Spine Bone Mineral Density Research Articles

Effect of bisphosphonate and denosumab treatment on TBS in Japanese breast cancer patients with AIBL.

Bisphosphonates and denosumab increase bone mineral density (BMD) for osteoporosis treatment in patients with aromatase inhibitor-associated bone loss (AIBL). This study aimed to directly compare bisphosphonates with denosumab in treating patients with AIBL and to determine the effect of denosumab on the trabecular bone score (TBS). Thirty-nine patients with AIBL receiving osteoporosis treatment (21 in the bisphosphonates group and 18 in the denosumab group) were retrospectively evaluated for changes in lumbar spine and femoral BMD, lumbar spine bone quality (assessed by TBS), and blood bone metabolic markers. The Mann-Whitney and Wilcoxon tests were used for statistical evaluation. After 24months of treatment, the lumbar spine BMD change rate was 5.82 ± 1.10% with bisphosphonates and 10.49 ± 1.20% with denosumab, with the change rate of denosumab significantly increasing over that of bisphosphonates. The change rate in femoral BMD was 2.69 ± 1.16% with bisphosphonates and 2.95 ± 1.26% with denosumab, with no significant difference between the two groups. The rate of decrease in tartrate-resistant acid phosphatase isoform 5b was significantly higher in the denosumab group. The change rate in TBS at 24months of treatment was 0.53 ± 1.26% in the bisphosphonates group and 1.08 ± 1.33% in the denosumab group, with no significant difference between the two groups. After 24months, TBS remained stable. Both bisphosphonates and denosumab may increase BMD, improve bone metabolism, and inhibit bone quality loss in patients with AIBL.

The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study.

The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass. We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)-10 mm anterior from the MF; molar (M)-10 mm posterior from the MF; posterior (P)-25 mm posterior from the MF; symphysis (S)-equidistant from the centers of the right and left MF. We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women. These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice.

One versus 2years of alendronate following denosumab: the CARD extension.

When denosumab is discontinued, antiresorptive therapy is critical to attenuate high-turnover bone loss. The ideal choice and duration of antiresorptive therapy are not yet defined, however. In the Comparison of Alendronate or Raloxifene following Denosumab (CARD) study, we demonstrated that 12months of alendronate was better able to maintain the bone mineral density (BMD) gains achieved with 12months of denosumab versus 12months of raloxifene. In this extension, we wished to determine if 12months of alendronate would be sufficient in maintaining these denosumab-induced BMD gains. In the CARD study, postmenopausal osteoporotic women aged 60-79 at high fracture risk received 12months of denosumab 60-mg SC every 6months followed by 12months of either alendronate 70mg weekly (N = 26) or raloxifene (N = 25). All subjects in the alendronate arm were then offered participation in a 1-year extension in which they were randomized to continue alendronate for an additional 12months (N = 10) or to receive calcium and vitamin D alone (N = 8). The primary outcome was change in spine BMD between months 24 and 36. Exploratory endpoints included changes in areal BMD (aBMD) at other anatomic sites as well as changes in serum bone turnover markers. The CARD study demonstrated the effectiveness of 12months alendronate in preserving denosumab-induced BMD gains. In the extension, aBMD was maintained at the spine, total hip, and femoral neck in both those randomized to an additional year of alendronate and those randomized to calcium/vitamin D alone. We did, however, observe a transient comparative decrease between months 24-30 in the calcium/vitamin D group at the total hip (P = 0.008) and femoral neck (P = 0.040). At the end of 24months of the CARD study, bone turnover markers serum c-telopeptide (CTX) and procollagen N-propeptide of type I collagen (PINP) were suppressed in both groups and then increased more between months 24-36 in the calcium/vitamin D group than the alendronate group (P = 0.051 for CTX, P = 0.030 for P1NP). Both CTX and PINP remained below the month 0 baseline in both groups (P < 0.05 for all comparisons). With the limitations of our small sample size, these data suggest that both 1 and 2years of alendronate effectively maintain BMD gains achieved with 1year of denosumab and prevented any rebound in bone turnover marker levels above pre-denosumab baseline. This is the first randomized trial to assess minimum duration of bisphosphonate after short-term denosumab and may be helpful to guide clinical care. Similar studies performed after longer durations of denosumab would be helpful to further define optimal management. ClinicalTrials.gov registration number: NCT03623633.

