Total Body Densitometry Research Articles

EVALUATION OF ASSOCIATION BETWEEN BONE MINERAL DENSITY AND VASCULAR CALCIFICATION IN CHRONIC KIDNEY DISEASE PATIENTS

A one-year prospective study was conducted in the Nephrology Department of Nishtar Hospital, Multan, to analyze the association between bone mineral density and vascular calcification in patients with chronic kidney disease. The study included 80 patients at various stages of chronic kidney disease. Vascular calcification was calculated using echocardiography, the Kauppila score, and the ankle-brachial index. Bone mineral density was computed by using total body densitometry. The study results showed that 41.25% of the patients (33 patients) had a Kauppila score more significant than one. Peripheral vascular calcification was observed in 22.5% of the patients (18), whereas 40% (36) had valvular calcification. Moreover, ABI and heart lesions were found to be positively correlated. The study also revealed that bone mineral density was an independent determinant, and valvular calcification was significantly associated with the total BMD and BMD of the femoral neck and femur. Therefore, the study concluded that there is a significant correlation between vascular calcification and bone mineral density in patients with chronic kidney disease.

Significant associations between bone mineral density and vascular calcification in patients with different stages of chronic kidney disease

IntroductionChronic kidney disease—mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients.MethodsWe performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD.ResultsNinety patients (41% male, median age 64 years (range 29–87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck.ConclusionsOur work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.

Classificação do estado nutricional pelo índice de massa gorda: o instrumento de medição importa?

Abstract Assessment of the Nutritional Status (NS) allows screening for malnutrition and obesity, conditions associated with chronic non-communicable diseases. The fat mass index (FMI) stands out concerning traditional NS indicators. However, proposals that define thresholds for FMI are not sensitive to discriminate extreme cases (degrees of obesity or thinness). Only one proposal (NHANES), determined by total body densitometry (DXA), established eight categories of NS classification (FMI). However, DXA is expensive and not always clinically available. Our study aims to test the validity of the NHANES method using electrical bioimpedance (BIA) and skinfold thickness (ST) to classify NS. The FMI of 135 (69 women) university students aged 18 to 30 years old was determined using DXA, BIA, and ST. The agreement between the instruments (Bland-Altman) and the agreement coefficient in the NS classifications (Chi-square and Kappa index) were tested. The agreement test against DXA indicated that ST underestimated the FMI (-1.9 kg/m2) for both sexes and BIA in women (-2.0 kg/m2). However, BIA overestimated FMI (1.4 kg/m2) in men, although with less bias. There was no agreement between the NS classifications (NHANES) by FMI between DXA and BIA, or DXA and ST. The exception occurred between DXA and BIA in men who showed a slightly better consensus, considered “fair” (k = 0.214; p = 0.001). In conclusion, ST and BIA did not show enough agreement to replace DXA for NS classification, within NHANES thresholds. The FMI measurement tools for the NHANES classification of the categories of NS matters.

Sarcopenia in Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study.

Background The aim of this study was to compare the prevalence of low muscle mass and sarcopenia in patients with type 2 diabetes mellitus (T2DM) versus paired controls (control group, CG) and the association between sarcopenia and chronic diabetes complications. Methods Men and women ≥50 years with T2DM (T2DM group, T2DMG) were recruited during routine outpatient visits. Total body densitometry and handgrip strength (HGS) were evaluated in the T2DMG and CG, while the T2DMG was also evaluated for the physical performance using the gait speed (GS) test. Sarcopenia was diagnosed according to the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). Results The study included 177 individuals in the T2DMG and 146 in the CG. The mean HGS value was lower in the T2DMG (24.4 ± 10.3 kg) compared with the CG (30.9 ± 9.15 kg), p < 0.001, with low HGS in 46 (25.9%) and 10 (9%) in the T2DMG and CG, respectively (p < 0.001). The prevalence of sarcopenia defined according to the FNIH criteria was higher in the T2DMG 23 (12.9%) compared with the CG 8 (5.4%), p < 0.03. The presence of albuminuria increased the odds of sarcopenia (odds ratio (OR) 2.84, 95% confidence interval (CI) 1.07–7.68, p=0.04) and osteoporosis (OR 3.38, 95% CI 1.12–9.89, p=0.03), even in patients with mild to moderate nephropathy. The body composition analysis showed increased odds of sarcopenia with increased percentage of total fat (%TF) in women (OR 1.18, 95% CI, 1.03–1.43, p=0.03) and men (OR 1.31, 95% CI, 1.10–1.75, p=0.01). Conclusion Patients with T2DM presenting with albuminuria, osteoporosis, and increased %TF were more likely to have sarcopenia. This finding emphasizes the need for patients with T2DM to be evaluated for sarcopenia to allow for early implementation of measures to prevent or treat this disorder.

