Bone mineral density in adolescent women using depot medroxyprogesterone acetate

PURPOSE: To present current data on bone mineral density (BMD) in adolescent women using the long-acting contraceptive depot medroxyprogesterone acetate (DMPA) and also to discuss the importance of developing maximal bone mass during adolescence to offset bone demineralization later in life. DATA SOURCES: Research-based articles in the medical literature, review articles, and recommendations from the American Academy of Pediatrics and the National Osteoporosis Foundation. CONCLUSIONS: Osteoporosis is a preventable disease that affects millions of Americans, particularly older women. Factors influencing the attainment and maintenance of peak bone mass during childhood and adolescence affect the future risk of fractures. Although longitudinal studies conducted on adolescent women using DMPA are very limited, findings suggest that adolescents are losing bone density during a time of expected bone accretion. IMPLICATIONS FOR PRACTICE: Clinicians must consider all the risks and benefits when prescribing contraceptives to adolescents. By themselves, the findings related to BMD and DMPA use by adolescents are not sufficient to limit the use of DMPA as a contraceptive method. However, clinicians must take into account the addition of other modifying factors associated with BMD that may contribute to overall bone loss in adolescent females. More prospective data on the long-term use of DMPA by adolescents are needed to determine DMPA's effect on bone loss and to determine if bone loss is transient in adolescents.     

Bone mineral density in diabetes mellitus patients with and without a Charcot foot

Objective:  To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA). Research design and methods:  A total of 49 patients with diabetes were investigated. The population consisted of patients with an acute CA (n = 17) or chronic CA (n = 7). Control groups consisted of diabetes patients with (n = 9) and without neuropathy (n = 11) and who had an amputation of the first toe (n = 5). Values measured were bone mineral density (BMD) in lumbar spine, hip and calcaneus, using lunar DEXA scanner. The bone turnover markers CTX‐1 and N‐MID were measured. Results:  There were no differences in BMD measured in the spine and hip. There was an increase in the markers of bone turnover in the patients with acute CA. The BMD of the calcaneus was statistically lower in the affected foot in patients with chronic Charcot (P < 0·01), than in the unaffected foot, but there were no statistically significant differences between the BMD of the calcaneus in the feet in the other groups. Conclusions:  From this study, we can conclude that there were no differences in BMD values in the spine and hip between groups. There were no differences between BMD of the calcaneus between groups, except that patients with chronic Charcot had a significantly lower calcaneal BMD in the affected foot than in the healthy foot. Furthermore, there was an increased bone turnover in the group with acute CA, which was not found in the other patients groups. This suggests that the Charcot foot is a rather local phenomenon, with little effect on the skeleton in general.     

Bone mineral density,bone metabolism‐related factors,and microRNA‐218 are correlated with disease activities in Chinese ankylosing spondylitis patients

ObjectiveTo investigate bone mineral density (BMD), bone metabolism‐related factors, and microRNA‐218 in Chinese ankylosing spondylitis (AS) patients and to identify their correlation with disease activities and the treatment with TNF‐α inhibitors.MethodsA total of 89 AS patients were enrolled in the study. Patients’ information and laboratory examination results were collected. BMD of the anteroposterior lumbar spine (L2‐L4), left femoral neck, and whole body were measured and T‐scores were calculated. MicroRNA‐218 was extracted from PBMCs of AS patients and detected by RT‐PCR. Bone metabolism‐related factors were detected using protein chips and flow cytometer.ResultsOut of 86 patients undergoing whole‐body BMD measurement, 14 had osteopenia and 72 had normal BMD without osteoporosis or high BMD. Compared with short‐ (disease duration ≤3 years) and long‐term groups (disease duration ≥10 years), medium‐term group (disease duration ranges from 3 to 10 years) showed lowest BMD. Patients with onset age ≤20 years old had significantly lower BMD than the other groups (p < 0.05). The BMD of femoral neck had negative correlation with CRP (p < 0.05) and no correlation with BASDAI or ESR. Both whole‐body BMD and femoral neck BMD were negatively correlated with BASMI (p < 0.05). Dickkopf‐1 (DKK‐1), platelet‐derived growth factor‐BB (PDGF‐BB), and receptor activator of NF‐κB ligand (RANKL)/osteoprotegerin (OPG) were significantly increased, while Osteopontin (OPN) was significantly decreased in AS patients. Expression of microRNA‐218 in PBMC of AS patients was low and was positively correlated with BASMI (p < 0.05), but it was not correlated with the duration of disease, age of onset, BASDAI, ESR, or BMD.ConclusionLoss of bone mass mainly occurred at the inflammatory sites in AS patients, depending on the severity of inflammation. The alleviation of inflammation can improve loss of bone mass and bone metabolism disorders. Anti‐inflammatory treatment is critical for the treatment of secondary osteoporosis caused by AS.     

