BMI vs. body composition and radiographically defined osteoarthritis of the knee in women: a 4-year follow-up study

OBJECTIVE: To elucidate the role of body mass index (BMI) and knee osteoarthritis (OAK) by evaluating measures of body composition including fat mass and skeletal muscle mass (SMM). METHODS: Data are from 541 women enrolled in the Michigan Bone Health Study, a longitudinal, population-based study. At visits in 1998 and 2002, radiographs were taken of both knees and were evaluated for the presence of OAK (>or=2 on the Kellgren-Lawrence (K-L) scale). Joint space width (JSW) was measured with electronic calipers. Fat mass and SMM were determined using bioelectrical impedance analysis. RESULTS: In 2002, the prevalence of OAK was 11% in this population of women whose mean age was 47 years. Fat mass, lean mass, SMM, waist circumference and BMI were greater in women with OAK compared to those without OAK. In multiple variable analyses adjusted for age, fat mass and SMM explained OAK prevalence and increasing OAK severity better than models with BMI; further SMM explained more variation than did fat mass. SMM was positively associated with level of left and right medial JSW while there was no consistent association of JSW and BMI or fat mass. CONCLUSION: Fat mass and SMM were associated with K-L OAK score and the amount of joint space, with more variation explained by SMM. SMM was highly associated with JSW. Therefore, though obesity, frequently characterized by BMI, is a frequently reported risk factor for OAK, this mis-attribution may mean that interventions that focus on weight loss as treatment for osteoarthritis should be aware that this may negatively impact muscle mass.     

A case of lymphangioma of penis

A 9-year-old boy was seen with chief complaint of a penile mass with pain. The movable mass was palpable in the subcutaneous tissue of the penis apart from the median raphe. The mass was excised enbloc. Histological examination revealed that the mass was a lymphangioma of penis consisting of several endothelial-lined cysts. Convalescense was uneventful. Eighteen cases of lymphangioma or lymphangiectasia of penis including the present case in the Japanese literature are reviewed.     

Urachal xanthogranuloma caused by a swallowed fish bone: a case report]

A 30-year-old man was referred to our department with a complaint of bladder irritability and with development of high fever. Physical examination revealed a tender mass in the suprapubic area. Computed tomographic scan and magnetic resonance imaging indicated a cystic mass above the bladder dome, extending toward the umbilicus. Urachal abscess was suspected and the mass was excised en bloc with the urachus. The wall of the mass was thickened, and a linear foreign body was detected in the mass, which was considered to be a fish bone. Pathological diagnosis of the mass was xanthogranuloma. We speculated that a swallowed fish bone had penetrated the bowel and might have migrated into the urachal cyst, which induced a xanthogranulomatous change of the wall.     

Dermoid cyst in bony pelvis that coexists with pheochromocytoma: Report of a case and review of the literature

A 42-year-old man presented with right lower quadrant abdominal pain and dysuria. The bladder was displaced to the right side of the pelvis in excretory urography. Abdominal CT revealed a mass in right adrenal gland, measuring 8 cm in diameter. There was also a cystic mass; filling left half of the bony pelvis and displacing bladder to the right, measuring 14.5 x 10, 5 x 7 cm. The patient underwent right adrenalectomy and pelvic mass excision. Pathologic examination showed that the adrenal mass was pheochromocytoma and pelvic mass was dermoid cyst. This case is the first one in literature that an intrapelvic dermoid cyst is not derived from an organ coexists with pheochromocytoma.     

Body mass and fracture risk. A study of 330 patients.

Low body mass is a major risk factor for low energy hip fractures among women. The purpose of this study was to ascertain whether normal body mass also protects against low energy wrist fractures. A retrospective analysis of body mass indices of 330 women who sustained hip or wrist fractures from falls was performed. Data were grouped by race and age. The mean body mass index for white patients with wrist fractures was 26.4, compared with a mean body mass index of 22.3 in white patients with hip fractures. For black patients, those with wrist fractures had a mean body mass index of 28.5, compared with a mean body mass index of 22.9 for those with hip fractures. Using data from The National Health and Nutrition Examination Surveys, the mean body mass index of patients with wrist fractures was seen to be equal to or greater than the national mean body mass index, whereas that of patients with hip fractures was substantially below average. Accordingly, normal body mass was protective against hip fractures but not against wrist fractures. Because adipose tissue more typically is distributed about the hip than the wrist, the protective mechanism of normal body mass against osteoporotic fractures may promote better preventative interventions against this disease.     

Estimated Lean Mass and Fat Mass Differentially Affect Femoral Bone Density and Strength Index but Are Not FRAX Independent Risk Factors for Fracture

Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥50 years at the time of baseline dual‐energy X‐ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross‐sectional area (CSA), and cross‐sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near‐linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5‐year follow‐up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5‐year follow‐up. FRAX robustly predicts fractures and was not affected by variations in body composition. © 2014 American Society for Bone and Mineral Research.     

