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Osteoporosis, characterized by compromised bone strength leading to fragility fractures, is a common event in patients with primary biliary cholangitis (PBC). Osteomalacia, defined by poor bone mineralization is very uncommon. The pathogenesis of osteoporosis is not well clarified, but it mainly results from low bone formation. Few reports have revealed increased bone resorption, particularly in end-stage disease. The prevalence of osteoporosis is about 35% in the most significant studies, and it depends on the diagnostic criteria and severity of liver damage. Osteoporosis is associated with age, postmenopausal status, duration of PBC and advanced histological stage. Bone densitometry is the common method for the diagnosis of osteoporosis and should be performed in all patients with PBC. Lateral X-rays of the dorsal and lumbar spine should also be carried out to disclose vertebral fractures. There is no specific treatment but bisphosphonates, especially alendronate and ibandronate, efficiently increases bone mass and prevents bone loss. Despite these positive effects on bone mass no clear results on decreasing the fracture rate have been demonstrated, probably because the low number of patients included in the trials. The potential value of new agents requires further evaluation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Osteoporosis in children and young adults is relatively rare. Hereditary causes are often overlooked in the absence of a positive family history. We report a 29-year-old male presenting with recurrent fragility fractures since 6 years of age. Secondary causes, such as celiac disease, inflammatory disorders, and hypogonadism, were ruled out. Family history was negative for any bone disease. Exome sequencing revealed 2 variants of LRP5 gene—intron 5 c.1015 + 1G > A and exon 5 c.892C > T. Although the former variant has been described in literature as a cause of osteoporosis in homozygous state only, it manifested as osteoporosis in our patient, in the heterozygous state, in presence of a second variant of uncertain significance. However, eye involvement, which is classically seen in "osteoporosis-pseudoglioma syndrome" homozygote, was absent in our patient. Genetic analysis of the parents revealed father to be a carrier of intron 5 c.1015 + 1G > A and mother exon 5 c.892C > T variants of the LRP5 gene. However, none of them had osteoporosis on bone densitometry. The patient was subsequently treated with IV zoledronic acid (planned to be administered annually) and showed improvement in bone density by 11% at the spine and 9.5% at the left femur; there were no further fractures over 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Osteoporosis is the most common bone disease, affecting one in three women and one in five men over the age of 50 worldwide, ultimately affecting nearly 70% of women over the age of 80. The clinical consequence of osteoporosis, which also constitutes its major complication, is a fragility fracture. Globally, it is estimated that osteoporosis is responsible for 9 million fractures each year, or one fracture every 3 seconds. Therefore, its screening in general medicine appears essential. This observation leads to several questions: what is the prescribing attitude of general practitioners? What importance do they give to this screening in their practice? What are the possible obstacles to this screening? [ABSTRACT FROM AUTHOR]

(1) Background: Low bone mineral density (BMD) is a significant risk factor for complicated surgery and leads to the increased use of bone substitutes in patients with distal radius fractures (DRFs). No accepted model has yet been established to predict the use of bone substitutes to facilitate preoperative planning. (2) Methods: Unenhanced dual-energy CT (DECT) images of DRFs were retrospectively acquired between March 2016 and September 2020 using the internal PACS system. Available follow-up imaging and medical health records were reviewed to determine the use of bone substitutes. DECT-based BMD, trabecular Hounsfield units (HU), cortical HU, and cortical thickness ratio were measured in non-fractured segments of the distal radius. Diagnostic accuracy parameters were calculated for all metrics using receiver-operating characteristic (ROC) curves and associations of all metrics with the use of bone substitutes were evaluated using logistic regression models. (3) The final study population comprised 262 patients (median age 55 years [IQR 43–67 years]; 159 females, 103 males). According to logistic regression analysis, DECT-based BMD was the only metric significantly associated with the use of bone substitutes (odds ratio 0.96, p = 0.003). However, no significant associations were found for cortical HU (p = 0.06), trabecular HU (p = 0.33), or cortical thickness ratio (p = 0.21). ROC-curve analysis revealed that a combined model of all four metrics had the highest diagnostic accuracy with an area under the curve (AUC) of 0.76. (4) Conclusions: DECT-based BMD measurements performed better than HU-based measurements and cortical thickness ratio. The diagnostic performance of all four metrics combined was superior to that of the individual parameters. [ABSTRACT FROM AUTHOR]

Background: It has been estimated that about 1% of the US population is treated with long-term glucocorticoids. High doses of glucocorticoids particularly those used by rheumatologists and others for systemic autoimmune rheumatic disease result in bone loss, causing glucocorticoid-induced osteoporosis and an increase in the risk of fractures. The increased risk is related to both the daily dose and the cumulative dose of the glucocorticoids. Despite the availability of effective preventative and treatment options, glucocorticoid-induced osteoporosis is often not mitigated with the use of these preventive therapies. The risk of glucocorticoid-induced osteoporosis often also goes underrecognized, because it occurs in a different group of patients compared to age-related osteoporosis. As a result, glucocorticoid-induced osteoporosis is not always treated until after fractures may have occurred. Our objective is to determine if a structured health-care provider's educational intervention with intermittent educational updates would lead to improvement in the identification, evaluation, and prevention of glucocorticoid-induced osteoporosisin those patients at the highest risk of glucocorticoid-induced osteoporosis. Methods: In this single-center, prospective study, patients over 40 years of age, receiving a total cumulative dose of glucocorticoids of >5 g or a single dose of >30 mg of prednisone or its equivalent was enrolled. All providers attended an academic Journal Club, where the current American College of Rheumatology guidelines regarding glucocorticoid-induced osteoporosiswas reviewed. All providers received monthly reminders during academic meetings within the department. Results: There was a statistically significant improvement between pre- and post-educational data, with increasing use of glucocorticoid-induced osteoporosis preventive measures, which was sustained over the 12-month duration of the study. Conclusion: This research shows the importance of provider education as a means of disseminating information and improving the quality of patient care. [ABSTRACT FROM AUTHOR]