Accuracy of BMI and waist circumference cut-off points to predict obesity in older adults.

The main objectives were to analyse the validity and accuracy of Body Mass Index (BMI) and Waist Circumference (WC) to evaluate obesity by excess of body fat in older adults and to identify more adequate cut-off points for this age group. The recommended cut-off points for BMI (25, 27 or 30 kg/m2) and WC (≥ 102 cm for men and ≥ 88 cm for women or ≥ 90cm for men and ≥ 80 cm for women) were compared to the total body densitometry. BF was defined by a value higher than the 90th percentile. Out of the 132 participants, 61% were women and aged between 60 and 91 years. The recommended cut-off points of BMI ≥ 25kg/m2 and BMI ≥ 27 kg/m2 showed similar performances. BMI ≥ 30 kg/m2 showed high specificity but low sensitivity to identify BF in men and better performance in women. Conventional WC cut-off points showed low sensitivity and specificity. Based on our analyses, new cut-off points for BMI (25 kg/m2 for men and 26.6 kg/m2 for women) and WC (98.8 cm for men and 77.8cm for women) were proposed. The new cut-off points showed sensitivity and specificity values > 74% and accuracy > 76%. The areas under the curve (ROC) were > 0.86. The new BMI and WC cut-off points proposed in the present study for the diagnosis of obesity in older adults showed the best levels of sensitivity and specificity for this age group.

PB1846 ANTHROPOMETRIC AND HORMONAL PARAMETERS IN COMPARISON WITH BONE MINERAL DENSITY IN MEN WITH HAEMOPHILIA FROM LOWER SILESIA ‐ PRELIMINARY REPORT

Background:In patients with haemophilia, recurrent episodes of bleeding lead to joint deterioration and bone resorption. To date, the effect of various risk factors on the bone mineral density (BMD) reduction have found conflicting results.Aims:The aim of the study was to analyze the impact of certain parameters, such as: viral status of patients, estradiol, testosteron, parathormone and vitamin D levels in relation to bone density.Methods:24 men with moderate and severe haemophilia, aged 18‐35 were enrolled. BMD at the lumbar spine, trabecular bone score (TBS) and total body densitometry were measured using dual X ray absorptiometry method (DXA) (densitometer Horizon, Hologic, 2017). Blood analyses were performed for morphology parameters, liver and kidney function parameters, HCV, HBV, HIV viral status, estradiol, testosteron, DHEA‐S, TSH, parathormone and Vitamin D levels.Results:The study population included 24 men with haemophilia A, who had been receiving prophylactic factor replacement therapy. HCV seropositivity was found in 6/24 patients (25%), whereas HBV seropositivity was detected in 4 patients (16,7%). There was no patient infected with HIV virus. No statistical correlation was found between BMD and viral serological status. It was found that in 15/24 patients BMD was normal with a Z‐score of &gt; ‐1 (62,5%), whereas in 9/24 patients (37,55%), BMD was decreased. In hemophilic patients with normal BMD Z‐score, the increased BMI, androidal fat deposit (AFD), gynoidal fat deposit (GFD), fat mass index (FMI), free fat mass index (FFMI), Estimated visceral adipose tissue (Est VAT) mass were detected. Among all analyzed hormones, only serum estradiol concentration was statistically higher in patients with normal BMD. In 17/24 examined patients Vitamin D deficiency (&lt;20 ng/ml) was detected (71%), although Vitamin D insufficiency (&lt;30 ng/ml) was found in 4/24 patients (16,7%). Three patients (12,5%) had a normal Vitamin D concentration.Summary/Conclusion:The higher BMD in haemophilic patients is related with certain anthropometric parameters, such as body‐fat‐, free‐fat‐mass indexes and visceral fat tissue. BMD negatively correlated with % body fat, androidal fat mass and PTH, whereas TBS negatively related with androidal/visceral fat mass. We found that Vitamin D deficiency is very common in haemophilic patients, however there was no correlation between Vitamin D levels and BMD.

