Total Femoral Bone Mineral Density Research Articles

U-Shaped Association between Dietary Acid Load and Risk of Osteoporotic Fractures in 2 Populations at High Cardiovascular Risk

BackgroundBone contributes to maintaining the acid-base balance as a buffering system for blood pH. Diet composition also affects acid-base balance. Several studies have linked an imbalance in the acid-base system to changes in the density and structure of bone mass, although some prospective studies and meta-analyses suggest that acid load has no deleterious effect on bone. ObjectiveThe aim of this study was to examine the associations between potential renal acid load (PRAL) and net endogenous acid production (NEAP) and the risk of osteoporotic fractures and bone mineral density (BMD) in 2 middle-aged and elderly Mediterranean populations. MethodsWe conducted a longitudinal analysis including 870 participants from the PREvención con DIeta MEDiterranea (PREDIMED) Study and a cross-sectional analysis including 1134 participants from the PREDIMED-Plus study. Participants were adults, aged 55–80 y, either at high cardiovascular risk (PREDIMED) or overweight/obese with metabolic syndrome (PREDIMED-Plus), as defined by the International Diabetes Federation, the American Heart Association, and the National Heart Association. PRAL and NEAP were calculated from validated food-frequency questionnaires. BMD was measured using DXA scans. Fracture information was obtained from medical records. The association between mean PRAL and NEAP and fracture risk was assessed using multivariable-adjusted Cox models. BMD differences between tertiles of baseline PRAL and NEAP were evaluated by means of ANCOVA. ResultsA total 114 new fracture events were documented in the PREDIMED study after a mean of 5.2 y of intervention and 8.9 y of total follow-up. Participants in the first and third PRAL and NEAP tertiles had a higher risk of osteoporotic fracture compared with the second tertile, showing a characteristically U-shaped association [HR (95% CI): 1.73 (1.03, 2.91) in tertile 1 and 1.91 (1.14, 3.19) in tertile 3 for PRAL, and 1.83 (1.08, 3.09) in tertile 1 and 1.87 (1.10, 3.17) in tertile 3 for NEAP]. Compared with the participants in tertile 1, the participants in the top PRAL and NEAP tertiles had lower BMD [PRAL: mean total femur BMD: 1.029 ± 0.007 and 1.007 ± 0.007 g/cm2; P = 0.006 (tertiles 1 and 3); NEAP: mean total femur BMD: 1.032 ± 0.007 and 1.009 ± 0.007 g/cm2; P = 0.017 (tertiles 1 and 3)]. ConclusionsThe results of our study suggest that both high and low dietary acid are associated with a higher risk of osteoporotic fractures, although only high dietary acid was found to have a negative relation to BMD in senior adults with existing chronic health conditions. This trial was registered at http://www.isrctn.com/ as ISRCTN3573963 (PREDIMED) and ISRCTN89898870 (PREDIMED-Plus).

Bone Mineral Density and Related Scores in Parkinson's Disease: A Systematic Review and Meta-Analysis

Parkinson's disease (PD) is the second most common degenerative neurologic disorder in older adults, and increasing attention has been paid to bone health in PD. Although several studies have shown that patients with PD have a lower bone mineral density (BMD) than do non-PD controls, there have been no systematic reviews in recent years. PubMed, Medline, and Web of Science were used to search relevant studies up to May 2020. BMD, BMD T score, and BMD Z score of patients with and without PD were statistically analyzed. Meta-analysis was conducted using Review Manager version 5.3. This meta-analysis included 17 studies comprising 10,289 individuals. In the meta-analysis, adults with PD had lower total body, total hip, total radius, lumbar spine, total femur, femur neck, right-hand, and left-hand BMD than did non-PD controls. The T score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, total femur BMD, and femur neck BMD in adults with PD were lower than those in non-PD controls. Futhermore, the Z score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, and femur neck BMD was lower in adults with PD than in non-PD controls. Patients with PD had a lower BMD, BMD T score, and BMD Z score compared with non-PD controls. Therefore, clinicians should routinely monitor BMD of patients with PD to prevent falling and fragility fractures in older adults and optimize BMD before surgical treatment of severe spinal deformity caused by PD.

Does Hip Bone Density Differ between Paretic and Non-Paretic Sides in Hemiplegic Stroke Patients? and Its Relationship with Physical Impairment.

