A Comparative Study of Dual-X-ray Absorptiometry and Quantitative Ultrasonography for the Evaluating Bone Status in Subjects with Rett Syndrome

Rett syndrome, an X-linked neurodevelopmental disorder primarily affecting girls, is frequently characterized by a reduced bone mineral density (BMD) with an increased risk of fragility fractures. The aim of the study was to assess bone status by DXA technique and by quantitative ultrasound (QUS) in subjects with Rett syndrome and to evaluate which DXA or QUS parameters better correlate with clinical features. In 156 Rett subjects (mean age 13.6 ± 8.2 years) and in 62 controls, we measured BMD at femoral neck (BMD-FN) and at total femur (BMD-TF). Apparent volumetric bone mineral density (vBMAD) was also calculated. In all subjects, QUS parameters at phalanges by Bone Profiler-IGEA (amplitude-dependent speed of sound: AD-SoS and bone transmission time: BTT) were evaluated. We found that both DXA parameters and QUS parameters were significantly lower in Rett subjects than in controls. All clinical characteristics were positively correlated to BMD-FN, BMD-TF, AD-SoS, and BTT (p < 0.001) but not with vBMAD-FN. All ultrasonographic parameters were significantly correlated to BMD-FN and BMD-TF, whereas vBMAD-FN showed only positive significant correlation with densitometric parameters (p < 001). In Rett subjects BMD-FN was predicted primarily by weight and movement capacity, whereas vBMAD-FN was predicted by weight, height, and calcium intake. Moreover, AD-SoS was predicted by weight, height, and age, while BTT was predicted only by height. In conclusion, in our study the performance of QUS at phalanges was similar to those of BMD at femur, therefore, both areal BMD at femur and QUS at phalanges (AD-SoS and BTT) may be equally useful in the evaluation of skeletal status in Rett patients.     

Bone quantity and quality in Brazilian female schoolchildren and adolescents

The aim of the present study was to evaluate quantitative ultrasound parameters of the finger phalanges bones (AD-SoS, amplitude-dependent speed of sound, and BTT, bone transmission time) of schoolchildren, using a DBM Sonic device (IGEA, Carpi, Italy), to obtain normative values for the Brazilian population. The sample consisted of 1,775 healthy schoolchildren, all females, aged 8–17 years. We observed a progressive increase for the variables of weight, height, body mass index (BMI), AD-SoS, and BTT with advancing age. Results for AD-SoS showed increasing and significant variation from 8 to 17 years old (1,938–2,103 m/s, an increase of 8.52%, P < 0.0001), and also for BTT (0.84–1.45 μs, an increase of 72.6%, P < 0.0001). A gradual increase in the values of AD-SoS and BTT was observed with advances in pubertal stages. There was an interaction between the variables of age, height, and pubertal stages, predicting AD-SoS (R ² = 0.49) and BTT (R ² = 0.53). The study showed that AD-SoS and BTT, evaluated by means of bone ultrasonometry of the phalanges in females, increase gradually with age, being more evident during puberty, probably as a reflex of the structural organization of bone growth and development, or changes in the content of the bone tissue.     

Changes in bone mineral density following long-term simultaneous pancreas-kidney transplantation

The symptoms of chronic renal disease-related mineral and bone disease improve significantly in patients after successful simultaneous pancreas-kidney transplantation (SPKT); however, bone pathology is still present even after many post-transplant years. The aim of this study was to analyze the bone densitometry in different periods after SPKT. Three-point densitometry was performed with the dual-energy X-ray absorptiometry (DXA) technique. Serum levels of alkaline phosphatase (ALP), total serum calcium, phosphate and parathyroid hormone were analyzed as markers of mineral metabolism. The study population consisted of 48 patients (28 females, 20 males) with a mean age of 35 ± 6 years and mean 24 ± 6 years of prior diabetes. Mean period of maintenance dialysis was 36 ± 26 months. The median time from SPKT and DXA measurement was 0.53, 26.2 and 41.9 months, respectively. Based on the DXA technique, 35.4 % of patients were categorized as having osteoporosis at the lumbar spine and 39.6 % at the femoral neck. Patients with diagnosed osteoporosis had significantly higher levels of ALP (OR = 1.5; 95 % CI = 1.1–2.2; p < 0.05 at the lumbar spine; OR = 1.4; 95 % CI = 1.0–1.9; p < 0.05 at the femoral neck). In addition, subjects with lumbar osteoporosis were characterized by a significantly lower body mass index (BMI) (OR = 0.5; 95 % CI = 0.3–0.9; p < 0.05). In the long-term follow-up, BMD increased significantly at the lumbar spine (T-score ?1.86 ± 1.07 to ?1.08 ± 0.89) and femoral neck (T-score ?2.12 ± 0.78 to ?1.63 ± 0.65). A multivariate linear model identified a BMI increase as a significant factor associated with improvement in BMD. Results of our study led us to conclude that, according to three-point densitometry, BMD among patients with functioning kidney and pancreas grafts improved. Increased serum levels of ALP were significantly associated with a decrease in BMD, suggesting a higher risk of osteoporosis. BMI gain was predictive of BMD improvement.     

