).Aromatase Inhibitors GroupFEMORAL NECKFEMURLUMBAR SPINEBefore6M5YBefore6M5YBefore6M5YNormal383426514433384238Osteopenia323644192637322226Osteoporosis000000066p-value0,002*0,000*0,03*0,01*0,10,2Control GrroupNormal393028524635503939Osteopenia31404218243592624Osteoporosis0000001157p-value0,05*0,006*0,05*0,002*0,40,2M: Months; Y: Years. Table 2.Bone mineral density at the evaluated times (n=140).Aromatase Inhibitors GroupFEMORAL NECKBefore6M5YLoss 6MLoss 5YMean±SD0,95±0,130,89±0,160,85±0,14-5,75±13,51-9,41±13,79p-value0,019*0,0003*0,070,05*FEMURMean±SD1,01±0,180,96±0,190,92±0,17-4,25±14,67-7,87±16,05p-value0,05*0,001*0,090,08LUMBAR SPINEMean±SD1,13±0,161,11±0,171,07±0,22-1,5±6,96-4,57±15,45p-value0,270,05*0,140,06Control GrroupFEMORAL NECKBefore6M5YGain 6MLoss 5YMean±SD0,94±0,130,89±0,150,85±0,15-4,36±21,80-8,10±20,26p-value0,01*0,0001*0,10,14FEMURBefore6M5YLoss 6MLoss 5YMean±SD1,0±0,190,94±0,170,92±0,18-2,03±28,92-5,31±21,94p-value0,02*0,007*0,260,22LUMBAR SPINEMean±SD1,1±0,191,11±0,161,07±0,223,77±25,83-0,85±24,89p-value0,410,150,10,14M: Months; Y: Years; SD: Standard Deviation Citation Format: Marcelo Antonini, Gisela RosaFranco Salerno, Natalia DanielaKovalinski Vieira, Mariana Soares Cardoso, Matheus de Paula Solino, Raissa Naiarade Barros Vasconcelos, Lais de Albuquerque Vasconcelos, Odair Ferraro, Andre Mattar, Reginaldo GuedesCoelho Lopes, Juliana Monte Real. Evaluation of the impact Vitamin D and Calcium supplementation on bone mineral density in breast cancer patients using or not taking Aromatase Inhibitors: 5-year follow-up [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-13-04.

Le type de insert n’a aucun impact sur les changements de densité minérale osseuse autour d’une cupule acétabulaire en titane trabéculaire imprimée en 3D

BackgroundThree-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic “normal” bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings, therefore we did a prospective study aiming to answer: 1) Is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip? 2) Does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HypothesisBMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. Material and methodsThis is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed Trabecular Titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6,12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. ResultsA total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DiscussionThis study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. Level of EvidenceIII; prospective comparative study.

The efficacy of a comprehensive bone health program in maintaining bone mineral density in postmenopausal women with early-stage breast cancer treated with endocrine therapy: real-world data.

Aromatase inhibitors (AI) are the gold standard treatment option for hormone-sensitive postmenopausal women with breast cancer. Several studies had documented the accelerated bone loss associated with AI. In this study, we present real-world data describing the efficacy of implementing a comprehensive bone health program to maintain bone mineral density (BMD) in postmenopausal patients with early-stage breast cancer treated with AI. A comprehensive bone health program that includes counseling, exercise, nutritional advice, vitamin D supplements and, when needed, intravenous bisphosphonate infusion was implemented following the initiation of endocrine therapy with AI. Postmenopausal women with hormone-sensitive, early-stage breast cancer treated with endocrine therapy using AI were retrospectively identified. All patients had BMD measurements before and at least 1year after ET initiation. A total of 210 patients were included, median (range) age 67 (43-86) years. At baseline, osteoporosis was documented in 38 (18.1%) and osteopenia in 101 (48.1%) patients. Despite the known negative effect of AI, 32 (84.2%) patients with baseline osteoporosis and 69 (68.3%) of those with osteopenia, had a stable or better BMD. On the other hand, 41 (57.7%) of those with normal baseline BMD had a drop in their follow up BMD, p < 0.001. Vertebral fractures were reported in 3 (11.1%) patients with osteoporosis compared to none in patients with normal BMD, p = 0.021. Despite the known negative effect of ET on bone health of breast cancer patients, implementing a comprehensive bone health program stabilized or improved BMD.

The phytochemical plumbagin reciprocally modulates osteoblasts and osteoclasts.

Bone metabolism is essential for maintaining bone mineral density and bone strength through a balance between bone formation and bone resorption. Bone formation is associated with osteoblast activity whereas bone resorption is linked to osteoclast differentiation. Osteoblast progenitors give rise to the formation of mature osteoblasts whereas monocytes are the precursors for multi-nucleated osteoclasts. Chronic inflammation, auto-inflammation, hormonal changes or adiposity have the potential to disturb the balance between bone formation and bone loss. Several plant-derived components are described to modulate bone metabolism and alleviate osteoporosis by enhancing bone formation and inhibiting bone resorption. The plant-derived naphthoquinone plumbagin is a bioactive compound that can be isolated from the roots of the Plumbago genus. It has been used as traditional medicine for treating infectious diseases, rheumatoid arthritis and dermatological diseases. Reportedly, plumbagin exerts its biological activities primarily through induction of reactive oxygen species and triggers osteoblast-mediated bone formation. It is plausible that plumbagin's reciprocal actions- inhibiting or inducing death in osteoclasts but promoting survival or growth of osteoblasts- are a function of the synergy with bone-metabolizing hormones calcitonin, Parathormone and vitamin D. Herein, we develop a framework for plausible molecular modus operandi of plumbagin in bone metabolism.

Liner type has no impact on bone mineral density changes around a 3D printed trabecular titanium acetabular component

BackgroundThree-dimensional printing of implants allows the ability to produce implants and interfaces which theoretically better mimic “normal” bone behaviour, leading to a possible reduction in stress shielding thus maintaining bone mineral density (BMD). This issue was not investigated in vivo using bone scan and different bearings; therefore, we did a prospective study aiming to answer: 1) is there a loss of BMD around the 3D printed trabecular titanium cup, when compared to the native hip?; 2) does liner type influence the BMD changes around the acetabulum when a 3D printed trabecular titanium cup is used? HypothesisBMD changes around the acetabulum are not influenced by the liner type, and the cup will be associated with a reduction in BMD when compared to the native hip. Material and methodsThis is a prospective observational study of patients receiving a primary total hip arthroplasty. A 3D printed trabecular titanium uncemented acetabular component was used in all cases. All patients received a ceramic femoral head, with either a ceramic or polyethylene acetabular liner. BMD measurements using DXA were performed at 6 weeks, 6, 12 and 24 months after surgery to evaluate remodeling changes. The 3 acetabular regions of interest (ROI) of DeLee and Charnley were used for serial comparisons of peri-acetabular BMD. The study was powered as a non-inferiority study with the principle variables compared using a two-step repeated analysis of variance. ResultsA total of 48 consecutive patients were included in the study, with all patients completing their 2 year follow-up. There were no failures, revisions or complications within this cohort. We found no statistically significant difference in the BMD change scores between the operated and the native hip in any of the 3 ROI zones. We found no differences in BMD scores when comparing ceramic to polyethylene acetabular liners, head sizes and BMI. DiscussionThis study shows a similar pattern of BMD behaviour around a 3D printed cup when compared to the contralateral native hip. We were unable to show a clinical or radiological difference between the bearing material, head size, or BMI when used with this type of acetabular component. Level of evidenceIII; prospective comparative study.