Poor Bone Health Research Articles

Osteoporosis Knowledge and Its Risk Factors in Older Adults With Upper Extremity Fragility Fractures: A National Cross-Sectional Study.

It is crucial to recognize upper extremity fragility fractures as sentinel events that allow healthcare professionals the opportunity to identify and address underlying factors contributing to poor bone health, thereby reducing the risk of future fragility fractures. This study seeks to evaluate the extent of understanding and factors influencing osteoporosis in older adults with upper extremity fragility fractures, aiming to establish a foundation for enhancing their comprehension. A total of 1443 participants in 31 provinces were included in this study as survey subjects from September to November 2023. A general information questionnaire and an osteoporosis knowledge assessment tool were used for a cross-sectional survey. The univariate analysis and logistic regression were used to analyze the risk factors. The score of osteoporosis knowledge assessment tool of participants was 10.00 (7.00, 12.00), with only 24.95% scoring above 12 points. Being in an eastern hospital, suffering from chronic obstructive pulmonary disease, being diagnosed as severe osteoporosis, having bone mineral density testing, receiving osteoporosis health education, and receiving health education by phone were associated with higher knowledge of osteoporosis. The osteoporosis knowledge of older adults with upper extremity fragility fractures needs to be improved. To help the secondary prevention of osteoporosis, the standardized osteoporosis health education should be strengthened, and attention should be paid to key groups.

A Bone Health Optimization Framework for Malaysia: a position paper by the Malaysian Bone Health Optimization Network (MyBONe).

Osteoporosis and osteopenia are highly prevalent among older patients scheduled for elective arthroplasties and spinal surgeries. This position paper aims to establish, promote, and standardise effective Bone Health Optimization (BHO) strategies for such patients within orthopaedic practices in Malaysia. It emphasises the need for bone health assessments to be undertaken at the pre-operative, intra-operative, and post-operative stages, with tailored management strategies to meet individual patient needs. A comprehensive literature review was conducted, focusing on articles published from 2019 to 2024. Twelve broad themes were defined including definitions and importance of BHO, epidemiological data, assessment techniques, risk stratification, management strategies, and outcome metrics. Elective surgeries on patients with poor bone health are associated with adverse outcomes, such as periprosthetic fractures, aseptic loosening of implants, and complications after spinal surgeries. This position paper advocates for routine bone health assessments and monitoring during the pre-operative, intra-operative, and post-operative phases. It provides summaries of imaging modalities, risk assessment tools, and techniques for each phase. By adapting the successful "5IQ" approach from secondary fracture prevention, we propose 5IQ-based Clinical Standards for BHO, including 18 Key Performance Indicators. A Malaysian BHO Registry is proposed to benchmark care in real-time and support a national quality improvement programme. Practical resources, such as a BHO algorithm and key practice points, are included. This position paper proposes a paradigm shift in the management of bone health for patients undergoing elective orthopaedic surgery in Malaysia, aiming to improve surgical outcomes and patient care through standardised BHO strategies.

Strategies to build stronger bones in Indian children: Challenges for implementation.

Background & objectives Globally, vitamin D deficiency has been incriminated in poor bone health and growth retardation in children, impaired adult musculoskeletal health (classically described), increased risk of cardiovascular events, immune dysfunction, neurologic disorders, insulin resistance and its multiple sequelae, polycystic ovary syndrome (PCOS) and certain cancers. This review intends to holistically highlight the burden of vitamin D deficiency among children in India, the public health importance, and potential therapeutic and preventive options, utilizing the concept of implementation research. Methods A systematic search was carried out on PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Cochrane database, clinicaltrials.gov, Google Scholar, and ctri.nic.in with the keywords or MeSH terms namely 'vitamin D', 'cholecalciferol', 'ergocalciferol', 'children', connected with appropriate boolean operators. Results Vitamin D deficiency/insufficiency prevalence varies from 70-90 per cent in Indian children. Rickets, stunting, impaired bone mineral health, and dental health are common problems in these children. Serum 25-hydroxy vitamin D (25(OH)D) should be maintained >20 ng/ml in children. Oral vitamin D supplementation has a high therapeutic window (1200-10,000 IU/d well tolerated). Fortification of grains, cereal, milk, bread, fruit juice, yogurt, and cheese with vitamin D has been tried in different countries across the globe. From Indian perspective, fortification of food items which is virtually used by everyone would be ideal like fortified milk or cooking oil. Fortification of "laddus" made from "Bengal gram" with vitamin D as a part of a mid-day meal programme for children can be an option. Interpretation & conclusions There is enough evidence from India to suggest the importance and utility of food fortification with vitamin D to address the epidemic of vitamin D deficiency/insufficiency in children.