低剂量雌激素替代疗法对围绝经期综合征患者激素水平及骨密度的影响

目的观察低剂量雌激素替代疗法对围绝经期综合征患者临床症状、激素水平及骨密度的影响。方法根据患者是否愿意接受雌激素替代疗法将105例围绝经期综合征患者分为试验组52例和对照组53例,对照组不接受任何药物治疗,试验组口服替勃龙,2.5 mg/次,1次/d,连续治疗6个月。结果试验组治疗后Kupperman各项评分均下降,卵泡刺激素(FSH)、黄体生成素(LH)水平下降,雌二醇(E2)水平升高,L1~4骨密度及股骨颈骨密度显著增加(P0.05或P0.01)。试验组未出现需要停药的不良反应,但子宫内膜厚度显著增加。结论低剂量雌激素替代疗法可有效改善围绝经期综合征患者临床症状,调节激素水平,增加骨密度值,但可能会增加患者子宫内膜厚度,临床应用时应采用最低有效剂量,确保安全性。     

跑步和游泳对青春期女孩骨密度的影响

摘要 目的：探讨跑步、游泳运动是否对青春期女孩的局部和全身骨密度（BMD）产生影响。 方法：58例骨龄10—12岁女孩作为研究对象,其中业余少体校跑步运动员（RG）14例、游泳运动员（SG） 25例作为实验组,普通学生（CG）19例作为对照组。采用Lunar Prodigy DXA测量受试者的全身等7个部位的骨密度,采用CHN-05标准评定受试者的骨龄和问卷调查其日常体育锻炼和训练时间等信息。 结果：①调整体表面积后,SG的上肢骨密度（0.552 g/cm2）分别比CG（0.517 g/cm2）和RG（0.511 g/cm2）高出6.8%和8.0%（P＜0.05）,RG的下肢骨密度（0.798 g/cm2）分别比SG（0.746 g/cm2）和CG（0.754 g/cm2）高出7.0%和5.8%（P＜0.05）,全身骨密度和去颅骨全身骨密度不存在组间差异;②SG的上肢瘦软组织显著高于其他两组,RG的下肢瘦软组织显著高于其他两组,CG的全身瘦软组织低于其他两组;③对照组的课余体育锻炼时间每周仅为111.1min,明显低于跑步组（661.4min）和游泳组（705.6min）,P＜0.01。 结论:经常进行游泳、跑步运动对女孩骨骼的影响产生了局部效应,该效应又体现了项目特异性,同时说明不同运动对骨密度产生的正效应在青春期阶段就已出现;建议女孩应在此阶段进行有规律的游泳、跑步运动,提高上、下肢的骨密度。     

秦皇岛市某医院老年人骨密度调查及其与体质量指数的关系

目的：调查秦皇岛市第一医院就诊的老年人骨密度及其与体质量指数的关系。方法应用双能 X 线骨密度仪对入选的898例（男415例,女483例）60～94岁人群进行左侧股骨颈、ward’s 三角、大粗隆及腰椎的骨密度测定,按5岁为1年龄组,统计其骨质疏松发生率,记录年龄、身高、体质量,计算体质量指数。结果60～64．9岁年龄组及90岁以上年龄组男女骨质疏松发生率分别为8．2％（4／49）、18．5％（15／81）和80．0％（4／5）、100％（6／6）,差异无统计学意义（P ＞0．05）;65～69．9岁年龄组男女骨质疏松发生率11．3％（7／62）、27．1％（16／59）,70～74．9岁25．3％（20／83）、42．6％（46／108）,75～79．9岁22．8％（21／92）、67．3％（68／101）,80～84．9岁33．7％（29／86）、79．5％（62／78）,85～89．9岁60．5％（23／38）、88．0％（44／50）,差异均有统计学意义（P ＜0．01）。体质量及体质量指数与左侧股骨颈、ward’s 三角、大粗隆及腰椎1～4骨密度呈正相关（P ＜0．01）,而年龄与左侧股骨颈、ward’s 三角、大粗隆骨密度呈负相关（P ＜0．01）。结论随着年龄增加男女性骨质疏松发生率逐渐增加,65～89．9岁女性骨质疏松发生率明显高于男性,体质量及体质量指数是骨质疏松的保护因素。     

Associations of serum sclerostin with bone mineral density,markers of bone metabolism and thalassaemia characteristics in adult patients with transfusion-dependent beta-thalassaemia

Abstract

Aim of the study: To assess serum sclerostin in transfusion-dependent beta-thalassaemia patients versus healthy controls and to examine its associations with bone mineral density, bone metabolism markers and beta thalassaemia alterations.

