Spine Bone Mineral Density Values Research Articles

Dynamic Foot Pressure During Walking: A Potential Indicator of Bone Mineral Density.

Physical skeletal loading can affect the bone mineral density (BMD). This study investigated the association between BMD and dynamic foot pressure during gait. A total of 104 patients (mean age, 62.6 ± 12.4 years; 23 male and 81 female) who underwent dual x-ray absorptiometry and pedobarography were included. BMD values of the lumbar spine, femoral neck, and total femur were assessed. The mean and maximum pressures were measured at the hallux, lesser toes, 1st metatarsal head, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, midfoot, medial heel, and lateral heel. Multivariable regression analysis was performed to identify factors significantly associated with BMD. The lumbar spine BMD was significantly associated with the mean pressure at the 4th and 5th metatarsal heads (p = 0.041, adjusted R 2 of model = 0.081). The femoral neck BMD was significantly associated with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.002, adjusted R 2 = 0.213). The total femoral BMD also showed a significant association with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.003, adjusted R 2 = 0.360). Foot plantar pressure during gait was significantly associated with BMD, and could potentially be used to predict the presence of osteoporosis. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

FRI673 REMS Technology For The Evaluation Of BMD In Hypothyroidism

Abstract Disclosure: F.A. Lombardi: None. P. Pisani*: None. A.P. Quezada*: None. M. Muratore*: None. M. Di Paola*: None. E. Casciaro*: None. F. Conversano*: None. S. Casciaro: None. *Equal contributors in alphabetical order Thyroid hormones play a crucial role in skeletal development, adult bone turnover, and bone maintenance, but they can also have detrimental effects on bone formation when there is thyroid dysfunction. Thyrotoxicosis (hyperthyroidism), including subclinical illness, can affect bone metabolism, resulting in decreased Bone Mineral Density (BMD) and increased fractures risk, and is a significant contributor to secondary osteoporosis, especially in postmenopausal women. On the other hand, little is known about the impact of overt or subclinical hypothyroidism on bone metabolism. However, hypothyroidism lessens bone turnover, reducing both osteoclastic bone resorption and osteoblastic activity. Such alterations in bone metabolism could potentially result in an increase in bone mineralization, although data on BMD and the risk of fracture in hypothyroidism are lacking and conflicting. Radiofrequency Echographic Multi-spectrometry (REMS) is a novel radiation-free technology for assessing BMD and fracture risk. In this context, the goal of this study was to assess BMD using REMS in patients with and without hypothyroidism, in order to look a possible correlation between the disease, BMD loss and fracture risk. Methods: A sample of 51 Caucasian females with hypothyroidism was compared to a reference group of healthy women who were matched for gender, ethnicity, age, and body mass index (BMI). Using REMS technology, the BMD was measurement at the lumbar spine in all participants at the study. To determine whether the two groups’ lumbar spine BMD value varied, a t-test was run. Results: Patients with and without hypothyroidism were matched in order to get similar anthropometric parameters. In patient with and without hypothyroidism mean ± standard deviation (SD) for age and BMI are (64.8 ± 10.2, 65.2 ± 9.8) and (25.1 ± 3.6, 25.0 ± 3.7), respectively. Patients with hypothyroidism were shown to have a significative lumbar spine BMD difference (0.801 g/cm2 ± 0.063 vs 0.831 g/cm2 ± 0.071, p=0.03) respect to the healthy subjects. Conclusions: Although just a small number of hypothyroidism patients are included in this investigation, without any indication of the drug therapy and its effect, it has been shown that, as compared to controls, women with hypothyroidism have a net decline in REMS-measured BMD values. Based on this thought, REMS technology, thanks to its precision and diagnostic accuracy, might improve the efficient care and follow-up programmes of these patients. Presentation: Friday, June 16, 2023

Zoledronic acid for osteoporosis after distal radius fracture surgery: Prospective longitudinal study

