Skeletal health in adult patients with classic galactosemia

Summary

This study evaluated bone health in adults with galactosemia. Associations between bone mineral density (BMD) and nutritional and biochemical variables were explored. Calcium level predicted hip and spine BMD, and gonadotropin levels were inversely associated with spinal BMD in women. These results afford insights into management strategies for these patients.

Introduction

Bone loss is a complication of galactosemia. Dietary restriction, primary ovarian insufficiency in women, and disease-related alterations of bone metabolism may contribute. This study examined relationships between clinical factors and BMD in patients with galactosemia.

Methods

This cross-sectional sample included 33 adults (16 women) with classic galactosemia, mean age 32.0?±?11.8 years. BMD was measured by dual-energy X-ray absorptiometry, and was correlated with age, height, weight, fractures, nutritional factors, hormonal status, and bone biomarkers.

Results

There was a significant difference in hip BMD between women and men (0.799 vs. 0.896 g/cm², p?=?0.014). The percentage of subjects with BMD-Z <?2.0 was also greater for women than men [33 vs. 18 % (spine), 27 vs. 6 % (hip)], and more women reported sustaining fractures. Bivariate analyses yielded correlations between BMI and BMD-Z [at the hip in women (r?=?0.58, p?<?0.05) and spine in men (r?=?0.53, p?<?0.05)]. In women, weight was also correlated with BMD-Z (r?=?0.57, p?<?0.05 at hip), and C-telopeptides (r?=??0.59 at spine and ?0.63 hip, p?<?0.05) and osteocalcin (r?=??0.71 at spine and ?0.72 hip, p?<?0.05) were inversely correlated with BMD-Z. In final regression models, higher gonadotropin levels were associated with lower spinal BMD in women (p?=?0.017); serum calcium was a significant predictor of hip (p?=?0.014) and spine (p?=?0.013) BMD in both sexes.

Conclusions

Bone density in adults with galactosemia is low, indicating the potential for increased fracture risk, the etiology of which appears to be multifactorial.     

Fibroblast growth factor 21 (FGF21) and bone: is there a relationship in humans?

Summary

In animals, high fibroblast growth factor 21 (FGF21) states improve insulin resistance but induce bone loss. Whether FGF21 relates to bone mineral density (BMD) is unknown in humans. Contrary to prediction from animal findings, we found higher FGF21 levels associating with greater BMD in women, independent of age and body composition.

Introduction

Recent laboratory studies suggest that FGF21 is involved in reciprocal regulation of bone and energy homeostasis. Systemic administration of FGF21 protects animals from obesity and diabetes but causes severe bone loss, smothering the enthusiasm over FGF21 as a potential antiobesity therapeutic. To date, there is no information on whether FGF21 relates to BMD in humans. We thus studied the relationship between plasma FGF21 levels and BMD in healthy adults.

Methods

Fasting plasma FGF21 levels were measured by enzyme-linked immunosorbent assay and body composition by dual-energy X-ray absorptiometry.

Results

Among 40 healthy volunteers (age 32?±?10 year, 16 women), men had significantly higher lean body mass (p?<?0.01) and total BMD (p?<?0.05), and lower percent body fat than women (p?<?0.01). Median plasma FGF21 levels were not different between the sexes. While there was no association between FGF21 concentrations and body composition in men, FGF21 levels correlated positively with fat mass (p?<?0.01) in women. In men, no significant correlation between FGF21 with BMD was observed. However, in women, FGF21 correlated positively with total BMD (R ²?=?0.69, p?=?0.003) and spine BMD (R ²?=?0.76, p?=?0.001); the correlation remained significant after adjusting for age, ethnicity, and body composition.

Conclusions

This study reveals for the first time a strong positive association between plasma FGF21 levels and BMD in healthy women, suggesting the association between bone loss and high FGF21 states in animals may not be directly translated to humans in physiologic states. We hypothesize that FGF21 may increase bone mass particularly in women through paracrine mechanisms in the bone–adipose interface.     

Skeletal findings in the first 12 months following initiation of glucocorticoid therapy for pediatric nephrotic syndrome

Summary

Incident vertebral fractures and lumbar spine bone mineral density (BMD) were assessed in the 12 months following glucocorticoid initiation in 65 children with nephrotic syndrome. The incidence of vertebral fractures was low at 12 months (6 %) and most patients demonstrated recovery in BMD Z-scores by this time point.

Introduction

Vertebral fracture (VF) incidence following glucocorticoid (GC) initiation has not been previously reported in pediatric nephrotic syndrome.

