Prevalence Of Low Bone Mineral Density Research Articles

Bone mineral density in adults growth hormone deficiency with different ages of onset: a real-world retrospective study.

Bone mineral density (BMD) impairment is one of the critical factors for long-term quality of life in adults growth hormone deficiency (AGHD). This study aims to investigate the annual changes in BMD in AGHD patients with different ages of onset and to identify predicting factors that influence BMD. AGHD patients (n = 160) with available data for 4 years follow-up from a major tertiary medical center in China were retrospectively included (110 [68.8%] childhood-onset, 119 [74.4%] male). BMD of the axial bone (including total hip, neck of femur, and L1-4) derived from dual X-ray absorptiometry and final height were investigated at the first visit, 12 months, 24 months, 36 months, and 48 months thereafter. Low BMD was defined as Z-score ≤ -2. The prevalence of low BMD was 30.0% at baseline and 12.5% at 4 years of follow-up. The CO AGHD group presented a significantly lower BMD than the AO AGHD group at the baseline (P = 0.009). In contrast, the CO AGHD group had significantly greater median annual BMD change than the AO AGHD group (0.044 vs. -0.0003 g/cm2/year in L1-4, P < 0.001), indicating a significant difference in the overall BMD trend between CO and AO groups. Childhood-onset (odds ratio [OR] 0.326, P = 0.012), low serum testosterone (OR 0.847; P = 0.004) and FT4 (OR 0.595; P = 0.039) level were independent risk factors for BMD loss. The annual changes of BMD show a different pattern in AGHD patients with varying ages of onset. Patients with CO AGHD have a lower bone mass, and in general, appropriate replacement therapy is necessary for long-term bone health in AGHD patients.

Association of Insulin-like Growth Factor-1 with Bone Mineral Density in Survivors of Childhood Acute Leukemia.

In this study, we investigated bone mineral deficits in children who survived childhood acute leukemia and explored the association between the insulin-like growth factor-1 (IGF-1) level and bone mineral density (BMD). This retrospective analysis enrolled 214 patients treated for acute leukemia, measuring various factors including height, weight, body mass index (BMI), and lumbar spine BMD after the end of treatment. The study found an overall prevalence of low BMD in 15% of participants. Notably, IGF-1 levels were significantly different between patients with low BMD and those with normal BMD, and correlation analyses revealed associations of the IGF-1 level and BMI with lumbar spine BMD. Regression analyses further supported this relationship, suggesting that higher IGF-1 levels were associated with a decreased risk of low BMD. The study findings suggest that IGF-1 may serve as a valuable tool for evaluating and predicting osteoporosis in survivors of childhood acute leukemia.

Associations of blood trace elements with bone mineral density: a population-based study in US adults

BackgroundThis study aimed to investigate the association between blood trace elements and bone mineral density (BMD) and to determine the association between blood trace elements and the risk of low BMD/osteoporosis among US adults.MethodsWe performed a cross-sectional study using data from National Health and Nutrition Examination Survey (NHANES, 2011–2016). Multivariable linear regression models were employed to assess the associations of BMD in lumbar spine (LS-BMD), pelvic (PV-BMD) and total femur (TF-BMD) with blood trace elements, including Fe, Zn, Cu, Se, Mn, Cd, Pb, Hg. Additionally, the associations of low BMD/osteoporosis with blood trace elements were also evaluated using multivariable logistic regression.ResultsHigher blood Pb levels were found associated with decreased LS-BMD (p for trend < 0.001), PV-BMD (p for trend = 0.007), and TF-BMD (p for trend = 0.003) in female, while higher blood Se levels were associated with increased PV-BMD in female (p for trend = 0.042); no linear association between BMD and other blood trace element was observed. Also, significant associations were found between Pb levels and the prevalence of low BMD (p for trend = 0.030) and the prevalence of osteoporosis (p for trend = 0.036), while association between other blood trace elements and low BMD/osteoporosis was not observed.ConclusionThis study provides comprehensive insight into the association between blood trace elements and BMD and supports a detrimental effect of blood Pb levels on bone mass in women. Considering our analysis from a representative US general population, further study is warranted for the extreme levels of blood trace elements on bone metabolism.