BackgroundDistal radius fractures (DRFs) are the most frequent first-ever osteoporotic fragility fractures. However, most patients are treated only for fractures and not for osteoporosis. Therefore, we investigated early osteoporosis intervention using zoledronic acid. MethodsThis prospective study enrolled 30 patients aged 50 years or older who had no history of fragility fractures or osteoporosis treatment and who underwent surgical treatment for DRFs. Patients whose lumbar spine or femur bone mineral density (BMD) values were less than 80% of the young adult mean (YAM) were treated with a 5-mg intravenous infusion of zoledronic acid. Lumbar spine and femur YAM BMD values, TRACP-5b and PINP were statistically evaluated using the paired t-test. The relationship between adverse effects, age, body mass index (BMI), and creatinine clearance (CCr) was statistically examined using Mann-Whitney's U test. The incidence of the bone fusion and secondary fractures within the 60-months postoperative period were assessed. ResultsThe mean lumbar spine and femur YAM BMD values before treatment were 76.1 ± 13.1% and 70.7 ± 8.5%. This indicates osteopenia in both locations. These values differed significantly between the pre-treatment period and each subsequent period. Five patients with a target YAM BMD value over 80% within 60 months after treatment were observed. The TRACP-5b and PINP values differed significantly between the pre-treatment period and each subsequent period. Adverse drug reactions were observed in 12 patients (40%). Age, BMI, and CCr did not show statistically significant differences in the occurrence of adverse effects. Bone fusion was confirmed at a mean of 3.6 months postoperatively. Secondary fractures were observed in 3 patients within 60 months after treatment. ConclusionDRFs occur at a younger age than other fragility fractures, and it is important to intervene aggressively with osteoporosis treatment to prevent secondary fractures. Level of evidenceLevel V.

Serum Intact Fibroblast Growth Factor 23 Levels Are Negatively Associated with Bone Mineral Density in Chronic Hemodialysis Patients

(1) Background: Fibroblast growth factor 23 (FGF23) is predominantly secreted from bone and plays an important role in mineral balance in chronic kidney disease. However, the relationship between FGF23 and bone mineral density (BMD) in chronic hemodialysis (CHD) patients remains unclear. (2) Methods: This was a cross-sectional observational study that involved 43 stable outpatients on CHD. A linear regression model was used to determine risk factors for BMD. Measurements included serum hemoglobin, intact FGF23 (iFGF23), C-terminal FGF23 (cFGF23), sclerostin, Dickkopf-1, α-klotho, 1,25-hydroxyvitamin D, intact parathyroid hormone levels and dialysis profiles. (3) Results: Study participants had a mean age of 59.4 ± 12.3 years, and 65% were male. In the multivariable analysis, cFGF23 levels showed no significant associations with the BMD of the lumbar spine (p = 0.387) nor that of the femoral head (p = 0.430). However, iFGF23 levels showed a significant negative association with the BMD of the lumbar spine (p = 0.015) and that of the femoral neck (p = 0.037). (4) Conclusions: Among patients on CHD, higher serum iFGF23 levels, but not serum cFGF23 levels, were associated with lower BMD values of the lumbar spine and femoral neck. However, further research is required to validate our findings.

Trends in Bone Mineral Density in US 6-80 Years Old: Findings from 2005-2020 NHANES Surveys

<h3>Research Objectives</h3> The bone mineral density (BMD) reflects bone health and is associated with the risk of developing osteoporotic fractures. This study aimed to examine the trends in BMD values in US 6-80 years old, and the changes in BMD values between 2005 and 2020. <h3>Design</h3> This is a cross-sectional observational study. <h3>Setting</h3> General community. <h3>Participants</h3> Data from 28,514 noninstitutionalized participants, aged 6 to 80, were obtained from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) study. We described the distributions of BMD values by sex, age group (6-8, 9-11, 12-15, 16-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80+ yr), and compared the trends in six cross-sectional surveys during 2005-2006, 2007-2008, 2009-2010, 2013-2014, 2017-2018, 2017-2020. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> BMD at the lumbar spine and femur was assessed using Dual-Energy X-ray Absorptiometry (DEXA). <h3>Results</h3> BMD changed by age and differed by sex. For males, mean femur BMD values (g/cm2) increased from 0.71 (6-8 yr), to 0.93 (12-15 yr), to 1.11 (16-19 yr), and decreased gradually to 0.92 (80+ yr) by age. For females, mean femur BMD values (g/cm2) increased from 0.66 (6-8 yr), to 0.93 (12-15 yr), to 0.98 (16-19 yr), and decreased gradually to 0.74 (80+ yr) by age. For males, mean spine BMD values (g/cm2) increased from 0.58 (6-8 yr), to 0.82 (12-15 yr), to 1.07 (25-29 yr), and maintained the levels by age (mean BMD = 1.07 at 80+ yr). For females, mean spine BMD values (g/cm2) increased from 0.60 (6-8 yr), to 0.94 (12-15 yr), to 1.08 (35-39 yr), and decreased gradually to 0.90 (80+ yr) by age. Males had higher femur BMD values in the age group 16-80 years old, and higher spine BMD values in the age group 50-80 years old, compared to females (p<.001). Mean BMD values (g/cm2) were relatively stable across data releasing cycles 2005-2020. <h3>Conclusions</h3> Between 2005 and 2020, stable trends in BMD values were observed among noninstitutionalized residents in the US. <h3>Author(s) Disclosures</h3> The authors declare no conflict of interest.