A case of sinus pericranii manifesting as a parietal midline mass]

A case of sinus pericranii was reported. A 5-year-old boy was admitted to our hospital, complaining of scalp mass located at the midparietal region. He was noticed to have had it since 3 years before. The mass decreased in size under mild compression, and during standing position, but increased in size due to lying down. Magnetic resonance imaging (MRI) demonstrated a mass with mixed signal intensity on the T1 weighted image and high signal intensity on the T2 weighted image. Gd-DTPA study showed irregular enhancement. Cerebral angiogram showed no communication between the mass and the superior sagittal sinus. Neither did direct injection of contrast medium into the mass revealed any communication. 3D-CT demonstrated three tiny bone defects beneath the mass. Open surgery revealed that the mass existed between the galea aponeurotica and the periosteum, which had a small communication with the emissary vein. Pathological examination showed a multiple lobular cyst with endothelial wall lining. This case report highlighted the fact that sinus pericranii with minimal communication with the dural sinus can be treated by removal of the mass and closure of the cranial bone abnormalities with bone wax without craniotomy.     

Castleman disease in the posterior mediastinum showing atypical feature in computed tomography; report of a case

A 41-year-old man was referred to our hospital because of an abnormal mass on a chest X-ray. An enhanced computed tomography (CT) showed a well-defined round mass (30 x 45 x 66 mm in diameter) that was heterogeneously enhanced owing to central necrotic or cystic change. A 3-dimensional CT demonstrated a couple of feeding arteries to the mass. The mass was completely resected through thoracotomy. Dissection of tight adhesion between the hypervascular mass and the surrounding tissues caused relative amount of hemorrhage during the surgery. The cystic lesion of the mass was fulfilled with brown liquid. The pathological examination revealed the mass as Castleman disease, and scattered cells in the cystic lesion.     

Bone mineral and soft-tissue changes in AIDS-associated lipoatrophy

It is well established that body weight influences bone mass, but there is considerable controversy in the literature as to whether the principal determinant is lean mass, fat mass, or combinations of both, with variable degrees of relative influence as a function of age and sex. Total body and regional tissue composition studies were performed with DXA in a cohort of 102 HIV+ males who were on highly active antiretroviral therapy. These medications may be associated with a unique peripheral lipoatrophy without commensurate loss of lean tissue mass, and thereby provide an opportunity to assess the relative influence of fat mass on BMC levels in the absence of lean mass change. A comparison of the first quartile of peripheral fat (the lowest fat mass) with the remainder of the cohort showed no significant difference in lean mass in the total body, trunk, lower limbs, and upper limbs. In contrast, a significantly lower BMC was registered in the first peripheral fat quartile for all regions, implying an association of fat mass with BMC. By quartile stratification of the regional BMC, a comparison of the first and fourth quartiles demonstrated that the percentage fat mass decrease exceeded the lean mass decrease by a factor of 1.8 to 4.5. Regional BMCs were also stratified into two groups, 50 percentile and >50 percentile, and analyzed by Spearman correlation and robust multiple regression. It was found that lean mass was a determinant of BMC in both groups, whereas fat mass was an independent predictor in the >50 percentile BMC group only. The BMD t-score for the total hip was significantly lower in the first quartile of lower limb fat mass than the t-score of the remaining cohort, but this difference was not significant for the BMD lumbar spine t-score. This is a reflection of the influence of preferential local peripheral lipoatrophy on the adjacent mineral content and provides further evidence of fat mass as a determinant of BMC in addition to lean mass.     

Efficacy of contrast-enhanced color Doppler ultrasonography for the diagnosis of renal mass lesions]

We evaluated the efficacy of contrast-enhanced color Doppler ultrasonography with a galactose-based echo contrast agent, Levovist, for the diagnosis of renal mass lesions. The final pathologic diagnosis of eight renal mass lesions was renal cell carcinoma in 6 patients, transitional cell carcinoma in 1 patient and renal cyst in 1 patient (age range, 47 to 77 years; mean, 59.1). Especially in patients with renal cell carcinoma, contrast-enhanced color Doppler ultrasonography showed enhancement of mass lesion blood flow signal intensities. In all patients, contrast enhancement was demonstrated. Diagnostic capacity was improved in all patients, excluding 2 in whom mass lesion blood flow was detected by plain color Doppler ultrasonography. Furthermore, in patients with transitional cell carcinoma, the hemodynamics of mass lesions could be visualized, and diagnostic capacity was high. Contrast-enhanced color Doppler ultrasonography with Levovist, showed markedly higher mass lesion blood flow than that obtained by the plain color Doppler procedure, improving diagnostic capacity. This procedure was useful for diagnosing renal mass lesions.     