BackgroundBone loss after stroke escalates the risk of fractures, mainly in the hip, leading to further disability in individuals with stroke. We aimed to investigate the skeletal effect of bone mineral density (BMD) based on the duration of onset of stroke, compare the BMD of the paretic and non-paretic sides, and elucidate the relationship between BMD and disability variables.MethodsThe 31 male hemiplegic stroke patients between 20 and 70 years of age with cerebral infarction or hemorrhage were considered in this study. Subacute and chronic cases included 13 and 18 patients with lag time from the onset of 1 to 6 months and beyond 6 months, respectively. BMD in the lumbar, paretic, and non-paretic hip as well as the disability variables were analyzed retrospectively.ResultsThe subacute group showed a significant reduction in the femoral neck BMD on the paretic side compared to that on the non-paretic side based on T-scores (P=0.013). Bone loss was significantly correlated with lower limb muscle strength and overall physical impairment (P<0.05). The chronic group demonstrated significant reduction in femur neck and total femur BMD on the paretic side compared to that on the non-paretic side based on T-scores (P=0.002 and P<0.001, respectively). T-scores of BMD in the chronic phase were not significantly associated with the clinical parameters.ConclusionsEarly screening of bilateral hip BMD in the early stages after stroke, monitoring, and timely implementation of prevention strategies are important to minimize subsequent bone loss and prevent possible complications in patients who experience stroke.

Short-Term Precision Error of Bone Strain Index, a New DXA-Based Finite Element Analysis Software for Assessing Hip Strength

Bone Strain Index (BSI) is a new finite element analysis tool applied to hip dual energy X-ray absorptiometry scans. The aim of this study was to assess the short-term precision error of BSI on the proximal femur, both on a phantom and patients. The International Society for Clinical Densitometry guidelines were followed for short-term precision error assessment. Dual energy X-ray absorptiometry measurements were performed on an anthropomorphic femur phantom that was scanned twice for 30 times, for a total of 60 scans. For the in vivo part, 30 subjects were scanned twice. BSI precision error was compared to that of bone mineral density (BMD). Both for the phantom and the in vivo study BSI reproducibility was lower compared to that of BMD, as the precision error of BSI resulted 3 times higher compared to that BMD. For phantom measurements, the highest precision value was that of total femur (TF) BMD (coefficient of variation [CoV] = 0.63%, reproducibility = 98.24%), while the lowest precision was the femoral neck (FN) BSI (CoV = 3.08%, reproducibility = 91.48%). Similarly, for the in vivo study, the highest precision was found at TF BMD (CoV = 1.36%, reproducibility = 96.22%), while the lowest value of precision was found for FN BSI (CoV = 4.17%, reproducibility = 88.46%). Reproducibility at TF was always better compared to that of the FN. BSI precision error was about 3 times higher compared to BMD, confirming previous results of lumbar spine BSI. The main source of variability of this new software is related to patient positioning.

Irisin Correlates Positively With BMD in a Cohort of Older Adult Patients and Downregulates the Senescent Marker p21 in Osteoblasts.

Irisin is a myokine produced by skeletal muscle during exercise in both mice and humans. We previously showed that irisin treatment ameliorates immobility-induced osteoporosis and muscular atrophy in mice. Data in humans showed a positive association between irisin and bone mineral density (BMD) in athletes and a population of healthy children. However, the role of this myokine regarding the state of muscle and bone in the same population remained to be determined. For this purpose, 62 patients (age 68.71 ± 12.31 years) undergoing total hip or knee replacement were recruited. Our results showed that irisin serum levels negatively correlated with age (R = -0.515; p = .000018) and positively correlated with femoral BMD (R = 0.619; p = .001) and vertebral BMD (R = 0.201; p = .0001). Irisin was also positively associated with Fndc5 mRNA in muscle biopsies (R = 0.248; p = .016), as well as with Osteocalcin (Ocn) mRNA in bone biopsies (R = 0.708; p = .006). In skeletal muscle, FNDC5 positive fibers positively correlate with BMD of total femur (R = 0.765; p = .0014) and BMD of femoral neck (R = 0.575; p = .031), Interestingly, by analyzing patients divided by their T-score, we found lower irisin levels (p = .0011) in patients with osteopenia/osteoporosis (OP) compared to healthy controls matched for age and sex. By analyzing the senescence marker p21, we found a significant increase of its mRNA expression in the bone biopsies of OP patients compared to control ones. Therefore, we investigated in vitro whether rec-irisin had a direct effect on this senescence marker, showing that p21 mRNA expression was significantly downregulated in osteoblasts by the treatment with irisin. Overall, these results indicate that higher irisin levels are associated with a lower rate of age-related osteoporosis and that irisin could be effective in delaying the osteoblast aging process, suggesting a potential senolytic action of this myokine. © 2020 American Society for Bone and Mineral Research (ASBMR).