Ethnic differences in vitamin D status, bone and body composition in South Asian indian and caucasian men

BackgroundHigh prevalence of metabolic abnormalities and poor bone health in ethnic minorties may stem from differences in body composition and alterations in endocrine milieu. South Asian Indians (SAIs) are at greater risk for metabolic syndrome (MetS) and poor bone health than Caucasians. Often these differences are reported later in life and/or in a resident immigrant population compared to a Caucasian population. In this study, we determined whether vitamin D status, bone, body composition differed in young SAIs and Caucasians. Notably we compared differences amongst recent SAI immigrants and Caucasians. MethodsWe examined differences in bone density, body composition, serum 25-hydroxy vitamin D (s25(OH)D), parathyroid hormone (sPTH), vitamin D binding protein (sDBP), osteocalcin (sOC), and dietary intakes in young healthy SAI and Caucasian men. ResultsSixty men (N = 30 SAIs and N = 30 Caucasians) with a mean age of 27.8 ± 7.4 years completed the study. Compared to the Caucasians, SAIs had statistically significantly lower s25(OH)D and higher sPTH (p < 0.05). We also found that s25(OH)D was negatively associated with sPTH only among the SAIs (r = - 0.389, p = 0.037). Also, lean mass% (LM%) and fat-free mass% (FFM%) were lower in SAIs (p < 0.05) compared to caucasians. s25(OH)D correlated with nearly all body composition parameters, while sPTH correlated negatively with LM% and FFM%, and positively with FM% (all p < 0.05) in the Caucasian group. Bone mineral density at most sites were also significantly lower (p < 0.05) in the SAI's compared to caucasians. ConclusionYoung SAIs have a poor vitamin D status and less favorable bone and body composition parameters compared to Caucasians. These findings highlight the possible complex interplay between skeletal and metabolic health in different ethnicities which may be evident early on in life. Interventions to improve bone and metabolic health should therefore target younger ethnic minorities.

Serum level of sclerostin and vitamin D in children with epilepsy

BackgroundEpileptic children can pose an additional risk of poor bone health; this study aimed to evaluate the influence of anti-seizure medications (ASMs) on vitamin D level and sclerostin as a bone turnover biomarker in children with epilepsy.Subject and methodsThis case–control comparative study was conducted on 180 children aged from 5–18 years diagnosed with epilepsy according to the definition of the International League Against Epilepsy on ASMs for more than 3 months and were classified into 90 epileptic children on ASM monotherapy and 90 epileptic children on ASM polytherapy, in addition to 90 healthy children age- and sex-matched who served as controls. After obtaining basic data, laboratory investigations were performed, including serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, vitamin D, and serum sclerostin.ResultsWhen we compared epileptic patients to the control group, there was a statistically significant low level of vitamin D, calcium, and phosphorus and a high level of sclerostin among both epileptic groups with mono or polytherapy. Sclerostin has a statistically significant negative correlation with vitamin D, alkaline phosphatase and parathyroid hormone. Additionally, it has a negative correlation with serum phosphorus, but without a significant correlation. On the other hand, sclerostin has a statistically positive correlation with age and serum calcium, but without a significant correlation. Multiple linear regression analyses were conducted to predict the contributing factors of sclerostin. Only duration of treatment and BMI were significant predictors of high levels of sclerostin. In contrast, the other factors failed to show any significant contribution.ConclusionThe present study showed that ASMs modulate the serum levels of sclerostin and vitamin D hence, might be involved in their adverse effects on bone.

A Comparative Study of Bone-Health and Associated Factors in Healthy Indian Adolescents and Young Women.