We retrospectively evaluated the clinical and imaging features of 6 patients with bone hydatid disease confirmed by surgery and pathological examination. Among the 6 patients, 2 were infected with Echinococcosis granulosus metacestode and 4 were infected with E. multilocularis metacestode. The 2 cases with cystic echinococcosis were diagnosed by computed tomographic (CT) examination, and other 4 cases were diagnosed by magnetic resonance (MR) imaging. On the initial evaluation, 1 case each was misdiagnosed as a giant cell tumor or neurogenic tumor, and 2 were misdiagnosed as tuberculosis. The imaging manifestations of bone hydatid disease are complex, but most common findings include expansive osteolytic bone destruction, which may be associated with sclerosing edges or dead bone formation, localized soft tissue masses, and vertebral lesions with wedge-shaped changes and spinal stenosis. Combining imaging findings with the patient's epidemiological history and immunological examinations is of great help in improving the diagnosis and differential diagnosis of bone hydatid disease. [ABSTRACT FROM AUTHOR]

Bone fragility is increasingly recognized as an important complication of diabetes mellitus (DM), and both type 1 (T1DM) and type 2 (T2DM) diabetes are associated with a higher risk of fracture. The causes of bone fragility in diabetic patients are not yet fully understood; probably they are linked to low bone mineral density (BMD), poor bone quality due to the alterations in bone remodelling, microarchitecture and composition of the bone matrix. Quantitative ultrasound (QUS) is a validated, low-cost and free ionizing radiation alternative to DXA measurement of BMD for the assessment of fracture risk. The results obtained by using QUS in T1DM and T2DM have been summarized and reported in this review. QUS technique presents some benefits but also some limits. These limits could be overcome by radiofrequency echographic multispectrometry (REMS) that is a non-ionizing technology recently introduced for the assessment of bone status that can also calculate parameters related to bone quality and strength. Therefore, REMS may represent a promising approach to evaluate bone status and fragility fracture risk in DM subjects. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is characterized by critical alterations of the subchondral bone microstructure, besides the well‐known cartilaginous changes. Clinical computed tomography (CT) detection of quantitative 3D microstructural subchondral bone parameters is applied to monitor changes of subchondral bone structure in different stages of human OA and is compared with micro‐CT, the gold standard. Determination by clinical CT (287 µm resolution) of key microstructural parameters in tibial plateaus with mild‐to‐moderate and severe OA reveals strong correlations to micro‐CT (35 µm), high inter‐ and intraobserver reliability, and small relative differences. In vivo, normal, mild‐to‐moderate, and severe OA are compared with clinical CT (331 µm). All approaches detect characteristic expanded trabecular structure in severe OA and fundamental microstructural correlations with clinical OA stage. Multivariate analyses at various in vivo and ex vivo imaging resolutions always reliably separate mild‐to‐moderate from severe OA (except mild‐to‐moderate OA from normal), revealing a striking similarity between 287 µm clinical and 35 µm micro‐CT. Thus, accurate structural measurements using clinical CT with a resolution near the trabecular dimensions are possible. Clinical CT offers an opportunity to quantitatively monitor subchondral bone microstructure in clinical and experimental settings as an advanced tool of investigating OA and other diseases affecting bone architecture. [ABSTRACT FROM AUTHOR]

Background: Bone mineral density (BMD) testing is indicated for women aged 65 years, but screening strategies for osteoporosis are controversial. Currently, there is no study focusing on the BMD testing interval in Asian populations. The current study aimed to evaluate the estimated time interval for screening osteoporosis. Methods: We conducted a study of 6,385 subjects aged 50 years and older who underwent dual-energy X-ray absorptiometry screening more than twice at Samsung Medical Center as participants in a routine health checkup. Subjects were divided based on baseline T-score into mild osteopenia (T-score, <-1.0 to >-1.5), moderate osteopenia (T-score, ≤-1.5 to >-2.0), and severe osteopenia (T-score, ≤-2.0 to >-2.5). Information about personal medical and social history was collected by a structured questionnaire. Results: The adjusted estimated BMD testing interval for 10% of the subjects to develop osteoporosis was 13.2 years in mild osteopenia, 5.0 years in moderate osteopenia, and 1.5 years in severe osteopenia. Conclusion: Our study provides extended information about BMD screening intervals in Asian female population. Baseline T-score was important for predicting BMD screening interval, and repeat BMD testing within 5 years might not be necessary in mild osteopenia subjects. [ABSTRACT FROM AUTHOR]