Undercarboxylated Osteocalcin and Its Associations With Bone Mineral Density, Bone Turnover Markers, and Prevalence of Osteopenia and Osteoporosis in Chinese Population: A Cross-Sectional Study.

ObjectiveUndercarboxylated osteocalcin (ucOC) is one form of osteocalcin lacking full carboxylation, which plays an important role in bone homeostasis, glucose homeostasis, and energy metabolism. Our aim is to obtain the profile of serum ucOC level according to gender and age and explore its associations with bone mineral density (BMD), bone turnover markers (BTMs), and prevalence of osteopenia and osteoporosis in the Chinese population.MethodsThis is a cross-sectional study with 900 subjects, composed of 431 men and 469 women. Clinical information was collected, and BMD values of the lumbar spine (L1–4), left femoral neck, and total hip were scanned. Biochemical markers including hepatic and renal function, serum calcium, serum phosphorus, procollagen type 1 N-propeptide (P1NP) β-CrossLaps of type I collagen-containing cross-linked C-telopeptide (β-CTX) intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ucOC were measured.ResultsWe found that the median ucOC level was higher in men than women [men, 2.6 ng/ml; women, 1.6 ng/ml; p < 0.001]. The profile according to age showed that ucOC levels were the lowest at the age of 40–49 years in both men [2.55 ng/ml (95% CI = 1.96–3.13 ng/ml)] and women [1.57 ng/ml (95% CI = 1.12–2.03 ng/ml)]; in patients younger than 49 years, they decreased with age; then over 50 years, they quickly increased. Furthermore, we found that a higher ucOC level was correlated with lower BMD values at the lumbar spine (men, r = −0.128, p = 0.013; women, r = −0.321, p < 0.001), femoral neck (men, r = −0.095, p = 0.062; women, r = −0.260, p < 0.001), and total hip (men, r = −0.123, p = 0.015; women, r = −0.209, p < 0.001) and higher P1NP (men, r = 0.307, p < 0.001; women, r = 0.239, p < 0.001) and β-CTX (men, r = 0.169, p = 0.001; women, r = 0.354, p < 0.001) levels in both men and women. Furthermore, we also showed that a 1 − SD increase in ucOC was associated with an odds ratio (OR) of 1.63 and 1.70 for having osteopenia or osteoporosis in men and women, respectively (men, 95% CI = 1.25–2.13, p = 0.004; women, 95% CI = 1.19–2.42, p = 0.004).ConclusionsWe first revealed the profile of serum ucOC levels according to gender and age in the Chinese population and demonstrated the associations of ucOC with BMD and BTMs and the risk of prevalent osteopenia or osteoporosis. Our findings provide a clue to elucidate the function of ucOC in bone metabolism.

Effect of cyclic pamidronate administration on osteoporosis in children with β-thalassemia major: a single-center study.