The relationship between serum monoterpene levels and bone health: a retrospective cross-sectional analysis from the National Health and Nutrition Examination Survey (NHANES) data.

Monoterpenes, a subset of the terpene family composed of two isoprene units, have garnered significant attention in research circles owing to their potential medicinal benefits. Recent experimental studies indicate that they might exert positive effects on bone health. Nevertheless, the impact of monoterpenes exposure on bone health remains unexplored in humans. We examined 748 adults (age ≥ 40 years) from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to explore the correlation between three monoterpenes (α-pinene, β-pinene, and limonene), bone mineral density (BMD) in the total lumbar spine and proximal femur, FRAX® scores, and prior bone fracture history. Our analysis unveiled a significant inverse association between a one-unit increase in the natural logarithm (ln) of α-pinene and limonene and total proximal femur BMD (ß = -0.027, S.E. = 0.008, P = 0.004 and ß = -0.019, S.E. = 0.007, P = 0.016, respectively). As serum α-pinene levels ascended across quintiles, there was a notable decrease in total proximal femur BMD (P for trend = 0.025). The inverse relationship between ln α-pinene levels and total proximal femur BMD was more pronounced in women, especially pre-menopausal women. Compared to subjects with α-pinene and limonene levels at or below the 50th percentiles, those exceeding this threshold exhibited the lowest mean value of total proximal femur BMD (0.8628 g/cm2, S.E. = 0.026, P = 0.009). However, the trend was not statistically significant (P = 0.070). Additionally, all three monoterpenes were linked to a higher prevalence of previous spine fractures, whereas β-pinene showed a reduced incidence of other types of fractures. In this comprehensive survey of American adults aged 40 and above, higher serum levels of α-pinene and limonene correlated with decreased total proximal femur BMD. Furthermore, our findings suggest a potential combined effect of α-pinene and limonene on total proximal femur BMD. Further investigation is essential to elucidate the clinical relevance and causative nature of our findings.

Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in virologically suppressed patient with chronic hepatitis B.

Our study evaluated the outcomes of switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) in patients with chronic hepatitis B (CHB). We assessed viral and biochemical responses as well as changes in the estimated glomerular filtration rate (eGFR) and bone mineral density (BMD). This retrospective multicenter study included CHB patients who achieved virologic response (VR) (HBV DNA<20IU/mL) while on TDF and were subsequently switched to TAF between April 2018 and October 2021. This study included 309 patients with a median age of 59years, and 42.1% were male. The mean duration of TDF and TAF administration were 54.0 and 37.5months, respectively. All patients maintained VR after switching to TAF. Alanine aminotransferase (ALT) normalization rate significantly increased 6months after switching (74.8%-83.5%; P=0.008). Adjusted eGFR significantly improved at 6months (+5.55±10.52mL/min/1.73m2; P<0.001) and 12months (+6.02±10.70mL/min/1.73m2; P<0.001) after switching. In the subgroup of patients with renal impairment (eGFR<60mL/min/1.73m2), significant improvement in renal function was observed at 6months (+0.6±10.5mL/min/1.73m2; P<0.001) and 12months (+1.0±10.7mL/min/1.73m2; P<0.001) after switching to TAF. In patients with osteoporosis (n=182), switching to TAF resulted in significant improvement in spine and hip BMD at 12months, with increases of 9.7% (95% CI: 7.0-12.5) and 9.4% (95% CI: 7.0-11.8), respectively. In this real-world study, switching to TAF was effective and safe in patients, with notable improvements in ALT levels, renal function, and BMD.

Optimizing preoperative bone health assessment for adult spinal deformity: a prospective correlation analysis of intraoperative pedicle screw insertion torque and imaging modalities in Japan.

