Ray Absorptiometry Research Articles

Evaluation of Bone Density in Ankylosing Spondylitis Patient on Biologic Agents in Erbil City Case Control Study

Background: Ankylosing spondylitis is a chronic autoimmune inflammatory disease, mostly affect young men. Reduced bone density is the most common complication in ankylosing spondylitis, since reduced bone density occurs in most of the patients. Assessment of bone density in the early stages of the disease by using X- ray absorptiometry is essential. Objective: To determine and evaluate the bone mineral density of ankylosing spondylitis patients compared healthy to control group. Patients and Methods: This is a cross-sectional case control study of 50 patients with ankylosing spondylitis according to the Modified New York criteria and 50 healthy control group. The data were collected including socio demographic information of all patients (age, gender, medical history); systemic diseases type of biology treatment, using supplements, duration of ankylosing spondylitis, regular exercise, and smoking. The body mass index was calculated. Bone mineral density of the lumbar spine (L1-L4), and the left femoral neck were measured by using a dual energy x-ray absorptiometry. Statistical analysis was done by using a statistical package for social sciences (SPSS) version 22; Fisher’s exact, and Student’s t tests were used to compare two means. A p value of ≤ 0.05 was considered statistically significant. Results: The prevalence of osteoporosis and osteopenia among patients group according to T-spine score were 12% and 42% respectively, compared with 0% and 26% respectively among the control group (p= 0.002) which was statistically significant. According to the T-left femur none patients group and the control group had osteoporosis, but 46% of the cases had osteopenia, compared with 8% of the controls which was statistically significant. There was a significant but non-consistent association between the disease duration and the osteoporosis, and osteopenia in spine and femur. The prevalence of osteopenia and osteoporosis in the spine and femur were highest among those with low body mass index. Conclusion: Osteoporosis and osteopenia are common among patients with ankylosing spondylitis. In the early stage of disease osteoporosis can occur. The osteoporosis of the spine is more common than in the femur. Osteoporosis related to the duration of the diseases and body mass of the patient.

Osteoporosis and lifestyle medicine

Osteoporosis is a major public health threat in this 21st century. It has high prevalence among postmenopausal women & elder patients (age > 60 years). It is a skeletal disorder characterized by compromised bone strength and suffer having greater chances of fractures. Osteoporosis is a condition where bones became weak & brittle that may increase chances of fracture in the patients. According to the WHO criteria, osteoporosis is defined as a bone mineral density (BMD) that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of <-2.5 SD). Osteoporosis is occurs due to too much bone mineral density is decreased that results into the changes in the structure of bone. Etiological factors includes advanced age, sex (women > male), sedentary lifestyle, minimal/ absence of sun exposure, smoking, alcohol consumption, hormonal imbalance and disease conditions such as diabetes, malignancies (multiple myeloma, lymphoma, leukemia). The diagnosis of condition must be confirmed by using spine dual energy X- ray absorptiometry (DXA) with WHO T-score thresholds. Osteopenia or low bone mass is having T-score of –1 to -2.4 & on the basis of T score, it will be classified in to two types that is primary and secondary osteoporosis. Primary osteoporosis more common in disease such as postmenopausal osteoporosis (type1) and senile osteoporosis (type2). It has severe morbid consequences, the prevention and management of this condition and associated fractures is considered to the essential to the maintenance of health status or quality of life (QoL) of patient. Patient can prevent to suffer from this condition by applying various tools of lifestyle medicines i.e. staying physically active or doing weight bearing exercises. Smoking cessation, moderate alcohol consumption are also became major approaches to manage or prevent occurrence of condition. Nutritious diet rich in calcium, vitamin D, Vitamin A, Vitamin C and other nutrition also play a key role in the management or prevention of disease.

Association between Body Mass Index and Bone Mineral Density in Patients Referred for Dual-Energy X-Ray Absorptiometry Scan in INMAS, Sylhet