Methods

VF was assessed on radiographs (Genant method); lumbar spine bone mineral density (LS BMD) was evaluated by dual-energy X-ray absorptiometry.

Results

Sixty-five children were followed to 12 months post-GC initiation (median age, 5.4 years; range, 2.3–17.9). Three of 54 children with radiographs (6 %; 95 % confidence interval (CI), 2–15 %) had incident VF at 1 year. The mean LS BMD Z-score was below the healthy average at baseline (mean ± standard deviation (SD), ?0.5?±?1.1; p?=?0.001) and at 3 months (?0.6?±?1.1; p?<?0.001), but not at 6 months (?0.3?±?1.3; p?=?0.066) or 12 months (?0.3?±?1.2; p?=?0.066). Mixed effect modeling showed a significant increase in LS BMD Z-scores between 3 and 12 months (0.22 SD; 95 % CI, 0.08 to 0.36; p?=?0.003). A subgroup (N?=?16; 25 %) had LS BMD Z-scores that were ≤?1.0 at 12 months. In these children, each additional 1,000 mg/m² of GC received in the first 3 months was associated with a decrease in LS BMD Z-score by 0.39 at 12 months (95 % CI, ?0.71 to ?0.07; p?=?0.017).

Conclusions

The incidence of VF at 1 year was low and LS BMD Z-scores improved by 12 months in the majority. Twenty-five percent of children had LS BMD Z-scores ≤?1.0 at 12 months. In these children, LS BMD Z-scores were inversely associated with early GC exposure, despite similar GC exposure compared to the rest of the cohort.     

Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial

Summary

Our randomized controlled trial in prematurely menopausal breast cancer survivors showed that impact + resistance training prevented increases in percentage of body fat compared with controls and also improved BMD at the hip and prevented BMD loss at the spine among exercise-trained women who were menopausal for >1 year.

Introduction

Cancer treatment-related menopause worsens bone health and body composition in breast cancer survivors (BCS). We investigated whether impact + resistance training could improve bone mineral density (BMD), reduce bone turnover, build muscle, and decrease fat mass in BCS with premature menopause.

Methods

We conducted a randomized controlled trial in 71 BCS (mean age, 46.5 years) within 5 years of treatment-related menopause. Women were randomly assigned to one of two groups: (1) impact + resistance training (prevent osteoporosis with impact + resistance (POWIR)) or (2) exercise placebo (FLEX) 3×/week for 1 year. Outcomes were hip and spine BMD (in grams per square centimeter) and body composition (percent body fat (%BF) and lean and fat mass (in kilograms)) by DXA and bone turnover markers (serum osteocalcin (in nanograms per milliliter) and urinary deoxypryrodinoline (in nanomoles per milliliter).

Results

There were no significant group × time interactions for bone outcomes when using an intent-to-treat approach on the full sample. In analyses restricted to BCS who were menopausal for ≥1 year, POWIR increased BMD at the hip and slowed BMD loss at the spine compared with FLEX (femoral neck—POWIR, 0.004?±?0.093 g/cm² vs. FLEX, ?0.010?±?0.089 g/cm²; p?<?0.01; spine—POWIR, ?0.003?±?0.114 g/cm² vs. FLEX, ?0.020?±?0.110 g/cm²; p?=?0.03). POWIR prevented increases in %BF (POWIR, 0.01 % vs. FLEX, 1.3 %; p?<?0.04). Women with attendance to POWIR at ≥64 % had better improvements in %BF than women attending less often (p?<?0.03).

Conclusion

Impact + resistance training may effectively combat bone loss and worsening body composition from premature menopause in BCS.     

Impaired skeletal health and neuromuscular function among amphetamine users in clinical treatment

Summary

This study examined musculoskeletal health in amphetamine users, compared with healthy age-matched controls. We show that amphetamine users have reduced bone mass at several skeletal sites and attenuated maximal muscle strength and force development capacity in the lower extremities.

Introduction

Amphetamine use may cause poor bone quality and elevated risk of osteoporosis. The purpose of this study was to investigate whether amphetamine users exhibit reduced regional and whole body bone mineral density (BMD), altered bone metabolism, and how muscle function may relate to the patient groups’ skeletal health.

Methods

We assessed hip, lumbar spine and whole body BMD, and trabecular bone score (TBS) by dual x-ray absorptiometry (DXA), and bone metabolism markers in serum and maximal strength and force development capacity in 36 amphetamine users (25 men, 30?±?7 years; 11 women 35?±?10 years) and in 37 healthy controls (23 men, 31?±?9 years; 14 women, 35?±?7 years).