Exploring the Bone Mineral Density of Health Professionals of Medical College by Using Calcaneal Quantitative Ultrasound

Background: Osteoporosis, an important cause of fracture in Bangladesh is a highly unrecognized and unaddressed issue among health professionals. Osteoporosis means low bone mineral density (BMD) and screening is not done routinely to diagnose it. Moreover, the prevalence of low BMD among Health professionals in the country is not well known. To prevent osteoporosis-induced fracture it demands more attention to early detection, prevention, and treatment. Objectives: The present study was carried out to assess the bone mineral status of health professionals of Cox’s Bazar medical college and also to find out the correlation with age, sex, Vitamin D, calcium supplementation, and physical activity by using quantitative ultrasound (QUS) of the calcaneus. Materials and Method: This is a descriptive, cross-sectional study that has been done at Cox’s Bazar Medical College. Result: The total number of participants was 267 which were screened by using a calcaneal ultrasound heel bone densitometer. Among them 190 were female and 77 were male. The majority of the health professionals 237(88.76%) were below 45 years. Mostly, 194(72.66%) participants had normal BMD, 73(27.34%) participants were in osteopenia and none of them were osteoporotic. Among those above 45 years old study people, nearly half 14(46.67%) were osteopenic, and for ages below 45 years of health professionals, only 59(24.89%) were osteopenic. Out of 77 male participants, 15(19.48%) were osteopenic and out of 190 female participants, 58(30.53%) were osteopenic. Out of the total 267 study people, 81(30.34%) agreed to take calcium and vitamin-D supplementation with significant p-value = 0.003 whereas 32(39.51%) participants were in the osteopenic stage and 49(60.49%) had healthy bony status. The number of using Calcium and vitamin-D supplementation was high, which may be due to positive answers from particular participants like the elderly and health care supporting staff. In our study 120(44.94%) participants did exercise but mostly irregularly, and 147(55.06%) did not do exercise. Out of 120(44.94%) participants doing regular exercise 37(30.83%) were osteopenic and the rest of 83 (69.17%) health professionals were in normal BMD. Conclusion: Among the health care professionals, osteopenia is not uncommon and regular exercise practice and rational Calcium and vitamin-D supplementation may be preventive for osteoporosis. J MEDICINE 2023; 24(2): 131-134

Evaluation of Bone Mineral Density in Juvenile Systemic Lupus Erythematosus.

The present study aimed to determine the prevalence of low bone mineral density (BMD) and low bone mineral content (BMC) as chronic complications of juvenile systemic lupus erythematosus (JSLE) and identify the associated variables and patient characteristics to investigate the relationship between BMD and influential factors. This cross-sectional study enrolled 54 patients with JSLE, including 38 females and 16 males. The BMD and BMC were assessed by dual-energy X-ray absorptiometry in the hip (femoral neck) and the lumbar spine. Low BMD was considered a Z-score < -2. The study investigated the association of BMC and Z-score with the current daily dose of corticosteroids, the daily dose of corticosteroids at disease onset, the duration of disease, the duration of steroid treatment, the time from the onset of symptoms to diagnosis, and renal involvement. The prevalence of low BMD in the lumbar spine and the femoral neck was 14.8% and 18.5%, respectively; the reduction of BMD was more significant in the femoral neck compared to the lumbar spine. Osteoporosis was detected in one patient. The multiple linear regression analysis found a significant association between a higher daily corticosteroid dose and lower BMC of the femoral neck and the lumbar spine. In addition, patients receiving higher doses of corticosteroids at disease onset showed better follow-up bone mineral densitometry results. Based on the findings of this study, JSLE more affects the femoral neck than the lumbar spine. Patients receiving a more robust treatment with higher doses of corticosteroids at disease onset (to control the inflammatory processes) showed better spinal BMC results. A higher dose of daily corticosteroid treatment during assessment was identified as a risk factor for low BMD.

Prevalence of low bone mineral density at axial sites and fracture risk in Bulgarian population.

