Normal Bone Health Research Articles

Preoperative abaloparatide plus zoledronate treatment accelerates femoral bone healing in rats following osteotomy.

Purpose: We investigated the potential efficacy of abaloparatide (Abalo) and zoledronate (ZA) combination therapy for accelerating femoral union in a rat osteotomy model. Methods: Nine-week-old male Sprague-Dawley rats were randomly divided into four groups (n = 14 per group): control, abaloparatide (Abalo, 30μg/kg via subcutaneous injection [s.c.] 5 times per week for 6weeks), zoledronate (ZA; 0.1mg/kg via s.c., single dose), and Abalo + ZA. Rats were then subjected to unilateral osteotomy of the femoral shaft, followed by osteosynthesis with intramedullary nailing to establish bone healing models. At 2 and 4weeks after osteotomy, both femurs were removed from seven rats per group for soft X-ray imaging to evaluate bone union and microcomputed tomography (micro-CT) for bone morphometric evaluation. Blood samples were collected from all rats every 2week starting 6weeks pre- to 4weeks postosteotomy. Toluidine blue staining was used for histopathological evaluation of the undecalcified specimens. Results: Soft X-ray imaging revealed accelerated callus formation, callus maturation, and fracture line closure in Abalo and Abalo + ZA groups compared to ZA and control groups. Micro-CT demonstrated greater cortical bone and trabecular bone to total volume ratios in contralateral (left) femurs of the Abalo + ZA group compared to the Abalo group. Both trabecular and cortical bone mineral densities were also greater in contralateral femurs of the Abalo + ZA group compared to Abalo and ZA groups. Conclusion: These findings suggest substantial additive or synergistic efficacy of abaloparatide plus zoledronate combination therapy for accelerating bone healing following osteotomy and for maintaining normal bone health.

Correlation of Hounsfield Units with Bone Mineral Density and T-Score in Chinese Adults

PurposeThe purpose of this study was to examine the association between vertebral cancellous Hounsfield Units (HUs), age, Bone Mineral Density (BMD), and T-score in a sample of Chinese adults. MethodsThe study included a sample of 739 participants. Age, BMD, and T-score of each participant were recorded, and HUs were measured in the L1-L4 vertebrae. ResultsData analysis revealed that Hounsfield Unit of vertebral cancellous bone across the pedicle level (HU-PL) decreased with age, with females having higher values than males up to age 50 and vice versa thereafter. Furthermore, a positive correlation was found between HU-PL and BMD/T-score in the L1 to L4 vertebrae, but with a weaker correlation in the L4 vertebrae. Additionally, HU values for those with osteoporosis were significantly lower than those with osteopenia and normal bone health. ConclusionFrom the findings of this study, it can be concluded that HUs may be a potential predictor of bone health, with implications for pre-surgical assessment of the quality of bone-screw interfaces for spinal surgery.

Deficiency and excess in dietary vitamin K3 negatively affect gilthead seabream (Sparus aurata) larvae performance and bone health

Despite the importance of vitamin K to maintaining normal growth, survival, and bone health in fish, studies on the effect of different dietary levels of vitamin K on marine fish larvae are very scarce. In the present study, the effect of vitamin K on growth performance, incidence of bone anomalies, bone mineralization, and expression of bone biomarkers were investigated in gilthead seabream larvae by feeding microdiets with six different levels of vitamin K3 (1.32, 1.63, 4.98, 12.26, 22.90, and 58.51 mg kg−1) for 14 days. The highest total length and body weight were registered in larvae fed 4.98 mg kg−1 vitamin K3, whereas the further increase in dietary vitamin K3 up to 22.9 and 58.51 mg kg−1 reduced growth and survival. The highest incidence of anomalies in branchiostegal rays, glossohyal, or neurocranium bones was found in larvae fed the lowest vitamin K3 level (1.32 mg kg−1), whereas the increase in vitamin K3 reduced these anomalies following potential regressions with inflection points close to 5 mg kg−1 vitamin K3. However, larvae fed the highest vitamin K3 levels (22.9 and 58.51 mg kg−1) showed a high incidence of abdominal kyphosis, reduced mineralization, and unbalances in the expression of bone health-related genes. In conclusion, the present study suggested an optimum dietary level of 5 mg kg−1 of vitamin K3 to promote seabream larval growth and reduce the incidence of bone anomalies. On the contrary, the elevation of dietary vitamin K3 levels up to 22.9 and 58.51 mg kg−1 has a deleterious effect on larval performance and bone health.