Adolescence is a critical period for the accrual of bone mass. However, few studies have assessed the bone geometry in slum-dwelling girls/young women. We thus conducted this study: (1) to assess bone health in Indian adolescent girls and young women residing in slum vs nonslum (NS) areas and (2) to identify factors associated with poor bone health. This cross-sectional case-control study was performed on 110 apparently healthy unmarried, nonpregnant, nonlactating, postmenarchal adolescent girls and young women aged 11 to 24 years residing in urban slums with the same number of age-matched controls from NS areas. Anthropometric, dietary, physical-activity and bone-health parameters (using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography-DXA and pQCT-respectively) were evaluated using standard protocols. A P value of < 0.05 was considered statistically significant. Slum girls were significantly shorter and lighter and had lower dietary intakes of calcium and protein after adjusting for total daily calorie intake than NS girls (P < 0.05). Areal bone-mineral density (BMD) at lumber spine (0.940 ± 0.13 vs1.042 ± 0.15 g/cm2), femur and total body (less-head), bone-mineral apparent density adjusted for volume at the lumbar spine (0.295 ± 0.04 vs 0.319 ± 0.04 g/cm3) and height-adjusted bone density at femur (0.862 ± 0.011 vs 0.905 ± 0.011 g/cm2) were significantly lower in slum dwelling participants as compared to their NS counterparts (P < 0.05). After adjusting for confounders like sunlight exposure, anthropometric parameters and dietary calcium intake, area of dwelling was still a significant factor for the difference in BMD. The potential determinants of poor bone density and geometry in girls and young women residing in slums include residential location, dietary habits, and physical activity levels. Despite adjustments for confounding factors, differences in bone health between those in slum and nonslum areas suggest adaptations developed over generations of deprivation in these individuals, necessitating urgent intervention.

Changes in bone turnover markers 6–12 months after bariatric surgery

A rise in bone turnover markers (BTM) after bariatric surgery predicts poor bone health years later. This study explored factors associated with BTM and changes in BTM after bariatric surgery. Inclusion criteria were subjects 18 to 65 years of age with morbid obesity undergoing bariatric surgery. All data were measured before and 6 and 12 months after surgery. The study included 104 subjects: women/men: 83/21; mean age 43.1 (SD 8.4) years; BMI: 38.8 kg/m2 (SD 3.8). Surgery with Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) was performed in 84 (81%) and 20 (19%) subjects, respectively. From before to 6–12 months after surgery, procollagen type 1 N-terminal propeptid (P1NP) increased by 45.6 µg/L (95% CI 41.5–50.0, p < 0.001), and alkaline phosphatase (ALP) by 10 U/L (95% CI 7–14, p < 0.001). The increases were significantly larger after RYGB than after SG. The APOE- Ɛ3 allele was associated with low levels of BTM and high levels of leptin. There was an unfavourable increase in BTM after bariatric surgery. SG compared to RYGB and the presence of the APOE-Ɛ3 allele were associated with less unfavourable effects. The study emphasises the importance of optimal prophylactic interventions after bariatric surgery to prevent osteoporosis.

Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants

SummaryThe effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health.PurposeSocioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40–69 years at recruitment during 2006–2010.MethodWe examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant’s residential postcode.ResultsAt baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42–1.49), 1.26 times (95% CI 1.22–1.30), 1.31 times (95% CI 1.26–1.36) and 1.16 times (95% CI 1.13–1.19) higher for the most deprived compared with the least deprived quantile.ConclusionSocioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.

Osteoporosis screening in Australian community pharmacies: A mixed methods study.