Osteoporosis is a common chronic disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of the bone, which are associated with increased risk of fragility fractures. Currently the most popular tool is the fracture risk assessment model FRAX to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF). To investigate the prevalence of low BMD at axial sites and fracture risk in Bulgarian population. We retrospectively analyzed dual energy X-ray absorptiometry (DXA) scan results of 12 478 subjects. Scan results included BMD and T-score assessments of lumbar spine and femoral neck. FRAX major osteoprotic fracture (MOF) and FRAX hip fracture (HF) were assessed in subjects between 40 and 90 years using BMD values. Of total 12478 subjects, 12119 were women and 359 were men. The mean age of the subjects was 61 years (yrs.) ± 10 yrs. The overall prevalence of low BMD at the lumbar spine was 6084/9336 subjects (65.2%). 3502/9336 subjects (37.5%) were considered as osteopenic and 2582/9336 subjects (27.7%) were considered as osteoporotic. The overall prevalence of low BMD at the femoral neck was 2036/3140 (64.8%). 1641/3140 subjects (52.3%) were classified as osteopenic and 395/3 140 subjects (12.6%) were classified as osteoporotic. The mean values of FRAX MOF and FRAX HF increased significantly with increasing the age interval. This study is the largest epidemiological research in Bulgaria up to date about the prevalence of low BMD at axial sites.

Global, Regional, and National Burden of Low Bone Mineral Density From 1990 to 2019: Results From the Global Burden of Disease Study 2019.

ObjectiveWe aim to explore the global spatial prevalence and temporal trends of the burden of low bone mineral density (LBMD) worldwide, due to a lack of related studies.DesignCross-sectional study.MethodsWe used data from the Global Burden of Disease Study 2019 to conduct this study. LBMD in the GBD study includes both osteopenia and osteoporosis. The estimation for the prevalence, measured by the summary exposure value (SEV), and burden of LBMD was made in DisMod-MR 2.1, a Bayesian meta-regression tool. Correlation analysis was performed using the Spearman rank order correlation methods. The temporal trends were represented by the estimated annual percentage change (EAPC).ResultsIn 2019, there were 438 thousand deaths and 16.6 million DALYs attributable to LBMD, increasing by 111.1% and 93.8% respectively, compared to that in 1990. From 1990 to 2019, the prevalence of LBMD has decreased worldwide, but has increased in high-income North America. Some countries, such as the United States, Australia, Canada, and China had increased disability and mortality rates of LBMD with time. Countries with low socio-demographic index (SDI) had higher incidence and mortality rate than those with high SDI. The prevalence of LBMD was lower in males, but the attributable disability and mortality were higher in males in all years from 1990 to 2019.ConclusionWith population aging, countries worldwide, especially those with low-SDI, will face increasing challenges in reducing the burden attributable to LBMD and osteoporosis. The treatment of osteoporosis has been overlooked in men for a long time. Effective measures are warranted to control the prevalence and burden of LBMD.

Evaluation of bone mineral density in children with type 1 diabetes: A cross-sectional case–control study

Objectives: To compare the bone mineral density (BMD) and vitamin D levels of children with type 1 diabetes (T1D) with normal children. Material and Methods: Children with T1D, aged 4–18 years, and age- and gender-matched healthy controls, were recruited. Children with chronic systemic disorders and those taking medications that impair BMD were excluded from the study. Dual-energy X-ray absorptiometry, vitamin D, intact parathyroid hormone, calcium, phosphorus, alkaline phosphatase, osteocalcin, and spot urine deoxypyridinoline crosslinks (Pyrilinks-D)/ creatinine ratio were estimated in both cases and controls. Results: Thirty-seven children with T1D with a mean age of 9.7 ± 2.1 years were enrolled and compared with controls. The bone mineral content (BMC) in cases was 24.5 g (20.3–30.6) and in controls 25.5 g (23.5–26.8) (P = 0.66) and BMD in cases was 0.68 ± 0.165 g/cm2 and in controls 0.69 ± 0.149 g/cm2 (P = 0.76). However, the prevalence of low BMD (BMD &lt;-2 Z-score) was seen in only 3 (8%) cases (P – &lt;0.001). Serum 25-hydroxyvitamin D [25(OH)D] levels were also lower in cases 14.1 ng/mL (12.05–14.75 ng/mL) as compared to controls 15.73 ng/mL (13.1–23.2 ng/mL) (P = 0.01). Thirty-three (89%) cases and 24 (64%) controls had low 25(OH)D levels (&lt;20 ng/mL). There was no significant difference in the bone turnover markers between cases and controls. Conclusion: Children with T1D have similar BMD and lower vitamin D levels compared to healthy children.

