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Introduction: Few studies on rheumatoid arthritis have investigated disease activity and body composition by dual-energy X-ray absorptiometry including evaluation of visceral adipose tissue. Thus, we sought to verify the association between body composition by dual-energy X-ray absorptiometry, including visceral adipose tissue, and inflammatory activity in long-standing established rheumatoid arthritis. Methods: Seventy-eight postmenopausal women with rheumatoid arthritis (American College of Rheumatology 2010) were studied. Disease activity was assessed by composite indexes (DAS28, CDAI, SDAI) and C-reactive protein. Potential association between body composition and disease activity was analysed by Pearson correlation and Tukey´s test (p < 0.05). Results: There was significant negative correlation between C-reactive protein and appendicular lean mass index (r = −0.234, p = 0.039). After adjusting for confounding variables, women with C-reactive protein >10 mg/L had a lower appendicular lean mass index than those with C-reactive protein 5–10 mg/L and <5 mg/L (6.3 ± 0.8 kg/m2 vs 7.2 ± 1.2 kg/m2 vs 6.8 ± 1.0 kg/m2, respectively; p = 0.013). Women with moderate inflammation (C-reactive protein 5–10 mg/L) had more fat than those with C-reactive protein >10 mg/L and C-reactive protein <5 mg/L (12.4 ± 3.5 kg/m2 vs 9.9 ± 3.6 kg/m2 vs 10.5 ± 2.8 kg/m2, respectively; p = 0.040), as well as more visceral adipose tissue than women with higher and lower C-reactive protein (812.5 ± 266.4 cm3 vs 604.3 ± 236.3cm3 vs 658.9 ± 255.6 cm3; p = 0.009). Conclusions: High inflammatory activity that persists after a long disease duration was associated with both lower muscle and fat mass (including visceral adipose tissue), which is suggestive of more exuberant rheumatoid cachexia. Conversely, moderate activity was associated with greater visceral adipose tissue, which is associated with increased cardiovascular risk. These results point to the existence of different body composition profiles according to inflammatory status and the importance of individualized approaches to muscle mass and adiposity according to disease activity level in long-standing rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Introduction: Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women. Methods: A total of 408 women aged ≥65 yr from the São Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005–2007). After a follow-up of 4.3 ± 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM. Results: At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 ± 4.9 yr in the LMM group and 72.5 ± 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 ± 5.2 kg/m2 in the LMM group and 28.1 ± 4.7 kg/m2 in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 μUI/L-increase), serum creatinine levels (OR = 11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase). Conclusions: Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention. [ABSTRACT FROM AUTHOR]

