Ray Absorptiometry Research Articles

SAT0369 An audit of androgen deprivation therapy and bone protection in secondary care

BackgroundProstate cancer is the most common cancer in men, with an incidence of 37,000 in 2008 in the UK1. Androgen deprivation therapy plays an important role in prostate cancer treatment...

FRI0451 Early increase of visceral adipose tissue in patients with spondyloarthritis receiving anti-tumor necrosis factor alpha treatment

BackgroundPrevious studies have shown a significant increase in body weight and body composition changes (increase in lean and fat masses) in patients with spondyloarthritis receiving anti-TNF-alpha (anti-TNFa) treatment. SpA is...

AB0300 Medium and large sized joint involvement is more associated with functional disability than small joint destruction in 102 active advanced rheumatoid arthritis patients treated with non-biological dmards (cross-sectional study)

BackgroundIt has been reported that small joint destruction (hands and feet) affects damage (DAM)-HAQ index, whereas disease activity worsens activity (ACT)-HAQ index caused by inflammation. Clinically, in advanced rheumatoid arthritis...

AB1057 Osteoporosis in calcium pyrophosphate deposition disease

ObjectivesTo study the frequency of osteoporosis (OP) in patients with calcium pyrophosphate deposition disease (CPPD).Methods85 pts with crystal-proven diagnosis of CPPD and chondrocalcinosis phenomena, confirmed either by conventional radiography (Rg)...

Variation in the Prevalence of Sarcopenia and Sarcopenic Obesity in Older Adults Associated with Different Research Definitions: Dual‐Energy X‐Ray Absorptiometry Data from the National Health and Nutrition Examination Survey 1999–2004

To determine the prevalence range for sarcopenic obesity and its relationship with sex, age, and ethnicity. Cross-sectional analysis of a population-based sample. Noninstitutionalized persons in the United States participating in the National Health and Nutrition Examination Surveys 1999-2004. Subsample of 4,984 subjects aged 60 and older with dual-energy X-ray absorptiometry body composition data. Eight definitions of sarcopenic obesity identified from six studies found using a systematic literature review (Baumgartner, Bouchard, Davison, Zoico, Levine, Kim-1,2,3) were applied to the sample. Results were stratified according to sex, age, and ethnicity. Prevalence of sarcopenic obesity ranged from 4.4% to 84.0% in men and from 3.6% to 94.0% in women. Prevalence was higher in men using definitions from Baumgartner (17.9% vs 13.3%, P < .001), Levine (14.2% vs 6.6%, P < .001), and Kim-1 (30.0% vs 9.3%, P < .001); lower for men using the Davison (4.4% vs 11.1%, P < .001) and Kim-2 (83.7% vs 94.0%) definitions; and the same for men and women using the Bouchard (45.3% vs 44.3%, P = .32) and Kim-3 (75.6% vs 77.0%, P = .51) definitions. For all but one definition, sarcopenic obesity increased with each decade and was lower in non-Hispanic blacks than whites. Prevalence of sarcopenic obesity in older adults varies up to 26-fold depending on current research definitions. Such a high degree of variability suggests the need to establish consensus criteria that can be reliably applied across clinical and research settings.

The Association of Serum Osteocalcin with the Bone Mineral Density in Post Menopausal Women

The markers of bone remodelling, such as serum osteocalcin, may be used to assess osteoporosis and to predict the fracture risk in elderly persons, especially in women. The bone mineral density which reflects the bone mass and strength, also predicts osteoporotic related hip fractures. So, this work highlights the association between the bone turnover and the bone mass and strength. To assess the association between the biochemical markers of bone remodeling and osteocalcin with the bone mineral density in non osteoporotic and osteoporotic women among post menopausal subjects. Sixty postmenopausal women whose ages ranged from 55-65 years included in this study, were further divided into group 1 (thirty non osteoporotic subjects) and group 2 (thirty osteoporotic subjects). For all the subjects, serum osteocalcin was measured by ELISA. BMD was measured by the Dual Energy X- Ray Absorptiometry (DXA) scan. The women with osteoporosis were diagnosed, based on the T- score of the bone mineral density, by the DXA scan. The Student's "t" test was performed between the variables of both the groups and a correlation test was also performed between osteocalcin and BMD by using SPSS. A negative correlation was found between the osteocalcin level and the bone mineral density in post menopausal women. The mean values of both serum osteocalcin and BMD between the osteoporotic and the non osteoporotic subjects were statistically significant. An increased bone turnover coincides with the trabecular deterioration in osteoporotic women of the post menopausal age group. A combination of biochemical markers and BMD may be a better predictor of the fracture risk than when it was assessed by either alone. The biochemical markers of the bone turnover cannot be a substitute for the serial BMD measurement, but they may be useful when they are considered in conjunction with the BMD measurement.