Comparison of Cytokine Profile between Postmenopausal Women with and Without Osteoporosis - A Case-Control Study.

Chronic low-grade inflammation is involved in the pathogenesis of postmenopausal osteoporosis, but the cytokines implicated remain elusive. This study aimed to compare the difference in cytokine profile between postmenopausal women with and without osteoporosis in Klang Valley, Malaysia. Postmenopausal women with (n = 20) and without osteoporosis (n = 20) were recruited for this study. Their bone health status was determined using dual-energy X-ray absorptiometry. Their fasting blood was collected for proteomic analysis. A protein array was performed for four subjects randomly selected from each group to screen the potential cytokines. Three cytokines at least 20% different between groups and consistently expressed by each subject were selected for validation using enzyme-linked immunosorbent assays (ELISA). The protein array screening demonstrated that platelet-derived growth factor-BB, interleukin- 6 receptor (IL-6R), and tissue inhibitor of metallopeptidase-2 were higher in women with osteoporosis than women without osteoporosis (n = 4 per group), and consistently expressed by all women. Only body mass index (BMI)-adjusted logarithmically transformed IL-6R levels were lower among postmenopausal women with osteoporosis compared to women with normal bone health (p = 0.026) (n = 16 per group) in the ELISA test. IL-6R was lower among postmenopausal women with osteoporosis compared to women with normal bone health after adjusting for BMI. However, a large-scale epidemiological study with proteomic analysis needs to confirm the findings.

Opening-Wedge Distal Femoral Osteotomy With Concomitant Medial Meniscal Root Repair

Background: Valgus malalignment leads to excessive loading of the lateral compartment and has been associated with lateral compartment meniscal injuries and early-onset knee osteoarthritis. Distal femoral osteotomy (DFO) is a treatment option that allows correction of the mechanical access to offload the lateral compartment. Lateral opening-wedge distal femoral osteotomy and medial meniscal root repairs are both aimed to address the pathologic biomechanics of the tibiofemoral joint and when successful can delay or even prevent progression to end-stage osteoarthritic changes in the lateral and medial compartment, respectively. Indications: Distal femoral osteotomy is indicated for patients with normal metabolic bone health and valgus malalignment who may present with concurrent lateral meniscal injury, symptomatic lateral compartment arthritis, or a chronic medial collateral ligament tear/laxity. Technique Description: Long-leg alignment radiographs and preoperative magnetic resonance images are required to evaluate the degree of mechanical access deviation and to evaluate for soft tissue injury, as there is often concomitant lateral meniscal or cartilage pathology present. This technique demonstrates the optimal order of surgical steps for DFO with a concurrent medial meniscal root repair. The senior author’s preferred order is to first perform the open lateral approach and expose the lateral cortex for the placement of plate prior to arthroscopic work and excess fluid extravasation. Intra-articular work is then performed with a diagnostic arthroscopy followed by medial meniscal root repair. Finally, the osteotomy and subsequent internal fixation are performed. Results: The literature on opening-wedge DFO outcomes is heterogeneous, with variable rates of successful outcomes and complications. Saithna et al reported that International Knee Documentation Committee and the pain subdomain of Knee injury and Osteoarthritis Outcome Scores significantly improved postoperatively following lateral opening-wedge DFOs in patients with lateral compartment osteoarthritis. The 10-year success rate of varus-producing DFO has been reported to be 64% to 85%. Discussion: We describe a technique for correction of a valgus deformity with opening-wedge DFO and concurrent meniscal root repair. This surgical technique effectively restores the native femoral and tibial axis with appropriate load distribution and also concurrently restores the appropriate function of the medial meniscus which allows axial force dispersion via hoop stresses for the medial compartment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

The Role of Vitamin D and Vitamin D Binding Protein in Chronic Liver Diseases.