Bone biopsy is the gold standard for characterization of renal osteodystrophy (ROD). However, the classification of the subtypes of ROD based on histomorphometric parameters is not unambiguous and the range of normal values for turnover differ in different publications. 18F-Sodium Fluoride positron emission tomography (18F-NaF PET) is a dynamic imaging technique that measures turnover. 18F-NaF PET has previously been shown to correlate with histomorphometric parameters. In this cross-sectional study, 26 patients on dialysis underwent a 18F-NaF PET and a bone biopsy. Bone turnover-based classification was assessed using Malluche's historical reference values for normal bone turnover. In unified turnover-mineralization-volume (TMV)-based classification, the whole histopathological picture was evaluated and the range for normal turnover was set accordingly. Fluoride activity was measured in the lumbar spine (L1–L4) and at the anterior iliac crest. On the basis of turnover-based classification of ROD, 12% had high turnover and 61% had low turnover bone disease. On the basis of unified TMV-based classification of ROD, 42% had high turnover/hyperparathyroid bone disease and 23% had low turnover/adynamic bone disease. When using unified TMV-based classification of ROD, 18F-NaF PET had an AUC of 0.86 to discriminate hyperparathyroid bone disease from other types of ROD and an AUC of 0.87, for discriminating adynamic bone disease. There was a disproportion between turnover-based classification and unified TMV-based classification. More research is needed to establish normal range of bone turnover in patients with CKD and to establish the role of PET imaging in ROD. [ABSTRACT FROM AUTHOR]

Objective: To explore the association of superscan image in technetium 99m-labeled methylene diphosphonate bone scans with chemical parameters of high turnover bone disease and bone mineral density measurement findings in chronic peritoneal dialysis patients. Methods: Technetium 99m-labeled methylene diphosphonate bone scans of 15 chronic peritoneal dialysis patients with superscan images were matched by their age, gender, dialysis vintage, body mass index, and Kt/V values with 20 patients with no superscan image. Serum iPTH, Ca, P, 25(OH)D3, 1-25(OH)2D3, total and bone alkaline phosphatases, dual-energy X-ray absorptiometry-based bone mineral density results were measured. Results: Serum iPTH levels were significantly higher in superscan patients (587.3±515.9 pg/ml vs 214.8±224.9 pg/ml, P=.001) and correlated with the existence of superscan image (P=.007, r=−0.450) in bone scans. Total alkaline phosphatase levels were also significantly higher in superscan patients (414.7±400.6 vs 235.6±117.6 U/L, P=.046). Ca, P, CaXP, 25(OH)D3, 1-25(OH)2D3, bone alkaline phosphatase levels, and bone mineral densities were not different between groups. Conclusion: Superscan image in technetium 99m-labeled methylene diphosphonate bone scans correlated well with serum iPTH and total alkaline phosphatase levels, and therefore, it may be suggestive for high turnover bone disease in chronic peritoneal dialysis patients. Lack of any difference between groups regarding their bone mineral densities suggests that the main difference between groups may be a metabolic one, rather than being structural. We believe that superscan images may be a diagnostic tool for high turnover bone disease, and they may have a role as an excluding tool of a dynamic bone disease especially before the use of bisphosphonates. [ABSTRACT FROM AUTHOR]

Introduction: Long-term treatment is used in patients with osteoporosis, and bisphosphonates (BPs) are the most commonly prescribed medications. However, in some patients this therapy is not effective, cause different side effects and complications. Unfortunately, at least one year is needed to identify and confirm an ineffectiveness of BPs therapy on bone mineral density (BMD). Among other factors, a response to BPs therapy may also be explained by genetic factors. The aim of this study was to analyze the influence of SOST, PTH, FGF2, FDPS, GGPS1, and LRP5 gene variants on the response to treatment with aminobisphosphonates. Materials and methods: Women with postmenopausal osteoporosis were included to this study if they used aminobisphosphonates for at least 12 months. Exclusion criteria were: persistence on BPs therapy less than 80%, bone metabolic diseases, diseases deemed to affect bone metabolism, malignant tumours, using of any medications influencing BMD. The study protocol was approved by the local ethics committee. The BMD at the lumbar spine and femoral neck were measured using dual x-ray absorptiometry (GE Lunar) before and at least 12 months after treatment with BPs. According to BMD change, patients were divided in two groups–responders and non-responders to BPs terapy. Polymorphic variants in SOST, PTH, FGF2, FDPS, GGPS1, and LRP5 genes were determined using PCR analysis with TaqMan probes (Thermo Scientific). Results: In total, 201 women with BPs therapy were included in the study. No statistically significant differences were observed in age, age at menopause, weight, height, BMI and baseline BMD levels between responders (122 subjects) and non-responders (79 subjects). As single markers, the SOST rs1234612 T/T (OR = 2.3; P = 0.02), PTH rs7125774 T/T (OR = 2.8, P = 0.0009), FDPS rs2297480 G/G (OR = 29.3, P = 2.2×10−7), and GGPS1 rs10925503 C/C+C/T (OR = 2.9; P = 0.003) gene variants were over-represented in non-responders group. No significant association between FGF2 rs6854081 and LRP5 rs3736228 gene variants and response to BPs treatment was observed. The carriers of T-T-G-C allelic combination (constructed from rs1234612, rs7125774, rs2297480, and rs10925503) were predisposed to negative response to BPs treatment (OR = 4.9, 95% CI 1.7–14.6, P = 0.005). The C-C-T-C combination was significantly over-represented in responders (OR = 0.1, 95% CI 0.1–0.5, P = 0.006). Conclusions: Our findings highlight the importance of identified single gene variants and their allelic combinations for pharmacogenetics of BPs therapy of osteoporosis. Complex screening of these genetic markers could be used as a new strategy for personalized antiresorptive therapy. [ABSTRACT FROM AUTHOR]

