Total Proximal Femur Research Articles

8810 Improvement in bone mineral density in tertiary hyperparathyroidism after renal transplant treated with parathyroidectomy

Abstract Disclosure: M. Zakher: None. 55 year old man with past medical history of end-stage renal disease (ESRD) and alcoholic cirrhosis who underwent simultaneous liver-kidney transplant (SLKT) seven months prior to presentation to endocrinology who was referred for management of hypophosphatemia as low as 1.0 mg/dl. Prior to the transplant, he had hyperphosphatemia and hyperparathyroidism with phosphate and parathyroid hormone (PTH) levels as high as 8.2 mg/dL and 682 pg/mL, respectively. PTH remained elevated at 244 pg/mL and vitamin D was 35 ng/mL the week of the initial endocrinology visit. Initial DXA scan six months after SLKT showed osteoporosis of the lumbar spine, total left proximal femur, and left femoral neck with T-scores of -3.4, -4.9, -5.6, respectively. Alendronate was started three weeks prior to the initial visit. Urine studies confirmed phosphate wasting with urinary phosphate excretion significantly higher than 100 mg/24h, FEPO4 greater than 70%, and TmP/GFR less than 2 mg/dL. Increased urinary excretion of phosphate was consistent with hyperparathyroidism. The extremely low urinary calcium in the setting of normocalcemia and the history of renal transplant suggested a tertiary hyperparathyroidism. Alendronate was discontinued eight months after the initial visit to reduce the risk of post-parathyroidectomy hypocalcemia and post-parathyroidectomy bone remodeling inhibition.One year after the initial visit, the patient had a bilateral neck exploration with total parathyroidectomy and auto transplantation of the parathyroid. Pathology showed hypercellular parathyroid tissue. He was hospitalized one week after surgery for symptomatic hypolcalcemia (calcium 5.8 mg/dL). He was taking one tablet of calcium carbonate three times daily at home instead of three tablets three times daily as prescribed. He was discharged on calcitriol 0.5 mcg once daily, magnesium oxide 800 mg twice daily, calcium carbonate 1 g three times daily, and cholecalciferol 5000 units once daily. He remained on these for eleven months as well as calcitriol for fifteen months with dose adjustments during visits. Calcitriol was discontinued when calcium was found to be 8.9 mg/dL and the patient was asymptomatic. Repeat DXA scan two years after the baseline DXA showed osteoporosis of the left femoral neck with a T score of -2.5. There was a tremendous improvement from the baseline DXA scan from +20% in the total lumbar spine to +170% in the left femoral neck. DXA scan four years after the baseline DXA scan showed osteopenia of the lumbar spine, total left proximal femur, and left femoral neck with T-scores of -1.7, -2.4, -1.9.This is a 55 year old man who underwent SLKT seven months prior to presentation to endocrinology who was referred for management of hypophosphatemia as low as 1.0 mg/dL found with tertiary hyperparathyroidism who underwent a parathyroidectomy that resulted in significant improvement in bone mineral density test. Presentation: 6/2/2024

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.

Biochemical characteristics and clinical manifestation of normocalcemic primary hyperparathyroidism.

Normocalcemic primary hyperparathyroidism (nPHPT) is a condition characterized by persistently high levels of parathyroid hormone (PTH) and normal serum calcium levels in the absence of other causes for secondary hyperparathyroidism. The aim of the present study was to assess the clinical presentation and the biochemical characteristics in patients with nPHPT and to compare them with those in patients with hypercalcemic PHPT (hPHPT). The study included 316 patients (277 women and 39 men, average age 58.7 ± 12.1) diagnosed with PHPT. Total serum calcium, inorganic phosphates (PO4), PTH, urinary Ca (uCa), albumin, creatinine, 25(OH)D and bone markers (b-CTX and ALP) were examined in all of them. BMD of the lumbar spine (LS), distal third of the radius (DR), femoral neck (FN) and total proximal femur (TF) were measured by a dual-energy X-ray absorptiometry (DXA). The patients were divided into two groups according to albumin-corrected calcium (Ca) level - with hPHPT (Ca>2.62 mmol/L) and with nPHPT (Ca 2.12-2.62 mmol/l), without other causes for secondary hyperparathyroidism. The frequency of nPHPT was 15.2%. Normocalcemic patients had lower levels of PTH, higher PO4 and 25(OH)D, and smaller parathyroid adenomas. No significant difference in the frequency of osteoporosis, low-energy fractures, nephrolithiasis and gastrointestinal disorders was found between nPHPT and hPHPT. There was no difference in BMD between the two groups. The patients with nPHPT show a more favorable biochemical profile compared to those with hPHPT. Nevertheless, clinical manifestations and complications are similar, without a significant difference in the frequency of osteoporosis, nephrolithiasis, gastrointestinal disorders and low-energy fractures.