Vitamin D (calciferol) is a fat-soluble vitamin that has a significant role in phospho-calcium metabolism, maintaining normal calcium levels and bone health development. The most important compounds of vitamin D are cholecalciferol (vitamin D3, or VD3) and ergocalciferol (vitamin D2, or VD2). Besides its major role in maintaining an adequate level of calcium and phosphate concentrations, vitamin D is involved in cell growth and differentiation and immune function. Recently, the association between vitamin D deficiency and the progression of fibrosis in chronic liver disease (CLD) was confirmed, given the hepatic activation process and high prevalence of vitamin D deficiency in these diseases. There are reports of vitamin D deficiency in CLD regardless of the etiology (chronic viral hepatitis, alcoholic cirrhosis, non-alcoholic fatty liver disease, primary biliary cirrhosis, or autoimmune hepatitis). Vitamin D binding protein (VDBP) is synthesized by the liver and has the role of binding and transporting vitamin D and its metabolites to the target organs. VDBP also plays an important role in inflammatory response secondary to tissue damage, being involved in the degradation of actin. As intense research during the last decades revealed the possible role of vitamin D in liver diseases, a deeper understanding of the vitamin D, vitamin D receptors (VDRs), and VDBP involvement in liver inflammation and fibrogenesis could represent the basis for the development of new strategies for diagnosis, prognosis, and treatment of liver diseases. This narrative review presents an overview of the evidence of the role of vitamin D and VDBP in CLD, both at the experimental and clinical levels.

Serial Bone Density Changes in Women Undergoing Pelvic (Chemo) Radiation: Results From the PARCER Trial

Pelvic irradiation leads to substantial dose to the pelvic girdle. However, bone density loss as a function of radiation therapy dose and time has not been investigated. This study was undertaken to evaluate such a dose-response relationship. Women undergoing pelvic radiation therapy for cervix cancer within a phase 3 trial were included. The study necessitated 2 computed tomography imaging sets acquired at least 12 months apart in patients with no evidence of relapse. All images were transferred to the treatment planning system to determine radiation dose and Hounsfield unit (HU). Across the entire lumbopelvic region (lumbar 1-5 [L1-5] vertebrae, pubic symphysis, femur, acetabulum, greater trochanter, and anterior-superior iliac spine) multiple regions were defined to measure radiation therapy dose and HU. Bone health was categorized as normal if >130 HU, osteopenic at 110 to 130 HU, and osteoporotic <110 HU at baseline and follow-up. Univariate analysis was performed to test the effect of various factors on HU. Further interaction among radiation therapy dose, time, and HU was assessed using a linear mixed model. Overall, 132 of 300 patients were eligible. The median age was 49 (42-56) years. With a prescription dose of 50 Gy, the L1 and L2 vertebrae received a median dose of 1.2 and 4 Gy, respectively, and L3-5 received 10 to 50 Gy. At 24 months, median HU loss at L4-5 was 45 HU (interquartile range, 34-77 HU). Out of the 132 patients, at baseline 96% had normal bone health. However, at the last follow-up, 3% of patients had normal bone health, 12% developed osteopenia, and 85% developed osteoporosis (P < .001). There were no patient- or treatment-related factors predicted for HU loss on univariate analysis. HU loss >60 to 70 was observed at >45 Gy at L5 vertebra (60-70 HU, P < .02) and >15 Gy at L4 vertebra (33 HU; P=.04). Dose-response relationship is observed between radiation dose and bone mineral density loss. Prospective studies are needed to corroborate these observations and design future interventions.