With an aging population, osteoporosis is increasingly becoming a public health concern. Bangladesh has a high incidence of osteoporosis and occurs among a relatively younger age group than in the developed world. There are several factors that could be associated with bone mineral density (BMD). We are keen to determine the association with BMD and BMI. The study was carried out on 152 patients who were referred to INMAS for dual energy X- ray absorptiometry (DEXA) measurement of bone mineral density (BMD) during the periods of January 2018 to July 2019. BMD was measured at right femoral neck and lumbar spines. Data about age and sex, BMI were recorded. Reporting was done according to the T score following WHO criteria. Prevalence were compared using chi-squared tests. Among 152 patients, 84.9% were females and 15.1% were males. Results showed for right femur that normal bone density in 91 (59.1%), osteopenia in 54 (35.1%), osteoporosis in 9 (5.8%) and BMD in spine was normal in 57 (37.0%) osteopenia in 44 (28.6%), osteoporosis in 53 (34.4%). About 60% of the study population was normal weight and others were underweighted or overweighed. Status of BMD was associated with BMI in the lumbar spine and femur. In this study group, total 61.2% and 26.3%were found low BMD in spine and right femur respectively. In age group ≥ 60 years, low BMD in spinewas 72.0% that is 42.29% higher compare to below 60 years’ group (50.6%).Correlation of BMI with lumbar spine T score, right femur and left femur T score were measured by Pearson’s correlation coefficient test. Positive significant Pearson’s correlation was observedbetween BMI with spine T score (r = 0.397; p = <0.001), BMI with right femur T score (r = 0.347; p = <0.001) and BMI with left femur T score (r = 0.382; p = <0.001).
 Bangladesh J. Nuclear Med. 22(2): 108-113, Jul 2019

Factors associated with measures of sarcopenia in pre and postmenopausal women

BackgroundMenopause associated low serum estradiol marks varieties of derangements in muscle mass and functions leading to sarcopenia. This cross-sectional study was carried out to examine the factors associated with measures of sarcopenia; skeletal muscle mass (SMM), muscle strength and physical performance (PP) in a group of premenopausal (PrMW) and postmenopausal women (PMW) selected from Sri Lanka.MethodsRandomly selected 184 PrMW and 166 PMW from Galle district, Sri Lanka were studied. SMM was measured with duel energy X ray absorptiometry and relative appendicular SMM index (RSMI; kg/m2) was calculated. Other measurements made include handgrip strength (HGS; kg) and gait speed (GS; m/s), anthropometric indices, consumption of macro and micronutrients, and pattern of physical activities (PA). A serum sample was analyzed for fasting insulin, serum estradiol and vitamin D. Variables which significantly correlated with RSMI, HGS and GS of PrMW and PMW were separately entered into multiple linear regression models to extract the associated factors.ResultsMean (SD) age of PrMW and PMW were 42.4 (6.0) and 55.8 (3.8) years respectively. In the regression analysis, RSMI in PrMW showed significant associations with body mass index (BMI), HGS, total-body-fat-mass (TBFM) and weight (adjusted R2 = 0.85) and in PMW with BMI, weight, TBFM, hip-circumference and fasting insulin (adjusted R2 = 0.80). BMI showed the strongest association with RSMI in both PrMW (r = 0.87, R2 = 0.76) and in PMW (r = 0.87, R2 = 0.76). HGS in PrMW showed significant associations with appendicular SMM (ASMM), total-body-bone-mineral-content, vigorous PA score, age and weight (adjusted R2 = 0.33) and in PMW with ASMM and height (adjusted R2 = 0.23). ASMM showed the strongest association with HGS in both PrMW (r = 0.44, R2 = 0.20) and PMW (r = 0.44, R2 = 0.20). GS in PrMW showed significant associations with height, BMI and energy consumption (adjusted R2 = 0.13) while in PMW, with carbohydrate consumption and total-body-bone-mineral-density (adjusted R2 = 0.09). While in PrMW, height showed the strongest association with GS (r = 0.28, R2 = 0.08) in PMW, it was carbohydrate consumption (r = 0.24, R2 = 0.06).ConclusionsFactors that are associated with different measures of sarcopenia are not uniform and vary widely from anthropometry to nutrient intake indicating that these measures are somewhat independent and are governed by different factors.

Rapid infant weight gain is associated with excess adiposity at 7-years of age in children from Aragon, Spain