Bone mass in women with premature ovarian insufficiency: a comparative study between hormone therapy and combined oral contraceptives.

The aim of the study was to evaluate whether combined oral contraceptives (COCs) can be used as hormone therapy (HT) to preserve bone mineral density (BMD) in women with premature ovarian insufficiency (POI). An observational study of women with POI comparing the use of COC (ethinylestradiol 30 μg + levonorgestrel, continuously) with: low-dose HT (continuous conjugated estrogen 0.625 mg plus medroxyprogesterone or continuous estradiol [E2] 1 mg + norethisterone), high-dose HT (continuous conjugated estrogen 1.25 mg + medroxyprogesterone or continuous E2 2 mg + norethisterone), tibolone 2.5 mg, or no treatment. Bone density scans were performed every 2 ± 1 years. The difference between final and initial (delta) BMD values was calculated for the lumbar spine, total femur, and femoral neck. Generalized estimating equations were used to analyze the effect of treatment over time. Variables without normal distribution were transformed into ranks. Overall, 420 scans (210 deltas) of 119 women were analyzed. The women were 30.3 ± 9.2 years old (mean ± SD). BMD deltas at the lumbar spine and total femur were grater in the COC and high-dose HT groups. At the lumbar spine, the differences between two scans were greater in the COC group when compared to low-dose HT group: -0.043 (95% CI -0.062 to -0.024), untreated: -0.056 (-0.080 to -0.032), and tibolone: -0.050 (-0.094 to -0.006) groups. Total femur BMD decreases and the delta were lower in the low-dose HT group -0.038 (-0.052 to -0.024) when compared to COC. Continuous COC was associated with increased BMD in women with POI compared to low-dose HT, with similar improvement in the COC and high-dose HT groups. : Video Summary:http://links.lww.com/MENO/A620.

Observational Study to Evaluate the Effect of Epidural Steroid Injection on Bone Mineral Density and Bone Turnover Markers

Background: Epidural steroid injection (ESI) is widely used to manage low back pain. ESIs are commonly performed to treat pain accompanying intervertebral disc prolapse, spinal stenosis, facet joint pathologies, and other degenerative spinal pathologies. Corticosteroids for musculoskeletal conditions, regardless of the route of administration, can reduce bone mineral density (BMD) and increase the risk of fracture. With paraspinal administration of steroids, the severity of risk is enhanced as the steroid is being deposited in close proximity to bone. BMD and molecular markers of bone metabolism are the standard methods to assess the effect of any insult on bone strength and bone metabolism. Carboxy terminal crosslinked telopeptides of type 1 collagen (sCTX) and serum Procollagen Type I N-terminal propeptide (P1NP) are the reference markers of bone resorption and formation, respectively. Objective: We conducted this study to determine the effect of ESI on BMD and bone turnover markers. Study Design: This was a prospective observational cohort study, involving a cohort of 264 patients between the ages of 40 to 60 years who were advised to undergo ESI at L3-4 or L4-5 by their pain physician. Setting: Research was conducted at a tertiary care teaching hospital pain clinic in collaboration with the department of orthopaedics and radiodiagnosis. Methods: Serum CTX-1, P1NP, and pre-ESI BMD of the spine, femur neck, and dual femur were evaluated at baseline; these same parameters were serially evaluated post ESI on follow-ups at 1, 3, and 6 months. Additional follow-up at 10 days post ESI was called for evaluation of bone turnover markers (BTMs). A paired t test was used to analyze changes in BMD and BTMs vs baseline within the group. Cumulative incidence and relative risk of moderate to markedly low BMD were calculated using standard formulas. Any fractures sustained during follow-ups were also evaluated thoroughly and quantified separately. A P value less than .05 was considered statistically significant. Results: The proportion of pre-ESI moderately to markedly low BMD was 10.22% in the study population. There was a statistically significant increase in serum CTX 10 days post ESI which persisted at the one-month and 3-month follow-ups. There was no significant change in serum P1NP level post ESI after 7 days and at the one-month follow-up. The mean value of serum P1NP was, however, significantly higher at the 3-month follow-up. Statistical comparison of the mean BMD value at the spine and femur neck revealed statistically significant decline 3 months post ESI. There was no significant impact of ESI on the total femur BMD. The cumulative incidence of moderately low to markedly low BMD over a period of 6 months in the study population was 45 out of 223, i.e., 20.17%. Limitations: The study’s primary limitations included its high dropout rate, a larger reference range for BTMs, making them a less specific tool for comparison, and the absence of a control group. ESI has a negative impact on the BMD of the hip and spine. Reduced BMD should be considered as a potential side effect of ESI. Key words: Bone mineral density, bone turnover markers, epidural steroid injection, low back ache, osteoporosis Pain Physician 202

Selenium status is independently related to bone mineral density, FRAX score, and bone fracture history: NHANES, 2013 to 2014.