PS-05-003 The role of nutritional intervention in the treatment of male hypogonadism secondary to obesity

The aim of the study was to evaluate the effects of nutritional intervention on body composition and hormonal profile in a group of obese patients after a weight loss of 10%. In particular, the study focused on the evaluation of aromatase activity, calculated as the ratio between total testosterone and estradiol. 28 patients aged between 18 and 65 were enrolled, fat percentage was > 30% and it was estimated with total body densitometry. Body composition (anthropometry, circumferences, DEXA), hormonal profile, cardiovascular risk indices and the HOMA index were evaluated. The patients underwent two tests: Yale Food Addiction Scale (YFAS) and Aging Male Symptoms (AMS), respectively for the assessment of carbohydrate dependence and symptoms related to hypogonadism. The nutritional treatment was based on hypocaloric, high-protein diet (1.5 g/kg ideal body weight/day). Diet energy gap was between 170–250 kcal/day. After a mean time of 6 months and a mean weight loss of 10% from baseline, a significant increase in serum total testosterone levels (405.3 ± 124.8 vs 298.2 ± 81.4 ng / dl, p = 0.002) and a significant reduction of estradiol (37.8 ± 16.2 vs 46.4 ± 12.1 pg / ml, p = 0.049) were observed. There was also a significant reduction in the percentage of total (36.1 ± 4.7 vs 39.8 ± 6.9, p = 0.0001) and segmental fat mass (android fat mass 46.3 ± 6.5% vs 52.1 ± 6.3% P = 0.0012; gynoid fat mass 36.4 ± 5.9 % vs 39.1 ± 6.1% p = 0.0001). The lean mass remained unchanged. The reduction in aromatase activity (expressed as the total testosterone / estradiol ratio) was statistically significant (110.9 ± 52.8 vs 69.1 ± 34.1, p = 0.003). Food addiction has not improved after the nutritional intervention and probiotic supplementation.

Terapia combinada (ultrassom e eletroterapia) na redução da adiposidade abdominal: relato de casos

Introdução: O acúmulo de gordura na região do abdome, além de estar relacionado à saúde cardiovascular e a problemas metabólicos, tornou-se uma questão estética relevante pelo fato de influenciar a saúde psicossocial de indivíduos. Objetivo: Avaliar os efeitos da Terapia Combinada, através de ultrassom e eletroterapia, na adiposidade abdominal de mulheres. Métodos: Trata-se de um estudo de casos no qual 9 mulheres (30,33±8,5 anos) foram submetidas a 10 sessões de terapia, 2 vezes/semana, durante 5 semanas. A avaliação da área tratada foi realizada através de perimetria, plicometria e exames de densitometria de corpo total pré e pós-intervenção. Resultados: Os resultados da densitometria mostraram que a combinação de ultrassom e eletroterapia reduziu o percentual de gordura da região abdominal em média 2,44±2,31. Pela perimetria e plicometria verificouse reduções da circunferência abdominal e das pregas cutâneas supra-ilíaca e abdominal. Conclusão: Neste estudo de casos a intervenção através de terapia combinada mostrou-se eficaz na redução da adiposidade abdominal de mulheres.

Effectiveness of Aquatic Exercises in Women With Rheumatoid Arthritis: A Randomized, Controlled, 16-Week Intervention-The HydRA Trial.

The purpose of this study was to compare the effectiveness of land-based (LB) and water-based (WB) aerobic exercises in women with rheumatoid arthritis (RA). A total of 133 women with RA were included in this randomized, blinded, prospective, 16-week controlled trial. The subjects were randomized into 3 groups: WB (n = 33), LB (n = 33), and control (n = 34). Muscle strength (MS) was measured using an isokinetic dynamometer. Disease activity (DAS-28) and functional ability (health assessment questionnaire) were measured by an expert rheumatologist. Total body densitometry was used to assess body composition. The intervention was performed 3 times per week, and all groups were evaluated at baseline and after 8 and 16 weeks. Compliance, concomitant medications, and adverse events were recorded. The data were analyzed by intention to treat. P < 0.05 was set as significant. Of the 133 patients recruited, 100 were randomized and 82 completed the study. In the first evaluation, the 3 groups were matched to age, body composition, functional capacity, MS, and concomitant medications. After 16 weeks, there were no significant changes of knee MS neither body composition among the groups. However, there was a significant improvement in disease activity and functional ability in the WB after 8 and 16 weeks. Aquatic exercises provided significant improvement in disease activity, pain, and functional capacity.

Bone Mineral Density in the Noninstitutionalized Elderly: Influence of Sociodemographic and Anthropometric Factors.