Results

Whole body BMD was lower in amphetamine users (8 % in males and 7 % females, p?<?0.01), as were BMD at the total hip and sub-regions of the hip (9–11 % in men and 10–11 % in women, p?<?0.05). Male users had 4 % lower TBS (p?<?0.05) and higher serum level of type 1 collagen amino-terminal propeptide (p?<?0.01). This coincided with reduced lower extremity maximal strength of 30 % (males, p?<?0.001) and 25 % (females, p?<?0.05) and 27 % slower muscular force development in males compared to controls (p?<?0.01).

Conclusions

These findings demonstrate that amphetamine users suffer from a generalized reduction in bone mass, which was associated with attenuated maximal muscle strength and force development capacity in the lower extremities.

     

Bone quality assessment in type 2 diabetes mellitus

Summary

The increased risk for fractures in type 2 diabetes mellitus (T2DM) despite higher average bone density is unexplained. This study assessed trabecular bone quality in T2DM using the trabecular bone score (TBS). The salient findings are that TBS is decreased in T2DM and low TBS associates with worse glycemic control.

Introduction

Type 2 diabetes mellitus is a risk factor for osteoporotic fractures despite high average bone mineral density (BMD). The aim of this study was to compare BMD with a noninvasive assessment of trabecular microarchitecture, TBS, in women with T2DM.

Methods

In a cross-sectional study, trabecular microarchitecture was examined in 57 women with T2DM and 43 women without diabetes, ages 30 to 90 years. Lumbar spine BMD was measured by dual-emission x-ray absorptiometry (DXA), and TBS was calculated by examining pixel variations within the DXA images utilizing TBS iNsight software.

Results

Mean TBS was lower in T2DM (1.228?±?0.140 vs. 1.298?±?0.132, p?=?0.013), irrespective of age. Mean BMD was higher in T2DM (1.150?±?0.172 vs. 1.051?±?0.125, p?=?0.001). Within the T2DM group, TBS was higher (1.254?±?0.148) in subjects with good glycemic control (A1c?≤?7.5 %) compared to those (1.166?±?0.094; p?=?0.01) with poor glycemic control (A1c?>?7.5 %).

Conclusion

In T2DM, TBS is lower and associated with poor glycemic control. Abnormal trabecular microarchitecture may help explain the paradox of increased fractures at a higher BMD in T2DM. Further studies are needed to better understand the relationship between glycemic control and trabecular bone quality.     

High serum pentosidine but not esRAGE is associated with prevalent fractures in type 1 diabetes independent of bone mineral density and glycaemic control

Summary

Fracture risk in type 1 diabetes (T1D) is supposed to be underestimated by bone mineral density (BMD). Individuals with T1D had more prevalent fractures in a cross-sectional study. Serum levels of pentosidine, an advanced glycation end product, and poor glycaemic control were associated with prevalent fractures independent of BMD.

Introduction

Type 1 diabetes (T1D) is associated with increased fracture risk. Bone mineral density (BMD) underestimates the risk of fractures in some individuals. The accumulation of advanced glycation end products (AGEs) impairs bone matrix and reduces bone strength.

Methods

In a cross-sectional study, 128 men and premenopausal women with T1D were evaluated. We compared traditional risk factors for fractures, BMD, parameters of bone metabolism and AGEs in individuals with and without prevalent fractures. An independent association of serum AGE levels with prevalent fractures was investigated.

Results

Individuals with prevalent fractures exhibited a longer duration of T1D, higher HbA1c and more diabetic-related complications. BMD at the femoral neck (z-score ?0.76?±?0.94 vs. ?0.23?±?1.02; p?=?0.031) and total hip (z-score ?0.54?±?0.93 vs. 0.11?±?1.11; p?=?0.017) was lower in those with prevalent fractures. Individuals with fractures had higher pentosidine levels (164.1?±?53.6 vs. 133.2?±?40.4; p?=?0.002). The levels of N-ε-(carboxymethyl)-lysine (CML) and endogenous secretory receptor for AGEs (esRAGE) did not significantly differ. Multivariate logistic regression analysis adjusted for age, BMI, family history of fractures, smoking, vitamin D deficiency, BMD at lumbar spine, femoral neck and total hip identified pentosidine levels and HbA1c as independent factors associated with prevalent fractures (odds ratio 1.02, 95 % CI 1.00–1.03/pmol/ml increase of pentosidine; p?=?0.008 and odds ratio 1.93, 95 % CI 1.16–3.20 per percentage increase of HbA1c; p?=?0.011).