ABSTRACT Background: Infants with rapid weight gain (RWG) during the 1st year are at increased risk of overweight. Objective: To examine its associations with body mass index z-score (BAz), fat mass index (FMI) and free fat mass index (FFMI) in 7 y-old Spanish children from the CALINA study. Methods: Dual X – Ray Absorptiometry scans and weight and height measurements were conducted. RWG was defined as a positive change in weight/age Z-score greater than 0.67 from birth to 6 months (0–6 m), 6 to 12 months (6–12m) and 0 to 12 months (0–12m). Adjusted linear regressions were performed. Results: A RWG from 0-6m, 6-12m and 0-12m was associated with BAz in children (B = 0.607, B = 0.522 and B = 0.649, p ≤ 0.001 in all cases), specifically in boys with RWG from 0-6 m (B = 0.734, p = 0.001) and in girls from 6 to 12 m (B = 0.678, p = 0.006). RWG predicted FMI in children with RWG from 6-12 m (B = 0.590, p = 0.008), being significative only in girls (B = 1.259, p = 0.001) and in children with RWG from 0-12 m (B = 0.493, p = 0.024), being significative only in boys (B = 0.593, p = 0.035). FFMI was higher in those with RWG from 0-6 m, 6-12 m and 0-12 m (B = 0.618, B = 0.468, B = 0.575 p < 0.001 in all cases), being significative in boys in all periods (B = 0.657, B = 0.411, B = 0.579, p < 0.021 in all cases) and in girls that developed RWG from 0-12 m (B = 0.380, p = 0.049) Conclusions: In a subsample from the CALINA Study, there are associations between RWG in the 1stY and BAz, FMI and FFMI at 7 years.

Analysis of efficacy of intravenous zolendronic acid therapy in osteoporosis with dexa scan

Introduction: Bisphosphonates are one of the commonly used drugs for the treatment and prevention of osteoporosis. Many of the old generation oral bisphosphonates have got lesser affinity to bone mineral matrix and low patient compliance. Newer generation intravenous zolendronic acid has got a better compliance due to once a year dose and it is more effective due to its more affinity towards bone mineral matrix. Hence this study was conducted to evaluate the results of intravenous zolendronic acid in osteoporotic individuals using Dual Energy X ray Absorptiometry. Materials and Methods: The study was conducted in a tertiary centre between January 2012 to January 2016. The sample size was 36. The patient recruitment was done in a consecutive manner. Patients were diagnosed by DEXA scan and Lumbar spine BMD taken as representative and inj. zolendronic acid was given once a year, repeated every year, total for 3 years duration therapy. Student Paired t-test was used to find the statistical significance. Gender, fracture sustained during the study, complication, hypothyroidism and status of improved were expressed as frequency and the percentage. p < 0> Results and Analysis: The mean age of our study population was 67.7 yrs. 12 patients in our study had improvent in BMD (t - score) which was 40% of the whole study group. These 12 patients had an actual percentage rise in BMD by 11.62% on average, detected by DEXA Scan. All these patients were under the age bracket of 65 years. 18 patients did not have any improvement in or worsening of BMD and were above the age bracket of 65 yrs of age. This could be attributed to their medical co - morbid conditions and nutrional status. The incidence of another fracture was 8% among people who had a previous fracture. 10% of the study population had adverse effects like fever and myalgia. There were no other serious adverse effects. Keywords: Osteoporosis, Zolendronic acid, DEXA.

Low Bone Mineral Density and Immunological Insights in Postmenopausal Women Affected by Primary Sjandouml;grenandrsquo;s Syndrome

Objective: Osteoporosis is the pathological reduction of bone mineral density (BMD) and the most represented metabolic skeletal disease among population. A reduction in bone mineralization levels is associated with an increased risk of frailty fractures and of healthcare costs. Although there are many evidences bridging rheumatological diseases (such Systemic Sclerosis, Lupus Erythematosus Systemics and Rheumatoid Arthritis) with bone loss, very scarce and contradictory papers evaluate bone health in primary Sjogren's syndrome (pSS). Aim of this retrospective study is to evaluate BMD in pSS and its relationship with inflammatory markers, Ro/SSA and La/SSB antibodies. Methods: Fifty-three postmenopausal pSS were matched with 93 controls and studied for BMD measured by Dual Energy X- ray absorptiometry (DXA). Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA), Anti- Ro/SSA, and anti-La/SSB antibodies, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected too. Mean BMDs of each explored region was compared and osteoporosis’s (OP) prevalence was assessed. Pearson’s analysis and multivariate regression models were built to highlight variables interrelations. Results: BMD was lower in pSS compared to controls, both expressed as g/cm2 and T-score considering lumbar spine and femoral neck. OP prevalence was higher among pSS compared to controls. Weight acted as the best predictor of lumbar BMD in multivariate model. No difference on BMD status was found between pSS with antibodies positivity and altered inflammatory markers with subjects displaying normal sera levels of the abovementioned variables. Conclusions: pSS female patients in an early stage of disease have lower BMD compared to healthy controls. Anti- Ro/SSA and anti/La antibodies and inflammatory markers are not related with BMD.