Osteoporosis and poor bone health impact a large proportion of the Australian population, but is drastically underdiagnosed and undertreated. Community pharmacies are a strategic location for osteoporosis screening services due to their accessibility and the demographic profile of customers. The aim of this study was to develop, implement and evaluate a community pharmacy health promotion service centred on encouraging consumers to complete an anonymous osteoporosis screening survey called Know Your Bones. The implementation process was documented using the REAIM (reach, effectiveness, adoption, implementation, maintenance) framework. Uptake of the Know Your Bones screening tool was monitored anonymously with website traffic. Surveys and interviews were designed to capture consumer outcomes after screening. Semi-structured interviews were conducted with Australian community pharmacy stakeholders during design and implementation phases to explore their perspectives of the barriers and facilitators. The service was implemented in 27 community pharmacies. There were 448 visits to the screening website. Interviews were conducted with 41 stakeholders. There were a range of factors that appeared to influence implementation of the service. Perceived acceptability was critical, which depended on staff training, pharmacists' altruism, and remuneration. Staff relied heavily on their existing close relationships with consumers. No consumers completed non-anonymous surveys or agreed to participate in interviews post-screening. Using an implementation science approach, a community pharmacy osteoporosis screening service for the Australian context was designed and found to be acceptable to pharmacy staff and effective in reaching the target population. SO WHAT?: This low-cost and non-invasive health promotion has potential to sustainably increase national screening rates for osteoporosis.

Factors Associated With High-Risk and Low-Risk Bone Stress Injury in Female Runners: Implications for Risk Factor Stratification and Management.

Bone stress injury (BSI) is a common overuse injury in active women. BSIs can be classified as high-risk (pelvis, sacrum, and femoral neck) or low-risk (tibia, fibula, and metatarsals). Risk factors for BSI include low energy availability, menstrual dysfunction, and poor bone health. Higher vertical load rates during running have been observed in women with a history of BSI. The purpose of this study was to characterize factors associated with BSI in a population of premenopausal women, comparing those with a history of high-risk or low-risk BSI with those with no history of BSI. It was hypothesized that women with a history of high-risk BSI would be more likely to exhibit lower bone mineral density (BMD) and related factors and less favorable bone microarchitecture compared with women with a history of low-risk BSI. In contrast, women with a history of low-risk BSI would have higher load rates. Cross-sectional study; Level of evidence, 3. Enrolled were 15 women with a history of high-risk BSI, 15 with a history of low-risk BSI, and 15 with no history of BSI. BMD for the whole body, hip, and spine was standardized using z scores on dual-energy x-ray absorptiometry. High-resolution peripheral quantitative computed tomography was used to quantify bone microarchitecture at the radius and distal tibia. Participants completed surveys characterizing factors that influence bone health-including sleep, menstrual history, and eating behaviors-utilizing the Eating Disorder Examination Questionnaire (EDE-Q). Each participant completed a biomechanical assessment using an instrumented treadmill to measure load rates before and after a run to exertion. Women with a history of high-risk BSI had lower spine z scores than those with low-risk BSI (-1.04 ± 0.76 vs -0.01 ± 1.15; P < .05). Women with a history of high-risk BSI, compared with low-risk BSI and no BSI, had the highest EDE-Q subscores for Shape Concern (1.46 ± 1.28 vs 0.76 ± 0.78 and 0.43 ± 0.43) and Eating Concern (0.55 ± 0.75 vs 0.16 ± 0.38 and 0.11 ± 0.21), as well as the greatest difference between minimum and maximum weight at current height (11.3 ± 5.4 vs 7.7 ± 2.9 and 7.6 ± 3.3 kg) (P < .05 for all). Women with a history of high-risk BSI were more likely than those with no history of BSI to sleep <7 hours on average per night during the week (80% vs 33.3%; P < .05). The mean and instantaneous vertical load rates were not different between groups. Women with a history of high-risk BSI were more likely to exhibit risk factors for poor bone health, including lower BMD, while load rates did not distinguish women with a history of BSI.

The Current State of Knowledge on Osteoporosis in Holocaust Survivors and Their Descendants.

Starvation in early life can cause poor bone health and metabolic aberrations in bone minerals, leading to abnormal bone development. Holocaust survivors have been exposed to starvation and malnutrition before and during World War II. This paper aims to provide the current state of knowledge on the osteoporosis risk in Holocaust survivors and their descendants. The PubMed and Scopus databases were searched. Papers that reported original data on the risk of osteoporosis in Holocaust survivors and in their offspring were included in the study. Ten studies were included in this review. The majority of studies were case-control ones (n=7) versus two self-reported and one longitudinal study. Despite the limited cohort numbers and the small number of studies in the literature, the data showed a potential increased risk of osteoporosis in Holocaust survivors and especially in their descendants. The review of these studies showed a higher prevalence of osteoporosis among Holocaust survivors and their offspring. Knowledge of the trans-generational inheritance of osteoporosis in the descendants of Holocaust survivors should increase the awareness of primary care health workers on osteoporosis screening and early diagnosis and implementation of preventive measures, including adequate vitamin D and calcium supplementation, and pharmacological treatment.