Comparison of plain vertebral X‐ray and dual‐energy X‐ray absorptiometry for the identification of older women for fracture prevention in primary care

Recently, the dual-energy X-ray absorptiometry (DXA) diagnostic cut-off (T-score) for Australian Pharmaceutical Benefits Scheme (PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from -3.0 to -2.5. To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤-2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity. Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤-2.5 on DXA compared with 10.6% (n = 210) with a T-score ≤-3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% (n = 168) had both a T-score ≤-2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray. The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure.

Suspension criteria for dual energy X ray absorptiometry

The use of dual-energy X-ray absorptiometry (DXA) units primarily for the assessment of fracture risk and in the diagnosis of osteoporosis is ubiquitous in Europe and ever-expanding in its implementation worldwide. DXA is known for its reported low radiation dose and precision in the determination of bone mineral density. However, the use of simple suspension criteria, as proposed in the new EC report RP-162, will identify units that are unfit for useful and safe diagnosis. Such suspension levels, however, are not a substitute for regular maintenance, quality control testing and optimisation of clinical outcomes.

Dietary calcium intake and osteoporosis in postmenopausal women living in Sarajevo area

Introduction: Osteoporosis is a multifactorial polygenetic disease of which the genetic determinants are modulated by hormonal, environmental and nutritional factors. Identifi cation of the risk factors for osteoporosisrelated to nutrition is important in the prevention and treatment of this disease, considering that these factors can be modifi ed. The aim of this study was to examine infl uence of dietary calcium intake on bonemineral density in postmenopausal women who hadn’t a deficit of estrogen in their menstrual history.Methods: A total of 100 postmenopausal women living in Sarajevo area, aged 50-65 years, without estrogen deficiency in menstrual history were included in the study. Mineral bone density was measured at the lumbarspine and proximal femur by Dual–Energy X–ray Absorptiometry using Hologic QDR-4000 scanner. Examination and control group were formed based on mineral bone density values. The women in the examinationgroup had osteoporosis. The women in the control group had osteopenia or normal mineral bone density. Estimates of daily dietary calcium intake were performed based on a Food Frequency Questionnaire.Results: The average daily intake of dietary calcium among women who had osteoporosis was 967.32 mg, and in women who hadn’t osteoporosis 1195.12 mg. The difference between two groups was statistically significant (p&lt;0.001). There was registered signifi cant correlation between intake of dietary calcium and mineral bone density in examination (p&lt;0.01) and in control group (p&lt;0.01).Conclusion: The results of this study have shown that adequate daily intake of dietary calcium in postmenopausal women aged 50-65 years living in Sarajevo area, which hadn’t estrogen defi ciency in their menstrualhistory (in the group of women without osteoporosis amounted to 1195.12 mg) has a positive impact on bone mineral density.

Prospective study of histomorphometry, biochemical bone markers and bone densitometric response to pamidronate in β‐thalassaemia presenting with osteopenia‐osteoporosis syndrome

This study aimed to evaluate bone remodelling disorders in thalassaemia by using pamidronate (PD) infusion with or without hormone replacement therapy (HRT) as a diagnostic-therapeutic tool. In this prospective study, 24 adult thalassaemia major (TM) and 10 thalassaemia intermedia (TI) patients received either PD and HRT or HRT only (controls) for 3 years. Eugonadal patients with TI had PD only. Bone remodelling was assessed by dual energy X ray absorptiometry (DXA scan), type 1-collagen biochemical bone markers (BBM) and histomorphometry of iliac crest biopsy before and after PD. As a group, thalassaemics had a significant improvement in spinal and femoral bone mineral density Z scores following PD (P < 0·01) compared to the controls. Although BBM were comparable pre-therapy, they were significantly lower in the PD cohort (P < 0·001) compared to the control group. All patients had osteopenia, diminished osteoid formation and bone volume on histomorphometry pre-therapy with high turnover bone disease (HTO) in TM and low-turnover disease (LTO) in TI. In TM, bone volume improved significantly, whereas TI patients showed little or no response to PD. In conclusion, histomorphometry data suggest that TM patients have a distinct pathology of high turnover bone disease compared to TI patients, who have low-turnover disease.