Bone Mineral Density in an Urban Hospital in Dhaka City of Bangladesh

Background: Osteoporosis behaves as a silent killer. Therefore, a high percentage of the affected people are not aware they have this chronic condition. In this way, the burden of osteoporosis is the burden of its clinical outcome: osteoporotic fractures, which are generally characterized by low-trauma fractures resulting from low bone mineral density (BMD). Objectives: The present study aimed to assess BMD distribution among urban and rural subjects and its relationship with key foods.Material &amp; Methods:In this study, a total of 140 subjects were studied from the study BMD lab of the study hospital. Data were analyzed using Mean, SD, % and correlation by SPSS 24.Results:Mean±SD value of age (yr), BMI, WHR, Lumber-T score, Lumber-BMD, Right Femur -T score, Right Femur-BMD, Left Femur-T score, Left Femur-BMD, Supplementation of the study participants were 54±19, 25±5, 1.0±0.25, -1.0±1.0, 1.0±0.2, -1±1, 1±0.2, -1±1, 1±0.15.Age (yrs), BMI, waist (cm), hip (cm), WHR, Lumber T-score, Lumber Z-score, Lumber BMD (g/cm²), Rt. Fem Neck T-score,Rt. Fem Neck Z-score, Rt. Fem Neck BMD (g/cm²), Lt. Fem Neck T-score,Lt. Fem Neck Z-score, Lt. Fem Neck BMD (g/cm²) of the urban study participants were 51±13, 30±5, 88±16, 95±20, 1±20, -1.6±1.6, -1±1.6, 0.9±0.2, -0.9±1.3, -0.2±1.9, 0.9±0.2, -1±1.2, -0.3±1, 0.8±0.1 respectively and for rural participants the values were 54±14, 25±2.5, 86±9, 92±10, 1±0.2, -2.4±1.5, 0.8±0.2, -1.5±1.3, -0.6±1, 0.7±0.2, -1.6±1.2, -0.7±1 and 0.8±2 respectively. About 48.18% rural subjects had osteoporosis, 34.54% had osteopenia and 17.27% had normal bone health. Again, 28.57% of the urban subjects had osteoporosis, 41.40% had osteopenia and 30% had normal bone density. Fish, egg and meat were associated with BMD. Fish intake had a positive association with lumber T score (r=0.194, p=0.009), LumZ (r=0.016, p=0.031), Lumber BMD (r=0.183, p=0.014). Milk intake has positive association with Lumber t and Lumber BMD (p=0.027, 0.049). Similarly, egg intake has positive association with Lumber BMD, Rt BMD, Lt BMD (p= 0.035, 0.01, 0.019).Conclusions:Nearly 48.18% rural subjects have osteoporosis, 34.54% have osteopenia and 17.27% have normal bone health. Again, 28.57% urban subjects have osteoporosis, 41.40% have osteopenia and 30% have normal bone density. The prevalence of osteoporosis is higher in rural area than urban peopleand osteopenia is higher in urban area than rural area. Fish, milk and egg consumption positivelyassociated with BMD.

Normal bone health in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy.

To compare regional bone mineral densities (BMDs) and bone statuses of young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency with a control group. The duration and dose of glucocorticoid therapy and relative skeletal muscle index (an indicator of sarcopenia) were also analyzed as parameters to predict bone health. This case-control study included 23 patients (7 male and 16 female) and 20 controls (8 male and 12 female) matched by age range (18 to 31years). Dual energy X-ray absorptiometry and phalangeal quantitative ultrasound (QUS) were used to estimate BMD and bone status, respectively. No difference was observed between patients and controls (of both sexes) in absolute values of BMD and Z-scores for the total body, lumbar spine, and femoral neck; or the bone status (estimated by phalangeal QUS). Multiple linear regression analysis demonstrated that relative skeletal muscle index independently correlated with BMD of the entire body (β: 0.67, P = 0.007), the lumbar spine (β: 0.73, P = 0.005), and the femoral neck (β: 0.67, P = 0.007). However, the dose of glucocorticoids (β: - 0.38, P = 0.028) independently correlated with BMD in the femoral neck region alone. No signs of change in bone health were observed in patients with CAH when compared to the reference group. Additionally, a marker of sarcopenia was demonstrated to have a role in mineral density mechanisms in all analyzed bone sites. Only the femoral neck BMD seemed to be significantly dependent on glucocorticoid dose.