Prospective cohort study. This study aimed to identify the optimal preoperative bone health assessment for adult spinal deformity (ASD) surgery through correlation analysis between intraoperative pedicle screw (PS) insertion torque and various bone quality measures, including bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DEXA), Hounsfield unit (HU) by computed tomography (CT), and vertebral bone quality (VBQ) score by magnetic resonance imaging. Existing data on optimal assessment tools for ASD surgery are limited. The study included patients with ASD aged >60 years who underwent spinal corrective fusion surgery from the lower thoracic spine to the pelvis. The intraoperative PS insertion torque was measured using a torque meter. Pearson correlation coefficients were calculated between the PS insertion torque and the BMD, HU, and VBQ score. Preoperative bone quality was compared between the proximal junctional failure (PJF) and non-PJF groups. Thirty-one patients with 177 PS at T10, T11, and T12 were analyzed. The PS insertion torque showed a moderate positive correlation with lumbar spine BMD (r=0.59-0.69, p<0.01), total hip BMD (0.58-0.62, p<0.01), and HU value (r=0.58-0.66, p<0.01). However, the VBQ score did not show significant correlation (r=-0.28 to -0.23, p >0.05). Notably, a strong correlation was found between the PS insertion torque and the HU value for screws of the same size (r=0.71 and 0.74, p<0.01). The HU value at T12 and the PS insertion torque at T10 were significantly lower in the PJF group than in the non-PJF group. This study demonstrates a positive correlation between the PS insertion torque and HU value in the lower thoracic spine and a moderate correlation with BMD but not the VBQ score. Preoperative assessment using DEXA and CT is crucial for optimizing bone health management in ASD surgery.

Idiopathic juvenile osteoporosis-a polygenic disorder?

Idiopathic juvenile osteoporosis (IJO) is a rare condition presenting with vertebral and metaphyseal fractures that affects otherwise healthy prepubertal children. Bone mineral density (BMD) measurements are very low. The primary problem appears to be deficient bone formation, with a failure to accrue bone normally during growth. The onset in childhood suggests IJO is a genetic disorder, and a number of reports indicate that some children carry heterozygous pathogenic variants in genes known to be associated with defective osteoblast function and low bone mass, most commonly LRP5 or PLS3. However, a positive family history is unusual in IJO, suggesting the genetic background can be complex. We describe a young man with classical IJO who was investigated with a bone fragility gene panel and whole genome sequencing. The proband was found to carry four variants in three different genes potentially affecting osteoblast function. From his mother he had inherited mutations in ALPL (p.Asn417Ser) and LRP5 (p.Arg1036Gln), and from his father mutations in LRP5 (p.Asp1551Alsfs*13) and activating transcription factor 4 (ATF4) (p.Leu306Ile). His sister had also inherited the LRP5 (p.Asp1551Alsfs*13) from her father, but not the ATF4 mutation. Their spinal BMD z-scores differed substantially (sister -1.6, father -3.2) pointing to the potential importance of the ATF4 mutation. Activating transcription factor 4 acts downstream from RUNX2 and osterix and plays an important role in osteoblast differentiation and function. This case, together with others recently published, supports the view that IJO can result from clustering of mutations in genes related to osteoblast development and function. Novel genes in these pathways may be involved. Our case also emphasizes the value of detailed study of other family members. After a bone biopsy had excluded a mineralization defect due to hypophosphatasia, the proband was treated with zoledronate infusions with good clinical effect.

Osteoporosis should be evaluated by bone mineral density at the combination of the lumbar spine and ipsilateral femoral neck in female patients with knee osteoarthritis scheduled for knee arthroplasty: A retrospective observational study

BackgroundKnee arthroplasty is a well-established surgery with good clinical outcomes. However, periprosthetic fractures and aseptic loosening negatively impact clinical outcomes, and osteoporosis is one of the causes of such complication. Osteoporosis is usually evaluated by bone mineral density of the lumbar spine and hip using dual-energy X-ray absorptiometry (DXA). However, the prevalence of this disease in patients with knee osteoarthritis scheduled for knee arthroplasty may be underestimated due to differences in the measurement sites. This study aimed to determine the appropriate measurement site for DXA that would not miss osteoporosis in female patients with knee osteoarthritis undergoing knee arthroplasty. MethodsWe measured bone mineral density preoperatively in the consecutive 50 female patients with knee osteoarthritis scheduled for knee arthroplasty by dual-energy X-ray absorptiometry at five sites: the lumbar spine, bilateral-total hip, and femoral neck. We then compared the prevalence of osteoporosis among the four combinations of the lumbar spine and single hip site (ipsilateral or contralateral total hip or femoral neck). ResultsOsteoporosis prevalence in the combination of the lumbar spine and ipsilateral or contralateral total hip was 32%, and that in the combination of the lumbar spine and contralateral femoral neck was 44%. Notably, the disease's prevalence in the combination of the lumbar spine and ipsilateral femoral neck was 50%, which was significantly higher than that in the other combinations. ConclusionOsteoporosis should be evaluated by bone mineral density in the combination of the lumbar spine and ipsilateral femoral neck in female patients with knee osteoarthritis scheduled for knee arthroplasty.