Conclusions

The pentosidine levels but not BMD are independently associated with prevalent fractures. Impaired bone quality in T1D may result from increased AGE formation.     

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.     

Changes in Bone Mineral Density After Sleeve Gastrectomy or Gastric Bypass: Relationships with Variations in Vitamin D,Ghrelin, and Adiponectin Levels

Background

A major long-term concern after gastric bypass (GBP) is the risk of osteoporosis; however, little is known about this complication in patients undergoing sleeve gastrectomy (SG).

Objective

To evaluate changes in bone mineral density (BMD) after GBP and SG, and its relationship with changes in vitamin D, parathyroid hormone (PTH), ghrelin, and adiponectin.

Methods

Twenty-three women undergoing GBP (BMI 42.0?±?4.2 kg/m²; 37.3?±?8.1 years) and 20 undergoing SG (BMI 37.3?±?3.2 kg/m²; 34.2?±?10.2 years) were studied before and 6 and 12 months after surgery. BMD was measured by dual-energy X-ray absorptiometry. Plasma PTH, 25-hydroxyvitamin D (25-OHD), ghrelin, and adiponectin concentrations were determined. Food as well as calcium and vitamin D supplement intake was recorded.

Results

Excess weight loss (mean?±?SE), adjusted by baseline excess weight, was 79.1±3.8 % and 74.9?±?4.1 % 1 year after GBP and SG, respectively (p?=?0.481). Significant reduction in BMD for total body (TB), lumbar spine (LS), and femoral neck (FN) was observed after GBP. In the SG group, reduction in BMD was significant only for TB. Adjusted by baseline BMD, the difference between change in BMD for GBP vs. SG was not significant for TB, LS, or FN. Percent reduction in ghrelin concentration was a main factor related to total BMD loss (GBP group) and LS BMD loss (GBP and SG groups).

Conclusions

One year after gastric bypass, bone mineral density was significantly affected, mainly at the femoral neck. Decreases in bone mineral density were more dramatic among patients who had greater baseline BMD and greater reduction in ghrelin concentrations.     

Changes in trabecular bone density in incident pediatric Crohn’s disease: a comparison of imaging methods

Summary

This study of changes in dual energy x-ray absorptiometry (DXA) spine BMD following diagnosis and treatment for childhood Crohn’s disease demonstrated that changes in conventional posteroanterior BMD results were confounded by impaired growth, and suggested that lateral spine measurements and strategies to estimate volumetric BMD were more sensitive to disease and treatment effects.

Introduction

We previously reported significant increases in peripheral quantitative CT (pQCT) measures of trabecular volumetric bone mineral density (vBMD) following diagnosis and treatment of pediatric Crohn’s disease (CD). The objective of this study was to compare pQCT trabecular vBMD and three DXA measures of spine BMD in this cohort: (1) conventional posteroanterior BMD (PA-BMD), (2) PA-BMD adjusted for height Z (PA-BMD_HtZ), and (3) width-adjusted volumetric BMD (WA-BMD) estimated from PA and lateral scans.

Methods

Spine DXA [lumbar (L1–4) for posteroanterior and L3 for lateral] and tibia pQCT scans were obtained in 65 CD subjects (ages 7–18 years) at diagnosis and 12 months later. BMD results were converted to sex, race, and age-specific Z-scores based on reference data in >650 children (ages 5–21 years). Multivariable linear regression models identified factors associated with BMD Z-scores.

Results

At CD diagnosis, all BMD Z-scores were lower compared with the reference children (all p values <0.01). The pQCT vBMD Z-scores (?1.46?±?1.30) were lower compared with DXA PA-BMD (?0.75?±?0.98), PA-BMD_HtZ (?0.53?±?0.87), and WA-BMD (?0.61?±?1.10) among CD participants. Only PA-BMD Z-scores were correlated with height Z-scores at baseline (R?=?0.47, p?<?0.0001). pQCT and WA-BMD Z-scores increased significantly over 12 months to ?1.04?±?1.26 and ?0.20?±?1.14, respectively. Changes in all four BMD Z-scores were positively associated with changes in height Z-scores (p?<?0.05). Glucocorticoid doses were inversely associated with changes in WA-BMD (p?<?0.01) only.

Conclusions

Conventional and height Z-score-adjusted PA DXA methods did not demonstrate the significant increases in trabecular vBMD noted on pQCT and WA-BMD scans. WA-BMD captured glucocorticoid effects, potentially due to isolation of the vertebral body on the lateral projection. Future studies are needed to identify the BMD measure that provides greatest fracture discrimination in CD.     