Validity of Bioimpedance Equations to Evaluate Fat-Free Mass and Muscle Mass in Severely Malnourished Anorectic Patients.

Background: Bioelectrical impedance analysis (BIA) is a simple and rapid technique to measure body composition (BC). Validity of BIA in patients with low body mass index (BMI) remains controversial. We assessed the validity of several BIA equations to evaluate fat-free mass (FFM), fat mass (FM) and muscle mass in patients with anorexia nervosa (AN) by using dual X ray absorptiometry (DXA) as reference. Methods: Sixteen BIA equations developed for FFM and appendicular lean mass (ALM) were applied on electrical data measured by BIA in AN patients with BMI <16 kg/m². BIA and DXA were done the same day after overnight fasting. Results were compared with the Bland–Altman method, Pearson correlation and a Lin concordance test. Results: Data from 115 female AN patients (14.6 ± 1.2 kg/m²; 32.3 ± 14.5 years) were included. FM and FFM assessed by DXA were, respectively, 4.2 ± 2.4 kg and 35.5 ± 3.8 kg. The best results were obtained with Sun’s equation: respectively for FM and FFM, Bland Altman bias at 0.548 and 0.706 kg, Pearson correlation r at 0.86 and 0.86 and Lin concordance coefficient at 0.81 and 0.84. However, confidence intervals (CI) at 95% were high (−2.73–3.83 kg for FM; −4.55–3.13 kg for FFM). Other equations also showed high 95% CI. Accuracy was acceptable for Sun and Bedogni equations for FFM (approximately 66%) but very low for FM prediction considering all equations (<15%). Concerning ALM evaluated at 14.88 ± 2.04 kg by DXA, only Scafoglieri and Yoshida equations showed acceptable values: bias (−0.2 and 2.8%), Pearson r (0.89 and 0.86), Lin concordance coefficient (0.82 and 0.82) and accuracy (83.5 and 82.6%). Confidence intervals at 95% were high for both equations (−2.1–2.0 for Scafoglieri equation and −1.6–2.4 for Yoshida equation). Conclusion: In AN patients with BMI < 16 kg/m², no BIA equation tested was adapted to evaluate BC at the individual level.

Echocardiographic abnormalities in 124 severely malnourished adult anorexia nervosa patients: frequency and relationship with body composition and biological features

BackgroundAnorexia Nervosa (AN) is a complex psychiatric disorder that can lead to specific somatic complications. Heart abnormalities are frequently reported, while their frequency and associated factors in severely malnourished AN patients remain poorly defined.ObjectivesThis study aimed to characterize echocardiographic abnormalities in severely malnourished AN patients and to assess associated clinical, biological and related body composition features.MethodsBetween January 2013 and January 2015, all severely malnourished adult patients with AN (Mental Disorders, 4th Edn.-DSM IVr) were included in a monocentric study performed in in a highly specialized AN inpatient unit. Electrocardiogram (ECG) and echocardiography were used to assess both heart rhythm and function. All inpatients underwent a Doppler echocardiography procedure after undergoing combined blood volume adjustment, micronutrients deficiencies supplementation and electrolyte disorders correction. Right Ventricular (RV) and Left Ventricular (LV) systolic and diastolic functions were collected and compared to 29 healthy normal subjects in a control group.ResultsOne hundred and 24 patients (119 (96%) women, 5 (4%) men) with a mean age of 30.1 ± 11 years old and an average Body Mass Index (BMI) of 12 kg/m2 were included. Ninety patients (73%) had been diagnosed with AN Restrictive type (AN-R), 34 (27%) an AN Binge eating/Purging type (AN-BP). Eighteen patients (15%) disclosed an abnormal Left Ventricular Ejection Fraction (LVEF) (< 52% for male and < 54% for female). LVEF impairment was associated with AN-BP patients (p < 0.017) and hypertransaminasemia (AST and/or ALT ≥2 N) (p < 0.05). Left Ventricular mass (LV mass) and Left Ventricular End Diastolic Diameter (LVEDD) were significantly reduced in patients (p < 0.001, p < 0.001). Left and right ventricular tissue Doppler Imaging Velocities (TDI) peak were reduced in patients: Septal and Lateral LV Sm velocities peaks respectively 10 ± 2 cm/s (vs 14 ± 2 cm/s in controls, p < 0.001), 12 ± 3 cm/s (vs 16 ± 3 cm/s in controls, p < 0.001), basal RV Sm velocity peaks at 14 ± 3 cm/s (vs 19 ± 3 cm/s in controls, p < 0.001). Additionally, LV and RV diastolic velocity peaks were reduced: LV septal and lateral velocity peaks were respectively 13 ± 3 cm/s (vs 18 ± 2 cm/s p < 0.001), 12 ± 3 cm/s (vs 22 ± 4 cm/s, p < 0.001) and RV diastolic velocity peaks at 14 ± 3 cm/s (vs 21 ± 4 cm/s p < 0.001). LV diastolic velocity TDI peaks were significantly associated with hypertransaminasemia (p < 0.05) and tended to be associated with a low all body Fat-Free Mass Index (FFMI) (using Dual-energy X- ray Absorptiometry (DXA) (HOLOGICQDR 4500) (p = 0.056). Thirty-four patients (27%) had a pericardial effusion and were significantly associated with a decreased all body FFMI (p < 0.036).ConclusionHeart abnormalities are frequent in malnourished patients with AN, particularly in AN-BP type. Both liver enzymes and body composition abnormalities tended to be associated with heart dysfunction (non-significant association). Prospective studies are needed to better characterize and describe the evolution of cardiac abnormalities during the refeeding period and subsequent weight restoration.