Objective. Analysis of bone mineral density (BMD) in the elderly and its associated factors according to sex. Methods. A cross-sectional study is presented herein, with a random sample of 132 noninstitutionalized elderly people. Individuals who did not use diuretics were excluded. BMD was obtained from examination of total body densitometry and its association with sociodemographic variables, lifestyle, anthropometric, and body composition was verified. Results. Mean BMD for men was 1.17 ± 0.12 g/cm2 and for women was 1.04 ± 0.11 g/cm2. Higher education was associated with higher BMD values in men (p < 0.05). There was a reduction in BMD in the age group 75–79 years of age in women and over 80 years of age in men (p < 0.05). Underweight was associated with significantly low BMD for both sexes (p < 0.01), while normal weight was associated with low BMD in women (p < 0.001). Discussion. The elderly with low schooling and in older age groups are more probable to also present low BMD. Lower levels of body mass index also indicated towards low BMD.

Mechanical vibration preserves bone structure in rats treated with glucocorticoids

Glucocorticoids are an important cause of secondary osteoporosis in humans, which decreases bone quality and leads to fractures. Mechanical stimulation in the form of low-intensity and high-frequency vibration seems to be able to prevent bone loss and to stimulate bone formation. The objective of this study was to evaluate the effects of mechanical vibration on bone structure in rats treated with glucocorticoids. Thirty 3-month-old adult male Wistar rats were randomized to three groups: control (C), glucocorticoid (G), and glucocorticoid with vibration (GV). The G and GV groups received 3.5 mg/kg/day of methylprednisolone 5 days/week for a duration of 9 weeks, and the C group received vehicle (saline solution) during the same period. The GV group was vibrated on a special platform for 30 min per day, 5 days per week during the experiment. The platform was set to provide a vertical acceleration of 1 G and a frequency of 60 Hz. Skeletal bone mass was evaluated by total body densitometry (DXA). Fracture load threshold, undecalcified bone histomorphometry, and bone volume were measured in tibias. Glucocorticoids induced a significantly lower weight gain (− 9.7%) and reduced the bone mineral content (− 9.2%) and trabecular number (− 41.8%) and increased the trabecular spacing (+ 98.0%) in the G group, when compared to the control (C). Vibration (GV) was able to significantly preserve (29.2%) of the trabecular number and decrease the trabecular spacing (+ 26.6%) compared to the G group, although these parameters did not reach C group values. The fracture load threshold was not different between groups, but vibration significantly augmented the bone volume of the tibia by 21.4% in the GV group compared to the C group. Our study demonstrated that low-intensity and high-frequency mechanical vibration was able to partially inhibit the deleterious consequences of glucocorticoids on bone structure in rats.

Importance of lean mass in the interpretation of total body densitometry in children and adolescents

Objective Most studies that use total body dual energy x-ray absorptiometry (DEXA) in children rely on areal bone mineral density (BMD=bone mineral content [BMC]/bone area [BA]) and compare the output with age- and sex-specific normative data. Because this approach is prone to size-related misinterpretation, this study focuses on the interrelations among BMC, body size (height), and lean tissue mass (LTM).Study design This cross-sectional study presents normative total body LTM data in relation to height and BMC for 459 healthy white subjects (249 female), 3 to 30 years of age. Guidelines for DEXA interpretation in children are provided and illustrated for patients with growth hormone deficiency (n=5) and anorexia nervosa (n=5).Results LTM/height tended to be greater in male than in girls. The BMC/LTM ratio was greater in female than in boys (P<.001), even after adjustment for age and height. Sex-specific reference curves were created for LTM/height, the BMC/LTM ratio, BA/height, and BMC/BA.Conclusions We recommend that total body DEXA in children should be interpreted in 4 steps: (1) BMD or BMC/age, (2) height/age, (3) LTM/height, and (4) BMC/LTM ratio for height. This allows differentiation of the origin of a low BMD or BMC/age, for example, short stature and primary, secondary, and mixed bone defects.

Cirrosis alcohólica y osteodistrofia hepática: ¿cuáles son los principales factores implicados?