What is normal bone health? A bioarchaeological perspective on meaningful measures and interpretations of bone strength, loss, and aging.

Bioarchaeological (the study of archeological human remains together with contextual and documentary evidence) offers a unique vantage point to examine variation in skeletal morphology related to influences such as activity, disease, and nutrition. The human skeleton is composed of a dynamic tissue that is forged by biocultural factors over the entire life course, providing a record of individual, and community history. Various aspects of adult bone health, particularly bone maintenance and loss and the associated skeletal disease osteoporosis, have been examined in numerous past populations. The anthropological study of bone loss has traditionally focused on the signature of postmenopausal aging, costs of reproduction, and fragility in females. The a priori expectation of normative sex-related bone loss/fragility in bioanthropological studies illustrates the wider gender-ideological bias that continues in research design and data analysis in the field. Contextualized data on bone maintenance and aging in the archeological record show that patterns of bone loss do not constitute predictable consequences of aging or biological sex. Instead, the critical examination of bioarchaeological data highlights the complex and changing processes that craft the human body over the life course, and calls for us to question the ideal or "normal" range of bone quantity and quality in the human skeleton, and to critically reflect on what measures are actually biologically and/or socially meaningful.

English

BACKGROUND Menopause is defined as the permanent cessation of menstruation following loss of ovarian activity. One of the most important problems associated with menopause is osteoporosis. This study was conducted to evaluate the relationship between bone mineral density, body mass index, age, serum calcium, and serum magnesium in 120 women. METHODS Present study was an observational study done from Feb 2017 to July 2017 in Pt. J.N.M. Medical College to evaluate the relationship of bone mineral density with age, body mass index (BMI), obesity and serum magnesium in 120 postmenopausal women. A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designed for the study. Past fracture history, family history of fracture and osteoporosis, socioeconomic status, occupation, educational level and weightbearing exercises were collected and recorded. RESULTS Average age of women with normal bone health was 30.5 + 0.58 years, while the age of osteopenic and osteoporotic women was 43.11 + 6.79 years and 54.64 + 11.92 years respectively. Most of the osteopenic women belonged to the age group of 40 – 49 years. Osteoporotic patients (78.57 %) had a high (&gt; 0.85) waist-hip ratio, while women with normal bone mineral density had a normal waist-hip ratio. Most of the women with normal bone mineral density (100 %), osteopenia (85.29 %) and osteoporosis (57.14 %) had normal serum magnesium levels. CONCLUSIONS We found that the bone mineral density reduced with advancing age, decreasing BMI and obesity, while we found no correlation of serum magnesium level with bone mineral density (BMD). KEY WORDS Bone Mineral Density, Body Mass Index, Perimenopause, Magnesium, Calcium

MANAGEMENT OF ENDOCRINE DISEASE Subclinical hypothyroidism in children.

Subclinical hypothyroidism (SH) is biochemically defined as serum TSH levels above the upper limit of the reference range in the presence of normal free T4 (FT4) concentrations. While there is a general agreement to treat subjects with serum TSH levels above 10 mU/L, the management of mild form (TSH concentrations between 4.5 and 10 mU/L) is still a matter of debate. In children, mild SH is often a benign and remitting condition and the risk of progression to overt thyroid dysfunction depends on the underlying condition, being higher in the autoimmune forms. The major concern is to establish whether SH in children should always be considered an expression of mild thyroid dysfunction and may deserve treatment. Current data indicate that children with mild SH have normal linear growth, bone health and intellectual outcome. However, slight metabolic abnormalities and subtle deficits in specific cognitive domains have been reported in children with modest elevation of TSH concentration. Although these findings are not sufficient to recommend levothyroxine treatment for all children with mild SH, they indicate the need for regular monitoring to ensure early identification of children who may benefit from treatment. In the meanwhile, the decision to initiate therapy in children with mild SH should be based on individual factors.