Evaluation of bone mineral density (BMD) and the effect of type of factor replacement therapy on BMD in children with hemophilia: A single-center observational study

BackgroundThe higher life expectancy in patients with hemophilia (PWH) due to better care has increased the incidence of age-related complications such as osteoporosis. This study was conducted to assess the bone mineral density (BMD) and its correlation with determinants of hemophilic arthropathy and to evaluate the effect of type of factor replacement therapy on BMD in Indian hemophilic children. MethodsThis study was conducted on 39 hemophilic children and 40 healthy controls. Total range-of-motion (ROM) score was calculated for major affected joints and BMD was measured by dual-energy x-ray absorptiometry at baseline and repeated at follow-up after 6 months period during which all patients received either prophylaxis or on-demand therapy. ResultsBMD and BMD Z-scores were significantly reduced in hemophiliacs as compared to controls (p < 0.05). The prevalence of low BMD in hemophiliacs ranged from 30.8 to 41% at various sites. A significant correlation was found between BMD Z-score and episodes of joint bleed, number of target joints, and total joint ROM score (p < 0.05). BMD Z-score showed a significant difference between the prophylaxis group and on-demand therapy group at baseline, and a significant increase in BMD Z-score was observed among patients in prophylaxis group at follow-up after 6 months compared to baseline (p < 0.05) but not among patients in on-demand therapy group. ConclusionsHemophilic children showed reduced BMD that correlated with hemophilic arthropathy. Prophylaxis, as compared to on-demand therapy, markedly decreased hemarthrosis and consequent immobilization, and thereby retarded the progression of bone mineral loss and improved BMD in these patients.

829. Incidence of Low BMD and Barriers to Routine Screening for Osteoporosis in HIV Patients in Eastern North Carolina

BackgroundWith HIV therapy, the life expectancy of persons with HIV (PWH) has improved and complications associated with long-standing HIV and antiretroviral drugs have become more apparent. Low bone mineral density (BMD) (defined by T score < -1) and osteoporosis (defined by T-score < -2.5) are common in PWH. In a meta-analysis of 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis which is 3 times greater than HIV uninfected controls. IDSA guidelines recommend routine screening for osteoporosis in PWH aged ≥ 50 years, yet the rate of screening for osteoporosis in these patients remains low (7.4%-17%). This QI project aimed to estimate the frequency of and identify the barriers to screening for osteoporosis in eligible HIV patients.MethodsThis prospective observational study was conducted in the HIV clinic at East Carolina University from 2018-2019. A sample of 104 HIV patients, ≥ 50 years were selected randomly. Data regarding referral for DXA (dual X-ray absorptiometry) scan, its results, and their insurance provider was collected. The plan was to analyze the barriers associated with guideline-recommended BMD screening and implement it in eligible patients.ResultsFrom a total of 104, 89 patients (85.6%) were referred for a DXA scan. The reasons for lack of referral were obesity, insurance barrier, wheelchair-bound, and test ordered by another provider. Of the 89 patients referred for DXA, only 49 (47% of total) underwent the scan. In terms of barriers, insurance limitation was the most common reason. Out of the patients that had DXA scans, 19 (39%) were found to have low bone density and 1 had osteoporosis. Low BMD was more common in men (63%) as compared to women (37%) in this group.Percentage of patients who underwent a DXA scan and the barriers in those who didn’t Frequency of BMD screeningIncidence of Low BMD BMD resultsConclusionIn our study, 47% of patients had a BMD assessment. This is better than what has been reported in other single-center studies, however, it is not ideal. About 34% of the patients had insurance coverage as the major barrier for routine screening, as has been mentioned in other similar studies. Of the patients who underwent the DXA scan, 41 % had a low BMD. Other studies have reported variable prevalence of abnormal BMD, from 47-93%. Interestingly, the prevalence of low BMD in our cohort was close to the national average in non-HIV patients.Disclosures All Authors: No reported disclosures

Bone mineral density and osteoporosis risk in young adults with atopic dermatitis

