Mean Lumbar Bone Mineral Density Research Articles

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES—a population-based study

BackgroundThe modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.MethodsData from 2007 to 2008, 2009–2010, 2013–2014 and 2017–2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1–L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.ResultsA total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = − 0.0103 (95% CI − 0.0160 to − 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = − 0.0120 (95% CI − 0.0172 to − 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371–0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.ConclusionsThe results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Zoledronate Therapy in Osteogenesis Imperfecta: Perspectives in Indonesia Tertiary Hospital.

Osteogenesis imperfecta (OI) is a rare disease with an estimated incidence of between 1/25,000 and 1/10,000 globally. The main treatment for OI is the administration of bisphosphonate drugs. Research on clinical, radiographic, and biochemical markers to monitor patients with OI treated with zoledronate can be challenging in countries in which patients have limited national health insurance. We aimed to examine patients with OI treated in Indonesia with a minimum follow-up period of 2 years. An observational study was conducted of all patients with OI treated with zoledronate between 2021 and 2023 at a tertiary hospital in Indonesia. We evaluated the paediatric quality of life (PedsQL), bone mineral density (BMD), and alkaline phosphatase (ALP) level before and after zoledronate treatment. To monitor safety, serum creatinine and calcium levels were also measured. Eleven boys (55%) and nine girls (45%), with an average age of 6.9 years (range, 4-17 years), were included. After 2 years of zoledronate treatment, the total PedsQL score increased from 66.7 to 76.9 (P=0.0001) and the mean lumbar and total body BMD increased from 0.467 and 0.501 to 0.599 g/cm2, and 0.626 g/cm2 (P=0.001), respectively. The ALP level decreased from 310.6 to 186.4 mg/mL (P=0.0001). Neither serum creatinine (P=0.586) nor calcium (P=0.53) levels changed from the pre-treatment to 2 years post-treatment time points. Zoledronate was safe and effective for the treatment of OI. There were significant improvements in the quality of life and BMD in patients with OI. The ALP level decreased, but serum creatinine and calcium levels were not affected by zoledronate.

Association between Low Bone Mineral Density and Pain in a Prospective Cohort of Adults with Sickle Cell Disease: Preliminary Results from the SCD Bone Pain Study