THU441 Teriparatide As Treatment For Severe Osteoporosis In Lung Transplant Recipients

Abstract Disclosure: C.A. Muir: None. L.M. Raven: None. L. Goodall: None. J.R. Center: None. Background: Lung transplantation (LTx) is a life-saving treatment for end-stage pulmonary disease. With improvements in immunosuppression, LTx survival continues to improve with current 5-year survival rates of over 70%. Consequently, management of long-term transplant-related complications is increasingly important. Osteoporosis is one such complication, with the incidence of osteoporosis and osteoporotic fracture highest in LTx patients compared to other solid organ transplant recipients. Despite high fracture rates, including in patients treated with anti-resorptive medications, no data has been published using anabolic treatments for the management of osteoporosis in LTx recipients. Study design: Clinical case series. We present clinical, biochemical and bone mineral density data for four patients with severe osteoporosis post LTx treated with teriparatide. Results: Four LTx patients were treated with teriparatide 20 mcg daily for 18 months. Prednisone dose ranged between 5-10 mg daily throughout the treatment period. All patients had been previously treated for osteoporosis using zolendronate (last dose 12-24 months prior to teriparatide initiation). Bone turnover was monitored repeatedly during treatment in two patients. Following completion of teriparatide treatment, all patients received consolidation treatment with zolendronate (3 patients) or denosumab (1 patient). Bone density was measured prior and within 6-12 months after completion of teriparatide. All four patients experienced an increase in bone density at the spine (median 13%; range 2-14%) and total proximal femur (median 8%, range 6-10%) related to teriparatide treatment. No adverse effects were observed. Conclusion: Given that severe osteoporosis is highly prevalent in LTx patients and that fractures often continue to occur after treatment with anti-resorptive medication, teriparatide should be further studied as an alternative treatment in this clinical setting. Our experience in four patients suggest it is safe and effective. Presentation: Thursday, June 15, 2023

THU421 Utility Of Forearm DXA As A Tool For Identification Of Osteoporosis: A Cleveland Clinic Experience

Abstract Disclosure: A.F. Ishola: None. K. Alsibai: None. A. Iqbal: None. A. Elsherif: None. P. Rao: None. L.Z. Khan: None. Background: Osteoporosis is a preventable and treatable condition with a significant impact on the quality of life. According to the National Osteoporosis Foundation, 10.2 million Americans have osteoporosis. In addition, more than 2 million osteoporosis-related fractures occur annually in the US and >70% of these occur in women. Unfortunately, most individuals at risk do not undergo appropriate assessment or treatment. Clinically osteoporosis may be diagnosed if there is a fragility fracture, independent of bone mineral density (BMD) T-score value. Diagnosis based on BMD can also be made with a T-score of − 2.5 or below in the lumbar spine, femoral neck, total proximal femur, or distal 1/3 radius. Due to the limitations in interpreting BMD values in patients with degenerative joint disease (DJD), using the forearm (distal 33% radius) as an alternative skeletal site could serve as a more sensitive screening test. Our study primary aims were to assess the frequency at which females age ≥ 65 undergoing BMD testing had DJD of the spine, to determine the frequency at which BMD testing of the forearm was performed in patients with DJD of the spine, and to assess skeletal site-specific rates of osteoporosis. Methods: This is a large, single-center, retrospective, IRB- approved study conducted at Cleveland Clinic Foundation. Postmenopausal female patients above the age of 65 who underwent DXA scans between January 2018 and December 2019 were identified. Manual chart reviews were performed. Patients receiving osteoporosis treatment and those with hyperparathyroidism were excluded. Results: 195 patients were eligible for the study. The mean age was 73.4 ± 8.2 years. DJD of spine and osteoarthritis were present in 74.5% and 58.2% of patients respectively. Forearm BMD testing was only performed in 18.9% of patients with DJD of the spine. Osteoporosis was diagnosed in 39.1 % at the femoral neck, 35.4% of patients at the lumbar spine, 9.3 % at the distal 1/3 radius, and 6.8% at the total hip. Conclusion: DJD of the spine and hip osteoarthritis often lead to falsely elevated T-scores resulting in under-diagnosis and under-treatment of osteoporosis. Although there is a higher sensitivity of using forearm BMD values to diagnose osteoporosis in patients with DJD of spine and/or osteoporosis, our preliminary data show that the forearm DXA scan is an under-utilized clinical tool in cases of DJD of spine, osteoarthritis, and hip replacement. Presentation: Thursday, June 15, 2023