Atopic dermatitis (AD) has been increasing worldwide over the past few decades. AD has been reported to be associated with an increased risk of osteoporosis and fractures in adult AD patients. The aim of this study was to investigate the bone mineral density (BMD) to evaluate osteoporosis risk in young adults with AD by sex. This was a case–control cohort study using a national dataset from the Korea National Health and Nutrition Examination Survey 2007–2009. We included young adult AD patients (men aged 19 ≤ and < 50 years, premenopausal women aged 19 ≤ and < 50 years) and 1:5 propensity score weighting controls by age, sex, body mass index (BMI), vitamin D level, and alcohol/smoking status. BMD was measured by double energy X-ray absorptiometry at the lumbar spine, femur neck, and total femur. The prevalence of low BMD, defined by a Z-score ≤ − 2.0, was compared between AD and without AD. We analyzed 311 (weighted n = 817,014) AD patients and 8,972 (weighted n = 20,880,643) controls. BMD at the lumbar spine was significantly lower in the male AD group than in the male control group (mean ± SE, 0.954 ± 0.016 vs. 0.989 ± 0.002, P = 0.03). The prevalence of low BMD (Z-score) did not significantly differ between AD and non-AD subjects in both men (3.8% vs. 2.7%, P = 0.56) and women (6.4% vs. 3.3%, P = 0.40). Among AD patients, early age at diagnosis of AD, longer duration of AD, lower BMI, rural residence (for men), less education, low vitamin D level, late menarche, and more pregnancies (for women) were associated with low BMD. In conclusion, low BMD did not occur more frequently in young adults with AD than in non-AD controls. However, early-onset/longer AD duration and lower BMI were associated with low BMD among young adult patients with AD.

Prevalence of Triad-RED-S symptoms in high-level Kenyan male and female distance runners and corresponding control groups.

This study examined and compared select Triad-RED-S components/risk factors in high-level Kenyan male and female distance runners to corresponding control groups; focusing on examining energy intake (EI), bone indices, and hormonal markers. A cross-sectional, observational design was used in which Kenyan male and female (n = 30 and n = 26, respectively) middle- and long-distance runners and corresponding male and female control groups (n = 29 and n = 29, respectively) were examined. The participant's bone mineral density (BMD) at the lumbar spine, right femur, and total body were measured using a dual-energy X-ray absorptiometry analysis. Complete blood counts (CBC) were done on the whole blood specimens and hormonal measurements were performed on plasma specimens. In addition, athletes completed metabolic testing to determine maximal oxygen uptakes and 7-day dietary diaries. Overall daily EI across runners and controls within each sex were low, but not significantly different (p > 0.05). Prevalence of low BMD values (Z score < -2.0) was comparable across groups in each sex (p > 0.05). CBC measures suggested that both runners and controls were healthy. Finally, slight hormonal differences between runners and their respective controls existed (p < 0.05), but were not clinically meaningful or observed in typical Triad-RED-S-related parameters. High-level Kenyan male and female runners had low daily EI, but no tendency toward a higher prevalence of low BMD, or Triad-RED-S-related hormonal abnormalities. The occurrence of low EI was not a major risk factor in our athletes; this calls into question whether the current criteria for Triad-RED-S are entirely applicable for athletes of African ethnicity.

Assessment of Low Bone Mineral Density in Untreated Patients with Takayasu's Arteritis.

Chronic inflammation affects bone metabolism and accelerates bone loss. This study is aimed at analyzing the prevalence of low bone mineral density (LBMD) in patients with untreated Takayasu's arteritis (TA) and risk factors. Forty untreated TA patients were enrolled, including 38 premenopausal women and 2 men before 50 years old. The control group included 60 age- and gender-matched healthy persons. Bone mineral density (BMD) of lumbar vertebrae and hip in patients with TA and the control group was measured by the dual-energy X-ray method. Serum 25OHD and β-CTX were also measured. The lumbar BMD of TA patients (0.89 ± 0.11 g/cm2) was significantly lower than that of the healthy control (0.97 ± 0.11 g/cm2). The prevalence of LBMD at the lumbar spine (17.50%) was significantly higher than that of the control group (3.33%). However, there was no significant difference at the hip. The 25OHD of TA patients was lower than that of healthy controls, while the level of β-CTX was higher. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in patients with LBMD were higher than those in patients with normal BMD. According to univariate correlation analysis, there was a significant negative correlation between LDL-C and lumbar BMD. Binary logistic regression analysis showed that LDL-C was an important factor affecting the occurrence of LBMD in patients with TA (OR = 25.269, P = 0.02). Our result reveals bone loss in TA patients, which hints the relationship among inflammation, lipid metabolism, and bone metabolism.