Selenium is an essential trace mineral element for humans. Although previous in vitro and animal studies have reported the vital role of selenium in bone, the results of the relationship between the selenium status and bone health were inconsistent in epidemiological studies. The risk of selenium deficiency is negligible for U.S. general population, however, the relationship between selenium status and bone health has never been surveyed in a nationally representative sample. In this study, we analyzed the data of 2983 adults (aged ≥40years) in the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to investigate the association among three markers of the selenium status (measured from whole blood, serum, and dietary intake), total spine and femur bone mineral density (BMD), and FRAX scores, and history of bone fractures. We found a one-unit increase in the ln-whole-blood selenium level was correlated with an increase in the total femur BMD of 0.064g/cm2 (S.E. = 0.025; P=0.022) in all participants and 0.086g/cm2 (S.E. = 0.031; P=0.013) in menopausal women. Additionally, a one-unit increase in the ln-selenium intake amount was associated with an increase in the total femur BMD of 0.014g/cm2 (S.E. = 0.007; P=0.043) in all participants. We also found that the dietary and whole-blood selenium statuses were negatively associated with the FRAX score, while levels of all the three selenium biomarkers were negatively associated with a history of bone fractures. In conclusion, increased selenium status is correlated with an increased total femur BMD, decreased FRAX scores, and a reduced incidence of previous bone fractures in the U.S. representative survey of adults. Further study is warranted to clarify the causal inference.

Association of bone mineral density with the development of knee osteoarthritis in men and women: a cross-sectional study using the fourth and fifth Korea National Health and Nutrition Examination Surveys.

The purpose of this study was to evaluate the association of BMD in various body parts in conjunction with the presence or severity of radiographic knee osteoarthritis (KOA) in relation to sex. This study was a cross-sectional analysis using Korea National Health and Nutrition Examination Surveys. KOA was graded using the Kellgren-Lawrence (KL) grading system. Radiographic KOA was defined as a KL grade 2 or higher. The associations between KOA and BMD in certain body parts (femur, pelvis, lumbar, lower leg, and whole-body) were assessed. BMD was measured using dual-energy X-ray absorptiometry. The BMD of each body part was divided into quartiles and the relationship between KOA and BMD was examined according to sex. BMD did not show a significant tendency according to KL grade in either sex. In men, the severity of KL grade have a statistically significant relationship with total femur (R2 = 0.303, p < 0.05), femur neck (R2 = 0.257, p < 0.05), lumbar (R2 = 0.137, p < 0.05), and pelvis BMD (R2 = 0.185, p < 0.05). In women, total femur (R2 = 0.466, p < 0.05), lumbar (R2 = 0.316, p < 0.05), pelvis (R2 = 0.343, p < 0.05), and lower leg BMD (R2 = 0.133, p < 0.05) were associated with the severity of KL grade. When the BMD was divided into quartiles, lumbar (p < 0.05) and pelvis BMD (p < 0.05) in men had statistically significant association with knee OA as BMD decreased. In women, femur neck (p < 0.05) and lumbar BMD (p < 0.05) were significantly associated with knee OA as BMD increased. The relationship between BMD and OA severity varied according to sex. In women, there was a positive association between femur neck and lumbar BMD and OA, while BMD of the lumbar and pelvis in men was negatively correlated with OA. Cohort study, III.

Relationship Between Physical Activity Intensity And Bone Mineral Density In Premenopausal Women