Background: Bone densitometry (e.g., dual-energy X-ray absorptiometry or "DXA") is strongly associated with osteoporosis treatment; however, rates of DXA are low. While studies have demonstrated a continued need for primary care provider education on the role of DXA in preventive care, little is known about the role of patient attitudes toward DXA. This review's purpose is to synthesize the evidence about the effects of patient perceptions and experiences of DXA on osteoporosis prevention.Methods: A metasynthesis was conducted of English language, peer-reviewed publications, searching relevant databases: MEDLINE, CINAHL, Web of Science Social Science Citation Index, PsycINFO, and Sociological Abstracts. Identified articles' quality was appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist, and an iterative process of data evaluation, integration, and synthesis was used to develop the findings.Results: Thirteen articles from ten studies were identified, composing an aggregated sample of 265 people (231 women). Participant attitudes toward screening ranged from receptive to ambivalent to concerned about results. Participants' understandings of DXA and its role in clinical care were limited. Knowledge of osteoporosis was also partial and influenced by lay sources, the media, and health care providers. Primary care providers strongly influenced participant behavior, especially if participants had a more passive approach to health care. Participants reported less concern about expected barriers of health care access and cost.Conclusion: Minimal knowledge exists of patient perceptions and experiences of DXA among those who are fracture naïve: Prior research has focused primarily on secondary fracture prevention contexts. Our metasynthesis reveals patients' significant reliance, given their limited risk appraisal and knowledge, upon primary care providers in decision-making. We urge colleagues to conduct qualitative research on DXA barriers among general primary care population in order to facilitate health care delivery systems better equipped to diagnose and treat patients before their first fracture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcome of bone metabolism and bone mineral density (BMD) in haemodialysis patients after parathyroidectomy (PTX).Methods: A total of 31 haemodialysis patients with secondary hyperparathyroidism (SHPT) were treated with PTX. BMD of lumbar spine (LS) and femoral neck (FN) was determined by dual energy X-ray absorptiometry.Results: Parathyroidectomy ledds to significant decrease of serum β-crosslaps (β-CTX), osteocalcin (OC) and procollagen type I amino-terminal propeptide (PINP) while serum sclerostin (SOST) increased after surgery. BMD was markedly improved in both LS and FN after PTX. Z-scores analysis further confirmed that PTX significantly benefited bone metabolism in haemodialysis patients, which well correlated with the improvement of serum iPTH and OC.Conclusions: Parathyroidectomy leads to significant improvement of serum OC, PINP, β-CTX and SOST, which may beneficially modify calcium-phosphorus metabolism and BMD in haemodialysis patients with SHPT. [ABSTRACT FROM AUTHOR]

Forward falls represent a risk of injury for the elderly. The risk is increased in elderly persons with bone diseases, such as osteoporosis. However, half of the patients with fracture were not considered at risk based on bone density measurement (current clinical technique). We assume that loading conditions are of high importance and should be considered. Real loading conditions in a fall can reach a loading speed of 2 m/s on average. The current study aimed to apply more realistic loading conditions that simulate a forward fall on the radius ex vivo . Thirty radii from elderly donors (79 y.o. ± 12 y.o., 15 males, 15 females) were loaded at 2 m/s using a servo-hydraulic testing machine to mimic impact that corresponds to a fall. Among the 30 radii, 14 had a fracture after the impact, leading to two groups (fractured and non-fractured). Surfacic strain fields were measured using stereovision and allow for visualization of fracture patterns. The average maximum load was 2963 ± 1274 N. These experimental data will be useful for assessing the predictive capability of fracture risk prediction methods such as finite element models. [ABSTRACT FROM AUTHOR]

• Osteopenia and osteoporosis are a major burden on the health care system due to the complications. • Due to increasing workload, osteopenia is often not described by radiologists. • AI-based evaluations as second reader allow an increase in the quality of reports. • AI-based quantification of vertebral body attenuation is a good parameter for osteopenia. As osteoporosis is still underdiagnosed by clinicians and radiologists, the aim of the present study was to assess the performance of an Artificial intelligence (AI)-based Convolutional Neuronal Network (CNN)-Algorithm for the detection of low bone density on routine non-contrast chest CT in comparison to clinical reports using DEXA scans as reference. This retrospective cross-sectional study included patients who underwent non-contrast chest CT and DEXA between April 2018 and June 2018 (n = 109, 19 men, mean age: 67.7 years). CT studies were evaluated for thoracic vertebral bone pathologies using a CNN-Algorithm, which calculates the attenuation profile of the spine. The content of the radiological reports was evaluated for the description of osteoporosis or osteopenia. DEXA was used as the reference standard. To estimate correlation the Spearman test was used and the comparison of the different groups was performed using the Wilcoxon rank sum test. Diagnostic was evaluated by performing a receiver operating characteristic curve analysis. The DEXA examination revealed normal bone density in 42 patients, while 49 patients had osteopenia and 7 osteoporosis. There was a statistically significant correlation between the mean CNN-based attenuation of the thoracic spine and the bone density measured on the DEXA in the hip (r = 0.51, p < 0.001) and lumbar spine (r = 0.34, p = 0.01). The mean attenuation was significantly higher in patients with normal bone density (172 ± 44.5 HU) compared to those with osteopenia or osteoporosis (125.2 ± 33.8 HU), (p < 0.0001). Diagnostic performance in distinguishing normal from abnormal bone density was higher using the CNN-based vertebral attenuation (accuracy 0.75, sensitivity: 0.93, specificity: 0.61) compared to clinical reports (accuracy 0.51, sensitivity: 0.14, specificity: 0.53). CNN-based evaluation of bone density may provide additional value over standard clinical reports for the detection of osteopenia and osteoporosis in patients undergoing routine non-contrast chest CT scans. This additional value could improve identification of fracture risk and subsequent treatment. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted to assess bone mineral density (BMD) and bone mineral content (BMC) of patients with hemoglobin H (HbH) disease.Methods: BMD and BMC were measured by dual energy X-ray absorptiometry of the lumbar spines and femur neck in 21 patients with Hb H disease over the age of 10 years. An association of BMD with sex, age, hemoglobin, calcium, phosphorus, and serum ferritin level was also evaluated.Results: Prevalence of BMD below the expected range for age in the lumbar spine and femur neck region in patients with HbH disease were 33.3 and 14.3 %, respectively. Lumbar BMD was significantly lower in the patients compared to healthy individuals (median (min-max) 0.725 (0.595-0.924) vs. 1.061 (0.645-1.238), P < 0.001)). There was no significant relationship between BMD in the lumbar and femur neck with any of the evaluated variables (P value >0.05).Conclusion: Data regarding bone density in HbH disease is limited; osteoporosis as a common complication of β-thalassemia intermedia syndrome should be considered even in HbH which shows its prevalence is less than β-thalassemia intermedia. [ABSTRACT FROM AUTHOR]