Low bone mineral density in Thai children with systemic lupus erythematosus: prevalence and risk factors.

Improvement of disease recognition and management has increased the survival of children with systemic lupus erythematosus (SLE), but has shifted the morbidity focus toward long-term complications, such as low bone mass and osteoporosis. Studies in adults with SLE show older age, chronic inflammation, and corticosteroid therapy are risk factors for low bone mineral density (BMD) and osteoporosis. To determine the prevalence of and identify risk factors associated with low BMD in Thai children with SLE. We conducted a retrospective review of demographic data and clinical variables for a cohort of 60 Thai children with SLE who underwent 2 dual-energy X-ray absorptiometry (DXA) at their initial examination and later follow-up. We considered a BMD z score ≤ -2.0 to indicate low BMD. Binary logistic regression was used to assess risk factors potentially associated with low BMD. The prevalence of low BMD at the first visit was 40% and increased to 55% over follow-up. We found a significantly decreased hip BMD z score (median difference -0.25, 95% confidence interval [CI] -0.40 to -0.05; P = 0.016) and lumbar BMD z score (median difference -0.49, 95% CI -0.69 to -0.28; P < 0.001) over time. The cumulative steroid dose tended to be higher for patients with low BMD (adjusted odds ratio [OR] = 1.08, 95% CI 1.00 to 1.17; P = 0.050). Low BMD has a 40% prevalence in Thai children newly diagnosed with SLE and progresses significantly over time. Higher cumulative corticosteroid dose tended to be associated with a low BMD, but we did not find a significant risk in this small sample.

Показатель качества трабекулярной костной ткани и оценка вертебральных переломов у португальских пременопаузальных женщин с гипертиреозом

Гипертиреоз является фактором риска снижения минеральной плотности костной ткани (МПКТ) и возникновения остеопоротических переломов. Оценка вертебральных переломов (ОВП) помогает диагностировать вертебральный перелом, а показатель качества трабекулярной костной ткани (ТКТ) — оценить костную микроархитектуру. Мы поставили себе цель оценить влияние гипертиреоза на МПКТ, состав мягких тканей тела, частоту «немых» (невыявленных) вертебральных переломов и ТКТ. 80 пременопаузальных португальских женщин были распределены в группу пациентов с подтвержденным гипертиреозом (n = 40) и контрольную группу (n = 40). МПКТ (г/см2) поясничного отдела позвоночника, бедренной кости, 33 % лучевой кости, всего скелета исследовали с помощью двухэнергетической рентгеновской абсорбциометрии (ДРА) с учетом массы тела (кг) пациентов. ОВП применялась для диагностики переломов, которые впоследствии классифицировали с применением полуколичественного метода Женанта и подтверждали с помощью рентгенографии. Показатель ТКТ получали с помощью ДРА поясничного отдела позвоночника. Ни один пациент ранее не получал лечения по поводу гипертиреоза, остеопороза или пониженной костной массы (остеопении). Полученные результаты подтверждались статистическими подсчетами. В группе пациентов с гипертиреозом средняя МПКТ (МПКТ бедренной кости, шейки бедренной кости, всего скелета), общая обезжиренная масса и ТКТ были достоверно ниже, чем в контрольной группе; согласно классификации Международной ассоциации клинической денситометрии (ISCD), отмечалась тенденция к большей частоте снижения МПКТ; количество вертебральных переломов также достоверно возрастало. Эти результаты свидетельствуют о том, что в группе пременопаузальных женщин с гипертиреозом показатели МПКТ, обезжиренной массы и ТКТ являются достоверно более низкими. Частота «немых» вертебральных переломов также достоверно выше.

Bone Mineral Density in Adults With Cerebral Palsy.