The Role of Glucose, Insulin and Body Fat in Assessment of Bone Mineral Density and Trabecular Bone Score in Women with Functional Hypothalamic Amenorrhea.

Background: For years, bone mineral density (BMD) has played a key role in assessing bone health, but the trabecular bone score (TBS) is emerging as an equivalent measure. However, BMD alone may not fully measure bone quality or predict osteoporosis risk. To evaluate the usefulness of TBS and BMD in estimating the risk of bone fracture in young women with FHA, this study examined the association between metabolic parameters and bone quality, which was measured using TBS and BMD. Methods: We analyzed the association of metabolic factors with tests assessing bone quality-TBS and BMD. Patients were checked for BMI, measured body fat, and determined serum glucose levels and insulin levels in a 75g glucose load test. Spearman correlation analysis was used. Results: Significant positive correlations were found between BMD and age (p < 0.001) and body fat (p < 0.001), as well as between TBS values and BMI (p < 0.001) and TBS and percent body fat (p < 0.001). Of the variables analyzed in the multivariate analysis, the only independent predictor of higher bone mineral density in the lumbar spine was found to be higher values of the trabecular bone index in the same segment (p < 0.001). Conclusions: The use of TBS provides a simple tool for estimating the risk of bone damage. Ultimately, early screening, diagnosis and treatment of patients with FHA may help prevent osteoporosis and fragility fractures in the long term.

The relationship of body composition with bone mineral density and 10-year probability of hip fracture in postmenopausal women

IntroductionPostmenopausal osteoporosis and fractures are widely prevalent. However, the relationship of body composition with bone health in this population remains unclear. The aim of this study was to investigate the association of body composition with bone mineral density (BMD) and 10-year probability of hip fracture in postmenopausal women. Materials and MethodsThis is a cross-sectional study. A total of 1285 subjects were included in our study. Body composition and BMD were assessed using dual-energy X-ray densitometry. The 10-year probability of hip fracture of participants was calculated. All participants were categorized into four groups: sarcopenic-obese (SO) group, sarcopenic-nonobese (S) group, nonsarcopenic-obese (O) group, or nonsarcopenic-nonobese control (C) group. Multivariate analyses and binary logistic regression were conducted to explore the relationship of body composition with BMD and 10-year probability of hip fracture. ResultsParticipants in S group were 2.8, 4.7 and 4.8 times more likely to develop osteoporosis in the lumbar spine, the total hip and femoral neck sites, respectively. Lean mass was positively correlated with BMD, wherein lumbar spine BMD was significantly affected by appendicular lean mass, while total hip BMD and femoral neck BMD were mainly influenced by trunk lean mass. Total fat mass was positively associated with total hip and femoral neck BMD, but not with lumbar spine BMD. A significant correlation was observed between lean mass and 10-year probability of hip fracture. ConclusionChanges in body composition in postmenopausal women could affect bone health. A decrease in regional lean mass may be associated with an increased risk of osteoporosis and fractures.

The influence of body fat content and distribution on bone mass in healthy Chinese adults.

Previous studies have reported a close relationship between body mass index (BMI) and bone mineral density (BMD). However, the effects of fat on bone mass remain controversial, particularly for fat tissue distribution. The aim of this study was to evaluate the association between regional fat percentage and BMD using a population-based database. This study included participants who were referred to the Department of Radio Diagnosis for dual-energy X-ray absorptiometry (DEXA) scan from January 2018 to December 2020. The relationships between BMI and regional fat percentage with BMD were assessed using multiple linear regression and generalized additive models. The risk of low bone mass was determined using logistic regression. There was a negative relationship between the regional fat percentage and femoral neck BMD (FN BMD) or lumbar spine BMD (LS BMD) in both genders (p < 0.05). In females, an inverted U-shaped relationship was observed between regional fat percentage and BMD at both the femoral neck and lumbar spine. The impact of trunk fat percentage on LS BMD was associated with the highest OR of low bone mass in females (OR 3.1, 95% CI 2.6 to 3.7, p for trend <0.001), while the impact of abdomen fat percentage on FN BMD was associated with the highest OR of low bone mass in males (OR 2.2, 95% CI 1.8 to 2.7, p for trend <0.001). There was an inverted U-shaped relationship between regional fat percentage and BMD. Excessive regional fat percentage may be harmful to bone health in both genders. To promote bone health, males should restrict their abdomen circumference and avoid abdominal adiposity, while females should control their trunk circumference.