Maximizing peak bone mass in childhood is relevant to optimizing bone health in later life, so the study of the skeleton in children in health and disease is important. Dual-energy X-ray absorptiometry (DXA) is the most widely used clinical tool for the assessment of bone status in children. Technological developments in DXA enable vertebral fracture assessment at much lower ionizing radiation doses than spinal radiographs. Quantitative computed tomography remains predominantly a research tool but has some advantages over DXA in not being size dependent. High-resolution peripheral computed tomography measures trabecular and cortical bone microstructure but is technically challenging, particularly in children, and not widely available, so it is unlikely to be used in clinical practice. Other quantitative techniques (quantitative magnetic resonance imaging, digital X-ray absorptiometry, quantitative ultrasound) have been applied in children but remain research applications, and they are only covered briefly in this review. [ABSTRACT FROM AUTHOR]

Purpose The aim of the study was to evaluate factors related to bone formation and resorption in Polish children and adolescents with cystic fibrosis and to examine the effect of nutritional status, biochemical parameters and clinical status on bone mineral density. Materials and methods The study group consisted of 100 children and adolescents with cystic fibrosis with a mean age 13.4 years old. Anthropometric measurements, included body height, body mass and body mass index (BMI); bone mineral densitometry and biochemical testing were performed. Bone mineral density was measured using a dual-energy X-ray absorption densitometer. Biochemical tests included serum calcium, phosphorus, parathyroid hormone and vitamin D concentrations, as well as 24-h urine calcium and phosphorus excretion. Pulmonary function was evaluated using FEV 1 %, and clinical status was estimated using the Shwachman–Kulczycki score. Results Standardized body height, body mass and BMI were significantly lower than in the reference population. Mean serum vitamin D concentration was decreased. Pulmonary disease was generally mild, with a mean FEV 1 % of 81%. Multivariate linear regression revealed that the only factors that had a significant effect on bone marrow density were BMI and FEV 1 %. There were no significant correlations between bone mineral density and the results of any of the biochemical tests performed. Conclusions Nutritional status and bone mineral density were significantly decreased in children and adolescents with cystic fibrosis. In spite of abnormalities in biochemical testing, the factors that were found to have the strongest effect on bone mineral density were standardized BMI and clinical status. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a disease characterized by a decreased bone mineral density and increased risk of fractures. Objective: To determine the prevalence and risk factors of osteoporosis in subjects older than 18 years, assisting to the Health Week of the Hospital Angeles Pedregal. Patients and method: A cross-sectional study was made in which we evaluated 432 subjects who were applied a questionnaire that included demographic information, medical history and risk factors for osteoporosis. In all patients, weight, height, bone mineral density, lipid profile and fasting glucose were measured. All subjects were performed bone densitometry of the right wrist. The 10-year probability of hip fracture and major osteoporotic fracture was calculated whit the FRAX tool. The study was conducted in the Hospital Angeles Pedregal, Mexico City, during the month of September 2013. Results: We reviewed a total of 276 patients, of them, 15.9% had low bone mass (LBM) and one patient (0.4%), osteoporosis. Age ≥ 40 years was associated with an increased risk of low bone mass (OR 8.84, 95% CI 3.06-25.49, p≤0.001). The group of patients with low bone mass and osteoporosis was associated with increased consumption of cigarettes per day (2.98 ± 2.58 vs 6.54 ± 7.24, p = 0.003). A history of parental hip fracture was associated with an increased risk of low bone mass (OR 2.35 95% CI 1.21-4.58, p=0.019). Osteopenia group presented a higher risk of major osteoporotic or hip fracture by FRAX score (1.65 ± 0.92 vs 4.787 ± 2.5, p<0.001 and 0.126 ± 0.17 vs 0.40 ± 0.42, p<0.001). Conclusions: The prevalence of osteoporosis was of 0.4% and 15.9% for low bone mass. Patients with low bone mass and osteoporosis had higher risk of major osteoporotic or hip fracture by FRAX score. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the agreement between FRAX scores calculated with and without femoral neck (FN) bone mineral density (BMD) and to investigate the resultant treatment recommendations in women with osteopenia. A cross-sectional review of postmenopausal women who were referred for DXA evaluation was conducted. One hundred twenty-nine postmenopausal women aged 40 years and older with osteopenia [FN T-score between −1 and (−2.5)] were recruited for the study. Absolute agreement between FRAX scores calculated with and without BMD was analyzed by intraclass correlation analysis (ICC). Thresholds recommended by National Osteoporosis Foundation were used for treatment recommendations. Correlation between demographic factors and the difference in BMD+ and BMD− FRAX scores was analyzed by Spearman correlation test. Agreement levels and treatment recommendations were also analyzed in 112/129 patients without previous fracture. Agreement between BMD+ and BMD− MO and hip FRAX scores was good (ICC 0.867) and fair to good (ICC 0.641), respectively. In patients without previous fracture, agreement between MO and hip fracture probabilities was good (ICC = 0.838 and ICC = 0.778, respectively). Treatment recommendations with respect to treatment threshold of ≥3 for hip fracture probabilities were identical in 120/129 (93 %) cases. Difference between BMD+ and BMD− fracture probabilities was correlated with age and FN BMD. In most cases, FRAX without BMD provided the same treatment recommendations as FRAX with BMD in postmenopausal women with osteopenia. Exclusion of patients with previous fracture yielded better agreement levels. [ABSTRACT FROM AUTHOR]