Psychological state, quality of life, and body composition in postmenopausal women with osteoporosis in Lithuania

Summary

The objective of this study was to determine body composition, physical activity, and psychological state in postmenopausal women with osteoporosis. Fat mass, lean mass, water mass, and basal metabolic rate are lower, self-reported physical activity and risk factors of fractures are higher, and cognitive functions were worse in osteoporotic patients than in controls. Significant correlations were found between physical activity and emotional state parameters.

Introduction

This study aims to determine peculiarities of body composition, physical activity, risk factors predicting fractures, psychological state and quality of life, and possible relations between them in postmenopausal women with osteoporosis in Lithuania.

Methods

Thirty-one postmenopausal women with osteoporosis and 29 healthy age- and sex-matched controls were included in the study. Profile of Mood State and Hospital Anxiety and Depression Scale were used for the assessment of emotional state. Trail Making Test and Digit Symbol Test of Wechsler Adult Intelligence Scale were used to evaluate cognitive functioning. Quality of life was evaluated using the World Health Organization Brief Quality of Life Questionnaire. Risk of fractures was assessed by the Risk Factors Predicting Questionnaire.

Results

Fat mass (22.4?±?4.7 vs. 40.6?±?14.2 kg, p?<?0.001), lean mass (37.3?±?6.0 vs. 48.1?±?7.6 kg, p?<?0.001), water mass (31.6?±?2.9 vs. 38.3?±?5.3 kg, p?<?0.001), and basal metabolic rate (1,253?±?132 vs. 1,456?±?126 kcal, p?<?0.001) were lower in osteoporotic patients than in controls. Self-reported physical activity (2.35?±?0.6 vs. 1.69?±?0.5, p?<?0.001) and risk factors of fractures (5.9?±?2.1 vs. 2.6?±?2.4, p?<?0.001) were higher in women with osteoporosis than in healthy age- and sex-matched controls (2.35?±?0.6 vs. 69?±?0.5, p?<?0.001). Trail making A and B scores were higher in patients than in age- and sex-matched controls (55.8?±?19.9 vs. 45.1?±?19.9, p?=?0.07 and 118.2?±?34.6 vs. 92.8?±?48.7, p?=?0.006). Some significant correlations were detected between physical activity and emotional state and quality of life parameters.

Conclusion

In postmenopausal women with osteoporosis, fat body mass, lean body mass, water body mass, basal metabolic rate, and waist-to-hip ratio are lower, physical activity and risk of fractures are higher, and cognitive functions are worse than in age- and sex-matched controls. Some psychological peculiarities could be related to physical activity in women with osteoporosis.     

Use of risedronate to prevent bone loss following a single course of glucocorticoids: findings from a proof-of-concept study in inflammatory bowel disease

Summary

We performed a randomised controlled trial (RCT) to determine whether risedronate 35 mg once weekly prevents bone loss following an 8-week reducing course of prednisolone given for an exacerbation of inflammatory bowel disease (IBD). The greatest change in bone mineral density (BMD) was at Ward’s triangle (WT), which fell by 2.2% in the placebo group, compared with a reduction of 0.8% in the risedronate group.

Introduction

Whether bisphosphonates can prevent bone loss associated with intermittent glucocorticoid (GC) therapy is unknown, reflecting the difficulty in performing RCTs in this context.

Method

To explore the feasibility of RCTs to examine this question, lumbar spine (LS; L2–4) and hip dual X-ray absorptiometry (DXA) scans were performed in 78 patients commencing a GC therapy course for a relapse of IBD. They were then randomised to receive placebo or risedronate 35 mg weekly for 8 weeks, after which the DXA scan was repeated.

Results

For LS BMD, there was no change in the placebo group (0.1?±?0.4, p?=?0.9), but there was an increase after risedronate (0.8?±?0.4, p?=?0.04; mean%?±?SEM by paired Student’s t test). There were small decreases in both groups at the total hip (?0.5?±?0.3, p?=?0.04; ?0.5?±?0.3, p?<?0.05, placebo and risedronate, respectively). At WT, BMD fell after placebo (?2.2?±?0.5, p?=?0.001) but not risedronate (?0.8?±?0.5, p?=?0.09; p?=?0.05 for between-group comparison).

Conclusion

RCTs can be used to examine whether bisphosphonates prevent bone loss associated with intermittent GC therapy, providing metabolically active sites such as WT are employed as the primary outcome.     