Suppression androgénique dans le cancer de la prostate et risque ostéoporotique

Androgen deprivation therapy represents an important part of the management of prostate cancer. However, epidemiological data have shown that it is a well-established cause of osteoporosis and increased risk of fracture. So far no consensus guidelines have been published regarding the screening and treatment of osteoporosis in men with prostate cancer. Here we report the design of a new questionnaire, derived from the FRAX(®) ("Fracture Risk Assessment Tool") algorithm, to evaluate the risk of fracture in those patients. In accordance with recent reviews and on the basis of their experience, our French board of experts recommends systematic screening for osteoporosis with dual energy x- ray absorptiometry scans, practice of exercise and calcium and vitamin D supplementation, and selective treatment with bisphosphonates in men at greatest osteoporotic risk.

Influence of health education on life quality of patients with osteoporotic fracture

Objective To study the effects of health education on quality of life in patients with osteoporotic fracture.Methods From March 2006 to July 2011,240 patients with osteoporotic fracture admitted into our hospital were randomly divided into the intervention group (130 cases)and the control group( 110 cases).The control group only received routine nursing.The intervention group was applied with health education intervention based upon routine nursing.Bone mineral density were measured with dual energy X ray absorptiometry (DXA,DMS)in L2-4,neck of femur and total hip.MMSE.NIHSS,HAMD,FMA,Barthel index (BI)and WHOQOL-BREF were adopted for effect evaluation before and after three years of follow-up.Results After 3 years of follow-up,NIHSS and HAMD scores in the intervention group were lower than the control group,MMSE,FMA and BI scores were higher than those in the control group,physical,psychological,social and environmental scores in the intervention group were higher than those in the control group.Conclusions Health education for patients with osteopomtic fracture is conducive to patients′ rehabilitation and improvement of quality of life. Key words: Health education; Osteoporosis; Fracture; Quality of life

Early and long term body composition evolution post kidney transplantation influenced by the pre transplant nutritional characteristics: results of the CORPOS study

Many previous studies of renal transplant recipients have demonstrated that weight gain post kidney transplantation (KT) is frequent and may predispose to co morbidity. The aim of this prospective study was to evaluate changes in body composition (BC) during the first two years post KT and to determine predictors of these changes, with a special focus on pre KT parameters. When listed for a KT, 41 patients (14 women - 27 men) were included between 2007 and 2008 in a longitudinal study of evaluation of BC. Fat Free Mass (FFM) and Fat Mass (FM) were estimated by Dual-energy X- ray absorptiometry. At the same time, Extra Cellular Water (ECW) was measured by bio impedance spectroscopy. Cellular Active Mass (CAM) was defined as FFM – ECW. Energy and protein intake (EI –PI), physical activity (PA), biochemical and nutritional parameters were also recorded. Patients were evaluated every 6 months before KT, and 15 days, 1, 3, 6, 12 and 24 months after KT. During the first 2 years post KT, FM increase 0.09 kg/month (p=0.007), FFM by 0.06kg/month (p=0.0556) and MCA by 0.04kg/month (p=0.04). Univariate analysis showed that during the first 30 days post KT, FFM is strongly influenced by male gender, higher BMI, higher PIbefore KT, higher PA before KT and lower CRP post KT. During the first 2 years, FFM evolution is associated with male gender, higher EI and PI post KT. Early post KT evolution of FM is related to high BMI and high cumulative dose of corticosteroids. Long term evolution is associated with EI and use of corticosteroids. Pre KT EI and PI, as well as male gender and BMI influenced significantly the early evolution of MCA. In adjusted analyses, BMI and gender remained independently associated with FM, FFM and CAM. Furthermore, higher FFM level was associated with higher EI. We confirm that successful KT is associated with BC modifications; which can be detected very early post KT. These very early changes are strongly associated with energy, protein intake and physical activity level pre KT. Management of post KT weight gain should be anticipated with a special care on nutritional intake and physical activity in patients waiting kidney transplantation.