BackgroundOsteopenia and osteoporosis represent a prominent cause of morbidity in children with thalassemia. Multiple factors are responsible for the pathogenesis of bone loss in thalassemia, including diabetes, hypothyroidism, parathyroid gland dysfunction, accelerated hemopoiesis, direct iron toxicity of osteoblasts, iron chelators, and deficiencies of growth hormone or insulin growth factors.PurposeTo assess the effect of pamidronate administration on β-thalassemia major-induced osteoporosis in children.MethodsThis study assessed the effects of different treatments (calcium and vitamin D versus calcium, vitamin D, and pamidronate) on patients with β-thalassemia major and osteoporosis. Bone mineral density (BMD) and z scores were measured at baseline and after 1 year of treatment using dual-energy x-ray absorptiometry.ResultsThe mean baseline BMD values of the lumbar spine were 0.71±0.07 (g/cm2) and 0.74±0.07 (g/cm2), respectively, while those at the end of the study were 0.81±0.07 (g/cm2) (P<0.001) and 0.78±0.07 (g/cm2) (P>0.05), respectively. The mean baseline z scores of the lumbar spine were -3.53±0.55 and -3.17±0.61, while those after treatment were -2.1±0.32 (P=0.001) and -3.11±0.67 (P>0.05), respectively. The baseline alkaline phosphatase levels were 351.5±86.07 μg/dL and 357.6±89.7 μg/dL, while those after treatment were 220.4± 59.26.07 μg/dL (P<0.001) and 320.3±83.99 μg/dL (P>0.05), respectively.ConclusionPamidronate administration effectively increased the BMD and z scores of children with β-thalassemia major. Pamidronate had a favorable safety profile with no related serious adverse events during the study period.

OSTEOPOROSIS WITHIN A COHORT OF POSTMENOPAUSAL PAKISTANI WOMEN USING DUAL X-RAY BONE DENSITOMETRY

OBJECTIVE: To explore the prevalence of osteopenia and osteoporosis within a cohort of Pakistani postmenopausal women with respect to the lumbar spine and hip. METHODS: This cross-sectional study was conducted at Shifa International Hospital Islamabad, Pakistan from September 2019 to Feb 2020. Study comprised of 237 postmenopausal females who visited the outpatient department of the hospital. The T-scores of Bone Mineral density (BMD) data was collected and arranged in three groups: normal, osteopenia and osteoporosis. Data was analyzed to explore the distribution of the data and correlation analyses using R software version 3.6.3. RESULTS: Out of 237 females, majority were ranging in age from 61-70 years (n=110; 46.4%), followed by 51-60 years age group (n=60; 25.3%). Osteopenia was noted in 98 (41.4%) cases in lumber spine and hip area. Osteoporosis was found in 79 (33.3%) and 59 (24.9%) cases in lumber spine and hip region respectively. Mean T score was -1.775±-2.000 and median T score was -1.469 for lumber spine and hip. T-scores distribution of lumbar spine and hip indicated the highest proportion having a sore of -2 SD (n=60; 25.3% each), followed by -3 SD in 52 (21.9%) cases. Bone mass density was negatively correlated with age (p≤0.01). However, no significant difference was found among the BMD values of lumbar spine and hip region. CONCLUSION: Decreased bone density was a common occurrence affecting postmenopausal females and there is increase in degenerative bone loss with increasing age. Hip and lumbar spine region are equally affected by degenerative bone loss.

Bone Mineral Density in Adult Survivors of Pediatric Differentiated Thyroid Carcinoma: A Longitudinal Follow-Up Study.

