Significant Decrease In Bone Mineral Density Research Articles

Abstract PO2-12-06: Comparative Study on Bone Mineral Density in Premenopausal Patients with Estrogen Receptor-Positive Breast cancer in ASTRRA study: a 5-year follow-up study

Abstract Background With the positive outcomes associated with Ovarian Function Suppression (OFS) treatment as reported in the ASTRRA study, which compare two therapeutic strategies, tamoxifen alone and ovarian function suppression (OFS) in premenopausal patients after chemotherapy, the role of OFS has getting important. However, considering the increased risk of bone density reduction associated with postmenopause in women, the understanding these effects is crucial in devising strategies that not only effectively combat the cancer but also concurrently safeguard the patients’ bone health. This study aimed to compare the impacts of two therapeutic strategies, tamoxifen alone and OFS on bone mineral density (BMD) in premenopausal patients after chemotherapy. Methods Of the 1483 premenopausal enrolled in ASTRRA study, we focused on a subset of 522 patients who had undergone BMD examinations at diagnosis, 3 years and 5 years after diagnosis. Patients were stratified into three categories: normal, osteopenia, osteoporosis, and we examined the changes in their classifications over the 3-year and 5-year periods from baseline to identify any deterioration in bone density. Also, Patients were examined ovarian function every 6 months for 2 years and have different randomization times. Further categorization was carried out according to the time of randomization, which means starting time of OFS after recovery of ovary function. Lastly, we conducted a subset analysis using data from the Asan Medical Center (AMC), specially focused on the absolute value of one density measured in g/cm3. Results The median age of 522 patients was 41.1 and at baseline, a higher incidence of osteopenia was observed in the OFS addition group (p=0.028). Both analysis of change in BMD categories of from baseline to 3-year and baseline to 5-year period showed no significant differences between TAM only and TAM+OFS group (3-year: p=0.567, 5-year: p=0.600). However, there was a significant increased risk of bone density deterioration in the OFS addition group, when randomization occurred at the first visit (HR= 2.970, p=0.008). Within the AMC subset, statistically significant decrease in BMD were observed in the OFS addition group at the spine (p=0.023) and femur (p=0.040) over a baseline to 3-year period. Although a decrease in BMD was also observed over a baseline to 5-year period at both the spine and femur, this change was not statistically significant. Conclusion This study revealed a deleterious impact on bone density associated with the addition of OFS, compared to tamoxifen-only treatment. Remarkably, our findings also indicated that early suppression of ovarian function exerts even more detrimental influence on bone health in premenopausal, estrogen receptor-positive breast cancer patients, who have recovered ovarian function. Change between baseline to 5 years according to randomization time interval The table shows the risk associated with bone health deterioration according to the duration of randomization, thus specifying the time interval between the recovery and suppression of ovarian function. Citation Format: Eunju Shin, Seung Il Kim, Min-ho Park, Hyun-Ah Kim, Yongsik Jung, Jai Min Ryu, Eun Hwa Park, Sung Yong Kim, Eun-Gyeong Lee, Min Hyuk Lee, Jung Ho Park, Seock-Ah Im, Soong June Bae, Su Hwan Kang, Woosung Lim, Hyun Jo Youn, Heung Kyu Park, Kyong Hwa Park, Tae-Hyun Kim, Shin-Young Park, Cheol wan Lim, Geum-Hee Kwak, Chanheun Park, Hyuk-Jae Shin, Young Bum Yoo, Sun Hee Kang, Bong Kyun Kim, Hee Jeong Kim. Comparative Study on Bone Mineral Density in Premenopausal Patients with Estrogen Receptor-Positive Breast cancer in ASTRRA study: a 5-year follow-up study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-12-06.

Results of bisphosphonate withdrawal: duration of antiresorptive activity, fractures, changes in BMD and bone turnover markers

The review discusses the possibility of discontinuation of bisphosphonates (BPs), based on the mechanism of action of the drugs, the duration of their antiresorptive activity, criteria for discontinuation and return to therapy. BPs have a unique feature – maintaining the clinical effect for a long time after their withdrawal. Since BPs therapy is carried out for a long time, their accumulation in bone tissue, on the one hand, and the risk of developing severe adverse events, on the other hand, gave rise to discussion on the concept of temporary withdrawal of drugs and the organization of «drug holidays». The main criteria that are relied upon in the question of discontinuation of BPs and re-prescription at present are: 1) the risk of developing new fractures, 2) changes in bone mineral density (BMD), 3) dynamics of markers of bone metabolism. The conducted studies suggest that the suspension of treatment after 3-5 years of continuous therapy with BPs is possible in women who do not have low BMD indicators at the end of the course of therapy, while with continuing low levels of BMD, additional benefits from continuing therapy are likely. The loss of bone mass in the proximal femur and its preservation in the spine 2 years after discontinuation of BPs treatment is explained by their different localization and longer-term effect on bone metabolism in the spongy bone, i.e. in the spine. Delivery and absorption of BPs in the spine may be more intense than in other parts of the skeleton. Tracking the level of markers during a break in the treatment of BPs can be useful to determine the time of resumption of therapy: if their concentration approaches the baseline (before treatment), the patient’s condition should be reassessed and the issue of resuming therapy should be discussed. It should be noted that the optimal duration of «drug holidays» has not been established and should be selected individually depending on clinical circumstances, taking into account the presence of fractures, a significant decrease in BMD or an increase in markers of bone metabolism, as well as the presence and/or appearance of new clinically significant risk factors.

Tobacco toxins induce osteoporosis through ferroptosis

Clinical epidemiological studies have confirmed that tobacco smoking disrupts bone homeostasis and is an independent risk factor for the development of osteoporosis. The low viability and inferior osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) are important etiologies of osteoporosis. However, few basic studies have elucidated the specific mechanisms that tobacco toxins devastated BMSCs and consequently induced or exacerbated osteoporosis. Herein, our clinical data showed the bone mineral density (BMD) values of femoral neck in smokers were significantly lower than non-smokers, meanwhile cigarette smoke extract (CSE) exposure led to a significant decrease of BMD in rats and dysfunction of rat BMSCs (rBMSCs). Transcriptomic analysis and phenotype experiments suggested that the ferroptosis pathway was significantly activated in CSE-treated rBMSCs. Accumulated intracellular reactive oxygen species activated AMPK signaling, furtherly promoted NCOA4-mediated ferritin-selective autophagic processes, increased labial iron pool and lipid peroxidation deposition, and ultimately led to ferroptosis in rBMSCs. Importantly, in vivo utilization of ferroptosis and ferritinophagy inhibitors significantly alleviated BMD loss in CSE-exposed rats. Our study innovatively reveals the key mechanism of smoking-related osteoporosis, and provides a possible route targeting on the perspective of BMSC ferroptosis for future prevention and treatment of smoking-related bone homeostasis imbalance.

Relationship between Waist Circumference, Waist-Height Ratio, Body Fat Percentage, Visceral Fat and Bone Mineral Density in Middle-Aged and Elderly Zhuang of China

Objective: To understand the correlation between different degrees of obesity and bone mineral density (BMD). Methods: 772 cases (300 men and 472 females) of Zhuang over 40 years old were randomly selected. The BMD and T score were calculated by measuring the right heel bone using a quantitative-ultrasound densitometer. Body composition index of body weight, waist circumference (WC), waist height ratio (WtHR), body fat percentage (BFP) and visceral fat (VF) were measured using a bioelectrical impedance method. Results: The BMI, WC, and WtHR of the male osteoporosis group were lower than those of the normal bone mass (NBM) group (P < 0.05). BMI, BFP, and WC in the female osteoporosis group were lower than those in the NBM group (P < 0.05); The BMI and WC in the osteoporosis group were lower than those of the NBM group (P < 0.05). After adjusting for factors such as age, weight, height, etc., the binary multivariate conditional logistic regression analysis showed that BMI was a protective factor for bone mass loss in men and women (P < 0.01). While the level of visceral fat was a risk factor for reduced bone mass (P < 0.05). Conclusion: BMI is positively correlated with BMD in Zhuang. BFP has a greater correlation with female BMD, and a small reduction in BFP can result in a significant decrease in BMD. BMD of male was positively correlated with abdominal obesity indicators (WC, WtHR, VF). However, abdominal obesity has no obvious effect on the promotion of BMD in women, and increased WtHR can lead to a decrease in BMD. Zhuang can appropriately increase the amount of fat within the normal weight range. At the same time, reasonable exercise and balanced nutrition to avoid excessive obesity or low body weight can reduce the incidence of osteoporosis and osteoporosis fractures.

Bone mineral density changes in osteoporotic and osteopenic patients after COVID-19 infection

BackgroundCoronavirus disease 2019 (COVID-19) infection is linked to high levels of inflammatory cytokines and prolonged immobilization; furthermore, corticosteroid treatment leads to increased bone loss and resorption. We aimed to study the change in bone mineral density (BMD) after COVID-19 infection in osteoporotic and osteopenic patients. One hundred osteoporotic or osteopenic patients were selected in this single-center retrospective study; the patients were divided into two groups. Group 1 included 56 patients who got COVID-19 infection. Group 2 included 44 patients who did not get COVID-19 infection. BMD was assessed at baseline, after 9 months of COVID infection, and then after 1 year follow-up using dual energy x-ray absorptiometry (DXA) scan.ResultsThere was no significant difference between two groups regarding demographic data (p > 0.05); there was a significant decrease in BMD of the lumbar region and femur at 9 months as compared to baseline in group1 (p < 0.001), while there was a significant increase in the lumbar BMD of osteoporotic patients who did not get COVID infection after 21 months. Concerning activity of COVID infection, there was a significant difference between the three subgroups of COVID patients regarding percentage of change in BMD after 9 months, the severe group having the highest decrease in BMD (p < 0.001).ConclusionsCOVID-19 may have deleterious effect on BMD in osteoporotic patients. It is recommended to assess BMD in osteoporotic/osteopenic patients who got COVID infection to detect if there is an increased risk of fracture which may necessitate post-COVID change in the therapeutic intervention plan.

HIV/AIDS Hastalarında Osteoporoz/Osteopeni Sıklığı, D Vitamini Düzeyleri ve İlişkili Risk Faktörleri

Amaç: İnsan immün yetmezlik virüsü (HIV) ile enfekte bireylerde kemik mineral yoğunluğunda (KMY) azalma sık görülmekte ve osteopeni, osteoporoz oranı ile kemiklerde kırık riski genel popülasyona göre daha yüksek seyretmektedir. Çalışmamızda çift enerjili X-ışını absorbsiyometrisi (DXA) sonucuna göre hastalarımızın osteoporoz/osteopeni sıklığı ve ilişkili risk faktörlerinin irdelenmesi, 25 (OH) vitamin D sonuçlarının değerlendirilmesi hedeflendi. Materyal ve Metod: Kliniğimizde 2011-2021 tarihleri arasında takip ettiğimiz HIV ile enfekte hastaların dosyaları geriye dönük olarak incelendi. DXA sonucuna ve 25 (OH) vitamin D düzeyine ulaşılan hastalar çalışma kapsamında değerlendirildi. Olguların yaş, cinsiyet, bulaş şekli, sigara kullanımı, CD4 T lenfosit düzeyleri, HIV RNA seviyeleri KMY sonuçlarına göre karşılaştırıldı. Bulgular: KMY sonucuna ulaşılan 146 hastanın yaş ortalaması 44, CD4 T lenfosit ortalaması 399 idi. Hastaların 9 (%6)’unda osteoporoz, 44 (%30)’ünde osteopeni saptandı. Osteoporoz/osteopeni saptanan hastaların % 49’u 50 yaş altında idi. Cinsiyet, CD4 T lenfosit sayısı, HIV viral yük açısından osteoporoz/osteopeni ile KMY normal olan grup arasında istatistiksel anlamlı fark saptanmadı. 25 (OH) vitamin D düzeyleri, 0-20 arasında olanlar 85/116 (%73), 21-30 arasında olanlar 24/116 (%20), 30’un üzerinde olanlar 7/116 (%6) bulundu. Sonuç: Çalışmamızda, HIV ile enfekte hastalarımızın önemli bir kısmında KMY’de azalma ve ciddi D vitamin eksikliği saptanmıştır. Özellikle tarama önerilmeyen genç hasta grubunda da osteoporoz/osteopeni insidansının yüksek olduğu gözden kaçırılmamalıdır. D vitaminin immünmodülatör ve kemik sağlığında ki etkileri göz ardı edilmeden eksikliğin olduğu hastalara replasman tedavilerinin uygulanması gerektiğini düşünmekteyiz.

Effect of Degarelix Administration on Bone Health in Prostate Cancer Patients Without Bone Metastases. The Blade Study.

As patients are now living with prostate cancer for longer, the long-term impact of hormonal treatment on bone health is an increasingly debated subject. To characterize the changes in bone mineral density (BMD) and bone turnover markers after degarelix administration in prostate cancer patients without bone metastases. To explore the predictive role of body composition on treatment induced bone loss. BMD and body composition (lean body mass, fat body mass, and appendicular mass index [ALMI]) were assessed by dual X-ray absorptiometry on study entry and after 12 months of degarelix therapy. Alkaline phosphate (ALP) and C-terminal telopeptide of type I collagen (CTX) were assessed at baseline, and 6 and 12 months. Twenty-nine patients entered the study. Degarelix administration was associated with a significant decrease in BMD after 12 months (2.4% reduction from baseline at lumbar spine). Serum CTX and ALP increased significantly (median increase from baseline 99% and 19.3%, respectively). An inverse correlation was observed between ALMI and CTX, but not ALP, at both baseline (Pearson r = -0.62, P < .0001) and month 12 (Pearson r = -0.41, P = .032). Moreover, a significant inverse correlation between changes in ALMI and CTX at 12 months (Pearson r = -0.43, P = .019) and a direct relationship between changes of ALMI and ALP (Pearson r = 0.44, P = .016) during degarelix therapy were observed. Degarelix administration is associated with a significant decrease in BMD and increase in bone turnover markers. ALMI is a promising predictor of bone loss in prostate cancer patients receiving androgen deprivation therapy, and ALMI changes during therapy are associated with bone turnover derangement favoring bone quality alterations.

Effect of Teriparatide on Subsequent Fracture and Bone Mineral Density in 47 Women with Pregnancy- and Lactation-associated Osteoporosis and Vertebral Fractures.

Introduction Pregnancy- and lactation-associated osteoporosis (PLO) with predominantly vertebral fractures is a rare but severe disease which can occur in the last trimester of pregnancy or postpartum. The aim of the present study was to assess the impact of teriparatide on subsequent fractures and bone mineral density (BMD) in patients with PLO. Materials and Methods A total of 47 patients with PLO and postpartum spinal fractures (mean: 4 fractures) undergoing treatment with teriparatide were investigated. The data collection period was set between 2006 and 2018. All patients received a subcutaneous injection of 20 µg teriparatide once a day for 24 months as well as individually adapted vitamin D supplementation. After 24 months of treatment, all women received no further treatment and either had regular menstrual cycles or took oral contraceptives. Fractures were confirmed by X-ray or MRI. Changes in BMD from baseline were examined using serial DXA measurements. Results After 24 months of teriparatide treatment, we could demonstrate an increase in BMD at the lumbar spine, femoral neck and total hip of + 30.1%, + 11.7% and + 12.2% respectively (p < 0.001 for all). At 12 months after cessation of treatment, BMD remained stable compared to the 24-month measurements at the lumbar spine, femoral neck and total hip which showed non-significant changes of + 1.4%, + 2.6% and + 4.1% respectively. Out of the 47 patients with PLO with a mean of 4 existing fractures, 4 patients (7.8%) sustained a subsequent fracture, two after 3 – 5 months of treatment and two at > 6 months of treatment. Conclusion 24 months of treatment with teriparatide in women with PLO and multiple vertebral fractures significantly increased BMD, predominantly BMD of the spine. As patients were premenopausal, there was no significant decrease in BMD in the following 12 months after cessation of treatment.

MO542: Bone Mineral Density, Bone Micro-Architecture Evolution After Kidney Transplantation: A Prospective Cohort Study

Abstract BACKGROUND AND AIMS Bone loss and mineral abnormalities are frequent in kidney transplant recipients (KTRs) and associated with a high risk of fracture, cardiovascular mortality and an increase in health care costs. In daily clinics, the detection of bone abnormalities after transplantation includes bone biomarkers and imaging technique [Dual Energy X-ray (DEXA)] to assess respectively the bone turnover and the bone mineral density (BMD), but with limitations. The high-resolution peripheral quantitative computed tomography (HR-pQCT) provides additional noninvasive information on bone microarchitecture and BMD with a better distinction between cortical and trabecular areas. The goal of our study is to evaluate the evolution of bone structure using HR-pQCT compared to standard technique (DXA) in a prospective cohort of KTRs. METHOD All patients referred for a single kidney transplant at the university hospital of Liège with no history of exposure to antiresorptive agents were eligible for inclusion (NCT04713774). Participants underwent baseline and 3-month biomarkers analysis, BMD measurements by DEXA. HR-pQCT images were obtained of the distal radius and distal tibia (non-dominant, non-fractured limb) using the XtremeCT device with standard protocols. HR-pQCT assessed quantitative measurement of the volumetric density of trabecular and cortical bone as well as bone structure (trabecular number or thickness or cortical porosity for instance). RESULTS A total of 26 patients were prospectively included. The mean age was 57.3 ± 12.1 years. The mean dialysis vintage was 27.5 ± 16.4 months before transplantation. Bone biomarkers showed a significant decrease at 3 months after transplantation. PTH decreased from 221.72 ng/L to 59.6 ng/L (P &amp;lt; 0.0001), P1NP from 211 ug/L to 72 ug/L (P &amp;lt; 0.013) and BLAP from 23 ug/L to 13 ug/L (P = 0.042). BMD was measured by DXA and HR-pQCT at 7 days [6; 8] and 102 days (90; 113) after transplantation. We observed a significant reduction of BMD by DXA at the hip site from 0.868 g/cm2 to 0.856 g/cm2 (P = 0.02), but not at the lumbar site. The HR-pQCT analysis demonstrated a significant reduction of the trabecular BMD from 152.62 mg HA/ccm to 150.80 mg HA/ccm (P &amp;lt; 0.0001) at the tibia site and from 159.09 mg HA/ccm to 156.25 mg HA/ccm (P &amp;lt; 0.0001) at the radius site. No change in bone structure have been observed at 3 months post-transplantation with the HR-pQCT analysis. CONCLUSION HR-pQCT is sensitive enough to show a significant decrease of BMD at the trabecular site, as soon as 3 months after transplantation compared to DEXA at the lumbar spine. However, no change in bone structure nor cortical bone volume has been observed. The sensibility of this technique might be higher than DEXA. The rapid assessment of bone structure (3 months post-transplantation) might be too soon to evaluate such abnormalities. Detecting properly rapid changes in bone density, as soon as 3 months after renal transplantation seems feasible. The impact on bone health management needs to be further studied.

Эффективность применения золедроновой кислоты при лечении остеопороза у больных раком предстательной железы, получающих терапию агонистами ГнРГ

Introduction. It has been established that prolonged androgen-deprivation therapy (ADT) of prostate cancer leads to a decrease in bone mineral density (BMD) and increases the risk of fractures, which is an important medical and social problem. Zoledronic acid (ZA) is most often used for the prevention of osteoporosis against the background of ADT. The purpose of the study is to determine the efficacy and safety of ZA for the treatment and prevention of osteopo-rosis in non-metastatic prostate cancer against the background of ADT therapy with GnRH agonists. Materials and methods. The study included 45 men aged 54-81 years with morphologically verified prostate cancer (stages T2-4 N0-1 M0) who underwent surgical castration at least 6 months before inclusion or continuously received therapy with GnRH agonists. The blood level of CTX-1 was used as the main marker of bone resorption. To assess the BMD, the screening method of dual-band X-ray densitometry of the calcaneus with laser determination of the examination area – DXL using the CALSCAN apparatus and the DXL Calscan Workstation software was used. Patients were randomized into groups of 15 people each: Group 1 – received intravenous infusion of ZA at a dose of 4 mg at the beginning of the study and after 3 months of treatment; Group 2 received ZA at 2 mg in the same mode; Group 3 – control. For antire-sorptive therapy (ART), the drug Resorba (JSC «Pharm-Synthesis», Russia) was used. The duration of follow-up was 6 months. Results. In 13 out of 15 patients of Group 1, 3 months after the first administration of ZA, a decrease in the level of CTX-1 by 50% or more was observed, and after 6 months all 15 patients (100%) reached the age norm («complete answer»). Group 2 patients also responded to ART and by the 6th month 13 out of 15 (87%) had achieved a «complete response». In the control group by the 6th month the decrease in CTX-1 was not observed in any of the patients. Initially, the values of BMD in the studied groups did not differ. By the 3rd month of the study, the BMD index significantly increased only in Group 1. In Group 2 this indicator significantly increased by the 6th month of treatment. At the same time, in Group 1 after 6 months the BMD index reached higher values than in Group 2: an increase of 27% and 13%, respectively. In the control group, by the 6th month of observation, a significant decrease in BMD by 12% was noted. In Group 1, the number of patients with osteoporosis decreased to 6% and with a normal level of BMD – reached to 40%. Conclusion. High efficacy and sufficient safety of ZA in doses of 4 mg and 2 mg i/v one time in 3 months for anti-resorptive therapy in patients receiving long-term hormonal therapy with GnRH agonists has been demonstrated.

Evaluation effects of sleeve gastrectomy to bone metabolism and bone mineral densitometry in patients over 50 years

Background: Despite the improvement in health, function and quality of life of patients with morbid obesity following bariatric surgery, such intervention may result in some potential complications such as metabolic disturbances especially involving bone motabolism. The aim of this study was to evaluate the extent of Bone Mineral Density (BMD) changes in older patients with morbid obesity and its relation with bone metabolism indices. Methods: This study was a single-center cross-sectional study on 50 new morbidly obese patients over 50 years old of age who were candidates for bariatric surgery. Before and 6 months after surgery, the values of BMD, anthropometric indices and metabolic serum biomarkers were assessed. Results: BMD examination before and 6 months after surgery showed decrease in the BMD in hip region from 1.242 ± 0.136 to 1.117 ± 0.112 g/cm2, in the femoral neck from 1.109 ± 0.131 to 0.987 ± 0.127 g/cm2, in the lumbar spine from 1.253 ± 0.146 to 1.190 ± 0.135 g/cm2. The analysis of BMD changes showed significant decrease in the bone density of all site measurement but with variable amounts. The decrement of BMD in the hip and femoral neck was significant but in the spine was not significant. The analysis on bone metabolism markers showed significant increase in 25-Hydroxy vitamin D and Alkaline phosphatase levels but decrease in calcium and parathyroid hormone (PTH) during 6 month follow up. Conclusion: There is significant decrease in BMD at various skeletal areas including femoral neck and hip region. Such changes can be in line with the changes in some serum metabolic and hormonal biomarkers such as calcium, PTH, vitamin D and alkaline phosphatase.

The Impact of Natural Calcium Carbonate and Ubiquinone on Bone Mineral Density in Rabbits

Objective: The aim of this study was to investigate the effect of ubiquinone and/or calcium carbonate (CaCO3) on bone mineral density in rabbits at healing site in mandibular bone postoperatively. Materials and Methods: Sixty healthy white male New Zealand rabbits almost the same age, weight and circumstance were used in this study. All animals were submitted to operation in the mandibular bone region. The groove of 2mm diameter and 6mm length was drilled by the heavy-duty dental engine. After operation rabbits were randomly divided into six groups (each group 10 rabbits) five rabbits for each period; control group (groove was not filled by anything) and treated groups which subdivided into five groups as follows: group I (groove was filled with Ubiquinone), group II (groove was filled with CaCO3), group III (groove was filled with CaCO3: Ubiquinone as a ratio (1:1)), group IV (groove was filled with CaCO3: Ubiquinone as a ratio (1:2)) and group V (groove was filled with CaCO3: Ubiquinone as a ratio (2:1)). Estimated BMD using Densitometry analysis was measured after 15 and 30 days respectively. Results: Statistical analysis showed significant differences between all groups (control and treated). The estimated BMD showed significant increase group I(101±1.05), group II(111±2.23), group III(125±3.54), group IV(126±5.13) and group V(133±6.29) comparing to control group (92±0.15) at follow-up times at 15 day. Also in the present study we found that significant decrease in BMD after 30 days of operation in group I(144±3.45), group II(153±6.24), group III(160±8.94), group IV(165±9.11) and group V(182±12.56) compare to control group(109±1.25) respectively. Adding the ubiquinone and/or CaCO3 showed a significant increase in BMD manifested by bone healing like space-filling and newly formed bone trabeculae and a high number of lacunas compared with the control group. Conclusion: This study concluded that the addition of ubiquinone and/or CaCO3 was successfully increasing in bone healing by increasing BMD compared with the control group. Keywords: Ubiquinone, CaCO3, Bone healing, BMD (Bone Mineral Density).

Comparison of periprosthetic bone mineral density between two types of short-stems in total hip arthroplasty with a mean follow-up of 4 years

IntroductionThe use of short stems in primary hip arthroplasty has grown considerably in recent years, with a large variety of designs and stabilization methods available. Few studies have directly compared how these designs and fixation modes influence the bone mineral density (BMD) that is said to be better preserved with shorter implants. This led us to carry out a medium-term retrospective comparative study to (1) specify how the design of two different types of short stems influences the periprosthetic BMD, (2) compare the radiological and clinical outcomes of these stems. HypothesisThe periprosthetic BMD of a short stem varies based on the implant's design. Materials and methodsNinety-three patients underwent total hip arthroplasty (THA) with a short stem between July 2012 and July 2014. Two groups of patients were formed: Vitae™ short stem (Adler Ortho, Milan, France), Optimys™ short stem (Mathys, Bettlach, Switzerland). The Vitae group consisted of 46 patients, while the Optimys group consisted of 47 patients. The mean age was 66 years, and the mean body mass index (BMI) was 26 kg/m2. The groups had comparable age, BMI, sex, Harris Hip score and preoperative radiological features. Periprosthetic BMD of the two types of implants was determined between the 1st and 4th year postoperative using dual-energy x-ray absorptiometry (DEXA) in the Gruen zones. The radiological and clinical outcomes were also determined. ResultsThere was a significant decrease in BMD in zone 7(−5.8%±0.1 CI95%[−0.09; −0.02] (p=0.003)), zone 2 (−4.8% ±0.1 CI95%[−0.093; −0.003] (p=0.038)) and zone 6 (−11% ±0.2 CI95%[−0.19; −0.03] (p=0.009)) in the patients with Vitae stems and in zone 2 (−13.7%±0.3 CI95%[−0.25; −0.03] (p=0.018)) in the patients with Optimys stems. A significant difference in BMD in zone 7 at 1 year (p=0.014) and 4 years (p=0.001) postoperative and in zone 6 (p=0.011) at 4 years postoperative existed between groups, with the Optimys group having higher BMD. There was a significant increase in femoral offset in the Optimys group but not the Vitae group: Δoffset=–0.50 mm±5.2 CI95%[−2.05; 1.05] (p=0.522) and Δoffset=2.79 mm±4.2 CI95%[1.21; 4.37] (p=0.001). The Harris Hip score was not significantly different between the two groups at 4 years postoperative (95.3±2.5 [88; 99] vs. 95.2±2.6 [88; 99] (p=0.991)). DiscussionThe design of short stems appears to influence the distribution of loads and the periprosthetic BMD. These stems are associated with very good radiological and clinical results in the medium term. Bone remodeling appears to continue beyond 1 year after the THA procedure. Level of evidenceIII; Retrospective case-control study.

Hypercalcemia as a marker of decreased bone mineral density in patients with peptic ulcer disease

Purpose of the study. To study calcium-phosphorus metabolism in patients with peptic ulcer (PU) in comparison with bone mineral density (BMD), its age and gender aspects. Materials and methods. 216 people with ulcer were in remission and 154 people without ulcer history and erosive-ulcerative changes during fibrogastroduodenoscopy (FGDS) were examined. All patients underwent clinical and endoscopic studies, dichromatic X-ray densitometry with the calculation of the T-test of the femoral neck (FN) and the lumbar spine (LS). Calcium and blood phosphorus have been studied. Results. In patients with PU compared with patients without this pathology there was a significant decrease of BMD. In 32% of patients with PU osteoporosis (OP) was diagnosed and in 34% of patients - osteopenia. In the group of persons who had no PU osteoporosis was found in 18%, osteopenia in 26% of cases. In both groups women prevailed. Blood calcium was significantly higher in patients with PU as compared to those examined without an ulcer history. A significant increase of calcium was observed in individuals with a comorbid course of PU and OP. Conclusion. The data obtained show that the study of blood calcium can serve as a simple criterion for diagnosing disorders of BMD and, if its values are high, conduct a more detailed examination of patients with PU for early detection of OP and the possibility of its treatment.

Effect of 6-12 Weeks of Systemic Glucocorticoids on Bone Mineral Density in Children

Introduction: Prolonged use of systemic steroids in children is associated with many side-effects including effect on Bone Mineral Density (BMD). Effect of more than three months of systemic steroids on BMD has been studied in children but not the effect of 6-12 weeks duration of steroid. Aim: To evaluate the effect of 6-12 weeks of systemic glucocorticoids on BMD in children. Materials and Methods: A longitudinal observational study was conducted at a Tertiary Care Hospital. Dual Energy X-ray Absorptiometry (DEXA) of Whole Body (WB), Lumbar Spine (LS) and Distal Radius (DR) were done at baseline, end of steroid therapy or third month whichever was earlier and end of six months, on 30 patients receiving systemic steroid (Nephrotic Syndrome (NS)-7, Systemic Onset Juvenile Idiopathic Arthritis (SOJIA)-12, Tubercular Meningitis-11). Age and sex adjusted values of Bone Mineral Content (BMC), BMD and Z scores were analysed. Bone densitometric parameters of Total Body Less the Head (TBLH) were derived from WB values. X-rays of whole spine (antero-posterior and lateral view) were done at baseline and follow-up. Equal number of age and sex matched healthy controls were subjected to biochemical and DEXA scans at baseline. Continuous and categorical variables were compared using Student’s t-test and Fisher-exact test, respectively. Pairwise comparison over period of time was done using Bonferroni correction. Results: Bone densitometric parameters of cases and controls were comparable at baseline. At follow-up statistically significant decrease in BMD was found at all three sites. A statistically significant negative correlation was found between cumulative dose of steroid and duration of steroid treatment with Z score of TBLH. No vertebral fractures were detected at baseline or follow-up. Conclusion: Use of systemic glucocorticoids for 6-12 weeks negatively affects bone mineralisation, not only during therapy but even three months after stopping it.

Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women

The objective of this study is to investigate the effect of adequate vitamin D supplementation on bone mineral density (BMD) following long limb-biliopancreatic diversion (LL-BPD), a malabsorptive bariatric operation. Marked weight loss following bariatric surgery is associated with significant decrease in BMD, attributed to the weight loss and to nutritional, mineral, and vitamin D deficiencies resulting in secondary hyperparathyroidism. Two groups, of 35 and 37 healthy, obese (BMI, 50.4+6.6 and 46.5+4.8g/cm2), premenopausal, normally menstruating women underwent LL-BPD. Both groups received high-calcium diets, 600IU of vitamin D, and 1000mg elemental calcium daily, while group B received an extra dose of vitamin D (10,000IU/day) during the first postoperative month, followed by dose adjustment in order to maintain 25OHD concentration higher than 30μg/L. Areal BMD (aBMD) was measured at the lumbar spine preoperatively and 1year postoperatively. One year postoperatively, BMI decreased by approximately 19kg/m2 in both groups, while 25-OH-vitamin D levels did not change in group A (18.7+9.1 to 20.2+13.0μg/L, (p = 0.57)) and increased in group B (15.58 ± 5.73 to 52.97 ± 15.46μg/L, (p = < 0.001). PTH levels increased in group A (from 38.5 ± 12.2 to 51.2 ± 32.8pg/ml) (p = 0.047) and decreased in group B (from 51.61 ± 18.7 to 45.1 ± 17.8pg/ml) (p = 0.042). Lumbar spine aBMD decreased similarly in both groups (p = 0.311, for the comparison between groups) from 1.198+0.14 to 1.103+0.15g/cm2 in group A (p < 0.001) and from 1.157+0.14 to 1.076+0.14g/cm2 in group B (p < 0.001) and Z-score from 0.93+0.97 to 0.19+1.02, (p < 0.001) and from 1.15+1.29 to 0.419+1.28, (p < 0.001), respectively. LL-BPD leads to similar and significant bone mass reduction 1year postoperatively, irrespective of adequate vitamin D replacement and in the absence of secondary hyperparathyroidism.

Effect of blood flow restriction during low-intensity resistance training on bone markers and physical functions in postmenopausal women

BackgroundThe aim of this study was to investigate the effects of 12-week low intensity resistance training (RT) with blood flow restriction on bone mineral density (BMD), bone turnover markers (BTM), physical functions, and blood lactate concentration in postmenopausal women with osteoporosis or osteopenia. Methods26 study participants (56 ± 1.8yrs, T-score: −2.5 ± 0.7) were randomly assigned into Moderate to High-Intensity RT (MHIRT, n = 7), BFR combined with Low-Intensity RT (LIBFR, n = 7), Low-Intensity RT (LIRT, n = 6), or Control group (CON, n = 6). Exercise group performed leg press, leg extension, biceps curl, and triceps extension 3 times a week for 12 weeks. Training intensity were set at 60% of 1-repetition maximum (1-RM) for MHIRT, and at 30% of 1-RM for LIBFR and LIRT, and reset every 4 weeks for increasing intensity. ResultsLower, and upper limb 1-RM only increased in MHIRT (65%, p < 0.001), and LIBFR (40%, p < 0.05), while LIRT only showed increment on lower limb 1-RM (28%, p < 0.05). All exercise groups demonstrated significant increment on blood lactate concentration after training session (p < 0.001). However, LIBFR showed 2.7 folds higher increment than LIRT (p < 0.001). Although no changes were observed in MHIRT, LIBFR, and LIRT, CON showed significant decrease in BMD (p < 0.05). While, LIRT showed no responses on BTM, LIBFR significantly increased bone formation markers (P1NP) about 7.05 ng/ml (p < 0.05). Lastly, balance improvement was only found in MHIRT, and LIBFR (p < 0.05). Conclusion12-week LIBFR can be implied as a safe, and effective method to improve muscle strength, P1NP, and balance similar to MHIRT in postmenopausal women with osteoporosis or osteopenia.

Bone Mineral Metabolism During Chemotherapy in Childhood Acute Lymphoblastic Leukemia.

The aim of this study was to evaluate levels of vitamin D, bone mineral density (BMD), and radiograph features at diagnosis and after 6 months of chemotherapy in patients with acute lymphoblastic leukemia (ALL). Vitamin D levels were also correlated with BMD and radiograph features. 25-Hydroxy vitamin D [25(OH)D] levels, BMD, and radiograph features were assessed in 50 newly diagnosed patients of ALL in the age group of 2 to 14 years. A total of 30 age-matched and sex-matched children were recruited as controls. Vitamin D deficiency was defined as 25(OH)D <10 ng/mL, Vitamin D insufficiency as 10 to 29 ng/mL, and Vitamin D sufficiency as ≥30 ng/mL. Enzyme immunoassay (EIA) was used for the quantitative measurement of 25(OH)D levels in plasma and a LUNAR DPX NT bone densitometer was used for the assessment of BMD. The mean age of the patients was 6.3 years, with a male:female ratio of 1.38:1. The mean 25(OH)D levels were 31.90±16.90 ng/mL in patients at diagnosis against 41.63±20.50 ng/mL in controls (P=0.02). Levels were 18.50±11.10 ng/mL postchemotherapy (P=0.00). Female sex was a risk factor for deficient 25(OH)D levels. There was a significant decrease in BMD postchemotherapy in the age groups of 5 to 10 and above 10 years at the femoral neck. Osteopenic changes were observed in more number of patients after 6 months of chemotherapy. There was a significant correlation between vitamin D levels, BMD, and osteopenic changes. Vitamin D deficiency was common among ALL patients, which worsened after chemotherapy. This had a significant correlation with BMD and osteopenic changes in radiograph.

Obesity potentially protects against systemic bone loss in patients with rheumatoid arthritis treated with tumour necrosis factor inhibitors.

We aimed to investigate how systemic bone metabolism was affected after 1 year of treatment with tumour necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) patients. A total of 29 seropositive RA patients not treated for osteoporosis were enrolled and TNF inhibitors were administered for a year. Bone mineral density (BMD) at the lumbar spine, femur neck, and total hip was measured at baseline and 12 months after anti-TNF treatment. Blood samples were collected at baseline and 6 and 12 months after anti-TNF treatment and osteoclasts were cultured on bone slices. Weight was the strongest factor influencing systemic bone loss. Patients were categorised into two groups: obese (body mass index (BMI) ≥25 kg/m2) and non-obese (BMI <25 kg/m2). All patients showed decreased BMD at all sites. The obese group showed relatively little change in BMD, although the non-obese group showed significant decreases in BMD at all sites after 1 year of treatment with TNF inhibitors. Resorption pits created by osteoclasts decreased at 6 months and increased at 12 months in the non-obese group, while the obese group presented with steadily decreasing sizes of resorption pits at all-time points. Levels of receptor activator of nuclear factor kappa B ligand were significantly decreased at 12 months compared to baseline in the obese group, while they were increased in the non-obese group. One year of treatment with TNF inhibitors failed to halt systemic bone loss in RA patients, but obesity may have protective effects against bone loss.

Pelvic fractures and changes in bone mineral density after radiotherapy for cervical, endometrial, and vaginal cancer: A prospective study of 239 women.

Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3months, 1year, and 2years after RT. Imaging studies were assessed for pelvic fractures for up to 5years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. The median age at diagnosis was 51years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3years, respectively. Fractures were associated with baseline osteoporosis (P<.001), higher baseline bone-specific alkaline phosphatase (P<.001), and older age (P=.007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3months, 1year, and 2years, respectively. A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.