Beneficial effects of intravenous pamidronate treatment in children with osteogenesis imperfecta under 24 months of age

Osteogenesis imperfecta (OI) is an inherited disorder characterized by bone fragility and low bone mass. Low bone density and fracture is a cause of morbidity. Limited data exists on bisphosphonate treatment in patients under 24 months of age. The objective of the study was to examine the safety and efficacy of pamidronate in children under 24 months with OI. To do so, we carried out a retrospective chart review and analysis of OI patients started on intravenous pamidronate under 24 months of age. Pamidronate was administered in three-day cycles. Growth, the number of fractures, and lumbar bone mineral densities were recorded both prior to and after treatment initiation. A total of 18 patients were reviewed. Five were classified as OI type I, seven were type III, and six were type IV. The mean age at treatment initiation was 12 months (range 11 days to 23 months). The mean lumbar z score at baseline was ?3.63, which improved to ?1.53 at one year (P < 0.01) and 0.79 (P < 0.01) at the end of the study. The fracture rate improved from 68 fractures in 209 months (0.32 fractures/patient-month) before treatment to 41 fractures in 1,248 months (0.03 fractures/patient-month) post-treatment (P < 0.05). Height standard deviation score (SDS) was conserved from baseline to end of study (?2.12 ± 2.45 vs. ?2.45 ± 2.73) (P = 0.05) with an average follow-up of 73 months. The only adverse effect recorded in six infants was fever during the initial pamidronate infusion. Treatment with intravenous pamidronate is safe, significantly improves lumbar bone mineral density (L-BMD), and reduces fracture rates in young infants with OI while preserving linear growth.     

IL-17A-mediated sRANK ligand elevation involved in postmenopausal osteoporosis

Summary

The role of proinflammatory IL-17 cytokine was studied in postmenopausal bone loss between 31 osteopenic and 41 osteoporotic women. The effect of serum IL-17A, soluble receptor activator of NF-κB (sRANK) ligand, and osteoprotegerin (OPG) levels on lumbar bone mineral densities was measured. The results demonstrated an increased IL-17A-mediated sRANK ligand elevation in postmenopausal osteoporotic bone loss.

Introduction

IL-17 proinflammatory cytokine is a new inducer of bone loss. Postmenopausal osteoporosis represents a cross talk between estrogen deprivation and increased immune reactivity. The role of IL-17 was studied in the bone loss of postmenopausal osteoporosis.

Methods

Serum IL-17A, sRANK ligand, and OPG levels were investigated on bone mineral densities (BMDs) in the total lumbar (L1–L4) region in 18 pre- and 72 postmenopausal women. IL-17A, sRANK ligand, OPG levels, and BMDs were measured with enzyme-linked immunosorbent assay (ELISA) and dual-energy X-ray absorptiometry (DXA).

Results

Increased serum IL-17A, sRANK ligand, and OPG levels were demonstrated in postmenopausal osteoporotic women compared to osteopenic women (3.65?±?0.61 vs 3.31?±?0.43 ng/ml for IL-17A, P?<?0.007; 2.88?±?0.84 vs 2.49?±?0.61 ng/ml for sRANK ligand, P?<?0.027; and 1.43?±?0.07 vs 1.39?±?0.07 ng/ml for OPG, P?<?0.038). In postmenopausal women, IL-17A levels correlated inversely with total lumbar BMDs (P?<?0.008, r?=??0.279) and positively with sRANK ligand levels (P?<?0.0001, r?=?0.387) or the ratio of sRANK ligand and OPG (P?<?0.013, r?=?0.261), but did not with OPG levels alone.

Conclusion

Increased IL-17A levels are involved in postmenopausal osteoporosis, playing a role in the bone-resorpting processes.     