• pJIA patients might present focal bone loss and juxta-articular osteopenia. • HR-pQCT is a remarkable imaging method for the detection of bone erosions. • Bone erosions are associated with decreased cortical bone parameters in pJIA. To analyze longstanding polyarticular juvenile idiopathic arthritis (pJIA) for possible associations between localized bone damage (erosions), and systemic bone loss. Besides, to compare the systemic bone mass of pJIA with healthy controls. Thirty-four pJIA women and 99 healthy controls (HC) were included. Radius and tibia of all subjects were scanned by HR-pQCT. Volumetric bone mineral density (vBMD), bone microarchitecture, and -finite element parameters were analyzed. Patients underwent HR-pQCT of 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the dominant hand, for bone erosions quantification. The mean age of patients was 31.5 ± 7.4yrs with a mean disease duration of 21.7 ± 9.2yrs. Bone erosions were detectable in 79% of patients. The number of bone erosions was positively correlated with cortical porosity (Ct.Po) at tibia (r = 0.575, p = 0.001), and radius (r = 0.423, p = 0.018); and negatively correlated with cortical vBMD at tibia (r =-0.420, p = 0.015). In a logistic regression analysis, adjusted for anti-CCP, the presence of bone erosions was independently associated with Ct.Po at radius (p = 0.018) and cortical vBMD at tibia (p = 0.020). Moreover, cortical and trabecular vBMD, trabecular number, and μ -finite element parameters were decreased in patients compared to HC (p < 0.05). Bone erosions in longstanding pJIA women were associated with decreased cortical bone parameters, and these patients showed systemic bone impairment at peripheral sites compared with healthy controls. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to evaluate hemiplegic stroke patients in terms of long-term changes in bone mineral density and related factors. We conducted a longitudinal cohort study, involving 57 first-stroke patients (40 males) with chronic hemiplegia (for more than 12mo), at a university rehabilitation center in the city of São Paulo, Brazil. Bone loss, body composition, lean mass, and fat mass were evaluated at 2 time points (mean interval, 16mo). Bone loss was significantly greater in paretic forearms than in nonparetic forearms (p =0.001) and in patients having suffered strokes more recently (p =0.015). We found no difference between paretic and nonparetic femurs. Femoral bone loss was significantly greater in patients using anticoagulants or anticonvulsants (p =0.025) and in those with greater spasticity (p =0.040), regardless of the time since stroke. Our results provide additional evidence that hemiplegic stroke patients have progressive bone loss and that such bone loss is more common in the arms than in the legs. Patients with poststroke hemiplegia should be densitometric monitored mainly in paretic arm and treated for bone loss, with attention to the determinants identified in this study. [Copyright &y& Elsevier]

Abstract: The risk of osteoporotic fractures is known to vary among populations. There are no studies analyzing concomitantly clinical, densitometric, and lab risk factors in miscigenated community-dwelling population of Brazil. A total of 1007 elderly subjects (600 women and 407 men) from São Paulo, were evaluated using a questionnaire that included risk factors for osteoporotic fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the hip and lumbar spine. Laboratory blood tests were also obtained. The prevalence of osteoporotic fractures was 13.2% (133 subjects), and the main fracture sites were distal forearm (6.0%), humerus (2.3%), femur (1.3%), and ribs (1.1%). Women had a higher prevalence (17.5%; 95% confidence interval [CI]: 14.6–20.6) than men (6.9%; 95% CI: 4.4–9.3) (p <0.001). After adjusting for significant variables, logistic regression revealed that female gender (odds ratio [OR]=2.7; 95% CI; 1.6–4.5; p <0.001), current smoking (OR=1.9; 95% CI: 1.2–3.3; p =0.013), and the femoral neck T-score (OR=0.7; 95% CI: 0.5–0.9; p =0.001) remain significant risk factors for osteoporotic fractures in the community-dwelling elderly. Our findings identified that female gender, current smoking, and low hip BMD are independent risk factors for osteoporotic fractures. [Copyright &y& Elsevier]

Abstract: Objective: Physical and psychological incapacity, including fear of falling is related to decreased satisfaction with life in osteoporosis (OP). The impact of a balance exercise program on improving the quality of life is not well established. We have, therefore, investigated the effect of 12-month Balance Training Program in quality of life, functional balance and falls in elderly OP women. Methods: Sixty consecutive women with senile OP were randomized into a Balance Training Group (BT) of 30 patients and no intervention control group (CG) of 30 patients. The BT program included techniques to improve balance over a period of 12 months (1h exercise session/week and home-based exercises). The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Questionnaire (OPAQ), functional balance was evaluated by Berg Balance Scale (BBS). Falls in the preceding year were noted and compared to the period of study. Results: The comparison of OPAQ variations (INITIAL–FINAL) revealed a significant improvement in quality of life in all parameters for BT compared to CG: well-being (1.61±1.44 vs. −1.46±1.32, p <0001), physical function (1.30±1.33 vs. −0.36±0.82, p <0.001), psychological status (1.58±1.36 vs. −1.02±0.83, p <0.001), symptoms (2.76±1.96 vs. −0.63±0.87, p <0.001), social interaction (1.01±1.51 vs. 0.35±1.08, p <0.001). Of note, this overall benefit was paralleled by an improvement of BBS (−5.5±5.67 vs. +0.5±4.88 p <0.001) and a reduction of falls in 50% in BT group vs. 26.6% for the CG (RR: 1.88, p <0.025). Conclusion: The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls. [Copyright &y& Elsevier]