Does bioimpedancemetry accurately assess muscle mass in severely malnourished patients?

Rationale: Measuring muscle mass is an important issue to diagnose sarcopenia. Bioimpedancemetry (BIA) is a simple and rapid technique and equations to calculate muscle mass have been proposed. However, validity of BIA in patients with low BMI remains controversial. Thus, we aimed to evaluate the validity of several BIA equations to measure muscle mass in severely malnourished patients with anorexia nervosa (AN) by using dual X ray absorptiometry (DXA) as reference.

Evaluation of bone mass and relevance ratio of osteoporosis among middle aged and elderly population in Beijing community

To investigate the relevance ratio of osteoporosis and bone mass of middle aged and elderly people in Beijing communities, in order to understand occurrence and development trend of abnormality of bone mass in high-risk population from community. Based on the method of cross-sectional investigation, the information data of 1 540 middle-aged and elderly people from 10 communities were collected, including 415 males and 1 125 females, aged from 45 to 80 years old with the average of (63.02±7.15) years old; the height was (161.34±7.24) cm, the weight was (65.90±10.19) kg, body mass index was (25.29±3.32) kg /m2. Bone mineral density (BMD) of lumbar vertebrae (L1-L4) and both hips were measured by dual energy X ray absorptiometry (DEXA). The differences of bone mineral density and bone mass in different age groups were evaluated, and the relevance ratio of osteoporosis in different parts of the subjects was calculated. Elbow venous blood was collected on an empty stomach, and the gender differences of serum bone metabolic markers were detected and compared. The level of β-CTX was(0.27±0.12) ng /ml, procollanen type 1 N-terminal propeptide(P1NP) was(51.03± 22.36) ng /ml, 25(OH) D3 was (16.68±6.24) ng /ml, serum calcium was(2.34±0.09) mmol / L, blood phosphorus was (1.43± 0.37) mmol / L, and blood magnesium was (0.94±0.07) mmol / L, alkaline phosphatase was (79.28±20.48) U/ L, parathyroid hormone was (3.09±1.60) pmol / L, osteocalcin was (13.29±6.65) ng /ml. Except for blood magnesium, the other indexes had significant differences between different sex groups(P<0.05). Results of T value of bone mineral density and level of bone mass showed that bone mineral density of lumbar vertebrae and both hips fluctuated and decreased with the increase of age, and there were significant differences in level of bone mass among different age groups in women(P<0.05), and except lumbar vertebrae in males, there were significant differences in other parts of bone mass among different age groups (P<0.05). The relevance ratio of lumbar osteoporosis, left hip osteoporosis, and right hip osteoporosis was 27.89%, 14.80% and 14.47%, respectively. There are obvious differences in relevance ratio of osteoporosis and low bone mass among different sites. It is suggested that the clinical diagnosis of osteoporosis should be combined with bone mineral density and bone metabolic markers. With the increasing prevalence of osteoporosis among middle aged and elderly people in Beijing community, continuous follow-up research based on community primary health care units could promote early examination, early diagnosis, and early treatment of middle aged and elderly people at high risk of osteoporosis in community.