Long-term follow-up of a rare calcified cardiac tumor: a case report

We describe a case of cardiac masses (high- and iso-echoic mass) which were detected by echocardiography in a 57-year-old man with cerebral infarction. Because he refused both biopsy and surgery, the patient was treated with an anticoagulant and antibiotic in our outpatient clinic. During 3-year follow-up, the iso-echoic mass disappeared and the high-echoic mass did not change. Thus, we considered the iso-echoic mass a thrombus and the high-echoic mass a benign tumor. Cardiac computed tomography revealed that the high-echoic mass had extensive calcifications like phleboliths, and magnetic resonance imaging pattern coincided with that of hemangiomas. We conclude that the benign tumor/high-echoic mass might be a vascular malformation.     

微量元素锌、铜含量对儿童骨量影响的初步探讨

为探讨微量元素与儿童骨量之间的关系，对３３０例健康儿童同时测定了骨密度和血微量元素锌、铜含量。并将其中８４例低骨量儿童与骨量正常儿童对比。结果发现低骨量儿童血锌、铜含量明显低于骨量正常儿童（２～４岁儿童血铜Ｐ＜０．０５，其它均Ｐ＜０．０１）。提示血锌、铜含量降低可能是造成儿童低骨量的重要因素之一。     

Perivesical abscess caused by migration of a fish bone from the intestinal tract.

A 55-year-old woman was admitted to the Department of Urology at Chiba University Hospital. The patient's chief complaint was frequent urination and micturition pain. Computed tomography of the abdomen demonstrated a mass lesion in contact with the anterior wall of the bladder. Mass extirpation was performed transperitoneally. On dissection of the mass, a thin foreign body shaped like a skewer was detected. A specimen of the mass revealed non-specific inflammation. Elemental analysis with an electron probe microanalyser (EPMA) revealed that the composition of the foreign body was consistent with bone. The perivesical mass was diagnosed as an abscess caused by a fish bone that migrated from the intestinal tract.     

A case of giant osteoma in the occipital bone

A 51-year-old female patient, admitted with a chief complaint of dizziness, had bulging of the occipital area, which had started insidiously. On admission, a bony hard swelling with a smooth surface was noted in the left occipital region, extending over the midline of the skull. Plain X ray films revealed a uniform shadow of an osteoid mass inside the occipital bone. A tomogram indicated that the mass originated in the diplo? or outer table of the skull, although there was no evidence of destruction of the inner table. CT scan revealed mixed density mass with high density of bone and an irregularly shaped low density area. In the T1-weighted images of MRI, the entire mass showed a low intensity, while in the T2-weighted image the mass showed 3 areas with different intensities. Bone scintigraphy was performed with 99mTc-MDP and revealed an image of accumulation in the mass. Carotid and vertebral angiograms were negative for evidence of feeding arteries to the mass, for tumor stain, and for occlusion of either sigmoid sinus or transverse sinus. The mass was diagnosed as a giant osteoma, and was totally removed. The excised tumor measured 10 x 9 x 5 cm, and inspection at operation revealed it to be composed of a fragile osteoid portion and a comparatively soft connective tissue portion. The histological diagnosis of the mass was that it was a spongy osteoma including a comparatively large amount of connective tissue. The postoperative recovery of the patient was satisfactory and her dizziness disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of pararenal angiomyolipoma arising from an existing exophytic angiomyolipoma

A 52-year-old healthy woman with a congenital solitary right kidney presented with an incidentally found pararenal mass. Computed tomography and magnetic resonance imaging revealed an exophytic mass in the right kidney consistent with an angiomyolipoma and an additional enhancing pararenal mass that contained fatty elements. Differential diagnosis of the mass included liposarcoma and angiomyolipoma. Upon exploration, the exophytic angiomyolipoma was found to be contiguous with the pararenal mass via an isthmus of fatty tissue. Frozen sections were taken from both masses which confirmed that both were angiomyolipoma. This is the first case reported in the literature wherein an angiomyolipoma extended extrarenally and formed a significantly larger pararenal mass.     

Fat mass is negatively associated with bone mineral content in Koreans

Summary

Although obesity and osteoporosis are important public health problems, the effect of fat mass on bone mass remains controversial. This study demonstrated that fat mass was inversely related to bone mineral content, and abdominal obesity was significantly associated with bone mineral content independent of total fat mass.

Introduction

Obesity and osteoporosis, two disorders of body composition, have become increasingly important public health problems throughout the world. However, the effect of fat mass on bone mass remains controversial. This study investigates the effect of fat mass and regional fat distribution on bone mass within a community-dwelling cohort.

Methods

A total of 3,042 subjects (1,284 men, 362 premenopausal women, and 1,396 postmenopausal women) were studied. Fat mass, percent fat mass, lean mass, percent lean mass, and bone mineral content (BMC) were measured by dual energy X-ray absorptiometry.