Calcaneal ultrasound reference ranges for Australian men and women: the Geelong Osteoporosis Study

Summary

Heel ultrasound is a more portable modality for assessing fracture risk than dual-energy X-ray absorptiometry and does not use ionising radiation. Fracture risk assessment requires appropriate reference data to enable comparisons. This study reports the first heel ultrasound reference ranges for the Australian population.

Introduction

This study aimed to develop calcaneal (heel) ultrasound reference ranges for the Australian adult population using a population-based random sample.

Methods

Men and women aged ≥20 years were randomly selected from the Barwon Statistical Division in 2001–2006 and 1993–1997, respectively, using the electoral roll. Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were measured at the heel using a Lunar Achilles Ultrasonometer. Gender-specific means and standard deviations for BUA, SOS and SI were calculated for the entire sample (men 20–93 years, n?=?1,104; women 20–92 years, n?=?914) and for participants aged 20–29 years (men, n?=?157; women, n?=?151). Associations between ultrasound measures and age were examined using linear regression.

Results

For men, mean ± standard deviation BUA, SOS and SI were 118.7?±?15.8 dB/MHz, 1,577.0?±?43.7 m/s and 100.5?±?20.7, respectively; values for women were consistently lower (111.0?±?16.4 dB/MHz, P?<?0.001; 1,571.0?±?39.0 m/s, P?=?0.001; and 93.7?±?20.3, P?<?0.001, respectively). BUA was higher in young men compared with young women (124.5?±?14.4 vs 121.0?±?15.1 dB/MHz), but SOS (1,590.1?±?43.1 vs 1,592.5?±?35.0 m/s) and SI (108.0?±?19.9 vs 106.3?±?17.7) were not. The relationships between age and each ultrasound measure were linear and negative across the age range in men; associations were also negative in women but non-linear.

Conclusion

These data provide reference standards to facilitate the assessment of fracture risk in an Australian population using heel ultrasound.     

Copper deficit as a potential pathogenic factor of reduced bone mineral density and severe tooth wear

Summary

The study evaluated if men and women with severe tooth wear were at increased risk of general bone loss. Enamel biopsies obtained from 50 subjects aged 47.5?±?5 years showed decreased copper content, which was associated with reduced spine bone mineral density, suggesting deficits of this trace element contributing to bone demineralization, enamel attrition, and deteriorated quality of mineralized tissues.

Introduction

The objective of this cross-sectional study was to assess associations between enamel trace minerals and bone mineral density (BMD) in severe tooth wear. We hypothesized that similar factors contributed to both the excessive abrasion of dental enamel and reduced BMD in subjects with tooth wear.

Methods

Fifty patients aged 47.5?±?5 years with severe tooth wear and 20 age-, sex-, and body mass index (BMI)-matched healthy volunteers with normal dental status were studied regarding dietary intakes of trace elements, serum and salivary copper (Cu), zinc (Zn), and calcium (Ca) concentrations, and serum PTH, osteocalcin, and hydroxyvitamin D levels. Tooth wear was determined using clinical examination based on standard protocol according to Smith and Knight. In all subjects, acid biopsies of the maxillary central incisors were carried out to assess mineral composition of the enamel. Atomic absorption spectroscopy with an air/acetylene flame was used to measure Ca and Zn, and graphite furnace atomic absorption spectroscopy was used to analyze Cu content. BMD was examined using dual energy X-ray absorptiometry.

Results

Tooth wear patients had reduced lumbar spine, but not femoral, BMD relative to controls (p?<?0.001). No differences were found in enamel Ca concentration and Zn content was slightly higher in tooth wear patients than in controls whereas Cu content was significantly decreased in the patients: 19.59?±?16.4 vs 36.86?±?26.1 μg/l (p?=?0.01) despite similar levels of Cu in serum and saliva. The differences were independent of serum 25-OH-D, osteocalcin concentrations or PTH either.

Conclusion

Severe tooth wear is associated with reduced spinal BMD. Enamel in adult individuals with severe tooth wear is low in copper content. Therefore, further work is needed to determine whether copper plays a role in bone pathophysiology in these patients.     

Age-related decline in bone density among ethnically diverse older men

Summary

We compared rates of BMD decline in older men of diverse ethnic backgroud. The rate of bone loss was statistically equivalent between men of African and Caucasian descent.

Introduction

Race differences in peak bone mineral density (BMD) are well established, but the magnitude of bone loss among non-white men has not been well characterized. Our objective was to compare and contrast the rates of decline in BMD with aging among older men of different race/ethnic groups.