Alteration of Volumetric Bone Mineral Density Parameters in Men with Spinal Cord Injury.

Spinal cord injury (SCI) induces severe losses of trabecular and cortical volumetric bone mineral density (vBMD), which cannot be discriminated with conventional dual-energy X-ray absorptiometry (DXA) analysis. The objectives were to: (i) determine the effects of SCI on areal BMD (aBMD) and vBMD determined by advanced 3D-DXA-based methods at various femoral regions and (ii) model the profiles of 3D-DXA-derived parameters with the time since injury. Eighty adult males with SCI and 25 age-matched able-bodied (AB) controls were enrolled in this study. Trabecular and cortical vBMD, cortical thickness and derived strength parameters were assessed by 3D-SHAPER® software at various femoral subregions. Individuals with SCI had significantly lower integral vBMD, trabecular vBMD, cortical vBMD, cortical thickness and derived bone strength parameters (p < 0.001 for all) in total proximal femur compared with AB controls. These alterations were approximately to the same degree for all three femoral subregions, and the difference between the two groups tended to be greater for cortical vBMD than trabecular vBMD. There were minor differences according to the lesion level (paraplegics vs tetraplegics) for all 3D-DXA-derived parameters. For total proximal femur, the decreasing bone parameters tended to reach a new steady state after 5.1years for integral vBMD, 7.4years for trabecular vBMD and 9.2years for cortical vBMD following SCI. At proximal femur, lower vBMD (integral, cortical and trabecular) and cortical thickness resulted in low estimated bone strength in individuals with SCI. It remains to be demonstrated whether these new parameters are more closely associated with fragility fracture than aBMD.

Older adults physically inactive in occupational and commuting domains have a higher risk for osteopenia and osteoporosis: A 12-month prospective study.

Bone mineral density (BMD) usually decreases with age, and the risk of osteometabolic diseases, such as osteopenia and osteoporosis, increases in older adults. PA is strictly related to BMD. However, the relationship between different domains of PA and bone health in older adults is still unclear, and needs to be further investigated, aiming at the implementation of preventative health measures for this population. Thus, the aim of the current study was to analyze the association between different domains of PA and the risk for osteopenia and osteoporosis in older adults in a 12-month follow-up. Prospective study that included 379 Brazilian community-dwelling older adults, aged ≥ 60years (70 ± 7years, 69% women). Areal bone mineral density (aBMD) total, proximal femur, and lumbar spine were measured by dual energy X-ray absorptiometry (DXA), and PA was self-reported. Binary logistic regression analysis and 95%CI were used to analyze the association between the practice of PA in different domains (at baseline and follow-up) and risk for osteopenia and osteoporosis (follow-up). The risk for osteopenia (total proximal femur or lumbar spine) is higher in older adults who are physically inactive in the occupational domain (OR:3.25; 95%CI:1.24-8.55). In addition, older adults who are physically inactive in the commuting domain (OR:3.43; 95%CI:1.09-10.82) and total PA (OR:5.58; 95%CI:1.57-19.88) present a higher risk for osteoporosis (total proximal femur or lumbar spine) compared to physically active older adults. The risk of osteopenia is higher in older adults who are physically inactive in occupational domain and for osteoporosis the risk is higher in physically inactive in commuting domain and total habitual PA.

Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study.

Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years. Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm2). We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118-1.256) and in total proximal femur (OR=1.158; 95% CI 1.066-1.258), both after adjusting for follow-up and excess weight loss. After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.

Comparison of the Right and Left Femur Bone Mineral Densities in Postmenopausal Women.