ObjectivesTo know the prevalence of bone disease in alcoholic cirrhotic males from 45 to 65 years old. To prove the intervention of several factors usually involved in hepatic osteodystrophy. Subjects and methodsstudy population: 52 alcoholic cirrhotic males from 45 to 65 years old.Design and variables: transversal descriptive study. The following factors were evaluated: bone disease: thoracic and lumbar spine standard X-ray and bone densitometry (dual energy X-ray absorptimetry-DPX plus LUNAR-DEXA) were performed), nutritional state: anthropometric evaluation (measuring skin thickness) and total body densitometry, factors usually involved in hepatic osteodystrophy: active alcoholism, smoking, diabetes, hypogonadism and physical execise and clinical severity of cirrhosis: Child-Turcotte classification.Statistical analysis: Mc Intosh computer (program Filemaker PRO). Results58% of patients had loss of bone mass. 80,85% were Child A, 12,76% Child B and 6,39% Child C. Bone disease was present in 52,63% of Child A, 83,33% of Child B and 100% of Child C. Discussion and conclusionsthe prevalence of osteopenia was higher than in other studies. The usual risk factors were no relevant in losing bone mass except for smoking. The clinical severity of cirrhosis was significantly related to the loss of bone mass in these patients.

Nutrición, enfermedad ósea y cirrosis alcohólica

Objectives: To know the prevalence of osteopenia and osteoporosis in alcoholic cirrhotic males from 45 to 65 years old. To prove if the nutritional state is involved in the loss of bone mass in the hepatic disease. Material and methods: Study population: 52 alcoholic cirrhotic males from 45 to 65 years old, with normal kidney function , non-sedentary and with no treatment that could alterate the study. Design and variables: transversal descriptive study finished in 2 years. The nutritional state was evaluated by means of classic anthropometric parameters (weight, height, perimeter of the arm and skin folds) and total body densitometry (DPX plus LUNAR-DEXA with dual energy X-ray absorptiometry. Statistical analysis: Mc Intosh computer (Filemaker PRO program). T Student was used to compare groups and p was significant if alpha 0.05. Clinical severity of cirrhosis: Child-Turcotte classification. Results: Osteopenia was diagnosed if bone mineral density (BMD) was higher than 1 standard deviation (SD) but lower than 3 SD below T score (mean values for adult women) and osteoporosis (OP) if BMD was higher than 3 SD or vertebral compression fractures appeared in simple radiographies. The prevalence of bone disease was 58%. The percentages of fat obtained by means of anthropometric and densitometric measures were higher in non-osteopenic patients. Discussion: The prevalence of bone disease was higher than another studies. The total body densitometry is a more exact method to measure the percentage of body fat. The percentages of fat obtained with both methods were not related to the loss of bone mass. The nutritional state as an isolated factor does not lead to bone disease in these patients.

Bone mass, body weight, and seasonal bone changes.

Bone densitometry is now used widely in studies of bone mass. In just a few years, as a result of technological developments and efforts to control health care costs by using densitometric methods in the prevention of bone disease, mainly osteoporosis, we have progressed from simple forearm densitometry to total body densitometry with vertebral morphometry. However , recent studies show that radiogrammetry, a simple and inexpensive radiologic technique that is available at any hospital, is as effective as spinal densitometry, the technique most widely used in bone mass studies [1, 2]. Regardless of the value of bone densitometry in bone mass studies, its results can be expressed as either total body bone mineral content (TBBMC) and regional bone mineral content (RBMC), both in grams, or the more frequent total body bone mineral density (TBBMD) and regional bone mineral density (RBMD), both in g/cm 2. A recent development is the measurement of volumetric bone mass by axial or peripheral quantitative computed tomography (in g/cm 3) [3]. Regardless of how the measurements are expressed, normalization of bone mass to g/cm 2 or g/cm 3 minimizes sexual differences. Mazess et al. [4], prolific researchers of densitometric measurement of bone mass, find that sexual differences that are evident when bone mass measurements are expressed as grams of regional BMC are unapparent when bone mass is normalized for density. Although we have no wish to enter into debates, we agree with Dequeker and Geusens [5] that bone mass measurements should be expressed as BMC rather than BMD because BMC better discriminates the sexual differences in bone mass. Moreover, if skeletal calcium content is what really matters, TBBMC informs us of the absolute amount of total calcium (TBCa) because skeletal calcium represents a constant proportion of total mineral content [6]. As such, TBBMC is undoubtedly important in some disorders. We find that another advantage of expressing bone mass as regional BMC is that it correlates better with bone resistance to fracture than does regional BMD [7]. Changes in bone mass in men and women are influenced significantly by changes in weight [8, 9], weight being the principal determinant of bone mass in women [10]. Because of possible fluctuations in weight in the course of longitudinal studies [ l l ] , bone mass measurements should be evaluated in the light of changes in other body components. This has not been done in most studies, which overlook the possible relation between variations in bone mass and changes in weight. In fact, even over short time intervals, changes in