Age related bone loss predisposes adults to osteoporosis. This is especially true for individuals with spinal cord injury (SCI). The effects of decreased bone loading with older age and paralysis significantly contribute to decreased bone mass and increased risk for fragility fractures. Loading bone via volitional muscle contractions or by using electrical stimulation are common methods for helping to prevent and/or decrease bone loss. However the effectiveness and safety of electrical stimulation activities remain unclear. The purpose of this review is to investigate the factors associated with aging and osteoporosis after SCI, the accuracy of bone measurement, the effects of various forms of bone loading activities with a focus on electrical stimulation activities and the safety of physical exercise with a focus on electrical stimulation cycling. Osteoporosis remains a disabling and costly condition for older adults and for those with paralysis. Both dual energy x-ray absorptiometry and peripheral quantitative computed tomography are valuable techniques for measuring bone mineral density (BMD) with the latter having the ability to differentiate trabecular and cortical bone. Physical activities have shown to be beneficial for increasing BMD however, the extent of the benefits related to aging and paralysis remain undetermined. Electrical stimulation activities administered appropriately are assumed safe due to thousands of documented safe FES cycling sessions. However, specific documentation is needed to verify safety and to development formal guidelines for optimal use. [ABSTRACT FROM AUTHOR]

The mechanisms linking fat intake to bone loss remain unclear. By demonstrating the expression of the free fatty acid receptor G-coupled protein receptor 40 (GPR40) in bone cells, we hypothesized that this receptor may play a role in mediating the effects of fatty acids on bone remodeling. Using micro-CT analysis, we showed that GPR40-/- mice exhibit osteoporotic features suggesting a positive role of GPR40 on bone density. In primary cultures of bone marrow, we showed that GW9508, a GRP40 agonist, abolished bone-resorbing cell differentiation. This alteration of the receptor activator of NF-κB ligand (RANKL)-induced osteoclast differentiation occurred via the inhibition of the nuclear factor κB (NF-κB) signaling pathway as demonstrated by decrease in gene reporter activity, inhibitor of κB kinase (IKKα/β) activation, inhibitor of κB (IkBα) phosphorylation, and nuclear factor of activated T cells 1 (NFATc1) expression. The GPR40-dependent effect of GW9508 was confirmed using shRNA interference in osteoclast precursors and GPR40-/- primary cell cultures. In addition, in vivo administration of GW9508 counteracted ovariectomy-induced bone loss in wild-type but not GPR40-/- mice, enlightening the obligatory role of the GPR40 receptor. Then, in a context of growing prevalence of metabolic and age-related bone disorders, our results demonstrate for the first time in translational approaches that GPR40 is a relevant target for the design of new nutritional and therapeutic strategies to counter bone complications. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Most studies have shown that patients with chronic hepatitis C virus (HCV) infection are affected by osteoporosis. However, liver function impairment and deranged nutrition may both play a role in the bone alterations observed. In some works no osteoporosis was found, and some cases of osteosclerosis have been reported. The aim of the study is to assess bone alterations in treatment-naïve, well-nourished HCV patients, in order to discern whether or not HCV infection causes osteoporosis. Methods: Whole-body bone densitometry and assessment of T-score at lumbar spine and hip were performed to 40 patients and 40 age‐ and sex-matched controls, with a Lunar Prodigy Advance (General Electric, Piscataway, NJ, USA). All the patients underwent liver biopsy. Nutritional evaluation was performed by subjective nutritional assessment, body mass index (BMI), and densitometric assessment of total lean mass and total fat mass. Serum osteocalcin, osteoprotegerin, RANKL, PTH, crosslaps, vitamin D3, testosterone, IGF-1, and estradiol were determined. Results: Patients did not show differences in total bone mineral density (BMD) or T-score with controls. On the contrary, about a third of them showed positive T scores. Patients showed lower IGF-1, vitamin D3 and testosterone, but higher telopeptide levels, and a trend to higher osteoprotegerin levels. Multivariate analyses disclosed that age, sex, and total lean mass were the only parameters independently related with BMD. Conclusions: Therefore, chronic HCV infection in well nourished patients with preserved liver function does not cause osteoporosis. [Copyright &y& Elsevier]