Background: Survivors of pediatric differentiated thyroid carcinoma (DTC) receive thyrotropin-suppressive therapy to minimize disease recurrence. However, knowledge about long-term effects of subclinical hyperthyroidism on bone mineral density (BMD) in pediatric DTC survivors is scarce, as is the information regarding long-term consequences of permanent hypoparathyroidism on BMD. We evaluated BMD in pediatric DTC survivors and investigated if BMD was affected by subclinical hyperthyroidism and/or permanent hypoparathyroidism during long-term follow-up. Methods: In this nationwide longitudinal study, we determined BMD in the lumbar spine and femur by dual energy X-ray absorptiometry in 65 pediatric DTC survivors. Measurements were repeated after minimal 5 years of follow-up in 46 pediatric DTC survivors. BMD results were evaluated according to the recommendations of the International Society for Clinical Densitometry (ISCD) and WHO. At both visits, we determined biochemical parameters and markers of bone resorption (C-terminal telopeptide of type I collagen [β-CTX]) and formation (N-propeptide of type I collagen [PINP] and osteocalcin). Results: First and second BMD measurements were done after a median follow-up of 17.0 (interquartile range [IQR] 8.0-25.0) and 23.5 (IQR 14.0-30.0) years after diagnosis, respectively. Median age at diagnosis was 15 years (IQR 13.0-17.0). Twenty-nine percent of the survivors had subclinical hyperthyroidism. In most survivors, BMD T- and Z-scores were within the reference range during both BMD evaluations. However, after 23.5 years of follow-up, a low BMD was found in 13.0%. In the 13 survivors with permanent hypoparathyroidism, BMD values did not differ after 5 years of follow-up compared with baseline values or in comparison with the 33 survivors without permanent hypoparathyroidism. During follow-up, turnover markers β-CTX and PINP remained stable. Conclusions: This longitudinal study of pediatric DTC survivors demonstrated normal and stable median lumbar spine and femur BMD values after a median time of 17 and 23.5 years after diagnosis. However, compared with controls, a lower BMD was still found in 13.0% after prolonged follow-up despite intensive follow-up. Based on the studied follow-up period, these data do not provide convincing evidence in support of standard monitoring of bone mass among DTC survivors, but may be restricted to individual cases at low frequency. Trial Registration: This follow-up study was registered in The Netherlands Trial Register under no. NL3280 (www.trialregister.nl/trial/3280).

Efficacy and safety of intravenous pamidronate infusion for treating osteoporosis in children and adolescents.

PurposeOsteoporosis is a skeletal disorder characterized by reduced bone mass that results in increased risk of fractures. Pediatric osteoporosis can be caused by monogenic diseases, chronic diseases, and/or their treatment. This study was performed to investigate the effect of pamidronate infusion on osteoporosis in children and adolescents.MethodsThis study included 13 unrelated pediatric patients (10 males and 3 females) whose bone mineral density (BMD) z-score was <-2.0. Pamidronate was administered intravenously at a dosage of 1 mg/kg for 3 consecutive days every 4 months. Clinical and biochemical findings were reviewed retrospectively. The BMD values of the lumbar spine and femoral neck were assessed by dual energy x-ray absorptiometry at baseline and annually.ResultsThe underlying diseases were immobilization (62%), inflammatory bowel disease (23%), protein-losing enteropathy (8%), and idiopathic juvenile osteoporosis (8%). The mean age at the start of treatment was 12.7±4.3 years. Duration of treatment ranged from 12–50 months. The baseline height-standard deviation score (SDS) and weight-SDS were -2.01±2.08 and -2.60±1.62, respectively. The lumbar spine BMD z-scores improved significantly after 1 year of pamidronate treatment, but the femoral neck BMD z-scores did not. However, both z-scores had significantly increased by the end of treatment.ConclusionsThis study demonstrated that pamidronate treatment increased BMD in pediatric patients with osteoporosis with no significant adverse events. Further studies are required to better define the long-term efficacy and safety of pamidronate therapy in a large number of pediatric patients.

Cross-calibration of GE Lunar iDXA and Prodigy Densitometer for measurement of bone mineral density in young adults

The assessment of bone mineral density (BMD) is essential to skeletal health, and dual-energy x-ray absorptiometry (DXA) is a type of bone densitometer that is extensively used in both clinical and research settings. When changing a DXA system during longitudinal monitoring or multicenter studies, it is important to conduct cross-calibration between the new and reference scanners to ensure that BMD values measured by the two systems are as close as possible. Purpose: To properly cross calibrate between the GE Lunar iDXA and Prodigy in healthy young adults. Methods: Thirty college students, ten males and twenty females, participated in the study. The BMD at the lumbar spine and dual femurs were measured using the GE iDXA and Prodigy by the same licensed technician on the same day. A paired sample t-test and linear regression analysis were utilized to compare the BMD values between the two systems. Limits of agreement were obtained by Bland-Altman analyses. Results: Although strong correlations were found between the two systems (r = 0.985 – 0.998), the iDXA had significantly higher lumbar spine (1.54%) and dual femur (1.28 - 1.56%) BMD values compared to the Prodigy. Conclusion: Our results suggest that calibration equations should be considered to examine data across densitometers to reduce system differences in the young adult population.