Abstract: Objective: To determine the risk factors for the presence of moderate/severe vertebral fracture, specifically 25-hydroxyvitamin D (25-OHD). Study design: Cross-sectional study conducted for 2 years in the city of São Paulo, Brazil including community-dwelling elderly women. Methods: Bone mineral density (BMD), serum 25-OHD, intact parathyroid hormone (iPTH), calcium and estimated glomerular filtration rate (eGFR) were examined in 226 women without vertebral fractures (NO FRACTURE group) and 189 women with at least one moderate/severe vertebral fracture (FRACTURE group). Vertebral fracture assessment (VFA) was evaluated using both the Genant semiquantitative (SQ) approach and morphometry. Results: Patients in the NO FRACTURE group had lower age, increased height, higher calcium intake, and higher BMD compared to those patients in the FRACTURE group (p <0.05). Of interest, serum levels of 25-OHD in the NO FRACTURE group were higher than those observed in the FRACTURE group (51.73nmol/L vs. 42.31nmol/L, p <0.001). Reinforcing this finding, vitamin D insufficiency (25-OHD<75nmol/L) was observed less in the NO FRACTURE group (82.3% vs. 93.65%, p =0.001). After adjustment for significant variables within the patient population (age, height, race, calcium intake, 25-OHD, eGFR and sites BMD), the logistic-regression analyses revealed that age (OR=1.09, 95% CI 1.04–1.14, p <0.001) femoral neck BMD (OR=0.7, 95% CI 0.6–0.82, p <0.001) and 25-OHD <75nmol/L (OR=2.38, 95% CI 1.17–4.8, p =0.016) remains a significant factor for vertebral fracture. Conclusion: Vitamin D insufficiency is a contributing factor for moderate/severe vertebral fractures. This result emphasizes the importance of including this modifiable risk factor in the evaluation of elderly women. [Copyright &y& Elsevier]

Objective To evaluate the prevalence of 25-hydroxyvitamin D insufficiency (25OHD<20ng/mL) and to develop a predictive model for this status. Methods This is a cross-sectional study including 908 community-dwelling older subjects, 18% (158) of which were randomly selected to be a "test" sample, with the remaining (750) composing a "development" sample. A radioimmunoassay technique was used to measure 25OHD levels. Anthropometrical data, information about lifestyle habits and co-morbidities were obtained. Multiple logistic regression models were created. An Index Risk of Vitamin D Insufficiency (IRVDI) was designed and subsequently validated. The performance of this tool was assessed through ROC analysis. Results The prevalence of 25OHD<20ng/mL was of 58.0% (CI 95% 51.6-64.6). The clinical independent factors for 25OHD<20ng/mL were female gender (OR=2.16; 95%CI 1.13-4.13; p=0.020), diabetes (OR=1.84; 95%CI 1.23-2.74; p=0.003) and season (winter/spring) (OR=3.63, 95%CI 2.62-4.88; p<0.001). After statistical adjustments, the IRVDI was able to identify older people at risk for vitamin D insufficiency with a sensitivity of 55.9%, specificity 72.3% and ROC area of 0.685 (p<0.001). Conclusions Our results suggest that vitamin D insufficiency is common among Brazilian community-dwelling elderly. Female gender, diabetes and the season (winter/spring) were the important parameters that predicted this status. The clinical use of these parameters can be help to design and target appropriate public health interventions. The IRVDI is a convenient tool for the selection of older people at risk for vitamin D insufficiency. [ABSTRACT FROM AUTHOR]

Abstract: This study aimed to examine the efficacy of creatine supplementation, associated or not with resistance training, in vulnerable older women. A 24-week, double-blind, randomized, placebo-controlled trial was performed. Sixty subjects were assigned to compose the following groups: placebo (PL), creatine supplementation (CR), placebo with resistance training (PL+RT), and creatine supplementation with resistance training (CR+RT). The subjects were assessed at baseline and after 24weeks. The primary outcome was muscle strength, as assessed by one-repetition maximum (1-RM) tests. Secondary outcomes included appendicular lean mass, bone mass, biochemical bone markers, and physical function tests. The changes in 1-RM leg press were significantly greater in the CR+RT group (+19.9%) than in the PL (+2.4%) and the CR groups (+3.7%), but not than in the PL+RT group (+15%) (p=0.002, p=0.002, and p=0.357, respectively). The CR+RT group showed superior gains in 1-RM bench press (+10%) when compared with all the other groups (p≤0.05). The CR+RT group (+1.31%) showed greater appendicular lean mass accrual than the PL (−1.2%), the CR (+0.3%), and the PL+RT groups (−0.2%) (p≤0.05). The CR and the PL+RT groups experienced comparable gains in appendicular lean mass (p=0.62), but superior to those seen in the PL group. Changes in fat mass, bone mass and serum bone markers did not significantly differ between the groups (p>0.05). In conclusion, creatine supplementation combined with resistance training improved appendicular lean mass and muscle function, but not bone mass, in older vulnerable women. Clinicaltrials.gov: NCT01472393. [Copyright &y& Elsevier]

Abstract: Objective: To analyze the association between abdominal aortic calcification scores (AACS) and bone metabolism parameters in a well-characterized general population of older adults. Background: Several studies suggest a link between bone mineral metabolism disorders and vascular calcification; although only few of them analyze bone mineral density(BMD), laboratory bone markers and cardiovascular parameters at the same time and none were done in a miscegenated population. Methods: This cross-sectional study included 815 subjects ≥65years old. The risk factors for osteoporosis and cardiovascular disease as well as a wide array of demographic and lifestyle characteristics were collected using a standardized questionnaire. BMD was measured by DXA. Kauppila''s method was used to quantify the AAC score (AACS) by spine X-rays. Laboratory analyses were also performed. Results: AAC was observed in 63.2% of subjects with a median AACS of 2 (IQR: 0–7). AACS were categorized in quartiles and the highest quartile of AACS (>7) were compared with the three lower quartiles of AACS (≤7). Logistic regression analysis was performed using parameters with statistical significance in the univariate analysis. The best logistic regression model revealed that AACS>7 was negatively associated with femoral neck BMD and positively associated with phosphorus, adjusted by age, current smoking, LDL, and arterial hypertension in the elderly community-dwelling population. Conclusions: We identified that higher serum phosphate levels and lower hip BMD are independent bone variables that are associated with elevated vascular calcification scores, supporting the search for effective prevention and treatment strategies that may simultaneously reduce these modifiable risk factors in older subjects. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study was to determine whether the addition of the measurement of bilateral hip bone mineral density (BMD) has an impact on indications for osteoporosis (OP) treatment in community-dwelling elderly individuals, based on criteria from the National Osteoporosis Foundation (NOF). Methods: In total, 605 consecutive community-dwelling elderly individuals who were 65 years and older were evaluated. Dual energy X-ray absorptiometry was used to determine the lowest T-score in the lumbar spine+unilateral hip, the bilateral hips, and the lumbar spine+bilateral hips. Risk factors associated with the lowest T-score in these three conditions were applied to indicate treatment in accordance with NOF criteria. McNemar''s test was used to assess the difference of adding bilateral hip BMD measurements. Results: There was a significant difference in the frequency of pharmacological indication using NOF criteria together with the lowest T-score for the three tests (72.8% for lumbar spine+bilateral hips and 71.2% for lumbar spine+unilateral hip; p =0.002). A higher frequency of treatment indication was also observed for lumbar spine+unilateral hip (71.2%) compared to bilateral hips (61.1%) (p <0.001). The discrepancies in treatment appeared to be more evident in women when analyzed by gender distribution. Conclusion: Our finding supports the theory that evaluation of the bilateral hips with the lumbar spine seems to be more sensitive measure for identifying patients with an osteoporosis treatment indication. Furthermore, despite the well-known artifact in the lumbar spine, this site should not be excluded when determining the indication for OP treatment in elderly people. [Copyright &y& Elsevier]