Summary Introduction: N-terminal propeptide of type 1 collagen (PINP) is a marker for bone formation. Blood PINP is found in trimeric and monomeric forms. There are two automated methods for its determination. ® R-PINP (Roche Diagnostics) determines both forms (Total PINP). IDS-PINP (IDS iSYS N-Mid Vitro) determines the trimeric part (Intact PINP). Objective: To compare the two methods. Material and method: 81 patients (64 men and 17 women, average age of 53 ± 8 years) with terminal hepatic insufficiency were recruited. Creatinine, PTH, 25-OH-vitamin D, beta-crosslaps (ß-CTX), desoxypyridinoline (Dpyr), hepatic function and PINP with both methods, were measured. Bone mineral ® density (BMD) was measured (Hologic , QDR 4500) in the lumbar spine and femoral neck. The comparison between the two methods was carried out using a Bland-Altman and Passing'Bablok analysis. Results: R-PINP showed higher values than IDS-PINP (85.03 ± 56.67 vs. 55.22 ± 32.81 ng/mL, p<0,001). The correlation between the two methods was r= 0.81 (p<0.01) and the Passing-Bablok regression analysis Y = 0.570 [0.475-0.669] X + 7.724 [2.130-12.542]. Conclusion: There is a good correlation between the two methods in patients with hepatic insufficiency, although not proportional or interchangeable. [ABSTRACT FROM AUTHOR]

Introduction: Thalassemia is the most common genetic disorder, affecting around 200 million people worldwide. The etiology of this bone disease is multifactorial. Seemingly, in the setting of increased bone turnover which manifests by increased bone resorption and remodeling; bone density decreases. In this research, thalassaemia patients with osteoporosis were placed on oral alendronate therapy for one year and their pre-and post-study bone mineral densitometry were compared. Method: Thalassaemia patients, comprising the major and intermedia types, in the range of 20 to 50 years old were included in the study. They were admitted to three different centers: Tehran Center of Thalassaemia, Iranian Blood Transfusion Organization and the Rheumatology Clinic of Rasool Akram(s) Hospital. First of all, osteoporotic patients diagnosed on the basis of densitometry were placed on oral regimen of 10mg of alendronate daily. After a year, their densitometries were repeated and compared for the changes in BMD(g/cm2) and T-score. Also, patient's serum calcium, phosphorus and alkaline phosphatase levels were measured at the beginning and the end of the year and the results were compared. Results: Ninety-six of 120 patients who underwent first and second bone density measurements showed an increase in BMD and T-score at the end of the study. BMD increased in patients who used their drugs regularly, while no increased BMD was found in patients who used drugs irregularly or essentially did not use any drug. Conclusion: we concluded that bisphosphonates like alendronate are highly effective at improving bone density of neck of femur and vertebral bones without having dangerous side effects. So, early diagnosis, treatment and prophylaxis of osteoporosis in this group of patients are highly recommended. [ABSTRACT FROM AUTHOR]

Abstract: Menopause is the major risk factor for the loss of bone mineral density (BMD) and bone mineral content (BMC) in women. In this study, we determined the prevalence of osteoporosis in postmenopausal women in Kuwait and compared it with that of other Middle East and west countries. Two thousand two hundred ninety-six postmenopausal women ranging in age from 40 to 87yr were included in the study and divided into 4 age groups by decade. We measured body weight, height, body mass index (BMI), BMD, and BMC. The mean age, height, and weight were 59.1+7.9yr, 154.7+6.5cm, and 77.3+14.9kg, respectively. The mean BMI and BMC were 32.4+6.6kg/m2 and 0.9+0.14g/cm2, respectively. The average T-scores for the hip and lumbar spine were −0.280+1.2 and −1.297+1.33, respectively. BMC significantly decreased with age from 0.95 to 0.81g/cm2. Four hundred forty-four (19.3%) were found to have osteoporosis. The incidence of osteoporosis significantly increased from 4.3% to 39.9% with age, which is lower than that reported for Saudi (40%) and Moroccan women (39.6%) and higher than that for US/European (31%) and Lebanese women (11%). [Copyright &y& Elsevier]

Bone loss is a common side effect of cancer treatments, especially antihormonal treatments used in the treatment of breast and prostate cancer. Denosumab is a monoclonal antibody given subcutaneously that inhibits osteoclast activity by targeting the RANK ligand. It is effective in settings ranging from preventing skeletal-related complications in cancer patients with metastatic disease to increasing bone mineral density in patients with osteoporosis. In cancer patients with early stage disease, denosumab can attenuate bone loss from antihormonal treatments, and in prostate cancer, may reduce disease progression. Here, we will discuss the important role denosumab may play in the management of bone loss in patients with cancer [ABSTRACT FROM AUTHOR]

Osteoporosis is a well-recognized problem in older women. However, there has been insufficient awareness among both the public and the medical profession that osteoporosis is also a common problem in older men. It is estimated that one in five 50-year-old men will sustain a fragility fracture during the remainder of his life. Although treatments that increase bone density are available, few men receive treatment. Until recently, treatment decisions in osteoporosis have been based almost entirely on bone density measurements. Recently, tools have been developed that enable a more precise assessment of absolute fracture risk, which is expected to significantly facilitate treatment decisions. It is hoped that a greater awareness of the problem of osteoporosis in men will lead to better treatment, and ultimately to a decrease in fractures and their associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract: It was investigated whether cadmium (Cd) may induce oxidative stress in the bone tissue in vivo and in this way contribute to skeleton damage. Total antioxidative status (TAS), antioxidative enzymes (glutathione peroxidase, superoxide dismutase, catalase), total oxidative status (TOS), hydrogen peroxide (H2O2), lipid peroxides (LPO), total thiol groups (TSH) and protein carbonyl groups (PC) as well as Cd in the bone tissue at the distal femoral epiphysis and femoral diaphysis of the male rats that received drinking water containing 0, 5, or 50mg Cd/l for 6months were measured. Cd, depending on the level of exposure and bone location, decreased the bone antioxidative capacity and enhanced its oxidative status resulting in oxidative stress and oxidative protein and/or lipid modification. The treatment with 5 and 50mg Cd/l decreased TAS and activities of antioxidative enzymes as well as increased TOS and concentrations of H2O2 and PC at the distal femur. Moreover, at the higher exposure, the concentration of LPO increased and that of TSH decreased. The Cd-induced changes in the oxidative/antioxidative balance of the femoral diaphysis, abundant in cortical bone, were less advanced than at the distal femur, where trabecular bone predominates. The results provide evidence that, even moderate, exposure to Cd induces oxidative stress and oxidative modifications in the bone tissue. Numerous correlations noted between the indices of oxidative/antioxidative bone status, and Cd accumulation in the bone tissue as well as indices of bone turnover and bone mineral status, recently reported by us (Toxicology 2007, 237, 89–103) in these rats, allow for the hypothesis that oxidative stress is involved in the mechanisms of damaging Cd action in the skeleton. The paper is the first report from an in vivo study indicating that Cd may affect bone tissue through disorders in its oxidative/antioxidative balance resulting in oxidative stress. [Copyright &y& Elsevier]