Efficacy and safety of candidate biosimilar CT-P41 versus reference denosumab: a double-blind, randomized, active-controlled, Phase 3 trial in postmenopausal women with osteoporosis

SummaryThis 78-week (18-month) study conducted in 479 postmenopausal women with osteoporosis evaluated the efficacy, pharmacodynamics, pharmacokinetics, safety, and immunogenicity of candidate biosimilar CT-P41 relative to US reference denosumab. CT-P41 had equivalent efficacy and pharmacodynamics to US-denosumab, with similar pharmacokinetics and comparable safety and immunogenicity profiles. PurposeTo demonstrate equivalence of candidate biosimilar CT-P41 and US reference denosumab (US-denosumab) in postmenopausal women with osteoporosis. MethodsThis 78-week (18-month), double-blind, randomized, active-controlled Phase 3 study (NCT04757376) comprised two treatment periods (TPs). In TPI, patients (N = 479) were randomized 1:1 to 60 mg subcutaneous CT-P41 or US-denosumab. At Week 52, those who had received CT-P41 in TPI continued to do so. Those who had received US-denosumab were randomized (1:1) to continue treatment or switch to CT-P41 in TPII. The primary efficacy endpoint was percent change from baseline in lumbar spine bone mineral density at Week 52. Efficacy equivalence was concluded if associated 95% confidence intervals (CI) for least squares (LS) mean group differences fell within ± 1.503%. The primary pharmacodynamic (PD) endpoint was area under the effect curve for serum carboxy-terminal cross-linking telopeptide of type I collagen through the first 26 weeks, with an equivalence margin of 80–125% (for 95% CIs associated with geometric LS mean ratios). ResultsEquivalence was demonstrated for CT-P41 and US-denosumab with respect to primary efficacy (LS mean difference [95% CI]: − 0.139 [− 0.826, 0.548] in the full analysis set and − 0.280 [− 0.973, 0.414] in the per-protocol set) and PD (geometric LS mean ratio [95% CI]: 94.94 [90.75, 99.32]) endpoints. Secondary efficacy, PD, pharmacokinetics, and safety results were comparable among all groups up to Week 78, including after transitioning to CT-P41 from US-denosumab. ConclusionsCT-P41 was equivalent to US-denosumab in women with postmenopausal osteoporosis, with respect to primary efficacy and PD endpoints.

Structural difference analysis of gut microbiota in different bone mass populations and relevant probiotic (lactobacilli) supplementation strategies

AbstractDisruption of the bone metabolic balance with advancing age leads to an escalating prevalence of bone‐related diseases, significantly compromising individuals’ quality of life. The gut microbiota actively participates in the regulation of bone metabolism, and perturbations in the gut microbiota can exacerbate bone diseases by compromising gut barrier integrity. Determining the microbial taxa involved in bone loss could offer valuable insights into the development of alternative therapies and nutritional interventions for disease management. Therefore, based on metagenomic and 16S ribosomal RNA data, this study analyzed the gut microbiota structure of 488 individuals with different bone masses (NC, normal; ON, osteopenia; OP, osteoporosis) to identify significant associations between the gut microbiota and bone loss. The results showed that at the genus and species levels, the microbiota diversity of the ON population increased, whereas that of the OP population decreased. Bacteroides were significantly enriched in the OP population, whereas the beneficial bacteria Bifidobacterium, Akkermansia, and lactobacilli decreased. Subsequent analyses revealed no significant variation in different bone populations in terms of Bifidobacterium levels, whereas lactobacilli exhibited diverse responses across distinct bone populations. The administration of lactobacilli effectively enhanced lumbar spine bone mineral density and modulated the gut microbiota structure in a population with unhealthy bone mass. This study contributes to the validation of the association between the gut microbiota and bone mass, enhances our understanding of the potential impact of probiotics (lactobacilli) on bone mass, and establishes a robust scientific basis for the application of probiotics in the regulation of bone mass.

Effects of exercise on bone density and physical performance in postmenopausal women: A systematic review and meta-analysis.