Osteoporosis has become a global health problem. Mechanical loading during physical activity (PA) and exercise increases and maintains bone mass and strength. Quantitative PA measures are needed to identify the functional loading intensity that is beneficial for bone health. PURPOSE: This study aimed to examine the relationship between PA intensity and bone mineral density (BMD) at the femur and spine in premenopausal women. METHODS: The data from 2005–2006 National Health and Nutrition Examination Survey (NHANES) were used for this study. PA was assessed using ActiGraph accelerometers, and bone health metrics were measured through dual-energy X-ray absorptiometry. After removing all missing values, 1446 female participants (Age: 47.61 ± 5.39 yr., Height: 162.01 ± 6.30 cm, Weight: 74.60 ±16.80 kg, BMI: 28.45 ± 6.30 kg/m2) remained. PA intensity is translated from accelerometer counts per minute (cnts/min) using the thresholds in previous calibration studies, e.g.: Light intensity activity = 100–1951 cnts/min, Moderate–vigorous intensity = 1952–5724 cnts/min, and Vigorous intensity > 5724 cnts/min. The bone health metrics were the BMD of femur neck, trochanter, total femur, and total spine. The correlations between PA intensity with bone health metrics were computed. RESULTS: The means and standard deviations of Light intensity = 537.79 ± 85.59 (cnts/min), Moderate-vigorous intensity = 2694.48 ± 340.54 (cnts/min), and Vigorous intensity = 7120.53 ± 1721.06 (cnts/min). A low correlation between overall PA intensity and total BMD (r = 0.01) was found. Correlations between different PA intensities and BMD are summarized below:CONCLUSION: Although low correlation was found between PA intensity and BMD, only no or low correlation was found between BMD and a specific PA intensity. Lack of variabilities within a specific PA intensity may be the reason. More studies are needed to understand the relationship between PA intensity and bone health.

Parameters Of The Athlete Triad In Male Ncaa Division I Athletes

Male athletes are at risk of developing a condition similar to the female athlete triad that is characterized by low bone mineral density (BMD), low energy availability (EA), and reduced reproductive hormones. However, the triad has not been well studied in males. PURPOSE: The purpose of this study was to assess BMD and EA in male NCAA division I athletes participating in leanness emphasized sports (cross country and wrestling) and non-leanness sports (soccer and basketball). We hypothesized that EA and BMD would be lower in XC and wrestling compared to soccer and basketball and EA would be positively correlated with BMD. METHODS: Participants included 27 NCAA division I male athletes (20.3 ± 0.3 yr) participating in soccer (n = 5) or cross country (XC, n = 7), wrestling (n = 10), or basketball (n = 5). Following a 12 hr fast and abstinence from physical activity, a resting metabolic rate test, dual energy X-ray absorptiometry scan, and 24-hour food intake recall was performed during an early morning testing session. Two unannounced follow-up food intake recalls were performed over the phone and used to determine mean daily energy intake. Activity energy expenditure was assessed using an Actigraph accelerometer for 7d. Low EA was defined: [(energy intake – activity energy expenditure) /fat free mass (kg)] ≤ 20 kcal/kg. RESULTS: XC had lower BMI, fat free mass, total, lumbar spine, and dual femur BMD (g/cm2) compared to soccer, wrestling, and basketball. XC athletes also had lower total BMD, lumbar spine, and dual femur Z-scores compared to wrestling and basketball, but not soccer. XC had significantly greater EA than basketball. CONCLUSIONS: In support of our hypothesis, BMD was lower in athletes participating in XC, a leanness sport, compared to all other sports. Surprisingly, EA was highest in XC and negatively correlated with BMD. These data suggest the interrelationship between components of the athlete triad is complex and low EA may not be the primary cause of low BMD in male athletes.

The Long-Term Effect of Very Low Birth Weight and Prematurity On Bone Mineral Density In 5-7 Years Old Children

Objective: Very low birth weight (VLBW) infants are at increased risk of osteopenia of prematurity due to interruption of intrauterine bone mineralization. In this study aimed to evaluate the bone mineral density (BMD) by evaluating DXA in children aged 5-7 years with VLBW and preterm birth. Methods: This study was conducted prospectively between February 2011 and September 2012. Seventy-five children aged 5-7 years, who were born under 1.500 grams were included. Results: Bone density measurements of the study group (42 female 56%) were found to be low compared to the DXA reference values (p < 0.001). According to the L1-L4 Z score, bone density was found to be low in 21.33% (n: 16) of the cases. Total femur Z score (p = 0.018), femur neck BMD (p = 0.001), total femur BMD (p = 0.012) values were significantly lower in females than males. Whole body BMD values (p = 0.021) were significantly lower in patients receiving postnatal systemic steroids than in the non-receiving group. Femur neck BMD values of the patients who received only breast milk in the first six months were found to be statistically significantly higher than those who received only formula in the first six months (p = 0.034).A significant correlation was found between the current height, weight, BMI increase and BMD measurement. Conclusion: In this study, it was shown that bone diseases in VLBW and preterm infants affect bone mineralization in long term. We determined the effects of drugs and nutrition used in treatments and current anthropometric measurements on bone health of preterm and VLBW.

