A 2-year prospective study of bone metabolism and bone mineral density in adolescents with anorexia nervosa

Summary Osteopenia and osteoporosis are complications of adolescent anorexia nervosa (AN) and may result in a permanent deficit of bone mass in adulthood. It is still unclear if a complete catch-up in bone mineral density (BMD) is possible after weight rehabilitation in AN. Methods. We investigated bone formation (bAP, PICP), bone resorption (CTX) and BMD (lumbar spine, femoral neck) along with endocrinological parameters in 19 girls with AN (14.4 ± 1.6 years) and in 19 healthy controls for 2 years after inpatient re-feeding. Results. Re-feeding normalised bone formation activity in patients. The pattern of bone turnover in patients after 2 years was similar to the pattern healthy controls had shown 2 years before. BMD of patients was significantly lower than in controls and did not change throughout the entire study. Conclusions. Weight rehabilitation leads to prolonged normalization of bone turnover in adolescent AN. Since we could not observe a “catch up” effect in BMD of girls with AN in a 2-year follow-up, BMD of these patients needs to be carefully monitored until adulthood to detect early osteoporosis. The first two authors contributed equally     

Muscle function and age are associated with loss of bone mineral density in Duchenne muscular dystrophy

Introduction: Patients with Duchenne muscular dystrophy (DMD) demonstrate decreased bone mineral density (BD). It is not clear which factors exert the greatest impact on BD loss in these patients. Methods: In 63 patients with DMD, serum cytokines (interleukin [IL]-1, IL-6, and tumor necrosis factor-beta [TNF-β]), C-reactive protein (CRP), creatine kinase (CK), muscle function (by Vignos scale), body composition, and total BD (the latter 2 measured by dual-energy X-ray absorptiometry, or DEXA) were determined. Results: The main factors associated with BD loss were muscle function (34.0%; β = −0.139; P < 0.023) and age (36.7%; β = −0.151; P = 0.004). Cytokines, CRP, body fat mass, and CK did not contribute to BD loss. Discussion: Muscle function and age contribute to BD loss in DMD. We propose that a cut-off of at least 6 points for the Vignos scale and at least 10.5 years of age predict a Z-score of less than or equal to −2.0. Muscle Nerve 59:417–421, 2019     

Long-term effects of intravenous high dose methylprednisolone pulses on bone mineral density in patients with multiple sclerosis

To determine the effects of high dose methylprednisolone (HDMP) pulses on bone mineral density (BMD) in patients with multiple sclerosis (MS), we studied 25 MS patients who received regular pulses of HDMP as well as pulses of HDMP for relapses, 18 MS patients who received HDMP at the same dose schedule only for relapses, and 61 healthy controls. We measured BMDs at lumbar spine and femoral neck and we assessed biochemical markers of bone metabolism and turnover. The average lifetime dosage of MP was 75.4 (SD 11.9) g in the pulsed HDMP group and 28.6 (SD 18.3) g in the HDMP for relapses group (P < 0.0001). Two MS patients (4.7%) and four controls (6.6%) had osteoporosis (P = NS), whereas 25 patients with MS (58.1%) and 21 controls (34.4%) had osteopenia (P = 0.016). BMDs measured at lumbar spine and femoral neck and biochemical indices of bone metabolism did not differ in MS patients and controls. BMD measures were not associated with lifetime methylprednisolone dosage. In partial correlation analysis, controlling for age, gender and menopausal status there was a significant inverse correlation between BMD at femoral neck and Expanded Disability Status Scale (EDSS) score (r = -0.31, P = 0.05). In conclusion, treatment with repeated HDMP pulses was not associated with osteoporosis in patients with MS who participated in a trial of methylprednisolone. However, osteopenia was observed more frequently in MS patients than healthy controls. Our data are reassuring, as them suggest that repeated pulses of methylprednisolone do not result in substantially increased risk of osteoporosis in MS patients. Moreover, osteopenia was found only in patients treated for relapses, who had a significantly higher EDSS score than patients in the HDMP group, suggesting that decreased mobility may contribute to bone loss more than corticosteroid use. BMD should be monitored in patients with MS, regardless of the use of methylprednisolone.     