Graphic Trace Analysis of Ultrasound at the Phalanges May Differentiate Between Subjects with Primary Hyperparathyroidism and with Osteoporosis: A Pilot Study

Bone loss characterizes both primary hyperparathyroidism (PHPT) and osteoporosis (OP) but with a different histologic pattern, and this could partially explain the different fracture incidence in these two populations. Quantitative ultrasound (QUS), influenced by bone structural parameters other than bone mineral density (BMD), could evidence these differences, opening new perspectives in the evaluation of patients with metabolic bone diseases. The aim of the present study was to investigate the usefulness of QUS graphic trace parameters, assessed at the phalanx, in discriminating between PHPT bone disease and osteoporosis. We studied 34 patients with PHPT (mean age 59.7 ± 12.7 years), 35 patients with OP (mean age 60.6 ± 7.1 years) and 34 healthy subjects as controls (mean age 59.1 ± 9.4 years). In all subjects QUS measurements were performed at the phalanx with a Bone Profiler (IGEA, Italy), obtaining the amplitude-dependent speed of sound (AD-SoS), fast wave amplitude (FWA), signal dynamic (SDy), bone transmission time (BTT) and ultrasound bone profile index (UBPI). Moreover, serum calcium, phosphorus, parathyroid hormone (PTH), bone isoenzyme of alkaline phosphatase (B-ALP) and ionized calcium were measured in all subjects in the morning under fasting conditions. In PHPT patients BTT was correlated with PTH, ionized calcium and B-ALP levels (r=–0.47, –0.57 and –0.44, respectively; p <0.01), whereas FWA, SDy and UBPI correlated only with B-ALP (r=–0.43, –0.46 and –0.50, respectively; p <0.01). Moreover, FWA, SDY and UBPI were significantly (p<0.01) lower and BTT significantly (p<0.001) higher in OP than in PHPT patients. UBPI, BTT, FWA and the BTT/FWA ratio, but not SDy, were able to discriminate between the two groups (area under the curve =0.66, 0.69, 0.67 and 0.81, respectively).  Our findings show that ultrasound signal parameters are differently influenced by bone changes characterizing primary hyperparathyroidism or osteoporosis. This suggests that the QUS signal could be a useful instrument in discriminating and studying some of the bone alterations typical of metabolic bone diseases. Received: 15 February 2001 / Accepted: 27 August 2001     

Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse

Introduction and hypothesis

The aim of this study was to investigate factors associated with long-term pessary use in patients with advanced pelvic organ prolapse (POP).

Methods

This was a retrospective chart review of patients with POP of stage ≥2 managed with a pessary. Patients were excluded if the date of fitting or follow-up was unavailable. Long-term use was defined as more than 1 year. Patient demographics, pessary fitting, and follow-up visit dates were collected. The primary end point was the duration of use and the prognostic impact of pessary type. Secondary objectives addressed other influencing factors including age, estrogen use, and prolapse stage. The data were analyzed using SPSS version 21.

Results

The final analysis included 311 patients. The mean (±?standard deviation, SD) duration of pessary use was 7.0?±?0.72 years (median 5.7 years). Long-term use was found in 76 % (164) of these patients. Factors associated with longer use were age >65 years (p?=?0.004) and estrogen use (p?=?0.048). The estimated mean (±?SD) durations of use of the Gellhorn, open ring, ring with support, cube and donut pessaries were 10.5?±?0.7 years, 3.4?±?0.6 years, 1.8?±?0.2 years, 1.8?±?0.3 years and 1.7?±?0.5 years, respectively. The Gellhorn pessary was associated with significantly longer use than other pessary types (10.5?±?0.7, p?<?0.0000001); this finding was independent of age, prolapse stage, hysterectomy, and vaginal estrogen use.

Conclusions

In this retrospective analysis, the duration of use was longest with the Gellhorn pessary. Older age and vaginal estrogen use were associated with longer pessary use.

     

Effects of anti-resorptive agents on trabecular bone score (TBS) in older women

Summary

We evaluated the longitudinal effects of anti-resorptive agents (534 treated women vs. 1,150 untreated) on lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). TBS was responsive to treatment in women over age 50. The treatment-related increase in TBS was less than the increase in BMD, which is consistent with bone texture preservation.

Introduction

In addition to inducing an increase in BMD, anti-resorptive agents also help to preserve bone architecture. TBS, a new gray-level texture measurement, correlates with 3D parameters of bone micro-architecture independent of BMD. Our objective was to evaluate the longitudinal effects of anti-resorptive agents on lumbar spine BMD and TBS.