A Body shape index significantly predicts MRI-defined abdominal adipose tissue depots in non-obese Asian Indians with type 2 diabetes mellitus

IntroductionWe aimed to determine the correlations of volumes of subcutaneous abdominal adipose tissue (SCAT) (anterior, posterior, superficial and deep), total SCAT, intraperitoneal adipose tissue, retroperitoneal abdominal adipose tissue (RPAT), total...

Bone health in young adult survivors born extremely preterm or extremely low birthweight in the post surfactant era.

Most infants born extremely preterm (EP; <28weeks' gestation) or extremely low birthweight (ELBW; <1000g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life. To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health. A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499g birthweight) were recruited into a longitudinal study from birth. At age 25years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight. Compared with controls (n=129), young adults born EP/ELBW (n=162) had lower areal bone mineral density (g/cm2) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength. Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.

Bone mineral density in ankylosing spondylitis: Relation to disease activity, functional capacity, spinal mobility and radiological damage

Aim of the workTo assess the bone mineral density (BMD) in Ankylosing Spondylitis (AS) patients and to investigate its relation to disease activity, functional capacity, spinal mobility and radiological damage. Patients and methodsThirty male AS patients (mean age 27.9 ± 6.2 and disease duration 4.2 ± 3.6 years) and thirty age-matched healthy controls were studied. Patients were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI) and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) to quantify radiological damage. BMD of the lumbar spine and femoral neck were assessed by Dual Energy X ray Absorptiometry (DEXA). ResultsPatients had a lower BMD of the lumbar spine (1.13 ± 0.14 versus 1.22 ± 0.09 g/cm2, p = 0.007) and femoral neck (0.89 ± 0.1 versus 1.05 ± 0.13 g/cm2, p = 0.001) than controls. BMD of the lumbar spine was negatively correlated with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), BASDAI, BASFI, BASMI and mSASSS (r = -0.6,-0.4, −0.5, −0.4, −0.5, −0.6; p = 0.001, 0.003, 0.01, 0.01, 0.004, 0.001, respectively) while BMD of the femoral neck was correlated negatively with the ESR,CRP, mSASSS (r = -0.5,-0.4,-0.5, p = 0.001, 0.004, 0.01) and positively with the modified Schöber test (r = 0.41, p = 0.02). On multiple regression analysis, the modified Schöber test, ESR and CRP were independent predictors of the BMD of the femoral neck (β = 0.45,-1.12, 0.58; p = 0.048, 0.02, 0.03, respectively). ConclusionBMD is reduced in AS patients and correlates with disease activity, functional capacity, spinal mobility and radiological damage.

Vitamin D, body mass composition and metabolic risk factors in healthy young Indians

BackgroundStudies have linked vitamin D to risk factors for cardiovascular disease. Obesity is a potential confounder in these studies. This study examined the relationship of 25 (OH) cholecalciferol (25[OH] D3) with insulin resistance, blood glucose, and lipid profile in lean male adults. MethodWe enrolled two hundred and thirty four military recruits before beginning of military training. Demographic and anthropometric data were collected from them. The participants underwent body mass composition analysis by dual energy X ray absorptiometry. Fasting samples were collected for measurement of blood glucose, lipid profile, 25(OH) D3, serum parathormone (PTH) and insulin. ResultsVitamin D deficiency and insufficiency was found in 47.7% (107/224) and 31.6% (71/224) of participants, respectively. Using Pearson's correlation coefficient 25(OH) cholecalciferol and fasting blood glucose (FBG) were inversely correlated (p = 0.023). However, similar relation was not found between 25(OH) D3 and total cholesterol, triglycerides, high-density lipoprotein–cholesterol, low-density lipoprotein–cholesterol, homeostatic model assessment of insulin resistance and levels of PTH. On body composition analysis, there was no correlation of 25(OH) cholecalciferol with body mass index or fat mass index. ConclusionThis study showed that in lean young male population, 25(OH) cholecalciferol and FBG are inversely correlated but no association of 25(OH) D3 with other cardiometabolic risk factors could be demonstrated.