Background: Osteonecrosis (ON), a prevalent skeletal complication of sickle cell disease (SCD), typically associates with severe chronic pain, frequent acute care utilization, and permanent disability. We previously showed that low bone mineral density (BMD) independently associates with hip ON and chronic pain in a pediatric SCD cohort. We now present preliminary data on the association between low BMD and pain in a prospective cohort of adults enrolled in the SCD Bone Pain Study (NCT05283148). Methods: Written informed consent was obtained from all participants, who were recruited from ambulatory adults with SCD seen at the University of California Davis Comprehensive Cancer Center. All participants underwent dual-energy X-ray absorptiometry (DXA) scans of their lumbar spine, left hip, and left forearm. Vertebral fractures were assessed by thoracolumbar morphometry in the DXA scanner. All participants also completed the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) Pain Impact questionnaire. We used linear regression to evaluate the association between ASCQ-Me pain scores and low BMD (categorically defined as BMD Z-score ≤ -2 at any DXA site). We also used linear regression to determine the association between ASCQ-Me pain scores and continuous total hip and lumbar spine BMD Z-scores. Lastly, we evaluated the impact of other covariates on pain scores, with low BMD or BMD Z-scores included in the least absolute shrinkage and selection operator (LASSO, no shrinkage). Results: Thirty adults (median age 34.5 years [20-67 years]) completed the study between Nov 2022-Jul 2023. Baseline characteristics are summarized in Table 1. There was a borderline significant association between low BMD and lower (worse) pain scores (p=0.077). Continuous BMD Z-scores of the total hip (p=0.081) and lumbar spine (p=0.024) were independently associated with higher (better) pain scores. In addition to low BMD, only white blood cell count (WBC), indirect bilirubin, and vitamin D were identified as possible covariates (all had non-zero coefficients in LASSO analysis). Low BMD was significantly associated with pain (p=0.024), even after adjusting for WBC, indirect bilirubin, and vitamin D (Table 2). Similarly, we found that higher hip (p=0.059) and lumbar (p=0.027) BMD Z-scores were associated with higher (better) pain scores, despite adjusting for the same confounders. Discussion: We found low BMD in 12 of 30 (40%) adults enrolled in the SCD Bone Pain Study. Like other chronic hemolytic anemias, compensatory increased erythropoiesis leads to trabeculae degradation, cortical bone thinning, and eventual low bone mass. Lumbar vertebrae comprises mostly of trabecular bone, while the hip joint has mostly cortical bone. This might explain why mean lumbar BMD Z-scores were lower than hip BMD Z-scores (Table 1), and why lumbar spine BMD Z-scores directly and significantly correlated with pain scores (Table 2). These preliminary data suggest that pain is more prevalent in SCD adults with low BMD than those with normal BMD as we previously reported in a pediatric SCD cohort. Pain scores decrease (worsen) with increasing WBC, which suggests an inflammatory component to chronic SCD pain. Contrary to expectation, higher indirect bilirubin (a marker of increased hemolysis) significantly correlated with higher (better) pain scores. Similarly, higher vitamin D (a proxy for bone health) correlated with lower (worse) pain scores, though this association was non-significant. The reason(s) for these counterintuitive associations between pain scores, indirect bilirubin, and vitamin D levels is currently unknown. Limitations include a small sample size, though using the LASSO method for multivariate regression adjusted for this. Further, low BMD causality could not be determined at this time. Recruitment is ongoing with an enrollment target of 50 adults with SCD by Nov 2023. Analysis are ongoing to determine if SCD-modifying therapies will impact the association between low BMD and pain. Bone biomarker studies are also pending. Further, the thoracolumbar morphometry is still undergoing radiologic review, so we can further assess how vertebral compression fractures (i) correlate with pain scores, and/or (ii) attenuate the association between low BMD and pain. Identifying and treating risk factors for low BMD may alleviate bone pain and potentially improve quality of life for all people with SCD.

Trabecular Bone Score as a Reliable Measure of Lumbar Spine Bone Microarchitecture in Acromegalic Patients.

Although GH and IGF-1 excess has a controversial impact on bone mineral density (BMD), acromegalic patients display variable degrees of bone structure impairment. In this study, we aim to investigate the usefulness of trabecular bone score (TBS), compared to BMD, in identifying acromegalic patients with impaired lumbar spine trabecular microarchitecture. Forty-four acromegalic patients were investigated for disease control, metabolic and gonadal status, bone metabolism parameters, and the presence of vertebral fractures (VFs). Patients and matched healthy controls underwent BMD and TBS examination. Mean TBS values were lower in patients than in controls (p &lt; 0.001), without significant differences in mean lumbar and femoral BMD. TBS values were significantly higher in controlled patients compared to the uncontrolled ones (p = 0.012). No significant differences were found in bone markers with respect to disease control. Mean TBS or lumbar BMD did not significantly differ in patients with or without VFs (prevalence 11.4%). TBS and BMD levels were lower in hypogonadal patients compared to the eugonadal ones (p = 0.030 and p &lt; 0.001, respectively). In conclusion, TBS values are significantly lower in patients than in controls, confirming the presence of impaired lumbar spine trabecular bone in acromegaly. Both uncontrolled disease and hypogonadism contribute to TBS deterioration in acromegaly.

Therapy of moderate-to-severe Graves\u2019 orbitopathy with intravenous methylprednisolone pulses is not associated with loss of bone mineral density

