Bone Mineral Density Research Articles

Romosozumab versus denosumab in long-term users of glucocorticoids: A pilot randomized controlled trial.

To compare the efficacy of romosozumab (ROMO) and denosumab (DEN) in prevalent long-term glucocorticoid (GC) users. Adult patients receiving oral prednisolone (≥5mg/day) with high risk of fracture were randomized to receive subcutaneous ROMO (210mg monthly) or DEN (60mg 6-monthly) for 12 months, followed by DEN for two more doses. The primary end point was the change in spine bone mineral density (BMD) from Months 0 to 12. Secondary end points included changes in BMD of the spine/hip/femoral neck and bone turnover markers at various time points and adverse events. Seventy patients (age 62.6±9.1 years; 96% women; median prednisolone dose 5.0mg/day; duration of therapy 10.7±7.4 years) were enrolled, and 63 completed the study. At Month 12, the spine BMD increased significantly in both ROMO (+7.3%±4.5%; p<0.001) and DEN (+2.3%±3.1%; p<0.001) groups. The absolute spine BMD gain from Months 0 to 12 was significantly greater in ROMO-treated patients (p<0.001). Although the total hip BMD at Month 12 also increased significantly in the ROMO (+1.6%±3.3%; p=0.01) and DEN groups (+1.6%±2.6%; p=0.003), the absolute BMD gain was not significantly different between the groups. At Month 24, the spine BMD continued to increase in both the ROMO (+9.7%±4.8%; p<0.001) and DEN group (+3.0%±3.0%; p<0.001) compared to baseline, and the absolute BMD gain remained significantly greater in ROMO-treated patients. The total hip BMD continued to increase in both groups (ROMO +2.9%±3.7%; p<0.001; DEN +2.2%±3.4%; p=0.001), but the changes from baseline were similar. Injection site reaction was more frequently reported in ROMO-treated patients. ROMO was superior to DEN in raising the spine BMD at Month 12 in chronic GC users. After switching to DEN, ROMO-treated patients continued to gain spine BMD to a greater extent than DEN until Month 24.

Effects of recreational artistic gymnastics on bone mineral density and content of school-age girls

Aims :This study aimed to evaluate whether Artistic Gymnastics (AG) practice has beneficial effects on Bone Mineral Density (BMD) and Bone Mineral Content (BMC) of young gymnasts.Methods : All girls involved in AG training from the city of Pelotas, aged 6 to 12 years were recruited. Control group participants could not be involved in any extracurricular sports activity. Predictive equations based on anthropometric and physical tests were used to assess bone mass (BMD and BMC).Results : When compared to control group, AG group showed higher Femoral neck (0.672 ± 0.147 vs 0.561 ± 0.172) and Upper limbs (1.482 ± 0.159 vs 1.289 ± 0.178) BMD. In addition, Lumbar spine BMD was higher in AG group regardless of the predictive equation used. When compared with girls not involved in extracurricular activities, AG practitioners presented higher upper limbs, femoral neck and lumbar spine BMD.Conclusion : However, caution is required when using predictive equations to assess BMD and BMC.

The difference in bone mineral density between femur and tibia is related to tibia deformation in endstage knee osteoarthritis

BackgroundThis study investigated bone mineral density (BMD) around the knee joint to clarify the mechanism by which tibia deformation exceeds that of the femur in patients with end-stage knee osteoarthritis (KOA). MethodsWe retrospectively analyzed 193 patients who underwent total knee arthroplasty for end-stage KOA with varus alignment. Preoperative T-score of the femur neck and femur total using dual-energy X-ray absorptiometry (DXA) and hounsfield units (HU) of the distal femur and proximal tibia using computed tomography (CT) were measured to asess the BMD. HU was measured by dividing the femur and tibia into medial, lateral, and total parts, respectively. Patients with medial proximal tibial angle (MPTA) ≥ 85° were considered ‘group 1′, and MPTA < 85° were ‘group 2′. The HU between femur and tibia were compared in group 1. T-score, HU, and HU difference between group 1 and group 2 were compared. ResultsThe HU of the proximal tibia was lower than that of the distal femur (femur lateral > femur medial > tibia medial > tibia lateral). T-score (femur neck, femur total) and HU (femur lateral, femur total, tibia lateral) were lower in group 2 than in group 1. There was no difference in femur-tibia HU difference between groups. ConclusionThe medial tibia collapse more than the medial femur in varus endstage KOA was associated with the lower BMD of the proximal tibia than that of the distal femur, and the MPTA collapse was affected by the absolute value of BMD rather than by the femur-tibia BMD difference.