Cervical spine injuries in elderly patients: Special considerations

High-income countries, including the United States, are confronting an evolving epidemiology of spinal trauma. This rise in geriatric spine trauma is marked by a growing occurrence of cervical spine trauma and incomplete spinal cord injuries. These trends are linked to the age-related prevalence of cervical spondylosis and higher fall risks. Cervical spine injuries in elderly patients require nuanced, patient-centered decision-making. This population is enriched for frailty, high comorbid burden, and poor bone health. This review discusses prevalent injury patterns in this group, evaluates surgical and non-surgical treatment options, and explores unique challenges in managing spine trauma among elderly patients.

Family/caregiver influence on osteoporosis management for older people: an integrative review.

An integrative literature review was conducted to understand family/caregiver influence on osteoporosis management for older people. Findings include caregivers' overprotection, caregivers' risks for fragility fractures due to caregiving role, poor bone health in caregivers, and caregivers' burden and facilitators. Caregivers should be included in bone health and discharge planning. Literature on family/caregiver influence on osteoporosis management for older people is sparse. Older people are prone to osteoporosis and fragility fractures due to their age, often triggering the need for a caregiver after experiencing a fragility fracture. These fractures pose significant costs to the patient and health systems and are projected to increase with the aging population. This study applied an integrative literature review methodology to key literature findings on family/caregiver influence on osteoporosis management for older people. Key findings include caregivers' tendency to overprotect persons who experience hip fracture by limiting mobilization, thus impeding recovery, caregivers' risks for their own fragility fractures due to the demands of their caregiving role, risks of poor bone health in caregivers, and caregivers' experience of significant burden for which facilitators have been identified. Family caregivers of older people with osteoporosis have unique needs and require support and resources, especially after their loved one experiences a hip fracture. Informal caregivers must be considered in bone health education and discharge planning. They should be considered in the creation of osteoporosis guidelines and within the work of fracture liaison services. More research is needed to increase understanding about family caregiver influence on osteoporosis management.

Effective counseling for children's bone health

Poor bone health is a significant contributing factor to the frequency and severity of many childhood injuries and fractures. Osteoporosis starts in childhood. Therefore, it is important to optimize bone health in children in order to decrease the risk of injury, improve healing and maximize peak bone mass. To do this, pediatricians and pediatric orthopedists need to effectively counsel patients and families to give them the tools necessary to effect lasting change. Bone health is a recipe that requires ingredients including calcium, vitamin D, vitamin C, vitamin K and physical exercise. Required amounts of each component change as children grow and are lifelong requirements. Unfortunately, at this time, there is no uniform consensus on vitamin D supplementation guidelines or optimal serum levels. Current vitamin D dosing guidelines are age-based, but vitamin D is stored in adipose tissue and higher weights/BMIs require higher doses of vitamin D. Routine monitoring of vitamin D is recommended in all patients. However, re-evaluating the dosing guidelines to base them on weight/BMI, rather than age, should be considered. Key Concepts(1)Bone health needs to be prioritized so that peak bone mass is reached by age 30.(2)Patient counseling and patient buy-in are imperative to create lasting impact.(3)Bone health is a recipe and amounts of ingredients needed will vary according to growth and body size.(4)Vitamin D dosing should take weight and body mass into consideration to achieve optimal serum levels.