PurposeTo evaluate the influence of intravenous methylprednisolone (IVMP) pulse administration on bone mineral density (BMD) of the lumbar spine and the femoral neck in patients with moderate-to-severe Graves’ orbitopathy (GO).MethodsThirty-five patients with GO in euthyreosis were treated with 12 IVMP pulses (6 × 0.5 g, 6 × 0.25 g on a weekly schedule). Supplementation with 1.0 g of calcium and 800 IU of vitamin D was initiated in all patients before beginning therapy. BMD of the lumbar spine (L1–L4) and the femoral neck were assessed at baseline and after the last IVMP pulse using dual-energy X-ray absorptiometry. To determine differences in BMD between values at baseline and after treatment, we used the least significant change (LSC) methodology. LSC values were calculated to be 3 and 5% for the lumbar spine and the femoral neck, respectively. Change in BMD equal to or exceeding the LSC was assessed as either increase or decrease of BMD. We then compared pre-treatment and post-treatment mean BMD values at the lumbar spine and the femoral neck.ResultsWe did not observe a decrease of BMD at any site equal to or exceeding the LSC. We found an increase of BMD in at least one measurement site equal to or exceeding the LSC value in 43% of patients, mostly in the lumbar spine (31%). Mean femoral neck BMD did not change while mean lumbar BMD increased.ConclusionsIVMP given in weekly intravenous pulses does not lead to loss of BMD of the lumbar spine and the femoral neck.

Correlation between sarcopenia and osteoporosis in patients with post-poliomyelitis syndrome

Muscle mass, -strength and -density, sarcopenia, exercise and physical activity are correlated with bone mass, bone density and osteoporotic fractures. Bone and muscle decay and dysfunction are seen in ageing, but in neurological disorders with muscular atrophy, bone loss can be seen also at younger ages. Femoral neck and lumbar spine bone mineral density (BMD) is measured using dual X-ray absorptiometry in 30 patients with post-poliomyelitis syndrome, 18 women and 12 men, with a mean age of 56.3 years (ranging from 37 till 70). Eight women were postmenopausal. Mean femoral neck BMD was −22.76% or −1.86 SD and mean lumbar BMD was −13.21% or −1.25 SD. Low femoral bone mass was found in 80% of the patients (12 men and 12 women, of whom 5 were post-menopausal) and low lumbar bone mass was seen in 63% (9 men and 10 women, of whom 8 were post-menopausal). Six patients (all women) had normal femoral BMD and 11 normal lumbar BMD, whereas 6 (3 male and 3 female) had osteoporotic femoral BMD-scores (< −2.5 SD) and 3 (1 man and 2 women) had osteoporotic lumbar BMD. The remaining patients had osteopenia: 18 showed femoral osteopenia (< −1 SD) and 16 lumbar osteopenia. A significant difference in femoral (cortical) BMD between men and women was found: −27.72% or −2.24 SD in men and −19.46% or −1.62 SD in women. Only small sex differences were seen in lumbar (trabecular) BMD: −13.85% or −1.37 SD in men and −12.78% or −1.17 SD in women. The lowest BMD scores were present in patients with visible and clear lower limb muscle atrophy. A correlation is shown between low muscle mass and low cortical BMD can be explained by neurogenic bone loss, both due to muscle atrophy and disturbed regulation of bone by the central nervous system.

Dienogest 2 mg Daily in the Treatment of Adolescents with Clinically Suspected Endometriosis: The VISanne Study to Assess Safety in ADOlescents

Study ObjectiveTo study the safety and efficacy of dienogest 2 mg in adolescents with suspected endometriosis. DesignA 52-week, open-label, single-arm study. SettingIn 21 study centers, in 6 European countries. ParticipantsAdolescents aged 12 to younger than 18 years with clinically suspected or laparoscopically confirmed endometriosis. InterventionsDienogest 2 mg once daily. Main Outcome MeasuresThe primary end point was relative change in lumbar spine (L2-L4) bone mineral density (BMD) measured using dual-energy x-ray absorptiometry. A key secondary end point was change in endometriosis-associated pain assessed using a visual analogue scale. ResultsOf 120 patients screened, 111 comprised the full-analysis set (ie, patients who took ≥1 dose of study drug and had ≥1 post-treatment observation) and 97 (87.4%) completed the study. Mean lumbar BMD at baseline was 1.1046 (SD, 0.1550) g/cm2. At the end of dienogest treatment (EOT; defined as at 52 weeks or premature study discontinuation), mean relative change in BMD from baseline was −1.2% (SD, 2.3%; n = 103). Follow-up measurement 6 months after EOT in the subgroup with decreased BMD at EOT (n = 60) showed partial recovery in lumbar BMD (mean change from baseline: −2.3% at EOT, −0.6% 6 months after EOT). Mean endometriosis-associated pain score was 64.3 (SD, 19.1) mm at baseline and decreased to 9.0 (SD, 13.9) mm by week 48. ConclusionIn adolescents with suspected endometriosis, dienogest 2 mg for 52 weeks was associated with a decrease in lumbar BMD, followed by partial recovery after treatment discontinuation. Endometriosis-associated pain was substantially reduced during treatment. Because bone accretion is critical during adolescence, results of the VISanne study to assess safety in ADOlescents (VISADO) study highlights the need for tailored treatment in this population, taking into account the expected efficacy on endometriosis-associated pain and an individual's risk factors for osteoporosis.