Effectiveness of assisted standing on bone mineral density in children with cerebral palsy. A systematic review.

Cerebral palsy is associated with complications such as low bone mineral density, which is more severe in patients with greater motor involvement. Assisted standing helps to prevent or delay this complication; however, its effect is controversial because the type of stander, the type of standing (dynamic or static), and its dosage are not clear. The objective of this study was to determine the effectiveness of assisted standing on bone mineral density in children with cerebral palsy. A systematic review was carried out in compliance with the PRISMA guidelines, using 5 databases. The results were presented using tables, a risk of bias analysis, and a narrative synthesis. Four studies met the inclusion criteria. Assisted standing generates positive changes in bone mineral density, but further research is required, with studies that have greater methodological rigor, longer follow-up periods, and a larger number of patients.

Hypoparathyroidism: Musculoskeletal Manifestations Related to Parathormone Deficiency.

Hypoparathyroidism is a rare metabolic disorder that can be responsible for musculoskeletal manifestations. We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE database, including manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism. Musculoskeletal manifestations included myopathy, shoulder disorder, immune-negative non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation, seen in patients with hypoparathyroidism, may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on calcium and active vitamin D supplementation. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand) expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density. However, the risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture. Our review showed that musculoskeletal manifestations are frequent in patients with hypoparathyroidism, including muscular, axial, peripheral articular, and entheseal manifestations.

Trabecular bone score norms in Asian-Indians and associations with serum 25(OH)D and parathyroid hormone.

There is limited information on population-specific norms of trabecular-bone-score (TBS) and its associated factors. Here, we provide norms of TBS in Asian-Indians and its relationship with serum 25-hydroxyvitamin D [25(OH)D] and intact-parathyroid hormone (iPTH). TBS, bone-mineral-density (BMD), and vertebral-fractures (VFs) were assessed using dual-energy X-ray absorptiometry in 923 healthy Asian-Indians (aged 20-60 years). Serum 25(OH)D, iPTH, T4/TSH,, glycosylated-haemoglobin (HbA1c) were measured and associations with TBS assessed using multivariable linear regression. Subjects with BMD Z-score ≤ -2.0 or ≥2.0 at any sites, VFs, TSH > 10.0 or <0.05 µIU/ml, blood-glucose >11.1 mmol/L or HbA1c > 8.0% were excluded for generating Asian-Indian norms. TBS norms were generated in 744 healthy Asian-Indians (M:F,389:385). The cut-offs generated for 'normal', 'partially-degraded', and 'degraded' TBS were >1.305, 1.204-1.305 and <1.204, respectively. Mean TBS was lower in females than males (p < .001). There was 75% congruency in TBS categories between Asian-Indian and existing norms. Specificity (97.8 vs. 77.9%, p < .001) and diagnostic-accuracy (97.8% vs. 78.4%, p < .001) of TBS to detect osteoporosis were higher with Asian-Indian norms. The sensitivity of 'partially-degraded' TBS to diagnose osteopenia was also higher with Asian-Indian norms. In multivariable regression, gender, body-mass-index (BMI), BMD-L1-L4, serum PTH, daily dietary-calorie intake and calcium intake were associated with TBS. Though 25(OH)D inversely correlated with PTH, 25(OH)D was not associated with TBS. This study provides norms for TBS in Asian-Indians with gender-specific differences. Increasing age and higher BMI were associated with lower TBS. Associations of TBS with circulating PTH and/or 25(OH)D need confirmation in further studies.