187-LB: Risk Factors for Lower Hip-Bone Density in Older Adults with Type 1 Diabetes

Type 1 diabetes (T1D) is associated with lower bone mineral density (BMD) and elevated fracture risk. In this study, we examined risk factors for lower BMD in the DCCT/EDIC study, a well-characterized cohort of older adults with T1D. Dual x-ray absorptiometry (DXA) scans were obtained in 1,058 study participants who had been followed for &amp;gt; 30 years. Cumulative glycemic control was defined as the time-weighted mean HbA1c from DCCT baseline (1983-1989) to the DXA visit. Levels of advanced glycation endproducts (AGE) were assessed by skin intrinsic fluorescence (SIF) in 2010-2011. Kidney disease (sustained eGFR&amp;lt;60 mL/min/1.73 m2 or ESRD), retinopathy, peripheral neuropathy and cardiac autonomic neuropathy were assessed. Associations between risk factors and total hip and femoral neck BMD were analyzed using multiple linear regression models. Mean age at DXA was 59±7 years; 48% of participants were female. Mean BMD for total hip and femoral neck was 0.921±0.149 and 0.757±0.129 g/cm2, respectively; 6% were osteoporotic, and 45% were osteopenic. Higher mean HbA1c, higher SIF, and kidney disease, but not retinopathy or neuropathy, were independently associated with lower BMD at the total hip in univariate and multivariable analyses, with similar results for femoral neck (Table). In conclusion, poorer glycemic control, AGE accumulation, and kidney disease are independent risk factors for lower hip BMD in older adults with T1D. Disclosure A.V. Schwartz: None. J.C. Backlund: None. I. deBoer: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Consultant; Self; George Clinical, Goldfinch Bio, Ironwood Pharmaceuticals. M. Rubin: Research Support; Self; Amgen, Ascendis Pharma, Takeda Pharmaceutical Company Limited. A.R. Barnie: None. K. Farrell: Stock/Shareholder; Spouse/Partner; Dexcom, Inc., Tandem Diabetes Care. V.R. Trapani: None. N.S. Gregory: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group. J.M. Lachin: Board Member; Self; Tolerion, Inc. B.H. Braffett: None. R. Gubitosi-Klug: None. Funding National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Disease (5U01DK094157, RES514948)

Differences in Bone Mineral Density between Adult Vegetarians and Nonvegetarians Become Marginal when Accounting for Differences in Anthropometric Factors

Persons following plant-based diets have lower bone mineral density (BMD) and higher fracture risk, possibly due to suboptimal nutrient supply. However, anthropometric measures were not considered as potential confounders in many previous studies, and body mass index (BMI) is positively associated with BMD but also generally lower among vegans and vegetarians. Our objective was to investigate if BMD measurements differ between vegetarians and nonvegetarians from the adult general population when accounting for important determinants of BMD, especially BMI and waist circumference. Using data from the NHANES (cycles 2007-2008 and 2009-2010), we evaluated the differences in BMD (femoral neck, total femoral, and total lumbar spine) between adult vegetarians and nonvegetarians. Linear regression models were used to determine the associations between BMD and diet. Statistical models were adjusted for important factors, i.e., age, sex, race/ethnicity, smoking status, alcohol consumption, serum vitamin D and calcium concentrations, waist circumference, and BMI. In statistical models adjusted for age, sex, race/ethnicity, menopausal status, and education level, BMD values were significantly lower among vegetarians than among nonvegetarians (P<0.001). These differences were attenuated upon adjustment for lifestyle factors, and became statistically nonsignificant upon adjustment for anthropometric variables (BMI and waist circumference) for femoral neck (0.77compared with 0.79g/cm2 among vegetarians versus nonvegetarians, P=0.10) and total femoral BMD (0.88compared with 0.90g/cm2, P=0.12). A small but statistically significant difference remained for total lumbar spine BMD (1.01compared with 1.04g/cm2, P=0.005). These findings suggest that lower BMD among adult vegetarians is in larger parts explained by lower BMI and waist circumference.