男性2型糖尿病患者骨代谢生化指标与骨密度变化的探讨

男性2型糖尿病患者骨代谢生化指标与骨密度变化的探讨 陈陵霞 苗懿德 刘杰 魏雅楠 郏蓉 宝辉 褚琳 北京大学人民医院老年科,北京100044 北京大学人民医院科研基金支持项目 陈陵霞,女,1972年生,重庆市人,汉族,1995年北京大学医学部本科毕业,2001年北京大学医学部博士毕业,2005-2007美国宾夕法尼亚大学博士后,副主任医师,副教授,研究方向为骨质疏松症及2型糖尿病并发症研究。 chenlingxia@medmail.com.cn 摘要 背景：2型糖尿病是骨质疏松症发生的高危人群,但其发生发展机制尚不明确。 目的 了解男性2型糖尿病患者骨代谢特点及骨密度变化,为2型糖尿病骨质疏松症的预防和治疗提供临床依据。 方法 观察住院及门诊男性2型糖尿病患者97例,非糖尿病男性76例,空腹采血测定血骨保护素（OPG）、抗酒石酸酸性磷酸酶（TRAP）、骨钙素（BGP）、骨碱磷酶（BAP）、I型胶原C-末端（CTX）。同时收集相关临床资料及生化指标。骨密度使用Hologic双能X线骨密度仪测定。 结果与结论 男性糖尿病患者各部位骨密度较非糖尿病组无显著变化。男性糖尿病患者OPG及CTX较非糖尿病者显著升高,分别为（1173.7±791.0）ng/L vs （868.6±483.0）ng/L(p<0.05)及（10.09±4.65）nmol/L vs （8.65±3.86）nmol/L(p<0.05)。BGP、BAP、TRAP无显著变化。提示OPG及CTX在男性2型糖尿病患者骨质疏松症的发生中有一定影响。 关键词：糖尿病;骨代谢;骨密度     

猪骨蛋白对骨质疏松模型大鼠血清磷水平与骨密度的影响

背景: 有报道显示美国处于高风险的骨质疏松妇女中磷水平较高,这是否意味着降低血磷水平的物质将会为防治骨质疏松提供新的有效手段？ 目的：观察猪骨蛋白对骨质疏松大鼠骨密度和血清中钙及磷水平的影响。 方法：以肌肉注射地塞米松建立Wistar大鼠骨质疏松模型。造模后以数字表法随机分为生理盐水组、接骨七哩片组、50,100, 200 mg/kg猪骨蛋白组,不作任何处置大鼠作为正常对照。治疗12周后,分离血清并用生物化学方法测定血清磷和血钙水平,同时收集大鼠胫骨制作成骨切片,以QDR-4000双能X射线吸收仪测定各组大鼠胫骨吸光度值;苏木精-伊红染色观察胫骨骨髓腔变化。 结果与结论：各组之间血清钙浓度比较差异无显著性意义(P > 0.05)。与生理盐水组比较,50,100,200 mg/kg猪骨蛋白组大鼠血清磷浓度下降(P < 0.05)。50,100,200 mg/kg猪骨蛋白组、接骨七哩片组骨密度值高于生理盐水组(P < 0.05)。正常对照组大鼠胫骨的骨髓腔是小的,生理盐水组大鼠胫骨的骨髓腔特别大,50,100,200 mg/kg猪骨蛋白组、接骨七哩片组大鼠胫骨骨髓腔比生理盐水组大鼠胫骨骨髓腔小。结果提示猪骨蛋白不改变骨质疏松大鼠血清钙的水平,但它能降低骨质疏松大鼠血清磷的浓度,增加骨密度。不过,在该实验浓度范围内,没有显示剂量效应关系;猪骨蛋白也能缩小骨质疏松大鼠胫骨骨髓腔。     

广西百色地区壮族男性人群骨密度与脂联素基因单核苷酸多态性的关系***

背景：脂联素可在骨代谢中发挥重要作用。 目的：观察脂联素基因单核苷酸多态性与广西百色地区壮族男性骨密度的关系。 方法：选取广西百色地区壮族男性跟骨骨量减少患者,采用单碱基延伸的单核苷酸多态性分型技术对广西百色地区302例壮族男性的脂联素基因的5个单核苷酸多态性位点(rs1063539、rs12495941、rs266729和rs3774261)进行了基因分型。 结果与结论：以5个多态性位点作为自变量的多元 Logistic回归检测结果显示,仅rs3774261多态性与跟骨超声振幅衰减显著相关(OR=1.948,95%CI：1.184~3.203,P < 0.01),并独立于骨量减少的传统危险因素。对基因型进行纯合子与杂合子合并后的协方差分析显示,仅rs3774261的AG+GG与AA基因型的跟骨超声振幅衰减值差异有显著性意义(P < 0.05),AG+GG型对骨密度具有一定的保护作用,AA型是骨密度降低的危险因素。结果证实,脂联素基因第2内含子rs3774261位点多态性与中国百色地区壮族男性骨密度有一定关联。     