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.

Serial Bone Density Measurement and Incident Fracture Risk Discrimination in Postmenopausal Women

Repeated bone mineral density (BMD) testing to screen for osteoporosis requires resources. For patient counseling and optimal resource use, it is important for clinicians to know whether repeated BMD measurement (compared with baseline BMD measurement alone) improves the ability to discriminate between postmenopausal women who will and will not experience a fracture. To assess whether a second BMD measurement approximately 3 years after the initial assessment is associated with improved ability to estimate fracture risk beyond the baseline BMD measurement alone. The Women's Health Initiative is a prospective observational study. Participants in the present cohort study included 7419 women with a mean (SD) follow-up of 12.1 (3.4) years between 1993 and 2010 at 3 US clinical centers. Data analysis was conducted between May 2019 and December 2019. Incident major osteoporotic fracture (ie, hip, clinical spine, forearm, or shoulder fracture), hip fracture, baseline BMD, and absolute change in BMD were assessed. The area under the receiver operating characteristic curve (AU-ROC) for baseline BMD, absolute change in BMD, and the combination of baseline BMD and change in BMD were calculated to assess incident fracture risk discrimination during follow-up. Of 7419 participants, the mean (SD) age at baseline was 66.1 (7.2) years, the mean (SD) body mass index was 28.7 (6.0), and 1720 (23%) were nonwhite individuals. During the study follow-up (mean [SD] 9.0 [3.5] years after the second BMD measurement), 139 women (1.9%) experienced hip fractures, and 732 women (9.9%) experienced major osteoporotic fracture. In discriminating between women who experience hip fractures and those who do not, AU-ROC values were 0.71 (95% CI, 0.67-0.75) for baseline total hip BMD, 0.61 (95% CI, 0.56-0.65) for change in total hip BMD, and 0.73 (95% CI, 0.69-0.77) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar discrimination for hip fracture. For discrimination of major osteoporotic fracture, AU-ROC values were 0.61 (95% CI, 0.59-0.63) for baseline total hip BMD, 0.53 (95% CI, 0.51-0.55) for change in total hip BMD, and 0.61 (95% CI, 0.59-0.63) for the combination of baseline total hip BMD and change in total hip BMD. Femoral neck and lumbar spine BMD values had similar ability to discriminate between women who experienced major osteoporotic fracture and those who did not. Associations between change in bone density and fracture risk did not differ by subgroup, including diabetes, age, race/ethnicity, body mass index, or baseline BMD T score. The findings of this study suggest that a second BMD assessment approximately 3 years after the initial measurement was not associated with improved discrimination between women who did and did not experience subsequent hip fracture or major osteoporotic fracture beyond the baseline BMD value alone and should not routinely be performed.

An analysis of osteoporosis in patients with hereditary multiple exostoses.

There are few reports of osteoporosis in hereditary multiple exostoses (HME) patients. Therefore, the purpose of this study was to analyze osteoporosis in HME patients. This retrospective cohort study included 20 patients diagnosed with HME. Patients underwent bone mineral density (BMD) measurement of the lumbar spine (n= 20) and femoral neck (n= 40). Bone metabolic parameters, including serum osteocalcin and urinary cross-linked N-telopeptide of type 1 collagen (NTx), were analyzed in all subjects. EXT1 and EXT2 genes were sequenced using genomic DNA. We also examined the correlation between genotype and BMD Z-score and T-score. The mean BMD values of the lumbar spine were 1.085 ± 0.116g/cm2 (n= 11) in male and 1.108 ± 0.088g/cm2 (n= 9) in female. The mean BMD values of the femoral neck area were 0.759 ± 0.125g/cm2 (n= 22) in male and 0.749 ± 0.115g/cm2 (n= 18) in female. Z-score of most HME patients show < 0, indicating that these patients tend to have low bone mass compared with the age-matched population. According to the T-score of BMD, 30% (6 of 20) and 67.5% (27 of 40) of the patients fell in the range of osteopenia in the lumbar spine and femoral neck areas, respectively. Serum osteocalcin and urinary NTx were in the normal range in most patients. There was no significant correlation between genotypes and Z-score. HME patients have low bone mass, especially in the femoral neck area. They do not have abnormal bone metabolism, and there was no correlation between genotypes and Z-score.