Low bone mineral density (BMD) is an emerging health issue in adults with cerebral palsy (CP). This cross-sectional study aimed to describe the characteristics of BMD in adults with CP, and to elucidate the risk factors for low BMD in this population. People aged ≥20 years and diagnosed with CP were recruited from February 2014 to November 2014. We assessed BMD using dual-energy X-ray absorptiometry (DXA) for the lumbar spine, femoral neck, and total femur. Moreover, the body composition was assessed using DXA. We included a total of 87 adults with CP (mean age 42.01 years; 52 men). The prevalence of low BMD was 25.3%. Male sex and age were associated with lower BMD. BMD was significantly lower in the non-ambulatory group than that in the ambulatory group for both lumbar spine and femoral neck. The total fat mass demonstrated a positive correlation with the Z-score and BMD for the femur neck and total femur. Body mass index (BMI) and total fat mass were positively correlated with BMD in the lumbar spine, femoral neck, and total femur. However, the Gross Motor Function Classification Scale levels were negatively correlated with BMD at the aforementioned three sites. In conclusion, adults with CP revealed decreased BMD, which was associated with male sex, age, decreased gross motor function, loss of ambulatory function, low BMI, decreased total fat mass, and decreased total fat-free mass.

Prevalence and Associated Factors of Low Bone Mineral Density in the Femoral Neck and Total Hip in Axial Spondyloarthritis: Data from the CASTRO Cohort

Studies on osteoporosis in axial spondyloarthritis (axSpA) have focused on the lumbar segment, and few studies have assessed bone mineral density (BMD) in the hip and femoral neck in these patients. The aim of this study was to evaluate the prevalence of low BMD and osteopenia in the total hip or femoral neck and the factors associated with these conditions in axSpA patients. This was a single-centre, observational, cross-sectional study among consecutive patients with axSpA according to the ASAS criteria from the CASTRO registry. All patients underwent total hip and femoral neck DXA BMD measurements. Low BMD was defined as a Z-score less than −1, and osteopenia was defined as a T-score less than −1. Multivariate logistic and generalised linear regressions were used to evaluate factors independently associated with low BMD and osteopenia in the hip or femoral neck and those associated with variability in BMD, respectively. A total of 117 patients were included, among which 30.8% were female and the mean age was 45 years. A total of 36.0% of patients had low BMD (28.1% in the total hip and 27.4% in the femoral neck), and 56.0% of patients had osteopenia (44.7% in the total hip and 53.8% in the femoral neck). A multivariate logistic regression showed that age, radiographic sacroiliitis and ASAS-HI were independently associated with low BMD in the total hip or femoral neck. Factors that were independently associated with osteopenia were Body Mass Index, disease duration, radiographic sacroiliitis and ASAS-HI. In conclusion, 36% of the patients with axSpA had low BMD in the total hip or femoral neck. A younger age and radiographic sacroiliitis were the most important factors associated with decreased BMD.

Prevalence of low bone mineral density in Human Immunodeficiency Virus-infected patients and its correlation with other determinants

Background: The patients infected with human immunodeficiency virus (HIV) are potentially at risk of low bone mineral density (BMD). The present study was done to find out the prevalence of low BMD in HIV-infected patients and its correlation with other factors such as gender, body mass index (BMI), CD4 count, and highly active antiretroviral therapy (HAART). Methods: This was an observational cross-sectional study conducted in a tertiary care center for 1 year period. A total of 127 HIV-infected patients were evaluated for BMD by dual-energy X-ray absorptiometry (DEXA) scans at two sites lumbosacral spine and bilateral neck femur. Correlation with other factors was also studied. Results: The diagnosis of low BMD was established in 105 (82.67%) patients. Osteoporosis (44.1%) was more common than osteopenia (38.6%) at the lumbosacral spine. The mean T score of the DEXA lumbar spine and bilateral neck femur was observed to be ?2.113 and ?1.379, respectively. Males (88.73%) had low BMD than females (75%). Approximately 94.5% of subjects having BMI &lt;18 had low BMD in contrast to 80.8% among subjects having BMI &gt;18. After treatment, 47 patients had CD4 count &lt;400 and 80 &gt; 400. Forty-three patients out of 47 (91.5%) had low BMD and 62 out of 80 (77.5%) had low BMD. Conclusion: Low BMD is prevalent in HIV-infected subjects. Low BMI, persistently low CD4 count, tenofovir containing HAART regimen showed a positive correlation with low BMD. Hence, HIV infection should be considered as a risk factor for bone disease.