Regression Equation from Dual Energy X Ray Absorptiometry (DEXA) for Estimating Muscle Mass Segment

Metodos antropometricos eran usados para estimar la masa muscular (MM) no especificando valores para segmentos de cuerpo, un hecho critico para individuos que practican actividades fisicas o el diagnostico clinico. En este estudio, 60 atletas recreacionales son evaluados antropometricalmente y por absorciometria de energia dual de Rayos X. La estadistica de regresion lineal posteriormente es usada para establecer el constante el permiso de la obtencion del mm de segmento. Tres ecuaciones fueron obtenidas, un para los miembros superiores: MMUL = (0.533*FAP) - (0.176*RAP) + (0.42*WP) + (0.282*SRL) - 19,985; una segunda ecuacion para la masa muscular de los miembros superiores: MMLL = (0.186*H) - (0.158*LTTL) - (0.024*LTL) + (0451*LP) ­ 24.535; y una tercera para la masa muscular del tronco: TrMM = (0.026*W) + (0.046*H) + (0.154*TTD) + (0.025*NP) ­ (0.025*AP) ­ 5.839. Estas ecuaciones permiten la adquisicion de la informacion detallada sobre la distribucion de MM por una tecnica de acceso facil y rapido, como la antropometria, de un Metodo de Gold Estandar como DEXA.

New Application of Bioelectrical Impedance Analysis by the Back Propagation Artificial Neural Network Mathematically Predictive Model of Tissue Composition in the Lower Limbs of Elderly People

The accurate evaluation of muscle mass by a non–invasive and easy method is the first step to help prevent falling events in elderly people. To develop greater predictive accuracy and precision in the measurement of body composition in lower limbs by bioelectrical impedance analysis (BIA), the Back Propagation Artificial Neural Network (BP–ANN) was used to calculate predictive results and was compared with data from dual–energy X–ray absorptiometry (DXA) in 22 male and 16 female elderly people in Taiwan. Fat–free mass (FFM), tissue weight, and fat mass (FM) of the lower limbs were directly measured by DXA, and the BIA values (Z) of left side hand to right side foot in the standing position were measured by BIA. The parameters of height, weight, age, gender and BIA values were combined to create the BP–ANN mathematical model, which was developed to predict the FFM and FM in lower limbs in elderly. A relatively lower correlation coefficient ( r 2 ) of 0.964 and standard deviation (2SD) of 0.01 ± 3.64% were obtained for the prediction of FFM and FM by BIA with the BP–ANN mathematical model, whereas the linear regression analyzing model had an r 2 value of 0.845 and 2SD of 0.12 ± 7.68%, respectively. The performance of the BP–ANN mathematical model at BIA measurement was superior to that of the current linear regression model. In summary, the greater predictive accuracy and precision made the application of BIA with the BP–ANN mathematical model more feasible for the clinical measurement of FM and FFM in the lower limbs of elderly people.

No evidence of circulating autoantibodies against osteoprotegerin in patients with celiac disease