Bone mineral density in elderly and senile women with knee and hip osteoarthritis

Objective: to study bone mineral density (BMD) in elderly and senile women with knee and hip osteoarthritis (OA).Patients and methods. The investigation enrolled 124 women (mean age, 73.3±8.46 years) diagnosed with OA meeting the ACR diagnostic criteria. Lumbar spine (LI-IV) and femoral neck BMD values were determined; knee and hip X-ray in the frontal projection was carried out to assess the radiographic stage according to the Kellgren and Lawrence classification.Results and discussion. The overall incidence of osteoporosis (OP) and ostopenia in the study cohort was 28 and 41%, respectively. OP was diagnosed in 20% of women aged 60–74 years and in 38% of those aged 75–90 years (p&lt;0.05); osteopenia was in 41 and 42%, respectively (p&gt;0.05). In the age groups of 65–74 years and ≥75 years, women with stage III–IV hip OA had a significantly higher femoral neck BMD than those with Stage I–II (p&lt;0.05). At the same time, the later radiographic stages of hip OA were associated with lower lumbar spine BMD (p&lt;0.05). The patients of both age groups who had Stages III and IV knee OA had a significantly higher lumbar spine BMD than those with Stage I–II OA (p&lt;0.05). The femoral neck BMD in patients with Stages I–II and III–IV knee OA was comparable in both age groups (p&gt;0.05).Conclusion. The relationship between BMD and OA-related structural changes is contradictory and requires further investigation.

The associations of CYP19A1 rs700518 polymorphism with bone mineral density and risk of osteoporosis: a meta-analysis

Osteoporosis is now a worldwide public health problem that seriously endangers human health, but its causes have not yet been fully clarified. Recently, increasing evidence suggested that polymorphisms in CYP19A1 gene were associated with osteoporosis risk and bone mineral density (BMD), but results remained conflicting. We herein performed a meta-analysis based on evidence currently available from the literature to make a more precise estimation of these relationships. The PubMed, Embase, Cochrane library, CNKI (China National Knowledge Infrastructure), and Wan Fang databases were searched for eligible studies. Odds ratio (OR), mean difference (MD), and 95% confidence interval (CI) were applied to assess the strength of these relationships. A total of 8 studies involving 2632 subjects were included in our meta-analysis. We observed that the AG genotype of CYP19A1 rs700518 was significantly associated with lower BMD values of lumbar spine and femoral neck (AG vs. GG: p = .001 and.01, respectively). However, this polymorphism had no obvious impacts on osteoporosis risk according to current available data. In conclusion, the present meta-analysis showed that CYP19A1 rs700518 polymorphism may be a potential candidate biomarker for osteoporosis screening, early diagnosis, and treatment, which will help improve individualized therapy of osteoporosis patients in clinics.

Bone tissue quality in patients with monoclonal gammopathy of uncertain significance.

Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels.

Quantification evaluation of 99mTc-MDP concentration in the lumbar spine with SPECT/CT: compare with bone mineral density.