Increased Bone Mineral Density in Male Patients With Idiopathic Hypogonadotropic Hypogonadism Who Undergo Sex Hormone Therapy: Findings From Cross-Sectional and Longitudinal Studies

ObjectiveThis retrospective observational study assessed the long-term impact of pulsatile gonadotropin-releasing hormone, combined gonadotropin, or testosterone replacement therapy on total hip, femoral, and lumbar bone mineral density (BMD) and Z-scores in adult men with idiopathic hypogonadotropic hypogonadism (IHH). MethodsIn the cross-sectional study, 69 patients were allocated to untreated (n = 42) and treated (n = 27) groups. The untreated group included IHH patients without hormone therapy history, while the treated group included age- and body mass index-matched patients who had received hormone therapy for at least 5 years. The longitudinal study included 53 IHH patients, and their hip and lumbar BMDs were measured several times during hormone therapy. We then evaluated the changes in their BMD. ResultsOur cross-sectional study showed that the treated group had a significantly higher BMD and Z-score for total hip, femoral neck, and lumbar spine (P < 0.001 for all) than the untreated group, and the average bone mass even reached the age-matched normal range. The prevalence of low BMD was 80.95% and 11.11% in untreated and treated groups, respectively. In the longitudinal study (N = 53), the total hip, femoral neck, and lumbar spine BMD gradually increased during treatment. The lumbar spine showed a greater increment in BMD compared with the total hip and femoral neck (P < 0.05). ConclusionSex hormone therapy improved hip and lumbar spine BMD and Z-scores in patients with IHH. The lumbar spine showed a greater improvement in BMD compared with the total hip and femoral neck.

Methadone Maintenance Treatment, Sex Hormones and Low Bone Density in a Population of Injection Drug Users

Background: Methadone maintenance treatment (MMT) is associated with low bone mineral density (BMD) in those treated for opioid addiction. However, it is unclear whether observed adverse effects on the skeleton are related to a direct effect of opioids on bone metabolism or mediated by other mechanisms including MMT-induced gonadal dysfunction. We hypothesized that MMT is associated with low BMD in persons with a history of injection drug use (PWID) and that this effect is explained by differences in sex hormones. Methods: We recruited 280 participants from the AIDS Linked to the Intravenous Experience (ALIVE) study, a long-standing cohort of PWID. All participants had been exposed to hepatitis C virus (HCV antibody positive). In addition to a morning assessment of free testosterone (FT) and estradiol (E2), all participants underwent dual-energy x-ray absorptiometry (DXA) of the lumbar spine (LS) and hip (total hip (TH) and femoral neck (FN)). Multivariable linear regression was used to assess the relationship between MMT and T-score with and without inclusion of E2/FT concentrations. Models were stratified by sex and adjusted for age, BMI, HCV infection, HIV, current alcohol use, current smoking, vitamin D3 level, and current heroin use. Results: All participants were African American and 37% female. The median (Q1, Q3) age was 57 years (51, 61), median (Q1, Q3) BMI was 26 kg/m2 (22, 30) and 107 (38%) were receiving MMT. FT and E2 were significantly lower in men receiving MMT vs not (p < 0.01 for both). In women, there were no differences in sex hormones based on MMT use. The prevalence of low BMD (defined as LS, TH, or FN T-score ≤ -1) was 25% (23% in men and 29% in women; p = 0.3); 12 (4.3%, 2 men and 8 women; p = 0.09) had osteoporosis (T-score ≤ -2.5). In men, MMT was associated with -0.7 lower LS-T score (95% CI [-1.3, -0.1], p=0.046) in adjusted models compared to those not receiving MMT. The magnitude of this association was reduced after adjusting for E2 and FT (-0.2, 95% CI [-0.8, 0.5], p=0.665)). In women, MMT was not associated with LS-T score (MD -0.3, 95% CI [-1.3, 0.4], p=0.631). There were no associations between MMT and TH or FN BMD in either men or women. Conclusion: In this study, MMT was associated with lower lumbar spine BMD in men with a history of IDU, which was potentially mediated by the effect of MMT on sex hormones. More rigorous screening for co-morbidities including hypogonadism and low BMD in men receiving MMT may be warranted.