Phosphorus nutrition in farmed Atlantic salmon (Salmo salar): Life stage and temperature effects on bone pathologies

Bone health is important for a viable and ethically sound Atlantic salmon aquaculture industry. Two important risk factors for vertebral deformities are dietary phosphorus and water temperature. Here, we explore the interplay between these two factors during a full production of Atlantic salmon. Salmon were fed one of three diets (low 4.4–5.0 g kg−1, medium 7.1–7.6 g kg−1, or high 9.0–9.7 g kg−1 soluble phosphorus) from 3 to 500 g body weight, followed by a common diet of 7.3 g kg−1 soluble phosphorus until harvest size at 4 kg. Additional groups were included to investigate the effects of water temperatures of 10 vs 16 °C (low and high diets only) and the switching of dietary phosphorus levels (from low to medium or high, from medium to low or high, from high to low or medium), starting at seawater transfer (~100 g body weight) and lasting for 4 months (~500 g body weight). During the experimental feeding period, the low phosphorus diet caused reduced bone mineralization and stiffness and a greater prevalence of vertebral deformities, compared to the medium and high phosphorus diets. However, the prevalence of severely deformed fish at harvest was reduced by switching from the low to either the medium or high phosphorus diets for 4 months after seawater transfer, followed by rearing on the standard commercial feed. Concurrently, switching from either the medium or high to a low phosphorus diet for the same period following seawater transfer had no effect on vertebral deformities at harvest. The higher water temperature for 4 months following seawater transfer increased the severity of deformities at harvest, irrespective of dietary phosphorus. Finally, low dietary phosphorus was associated with increased fillet damage, due to ectopic connective tissue around the spine, at harvest. In conclusion, dietary phosphorus levels of 5 g kg−1 for the initial 4 months in seawater are more of a risk factor for vertebral pathologies if preceded by low, but not medium or high, dietary phosphorus in freshwater. However, dietary phosphorus levels may not play a role in temperature induced radiologically detectable vertebral pathologies. Under the reported growing conditions and diet compositions, a combination of 7.5–7.6 g kg−1 soluble phosphorus during freshwater and 5.0 g kg−1 for the first 4 months in seawater, was sufficient for normal bone health and growth in Atlantic salmon.

Rationale to reduce calcium intake in adult patients with chronic kidney disease.

Calcium is an essential ion for the maintenance of normal bone health and physiologic functions. The extracellular and intracellular levels of calcium are maintained through hormonal regulation called homeostasis. Balance, the net intake minus excretion of calcium, is maintained by hormonal regulation of intestinal absorption and fecal/urinary excretion. Homeostasis and balance are disconnected in patients with chronic kidney disease (CKD). The purpose of this review is to understand how calcium homeostasis and balance are impaired in CKD. Two formal calcium balance studies have found that an oral intake of 800-1000 mg of calcium in adults with CKD leads to neutral calcium balance, whereas amounts greater than that lead to positive calcium balance. In patients with CKD, the main determinant of positive calcium balance is the intake and the lack of urinary calcium excretion. Calcium balance is different in patients with advanced CKD compared with patients without CKD. Thus, the oral intake of calcium in the form of diet and binders should not exceed 800-1000 mg/day to achieve neutral calcium balance in adult patients with CKD stages 3b/4.