Image-based finite element model stiffness and vBMD by single and dual energy CT reconstruction kernel

Single-energy quantitative computed tomography (SEQCT) provides volumetric bone mineral density (vBMD) measures for bone analysis and input to image-based finite element models (FEMs). Dual-energy CT (DECT) improves vBMD by accounting for voxel-specific material variations utilizing scans at multiple x-ray energies. vBMD is also altered by reconstruction kernel that cannot be accounted for using calibration phantoms. This study compared vBMD and FEM stiffness derived from SEQCT and DECT images reconstructed with two common kernels. SEQCT and DECT images of cadaveric shoulders (n = 10) were collected using standard (STD) and boneplus (BONE) kernels. Hounsfield Units were converted to vBMD using specimen-specific calibrations. DECT STD and BONE images were generated using an established material decomposition method with 40 and 90 keV simulated monochromatic images. A proximal humerus bone section below the anatomic neck was used for vBMD analysis and FEM generation. FEMs were loaded to 1 % apparent strain for stiffness measurements.Between STD and BONE kernel images, average vBMD differed 0.9 mgK2HPO4/cc and 4.1 mg K2HPO4/cc, in SEQCT and DECT images, respectively. Significant differences occurred in DECT images (p = 0.001). BONE reconstructed images produced higher vBMD measures across both SEQCT and DECT images. The difference between STD and BONE in both SEQCT- and DECT-based FEMs persisted, with larger estimated stiffness in BONE models. For six of the models DECT-based had higher stiffness than SEQCT-based models using the same kernel, although these models differed between STD and BONE kernels. Differences in stiffness between STD and BONE derived models were similar across image types (DECT: 17.5 kN/mm; SEQCT: 19.0 kN/mm). Stiffness values were significantly different within SECT kernels and between SEQCT BONE and DECT STD models. This study shows important differences in vBMD and FEM stiffness that occur due to CT-based imaging parameters alone. These results indicate that consistent imaging parameters should be used for vBMD analysis and FEM input to avoid systematic measurement errors.

Effect of Weight Bearing Exercises on Pain, Leg Function, Balance and Bone Strength in Females of Postmenopausal Age with Osteoarthritis Knee

Background/Objectives: Osteoarthritis (OA) of the knee is prevalent among postmenopausal women (PMW), impacting their quality of life. This Randomized Controlled Trial (RCT) aimed to assess the effectiveness of conventional physiotherapy combined with joint-loading exercises on stable and unstable platforms in improving knee function, muscle strength, balance, and bone mineral density - an important strength of the study - in PMW with OA. Methods: Thirty PMWs with knee OA were randomly allocated to three groups (n=10): Group A got conventional physiotherapy, Group B got conventional physiotherapy plus joint-loading exercises on a stable platform, and Group C got conventional physiotherapy plus joint-loading exercises on an unstable platform. Key tools utilized in the study included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Manual Muscle Test (MMT), Timed Up and Go Test (TUGT), and Dual Energy X-ray absorptiometry (DEXA) for assessing pain, function, balance, and bone strength. The interventions lasted six weeks, with pre-and post-test assessments. Mention how the analysis was done Findings: All groups showed significant improvements in KOOS (G-A: 10.9%, G-B: 18.0%, G-C: 9.3%), MMT (G-A: 3.4 to 4.2, G-B: 3.4 to 4.6, G-C: 3.5 to 4.6), TUGT (G-A: 7.5%, G-B: 6.1%, G-C: 9.9%) and DEXA (G-A at -0.077 ± 0.4, G-B at 0.225 ± 0.5, and G-C at -0.246 ± 0.5) no significant differences were found between groups, though G- B showed the highest improvements. Novelty: While all interventions effectively improved knee function, muscle strength, and balance in PMW with OA, joint-loading exercises on a stable platform demonstrated the greatest benefits. Keywords: Osteoarthritis, Postmenopausal Women, Physiotherapy, Joint-loading exercises, Muscle Strength, Balance

Comparison of efficacy of romosozumab with denosumab and risedronate in patients newly initiating glucocorticoid therapy