To evaluate the influence of vitamin D supplementation with a multimodal exercise program on postural balance and muscle strength in older women with low bone mineral density (BMD) and vitamin D insufficiency. 12-week, randomized, double-blind, placebo-controlled clinical trial. Total of 422 subjects were screened for participation, and 46 met the inclusion criteria. Those were randomized into an experimental group (EG; n = 23) and control group (CG; n = 23). At the time of enrollment, all subjects had low BMD, vitamin D insufficiency, and were not practicing resistance exercise. Muscle strength assessments were performed by the 30-s sit to stand test; 15-steps climbing test; handgrip dynamometer and knee muscle strength using an isokinetic dynamometer at 60°/sec. Postural balance was clinically evaluated by the MiniBESTest and by a force platform. Dynamic balance was assessed by standing up from a chair and walk over a step, using also a force platform. In the EG, vitamin D levels increased in the post-treatment period (P < 0.001) whereas in CG levels remained unchanged (P = 0.86). Both groups improved muscular strength in the dynamometry isokinetic test: flexors PT/BW – right (P < 0.02) and left side (P < 0.04). In the dynamic postural balance during the task to step up over: the Lift Up Left was better in the CG (P = 0.01); the Moment Time left was better in the CG (P = 0.01); the Impact index left was better in the EG (P = 0.01). The Mini-BESTest - both groups improved the postural balance test (P < 0.001). Vitamin D supplementation associated with multimodal exercise program did not augment muscle strength adaptation or postural balance in older women with low bone mineral density and vitamin D insufficiency. • Multimodal exercise effective for imuscle strength and postural balance • Vitamin D supplementation little effect on muscle strength gain • Vitamin D supplementation little effect on postural balance gain [ABSTRACT FROM AUTHOR]

Telmisartan (TEL), an angiotensin II type I receptor blocker and PPARγ partial agonist, has been used for to treat hypertension. It is known that PPARγ activation induces bone loss. Therefore, we evaluate the effects of telmisartan on PPARγ protein expression, biomechanics, density and bone microarchitecture of femurs and lumbar vertebrae in SHR ovariectomized animals, a model of hypertension in which preexisting bone impairment has been demonstrated. SHR females (3 months old) were distributed into four groups: sham (S), sham + TEL (ST), OVX (C) and OVX + TEL (CT). TEL (5 mg/kg/day) or vehicle were administered according to the groups. After the protocol, blood pressure was measured and density, microarchitecture and biomechanics of bone were analyzed. Western blotting analysis was performed to evaluate PPARγ protein expression in the bones. Castration induced a deleterious effect on mineral density and trabecular parameters, with telmisartan enhancing such effects. Telmisartan increased PPARγ levels, which were at their highest when the treatment was combined with castration. As to biomechanical properties, telmisartan reduced the stiffness in the castration group (CT vs. S or C group), as well as resilience and failure load in ST group (vs. all others groups). These results demonstrated that telmisartan compromised bone density and microarchitecture in animals that shows preexisting osteoporotic bone disorders, probably via mechanisms associated with increased PPARγ. If this translates to humans, a need for greater caution in the use of telmisartan by patients that have preexisting bone problems, as in the postmenopausal period, may be in order. [ABSTRACT FROM AUTHOR]