Material and methods: Sixty-two transfusion-dependent beta-thalassaemia (TDßT) patients and 30 healthy controls were evaluated for serum sclerostin, osteocalcin, beta-cross laps, osteoprotegerin and serum level of receptor activator of nuclear factor kappa-Β ligand (sRANKL). Bone mineral density was measured at the lumbar spine and femoral neck. Thalassaemia characteristics were collected from the patients’ medical records.

Results: A significantly higher sclerostin level (median 565.50?pmol/L) was observed in the transfusion-dependent beta-thalassaemia patients vs. the healthy controls (median 48.65?pmol/L, p?<?.001). Sclerostin showed significant associations with the Z-scores at the lumbar spine and femoral neck, osteocalcin, beta-cross laps, osteoprotegerin, sRANKL, pretransfusion haemoglobin, liver iron concentration and female gonadal state. Significantly higher levels of sclerostin were observed in splenectomized TDßT patients and in those with fragility fractures. Age, sex, body mass index, disease severity, serum ferritin, cardiac T2* and male gonadal state did not show significant associations with sclerostin.

Conclusion: Sclerostin may play a role in the bone pathophysiology of beta-thalassaemia patients and could serve as a marker of severe osteoporosis.

• KEY MЕSSAGES

• Serum sclerostin is more than 10-fold higher in adult patients with transfusion-dependent beta-thalassaemia compared to healthy controls.

• Serum sclerostin is negatively associated with bone mineral density and the bone synthesis markers and positively with the bone resorption indices.

• Serum sclerostin is significantly associated with pre-transfusion haemoglobin, liver iron concentration, splenectomy status and fragility fracture events in adult patients with transfusion-dependent beta-thalassaemia.

• Serum sclerostin could serve as a marker of severe osteoporosis in beta-thalassaemia patients.

     

老年男性2型糖尿病患者甲状旁腺素、维生素D与骨密度的关系

目的 探讨老年男性2型糖尿病患者主要钙调激素甲状旁腺素(PTH)和维生素D的变化对骨密度的影响.方法 应用双能X线骨密度仪测定60例老年男性2型糖尿病患者的腰椎和髋部骨密度,检测血清中骨代谢及血糖相关的指标,并根据骨密度测定结果将60例老年男性2型糖尿病患者分为骨量减少组(32例)、骨质疏松组(12例)、正常组(16例),测定3组的血清PTH和25羟维生素D3,分析其与患者不同部位骨密度的相关性.结果 依据患者腰椎或髋部的骨密度值,骨质疏松的检出率为20.0％(12/60),骨量减少的检出率为53.3％(32/60).3组的血清PTH比较差异有统计学意义(F=3.32,P=0.043),骨量减少组、骨质疏松组与正常组相比,PTH水平明显上升[(44.87±10.62)、(50.24±20.32)μg/L与(36.96±12.36)μg/L,P均＜0.05].但25羟维生素D3浓度3组比较差异无统计学意义(P＞0.05).相关分析显示,PTH水平与髋部骨矿面密度(BMD)呈显著负相关(r=-0.224,P ＜0.05),与腰椎BMD无显著相关性(r=-0.187,P＞0.05).结论 老年男性2型糖尿病患者的髋部BMD与血清PTH浓度负相关.     

Association of genetic polymorphisms of RANK,RANKL and OPG with bone mineral density in Chinese peri- and postmenopausal women

Objectives

To explore the influence of 14 single nucleotide polymorphisms (SNPs) in receptor activator of nuclear factor-kappa B (RANK), RANK ligand (RANKL) and osteoprotegerin (OPG) on bone mineral density (BMD) in a Chinese female population.

Design and methods

A cross-sectional study was conducted in 108 perimenopausal and 127 postmenopausal women aged 43–65 years. All participants underwent lumbar spinal and nondominant femoral BMD evaluation by dual energy X-ray absorptiometry. Fourteen RANK, RANKL and OPG genotypes were determined by chip-based MALDI-TOF mass spectrometry. The differences between the BMDs of the RANK genotypes were analyzed.

Results

Five SNPs (rs6993813, rs4355801, rs1032129 and rs2073618 in OPG and rs3018362 in RANK) were significantly associated with BMD or with BMD adjusted for body weight or years since menopause, mostly at the femoral neck but also partly at the total hip (p < 0.05). The risk allele frequencies observed in our sample were different from those found in Europeans but the effects of these risk alleles on BMD values had the same direction in our cohort as in Europeans, except for rs3018362 with G as the risk allele, which was contrary to other studies. None of the SNPs in RANKL were associated with BMD at any anatomical site.

Conclusions

Our findings suggest that OPG and RANK but not RANKL genetic polymorphisms influence BMD mainly in the femoral neck in peri- and postmenopausal Chinese women. This contributes to the understanding of the role of genetic variation in this pathway in determining bone health.