Postmenopausal bone loss and decreased physical performance are commonly presented issues. This study aimed through systematic review and meta-analysis to examine the benefits of adding exercise to medicine/supplements in postmenopausal women. A systematic search was conducted of four electronic databases for articles published from inception to December 2023. Clinical controlled trials comparing the effect of additional exercise and medicine/supplements alone in postmenopausal women were included. The outcomes studied were bone mineral density (BMD) and physical performance. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Nineteen articles with 1249 participants were included in this study for systematic review and meta-analysis. The results showed that additional exercise was not associated with significantly improved BMD at the lumbar spine and hip joint compared with medicine/supplements only. However, results of subgroup analysis of exercise types showed a significant improvement in lumbar spine BMD by combining multiple types of exercise training (SMD = 0.37; 95% confidence interval [CI] = 0.01-0.72; p = .04). Furthermore, additional exercise significantly improved lower extremity muscle strength (Standard Mean Difference [SMD] = 1.77; 95% CI = 0.56-2.98; p = .004), Berg's Balance Scale (SMD = 0.72; 95% CI = 0.12-1.32; p = .02), Timed Up and Go (SMD = -1.07; 95% CI = -1.35--0.78; p < .001), fear of falling (SMD = 1.32; 95% CI = 0.89-1.75; p < .001), and the quality of life (SMD = 1.39; 95% CI = 0.74-2.05; p < .001). The quality level of the evidence was between low to very low. The significant value of the exercise was demonstrated through enhancing physical performance and quality of life. Moreover, combining various exercise training programs has shown a positive effect on BMD at the lumbar spine. Therefore, for postmenopausal women, combining exercise with medicine/supplements is recommended to further improve physical function and specific areas of BMD. (PROSPERO: CRD42023390633).

Prevalence of Osteoporosis and Sarcopenia in Middle-Aged Subjects with Low Back Pain

Abstract Objective The genesis of both osteoporosis and sarcopenia is multifactorial, complicated, and interrelated. The present study has been undertaken to analyze the prevalence of low bone mineral density (BMD) and the pattern of imaging markers of sarcopenia (paraspinal skeletal muscle area [SMA] and skeletal muscle index [SMI] with respect to clinicodemographic profile in middle-aged patients (30–45 years) undergoing evaluation for low back pain (LBP). Materials and Methods Magnetic resonance imaging (MRI) of the lumbosacral spine and/or sacroiliac joints was done on 3T MRI. BMD of the lumbar spine (L1 to L4) was assessed using a dual-energy X-ray absorptiometry scan. SMA was calculated by measuring the cross-sectional area of paraspinal muscles (bilateral psoas, erector spinae, and multifidus), and SMI was calculated by dividing SMA by height2. Results The prevalence of osteoporosis was 12.1% in patients of age 30 to 45 years presenting with LBP. Both osteoporosis and paraspinal muscle mass were statistically associated with the duration of symptoms (p-value &lt;0.05). No statistically significant difference was observed in different MRI findings, that is, normal, inflammatory, infective, and degenerative etiology. Conclusion Low BMD and loss of muscle mass in cases with LBP are more related to duration of disease rather than etiology or gender in middle-aged subjects. Early intervention to manage LBP may prevent progression to osteoporosis and sarcopenia in young adults.

The effect of Mongolian Medicine Chagan Gaoyou-4 Powder on bone mineral density induced by retinoic acid in rats