Abstract Context Wnt/β-catenin signaling pathway is one of the pathogenic mechanisms of glucocorticoid-induced osteoporosis (GIOP). We previously reported the potential of inhibiting sclerostin as a treatment for GIOP. Objective To compare the efficacy of romosozumab (ROMO), a monoclonal antibody against sclerostin, with existing therapy for GIOP. Methods Patients with rheumatic diseases who had not previously received treatment for osteoporosis and were newly treated with prednisolone 15 mg/day or more were randomly assigned to receive ROMO, denosumab (DMAb), or bisphosphonates (BP). After the initiation of GC therapy, we measured the bone mineral density (BMD) of the lumbar spine, femoral neck, and total hip every 6 months and bone turnover markers every 3 months for 12 months. Results Eleven patients were assigned to the ROMO group, 14 to the DMAb group, and 14 to the BP group. The median [25th to 75th percentile] percent change in lumbar spine BMD from baseline at 12 months was the greatest in the ROMO group (ROMO; 8.6 [3.1–12.4] %, DMAb; 3.3 [1.5–6.2] %, BP; -0.4 [-3.4–1.1] %). Among bone formation markers, serum levels of bone alkaline phosphatase were slightly elevated in the ROMO group, while those of N-terminal propeptide of type I procollagen and osteocalcin decreased in all three groups; however, these changes were smaller in the ROMO group. Serum levels of bone resorption markers and a urine bone quality marker decreased in all groups. Conclusion Treatment with ROMO significantly increased lumbar spine BMD in GC-treated patients, suggesting that ROMO is effective for GIOP.

Increased risk of fracture among patients with iron overload: a population-based matched cohort study

Abstract Introduction Iron overloading disorders are associated with decreased bone mineral density. However, evidence on fracture risk is scarce. Therefore, we evaluated the risk of fracture associated with iron overload disorders, compared to matched controls. Methods Using THIN, a Cegedim database of UK general practice data, we identified patients &amp;gt;18 years with elevated iron (ferritin value &amp;gt;1000 µg/L) or an eligible diagnosis code for iron overloading disorders between 2010-2022. The first date of elevated iron or a diagnosis code defined the index date for iron overload patients, who were matched with to up to 10 controls. Time-varying confounder adjusted Cox proportional hazard models estimated the hazard ratios (HRs) and 95% confidence intervals. Analyses were stratified by osteoporotic fracture site (hip, vertebral, humerus, forearm), evidence of elevated serum ferritin at baseline (ferritin &amp;gt;1000 µg/L), and sex. Results We identified 20,264 eligible patients and 192,956 controls. Overall, there was a 55% increased risk of any fracture among iron overload patients (HR 1.55 [1.42-1.68]). Fracture risk was increased at all sites, with the highest risk observed for vertebral fractures (HR 1.97 [1.63-2.10]). Patients with ferritin &amp;gt;1000µg/L had a 91% increased risk of any fracture (HR 1.91 [1.73-2.16]) and a 2.5-fold increased risk of vertebral fractures (HR 2.51 [2.01-3.12]). There was no increased risk among patients without elevated serum ferritin at any site. Fracture risk was similar between sexes. Discussion This large population-based cohort study found a 55% increased risk of fracture associated with iron overload. The risk was highest among patients with laboratory confirmed iron overload, highlighting the importance for clinicians to consider initiating osteoporosis therapy in patients with serum ferritin &amp;gt;1000 µg/L to minimize fracture risk.

Does higher serum 25-hydroxyvitamin D levels will harm bone mineral density?: a cross-sectional study

Does higher serum 25-hydroxyvitamin D levels will harm bone mineral density?: a cross-sectional study

Exploring the impact of body mass index on the accuracy of vertebral bone quality in determining bone mineral density in patients undergoing lumbar fusion surgery

Exploring the impact of body mass index on the accuracy of vertebral bone quality in determining bone mineral density in patients undergoing lumbar fusion surgery

Subchondral Bone Degeneration and Pathology 3-15 Years Following Ankle Sprain Injury in Adolescent Sport.

Sport-related ankle sprains (SASs) are prevalent in adolescents (ages 10-19), increasing the risk of developing posttraumatic osteoarthritis (PTOA). Although early ankle osteoarthritis (OA) is not well defined, OA eventually includes alterations in bone mineral density (BMD), structural changes, and soft tissue pathology. This study examined the impact of SAS sustained in adolescent sport on bone and soft tissue structural outcomes 3-15 years postinjury. Participants (n = 10) with prior unilateral SAS in adolescent sport (HxAI) were compared to age- and sex-matched controls. To assess injury-related pathologies and BMD, 1.5-tesla (T) extremity magnetic resonance imaging (MRI) and computed tomography scans were used. Semiquantitative scores for injury patterns and OA features from MRI scans were summed and compared between groups. The talus, calcaneus, navicular, and 5% distal tibia were segmented, and BMD was measured for each bone. All HxAI participants exhibited MRI injury pathology (median 2; IQR 1-6), whereas only 1 of 10 controls showed pathology (median 0; IQR 0-0), χ2(1, n = 20) = 16.36, P < .001. Both the injured and uninjured ankles in HxAI displayed injury pattern pathology. Additionally, 3 of 10 injured ankles and 2 of 10 uninjured ankles in the HxAI group (median 0; IQR 0-3), but none of the controls (median 0; IQR 0-0), exhibited OA features. In the HxAI group, talus BMD was lower in the injured ankle (502.4 ± 67.9 g/cm3) compared with the uninjured ankle (515.6 ± 70.1 g/cm3) (F = 13.33, P = .002), with no significant BMD differences at the calcaneus, navicular, or 5% distal tibia. No differences were observed between the ankles of the control group. The presence of injury pattern pathology, structural changes, and reduced talus BMD suggest that degenerative changes may occur in individuals as early as 3-15 years following ankle injury.

A systematic review and meta-analysis of the effects of probiotics on bone outcomes in rodent models.

Emerging evidence demonstrates an opportunity for using probiotics to support bone health but findings in humans are limited. This systematic review investigated if probiotic supplementation improves bone mineral density and bone structure in rodent models compared to no supplementation. Studies (n = 71) examining the effect of oral consumption of any probiotic strain on bone mineral density or bone structure in rodents were included. Meta-analyses were conducted separately by study model (intact, ovariectomized) and bone site (femur, tibia, spine) to determine the probiotic effect (standardized mean difference, SMD) on volumetric bone mineral density (vBMD), bone volume fraction (BV/TV) and cortical thickness (Ct.Th). Reasons for heterogeneity were explored (probiotic genus, sex, type of rodent). In intact rodents, probiotics resulted in greater vBMD (SMD = 0.43, 95% CI [0.13, 0.74], I2 = 3%, P<.05) and higher BV/TV (SMD = 0.63, 95% CI [0.25, 1.02], I2 = 57%, P<.05) at the femur without changes in cortical bone structure. In ovariectomized models, probiotic supplementation resulted in greater vBMD (femur: SMD = 1.28, 95% CI [1.01, 1.55], I2 = 3%, P<.05; tibia: SMD = 1.29, 95% CI [0.52, 2.05], I2 = 67%, P<.05; and spine: SMD = 1.47, 95% CI [0.97, 1.97], I2 = 26%, P<.05) as well as higher BV/TV (femur: SMD = 1.16, 95% CI [0.80, 1.52], I2 = 56%, P<.05; tibia: SMD = 2.13; 95% CI [1.09, 3.17], I2 = 79%, P<.05; spine: SMD = 2.04, 95% CI [1.17, 2.90], I2 = 76%, P<.05) and Ct.Th at the tibia (SMD = 2.35; 95% CI [0.72, 3.97], I2 = 82%, P<.05) but not at the femur versus control. The syntheses support probiotics as a strategy to improve bone outcomes in rodent models.

Biomechanical effects of FNS on femoral neck fractures based on different reduction quality: finite element analysis.

The femoral neck system (FNS) has been extensively studied and applied for the treatment of young patients with femoral neck fractures. The purpose of this study was to explore the biomechanical impact variations in reduction qualities on femoral neck fractures, considering factors such as tip-apex distance, the positioning of the bolt in the cortical corridor of the femoral neck, and bone mineral density. A randomly selected volunteer was recruited, whose clinical data on the femur were collected to establish finite element models for positive reduction, anatomical reduction, and negative reduction respectively. Based on the constructed models, different scenarios were established by varying the tip-apex distance, bone mineral density, and positioning of the bolt in the cortical corridor of the femoral neck. Under a vertical load of 2100N, the displacement and Von Mises stress (VMS) distribution of each group of models were evaluated through simulation testing. Under a load of 2100N, the maximum VMS values of the femoral neck system and femoral head was recorded during negative reduction, 968.85MPa and 80.09MPa respectively. In addition, factors influencing the negative reduction of FNS and the femoral head were identified to be the tip-apex distance > 10mm, the presence of osteoporosis, and the bolt positioned in the lower-middle to the third part of the cortical corridor of the femoral neck. The displacement and stress of negative reduction were greater than those of positive reduction and anatomical reduction when the tip-apex distance > 10mm, and the bolt was situated in the lower-middle to the third part of the cortical corridor of the femoral neck, and in the presence of osteoporosis. This means that we recommend positive repositioning over negative repositioning when anatomical repositioning is not clinically feasible.

. Comparison of Denosumab versus Zoledronic acid on serum bone alkaline phosphatase (BAP), total procollagen type 1 amino-terminal propeptide (TP1NP), bone gamma carboxy-glutamic acid containing proteins (BGP), and β isomer of C-terminal telopeptide of ty

Background/aim: To compare the efficacy of Denosumab (DEN) versus Zoledronic acid (ZOL) in treating patients with osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP). Materials and methods:In this study, 128 OVCF patients who underwent PKP in our hospital from June 2020 to August 2023 were selected and randomized into a DEN group treated with DEN and a ZOL group treated with ZOL. Bone mineral density (BMD), bone metabolism, pain, and lumbar mobility were compared between the two groups before and after treatment, and the anterior vertebral height and local kyphotic angle were measured. Finally, the one-year re-fracture rate and treatment cost were counted. Results: The two groups showed no notable difference in pain, lumbar mobility, anterior vertebral height, and local kyphotic angle after treatment (P&gt;0.05). BMD was higher in DEN group at 6 and 12 months after treatment, while β isomer of C-terminal telopeptide of type I collagen (β-CTX) was lower (P&lt;0.05). No statistical inter-group difference was identified in the one-year re-fracture rate (P&gt;0.05), while the total treatment cost was lower in DEN group compared with ZOL group (P&lt;0.05). Conclusions: Both DEN and ZOL is effective in improving the prognosis of OVCF patients after PKP, but DEN can more significantly improve BMD and bone metabolism with higher economic benefits.

Fractures in the Transgender Population: A Retrospective Study

Introduction. While data on the bone health of transgender individuals exist, less is known about related fractures. The authors aimed to compare the anatomic locations of and impact of co-morbidities on fractures between transgender and cisgender populations at a single institution. Methods. The authors conducted a retrospective chart review of patients with fractures at a single institution between January 2020 and January 2021. Demographics, fracture locations, and comorbidities were identified and compared between cisgender and transgender individuals. Statistical analyses included χ2 or Fisher exact tests for proportions and independent t-tests or Wilcoxon rank-sum tests for continuous measures. Results. Transgender patients, compared to cisgender patients, were younger (W=258823, p&lt;0.001) and had a higher incidence of shoulder/upper arm fractures (10/26 [38%] vs 1,847/12,463 [15%], p=0.003) but no lumbar spine fractures. There were no other significant differences in fracture locations. The transgender group had a higher prevalence of depression (14/26 [54%] vs 2,696/12,463 [22%], p&lt;0.001), while hypertension was more common in the cisgender population (6,211/12,463 [50%] vs 5/26 [19%], p=0.003). While most fractures in the transgender group were not due to high-energy trauma, none of the individuals had a history of bone mineral density disorders. Conclusions. Our findings show that there were no significant differences in fracture locations between transgender and cisgender patients, except at one site. Larger studies, including longitudinal prospective studies, are needed to better understand bone health and fracture risk among transgender patients, particularly regarding changes over time with gender-affirming treatment.

Different contributions of fat and lean indices to bone strength by sex.

Bone strength depends on both bone density and quality. However, the differences in how body composition indices affect bone strength between men and women remains unclear. This study investigated the associations of various fat and lean indices with bone strength by sex. In this cross-sectional study involving 1,419 participants, bone mineral density (BMD) and body composition were measured using dual-energy X-ray absorptiometry. Bone quality was assessed using the trabecular bone score (TBS). Fat indices included total fat mass, body fat percentage, and waist circumference, while lean indices included appendicular lean mass (ALM) and hand grip strength. All fat indices demonstrated a positive association with BMD and a negative association with the TBS in both men and women. Fat indices were more strongly associated with BMD in women than in men. Furthermore, lean indices contributed more to BMD in men than in women. In women, ALM contributed more to BMD than hand grip strength, whereas in men, hand grip strength had a greater impact on BMD than ALM. Hand grip strength was also positively associated with the TBS in men. Overall, fat indices had a greater influence on BMD in women, while lean indices were more positively associated with bone strength in men. Considering different fat indices, ALM was more strongly associated with BMD in women, whereas hand grip strength played a greater role in men. Thus, maintaining both muscle mass and strength is crucial for preserving bone mass.

