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Clinical decision rules (CDRs) are designed to help physicians practice better. A number of CDRs to assist in identifying
women with low bone mass have been developed since the mid 1990s, including SCORE, OST (OSTA), OSIRIS, SOFSURF, NOF, ABONE,
pBW, ORAI, and weight-only-EPIDOS (which we have termed WO-E). This review discusses these CDRs in terms of development and
validation cohorts and their sensitivity and specificity. The sensitivities of the available CDRs exceed 80% and specificities
are about 50%. After much analysis, it appears that most experts prefer OST for its simplicity and SCORE for its flexibility,
but there is no consensus on what risk factors to use in the CDRs and what regions of interest (spine, total hip, femoral
neck, or a combination) to test with dual-energy x-ray absorptiometry (DXA). Because of the lack of consensus, there are barriers
to the clinical application of these CDRs. Agreement on a single CDR for worldwide use is required to optimally fulfill the
objective of identifying low bone mass. 相似文献
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Calcium and vitamin D are the mainstays of nutritional intervention for the prevention and treatment of osteoporosis. However,
conditions that alter nutritional status as well as other nutrients should be considered when diagnosing and treating osteoporosis
and osteopenia. Current research supports the early diagnosis and treatment of anorexia nervosa to prevent associated bone
loss and increased risk of fracture. Weight restoration in patients with anorexia nervosa is central to bone mass stabilization.
Other nutritional considerations include nutrients such as vitamin B-12 and vitamin K that may reduce fracture risk by increasing
bone mineral density as well as the improvement of bone microarchitecture. Diets high in fruits and vegetables contribute
nutrients such as magnesium associated with bone health and may also produce an alkaline environment, reducing calcium excretion
and thus improving bone density. 相似文献
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Merry Lynn Mann BS Denyse Thornley-Brown MD Ruth Campbell MD Emmy Bell MD Leandria Burroughs RT CDT Nancy Nunnally RT CDT Rui Feng PhD Sarah L. Morgan MD MS RD CCD FADA FACP 《Journal of clinical densitometry》2008,11(4):538-536
The bone mineral density of patients undergoing peritoneal dialysis (PD) is low compared to a healthy population. No studies have been conducted to investigate whether the presence of peritoneal dialysate affects dual-energy X-ray absorptiometry (DXA) results. We hypothesized that the presence of peritoneal dialysate would not affect the measurement of bone mineral density (BMD) or bone mineral content (BMC) in the spine. Thirty patients on PD had DXA scans of the lumbar spine and hip completed before and after the drainage of peritoneal dialysate. A paired t-test was used to compare the difference in area, BMC, and BMD before and after drainage of dialysate. A significant difference was found in the BMC of the spine before and after the drainage of dialyzate. We recommend that peritoneal dialyzate be removed prior to scanning patients on PD and that densitometry technologists should be observant about the presence of peritoneal dialysate. 相似文献
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Halley Wasserman MD MS CCD Andrea Dumenigo BS Lindsey Hornung MS Bret Augsburger BA Kalyani Marathe MD MPH Anne W. Lucky MD 《Pediatric dermatology》2023,40(1):100-106
Background
Epidermolysis bullosa (EB) is a group of rare genetic skin conditions that result in skin fragility. EB can be quite severe with chronic inflammation and malnutrition impairing growth and pubertal development. These factors have potential consequences for skeletal health. We aimed to determine the prevalence of delayed puberty and low bone mineral density (BMD) for age in children and young adults with EB.Methods
Electronic medical records (EMR) of patients with confirmed EB <30 years of age at time of initial encounter at Cincinnati Children's Hospital Medical Center between January 1, 2010 and September 30, 2020 were reviewed. Natural language processing software was used to categorize pubertal status of patients with EB as early, normal or delayed. BMD was measured by dual energy x-ray absorptiometry and categorized as low if height adjusted Z-score was <−2.0 using age, sex and race specific reference ranges.Results
29% of individuals with EB had low BMD with most cases occurring prior to 10 years of age. Of patients who reached adolescence, 23% failed to develop any signs of puberty in the normal range (before age 13 in females or 14 in males) and BMD Z-scores further declined in these individuals.Conclusion
Delayed puberty is an under-recognized comorbidity of individuals with EB, especially in those with recessive dystrophic EB, and can have a significant impact on BMD. 相似文献
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