Objective: To investigate the effects of Chagan-Gaoyou-4 powder on spine bone mineral density and serum estrogen and estrogen receptor alpha (ERa) and estrogen receptor beta (ERβ) protein expression in bone tissue induced by retinoic acid in rats. Methods: Sixty 3-month-old SPF female SD rats were randomly divided into model group (retinoin group), normal group (SHAM group), Mongolian medicine group (Chagan-Gaoyou 4 group), and control group (Gushukang granule group). After 14 days of administration, spinal Bone Mineral Density (BMD) was measured, and external manifestations were observed. Results: Compared with the SHAM group, the BMD values of all medication groups decreased (P &lt; 0.05, P &lt; 0.001). Compared with the model group, the spinal BMD value of the Chagan Gaoyou-4 group was increased after 21 days of treatment, and the difference was statistically significant (P &lt; 0.01, P &lt; 0.05). After 21 days, the spinal BMD value of all treatment groups was increased (P &lt; 0.05), the spinal BMD value was also increased, especially Chagan Gaoyou-4 group was more obviously increased (P &lt; 0.05). Compared with the normal group, ERa and ERβ levels in the model group were significantly decreased (P &lt; 0.001), and ERa and ERβ levels in all drug groups were significantly increased (P &lt; 0.001) compared with the model group. After 21 days of treatment, there was no significant difference among the three treatment groups (P &gt; 0.05). ERa and ERβ levels in the Chagan Gaoyou-4 group were higher than those in the model group (P &lt; 0.05), but there was no significant difference between the group and the Gushukang granule group (P &gt; 0.05). The E2 content of the Chagan Gaoyou-4 group was higher than that of the model group (P &lt; 0.05). The mRNA expression of estrogen receptor ERa and ERβ in bone tissue of the left proximal femur was detected by RT-PCR. Compared with the model group, the expression of ERa and ERβ mRNA in the Chagan Gaoyou-4 group and Gushukang granule group was increased. Compared with the model group, ERp mRNA expression was increased in the Chagan Gaoyou-4 powder medium-dose group. Compared with the Gushukang granule group, there was no significant difference in ERm RNA expression in the Chagan Gaoyou-4 dose groups. Chagan Gaoyou-4 can up-regulate the expression of ERa and ERβ induced by retinoic acid in rats, indicating that the Chagan Gaoyou-4 powder group may promote bone formation, regulate bone resorption, improve bone mineral density, and achieve the purpose of preventing and treating OP by increasing estrogen level, stimulating estrogen receptor, and increasing the expression of ERa and ERβ in bone tissue. Conclusion: Chagan-Gaoyu-4 powder may have estrogen-like effects on the bone tissue of rats induced by retinoic acid and may increase the level of serum estrogen, ERa, and ERβ protein expression, thereby improving the spinal BMD of experimental rats. The Chagan-Gaoyou-4 powder group could improve the general condition of osteoporosis induced by retinoic acid in rats.

Improvement of bone mineral density and new vertebral fractures during 8 years of TNF-α inhibition in patients with axial spondyloarthritis

ObjectiveIn our prospective cohort with standardized bi-annual measurements of bone mineral density (BMD) and spinal radiographs, we evaluated the long-term course of BMD and the development of radiographic vertebral fractures (VFs) during 8 years of TNFi treatment in patients with radiographic axial spondyloarthritis (r-axSpA). MethodsConsecutive axSpA patients from the GLAS cohort receiving TNFi for ≥8 years were included. Patients who received anti-osteoporotic treatment were excluded. Lumbar spine (LS) BMD was assessed at baseline, 1 year and bi-annually using DEXA. Radiographic VFs were evaluated using the Genant classification. Results126 axSpA patients were included; 75 % male, mean age 42 ± 11 years, ASDAS 3.8 ± 0.8, median LS BMD Z-score -0.5 (IQR -1.4–0.7) and 20 % had radiographic VFs at baseline. Disease activity improved rapidly and sustained. LS BMD Z-score improved significantly up to 4 years compared to the previous time point and sustained thereafter. Median percentage of improvement compared to baseline was 8.9 % (2.8–15.8) and 7.2 % (2.2–14.7) after 4 and 8 years, respectively. Of 90 patients with baseline and 8-year radiographs, 14 (16 %) developed new VFs and 5 (6 %) showed an increase in severity of existing VFs. Of all 44 VFs present at 8 years, 30 % were grade 2 (n = 12) or grade 3 (n = 1). ConclusionIn r-axSpA patients treated with TNFi for 8 years, LS BMD Z-score increased significantly, especially during the first 4 year of treatment. Radiographic VFs continued to develop or progressed, irrespective of improvement in BMD. Therefore, clinical attention for trabecular bone loss is important in daily clinical practice.