Importance of bone health in bone lengthening

Distraction osteogenesis describes the process of growing new bone (“regenerate”) to correct limb length discrepancies or limb deformities. Whether pure lengthening or a combination of lengthening and straightening is involved, this represents one of the highest anabolic demands on bone in orthopedic surgery. Because distraction osteogenesis requires the formation of new bone, often in large amounts, it is critically important to evaluate the bone health of any potential surgical patient. Patients undergoing limb lengthening, therefore, would be expected to be especially sensitive to poor bone health. This article will review opportunities to assess and potentially improve bone health for limb lengthening patients. Key Concepts-Many potential limb lengthening patients may be Vitamin D deficient or insufficient.-Other simple nutraceuticals such as Boron, Magnesium, Calcium, Silicon, Vitamin K, L-arginine, and Inositol should be considered as adjuncts to bone health.- Intra-operative technique such as minimally invasive incisions that protect the blood supply and periosteum combined with osteotomies that maximize the bone surface area are recommended.- Numerous proposed pharmacological and mechanical interventions to improve and accelerate the healing of the regenerate bone look promising but are still investigational.

Evaluation of the potential implications of following a vegan diet on bone health

Cow’s milk is the primary source of calcium in the NZ diet(1). The absence of dietary planning in a vegan diet can result in the individual unknowingly obtaining low intakes of calcium. Prolonged low calcium intakes can result in negative implications on bone mineral density by increasing the risk of osteoporosis later in life. The measurement of bone health parameters in NZ vegan adults have not been investigated. Therefore, we measured bone mineral density, markers of calcium homeostasis and assessed intake of essential nutrients for optimal bone health in vegans. This cross-sectional study included adults (&gt;18yrs), who followed a vegan diet for 2 years minimum. Demographic and lifestyle information was obtained from questionnaires including previous history of bone fractures and background of familial osteoporosis. A 4-day food record was completed for analysis of calcium, zinc, protein, magnesium, phosphorus and vitamin C intake and compared to the Estimated Average Requirement (EAR)(2). Weight, height and BMI were obtained, bone mineral density was measured at the hip and spine via dual x-ray absorptiometry (DXA) and reported as Z and T scores. Plasma calcium concentrations were corrected for albumin. All values are presented as mean and standard deviation. The study included 212 participants, aged 39 ± 12.38 years, 71% female. T scores at the lumbar spine and femoral neck were −0.63 ± 1.22 (Z score: −0.29 ± 1.12) and −0.66 ± 1.00 (Z score: −0.24 ± 0.89), respectively. Nine participants had a Z-score of &lt;-2.0 at the lumbar spine, and three at the femoral neck. Corrected calcium concentrations were 2.21 ± 0.33 mmol/L. Calcium intake was 917 ± 347.23 (range 195 to 2,429 mg/day) in all participants, which exceeded the EAR of 840 mg/day for adults aged 19-50 years. Men had higher intakes of calcium than women, 1,051 ± 363.7 mg/day (range 382 to 2,267 mg/day) vs. 867 ± 328.04 mg/day (range 194 to 2,428 mg/day), P-value &lt;0.001. The main source of calcium in the vegan diet was tofu. The intake of protein (77 ± 27.80) g/day, magnesium (569 ± 181.05) mg/day, and vitamin C (145 ± 96.94) mg/day met the EAR, excluding vitamin and mineral supplements. However, the intake of phosphorus (1,472 ± 459.98) mg/day and zinc (10.6 ± 4.01) mg/day were below the EAR. The findings of this study suggest that bone health of vegans are not negatively affected by the exclusion of dairy in the diet, provided that appropriate dietary planning is included to avoid nutrient deficiencies associated with poor bone health. Despite mean intake of calcium exceeding the EAR, very low intakes demonstrated significant variations between participants.