Results

Fat mass and percent fat mass decreased significantly across increasing tertiles of BMC in all three subgroups (men, premenopausal and postmenopausal women). In contrast, lean mass and percent lean mass increased significantly across tertiles of BMC in men, and a similar trend was also identified in postmenopausal women. Interestingly, although correlation analysis showed a positive association between fat mass and BMC (p?p?p?Conclusion This study demonstrated that fat mass was inversely related to BMC after removing the mechanical loading effect in Korean men and women. Moreover, abdominal obesity as measured by WC was significantly associated with BMC independent of total fat mass.     

Traumatic sinus pericranii. Case report]

The patient was involved in a traffic accident at the age of 1 and the left parieto-occipital scalp was contused without skull fracture. At the age of 5, an extracranial scalp mass was first noticed just beneath the multiple scalp scars. Angiography through the mass revealed that the extracranial mass cavity was connected to the superior sagittal sinus through the emissary veins. The mass located in the subgaleal, epiperiosteal space was totally resected and the connection with the intracranial sinus was closed with bone wax. Histologically, there were many capillaries and some large blood cavities with only one layered endothelium and connective tissue. Therefore, the mass was diagnosed as sinus pericranii and considered to be secondary to previous head trauma because: 1) The patient had a history of head trauma with considerably severe scalp injuries. 2) The extracranial blood sinus was located exactly beneath the traumatic scar. 3) There was no neoplastic tissue histologically. 4) No scalp mass was noticed before the traffic accident. 5) There was an elapsed time between the trauma and the growth of the mass. 6) No scalp nevus such as port-wine stain existed.     

The relative contributions of lean tissue mass and fat mass to bone density in young women

Although obesity is associated with increased risk of many chronic diseases including cardiovascular disease, diabetes, hypertension, and cancer, there is little evidence to suggest that obesity increases risk of osteoporosis. In fact, both weight and body mass index (BMI) are positive predictors of bone mass in adults, suggesting that those who are overweight or obese may be at lower risk of osteoporosis. However, recent evidence suggests that in children and adolescents, obesity may be associated with lower rather than higher bone mass. To understand the relation of fat mass to bone mass, we examined data gathered from an ethnically diverse group of 921 young women, aged 20-25 years (317 African Americans, 154 Asians, 322 Caucasians, and 128 Latinas) to determine how fat mass (FM) as well as lean tissue mass (LTM) is associated with bone mass. Bone mass, FM, and LTM were measured using dual energy X-ray absorptiometry (GE Lunar Corp, Madison, WI). Bone mass was expressed as bone mineral density (BMD; g/cm2) and bone mineral apparent density (BMAD; g/cm3) for the spine and femoral neck, and as BMD and bone mineral content (BMC; g) for the whole body. Regression techniques were used to examine the following: (1) in separate equations, the associations of LTM and FM with each bone mass parameter; and (2) in the same equation, the independent contributions of LTM and FM to bone mass. LTM and FM were positively correlated with BMD at all skeletal sites. When the contributions of FM and LTM were examined simultaneously, both FM and LTM continued to be positively associated with bone mass parameters but the effect of FM was noted to be smaller than that of LTM. We conclude that in young women, LTM has a greater effect than fat mass on bone density per kg of tissue mass.     

The functional muscle–bone unit in subjects of varying BMD

Summary

This study used the “functional muscle–bone unit” concept to investigate muscle–bone interaction of the lumbar spine in subjects of varying bone mineral density. It was found that unit bone mass corresponded to a relatively more muscle mass in subjects with reduced bone mineral density, indicating a relatively higher mechanical load from muscles exerted on trabecular bone.

Introduction

Bone is an architecturally adaptive tissue which responds to mechanical loading. This study is proposed to use “functional muscle–bone unit” to reflect this muscle–bone interaction at spine in subjects with different bone mineral density.

Methods

The study was carried out in young normal subjects (21 females; age, 29?±?3) and elderly subjects (155 females; age, 73?±?3.9) with varying bone mineral density. Cross-sectional area of paravertebral muscle groups was measured in MR images to indicate the muscle mass, while the bone mineral content by dual X-ray absorptiometry was used to represent the bone mass. The functional muscle–bone unit was calculated as the ratio between the bone mass to muscle mass.

Results

It showed that with aging, the muscle mass decreased with the bone mass losing. However, more pronounced reduction was found in bone mass than in muscle mass in the subjects with lower bone mineral density.

Conclusions

Muscle–bone interaction was changed in elderly, especially in those with osteoporosis. Unit bone mass corresponded to a higher muscle mass in subjects with reduced bone mineral density than those normal subjects. This may be contributory to the occurrence of nontraumatic vertebral fractures in elderly subjects with reduced bone mineral density.