To investigate risk factors for low bone mineral density (BMD) in celiac disease (CD) patients, focusing on circulating autoantibodies against osteoprotegerin (OPG). Seventy asymptomatic CD adult patients on gluten-free diet (GFD) and harbouring persistent negative CD-related serology were recruited. Conventional risk factors for osteoporosis (e.g., age, sex, menopausal status, history of fractures, smoke, and body mass index) were checked and BMD was assessed by dual energy X ray absorptiometry. Serum calcium and parathyroid hormone (PTH) levels were evaluated. Thirty-eight patients underwent repeat duodenal biopsy. Serum samples from a selected sub-group of 30 patients, who were also typed for human leukocyte antigen (HLA) DQ2 and DQ8 haplotype, were incubated with homodimeric recombinant human OPG and tested by western blotting with an anti-OPG antibody after immunoprecipitation. Despite persistent negative CD-related serology and strict adherence to GFD, 49 out of the 70 (74%) patients displayed low BMD. Among these patients, 13 (24%) showed osteoporosis and 36 (76%) osteopenia. With the exception of age, conventional risk factors for osteoporosis did not differ between patients with normal and low BMD. Circulating serum calcium and PTH levels were normal in all patients. Duodenal mucosa healing was found in 31 (82%) out of 38 patients who underwent repeat duodenal biopsy with 20 (64%) still displaying low BMD. The remaining 7 patients had an incomplete normalization of duodenal mucosa with 6 (84%) showing low BMD. No evidence of circulating antibodies against OPG was found in the serum of 30 celiac patients who were tested for, independent of BMD, duodenal histology, and HLA status. If any, the role of circulating autoantibodies against OPG in the pathogenesis of bone derangement in patients with CD is not a major one.

Skeletal Muscle Mass in Elderly Heart Failure Patients; Comparison between Systolic and Diastolic Heart Failure and Corresponding Significance in Exercise Capacity

Methods: We studied 39 ambulatory heart failure patients (age, 77.9±6.5; male, 17 (43.6%)) and 39 age and gender-matched, community-dwelling, elderly subjects. Clinical, laboratory, and echocardiographic evaluations were performed. Dual-energy X- ray absorptiometry was performed to assess the body composition. Exercise capacity was measured by a six-minute walk test. Comprehensive geriatric assessments were also performed to evaluate comorbidity, medication, physical function, cog- nitive function, and nutritional status. Results: Skeletal muscle mass of heart failure patients showed no differences when compared with that of age- and gen- der-matched control subjects in any part of the body or in the whole body. Although diastolic heart failure patients showed lower levels of skeletal muscle mass than systolic heart failure patients, no significant difference was identified in either systolic or diastolic heart failure patients compared with respective age- and gender-matched control groups. The six-minute walk distances showed no difference between the groups (257.2±117.8 m in the diastolic heart failure group versus 302.7± 109.4 m in the systolic heart failure group, p=0.226). Conclusion: Although skeletal muscle mass has been known to be an independent factor associated with exercise capa- city in advanced heart failure patients, skeletal muscle mass was not decreased in ambulatory, elderly heart failure patients when comparing age- and gender-matched control subjects.

Evidence of Increased Muscle Atrophy and Impaired Quality of Life Parameters in Patients with Uremic Restless Legs Syndrome

BackgroundRestless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival.Methodοlogy/Principal FindingsUsing the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition.ConclusionsThe low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep.

The foot in type 2 diabetes: Is there a link between vascular calcification and bone mineral density?

AimsTo examine the relationship between vascular calcification in the foot (FVC) and bone mineral density (BMD) in the heel of type 2 diabetes mellitus (DM) subjects. Methods65 subjects with type 2 DM and serum creatinine<125μmol/l underwent CT scanning of the foot to assess FVC and dual energy X ray absorptiometry (DEXA) scan to assess heel BMD. Routine biochemistry including osteoprotegerin (OPG) and Receptor activator of nuclear factor kappa-B ligand (RANKL) was also carried out. ResultsThe proportion of subjects with FVC was 43%, whilst 40% had low BMD (T score<−1.0). Age, neuropathy and 25 hydroxyvitamin D were independent predictors of FVC. Body-weight, eGFR, 25 hydroxyvitamin D, OPG, and total cholesterol were independent predictors of low heel BMD. There was no correlation between albuminuria and BMD or FVC. There was no difference in heel BMD between those with FVC and those without, but those with frank osteoporosis were significantly more likely to have FVC than those with higher BMD. ConclusionsThere is no clear-cut association between FVC and low BMD in type 2 DM with relatively well-preserved renal function. Age, neuropathy, eGFR, hyperlipidemia, body-weight, 25 hydroxyvitamin D and OPG play a complex role in their pathogenesis.

Dietary calcium intake and risk of fracture and osteoporosis: prospective longitudinal cohort study

Objective To investigate associations between long term dietary intake of calcium and risk of fracture of any type, hip fractures, and osteoporosis.Design A longitudinal and prospective cohort study, based on...