Bone mineral density (BMD) is measured in the hip and posteroanterior spine; moreover, according to the 2019 International Society for Clinical Densitometry guidelines, unilateral hip can be used. This study aimed to determine whether there is a difference between the BMD of both the femurs in postmenopausal women. A total of 343 postmenopausal women were enrolled in this study from January 1, 2010, to December 31, 2019 at a single tertiary hospital. By using the Hologic® Horizon W DXA System, the femur and spine BMD was measured; BMD was recorded in g/cm². Following regions were analyzed in both the femurs: the femur neck, the trochanter area, and total femur. Mean age at imaging was 62 ± 9.7 years, and significant difference in the total BMD of both the femurs (P = 0.003) was observed. In secondary analysis, patients with osteoporosis showed significant contralateral BMD discrepancies in trochanter and total proximal femur BMD (P = 0.041 and P = 0.011, respectively). However, in women with normal BMD, no significant difference between the right and left femur BMD was observed. Furthermore, measurement of solely the unilateral hip can lead to a 16.9% of underdiagnosis in postmenopausal women. In conclusion, it is necessary to check BMD in both hips, particularly in patients suspected of osteoporosis.

Bone mineral density, limb muscle mass, muscle strength, and exercise capacity are reduced in female patients with distal radius fractures when the unaffected side grip strength is less than 18 kg

BackgroundPrevention of domino effects after distal radius fractures is important for improving life expectancy. Fragility fractures secondary to falls are associated with decreased bone mineral density, muscle strength, and exercise capacity. Grip strength is one of the simplest and most useful tests to comprehensively judge muscle strength. The purpose of this study was to examine whether grip strength is associated with bone mineral density, limb muscle mass, muscle strength, and exercise capacity, by comparing patient backgrounds based on the presence or absence of grip weakness in female patients with distal radius fractures. MethodsThis study included women with distal radius fractures who visited our orthopedics outpatient department between April 2015 and April 2020. Bone mineral density, limb muscle mass, skeletal muscle mass index, muscle strength (grip strength on unaffected side and quadriceps muscle strength), the Timed Up and Go test, and the Two-Step test were evaluated six to eight weeks after injury. Patients were divided into two groups according to the cutoff value of grip strength (18–21 kg), and 90 age-adjusted and matched participants were compared and examined. ResultsAt the cutoff value of 18 kg, a significant decrease in lumbar spine and total proximal femur bone mineral density (p < 0.05, p < 0.05), limb muscle mass and skeletal muscle mass index (p < 0.01, p < 0.05), quadriceps femoris muscle strength (p < 0.01), the Timed Up and Go test (p < 0.05), and the Two-Step test (p < 0.01), was observed in the grip-weakness group compared to that in the no-grip-weakness group. ConclusionsIn women with distal radius fracture and grip strength <18 kg on the unaffected side, bone mineral density, limb muscle mass, quadriceps femoris strength, and exercise capacity may be reduced. These results suggest reduced grip strength may be an indicator for further testing to prevent domino effects.

The Effect of Region of Interest on Measurement of Bone Mineral Density of the Proximal Femur: Simulation Analysis Using CT Images.

While accurate measurement of bone mineral density (BMD) is essential in the diagnosis of osteoporosis and in evaluating the treatment of osteoporosis, it is unclear how region of interest (ROI) settings affect measurement of BMD at the total proximal femur region. In this study, we performed a simulation analysis to clarify the effect on BMD measurement of changing the ROI using hip computed tomography (CT) images of 75 females (mean age, 62.4years). Digitally reconstructed radiographs of the proximal femur region were generated from CT images to calculate the change in BMD when the proximal boundary of the ROI was altered by 0-10mm, and when the distal boundary of the ROI was altered by 0-30mm. Further, changes in BMD were compared across BMD classification groups. A mean BMD increase of 0.62% was found for each 1-mm extension of the distal boundary. A mean BMD decrease of 0.18% was found for each 1-mm alteration of the proximal boundary. Comparing BMD classification groups, patients with osteoporosis and osteopenia demonstrated greater BMD changes than patients with normal BMD for the distal boundary (0.68%, 0.64%, and 0.54%, respectively) and patients with osteoporosis demonstrated greater BMD changes than patients with osteoporosis and normal BMD for the proximal boundary (0.37%, 0.13%, and 0.03%, respectively). In conclusion, our study found that a consistent ROI setting, especially on the distal boundary, is necessary for the accurate measurement of total proximal femur BMD. Based on the findings, we recommend confirming that the ROI setting shown on the BMD result form is consistent with changes in serial BMD.