Low Bone Mineral Density Is Associated with High-Frequency Hearing Impairment in Women Over 50: An Observational Study in Korea.

Osteoporosis and hearing impairment are known to be associated, but specific data regarding gender, bone mineral density (BMD) measurement sites, and hearing frequency ranges remain unclear. This study aimed to clarify the relationship between hearing loss and BMD in adults over the age of 50. Additionally, the study sought to determine the frequency ranges of pure tone audiometry (PTA) related to osteoporosis, identify BMD measurement sites, and investigate gender differences. A total of 1,523 adults (651 men and 872 women) over the age of 50, who participated in a medical health check-up at a university hospital, were included. PTA was conducted to assess hearing, and BMD was measured using dual-energy X-ray absorptiometry at the lumbar vertebrae (LV) and femur. In women over the age of 50, a significant association was observed between hearing impairment and osteoporosis (P<0.01), but no such association was found in men. Lumbar BMD (L1-4) in women was significantly associated with hearing loss at 4,000 and 8,000 Hz (both P<0.05), whereas femoral neck and total femur BMD showed no significant relationship. In multiple logistic regression analysis, the odds ratio (OR) between osteoporosis and hearing threshold at 4,000 Hz (OR, 2.078; 95% confidence interval [CI], 1.092-3.954) and 8,000 Hz (OR, 2.648; 95% CI, 1.543-4.544) remained statistically significant in women after adjusting for age and other risk factors. In women over the age of 50, low BMD at the LV is significantly associated with hearing impairment, particularly at the high frequencies of 4,000 and 8,000 Hz.

The association between dietary flavonoid intake and bone mineral density and osteoporosis in US adults: data from NHANES 2007-2008, 2009-2010 and 2017-2018.

Epidemiological studies investigating the association between flavonoid intake and bone mineral density (BMD) draw inconsistent conclusions. Our study aims to investigate the association between flavonoid intake and BMD and osteoporosis and the mediating role of composite dietary antioxidant index (CDAI) in their relationship using data from the National Health and Nutrition Examination Survey (NHANES). The study assessed the relationship between flavonoid intake and femur BMD and osteoporosis in 10,225 individuals from NHANES 2007-2010 and 2017-2018. Multivariable linearregression analyses were used to detect the association between flavonoid intake and femur BMD in adult Americans. Restricted cubic splines (RCS) were used to examine the nonlinear relationship between flavonoid intake and their subclasses and osteoporosis risk in individuals 20years or older. We explored the mediating role of CDAI in the association between flavonoid intake and BMD. In fully adjusted multivariable regression analyses, compared with people in the first quartile, people in the fourth quartile of total flavonoid intake have a higher BMD at total femur (0.013, 95% CI: 0.004, 0.022, P = 0.001), femur neck (0.010, 95% CI: 0.004, 0.017, P = 0.001), trochanter (0.010, 95% CI: 0.004, 0.017, P = 0.001), and intertrochanter (0.012, 95% CI: 0.003, 0.020, P = 0.006). The positive relationship between flavonoid intake and femur BMD was present in both sexes. Furthermore, we found that people in the fourth quartile of total flavonoid intake have a lower risk of osteoporosis compared with the first quartile (OR = 0.686, 95% CI: 0.528-0.890, P = 0.005). RCS found a linear inverse relationship between total flavonoid intake and osteoporosis in individuals ≥ 20years (Overall P = 0.015, nonlinear P = 0.086). Moreover, CDAI partially mediates the association of total flavonoid intake with femur BMD. Our findings suggest that higher flavonoid intake is associated with higher BMD and lower risk of osteoporosis in Americans. Furthermore, we found distinct associations between different flavonoid subclasses and osteoporosis risk. More studies with stronger evidence are needed to explore the causal association between flavonoid intake and bone health and their underlying mechanisms.