Derangements in bone mineral parameters and bone mineral density in south Indian subjects on antiepileptic medications

Background:

Although there are reports describing the association of alternations of bone and mineral metabolism in epileptic patients with long-term anticonvulsant therapy, there are only limited Indian studies which have looked at this aspect.

Objectives:

This study was done to compare the prevalence of changes in bone mineral parameters and bone mineral density (BMD) in ambulant individuals on long-term anticonvulsant therapy with age- and body mass index (BMI)-matched healthy controls.

Materials and Methods:

There were 55 men (on medications for more than 6 months) and age- and BMI-matched 53 controls. Drug history, dietary calcium intake (DCI), and duration of sunlight exposure were recorded. Bone mineral parameters and BMD were measured.

Results:

The control group had a significantly higher daily DCI with mean ± SD of 396 ± 91 mg versus 326 ± 101 mg (P = 0.007) and more sunlight exposure of 234 ± 81 vs 167 ± 69 min (P = 0.05). BMD at the femoral neck was significantly lower in cases (0.783 ± 0.105 g/cm²) when compared to controls (0.819 ± 0.114 g/cm²). Majority of the patients (61%) had low femoral neck BMD (P = 0.04). There was no significant difference in the proportion of subjects with vitamin D deficiency (<20 ng/mL) between cases (n = 32) and controls (n = 37) (P = 0.234).

Conclusions:

Vitamin D deficiency was seen in both the groups in equal proportions, highlighting the existence of a high prevalence of this problem in India. Low femoral neck BMD found in cases may stress the need for supplementing calcium and treating vitamin D deficiency in this specific group. However, the benefit of such intervention has to be studied in a larger proportion of epileptic patients.     

葛根对睾丸切除骨质疏松模型小鼠骨密度和骨构造的作用

背景：研究证实,葛根不仅能够预防卵巢切除雌激素不足骨质疏松模型小鼠骨密度及骨量的下降,而且能够改善骨微细构造,可用于女性闭经后骨质疏松症的预防与治疗。其对男性骨质疏松的治疗是否具有相似的疗效？ 目的：课题以更接近应用为目的,观察未经提取的植物药葛根对雄激素不足骨质疏松模型小鼠骨密度和骨构造的影响。 方法：8周龄雄性ddY小鼠48只,体质量32~35 g,随机数字表法分为假手术组,模型组,低、中、高剂量葛根组和雌二醇组,每组8只。假手术组暴露睾丸与附睾,切除周围脂肪组织;其余各组小鼠摘除双侧睾丸。术后假手术组、模型组和雌二醇组都给予普通饲料,低、中、高剂量葛根组给予含有5%,10%和20%葛根粉的饲料。雌二醇组17β-雌二醇通过体内小渗透泵自动给药0.03 µg/d。饲料给予均为4.0 g/d。4周后,检测精囊质量,以双能X射线骨密度测定仪检测股骨骨密度,显微CT分析股骨远端干骺端海绵骨微细构造。 结果与结论：模型组股骨全体骨密度下降了10.9%,这种下降被低剂量葛根完全抑制,被中剂量葛根抑制进一步加强,但两者差异无显著性意义;高剂量葛根组骨密度较模型组、假手术组分别高出26.1%,12.4%,作用强度与雌二醇相当。低剂量葛根完全抑制了雄激素缺乏导致的股骨骨小梁数目下降以及骨小梁间距增大,中剂量葛根抑制作用更强,但两组之间差异无显著性意义;高剂量葛根组抑制作用最强,能够增加骨量和骨小梁数目达到显著高于假手术组水平。葛根各剂量对精巢无刺激作用。提示葛根在不刺激精囊的条件下,低、中剂量葛根可完全抑制雄激素缺乏所致的骨密度和骨量下降,改善骨构造,高剂量效果更显著,与雌二醇作用相当。     