High-intensity Interval Training Low-volume Vs Moderate-intensity Continuous Aerobic Training On Insulin Resistance In Metabolic Syndrome

Moderate-intensity continuous aerobic training (MICAT) and high-intensity interval training (HIIT) interventions improve insulin resistance (IR) and glycemic control in patients with metabolic syndrome (MS). Moreover, skeletal muscle mass negatively correlates with IR. However, there are contradictory results about the superiority of any of these interventions on the control of the glucose metabolism in MS. PURPOSE: to compare the efficacy of a HIIT-low volume protocol vs MICAT on the Homeostatic assessment model, glycated hemoglobin (HbA1c) and skeletal muscle mass, in adults with MS. METHODS: controlled, randomized, clinical trial using the minimization method, with two parallel groups for the purpose of showing superiority. Sixty patients with MS, of both genders, 40-60 years old, were included. A clinical evaluation, biochemical tests, an ergospirometry and a dual-energy X ray absorptiometry to determine total and regional skeletal muscle mass were carried out before and after a treadmill exercise program of 12 weeks, 3 sessions/week. Participants were assigned to an intervention with HIIT-low volume (n=29) in 22 min sessions that included six intervals at a load of 90% of maximum oxygen consumption (VO2max) for 1 min followed by 2 min at 50% of VO2max. The control group received MICAT (n=31) at an intensity of 60% of VO2max in sessions of 36 min. RESULTS: patients had a mean age of 50.8±6.0 years, body mass index of 30.6±4.0 kg.m-2, body fat percentage of 38.7±7.0% and VO2max of 29.0±6.3 mL O2.kg-1.min-1; 70% were women. Compared to MICAT, HIIT-low volume was not superior in reducing Ln of IR (marginal mean difference: 0.083 [95% CI -0.092―0.257]; Cohen's d: 0.249; p value=0.346) or increasing Ln of total lean mass (kg) (0.004 [-0.014―0.023]; Cohen's d: 0.120; p=0.637) and Ln of thigh lean mass (g) (0.008 [-0,020―0.038]; Cohen's d: 0.154; p=0.599). After the intervention, the HIIT-low volume group, compared to the MICAT, had a higher HbA1c (5.81% vs 5.69%; 0.119 [0.005―0.233]; Cohen's d: 0.554; p=0.040). When comparing before and after the intervention, both training groups decreased IR. CONCLUSION: HIIT-low volume, compared to MICAT, is not superior in reducing IR or increasing skeletal muscle mass in adults with MS. Colciencias 111562638757; Interinstitucional 2016-13041; Doctoral scholarships 727-2015

Long-term follow-up of bone remodelling after cementless hip arthroplasty using different stems

The present paper is concerned with the investigation of the phenomenon of long-term bone remodelling on cementless hip replacements. Changes in bone density in the periprosthetic region around the stem, measured by dual X–ray absorptiometry (DXA), were used as a measure of the osseous adaptation reaction. A postoperative follow-up of the use of four different types of prostheses of varying design after on average 13.3 (11.4–14.5) years. Specifically, the prostheses assessed in this study were the CLS/Spotorno stem with the Allofit cup by Zimmer, the Vision 2000 stem with the Duraloc cup by DePuy Synthes, the AlphaFit stem with the AlphaLock cup by Corin and the Mayo stem with the Trilogy cup by Zimmer. For the DXA measurement, the femur was divided into the zones suggested by Gruen et al. On the femur, there was a significant reduction in bone mineral density (BMD) in the proximal Region Of Interest (ROI) 1 (p = 0.003) and 7 (p < 0.001), whilst there was a significant increase in ROI 4 (p = 0.03). A greater degree of bone atrophy was seen in patients aged 60 years and older and in female patients. A remarkable finding when comparing the stems was a significantly greater reduction in BMD in ROI 6 (p = 0.003) in the case of the Vision 2000 stem and a markedly, but not statistically significantly smaller reduction in BMD in ROI 7 (p = 0.18) in the case of the short-stem Mayo-type prosthesis. The best clinical results were found with the use of the latter. The investigations provide a starting point for establishing a differential indication in the choice of prosthesis types, depending on age and sex, the use of short-stem prostheses, as well as the administration of bone-effective drugs for the prevention of stress shielding.

Hepatic osteodystrophy and fracture risk prediction using FRAX tool in Indian patients with cirrhosis.