Assessment of Vitamin D status of patients with human immunodeficiency virus

ABSTRACT Background: Vitamin D regulates calcium and phosphorus homeostasis. Vitamin D deficiency (VDD) commonly occurs in people living with human immunodeficiency virus (HIV) (PLWHIV) and is linked to bone disorders and metabolic and infectious diseases. HIV seropositivity and VDD may worsen the consequences on the individual. Methods: A cross-sectional analytical study was conducted using 90 serum samples from 42 HIV-positive and 48 HIV-negative patients attending the Nnamdi Azikiwe University Teaching Hospital (NAUTH). This study was approved by the NAUTH Ethics Committee. Serum Vitamin D levels were analyzed using enzyme-linked immunosorbent assay. Sociodemographic data were obtained using a questionnaire. Data analysis was performed using IBM SPSS Windows version 27, and P &lt; 0.05 was considered statistically significant. Results: Overall, 13.3% of the population had suboptimal Vitamin D levels, with 2.2% having VDD and 11.1% having Vitamin D insufficiency. VDD was found in 2.2% and 2.1% of the HIV-positive group and HIV-negative groups, respectively. No significant difference was observed in mean serum Vitamin D levels between the two groups (P &gt; 0.05). Within the HIV-positive group, education, place of living, and skin coloration were associated with suboptimal Vitamin D levels, and only skin coloration was associated with HIV-negative subjects. Conclusion: VDD is relatively low in the region; however, it may contribute to poor bone health in PLWHIV. Interventions should target individuals with poor educational attainment, living in rural domains, or dark skin coloration. Studies with large sample size are needed to determine the effects of Vitamin D supplementation or exposure to sunlight on HIV infection.

Actigraphic sleep patterns are associated with bone turnover and bone mineral density among university students.

Poorer sleep is associated with poorer bone health among older adults but the role of sleep in bone health during younger adulthood is understudied. In this observational study, the averages and variability in total sleep time (TST), sleep efficiency (SE), and sleep midpoint of university students were examined in relation to levels of bone turnover markers (BTMs) and bone mineral density (BMD) at the lumbar spine and femur. A sample of healthy, university students (N = 59, aged 18-25 years, 51.8% female, body mass index <30 kg/m2 ), wore a wrist actigraph for 7 days, completed a dual-energy X-ray absorptiometry scan, and underwent blood sampling to assess serum BTM concentrations of osteocalcin (OC) and N-terminal telopeptide of type 1 collagen. A sub-sample (n = 14) completed a one-year follow-up. Multiple regression models examined the associations between each sleep metric and bone health outcome at baseline and 1-year follow-up. At baseline, greater variability in sleep midpoint was cross-sectionally associated with greater OC (β = 0.21, p = 0.042). In the exploratory, follow-up sub-sample, lower average TST (β = -0.66, p = 0.013) and SE (β = -0.68, p = 0.01) at baseline were associated with greater increases in OC at follow-up. Greater delays in mean sleep midpoint over follow-up were significantly associated with decreases in lumbar spine BMD (β = -0.49, p = 0.03). In a sample of young adults, variable sleep schedules were associated with greater bone turnover suggesting the potential importance of regular sleep for optimising bone health into early adulthood.

Association of Anatomical Location of Neuroarthropathic (Charcot's) Destruction with Age-and Sex-Matched Bone Mineral Density Reduction.

It is well documented that diabetes has a systemic impact on bone mineral density. Recent literature has evaluated the relationship between the development of Charcot neuroarthropathy and reduced local bone mineral density; however, it is not clear if there is an association between osteoporosis/osteopenia and Charcot onset, or, even further, location of neuroarthropathic breakdown. We retrospectively identified and assessed 39 patients with 41 feet (4 bilateral) with a history of Charcot breakdown who underwent a bone mineral density scan over a 15-year period. Demographic, radiographic, and bone mineral density information was analyzed. The average patient age at the time of bone mineral density scan was 53.44 ± 8.09 years, and 52.77 ± 8.19 years at the time of Charcot diagnosis. Four feet were considered Sanders-Frykberg I (9.3%), 17 were Sanders-Frykberg II (39.5%), ten were Sanders-Frykberg III (23.3%), and 12 were Sanders-Frkyberg IV/V (27.9%). Neuroarthropathic breakdown of the rearfoot region (Sanders-Frykberg IV/V) was found to be associated and preceded by osteoporosis and osteopenia at the hip as demonstrated by a lower Z-score (P = 0.05). Charcot neuroarthropathy was not associated with poor bone health or loss of bone mineral density at the femoral neck, forearm, or lumbar spine. We believe that the present findings suggest a possible relationship between osteoporosis/osteopenia and the location of CN development. With these findings in mind, we conclude that patients with diabetic skeletal fragility may benefit from treatment of underlying poor bone mineral density to prevent the onset of Charcot neuroarthropathy.

Transition is associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer in pediatric-onset inflammatory bowel disease patients: results of a longitudinal, follow-up, controlled study.

Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer.