Spine Bone Density Research Articles

Cone Beam Computed Tomography Assessment of Cervical Spine Bone Density

Age-related loss of bone density is a characteristic of osteoporosis, leading to reduced bone strength and increased risk of fracture. In spine surgery patients, osteoporosis also leads to poor outcomes, including pedicle screw loosening, proximal junctional failure, cage subsidence, and adjacent segment disease. Osteoporosis screening is generally performed using dual energy X-ray absorptiometry (DXA) to assess bone density. Cone beam computed tomography (CBCT) is widely used in orthopedic surgeries, including spine surgeries, and in dental and maxillofacial surgery to visualize teeth and jaws for pathology, surgical planning for jaw and TMJ joint reconstruction, structural maxillofacial deformity, pre-operative implant site assessment, 3D cephalometry, and appropriate treatment planning. CBCT is also used for evaluation of cervical vertebrae in skeletal maturation - growth assessment, diagnosis of obstructive sleep apnea, and temporomandibular disorders. In comparison to traditional computed tomography (CT), CBCT introduces several advantages including high spatial resolution (favorable for bone architecture evaluation); high image accuracy; low cost, faster scan time, ease of use, compact machinery, and low radiation exposure. Few studies have investigated the potential use of CBCT images for opportunistic assessment of bone health as an alternative to traditional CT and DXA. This study investigates whether bone density in the C3 vertebrae as determined by CBCT image analysis aligns with previously known trends of age-related bone loss in women post-menopause. Specifically, this study examines changes in bone density of the C3 vertebrae in females, beginning from puberty to post-menopause to late adulthood. Since the use of CBCT beyond dentistry is not well-established, the overarching goal of this study is to provide support for the reliability of dental CBCT images in the determination of bone health for orthopedic applications. This study aims to provide support for the reliability of cone beam CT in allowing for measurements of bone density. The use of CBCT for opportunistic screening of osteoporosis and potentially orthopedic surgeries is highly relevant for medical and dental professionals. The various advantages of CBCT, including high accuracy, low costs, and greater convenience strengthens its position as a potential alternative to traditional CT. Also, as a result of longer life expectancies, more osteoporotic patients are visiting dental clinics, and existing CBCT scans could be utilized to assess osteoporosis risk. Cone beam scans of 416 female patients with ages ranging from 10 to 93 years were obtained between 2010 - 2019. CBCT scans included visualization of the patient's skull, jaw, facial bones, and upper portion of the cervical spine. Sagittal views of the scans were analyzed, with a specific focus on the C3 vertebrae. ImageJ analysis was used to quantify the intensity of the C3 vertebrae region of interest, as a measure of bone density after calibration. Intensity of the muscle area adjacent to the C3 vertebrae and intensity of air in the lungs were measured for the internal calibration of CT Hounsfield units (HU). A linear and spline lines of fit showing changes in bone density values as a function of age were generated to display the overall decline in bone density in females. The linear lines of fit, confidence intervals, linear equations, and R values were calculated using JMP statistical software based on measurements retrieved from the 416 patient scans. A decline in bone density with age was observed (-2.83 HU/year, p< 0.0001). A rapid decline was observed after 50 years of age (-3.72 HU/year, p=0.0001). These findings are consistent with previously established trends depicting changes in BMD as a function of age in females, such that peak loss of bone density occurs during the first few year's post-menopause, beginning around ages 50 to 54. The finding that female subjects aged 50-93 years exhibited a significant decrease in bone density is in line with scientific literature exploring the increased prevalence of osteoporosis in postmenopausal women. The ability to identify these established trends using CBCT scans provides evidence for the utility of obtaining bone density measurements through CBCT image analysis. Our findings may be useful in providing evidence in support of CBCT scans as an alternative method of osteoporosis screening and assessment of bone quality in orthopedic and dental surgery patients. Notable limitations of the present study include the exclusion of body mass index (BMI) and race, among other demographic information. Further efforts to obtain this demographic information would be crucial in developing a more complete understanding of our sample data.

Bisphosphonates and bone mineral density in patients with end-stage kidney disease and renal transplants: A 15-year single-centre experience

Chronic Kidney Disease Stage 5 (CKD-5) imparts a 4-fold increase in minimal trauma fracture with a substantial increase in mortality following hip fracture. Bone disease in CKD is complex, characterised by abnormal levels of PTH, calcium, phosphate, ALP, and vitamin D, manifesting as a condition known as CKD-Mineral and Bone Disorder (CKD-MBD). While bisphosphonates (BPs) are widely used in the management of osteoporosis, their therapeutic role when end-stage renal function and bone disease co-exist remains unclear. This 15-year retrospective cohort study examines the long-term use of BPs in CKD-4 and -5 patients receiving no renal replacement therapy, haemodialysis and renal transplant in a tertiary centre in Sydney, Australia. In multivariate regression adjusting for age, baseline bone mineral density (BMD) and history of fracture, BP use was associated with net gain in lumbar spine bone density in renal transplant recipients over a mean treatment period of 3.5 years (net annual BMD gain of 0.039 g/cm2, p = 0.005). No such benefit was seen in hip BMD in CKD subjects. Regardless of transplant status, CKD patients treated with BPs had no improvement in hip BMD with a general decline in hip BMD across both groups during the study period (hip BMD: transplant recipients decline 0.024 ± 0.81 g/cm2, non-transplant CKD patients decline 0.055 ± 0.84 g/cm2). BP therapy did not result in significant changes in biochemical parameters (ALP, PTH, and phosphate) and no serious adverse effects were detected in association with BP use. In particular, kidney function was not affected by BPs post-transplant (eGFR = 43 ± 29 ml/min/1.73 m2, p = 0.80). BPs preserved lumbar spine bone density in kidney transplant recipients but did not prevent declines in hip bone mineral density in either transplant patients or those with CKD-4 and -5. SummaryThere remains a lack of clarity of the risks vs. benefits of bone-sparing pharmacotherapy in chronic kidney disease Stages 4 and 5. This single-centre 15-year retrospective data analysis showed that bisphosphonates are not associated with any detectable serious adverse effects in CKD-4 and -5 and effective at mitigating lumbar spine bone loss in kidney transplant patients.

Thoracolumbar Instrumentation Surgery in Patients with Parkinson's Disease: A Case-Control Study.

With increasing prevalence of Parkinson's disease (PD), instrumentation surgery of the thoracolumbar spine of PD patients grows in importance. Poor operative results with high rates of revision surgery have been reported. The goal of this study was to compare the biomechanical complications of thoracolumbar instrumentation surgery of patients with and without PD. In a retrospective case-control study, we compared 16 PD patients with a matched cohort of 104 control patients regarding the following postinstrumentation complications: (1) adjacent joint disease, (2) material failure, and (3) material loosening. Also, we compared the spinal bone density, which is the main prognostic criteria for failed instrumentation surgery, between the groups. We found the rate of material revision to be significantly higher in PD patients (43.8 vs. 13.5%, p = 0.008, odds ratio (OR) = 5.0). Furthermore, the indications for revision surgery differed between the groups, with more hardware failures in the PD group and more adjacent segment degeneration in the control group. PD patients profited from modern operation techniques (percutaneous instrumentation and CT-navigated screw implantation). Hospitalization was significantly longer for PD patients (20.2 ± 15.1 vs. 14.1 ± 8.9 days, p = 0.03). PD patients exhibit challenging biomechanical demands on instrumenting the spine. Besides osteoporosis, especially sagittal imbalance, gait disturbance, and altered muscle tone may be contributive. PD patients may particularly profit from navigated and less invasive surgical techniques.

Role of Aromatase Inhibitors in Managing Hypogonadism in Adult Males Related to Obesity and Aging: A Systematic Review and Meta-Analysis.

No meta-analysis is available which has analysed the role of aromatase inhibitors (AIs) in hypogonadism in adult males related to obesity and aging. This meta-analysis intended to address this knowledge gap. Electronic databases were searched for studies involving adult males with hypogonadism. The primary outcomes were changes in total testosterone (TT). Secondary outcomes were alterations in oestradiol, luteinizing hormone (LH), and side-effect profile. From initially screened 177 articles, data from three randomised controlled trials(RCTs) (118 patients) and three uncontrolled studies(52 patients) were analysed. AIs were associated with significantly greater improvement in TT after three months [mean difference (MD) 7.08 nmol/L (95% Confidence Interval (CI): 5.92-8.24); P < 0.01; I2 = 0%], six months [MD 6.61 nmol/L (95% CI: 5.30-7.93); P < 0.01] and 12 months [MD 5.20 nmol/L (95% CI: 3.78-6.62); P < 0.01] therapy. AIs were associated with greater reduction in oestradiol after three months [MD -3.07 pmol/L (95% CI: -5.27- -0.87); P < 0.01; I2 = 40%], six months [MD -5.39 pmol/L (95% CI: -7.18- -3.60); P < 0.01] and 12 months [MD -8.3 pmol/L (95% CI: -15.97- -0.63); P = 0.03] therapy. AIs were associated with greater increase in LH after three months [MD 1.79 IU/L (95% CI: 0.77-2.81); P < 0.01; I2 = 0%], six months [MD 2.20 IU/L (95% CI: 0.29 - 4.11); P = 0.02] and 12 months [MD 1.70 IU/L (95% CI: 0.28-3.12); P = 0.02] therapy. Occurrence of treatment-emergent adverse events[Risk ratio (RR) 1.48 (95% CI: 0.47-4.66); P = 0.45; I2 = 0%] and severe adverse events[RR 2.48 (95% CI: 0.42-14.66); P = 0.32; I2 = 0%] were similar among AIs and controls. Following six-month treatment, AIs were associated with significantly lower bone mineral density (BMD) at lumbar-spine [MD -0.04 gm/cm2 (95% CI: -0.08- -0.01); P = 0.03], but not total hip [MD 0.01 gm/cm2 (95% CI: -0.02-0.04); P = 0.55] and femoral neck [MD 0.02 gm/cm2 (95% CI: -0.01-0.05); P = 0.12] compared to controls. This meta-analysis highlights the good efficacy of AIs in improving TT over 3-12 months of use. Adverse impact on spine bone density remains a concern in obese ageing males and warrants further evaluation.

The Effects of Milk Consumption on Blood Calcium Concentration and Bone Density of Adolescents Boys

Milk consumption during adolescence is considered an early means of preventing osteoporosis in adults. Osteoporosis is a systemic skeletal disease characterised by low bone density and microarchitectural deterioration of bone tissues, with a consequent increase in bone fragility and suspectibility to fracture. Augmenting bone mass during adolescence has been suggested as a strategy to prevent osteoporosis, because adolescents may represent the final opportunity for substantially increasing bone mass before skeletal consolidation. The purpose of this study was to determine effects of fresh and high calcium milk on blood calcium concentration and bone density. Variables measured in this study were blood calcium concentration, bone density of spine and bone density of whole body. &#x0D; The study using 55 adolescent boys that had 17 to 19 years old. The design of this study is nested randomized design with two factors are kind of mil (fresh milk, high calcium milk) and volume of each kind of milk (250 ml, 500 ml, 750 ml). Results of the study indicated that fresh and high calcium milk in this research not significant effects (P&gt;0.05) on blood calcium concentration and bone density of whole body. But, high calcium milk consumption was able to increase bone density. It was found that high calcium consumption showed very highly significant effect (P&lt;0.01) on bone density of spine with 1.79% contributions. Based on general linear model equation, bone density of trunk can be estimated by high calcium milk consumption.&#x0D; Keywords : milk consumption, adolescence, blood calcium concentration, bone density

Lifestyle Factors Related to Low Femoral and Spinal Bone Density in Young Saudi Adult Women

Osteoporosis is a major health problem both world wide and in Saudi Arabia, many lifestyle factors are considered as causes for the increase in osteopenia and osteoporosis. The aim of the study was to evaluate the effects of some lifestyle factors on bone mineral density (BMD) in young Saudi adult women. Measurements of BMD (g/m2) in the femoral neck area and the lumbar spine (L2-L4) was performed using dual-energy x-ray absorptiometry (DXA) in 101 females age range 20–24.9 years. BMD, T-score and Z-score were evaluated. Lifestyle factors were assessed through a questionnaire. Dairy and milk consumption, physical activity, animal protein consumption and sun exposure were the factors that showed significant association with some BMD parameters. Whereas limited calcium and Vitamin D intake and high consumption of soft drinks are the major contributers to osteopenia and osteoporosis in young females. Funding Information: This research was supported by a grant from the “Researchers Supporting Project number (RSP-2021/188), King Saud University, Riyadh, Saudi Arabia. Declaration of Interests: The author declares that she have no competing interests. Ethics Approval Statement: Before taking measurements, the study protocol was explained to participants, and the informed consent was signed upon their agreement before inclusion in the study. Measurements were performed according to principles of Helsinki declaration. the study was approved by the Research Ethics Committee of the College of Applied Medical Sciences – King Saud University (Ethics No. CAMS18/3536).

Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta-analysis.

To systematically review and compare the efficacy of different exercise interventions on bone mineral density (BMD, g/cm2 ) in patients with osteoporosis and osteopenia. It is vitally important to prevent and treat bone loss in patients with osteoporosis and osteopenia. Exercise can effectively increase bone density and slow down bone loss in middle-aged and older people. However, it is still unclear which type of exercise intervention is the most effective on bone mineral density. Systematic review and network meta-analysis (NMA) according to PRISMA. Randomised controlled trials of different exercise treatments for osteopenia and primary osteoporosis were included. A Frequentist network meta-analysis was conducted to appraise the efficacy of different types of exercise. The outcome was bone mineral density of different parts of the body. Ninety-seven studies were included. The network meta-analysis showed that combined exercise, resistance exercise, aerobic exercise and mind-body exercise had a significant effect in improving the bone density of lumbar spine. The surface under the cumulative ranking area (SUCRA) values for mind-body exercise was 0.99 and ranked first. For BMD of the femoral neck, all kinds of exercise interventions increased the bone density significantly compared with no exercise and the optimal type was mind-body exercise (SUCRA=0.99). In terms of the total hip bone mineral density, aerobic exercise and resistance exercise could improve hip bone density, with the resistance exercise (SUCRA=0.95) ranking as first. This NMA demonstrated the mind-body exercise might be the optimal exercise type to increase the BMD of the lumbar spine and femoral neck and resistance exercise is the most promising type for total hip BMD.

Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study

IntroductionIn older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults. AimTo assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD. MethodsWe evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD). Results43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion. ConclusionIn the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults.

A novel heterozygous mutation of CHD7 gene in a Chinese patient with Kallmann syndrome: a case report

BackgroundVariants of chromodomain helicase DNA binding protein 7 (CHD7) gene are commonly associated with Kallmann syndrome (KS) and account for 5–6% of idiopathic hypogonadotropic hypogonadism (IHH) cases. Here we report a novel mutation of CHD7 gene in a patient with KS, which may contribute to the better understanding of KS.Case presentationA 29-year-old male patient with KS and a chief complaint of delayed puberty for 13 years (Tanner B Stage< 4) was admitted to the Department of Endocrinology of the First Affiliated Hospital of Zhejiang University (Hangzhou, China) in September 2019. Dual-energy X-ray absorptiometry (DEXA) showed low bone density in both lumbar spine (L1 ~ L5 mean Z-score − 3.0) and femoral neck (Z-score − 2.7). Dynamic contrast-enhanced magnetic resonance imaging (MRI) of pituitary and contrast-enhanced computed tomography (CT) showed no abnormal findings. Ophthalmological evaluation showed that his both eyes showed exotropia, and no sight loss was noted. Heterozygous c.1619G > T mutation of TCD7 gene (p.G4856V) was detected, whereas none of his family members had this mutation. Human chorionic gonadotropin (HCG) and human menopausal gonadotropin (HMG) were injected for three times/week to treat idiopathic hypogonadotropic hypogonadism (IHH). After several months of therapy, the patient’s health condition improved. His testicles became larger, and his secondary sexual characteristics improved after treatment.ConclusionExploration of the novel splice-site mutation of CHD7 may further our current understanding of KS.

P117. Bone density distribution in the cervical spine: Establishing level specific reference values

<h3>BACKGROUND CONTEXT</h3> Bone density in the lumbar spine is variable by level and can impact surgical strategy. In the cervical spine, low Hounsfield units (HU) have been associated with cage subsidence. The distribution of HU in the cervical spine has not been established. <h3>PURPOSE</h3> To define level-specific cervical HU reference values and the relationship between cervical bone density, age, BMI, comorbidities and alignment. <h3>STUDY DESIGN/SETTING</h3> Retrospective review at a single center from May 2015 to December 2019. <h3>PATIENT SAMPLE</h3> A total of 224 patients, 18 excluded for previous hardware and 5 for known osteoporosis. <h3>OUTCOME MEASURES</h3> Hounsfield units. <h3>METHODS</h3> Patients who presented with neck symptoms and had a cervical spine CT for evaluation of pathology or surgical planning were included. Exclusions were hardware on CT, osteoporosis, or cervical deformity. Measurements were performed in 5 regions of each vertebral body (VB) (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (LMs) (C3-C6; mid-cor, mid-sag). The VB measurements were averaged at each level to obtain a composite value of each vertebral body (TotalVB), similarly the mid-cor and mid-sag values were averaged at each LM (TotalLatM). Outliers were excluded pairwise. To evaluate reliability, 6 observers each measured 355 HU values (71 over 5 patients), inter-relater reliability assessed with intraclass correlation coefficients (ICCs). Correlations of composite HU with age, BMI, Charlston Comorbidity Index (CCI) and cervical alignment were evaluated. <h3>RESULTS</h3> Average age 57±12 years, mean BMI 28±6 kg/m2, 63.5% male, 90.1% white. Diagnoses included radiculopathy (45.8%), myelopathy (37.9%) and facet arthropathy (46.3%). ICC for HU measurements were as follows: VB, 0.82 mid-axial, 0.59 ant-axial, 0.77 post-axial, 0.88 mid-cor, 0.88 mid-sag; LM, 0.46 mid-sag, 0.61 mid-cor. C4 VB and C4 LM had the highest HU (383.6±71.9 and 480.0±103, respectively) while T1 VB and C6 LM had the lowest (232.3±46.5 and 398.3±98.2, respectively). No significant correlations were found between LM HU and age, BMI, CCI, or alignment. Increased kyphosis was weakly correlated with VB HU at all levels (except C2) strongest correlations at C7 (0.25) and weakest correlation at C3 (0.16). Age and CCI showed weak-moderate correlations with VB HU at all levels (age, r=-0.20 to -0.35; CCI r=-0.28 [C2, C7, T1] to -0.17 [C4]). <h3>CONCLUSIONS</h3> Our level-specific cervical HU values may be referenced when evaluating cervical BMD. The most reliable measurement technique is on the mid-sag or mid-cor VB, measurement of LMs is less reliable. Bone is least dense in the lower cervical spine, which may influence instrumentation strategies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The effect of whole-body vibration exercise on postmenopausal women with osteoporosis: A protocol for systematic review and meta-analysis.

Background:Osteoporosis (OP) is an age-related disease characterized by reduced bone mass and increased bone fragility. It is more common in older people and postmenopausal women. As a new type of exercise training for OP, whole-body vibration (WBV) exercise has been proved to have a good effect on postmenopausal women with OP. It can increase bone density and improve strength and balance in postmenopausal population, which has certain clinical value, but lacks evidence-based medicine evidence. This study aims to systematically study the effectiveness of WBV exercise on postmenopausal women with OP.Methods:The English databases (PubMed, Embase, Web of Science, The Cochrane Library) and Chinese databases (China National Knowledge Network, Wanfang, Weipu, China Biomedical Database) were searched by computer. From the establishment of the database to February 2021, the randomized controlled clinical studies on WBV exercise on postmenopausal women with OP were conducted. The quality of the included studies was independently extracted by 2 researchers and literature quality was evaluated. Meta-analysis of the included studies was performed using RevMan5.3 software.Results:In this study, the efficacy and safety of WBV exercise on postmenopausal women with OP were evaluated by lumbar spine bone density, femoral neck bone density, pain, incidence of falls, incidence of fractures, and quality of life scale score, etc.Conclusion:This study will provide reliable evidences for the clinical application of WBV exercise on postmenopausal women with OP.Ethics and dissemination:Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/WPYT9

Premenopausal Osteoporosis &amp; Perfluoroalkyl Substance Exposure; Is There a Link?

Introduction: Perfluoroalkyl substances (PFAS) like Perflouroctanoate (PFOA) and Perflurooctane sulfonate (PFOS) are ubiquitous environmental contaminants that have been in industrial use for many years. Many known adverse effects include malignancies, reproductive and thyroid dysfunction. However, there is limited literature regarding PFAS causing low bone density. We report a case of a premenopausal woman with a history of exposure to PFAS who was recently diagnosed with osteoporosis.Clinical Case: A 36-year-old lady with a history of hypothyroidism, on levothyroxine, presented to the orthopedics clinic with complaints of sudden onset right foot pain with no trauma. She was found to have a fracture of her right second metatarsal bone. Notably, over a period of five years she had suffered multiple fractures including metatarsal, elbow and a wrist fracture, all with minimal or no trauma. She denied smoking, alcohol, chronic steroid or PPI use, history of malabsorption, celiac disease, kidney stones, malignancy or liver problems. Her menstrual cycles were regular; she was on oral contraceptives in the past for dysmenorrhea. She is on Vitamin D supplementation and consumes adequate dairy products daily. There is no family history of hip fracture or osteoporosis. Labs showed: Calcium 8.9mg/dl, Phosphorus 2.4mg/dl (2.5–4.5mg/dl), intact PTH was 92.7pg/ml (8-97pg/ml), 24-hour urine calcium was undetectable. Vitamin D was 56.6ng/ml (30-100ng/ml). CBC, TSH, FSH, liver & kidney functions were all normal. Anti-endomysial, anti-gliadin and anti-tissue trans glutaminase antibodies were all unremarkable. IgA level was 362mg/dl (8–352 mg/dl). DXA scan revealed the lowest Z-score (-3.1) in the lumbar spine. She reported a history of exposure to PFAS with a blood level of 22.3ng/ml for PFOA and 48.4ng/ml for PFOS in the year 2005. Plan is to initiate bisphosphonate therapy for the treatment of osteoporosis.Discussion: PFAS are known endocrine disruptive agents that have been used widely in making a wide range of consumer products including nonstick and stain-resistant coatings of cookware, food containers. Recent studies suggest that serum PFAS concentrations were associated with lower bone density. There was a higher incidence of lower lumbar spine bone density in patients exposed to PFOS. PFOA is believed to compete with calcitriol at the same binding site on Vitamin D receptor resulting in changes in the osteoblasts thereby decreasing bone mineralization.Conclusion: There needs to be increased awareness about the association of low bone density in patients exposed to PFAS. This is especially important in the evaluation of premenopausal osteoporosis.

Bone Density and Body Fat Distribution in Postmenopausal Women.

Background:In postmenopause there are changes in metabolism of bone tissue and consequent decrease of bone density. With ageing redistribution of fat occurs and an increase in body weight. Because of hormone changes in postmenopause fat is redistributed from gluteofemoral area to the abdominal region.Objective:The objective of this study was to examine the relationship between bone density and a body mass index (BMI), and distribution of the fat tissue in women in postmenopause (WHR).Methods:This research was prospective, and it included total of 83 women, 53 women were in the natural postmenopause and 30 women with the regular menstruation.Results:BMI in women in postmenopause was statistically significantly higher than BMI in women with the regular menstruations (p= 0,005). There was no statistically significant difference between waist hip ratio in women in the postmenopause in relation to the women with the regular menstruations. In women in the postmenopause significant positive correlation between BMI and density of the neck of femur was found (Z and T-score) (p=0,019; p=0,005). There was also significant negative correlation between the WHR and density of the lumbal spine (backbone) in women in the postmenopause (Z-score) (p=0,043). The identical analysis in women with regular menstruations, negative correlation between the density of the lumbal spine was found again (Z-score) and WHR , but the same was highly expressed (p=0,041). The observed correlation between BMI and bone density in this group of women was not statistically significant.Conclusion:Based on the presented results we conclude that the higher the BMI (p=0,019; p=0,005) the higher density of the femoral neck postmenopausal women have, and lower bone density of the lumbar spine the higher ratio waist / hip (p = 0.043). In the women with regular menstruation bone density of the lumbar spine is the lower the higher the ratio of waist and hip (p=0,041), while there was no correlation between BMI and bone density in this group of women.

Time-Course Changes in Bone Metabolism Markers and Density in Patients with Osteoporosis Treated with Romosozumab: A Multicenter Retrospective Study.

PurposeIn this multicenter retrospective observational study, we examined the early effects of romosozumab in patients with severe osteoporosis in terms of time-course changes in bone metabolism marker, improvement in bone density, and adverse effects.Materials and MethodsPatients with severe osteoporosis were included. We investigated the progress of TRACP 5b and P1NP before and 1–2 months after the administration of romosozumab. We also investigated the bone density of lumbar spine, femoral neck, and the entire femur, measured by the DXA method, before and 5–7 months after the administration of romosozumab.ResultsA total of 70 patients (7 males and 63 females, age 75.0±3.6 years) participated in this study. Significant improvements in TRACP 5b and P1NP levels were observed before and 1–2 months after romosozumab administration. The average bone density of lumbar spine, femoral neck, and the entire femur were measured before and 5–7 months after romosozumab administration; and a significant increase only observed in the lumbar spine.ConclusionConsistent with the findings of previous clinical studies, romosozumab has both bone formation-enhancing and bone resorption effects (dual effect). In addition, romosozumab also demonstrated improvement in bone density from the early phase after the administration, though the result was only seen in the lumbar spine.

Efficacy of Zoledronic Acid in Maintaining Areal and Volumetric Bone Density After Combined Denosumab and Teriparatide Administration: DATA-HD Study Extension.

Combined teriparatide and denosumab rapidly and substantially increases bone mineral density (BMD) at all anatomic sites. Discontinuation of denosumab however, results in high-turnover bone loss and increased fracture risk. The optimal way to prevent this bone loss remains undefined. This study is a preplanned extension of the DATA-HD study, where postmenopausal women with osteoporosis were randomized to receive 9 months of either 20 μg or 40 μg of teriparatide daily overlapping with denosumab (60 mg administered at months 3 and 9). At the completion of this 15-month study, women were invited to enroll in the DATA-HD Extension where they received a single dose of zoledronic acid (5 mg) 24 to 35 weeks after the last denosumab dose. Areal BMD and bone turnover markers were measured at month 27 and 42 (12 and 27 months after zoledronic acid, respectively) and spine and hip volumetric bone density by quantitative CT was measured at month 42. Fifty-three women enrolled in the DATA-HD Extension. At the femoral neck and total hip, the mean 5.6% and 5.1% gains in BMD achieved from month 0 to 15 were maintained both 12 and 27 months after zoledronic acid administration. At the spine, the mean 13.6% gain in BMD achieved from month 0 to 15 was maintained for the first 12 months but modestly decreased thereafter, resulting in a 3.0% reduction (95% CI, -4.0% to -2.0%, p < .0001) 27 months after zoledronic acid. The pattern of BMD changes between months 15 and 42 were qualitatively similar in the 20-μg and 40-μg groups. A single dose of zoledronic acid effectively maintains the large and rapid total hip and femoral neck BMD increases achieved with combination teriparatide/denosumab therapy for at least 27 months following the transition. Spine BMD was also largely, though not fully, maintained during this period. These data suggest that the DATA-HD Extension regimen may be an effective strategy in the long-term management of patients at high risk of fragility fracture. © 2021 American Society for Bone and Mineral Research (ASBMR).

A Comparison of Lumbar Spine and Lateral Distal Femur Bone Density in Girls With Rett Syndrome

Introduction/Background: Patients with Rett syndrome (RS) are at risk for low bone mineral density (BMD) and femoral fractures. In patients with RS, assessment with lateral distal femur (LDF) dual-energy X-ray absorptiometry (DXA) is recommended and clinically relevant. This study is the first to assess LDF BMD in girls with RS, and to compare LDF BMD results with lumbar spine BMD results in RS. Method Eleven girls (mean age 8.4 yr) with molecularly diagnosed RS and clinical DXA scan(s) were identified; medical charts were retrospectively reviewed. Baseline and serial lumbar spine and LDF BMD Z-scores were evaluated based on patients’ ambulation status, presence of epilepsy, and mutation type. Results At the time of first scan, 8 of 11 patients had normal lumbar spine BMD and low LDF BMD Z-scores. Two patients had fracture history. Fully ambulatory (3) patients had higher lumbar spine and LDF BMD than partially (5) and nonambulatory (3) patients. Patients with epilepsy had lower average BMD at all sites. No difference was seen in lumbar spine or LDF BMD in patients with high-risk BMD mutations. Seven patients had serial DXA scans with an average observation of 5.1 yr (range 3.1 yr to 6.2 yr). Lumbar spine BMD over time was variable, while LDF bone mass accrual occurred at a lower rate than typically developing girls. Conclusion Females with RS exhibited lower BMD Z-scores at the LDF than at the lumbar spine. LDF and lumbar spine results were discordant. Ambulatory status and the presence of epilepsy were related to BMD. LDF BMD accrual deviated from normal as patients aged.

Comparison of quantitative computed tomography and dual-energy X-ray absorptiometry in elderly patients with vertebral and nonvertebral fractures: Preliminary results

Aim: Dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) are methods used today to evaluate bone mass and structure and determine the risk of fractures. In this study, spinal and femoral bone density results measured by DXA and QCT in elderly patients with vertebral and non-vertebral fractures were compared to identify the most effective method in determining the risk of osteoporosis and fractures. Methods: In this retrospective cohort study, 45 elderly patients aged 65–84 years were analyzed. Group 1 included 11 patients with atraumatic vertebral fractures, Group 2 included 11 patients with non-vertebral fractures and Group 3 included 23 patients without fractures. T-scores and bone mineral density (BMD) values of spinal (lumbar 1-4) and femoral (neck) regions measured by both DXA and QCT were evaluated. Results: Spinal and femoral T-scores and BMD values measured by DXA and QCT were similar between the groups (P>0.05 for all). In Group 1, lumbar BMD value, lumbar and femoral neck T-scores measured by QCT were significantly lower than DXA (P<0.001, P=0.004 and P=0.037, respectively). In Group 2, lumbar BMD value and T-score measured by QCT were significantly lower than DXA (P<0.001 and P<0.001). In Group 3, lumbar T-score, lumbar and femoral neck BMD values measured by QCT were significantly lower than DXA (P<0.001, P<0.001 and P=0.004, respectively). Conclusion: QCT is an effective method that can be used in elderly patients with fractures and arthrosis where DXA may yield false-positive results.

Regular Supplementation With Resveratrol Improves Bone Mineral Density in Postmenopausal Women: A Randomized, Placebo-Controlled Trial.

ABSTRACTResveratrol, a naturally occurring polyphenol in red grapes and berries, can act as a phytoestrogen. It has been shown to improve both systemic and cerebral circulatory functions, possibly through activation of endothelial estrogen receptors. in vitro and in vivo studies in rodent models also indicate a bone‐protective role for resveratrol, particularly in ovariectomized rat models that mimic postmenopausal osteoporosis caused by estrogen deficiency. Hypothesizing a circulatory benefit of resveratrol in bone tissue, we investigated whether resveratrol supplementation could improve bone health in postmenopausal women. The Resveratrol for Healthy Aging in Women (RESHAW) trial was a 24‐month randomized, double‐blind, placebo‐controlled, two‐period crossover intervention conducted to evaluate the effects of resveratrol (75 mg twice daily) on cognition, cerebrovascular function, bone health, cardiometabolic markers, and well‐being in postmenopausal women. After 12 months of supplementation with resveratrol versus placebo, there were positive effects on bone density in the lumbar spine (+0.016 ± 0.003 g/cm2) and neck of femur (+0.005 ± 0.002 g/cm2), which were accompanied by a 7.24% reduction in C‐terminal telopeptide type‐1 collagen levels, a bone resorption marker, compared with placebo. The increase in bone mineral density in the femoral neck resulted in an improvement in T‐score (+0.070 ± 0.018) and a reduction in the 10‐year probability of major and hip fracture risk. The magnitude of improvement was higher in women with poor bone health biomarker status. Importantly, the improvement in femoral neck T‐score with resveratrol correlated with improvement in perfusion. Our subanalysis also revealed that the bone‐protective benefit of resveratrol was greater in participants who supplemented with vitamin D plus calcium. Regular supplementation with 75 mg of resveratrol twice daily has the potential to slow bone loss in the lumbar spine and femoral neck, common fracture sites in postmenopausal women without overt osteoporosis. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Changes in spinal bone density, back muscle size, and visceral adipose tissue and their interaction following a multi-component exercise program in older men: secondary analysis of an 18-month randomized controlled trial

In older men, we previously reported that a multi-component exercise program improved lumbar spine (LS) trabecular volumetric BMD (Tb.vBMD) compared with no exercise. This study aimed to investigate the following: (1) the effect of the exercise program on paraspinal and psoas (back) muscle CSA and VAT, and 2) if any exercise-related changes in muscle CSA and/or VAT were associated with changes in spinal BMD. Men (n = 180) aged 50-79 years were randomized to an exercise or no-exercise group. Exercise involved high-intensity progressive resistance training (60-85% max) with weight-bearing impact exercise (3 days/week) for 18 months. Quantitative computed tomography was used to assess L1-L3 Tb.vBMD, paraspinal, and psoas muscle CSA and VAT. Exercise resulted in a 2.6% ((95% CI, 1.1, 4.1), P < 0.01) net gain in back muscle CSA, but no effect on VAT (-1.6% (95% CI, -7.3, 4.2)) relative to no exercise. Robust regression indicated that percentage changes in Tb.vBMD were positively associated with changes (expressed as z-scores) in back muscle CSA in both the exercise (beta (β)-coefficient = 1.9, 95% CI 0.5, 3.2, P = 0.007) and no-exercise (β = 2.6, 95% CI, 1.1, 4.1, P = 0.001) group, and negatively with the changes in VAT (β = -2.0, 95% CI -3.3, -0.7, P = 0.003) in the exercise only group. There were no group differences in the slopes for the muscle-bone or VAT-bone relationships. Regression analysis (pooled data) revealed that back muscle CSA and VAT were independent predictors of the change in Tb.vBMD, explaining 14% of the variance. A multi-component exercise program in middle-aged and older men improved spinal BMD and back muscle size but not visceral fat. However, changes in back muscle size and VAT were associated with the changes in spinal BMD, independent of exercise. ACTRN 12617001224314, 22/08/2017 retrospectively registered.

P1402USE OF ROMOSOZUMAB FOR OSTEOPOROSIS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Recently, the importance of osteoporosis and chronic kidney disease-mineral bone disorder (CKD-MBD) has been highlighted as a cause of increased fracture risk in dialysis patients. However, many osteoporosis drugs require careful administration or are contraindicated in dialysis patients, and evidence for their use in dialysis patients is scarce. Here, we administered the new human anti-sclerostin antibody preparation romosozumab to hemodialysis patients with osteoporosis, and examined changes in bone density, bone metabolism markers and other values. Method Romosozumab was administered once per month to 12 hemodialysis patients (mean age: 72.6 ± 9.4 years old; 4 males, 8 females) who were diagnosed with osteoporosis while visiting our hospital and who had no history of cardiovascular complications in the preceding year. Bone density YAM value was measured every 3 months by dual energy X-ray absorptiometry (DXA). TRACP-5b, BAP, P1NP and whole-PTH values were measured every month as bone metabolic markers. Values at the start of observation were regarded as pre-dosing values and the mean values during the 6 months after administration were measured as post-treatment values. The results were then compared. Results At 6 months after the start of treatment, no change was seen in bone density of the proximal femur compared to the pre-dosing value. In contrast, lumbar spine bone density YAM value (%) was significantly improved, from 63.8% ± 9.4% to 70.9% ± 5.2% (P = 0.012). Regarding bone metabolism markers, mean value of bone resorption marker TRACP-5b after the start of administration did not significantly differ from that at the start of observation. BAP value increased significantly from 16.2 ± 8.7 to 25.2 ± 11.0 (p &amp;lt; 0.01) while whole-PTH significantly increased from 103.5 ± 52.8 to 236.1 ± 100.8 (p &amp;lt; 0.01). In addition, serial time changes for each bone metabolic marker, whole-PTH value, and corrected Ca value during the observation period are also reported. Conclusion Romosozumab may improve bone density in dialysis patients with osteoporosis.