Bone health and asymmetry in elite female cricketers

ABSTRACT The aim of this study is to determine if bone mineral density (BMD) and bone asymmetry differs between female cricket fast bowlers, spin bowlers and batters. BMD was determined at the total body, lumbar spine, and proximal femurs in 12 fast bowlers, 13 batters and 11 spin bowlers from pre-season DXA scans. High Z-scores at the total body, lumbar spine, and proximal femur were observed in all cricketers (mean Z-scores: +1.4 to +3.3) compared with a general age matched reference population. Fast bowlers had significantly greater BMD on the contralateral side of the lumbar spine compared with the ipsilateral side (p = 0.001, 5.9–12.1%). No asymmetry was found between hips in all groups. All cricket positions demonstrated high BMD at all measured sites. The lumbar spine of fast bowlers is asymmetric, with significantly greater BMD on the contralateral side of the spine, particularly at L4, possibly in response to the asymmetric lumbar loading patterns observed in bowling. Highlights Elite female cricketers demonstrate high BMD at total body, lumbar spine and proximal femur sites, regardless of playing position compared with a general age and ethnic group matched reference population. Fast bowlers have greater BMD on the contralateral (opposite bowling arm) side of the lumbar spine compared with the ipsilateral side, while a symmetrical pattern was observed in spin bowlers and batters. No asymmetry in BMD or section modulus between hips was observed at any proximal femur site for any cricket position.

COMPARISON OF BONE PARAMETERS BY BODY REGION IN UNIVERSITY ATHLETES: SYSTEMATIC REVIEW

ABSTRACT Introduction: Bone mineral density (BMD) and bone mineral content (BMC) vary depending on the type of sport practiced and the body region, and their measurement can be an effective way to predict health risks throughout an athlete’s life. Objective: To describe the methodological aspects (measurement of bone parameters, body regions, precision errors and covariates) and to compare BMD and BMC by body region (total body, upper limbs, lower limbs and trunk) among university athletes practicing different sports. Methods: A search was performed on the databases PubMed, Web of Science, Scopus, ScienceDirect, EBSCOhost, SportDiscus, LILACS and SciELO. Studies were selected that: (1) compared BMD and BMC of athletes practicing at least two different sports (2) used dual-energy X-ray absorptiometry (DXA) to assess bone parameters (3) focused on university athletes. The extracted data were: place of study, participant selection, participants’ sex, sport practiced, type of study, bone parameters, DXA model, software used, scan and body regions, precision error, precision protocol, covariates and comparison of bone parameters between different sports by body region. Results: The main results were: 1) BMD is the most investigated bone parameter; 2) total body, lumbar spine and proximal femur (mainly femoral neck) are the most studied body regions; 3) although not recommended, the coefficient of variation is the main indicator of precision error; 4) total body mass and height are the most commonly used covariates; 5) swimmers and runners have lower BMD and BMC values; and 6) it is speculated that basketball players and gymnasts have greater osteogenic potential. Conclusions: Swimmers and runners should include weight-bearing exercises in their training routines. In addition to body mass and height, other covariates are important. The results of this review can help guide intervention strategies focused on preventing diseases and health problems during and after the athletic career. Level of evidence II; Systematic Review.

Associations between bone mineral density in different measurement locations and coronary artery disease: a cross-sectional study.

Previous studies have reported that low bone mineral density (BMD) is closely related to coronary artery disease (CAD); however, it is not clear that the BMD loss at which location to what extent has the greatest effect in identifying risk of CAD. This study aimed to evaluate the ability of different measurement sites of BMD in identifying CAD and analyze the best measurement sites and the optimal cut-off of BMD for CAD. This was a cross-sectional study in which 180 of 817 participants were diagnosed with CAD. All participants in the study were measured by dual-energy X-ray absorptiometry (DEXA) for BMD at 8 locations, and following measurements were derived: the average BMD of lumbar spine (L1-L4), femoral neck (left and right), and total proximal femur (left and right). The association between BMD at different locations and CAD was analyzed using logistic regression. The receiver operating characteristic (ROC) curve was used to select the optimal measurement location and cut-off value of the BMD for identifying CAD. There were significant differences in BMD at 3 different measurement locations. Higher BMD is a protective factor against CAD, which is more pronounced in the femoral neck and total proximal femur (ORs = 0.47 ~ 0.66, P < 0.001) than in the lumbar spine (ORs = 0.74 ~ 0.79, P < 0.001). The optimal site for predicting the risk of CAD by BMD is the femoral neck, with the AUC (area under the ROC curve) is 0.72 (95% CI: 0.67 ~ 0.76) and the cut-off is - 1.70. The BMD below particular cut-off of the femoral neck rather than of the lumbar spine may have certain further research value for revealing the risk of CAD.