Methods

The rate of decline in hip BMD was measured by dual-energy X-ray absorptiometry (Hologic QDR-4500 W) with an average follow-up of 4.6?years in 3,869 Caucasian, 138 African American, 145 Asian, and 334 Afro-Caribbean men aged????65?years (Mean ages: 73?±?5, 70?±?4, 72?±?5, 71?±?5?years, respectively).

Results

The annual rate of decline in BMD at the femoral neck was ?0.32%, ?0.42%, ?0.09%, and ?0.44%/year for Caucasian, African American, Asian, and Afro-Caribbean men, respectively (p?<?0.05 for Caucasian versus Asian). Although men of African ancestry have higher peak BMD than Caucasians, rates of decline in BMD with aging appear to be statistically equivalent in our study. In contrast, Asian men experienced a slower rate of decline in BMD compared with Caucasians and African Americans.

Conclusion

More studies are needed to better define the natural history of and factors associated with bone loss among non-white men.     

Predictors of low bone mineral density of the stroke-affected hip among ambulatory individuals with chronic stroke

Summary

Risk of hip fracture is greater poststroke than in an age-matched healthy population, in part because of declining hip BMD. We found that individuals may be at risk of loss of hip BMD from muscle atrophy, asymmetrical gait, and poor affected-side ankle dorsiflexor strength. These impairments may be targeted during rehabilitation.

Introduction

This study aimed to determine predictors of low hip BMD on the stroke-affected side in people living in the community.

Methods

Forty-three participants (female; 27.9 %), mean age 62.4?±?13.5 and 17.9?±?32.8 months, poststroke with motor impairments underwent dual energy X-ray absorptiometry scans. Gait characteristics, isometric strength, body composition, and fasting plasma lipids were measured.

Results

At entry, 34.9 % (15/43) of the participants had low total hip BMD on the stroke-affected side. Of those with low BMD, 93.3 % (14/15) had a step length symmetry ratio >1, indicating greater reliance on the non-paretic leg for weight bearing. Logistic regression analysis revealed that lower affected-side ankle dorsiflexor strength (ß?=?0.700, p?=?0.02), lower total body fat-free mass index (ß?=?0.437, p?=?0.02), and greater step length symmetry ratio during walking (ß?=?1.135?×?10³, p?=?0.03) were predictors of low hip BMD.

Conclusion

Low BMD of the stroke-affected side hip is prevalent in over a third of individuals with lower limb motor impairments. These individuals may be at particular risk of accelerated loss of BMD at the hip from asymmetrical gait pattern and poor affected-side ankle dorsiflexor strength. These impairments are intervention targets that may be addressed during rehabilitation which includes resistance training and addresses gait impairments.     

Bone mass and vitamin D levels in women with a diagnosis of fibromyalgia

Summary

No differences in either bone mineral density or serum 25OHD levels have been found between 205 women with fibromyalgia (both pre- and postmenopausal) and their controls. However, a lack of the expected 25OHD summer rise was observed in patients.

Introduction

Contradictory data have been published regarding a possible association between fibromyalgia and osteoporosis or hypovitaminosis D. Most studies, however, have been performed in small size samples and have excluded postmenopausal women. We decided to study this association in a larger sample of fibromyalgia patients including both pre- and postmenopausal women.

Methods

Two hundred five patients were recruited from a clinic specializing in fibromyalgia and 205 healthy controls were enrolled from the census of a Primary Care Center. Controls were matched with patients by age and the time of the year they were included in the study. Bone mineral density (BMD) was measured by DXA. Serum 25OHD, iPTH, P1NP, and CTX were also determined.

Results

BMD was similar in both groups (lumbar spine, 0.971?±?0.146 g/cm² in patients and 0.970?±?0.132 g/cm² in controls; femoral neck, 0.780?±?0.122 g/cm² and 0.785?±?0.117 g/cm², respectively). 25OHD levels were also similar: 23.0?±?9.5 ng/ml and 24.1?±?9.6 ng/ml. However, while controls showed the usual summer rise in 25OHD, fibromyalgia patients did not. PTH did not show seasonal changes, but on average was higher in patients (51 pg/ml vs. 48 pg/ml; p?=?0.034). P1NP or CTX were similar in both groups.

Conclusions

No differences in BMD were found between patients and controls. As for 25OHD, a lack of its expected summer rise was observed. It is doubtful whether this has any homeostatic consequence. We consider that the association reported in other studies is merely circumstantial, and not due to the intrinsic characteristics of these disorders.     