Association between composite dietary antioxidant and bone mineral density in children and adolescents aged 8–19 years: findings from NHANES

Dietary antioxidants may have beneficial effects on bone health, but it remains uncertain in children and adolescents. This study investigates the association of composite dietary antioxidant index (CDAI) with bone mineral density (BMD) in children and adolescents aged 8–19 years from the National Health and Nutrition Examination Survey (NHANES) 2007–2010. The study assessed the relationship between CDAI and BMD in 2994 individuals aged 8–19 years (average age 13.48 ± 3.32 years) from the NHANES 2007–2010. Multivariate linear regression analyses were utilized to detect the association between CDAI and total spine, femur neck, and total femur BMD, adjusting for confounders including age, race/ethnicity, sex, poverty income ratio (PIR), body mass index (BMI), serum phosphorus and calcium. Stratified analyses and interaction tests were performed to examine the stability of the results. The weighted characteristics showed that subjects in the fourth CDAI quartile were more likely to be older, men, and Non-Hispanic White. They have higher values of serum total calcium and phosphorus. After adjusting all confounders, CDAI was positively associated with the total spine (β = 0.0031 95% CI 0.0021–0.0040), total femur (β = 0.0039 95% CI 0.0028–0.0049), and femur neck BMD (β = 0.0031 95% CI 0.0021–0.0040) in children and adolescents. Furthermore, we found no interaction effects between different race/ethnicity, age, and sex groups. Our findings suggest that dietary intake of multiple antioxidants was positively associated with BMD in children and adolescents. These findings provide valuable evidence for improving bone health in the early stages of life. However, more prospective studies are required to validate our findings and their causal relationship.

Efficacy and safety of romosozumab: a meta-analysis of placebo-controlled trials.

We aimed to comprehensively compile placebo-controlled trials on the efficacy and safety of romosozumab (210mg, subcutaneously, once monthly) in postmenopausal women and men with osteoporosis. PubMed, Google Scholar, and ClinicalTrials.gov were searched for relevant placebo-controlled trials (as of January 1, 2024). Percent change in bone mineral density (BMD), falls, fractures, and adverse events (AEs) after drug administration were collected. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Six trials (7990 patients; follow-up period, 6-12months) were included. Compared with placebo, romosozumab significantly increased lumbar spine BMD (MD = 12.69; 95% CI 11.10-14.29), total hip BMD (MD = 4.42; 95% CI 3.03-5.80), and femoral neck BMD (MD = 3.99; 95% CI 2.42-5.57) at 12months. Romosozumab significantly decreased falls (RR = 0.80; 95% CI 0.68-0.93) and major osteoporotic fractures (RR = 0.37; 95% CI 0.25-0.54), but increased injection-site reactions (RR = 1.83; 95% CI 1.46-2.30) within 12months. No significant differences were observed in other AEs (including cardiovascular AEs) within 12months. Romosozumab treatment resulted in a significant BMD gain, reduced falls and major osteoporotic fractures. It was generally well-tolerated, including the cardiovascular aspects. However, clinicians should consider the occurrence of minor AEs (e.g., injection-site reactions).

Risk factors for vertebral fracture in rheumatoid arthritis patients using biological disease-modifying anti-rheumatic drugs (cases over 5 years): An observational study.

While biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered beneficial for preventing osteoporosis and bone fracture, it is unclear whether bone loss is involved in the development of vertebral fracture, and few reports have examined the factors related to vertebral fracture in rheumatoid arthritis (RA) patients using bDMARDs. This study aims to identify factors influencing vertebral fracture in RA patients treated with bDMARDs. We retrospectively examined the records of 129 RA patients treated with bDMARDs for over 5 years. The lumbar spine and femoral bone mineral density, Disease Activity Score-28-C-Reactive Protein (DAS28-CRP) value, Simplified Disease Activity Index (SDAI), and modified Health Assessment Questionnaire (mHAQ) score were evaluated. The frequency of new vertebral fracture during the study and their risk factors were investigated. A comparison between the fracture group and the nonfracture group was performed. Multivariate analysis was performed using logistic regression analysis to detect risk factors for new vertebral fracture. The number of patients with new vertebral fracture during follow-up was 15 (11.6%) of the 129 patients in the study. Age and mHAQ score were significantly higher and lumbar spine and femoral neck bone mineral density were significantly lower in the fracture group than the nonfracture group. The risk factors for new vertebral fracture during the disease course were older age and higher mHAQ score indicating no remission over the 5 years of follow-up. In this study, there was no significant difference in disease indices such as the DAS28-CRP value and the SDAI between the fracture and nonfracture groups, suggesting an effective control of RA with bDMARDs. However, age and the mHAQ score, an index of RA dysfunction, were significantly higher in the fracture group. These results suggest that improving functional impairment may be important to prevent vertebral fracture in patients using bDMARDs.