Can gait kinetic data predict femoral bone mineral density in elderly men and women aged 50 years and older?

This retrospective study was conducted to investigate the correlation between kinetic gait parameters and femoral bone mineral density (BMD) in elderly subjects aged 50 years and older that could walk independently. Four hundred and twenty-six subjects (158 men and 258 women; mean age 68.7 years, standard deviation (SD) 7.9 years) were included in the study. BMDs (g/cm2) of the femoral neck, trochanter, shaft, and total proximal femur were collected. Kinetic data including maximum hip power and hip power-time integral was obtained from a three-dimensional gait analysis with self-selected walking speed. Correlation between BMDs of proximal femur and gait kinetic data was analyzed. Multiple regression analysis was also performed to identify factors significantly associated with BMD. Correlation between BMD and hip kinetic data was not prominent in elderly men. In women, BMD was significantly correlated with hip kinetic data. Hip power-time integral showed greater correlation with BMD than maximum hip power during gait in elderly women. Age (p < 0.001), weight (p = 0.007) and hip power-time integral (p = 0.008) were significant factors associated with femoral neck BMD, and these factors explained 25.4% of femoral neck BMD. In conclusion, the association between the mechanical load and BMD in the different sexes provokes future research into these issues. The effects of various types of exercises on BMD should be investigated more precisely using a gait analysis tool.

A pilot study comparing daily teriparatide with monthly cycles of teriparatide and raloxifene.

There is no cure for osteoporosis; better medications or different approaches with current agents are needed. We hypothesized that monthly cycles of teriparatide (TPD) followed by raloxifene (RLX) might promote ongoing bone formation. Additionally, as TPD might initially adversely affect hip BMD, such effects may be mitigated by a cyclic approach. Therefore, this 6-month pilot study evaluated the effect of cyclic TPD/RLX compared to daily subcutaneous TPD on bone markers, BMD, trabecular bone score (TBS), and hip parameters assessed by 3D modeling. Postmenopausal osteoporotic women (n=26) were randomized to open-label TPD 20 daily or alternating monthly cycles of TPD followed by monthly RLX 60 mg daily. BMD was measured at the lumbar spine (LS), femur, and radius by DXA. To further assess LS BMD, QCT and opportunistic CT (L1 Hounsfield units [HU]) were performed. LS TBS and hip cortical and trabecular parameters were assessed using DXA. Baseline group comparisons were performed by unpaired T-test with change over time evaluated by repeated measures ANOVA. Participant mean age, BMI, and lowest T-score were 67.0 years, 26.0 kg/m2, and -2.7; no between-group differences in serum chemistries, 25(OH)D, or BMD were observed. LS-BMD increased (p<0.001) with TPD or TPD/RLX as measured by DXA (4.8%/5.2%), QCT (13%/9.4%), or HU (15.6%/10.2%) with no between-group difference. TPD/RLX produced beneficial between-group differences in total proximal femur BMD (1.5%, p<0.05) and cortical thickness (1.6%, p<0.05). Compared with daily TPD, cyclic TPD/RLX comparably increased spine BMD and might have favorable effects on proximal femur BMD and cortical thickness.

Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury.

ObjectiveTo investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).MethodsPatients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.ResultsAmong 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.ConclusionThe duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

Effect of vitamin D therapy on bone mineral density in patients with diabetic nephropathy; a randomized, double-blind placebo controlled clinical trial.

Diabetes compromises bone strength resulting increased risk of osteoporosis. Objective of this study was to determine the effect of vitamin D given to patients with early diabetic renal disease on BMD and BMC. Patients with diabetic nephropathy were recruited. Treatment group received 50,000IU of vitamin D3 intramuscularly and the control group was given an equal volume of distilled water (0.25mL) monthly for six months. Baseline BMD, BMC in the total body, lumbar spine and proximal femur were measured by DXA. After six months measurements were repeated. When trial period was over, a randomly selected subgroup of patients (25 from each group) was followed up for further six-months and measurements were repeated. Selected patients were randomly assigned to two groups. After six months, the treatment group total body BMD, total body BMC and BMDs of spine, femoral neck and total hip regions increased by 2.0%, 2.2%, 1.8%, 2.1% and 2.6% (P < 0.05 for all within-group differences), respectively. In the Control group, BMD or BMC of any region mentioned above did not change significantly during the initial 6months (P < 0.05 for the between-groups differences). After 6months of stopping treatment, a statistically significant reduction of total BMD and BMC was observed in the treatment group (P = 0.009). This study showed that treatment with high dose vitamin D significantly influences total body BMC, total body BMD, BMDs of spine, femoral neck and hip among patients with diabetic nephropathy.

Effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mineral density, muscle mass, and exercise capacity for postmenopausal women with distal radius fractures

BackgroundDistal radius fractures are often the first fractures experienced by adults with osteoporosis, and such fractures provide an opportunity for treatment to prevent a domino effect of future fractures. Most of these fractures result from falls, which may be related to the individual's limb muscle mass, strength, and exercise capacity. Active vitamin D3 positively affects muscle and bone mass. However, the effect of a bone resorption inhibitor is unknown. This study aimed to determine the effects of eldecalcitol alone or a bone resorption inhibitor with eldecalcitol on bone mass, limb muscle mass, and exercise capacity of osteoporotic patients with distal radius fractures and to identify the preventive effects against future fractures. MethodsParticipants were postmenopausal women(n = 99) with distal radius fractures who visited the orthopedics outpatient department in a city general hospital from April 2015 to October 2017. Bone mass, limb muscle mass, skeletal muscle mass index, and muscle strength (grip strength and quadriceps muscle strength), walking speed, 2-step results, and timed up and go tests results were evaluated before and after 1 year of treatment. The instances of fall recurrence and refracture were investigated using a questionnaire. ResultsEighty-five patients completed follow-up assessments for 1 year. After treatment, bone mass and bone mineral density were significantly improved in the lumbar spine and total proximal femur compared to before treatment. Furthermore, skeletal muscle mass index, grip strength on the unaffected side, quadriceps muscle strength, walking speed and 2-step test results after 1 year of treatment were significantly improved. Nineteen and 4 patients experienced fall recurrence and refracture, respectively. ConclusionsEldecalcitol alone or a bone resorption inhibitor with eldecalcitol improved bone mass and bone mineral density, and maintained skeletal muscle mass index, muscle strength, and exercise capacity of osteoporotic patients with distal radius fractures.

Changes to bone mineral density, the trabecular bone score and hip structural analysis following parathyroidectomy: a case report

BackgroundReduction in bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) occurs in secondary hyperparathyroidism associated with chronic kidney disease. BMD generally increases following parathyroidectomy, however longitudinal changes to other DXA-derived parameters, the trabecular bone score (TBS) and hip structural analysis (HSA), have not been described. Postoperative calcium requirements and positive calcium balance raise concerns for an increased risk of vascular calcification. This case illustrates the dramatic increase in BMD that can follow parathyroidectomy in a patient on dialysis, and for the first time demonstrates improvements to HSA parameters and to the TBS.Case presentationA 30-year old woman on haemodialysis underwent subtotal parathyroidectomy for secondary hyperparathyroidism. She developed a post-operative ‘hungry bone syndrome’ requiring substantial calcium and calcitriol supplementation. Six months post-parathyroidectomy, BMD increased by 42% at the lumbar spine, 30% at the femoral neck and 25% at the total proximal femur, with increases sustained over the following 18 months. The TBS increased by 8%. HSA showed a 63% increase in femoral neck cortical thickness and 38% reduction in the buckling ratio, consistent with increased femoral neck stability. The abdominal aortic vascular calcification score (0–24) increased from zero 8-years pre-parathyroidectomy to 2/24 at 18-months post-parathyroidectomy.ConclusionBMD losses incurred by secondary hyperparathyroidism recover rapidly after parathyroidectomy, particularly at sites of trabecular bone. Bone architectural parameters, measured as the TBS and by HSA, also improve. Greater BMD gains may be associated with higher post-operative calcium requirements. While bone is the major reservoir for post-parathyroidectomy calcium supplementation, positive calcium balance may contribute to vascular calcification risk.