骨质疏松性骨折愈合中骨改建的动态参数及骨密度变化

背景：当骨质疏松骨强度下降时,遭受轻微创伤或其他各种风险因素均易发生骨折。目的：观察骨质疏松性骨折愈合过程中骨小梁组织学变化,骨密度及骨矿化沉积率的改变。方法：SD大鼠随机分为骨质疏松组与对照组,骨质疏松组大鼠切除双侧卵巢,术后3个月,建立骨折模型。骨折后4,8,12,16 周,荧光显微镜下观察骨改建的动态参数,双能X线骨密度仪下测定骨痂组织的骨密度;骨折后1,2,4,6,8,12,16 周,应用自动图像系统测量骨组织形态。结果与结论：骨质疏松组大鼠成熟小梁骨占骨痂面积比对照组小,且小梁骨厚度变薄、小梁骨间距较宽,骨质疏松组骨小梁表面荧光标记百分比及骨痂组织骨密度低于对照组;而骨矿化沉积率高于后者对照组。说明在骨质疏松性骨折愈合过程中,骨痂组织的组织学的异常改变导致骨折愈合质量的降低。     

护骨素基因T245G多态性与老年人骨密度关系的部位及性别差异*☆

背景：作为骨折发生的重要临床预测因子,骨密度在一定程度上由遗传因素决定。护骨素基因是骨质疏松症发病中的重要候选基因。 目的：探讨护骨素基因T245G多态性与骨密度的相关性。 方法：选取2008-09/2010-04在北京大学人民医院进行常规查体的老年人281名,其中男182名,女99名。应用PCR-RFLP结合DNA测序检测护骨素基因T245G多态性,使用双能X射线骨密度测量仪测定受试者腰椎、髋部标准位置及前臂的骨密度。同时收集受试者的生化指标及临床观察项目。应用ANOVA方法分析护骨素基因T245G多态性与各检测指标的关系。 结果与结论：在老年男性及绝经后女性中,T245G基因T,G等位基因频率分布差异无显著性意义(P > 0.05)。在老年男性中,GG和TG基因型具有较高的腰椎骨密度,而TT基因型的腰椎骨密度较低(P < 0.05),Ward’s三角区及前臂骨密度在各基因型间差异无显著性意义(P > 0.05)。在绝经后女性中,T245G多态性与骨密度无关,说明护骨素基因与老年男性腰椎骨密度有关。     

Bone mineral density in familial amyloid polyneuropathy and in other neuromuscular disorders

Neuromuscular diseases are a known risk factor for immobilization-induced osteoporosis. The aim of the study was to analyse bone mineral density (BMD) in patients with familial amyloid polyneuropathy (FAP) type I (Val30 Met) and to compare them with a population of patients with other neuromuscular disorders. We studied 24, ambulatory, neuromuscular patients, all men and premenopausal women. We included 12 FAP patients (GI) and 12 patients with other disorders (GII). Clinical data included age, sex, height, weight, alcohol intake, smoking, calcium intake, physical activity and history of fractures. Serum and urinary calcium, osteocalcin, bone alkaline phosphatase, parathyroid hormone, thyroid stimulating hormone and urinary N-telopeptide cross-linked type 1 collagen were determined in all patients. Bone mineral density of lumbar spine, hip and wrist were determined by dual energy X-ray absorptiometry scan. No statistical differences were found in clinical or analytic data between the two groups, except for body mass index and calciuria, which were lower in GI. In GI, 54.5% were osteoporotic, against 23.1% in GII ( P  = 0.04). Bone mineral density was lower in GI when compared with GII, and tended to decrease with disease duration. Decreased BMI and the early autonomic involvement in GI probably explain the results. The prevention and early treatment of osteoporosis, in FAP patients should be considered a priority.     

BsmI vitamin D receptor’s polymorphism and bone mineral density in men and premenopausal women on long‐term antiepileptic therapy