Despite recent technological advances allowing for quantitative single-photon emission computed tomography (SPECT), quantitative SPECT has not been widely used in the clinical practice of osteoporosis. The aim of this study is to evaluate the feasibility of quantitative bone SPECT/CT for measuring lumbar standard uptake value (SUV) in patients with different bone-mineral density (BMD), and investigate the correlation between SUV measured with 99mTc-methylene diphosphonate (MDP) SPECT/CT and BMD assessment by dual-energy X-ray absorptiometry (DXA). A retrospective analysis of 62 cases 99mTc-MDP whole-body bone imaging and local lumbar SPECT/CT tomography were performed. According to the results of dual-energy X-ray bone density examination, they were divided into normal group, osteopenic group, and osteoporosis group. The raw SPECT data were reconstructed using flash3D which includes attenuation correction, scatter compensation, and collimator resolution recovery, SPECT images from this algorithm were calibrated for SUV analysis. Comparing difference of lumbar SUV in different BMD subjects, and investigating the correlation between lumbar SUV and BMD. Data were analyzed by one-way ANOVA and Pearson regression analysis using SPSS 17.0 software. The maximum SUV (SUVmax) and mean SUV (SUVmean) of L1-L4 vertebral in 62 subjects were 7.39 ± 1.84 and 4.90 ± 1.27, respectively. The average BMD was 0.85 ± 0.15 (g/cm2), and the average CT value was 145.88 ± 53.99 (HU). The SUVmax, SUVmean, BMD, and CT values of the lumbar spine were statistically significantly different among the three groups (F = 24.089, 30.501, 94.847, 30.241, all p < 0.001), and the osteopenic group was significantly lower than the normal group (all p < 0.001), the osteoporosis group was significantly lower than the normal group and the osteopenic group (all p < 0.001). Lumbar SUVmax, SUVmean, and BMD were significantly negatively correlated with age (r = -0.328 to -0.442, all p < 0.05), and positively correlated with body weight and CT value (r = 0.299-0.737, all p < 0.05), but no significant correlation with height (r = 0.006-0.175, all p > 0.05). Lumbar SUVmax and SUVmean increased significantly with the increase of BMD (r = 0.638, 0.632, p < 0.001). The SUV of lumbar spine in 99mTc-MDP bone SPECT/CT was significantly different among subjects with different BMD, and the SUV was positively correlated with BMD. These findings justify that quantitative bone SPECT/CT is an applicable tool for clinical quantification of bone metabolism in osteoporosis patients.

Evolution of bone mineral density, bone metabolism and fragility fractures in Spinal Muscular Atrophy (SMA) types 2 and 3

With recent advances in the treatment of Spinal Muscular Atrophy (SMA), there is a strong need to increase knowledge on the involvement of organs and systems outside the central nervous system. We investigated bone metabolism, bone mineral density (BMD) and fractures, and their possible correlation with age and motor capacities. Thirty-two children with SMA (27 type 2, 5 type 3), mean age 40 ± 32.3 months, underwent two evaluations at an 18-month interval (V1 and V2). Twelve of these children also underwent a third evaluation at month 36 (V3). Diet, bone metabolism, BMD, X-rays, and motor function (by the Hammersmith Functional Motor Scale Expanded – HFMSE – and the Upper Limb Module – ULM) were assessed. At V1, 25-OH vitamin D3 (25OH D) therapy was started, and dietary calcium intake adjusted according to the recommended dietary allowance. Low 25OH D levels and asymptomatic vertebral fractures were mainly observed at V1. At all visits, bone resorption markers were higher than normal. At V2 and V3, decreased BMD was observed. Higher spine BMD values at follow-up were associated with HFMSE score >12 at baseline (p<0.03). This study suggests that even young children with SMA are at risk of severe bone fragility. Further investigations of the molecular mechanisms leading to altered bone metabolism in SMA could help identify novel therapeutic targets and establish better guidelines for bone fragility management.

PPARγ Pro12Ala and C161T polymorphisms, but not PPARα L162V, are associated with osteoporosis risk in Turkish postmenopausal women

Stimulation of peroxisome proliferator-activated receptors (PPARs) causes mesenchymal stem cells of the human bone marrow differentiate into adipocytes instead of osteoblasts leading to a decreased number of osteoblasts and a decrease in bone mineral density (BMD). Thus, PPARs may have impacts on bone metabolism. 224 postmenopausal women (171 osteoporotic and osteopenic, 53 healthy control) were included in this study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and agarose gel electrophoresis techniques were performed to detect PPARα L162V and PPARγ Pro12Ala/C161T polymorphisms. The distribution of PPARγ Pro12Ala genotype and allele frequencies was not statistically different in control and patient (osteopenic+osteoporotic) groups (p&gt;0.05). However, in the patient group, subjects with “Pro12Pro” genotype had lower lumbar spine (L1-L4) BMD values than those with “Ala” allele (p&lt;0.05). The frequency of PPARγ C161T “CC” genotype was higher in the patient group when compared with that in the control group (p&lt;0.05). There were no significant associations between the genotype and allele frequencies of PPARγ C161T/ PPARα L162V and BMD values (p&gt;0.05). We suggested that PPARγ Pro12Ala and C161T gene variants might be contributing factors in the development of osteoporosis.&nbsp;