Physical Fitness, Adiposity, and Diets as Surrogate Measures of Bone Health in Schoolchildren: A Biochemical and Cross-Sectional Survey Analysis

This study aimed to investigate the associations between adiposity, muscular fitness (MF), diet, sun exposure, and physical activity profiles as surrogate measures with bone health status in a sample of schoolchildren aged 8–18 yr old. A total of 250 Egyptian schoolchildren aged 8–18 yr were randomly invited to participate in these cross-sectional survey analyses. Calcaneal broadband ultrasound attenuation (c-BUA), bone mineral density (BMD), and bone formation markers (total calcium, serum bone alkaline phosphatase, and osteocalcin) were measured as markers of bone health. Adiposity profile, MF, physical activity (PA), sun exposure, Ca, and vitamin D dietary intake as related cofactors of bone health were measured by using prevalidated questionnaires and standard analytical techniques. A total of 85% (n = 213) of the study population showed normal bone health and 14.8% (n = 37) had abnormal bone health; most of them are girls (67.6%) classified according to BMD and c-BUA Z-scores into osteopenia (9.6%) and osteoporosis (5.2%). Compared with boys, higher correlations between c-BUA, bone mineral content, and BMD measures in the femoral neck, lumbar spine, whole body, and bone markers were reported in girls with lower bone mass. There was a positive significant correlation between body mass index, adiposity, sun exposure, MF, PA status, Ca and vitamin D intake, and c-BUA and BMD score analyses. These parameters were shown to be associated with about ~57.3%–88.4% of bone health characteristics of children and adolescents with osteopenia and osteoporosis. In children and adolescents, sun exposure, Ca and vitamin D diets, adiposity, PA, and changes in the levels of Ca, osteocalcin, and serum bone alkaline phosphatase were shown to be associated with bone health. Also, a significant correlation was reported between c-BUA score, dual-energy X-ray absorptiometry-BMD measures, and bone markers at clinically important bone sites of girls and boys. However, further clinical trials should be studied to consider c-BUA and bone markers as the benchmark estimates of bone mass for diagnostic purposes in young ages.

Chronic magnesium deficiency and human disease; time for reappraisal?

Numerous epidemiological, experimental and clinical studies over the last 30 years have consistently shown that chronic magnesium deficiency is associated with and/or exacerbates a number of major disorders (Table 1). Yet chronic magnesium deficiency is not widely recognized and a major reason for this failure is that serum magnesium levels do not accurately reflect body magnesium stores. Specifically, in chronic magnesium deficiency, serum magnesium levels are often within the normal reference range (usually lowest quartile) and may not progress to overt hypomagnesaemia. This raises serious questions namely (i) should chronic magnesium deficiency be considered in high-risk patients irrespective of serum magnesium, even when 'normal'? and (ii) if recognized, should oral magnesium supplement be given to restore body stores? Appreciating the vital role of magnesium for normal cellular function and bone health may help in formulating a well-considered and justifiable approach to these questions. Pragmatic tests for assessing magnesium status in the adult are suggested and discussed.

Morphological features osteointegration of porous tantalum implants in rats

Among the metallic materials, porous tantalum attracts grow­ing attention of orthopedics and traumatologists. The purpose of the study is to investigate osseointegration by using a porous tantalum implants in rats with normal bone health and osteopo­rosis simulated background. Methods: t he study was performed in 18 laboratory rats weighing 250 – 350 g. Osteoporosis modeled in 9 animals with the help of ovariectomy in 3 months prior to implantation. 3 mm diameter defect produced in the distal femoral metaphysis in normal rats (control) and with osteopo­rosis (experimental), porous tantalum pins implanted. After 14, 30 and 90 days postoperatively the material was examined by using a histology techniques. Re­sults: i t was found that the orientation of osteoreparation pro­cess was identical for both groups of animals, ie at all stages of monitoring, the formation of bone around the implant. However, in comparison with the control group osteoporosis animals had larger areas of direct contact with the tantalum implant intertrabecular spaces of the bone marrow and the formation of the parent bone connective tissue sections. In control and ex­perimental animals 90 days postoperatively bone tissue formed around the implant was presented collagen type I with a different refraction of collagen fibers. It is proved a good biologi­cal compatibility of porous tantalum implants with bone tissue and bone marrow, as well as higher quality of osseointegration. In animals with a normal structure of the bone implant 73.1 % of the perimeter was surrounded by mature bone tissue. In rats with osteoporosis this value was also quite high and amount­ed to 57.7 %. Conclusions: t he study has evidence indicating that tantalum implants can be used in orthopedics and trauma­tology in patients with normal bone health and osteoporosis.

Nutrición enteral en el paciente pediátrico con enfermedad de Crohn

The treatment of paediatric Crohn's disease (CD) requires careful attention to optimising normal growth and bone health in addition to achieving mucosal healing. Reducing exposure to systemic corticosteroids can be a highly important first step to influence these medium-to-long-term disease-specific and general health outcomes. An effective alternative to induction therapy with corticosteroids is exclusive enteral nutrition (EEN) which is recommended as first-line therapy in paediatric CD. In this review, we discuss the rationale behind EEN, its putative mechanisms of action and novel, promising modifications to EEN for the future dietary management of paediatric CD.

Association between Urinary Sodium Excretion and Bone Health in Male and Female Adults

Background: High salt intake is a well-known risk factor for osteoporosis, but the association between bone mass and urinary sodium excretion has not been studied as yet. This study investigates the hypothesis that urinary sodium excretion is negatively associated with bone mass and the risk of osteoporosis. Methods: This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey, 2008-2011. Participants (n = 16,279) were divided into age groups; men were categorized as younger than 50 years of age or 50 years or greater, women were categorized as pre- or post-menopausal. Results: Multivariate linear regression analysis showed that urinary sodium excretion was negatively associated with bone mineral content (BMC) and bone mineral density (BMD) in premenopausal and postmenopausal women. Sodium excretion was negatively associated with BMC and BMD of the lumbar spine in women with normal bone health, osteopenia and osteoporosis, but there was no association in men. Increased sodium excretion was significantly associated with risk for osteoporosis/osteopenia in premenopausal women. Conclusions: This study demonstrates that urinary sodium excretion is negatively associated with bone health, suggesting that high salt intake could be a possible risk factor for osteoporosis in Korean women, but not in men.

CBCT evaluation of buccal bone regeneration in postmenopausal women with and without osteopenia or osteoporosis undergoing dental implant therapy

Statement of problemBecause alveolar bone augmentation in women with osteoporosis/osteopenia has an uncertain prognosis, objective and reliable methods should be used to study standard surgical approaches. PurposeThe purpose of this clinical study was to evaluate bone regeneration 9 months after bone augmentation and implant placement in postmenopausal women with different levels of systemic bone health by using cone beam computed tomography (CBCT) and to test proof of concept for this measurement approach. Material and methodsA subset of 14 participants was analyzed in a best practice study of postmenopausal women receiving dental implants and simultaneous horizontal ridge augmentation. Women were categorized as osteopenic/osteoporotic or normal based on the results of preoperative dual-energy x-ray absorptiometry. All implant study sites received a particulate graft and/or buccal plate expansion. The study sites were evaluated with CBCT preoperatively, immediately postoperatively, and 9 months postoperatively. Nonparametric statistics were used for all analyses. The related samples Wilcoxon signed rank test was used to assess the differences in bone width between time points (α=.05 for all tests). ResultsAfter 9 months, 13 out of 14 participants showed increased bone width compared to the preoperative baseline measurements. The increase was statistically significant for the participants with osteoporosis/osteopenia (P=.007), but not for those with normal bone health (P=.066). The CBCT scans showed that mineralized tissue buccal to the implant surface had the radiographic appearance of mature bone. ConclusionsCBCT showed evidence of bone regeneration, with an increase in alveolar ridge width in postmenopausal osteopenic/osteoporotic women subsequent to surgical reconstruction.