Methods

Women (≥50 years), from the BMD program database for the province of Manitoba, Canada, who had not received any anti-resorptive drug prior to their initial dual X-ray absorptiometry (DXA) exam were divided into two groups: untreated, those without any anti-resorptive drug over the course of follow-up, and treated, those with a non-estrogen anti-resorptive drug (86 % bisphosphonates, 10 % raloxifene, and 4 % calcitonin). Lumbar spine TBS was calculated for each lumbar spine DXA examination. Changes in TBS and BMD between baseline and follow-up (mean follow-up 3.7 years), expressed in percentage per year, were compared between the two groups.

Results

A total of 1,150 untreated women and 534 treated women met the inclusion criteria. Only a weak correlation was seen between BMD and TBS in either group. Significant intergroup differences in BMD change and TBS change were observed over the course of follow-up (p?<?0.001). Similar mean decreases in BMD and TBS (?0.36 %/year and ?0.31 %/year, respectively) were seen for untreated subjects (both p?<?0.001). Conversely, treated subjects exhibited a significant mean increase in BMD (+1.86 %/year, p?<?0.002) and TBS (+0.20 %/year, p?<?0.001).

Conclusion

TBS is responsive to treatment with non-estrogen anti-resorptive drug therapy in women over age 50. The treatment-related increase in TBS is less than the increase in BMD, which is consistent with bone texture preservation.     

Changes in Bone Mineral Density After Kidney Transplantation

Background

Numerous studies have shown that osteoporosis is common in kidney transplant recipients. However, the change in bone mineral density after kidney transplantation (KT) is not fully understood.

Bone mineral density and parathyroid function in patients on maintenance hemodialysis

Background

The relationship between parathyroid function, an important determinant of bone turnover, and bone mineral density (BMD) in patients with chronic kidney disease is not fully understood. We wanted to analyze the association between BMD and parathyroid function in hemodialysis patients in details.

Methods

In a cross-sectional design, data from 270 patients (age 55 ± 15 years, 60% men, all Caucasian) on maintenance hemodialysis were analyzed. All patients underwent dual energy X-ray absorptiometry of the lumbar spine (LS), femoral neck (FN) and distal radius (DR). In addition to routine laboratory tests, blood samples were collected for iPTH, serum markers of bone metabolism (alkaline phosphatase, type I collagen crosslinked-C-telopeptide) and 25OH vitamin D.

Results

Based on Z-scores, bone mineral density was moderately reduced only at the femoral neck in the total cohort. The average Z-score of the ??low PTH?? group (iPTH < 100 pg/ml) was not different from the Z-score of patients with iPTH in the ??target range?? (100?C300 pg/ml) at any measurement site. While iPTH was negatively correlated with BMD at all measurement sites in patients with iPTH > 100 pg/ml (rho = ?0.255, ?0.278 and ?0.251 for LS, FN and DR, respectively, P < 0.001 for all), BMD was independent of iPTH in patients with iPTH < 100 pg/ml. Furthermore, iPTH was not associated with serum markers of bone metabolism, but these markers were negatively correlated with BMD in the ??low PTH?? group.

Conclusions

Low PTH levels are not associated with low BMD in patients with end-stage kidney disease. Furthermore, bone metabolism seems to be independent of iPTH in patients with relative hypoparathyroidism likely reflecting skeletal resistance to PTH.     

Core decompression and implantation of bone marrow mononuclear cells with porous hydroxylapatite composite filler for the treatment of osteonecrosis of the femoral head

Background

Implanted bone marrow mononuclear cells (BMMCs) may promote both osteogenesis and angiogenesis in the femoral head. The aim of this study was to investigate the effectiveness of core decompression and implantation of BMMCs with porous hydroxyapatite bone filler for the treatment of osteonecrosis of the femoral head (ONFH).

Methods

Patients with ONFH underwent core decompression and implantation of nano-hydroxyapatite/polyamide bone filler with or without BMMCs. Primary outcomes were changes in Harris hip and visual analogue scale (VAS) pain scores. Secondary outcomes included radiological and clinical success rates, adverse events, and complications.

Results

Demographic/baseline characteristics were similar between groups (BMMC, n = 17 with 26 ONFH hips; control, n = 17 with 27 ONFH hips). Harris hip scores were significantly increased (P < 0.05) in both groups of patients after surgery (last follow-up). The magnitude of increase was significantly greater in the BMMC as compared with the control group (28.6 ± 0.5 vs. 18.4 ± 1.7 %, P < 0.001). VAS scores were significantly decreased (P < 0.05) in both groups after surgery (last follow-up). The magnitude of decrease was significantly greater in the BMMC as compared with the control group (?66.3 ± 1.4 vs. ?51.7 ± 2.9 %, P < 0.001). Radiological and clinical success rates were significantly higher in the BMMC as compared with the control group (82.5 vs. 40.7 % and 75.4 vs. 37.0 %, respectively, P < 0.001). Postoperative collapse of the femoral head was less common in the BMMC as compared with the control group (17.5 vs. 59.3 %, P < 0.01).

Conclusions

Both core decompression with or without implantation of BMMC are effective treatment for ONFH. However, core decompression with implantation of BMMCs and porous hydroxyapatite bone filler may be a more effective treatment for ONFH.     

Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Previous studies suggested possible bone loss and fracture risk in patients with systemic lupus erythematosus (SLE). The aim of this systematic review and meta-analysis was to assess the strength of the relationship of SLE with fracture risk and the mean difference of bone mineral density (BMD) levels between SLE patients and controls. Literature search was undertaken in multiple indexing databases on September 26, 2015. Studies on the relationship of SLE with fracture risk and the mean difference of BMD levels between SLE patients and controls were included. Data were combined using standard methods of meta-analysis. Twenty-one studies were finally included into the meta-analysis, including 15 studies on the mean difference of BMD levels between SLE patients and controls, and 6 studies were on fracture risk associated with SLE. The meta-analysis showed that SLE patients had significantly lower BMD levels than controls in the whole body (weighted mean difference [WMD]?=??0.04; 95 % CI ?0.06 to ?0.02; P?<?0.001), femoral neck (WMD?=??0.06; 95 % CI ?0.07 to ?0.04; P?<?0.001), lumbar spine (WMD?=??0.06; 95 % CI ?0.09 to ?0.03; P?<?0.001), and total hip (WMD?=??0.05; 95 % CI ?0.06 to ?0.03; P?<?0.001). In addition, the meta-analysis also showed that SLE was significantly associated with increased fracture risk of all sites (relative risk [RR]?=?1.97, 95 % CI 1.20–3.25; P?=?0.008). Subgroup analysis by adjustment showed that SLE was significantly associated with increased fracture risk of all sites before and after adjusting for confounding factors (unadjusted RR?=?2.07, 95 % CI 1.46–2.94, P?<?0.001; adjusted RR?=?1.22, 95 % CI 1.05–1.42, P?=?0.01). Subgroup analysis by types of fracture showed that SLE was significantly associated with increased risks of hip fracture (RR?=?1.99, 95 % CI 1.55–2.57; P?<?0.001), osteoporotic fracture (RR?=?1.36, 95 % CI 1.21–1.53; P?<?0.001), and vertebral fracture (RR?=?2.97, 95 % CI 1.71–5.16; P?<?0.001). This systematic review and meta-analysis provides strong evidence for the relationship of SLE with bone loss and fracture risk.     

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

Summary

Treatment effects over 2 years of teriparatide vs. ibandronate in postmenopausal women with osteoporosis were compared using lumbar spine bone mineral density (BMD) and trabecular bone score (TBS). Teriparatide induced larger increases in BMD and TBS compared to ibandronate, suggesting a more pronounced effect on bone microarchitecture of the bone anabolic drug.

Introduction

The trabecular bone score (TBS) is an index of bone microarchitecture, independent of bone mineral density (BMD), calculated from anteroposterior spine dual X-ray absorptiometry (DXA) scans. The potential role of TBS for monitoring treatment response with bone-active substances is not established. The aim of this study was to compare the effects of recombinant human 1–34 parathyroid hormone (teriparatide) and the bisphosphonate ibandronate (IBN), on lumbar spine (LS) BMD and TBS in postmenopausal women with osteoporosis.

Methods

Two patient groups with matched age, body mass index (BMI), and baseline LS BMD, treated with either daily subcutaneous teriparatide (N?=?65) or quarterly intravenous IBN (N?=?122) during 2 years and with available LS BMD measurements at baseline and 2 years after treatment initiation were compared.

Results

Baseline characteristics (overall mean ± SD) were similar between groups in terms of age 67.9?±?7.4 years, body mass index 23.8?±?3.8 kg/m², BMD L1–L4 0.741?±?0.100 g/cm², and TBS 1.208?±?0.100. Over 24 months, teriparatide induced a significantly larger increase in LS BMD and TBS than IBN (+7.6 %?±?6.3 vs. +2.9 %?±?3.3 and +4.3 %?±?6.6 vs. +0.3 %?±?4.1, respectively; P?<?0.0001 for both). LS BMD and TBS were only weakly correlated at baseline (r ²?=?0.04) with no correlation between the changes in BMD and TBS over 24 months.

Conclusions

In postmenopausal women with osteoporosis, a 2-year treatment with teriparatide led to a significantly larger increase in LS BMD and TBS than IBN, suggesting that teriparatide had more pronounced effects on bone microarchitecture than IBN.     

Aneurysm sac expansion is independently associated with late mortality in patients treated with endovascular aneurysm repair

Background

Patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms can exhibit variations in sac behavior ranging from complete regression to expansion. We evaluated the impact of sac behavior at 1-year follow-up on late survival.

The Effect of Laparoscopic Gastric Bypass on Dyslipidemia in Severely Obese Patients: a 5-Year Follow-up Analysis

Background

Dyslipidemia is common in the morbidly obese population. A previous study from our institution demonstrated improved lipid parameters 1 and 2 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) with fewer patients taking lipid-modifying medications postoperatively, suggesting cost-savings over time. Our objective was to evaluate lipid parameters and lipid-modifying medication use at 5 years postoperative.

Methods

The medical records of patients who underwent LRYGB from September 2001 through July 2008 were reviewed. Inclusion criteria consisted of both preoperative and 5-year postoperative lipid values available.

Results

Six hundred eighty-two patients underwent LRYGB during the study period; 450 had data available at 5 years postoperative, and 187 patients met the inclusion criteria. Mean age was 46.3 years, and 83 % were women. Mean preoperative body mass index was 47.4 kg/m². Total cholesterol was 191.2?±?35.4 preoperatively and 181.1?±?33.0 at 5 years postoperative (P?=?0.003). Low-density lipoprotein (LDL) was 107.9?±?30.9 preoperatively and 95.3?±?29.7 at 5 years postoperative (P?<?0.001). High-density lipoprotein (HDL) was 48.7?±?12.8 preoperatively and 65.1?±?18.0 at 5 years postoperative (P?<?0.001). Triglycerides were 171.3?±?78.6 preoperatively and 112.9?±?60.7 5 years postoperative (P?<?0.001). Preoperatively, 35 % of patients were on lipid-modifying medications, and at 5 years postoperatively, 26 % required lipid-modifying medications (P?=?0.002).

Conclusions

Patients who have undergone LRYGB continue to show favorable change in their lipid profiles at 5 years postoperative. Furthermore, fewer patients were taking lipid-modifying medications at 5 years postoperatively than preoperatively.     

Idiopathic juvenile osteoporosis – an analysis of the muscle-bone relationship

Introduction Idiopathic Juvenile Osteoporosis (IJO), a disease of unknown etiology, manifests typically by pain, bone deformities and fractures. Due to limits in BMD data interpretation, evaluation of the muscle-bone functional unit has recently been proposed as a means to assess the general competence of the skeleton. The aim of this study was to evaluate skeletal status during the acute phase of IJO and during recovery from the disease in relation to muscles.Materials and methods The study population comprised 61 IJO children, including 34 girls (mean age: 13.6±3.1 years; range: 7–18) and 27 boys (14.3±3.3; 5–18 years). DXA total body (TB) and lumbar spine (S) bone mineral content (BMC) and density (BMD) were measured. Lean body mass (LBM) was employed to calculate SBMC/LBM, TBBMC/LBM, body height (BH)/LBM and LBM/body weight (BW) ratios. Previously established references for healthy controls were utilized for the calculation of Z-score values in IJO cases in respect to phase of the disease.Results IJO patients had significantly decreased Z-score values for TBBMD, SBMD, SBMC/LBM and TBBMC/LBM ratios but not for the LBM and BH/LBM or LBM/BW ratios. During the acute phase IJO girls had mean Z-scores for TBBMD and SBMD of −2.49±0.61 and −3.27±1.03, respectively, which were significantly lower than Z-scores during the recovery phase: −0.90±0.66, −1.38±0.95 (p<0.0001). IJO boys during the acute phase had Z-scores of −2.08±0.65 and −2.75±1.19 for TBBMD and SBMD, respectively, which were significantly lower than those during the recovery phase (−0.51±1.04 and −1.39±1.49; p<0.0001). Further, during the acute phase, TBBMC/LBM Z-scores of −2.95±1.15 and −2.56±1.49 were noted in girls and boys, respectively; the corresponding SBMC/LBM Z-scores were −2.66±1.07 and −2.22±1.62. During the recovery from IJO, TBBMC/LBM and SBMC/LBM Z-scores of −1.07±0.99 and −0.91±1.16 and of −1.15±1.40 and −0.68±1.45 were noted in girls and boys, respectively, and all were significantly higher than those during the acute phase (p<0.0001).Conclusions The results of this study indicate that IJO is a bone disorder characterized by an imbalanced muscle-bone relationship and fractures at onset and during the acute phase and by at least a partial recovery without bone pain and new fractures. Implementation of the BH/LBM, TBBMC/LBM and SBMC/LBM ratios to the armamentarium of pediatricians diagnosing bone disorders will provide mechanically meaningful data for diagnostic purposes and, hopefully, for proper therapeutic decisions.This study was in part financially supported by the International Osteoporosis Foundation.     

Six-year follow-up study of bone mineral density in patients with systemic lupus erythematosus

Summary

Long-term bone mineral density (BMD) changes and the associated factors in systemic lupus erythematosus (SLE) patients were assessed. Despite the remarkably low overall bone loss, significant spine bone loss was associated with the use of glucocorticoids, use of antimalarials, and lower 25-hydroxyvitamin D levels, stressing the importance of prevention of osteoporosis and vitamin D deficiency in SLE patients.

Introduction

The aim of this study is to assess the BMD changes in patients with SLE and to identify the associated factors.

Methods

Demographic and clinical data of 126 SLE patients were collected, and BMD measurements of the lumbar spine and the total hip were performed by dual-energy X-ray absorptiometry at baseline and follow-up. Statistical analyses were performed using independent Mann–Whitney U tests and linear regression analyses.

Results

At baseline, 39.7 % of the patients (90 % female, mean age 39?±?12.2 years) had osteopenia, and 6.3 % had osteoporosis. The median follow-up duration was 6.7 years (range 1.9–9.3 years). Mean changes in BMD at the lumbar spine (?0.08 %/year) and the hip (?0.20 %/year) were not significant. During follow-up, 70 % of the patients used glucocorticoids. The mean ± SD daily glucocorticoid dose was 5.0?±?5.0 mg. In multiple regression analysis, BMD loss at the spine was significantly associated with higher daily glucocorticoid dose and lower baseline 25-hydroxyvitamin D levels. BMD loss at the hip was associated with lower 25-hydroxyvitamin D levels at baseline, reduction of body mass index, and baseline use of antimalarials.

Conclusions

In this 6-year follow-up study, bone loss was remarkably low. A dose-dependent relationship between glucocorticoid use and spinal bone loss was found. In addition, the use of antimalarials and lower 25-hydroxyvitamin D levels at baseline were associated with BMD loss. These findings underline the importance of prevention and treatment of vitamin D deficiency and osteoporosis in SLE, especially in patients using glucocorticoids or antimalarials.     

Bone involvement in adult patients affected with Ehlers-Danlos syndrome.

Summary

The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients.

Introduction

The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients.

Methods

Fifty consecutive Caucasian patients, aged 30–50 years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects’ calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed.

Results

Patients showed reduced BMD (Z-scores LS ?0.45?±?1.00, FN ?0.56?±?1.01, FT ?0.58?±?0.92) and TBS (1.299?±?0.111) and increased prevalence of morphometric VFx (32 %) than controls (Z-scores LS 0.09?±?1.22, FN 0.01?±?0.97, FT 0.08?±?0.89; TBS 1.382?±?0.176; VFx 8 %, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245?±?0.138 vs 1.325?±?0.086, p?<?0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency.

Conclusions

EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.

     

Minimally Invasive Kidney Transplantation Had Better Cosmetic Effect and Comparable Safety: A Randomized Controlled Trial

PurposeTo prospectively evaluate short-term outcomes between a novel minimally invasive kidney transplantation (MIKT) technique and conventional kidney transplantation (CKT).Materials and MethodsFrom March 2018 to February 29, 2019, 148 patients were randomized into MIKT and CKT groups. All patients were followed up for 12 months.ResultsThe MIKT group had a significantly shorter incision length (5.6 ± 0.4 vs 11.4 ± 0.4 cm, P < .001). There was no difference in operation time, blood loss, acute rejection, infection, and wound dehiscence between MIKT and CKT groups. Both groups had comparable pain scores and analgesic requirements in the first 3 days after transplantation and comparable renal function at 12 months. The MIKT group had higher satisfaction than the CKT group during follow-up (9.3 ± 0.3 vs 8.1 ± 0.5, P < .001; 9.5 ± 0.2 vs 8.5 ± 0.3, P < .001; 9.4 ± 0.3 vs 8.5 ± 0.3, P < .001; 9.2 ± 0.3 vs 8.5 ± 0.4, P = .003 for posttransplant months 1, 3, 6, and 12, respectively). The MIKT group had a significantly lower Vancouver Scar Scale score (4.1 ± 0.4 vs 5.2 ± 0.5, P < .001; 4.3 ± 0.4 vs 6.1 ± 0.4, P < .001; 5.2 ± 0.6 vs 6.7 ± 0.5, P < .001; 7.7 ± 0.7 vs 8.9 ± 0.5, P = .009 for posttransplant months 1, 3, 6, and 12, respectively).ConclusionsMIKT has demonstrated equivalent safety and improved patient satisfaction compared to CKT. This technique may be an appropriate choice for selected patients.     

A comparative analysis of sagittal spinopelvic alignment between young and old men without localized disc degeneration

Introduction

The purpose of this study was to compare the sagittal spinopelvic parameters between young normal asymptomatic adults and older normal asymptomatic adults without localized segmental disc degeneration.

Materials and methods

Standing sagittal radiographs of the whole spine including the pelvis in 342 adult male volunteers (Group 1: n = 184, average age 21.2 years, range 19–28 vs. Group 2: n = 158, average age 63.8 years, range 53–79) were analyzed prospectively. Volunteers with history of spine operation, spinal disease, chronic pain in their back or legs, scoliosis, spondylolisthesis, 1–3 segmental disc space narrowing, and/or compression fractures in radiographs were excluded. The following parameters were included: thoracic kyphosis between T5 upper endplate (UEP) and T12 lower endplate (LEP), thoracolumbar kyphosis (T10 UEP ? L2 LEP), T12 LEP-horizontal (H) angle (minus denotes EP above the H line), lumbar lordosis (T12 LEP ? S1 UEP), lower lumbar lordosis (L4 UEP ? S1 UEP), sacral slope, pelvic incidence and distances from C7 plumb/T12 plumb to the postero-superior endplate of S1. Group 2 (old men group) demonstrated larger thoracic kyphosis (30.1° ± 8.6° vs. 21.1° ± 7.8° in Group 1, P < 0.001), thoracolumbar kyphosis (10.0° ± 7.5° vs. 2.8° ± 7.1° in Group 1, P < 0.001), total lumbar lordosis at T12–S1 (57.3° ± 8.8° vs. 52.2° ± 9.2° in Group 1, P < 0.001), lower lumbar lordosis at L4–S1 (39.4° ± 6.7° vs. 32.4° ± 6.4° in Group 1, P < 0.001), a higher ratio of lower to total lumbar lordosis (69.5 ± 11.6 vs. 62.7 ± 10.6 % in Group 1, P < 0.001) and T12 LEP-H angle (?20.4° ± 5.7° vs. ?15.7° ± 5.1° in Group 1, P < 0.001). There were no significant differences in sacral slope (36.5° ± 7.3° in Group 1 vs. 36.8° ± 6.7° in Group 2, P = 0.67) and pelvic incidence (46.5° ± 7.7° in Group 1 vs. 48.2° ± 8.5° in Group 2, P = 0.06). There was no significant difference in the measurement of distance from C7 plumb to the postero-superior endplate of S1 (?0.7 ± 2.4 cm in Group 1 vs. ?0.3 ± 2.7 cm in Group 2, P = 0.197). However, the distance from T12 plumb to the postero-superior endplate of S1 (?0.7 ± 1.7 cm in Group 1 vs. ?2.2 ± 1.7 cm in Group 2, P < 0.001) demonstrated a significant difference.

Conclusion

The old men group demonstrated a significant increase in thoracic kyphosis, thoracolumbar kyphosis, total and lower lumbar lordosis, a higher ratio of lower to total lumbar lordosis, and a longer distance from T12 plumb to the postero-superior endplate of S1 without changes in sacral slope and global sagittal balance.