Relationship of Age and Parity with Bone Mineral Density among Postmenopausal Women- A Study at Dhaka Medical College Hospital

Low Bone Mineral Density (BMD) leads to osteoporosis and increased bone fracture risk of a menopausal woman. Low Bone Mineral Density (BMD) is a major risk factor for osteoporosis and fragility fractures. Bone loss is accelerated following cessation of ovarian function and menstruation. Menopause is accompanied by estrogen deficiency and associated with bone loss. Generally accepted risk factors for osteoporosis in women are low BMI, age and duration of menopause. The effect of parity is controversial. So the aim of this cross-sectional observational study was to assess effect of parity on BMD. For this purpose total 100 women aged 50-70 years with parity three or more who had natural menopause were studied over the period of one year. All these women underwent measurement of Bone Mineral Density (BMD) at Dhaka Medical College Hospital (DMCH). Among 100 women 64 were para three to five, 30 were para 6-8 and only six were 9-11 para. BMD of L1-4 and total femur measured among para 3-5 women were (.938±.172,.855±.161) and it was (.851±.170,.769±.155) with para six to eight and (.765±.169, .656±.258) with para 9-11 respectively. ANOVA was done within and between groups, F = 3.996/4.959 ( P = .021/ .009). Negative correlation was found between parity and BMD of L1-4 and total Femur. This negative correlation was statistically significant. It can be concluded that with increasing parity BMD decreases.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(1): 15-19

Serum zinc levels and multiple health outcomes: Implications for zinc-based biomaterials

BackgroundZinc-based biomaterials, including biodegradable metal, nanoparticles, and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations. The impact of serum zinc concentrations on major health outcomes can provide insights for device design and clinical transformation of zinc-based biomaterials. MethodsThis nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey (NHANES, 2011-2014) including 3607 participants. Using unadjusted and multivariate-adjusted logistic regression analyses, two-piecewise linear regression model with a smoothing function and threshold level analysis, we evaluated the associations between elevated serum zinc levels and major health outcomes. ResultsElevated serum zinc levels were significantly associated with an increase in total spine and total femur bone mineral density (BMD). Every 10 μg/dL increase was associated with a 1.12-fold increase in diabetes mellitus (DM) and 1.23-fold and 1.29-fold increase in cardiovascular diseases (CVD) and coronary heart disease (CHD), in participants with serum zinc levels ≥ 100 μg/dL. It had no significant linear or nonlinear associations with risk of fractures, congestive heart failure, heart attack, thyroid disease, arthritis, osteoarthritis, rheumatoid arthritis, dyslipidemia and cancer. ConclusionSerum zinc levels are significantly associated with increased BMD in the total spine and total femur, and risk of DM, and CVD/CHD among participants with serum zinc levels ≥100 μg/dL.

The impact of protein diet on bone density in people with/without chronic kidney disease: An analysis of the National Health and Nutrition Examination Survey database.

High protein diet is essential for the healthy state of bones. Low protein diet is often recommended to patients with chronic kidney disease (CKD). Risk factors for femoral neck fractures are clear, but trochanteric and intertrochanteric fractures may have different risk factors. In this study, we determined the association between bone density at different femoral areas and a number of protein diets in patients with and without CKD. We extracted information from the database of the National Health and Nutrition Examination Survey (NHANES), 2005-2010. We have basic variables, metabolic diseases, and bone density of different femoral areas and separated them according to different protein diets (<0.8g/kg/day, 0.8-1.0g/kg/day, 1.0-1.2g/kg/day, and ≥1.2g/kg/day). The differences of differential femoral areas were analyzed according to different protein intakes in subjects with and without CKD. A total 12,812 subjects were analyzed. Among all four subgroups of protein diets, we found statistically significant differences over bone mineral density (BMD) or T scores (p<0.0001) among all femoral areas. For total femoral BMD and T scores, the higher the protein intake, and the higher the bone BMD and T scores were noticed (p<0.0001). We found similar relationship in the trochanter and intertrochanteric bone areas, but not in the femoral neck area. For the femoral BMD, higher protein diets led to higher BMD in the femoral neck, trochanter, intertrochanteric, and total femoral areas (p=0.032, 0.0036, 0.008, and 0.0039, respectively). Such increased BMD benefits of higher protein diet were not found in CKD patients. Higher protein diets led to higher femoral BMD only in subjects without CKD. CKD patients did not benefit in developing higher femoral BMD and those with Low protein diet did not reduce their femoral BMD. CKD was found to be a risk factor for low BMD in the intertrochanteric bone region.