Zoledronic Acid in Non-Ambulatory Children and Young Adults with Fragility Fractures and Low Bone Mass Associated with Spastic Quadriplegic Cerebral Palsy and Other Neuromuscular Disorders

Non-ambulatory patients with neurological disorders such as spastic quadriplegic cerebral palsy often have low bone mineral density (BMD) and fragility fractures from disuse osteoporosis. Limited data exists on zoledronic acid (a third generation bisphosphonate) treatment in the pediatric population. We report a case series of 10 patients with spastic quadriplegic cerebral palsy (n=6), spinal muscular atrophy (n=2), and myelomeningocele (n=2) treated with zoledronic acid for fragility fractures and/or low BMD associated with the underlying conditions. The clinical and BMD outcomes were retrospectively studied and compared with a historical cohort of 32 patients treated with intravenous pamidronate. Mean lumbar BMD increased significantly ( P < 0.01) by 28% at1 yearin zoledronic acid group, and by 19% in pamidronate group. Mean lumbar BMD weight-adjusted Z-scores improved from -4.31 at baseline to -2.55( P =0.003) at 1 year in zoledronic group, and from -3.66 to -2.30 in pamidronate group ( P =0.001). Total number of fractures in the zoledronic group was 18 before treatment and reduced to zero after treatment with an average follow-up of 3.9 years. All patients tolerated zoledronic acid infusion with fever in 3 patients (30%) during the initial infusion and nohypocal cemianoted during the treatment cycles. Treatment with zoledronic acid is safe, significantly improves bone density and reduces fractures in children and young adults with fragility fractures and low bone mass secondary to neuromuscular disorders. Further follow up studies are needed to confirm safety and efficacy in long-term fracture prevention.

Helicobacter pylori: A Possible Risk Factor for Bone Health.

BackgroundHelicobacter pylori (H. pylori) infection may cause systemic inflammation and increase the production of tumor necrosis factor-α, interleukin-1, and interleukin-6. Unfortunately, bone mineral density also may be affected by these cytokines. This study aimed to evaluate the association between bone mineral density and H. pylori infection.MethodsA cross-sectional study evaluated 1,126 men undergoing a comprehensive health screening in a private Korean screening center. Subjects' sera were tested for H. pylori antibodies (immunoglobulin G) using an enzyme-linked immunosorbent assay, and bone mineral densities (g/cm2) of the lumbar spine, femoral neck, and total femur were obtained using dual-energy X-ray absorptiometry. To evaluate the difference in bone mineral density according to H. pylori infection status, the adjusted mean bone mineral densities at each site were compared after adjusting for potential confounders, including age, sex, body mass index, smoking, alcohol consumption, and exercise.ResultsH. pylori infection was associated with a significant decrease in mean lumbar bone mineral density (H. pylori-positive, 1.190 g/cm2; H. pylori-negative, 1.219 g/cm2; P=0.006), which was greatest among men who were ≥50 years old (H. pylori-positive, 1.193 g/cm2; H. pylori-negative, 1.233 g/cm2; P=0.006). However, no significant association was observed in the bone mineral densities of the total femur and femoral neck.ConclusionIn men, H. pylori infection was negatively associated with lumbar bone mineral density. This association may be useful in the early detection, prevention, and management of male osteoporosis.