Background: Utilization of antiepileptic drugs (AEDs) has long been associated with bone deleterious effects. Furthermore, the BsmI restriction fragment polymorphism of the vitamin D receptor (VDR) has been associated with reduced bone mineral density (BMD), mostly in postmenopausal women. This study evaluates the association between bone metabolism of patients with epilepsy and the BsmI VDR’s polymorphism in chronic users of AEDs. Methods: This study evaluated 73 long‐term users of antiepileptic drug monotherapy, in a cross‐sectional design. Fasting blood samples were obtained to estimate the circulating serum levels of calcium, magnesium, phosphorus, parathormone, 25hydroxyvitamin D as well as the VDR’s genotype. Bone mineral density at the lumbar spine was measured with Dual Energy X‐Ray Absorptiometry. Results: Bone mineral density was significantly associated with the genotype of VDR (mean BMD: Bb genotype 1.056 ± 0.126 g/cm²; BB genotype 1.059 ± 0.113 g/cm²; bb genotype 1.179 ± 0.120 g/cm²; P < 0.05). Additionally, the presence of at least one B allele was significantly associated with lower bone mineral density (B allele present: BMD = 1.057 ± 0.12 g/cm², B allele absent: BMD = 1.179 ± 0.119 g/cm²; P < 0.01). Patients with at least one B allele had lower serum levels of 25hydroxyvitamin D when compared with bb patients (22.61 ng/ml vs. 33.27 ng/ml, P < 0.05), whilst they tended to have higher levels of parathyroid hormone. Discussion: Vitamin D receptor polymorphism is associated with lower bone mass in patients with epilepsy. This effect might be mediated through the vitamin D‐parathormone pathway.     

Trunk muscle strength,but not trunk rigidity,is independently associated with bone mineral density of the lumbar spine in patients with Parkinson's disease

Previous literature suggested that muscle forces applied to the skeleton may be an important factor in increasing bone mineral density (BMD). This purpose of this study was to determine whether trunk rigidity and trunk muscle strength were associated with lumbar spine BMD in patients with Parkinson's disease (PD). Forty‐three PD patients and 29 controls participated in this study. Dual‐energy X‐ray absorptiometry was used to measure lumbar spine BMD of PD patients. Additionally, an isokinetic dynamometer was used to evaluate trunk rigidity and trunk muscle strength of all subjects. The results showed that PD patients had significantly lower trunk muscle strength, but more trunk rigidity than controls by 46.6 and 162.8%, respectively (P < 0.001). In bivariate correlation analysis, lumbar spine BMD was significantly related to trunk muscle strength (r = 0.475, P = 0.001), but not trunk rigidity (r = 0.271, P = 0.079). In multiple regression analysis, after adjusting for relevant factors, only trunk muscle strength remained independently associated with lumbar spine BMD, accounting for 10.0% of the variance (R² = 0.342, F_5,37 = 3.838, P = 0.007). Trunk muscle strength, but not trunk rigidity, is independently associated with lumbar spine BMD in patients with PD. Further randomized controlled studies are required to determine whether trunk muscle strengthening exercise is effective in enhancing lumbar spine BMD. © 2009 Movement Disorder Society     

Psychiatric disorders are associated with hospital care utilization in persons with hypertension

Background  Psychiatric disorders and hypertension both independently increase risk for heart disease, cardiac events, and healthcare utilization. However, the contribution of specific psychiatric disorders to healthcare utilization in persons with hypertension is unknown. Objective  To evaluate associations between psychiatric disorders and receipt of hospital care in people with hypertension. Design  Cross-sectional epidemiologic survey. Subjects  A total of 8,812 hypertensive individuals drawn from a randomly selected sample of 43,093 US adults. Main outcomes  Participants were assessed in-person for a range of mental disorders (using the Diagnostic and Statistical Manual of Mental Disorders-IV), hypertension status (self-report), and past-year occurrence of emergency room treatment and overnight hospital stay (self-report). Results  After controlling for demographics and clinical variables, persons having any lifetime mood, anxiety, or personality disorders had increased likelihood of emergency room treatment [odds ratios (ORs) = 1.26, 1.18, and 1.47, respectively]. Persons having any mood or personality disorder had increased likelihood of overnight hospital stay (ORs  = 1.24 and 1.31, respectively). The specific disorders significantly associated with emergency room treatment were lifetime major depression, lifetime manic disorder, past-year major depression, past-year manic disorder, past-year panic disorder without agoraphobia, and paranoid, histrionic, antisocial, obsessive–compulsive personality disorders, with ORs ranging from 1.25 to 2.41. The specific disorders significantly associated with overnight hospital stay were lifetime dysthymia, lifetime manic disorder, past-year major depression, past-year manic disorder, and histrionic, antisocial, and paranoid personality disorders, with ORs ranging from 1.40 to 1.87. Conclusion  Results suggest that addressing mental health problems in persons with hypertension may decrease healthcare utilization.