Effects of infrared radiation and exercise on bone mass: implications for the prevention and management of osteoporosis

The aim of the current study was to investigate the effects of infrared radiation in conjunction with treadmill training on bone mass and muscle performance. Twenty postmenopausal women aged 50 to 60 years participated in this study. The investigated groups were (i) the Light Emitting Diodes (LED) group, which performed treadmill training associated with photobiomodulation therapy (n = 10) and (ii) the exercise group, which carried out treadmill training only (n = 10). Eighteen women completed the full study (9 per group). Training was performed for 12 months, twice a week for 45 min per session at 85 to 90% of maximal heart rate (HRmax); training intensity was determined by a progressive exercise testing. The irradiation parameters were infrared-LEDs (850 nm wavelength) at 100 mW power, 39 mW/cm2 power density, and 108 J/cm2 fluence for 45 min. Isokinetic dynamometry and bone densitometry were performed. The reduction in total femur bone mineral density (BMD) was significantly higher (p = 0.04) for the exercise group (∆ = − 0.024 ± 1.055 mg/cm3) compared with the LED group (∆ = − 0.011 ± 0.013 mg/cm3). The number of muscle contractions was significantly increased, while the fatigue was significantly reduced only in the LED group compared with baseline (p < 0.05). The average power was significantly higher for the LED and exercise groups compared with baseline (p < 0.01). There was no significant difference in quadriceps performance between 6 and 12 months for either group (p ≥ 0.05). Infrared radiation associated with treadmill training may synergistically act to further enhance muscle performance and attenuate the reduction of femur BMD, preventing osteoporosis and its associated health consequences.

The Relationship Among Bone Mineral Density, Bone Biomarkers and Vitamin D Levels in Patients with Parkinson's Disease.

Idiopathic Parkinson's disease (IPD) is the most common age-related neurodegenerative movement disorder. It causes a decrease and deceleration in movements. It may also lead to loss of bone mineral density, vi-tamin D deficiency, falls and fractures due to various factors. As indicated in our study, determining the prevalence of osteopenia and osteoporosis in IPD is important to determine complications. Thirty patients with IPD and 30 age-matched control subjects were included in the study. The bone mineral density (BMD) measurements of the participants were taken from the lumbar spine (L1-4) and double femur regions using the dual energy X-ray absorptiometry device. Serum 25 (OH) vitamin D, alkaline phosphatase, parathormone, osteocalcin, prolidase and urine hydroxyproline levels were measured. The femur total BMD and serum 25 (OH) vitamin D levels were lower in the patients with IPD than in the control group (p > 0.05). The serum prolidase and urinary hydroxyproline levels were higher in the IPD group relative to the control group (p < 0.05). The frequency of osteoporosis and osteopenia was significantly higher in the IPD group than in the control group (p < 0.05). Patients with Parkinson's disease tend to have lower vitamin D levels than those with a similar age without Parkinson's disease. Vitamin D levels are usually associated with BMD in people with Parkinson's disease, but administering vitamin D does not improve BMD. Cross-sectional studies suggest a correlation between vitamin D levels and the severity of symptoms of Parkinson's disease. Decreased exposure to sunlight due to immobilisation and reduced vitamin D intake by diet may lead to vitamin D deficiency and low BMD. There is a negative correlation among the duration of disease, disease severity, number of falls, parathormone level and serum vitamin D level in people with Parkinson's disease. Consequently, vitamin D levels may be low in Parkinson's disease patients. Therefore, patients with Parkinson's disease should be checked for vitamin D and osteoporosis by considering the risk of hip fracture, fall from a height and high risk of osteoporosis.

Bone mineral density and fragility fractures in stroke patients

The aim was to study the parameters of bone mineral density (BMD) and frequency of fragility fractures in males and females with ischemic stroke depending on a side of brain injury and duration of post-stroke period. Materials and methods. We examined 140 patients aged 50–80 years old, divided into 2 groups: I – subjects without any diseases influencing the bone state and II – patients after ischemic stroke. BMD indexes (BMDs) were measured using dual-energy X-ray absorbtiometry method. Results. The males with stroke had significantly lower parameters of total body, upper extremity and trunk BMDs compared to indexes of the control group without any differences in lower extremities BMDs in contrast to women with stroke who had lower BMDs of total body, trunk and upper/lower extremities compared to parameters of the control group. Almost all measured BMDs were significantly lower on a paretic side compared to BMDs on a non-paretic side, except distal radius and total lower extremities BMDs in men with stroke in contrast to women who demonstrated significantly lower femoral neck and total femur BMDs compared to the control group. Most BMDs were decreased in females with post-stroke period duration of more than 1 year in contrast to data in men who did not show any BMD differences, except significantly decreased BMD of upper extremities compared to the control group. Fragility fractures were revealed in 21.4 % of patients after stroke (31.8 % in women and 10.0 % in men, P < 0.05), their frequency was higher only in women compared to the control group patients. Conclusions. BMDs in stroke patients are lower and frequency of osteoporosis is higher with some sex differences that should be taken into account in their assessment and development of rehabilitation programs for older age subjects.