Shortening of the QT Interval is Observed Soon after Sleeve Gastrectomy in Morbidly Obese Patients

Background

Morbidly obese patients have an increased risk of sudden cardiac death. It is well known that obesity prolongs the QT interval, which in turn may cause ventricular arrhythmia and sudden cardiac death. The objective of this study was to establish whether sleeve gastrectomy shortens the QT interval.

Methods

Twenty-eight consecutive patients underwent sleeve gastrectomy at our institution between September 2010 and March 2011 and were included in the study. The indications for bariatric surgery were in accordance with French national guidelines. For each patient, an electrocardiogram was recorded before and then 3 months after surgery. The corrected QT (QTc) was determined independently by two physicians.

Results

The mean body mass index was 45.27?±?6.09 kg/m² before surgery and 38.32?±?5.19 kg/m² 3 months after surgery. The mean weight loss over this period was 20.71?±?7.57 kg. The QTc interval was 427?±?18.6 ms (415.7?±?12.06 in men and 428.4?±?18.96 in women) prior to surgery and was significantly lower 3 months after surgery (398.6?±?15.5 ms overall, 391.3?±?7.63 in men, and 399.6?±?16.02 in women). The QTc interval decreased in all individual patients (by an average of 28.5?±?15.6 ms overall, 24.3?±?8.38 in men, and 29?±?16.23 in women). Weight loss and decreased QTc interval were not significantly correlated (p?=?0.88).

Conclusion

Sleeve gastrectomy in morbidly obese patients was associated with a significantly lower QTc interval 3 months after surgery. These findings imply that bariatric surgery might reduce the risk of sudden cardiac death in this patient population.     

Changes in Bone Mineral Density in Women Following 1-Year Gastric Bypass Surgery

Background

Roux-en-Y gastric bypass (RYGB) surgery is the gold standard surgical treatment for obesity. However, unintended nutritional deficiencies following this surgery are common, including changes in bone metabolism. We assessed changes in bone mineral density (BMD), nutritional compounds, and bone resorption markers before and 1?year following RYGB surgery.

Methods

Our study included 22 female patients with class II/III obesity. A clinical questionnaire, a 24-h recall, blood and urine samples, and dual-energy X-ray absorptiometry were provided.

Results

Mean age was 37.2?±?9.6?years; 86?% were Caucasian and 77.2?% were premenopausal. Mean preoperative body mass index was 44.4?±?5.0 and 27.5?±?4.5?kg/m² at 1-year follow-up (p?p?=?0.327]. Serum N-telopeptide (16.3?±?3.4 vs. 38.2?±?7.0 nM BCE, p?p?=?0.026) increased after RYGB surgery, reflecting bone resorption. BMD decreased after RYGB surgery in the lumbar spine (1.13?±?0.11 vs. 1.04?±?0.09?g/cm², p?=?0.001), femoral neck (1.03?±?0.15 vs. 0.94?±?0.16?g/cm², p?=?0.001), and total femur (1.07?±?0.11 vs. 0.97?±?0.15?g/cm², p?=?0.003).

Conclusions

Decreased BMD in the lumbar spine, femoral neck, and total femur is detectable in women 1?year after RYGB surgery. Calcium malabsorption, caused by vitamin D deficiency and increased bone resorption, is partially responsible for these outcomes and should be targeted in future clinical trials.     

The Role of Gender in Primary Hyperparathyroidism: Same Disease, Different Presentation

Background

Hyperparathyroidism is much more common in women and therefore may represent different diseases in men and women. In order to understand the role of gender in hyperparathyroidism, we reviewed our experience.

Methods

We analyzed a prospective database of 1309 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy at our institution between March 2001 and August 2010.

Results

The female-to-male ratio was 3.3:1, and female patients were older at presentation (60?±?0 vs. 57?±?1?years, p?p?=?0.005) and the most common symptom for men was kidney stones (23?% vs. 13?%, p?p?p?=?0.03), higher parathyroid hormone level (140?±?7 vs. 124?±?4?pg/ml, p?=?0.04), higher urinary calcium level (376?±?10 vs. 314?±?5?mg/24?h, p?p?p?=?0.004). The operative approach as well as the number of glands involved and their location did not significantly differ between the groups. The mean gland weight for a single adenomas was higher in male patients (1123?±?128 vs. 636?±?32?mg, p?=?0.001). No significant difference was identified in the immediate and remote postoperative course.

Conclusions

Hyperparathyroidism appears to present differently depending on gender. Male patients more often present without symptoms, present with vitamin D deficiency, and have larger parathyroid glands. Importantly, surgical outcomes were equivalent between men and women.