Growth hormone treatment for osteoporosis in patients with scoliosis of Prader-Willi syndrome

Background Patients with Prader-Willi syndrome (PWS) have fragile bones. Osteoporosis is a major concern in scoliosis surgery. Our aim was to investigate bone mineral density (BMD) in PWS patients and to verify the efficacy of and scoliosis deterioration with growth hormone (GH) administration for osteoporosis.Methods We followed 148 PWS patients who underwent lumbar spine (L2–4) BMD testing. Sixty-four patients had scoliosis, and 84 were non-scoliosis patients. Patients were treated with GH (0.245 mg/kg/week) until they reached a skeletal age of 17 years for males and 15 years for females. We also evaluated the effect of GH treatment on BMD in 101 patients (60 males, 41 females) undergoing BMD testing more than twice. The mean patient age was 5.4 years. The mean duration of GH administration was 54 months.Results Mean lumbar BMD was 0.567 g/cm2. Fifty patients (33.8 %) had osteoporosis and 41 (27.7 %) had osteopenia. There was no significant difference in mean BMD between patients with scoliosis (0.598 g/cm2) and without scoliosis (0.548 g/cm2). GH treatment caused a significant increase in Z score (pre-GH: mean −2.28 vs. post-GH: mean −1.53, P < 0.001). There was no statistical difference in the prevalence of scoliosis between the GH treatment group (45/112, 40.1 %) and non-treatment group (19/36, 52.8 %).Conclusions Among patients with PWS, 61.5 % had low BMDs. GH administration significantly improved the lumbar BMD (Z score). There were no statistically significant differences in the prevalence of scoliosis among patients who received GH treatment compared to patients who did not.

Body composition profile of young patients with phenylketonuria and mild hyperphenylalaninemia.

Background:There is evidence in support of low bone density in young patients with disorders of phenylalanine metabolism; however, little is known about muscle and fat mass in these patients, especially in those with mild hyperphenylalaninemia (mHPA).Objectives:We aimed to evaluate body composition of children and adolescents with early-diagnosed disorders of phenylalanine metabolism.Patients and Methods:The study was conducted in the Institute of Child Health, which is the national center that performs newborn screening. Bone, muscle, and fat mass of 48 patients with phenylketonuria (PKU) and 32 patients with mild mHPA, aged five to 18 years, were compared to 57 age- and sex-matched controls. Dual energy X-ray absorptiometry was used for this purpose.Results:Compared to controls, bone mineral density (BMD) was lower in patients with PKU (mean total body BMD z score, 0.11; P = 0.03) and in those with mild mHPA (mean lumbar BMD z score, -0.34; P = 0.01). Lean body mass and fat mass were not significantly affected in the study group. Comparison between the two patients groups did not reveal any difference in body composition profiles; however, pubertal status appeared important for within-group comparisons. Fat mass was significantly increased in teenagers with PKU, which was more evident in those with poor dietary compliance irrespective of gender (fat mass z score, 0.66; P = 0.018). Finally, positive correlations were found not only between bone, muscle, and fat mass in both groups, but also between fat mass and Phenylalanine levels in patients with PKU (r, 0.46; P = 0.001).Conclusions:Bone mineral density appears suboptimal in young patients with disorders of phenylalanine metabolism. Adolescents seemed more prone to obesity, especially when their dietary adherence was poor, whereas muscle mass was not considerably affected. To ensure healthier bones and less fat content, close follow-up as well as proper lifestyle advice is needed.

AB0433 Prevalence of osteopenia and osteoporosis in women with systemic lupus erythematosus

BackgroundSystemic Lupus Erythematosus (SLE) is a chronic, autoimmune disease characterized by acute and chronic inflammation of various tissues of the body. Studies have found an increase in bone loss and...