The main clinical relevance of hepatic osteodystrophy is the increased risk of fractures. Dual-energy X ray absorptiometry (DEXA)-based assessment of bone mineral density, the current gold standard for diagnosing osteoporosis, is not the sole determinant of fracture risk. Other clinical risk factors also play an important role. This study was carried out to assess the prevalence and risk factors of hepatic osteodystrophy and estimate the entailed fracture risk by using the FRAX tool in a cohort of Indian cirrhotics. Consecutive patients with cirrhosis (n = 120) were recruited. Etiologic workup, liver function tests, serum calcium, phosphate, 25(OH)D, HbA1c, and DEXA scan were performed. Hepatic osteodystrophy was defined as a T score of < -1. FRAX scores were calculated using the Indian calculator. The study cohort was predominantly male (86.7%) with a median age of 49 (40-65) years. Alcohol was the most common etiology (80%). All patients had Child-Turcotte-Pugh class B (63.3%) or class B (36.7%) cirrhosis. Hepatic osteodystrophy was present in 83.3% patients. On multivariate analysis, smoking (odds ratio [OR]: 3.1 [1.76-4.7], P < 0.001) and serum 25(OH)D (OR: 0.23 [0.09-0.94]; P = 0.03) showed significant association with hepatic osteodystrophy. The 10-year probability of major osteoporotic fracture and hip fracture was 5.7% (2.1-28.9) and 2.5% (1.4-7.4), respectively. Using a FRAX probability cut-off of 20% for major osteoporotic fracture and 3% for hip fracture, 30% patients qualified for osteoporosis treatment. Hepatic osteodystrophy is widely prevalent among Indian patients with cirrhosis and entails a high risk of fractures. Approximately one-third of patients with cirrhosis need treatment to reduce the risk of osteoporotic fractures.

Effects of a carbohydrate-restricted diet on hepatic lipid content in adolescents with non-alcoholic fatty liver disease: A pilot, randomized trial.

Non-alcoholic fatty liver disease (NAFLD) has emerged as the most common form of liver disease among adolescents in industrialized countries. While lifestyle intervention remains the hallmark treatment for NAFLD, the most effective dietary strategy to reverse NAFLD in children is unknown. The objective of this study was to determine the effects of a moderately CHO-restricted diet (CRD) vs fat-restricted diet (FRD) in adolescents with NAFLD on reduction in liver fat and insulin resistance. Thirty-two children/adolescents (age 9-17) with obesity and NAFLD were randomized to a CRD (<25:25:>50% energy from CHO:protein:fat) or FRD (55:25:20) for 8 weeks. Caloric intakes were calculated to be weight maintaining. Change in hepatic lipid content was measured via magnetic resonance imaging, body composition via dual energy X ray absorptiometry and insulin resistance via a fasting blood sample. Change in hepatic lipid did not differ with diet, but declined significantly (-6.0 ± 4.7%, P < .001 only within the CRD group. We found significantly greater decreases in insulin resistance (HOMA-IR, <.05), abdominal fat mass (P < .01) and body fat mass (P < .01) in response to the CRD vs FRD. These findings suggest that consumption of a moderately CHO-restricted diet may result in decreased hepatic lipid as well as improvements in body composition and insulin resistance in adolescents with NAFLD even in the absence of intentional caloric restriction. Larger studies are needed to determine whether a CHO-restricted diet induces change in hepatic lipid independent of change in body fat.

Cognitive Function and Amyloid Marker in Frail Older Adults: The Cogfrail Cohort Study

BackgroundFrailty and cognitive impairment are common manifestations of the ageing process and are closely related. But the mechanisms linking aging, physical frailty, and cognitive disorders, are complex and remain unclear.ObjectivesWe aim to explore the role of cerebral amyloid pathology, but also a range of nutritional, physical, biological or brain-aging marker in the development of cognitive frailty.MethodCOGFRAIL study is a monocentric prospective study of frail older patients with an objective cognitive impairment (Clinical Dementia Rating Scale global score at 0.5 or 1). Three-hundred-and-twenty-one patients are followed up every 6 months, for 2 years. Clinical assessment at baseline and during follow-up included frailty, physical, mood, sensory, nutritional, and cognitive assessment (with a set of neuropsychological tests). Cerebral amyloid pathology is measured by amyloid Positron Emission Tomography (PET) or amyloid-β-1-42 level in cerebrospinal fluid. Brain magnetic resonance imaging, measurement of body composition using Dual X Ray Absorptiometry and blood sampling are performed. The main outcome of the study is to assess the prevalence of positive cerebral amyloid status according to amyloid PET or amyloid-β-1-42 level CSF. Secondary outcomes included biological, nutritional, MRI imaging, cognitive, clinical, physical and body composition markers to better understand the mechanisms of cognitive frailty.PerspectiveCOGFRAIL study will give the opportunity to better understand the link between Gerosciences, frailty, cognitive impairment, and Alzheimer’s disease, and to better characterize the physical and cognitive trajectories of frail older adults according to their amyloid status. Understanding the relationship between physical frailty and cognitive impairment is a prerequisite for the development of new interventions that could prevent and treat both conditions.