High Serum Osteopontin Levels Are Associated with Low Bone Mineral Density in Postmenopausal Women

Osteopontin (OPN) is an acidic, noncollagenous matrix protein produced by the bone and kidneys. It is reportedly involved in bone resorption and formation. We examined the association between serum OPN levels and bone mineral density in postmenopausal women. Premenopausal women (n=32) and postmenopausal women (n=409) participated in the study. We measured serum osteopontin levels and their relationships with bone mineral density and previous total fragility fractures. The postmenopausal women had higher mean serum OPN levels compared to the premenopausal women (43.6±25.9 vs 26.3±18.6 ng/mL; P<0.001). In the postmenopausal women, high serum OPN levels were negatively correlated with mean lumbar bone mineral density (BMD) (r=-0.113, P=0.023). In a stepwise multiple linear regression model, serum OPN levels were associated with BMD of the spine, femoral neck, and total hip after adjustment for age, body mass index, smoking, and physical activity in postmenopausal women. However, serum OPN levels did not differ between postmenopausal women with and without fractures. Postmenopausal women exhibit higher serum OPN levels than premenopausal women and higher serum OPN levels were associated with low BMD in postmenopausal women.

Association of nonalcoholic fatty liver disease with low bone mass in postmenopausal women

Osteoporosis is a disease associated with insulin resistant states such as central obesity, diabetes, and metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) is also increased in such conditions. However, little is known about whether osteoporosis and nonalcoholic fatty liver disease are etiologically related to each other or not. We examined whether bone mineral density (BMD) is associated with NAFLD in pre- and postmenopausal women. Four hundred eighty-one female subjects (216 premenopausal and 265 postmenopausal) were enrolled. Lumbar BMD was measured using dual-energy X-ray absorptiometry. Liver ultrasonography was done to check the severity of fatty liver. We excluded subjects with a secondary cause of liver disease. Blood pressure, lipid profile, fasting plasma glucose, alanine aminotransferase (ALT), aspartate aminotransferase, and body mass index were measured in every subject. Mean lumbar BMD was lower in subjects with NAFLD than those without NAFLD in postmenopausal women (0.98 ± 0.01 vs. 1.01 ± 0.02 g/cm², P = 0.046). Multiple correlation analysis revealed a significant association between mean lumbar BMD and NAFLD in postmenopausal subjects after adjusting for age, body mass index, ALT, smoking status, and alcohol consumption (β coefficient -0.066, 95% CI -0.105 to -0.027, P = 0.001). Even after adjusting the presence of metabolic syndrome, the significance was maintained (β coefficient -0.043, 95% CI -0.082 to -0.004, P = 0.031). Lumbar BMD is related with NAFLD in postmenopausal females. We suggest that postmenopausal women with NAFLD may have a higher risk of osteoporosis than those without.

Impact of hot flashes and night sweats on carotid intima–media thickness and bone mineral density among postmenopausal women

Objective To determine whether postmenopausal women with vasomotor symptoms have a lower bone mineral density (BMD) and a higher carotid intima–media thickness (CIMT) than those without vasomotor symptoms. Methods Postmenopausal women with (n = 87) or without (n = 117) vasomotor symptoms who did not receive hormone therapy were included. The CIMT and BMD were determined and the relationship with vasomotor symptoms evaluated. Results The presence of both hot flashes and night sweats was associated with a CIMT of more than 0.80 mm after adjusting for age, time since menopause, and body mass index (adjusted odds ratio 3.2; 95% confidence interval [CI], 2.3–4.5; P < 0.001). The adjusted odds ratio for a CIMT higher than 0.80 mm in women with night sweats was 3.6 (95% CI 1.5–8.9; P = 0.006); the adjusted odds ratio in women with hot flashes was 23.1 (95% CI 9.1–58.4; P < 0.001). The mean CIMT was 0.65 ± 0.08 mm in the asymptomatic group and 0.81 ± 0.06 mm in the symptomatic group ( P < 0.001). The mean lumbar (L1, L2, and L3) and total hip BMD values were lower in the symptomatic group ( P < 0.05). Conclusion Hot flashes and night sweats in postmenopausal women are associated with a higher CIMT and a lower BMD.

Low back pain, somatic dysfunction, and segmental bone mineral density T-score variation in the lumbar spine.

Identifying objective measures that correlate with somatic dysfunction palpatory findings will aid in establishing clinical relevance of the findings and provide outcome measures for future studies. To investigate the association of altered segmental lumbar vertebral mechanics (ie, somatic dysfunction) as assessed by palpation with bone mineral density (BMD) T-score variability in participants, some with chronic low back pain (CLBP) and others without low back pain (LBP). Individuals with CLBP and individuals without LBP were examined by 2 blinded examiners for the presence or absence of paraspinal tissue texture abnormalities, vertebral rotational asymmetry, anterior motion restriction, and tenderness from L1 to L4. All participants then received a dual-energy x-ray absorptiometry scan of the lumbar spine. Bone mineral density T scores were compared between the CLBP and non-LBP groups. Sixty-three individuals (16 CLBP, 47 non-LBP) participated in the study. Lumbar segments with perceivable rotational asymmetry had higher mean BMD T scores (95% confidence interval [95% CI]) than lumbar segments with no asymmetry (0.5 [0.4-0.7] vs -0.2 [-0.6 to 0.2], respectively; P=.002). Additionally, lumbar segments with anterior motion restriction had higher mean BMD T scores (95% CI) than lumbar segments with no motion restriction (0.6 [0.4-0.7] vs 0.1 [-0.2 to 0.3], respectively; P=.03). Participants with CLBP demonstrated higher regional mean lumbar BMD T scores (95% CI) than those without CLBP (0.9 [0.6-1.1] vs 0.3 [0.2-0.5], respectively; P<.001). After accounting for sex and body mass index, vertebral segments with rotational asymmetry (in non-LBP participants only) and vertebral segments with motion restriction had higher mean BMD T scores than vertebral segments with no asymmetry or motion restriction. Participants with CLBP had significantly higher lumbar BMD than participants without LBP. The presence of rotational asymmetry or motion restriction was associated with elevated BMD at the affected vertebrae.

Measurement of Thoracic Bone Mineral Density with Quantitative CT

To create standard thoracic bone mineral density (BMD) values for patients undergoing cardiac computed tomography (CT) by using thoracic quantitative CT and to compare these BMDs (in a subpopulation) with those obtained by using lumbar spine quantitative CT. The institutional review board approved this HIPAA-compliant study. A total of 9585 asymptomatic subjects (mean age, 56 years; age range, 30-90 years) who underwent coronary artery calcium scanning, including 4131 women, were examined. Patients with vertebral deformities or fractures were excluded. Six hundred forty-four subjects (322 of whom were female) also underwent lumbar quantitative CT. The mean thoracic vertebral BMDs for both sexes were reported separately in a subgroup of subjects aged 30 years and in 29 age-based subgroups in 2-year intervals from ages 30 to 90 years. The formulas used to calculate the female T score (T(f)) and the male T score (T(m)) on the basis of thoracic quantitative CT measurements were as follows: T(f) = (BMD(im) - 222)/36, and T(m) = (BMD(im) - 215)/33, where BMD(im) is the individual mean BMD. Comparisons between thoracic quantitative CT and lumbar quantitative CT measurements, as well as analyses of intraobserver, interobserver, and interscan variability, were performed. The young-subgroup mean BMD was 221.9 mg/mL ± 36.2 (standard deviation) for the female subjects and 215.2 mg/mL ± 33.2 for the male subjects. The mean thoracic BMDs for the female and male subjects were found to be 20.7% higher and 17.0% higher, respectively, than the values measured with lumbar quantitative CT (P < .001 for both comparisons). A significant positive association between the thoracic and lumbar quantitative CT measurements (r > 0.85, P < .001) was found. Intraobserver, interobserver, and interscan variabilities in thoracic quantitative CT measurements were 2.5%, 2.6%, and 2.8%, respectively. There was a significant association between the mean thoracic and lumbar BMDs. Therefore, standard derived measurements (young-subgroup BMD ± standard deviation) based on these data can be used with thoracic CT images to estimate the bone mineral status.

Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial

Dienogest is a selective progestin that has been investigated in a clinical trial programme for the treatment of endometriosis. The current non-inferiority trial compared the efficacy and safety of dienogest against leuprolide acetate (LA) for treating the pain associated with endometriosis. Patients with confirmed endometriosis were randomized to treatment with dienogest (2 mg/day, orally) or LA (3.75 mg, depot i.m. injection, every 4 weeks) for 24 weeks. The primary efficacy variable was absolute change in pelvic pain from baseline to end of treatment, assessed by visual analogue scale (VAS). Safety variables included adverse event profile, laboratory parameters, bone mineral density (BMD), bone markers and bleeding patterns. A total of 252 women were randomized to treatment with dienogest (n = 124) or LA (n = 128); 87.9 and 93.8% of the respective groups completed the trial. Absolute reductions in VAS score from baseline to Week 24 were 47.5 mm with dienogest and 46.0 mm with LA, demonstrating the equivalence of dienogest relative to LA. Hypoestrogenic effects (e.g. hot flushes) were reported less frequently in the dienogest group. As expected, bleeding episodes were suppressed less with dienogest than with LA. Changes in mean lumbar BMD between screening and final visit were +0.25% with dienogest and -4.04% with LA subgroups (P = 0.0003). Markers of bone resorption increased with LA but not dienogest. Dienogest 2 mg/day orally demonstrated equivalent efficacy to depot LA at standard dose in relieving the pain associated with endometriosis, although offering advantages in safety and tolerability.

P03-110 - The evaluation of bone mineral density and osteoporosis in schizophrenic patients

Introduction and objectivesSchizophrenic patients are prone to osteopenia and osteoporosis due to various reasons. No research has ever been conducted on this field in Iran.AimsThe aim of this study was to determine the bone mineral density in schizophrenic patients.MethodsIn a cross- sectional and descriptive study with random sampling, we used (DEXA) to determine Bone Mineral Density (BMD) in the lumbar and neck femur region of 85 in- schizophrenics and they were compared with general population. Statistical analysis was done finally.ResultsSixty eight of patients were males. The average age of males and females was 39.61± 6.77 and 36.29± 7.58 years respectively. The mean femur neck BMD of male and female patients were 0.88± 0.16 and 0.87± 0.15 respectively (Pv = 0.76). Mean lumbar BMD of male and female patients was 0.94± 0.18 and 0.96± 0.14 respectively (Pv = 0.761). Liner significant correlation was not found between age and femur neck BMD (P= 0.782). Liner significant correlation was found between femur neck BMD and lumbar BMD (P&lt; 0.001). Frequency of osteopenia in patient with the age of 30-50 years was significantly higher than other patients (P= 0.011). Frequency of femur neck osteopenia and osteoporosis were 50.6% and 4.7% respectively and frequency of lumbar osteopenia and osteoporosis were 40% and 14.1% respectively.ConclusionsSchizophrenic patients had lower bone mineral density than general population.

Prevalence of Metabolic Bone Disease in Children With Celiac Disease Is Independent of Symptoms at Diagnosis

: Given dietary gluten exposure, growing children with celiac disease may experience malabsorption of nutrients, negatively affecting bone health. The purpose of this study was to determine the prevalence of low bone mass in children with celiac disease, according to the presence of symptoms at diagnosis. : A retrospective chart review of the Stollery Children's Hospital Celiac Clinic charts (April 1989-September 2007) was conducted. Bone mineral density (BMD) of the spine was measured using dual energy x-ray absorptiometry. Demographics, symptoms at presentation, and anthropometric and biochemical data relevant to bone health were recorded. : Seventy-four children (9.6 +/- 3.7 years; range 3.3-16.0 years) were included. Lumbar BMD z scores more than or equal to -1 were observed in 58 cases (65%), z scores below -1 but above -2 were observed in 14 cases (19%) and z scores less than or equal to -2 were observed in 12 cases (16%). There was no significant difference in mean lumbar BMD z scores between symptomatic and asymptomatic children (P = 0.34). When adjusted for bone age and bone surface area, BMD lumbar z score was inversely correlated with age at diagnosis (P < 0.05). : An equivalent reduction in spine bone mass was observed in children with celiac disease at diagnosis regardless of the presence of symptoms. Delayed diagnosis of children with celiac disease may increase the risk of adult osteoporosis. Appropriate screening of children at risk of celiac disease for the purpose of early diagnosis, as well as routine evaluation of bone mineral density in such children, are important to prevent long-term complications associated with poor bone health.