Abstract: Low birth weight and poor childhood growth program a variety of adult diseases including bone disorders such as osteoporosis. We have previously reported that offspring born small, as a result of uteroplacental insufficiency, have shorter femurs, lower bone mineral content and a bone strength deficit as adults. The aim of this study was to determine the effects of calcium supplementation from adolescence on growth restricted male and female offspring which have a programmed bone deficit. Bilateral uterine vessel ligation (Restricted) or sham surgery (Control) was performed on gestational day 18 in WKY rats to induce uteroplacental insufficiency and growth restriction. At 2months pups were allocated to one of four diet groups: diet 1—constant normal calcium diet, diet 2—variable normal calcium diet, diet 3—constant high calcium diet, diet 4—variable high calcium diet. Diet groups 1 and 3 were fed their respective diets constantly for the duration of the study. In groups 2 and 4, rats were fed one diet for 5days, followed by a switch to a low calcium diet for the next 5days. At 6months Dual Energy Xray Absorptiometry (DXA) and Peripheral Quantitative Computed Tomography (pQCT) were performed on the right femur. Bone turnover markers were measured at 4months. Male and female Restricted offspring were born 14% lighter compared to Controls (p <0.05). At 6months both male and female Restricted offspring remained smaller and had shorter femurs compared to Controls (p <0.05). Restricted males and females had reduced trabecular and cortical content compared to Controls, regardless of diet (p <0.05). Trabecular bone density was lower in Restricted females only (p <0.05). A constant high calcium diet increased cortical BMD in Restricted male and both female groups (p <0.05). Measures of bone geometry indicated that Restricted offspring have narrower bones with preservation of absolute cortical thickness (p <0.05). Importantly, the stress strain index of bone bending strength was lower in male and female Restricted offspring, regardless of diet by up to 9.0% and 7.8%, respectively. DXA results were similar to pQCT results. Being born small, due to uteroplacental insufficiency, programs reduced adult femur length, dimensions and stress strain index. Supplementation with a high calcium diet from adolescence can increase adult cortical bone density in low birth weight males and females, and normal weight females. This increase in bone density was not sufficient to rescue the bone dimension and strength deficits which were programmed in utero, suggesting that the early life environment is critical for bone programming. [Copyright &y& Elsevier]

Abstract: In January 2007, in the United States (US), Medicare initiated a series of cuts to reimbursement for dual-energy X-ray absorptiometry (DXA) services performed in the nonfacility setting that by January 2010 reduced payments for these services by more than 60% compared with 2006 levels. The objectives of this study were to determine if a temporal association exists between Medicare Physician Fee Schedule changes in office-based DXA reimbursement and attendance at educational conferences for osteoporosis, physicians’ perceptions of changes in their medical practices, or national trends in retail prescription medications for osteoporosis in those aged 65 and older. Compared with the 2yr before the decline in Medicare reimbursement for DXA (2005–2006), attendance at educational meetings for osteoporosis in the US declined in the 2yr after these cuts (2007–2008) by 6%; declines in attendance were only present in meetings selective for bone densitometry. Survey participants reported changes in DXA services with approximately one-third indicating that they had either decreased the number of DXAs they performed or declined service contracts or hardware/software updates compared with 2005–2006. The number of retail prescriptions for Food and Drug Administration–approved osteoporosis drugs (excluding estrogen compounds and raloxifene) in the age 65 and older population increased by 5.5% in the time period 2007–2008 compared with 2005–2006. However, in the last year of the study (2008), total retail prescriptions for these drugs experienced for the first time over the interval of the study, a decline (1.4%) compared with the previous year. This occurred despite a 2.6% increase in the US population age 65 and older. In conclusion, there were temporal associations noted between Medicare cuts in DXA payments in attendance at educational conferences for bone densitometry, self-report of office-based provision of DXA services in the US, and retail prescriptions for osteoporosis therapies. [Copyright &y& Elsevier]

Background: The aim of this study was to investigate the effect of BMI and reproductive histories (age, age at menarche, the number of parities, reproductive years and years since menopause, and serum levels of estradiol, testosterone and SHBG) on bone densitometry of spine and femur in healthy postmenopausal women. Materials and Methods: In a descriptive cross-sectional study, 190 healthy postmenopausal women, aged 40-64, who did not have a history of co-existing diseases, diseases affecting the quality of life, bone diseases, and using drugs affecting the bone metabolism, were randomly selected. Bone densitometry, T score, Z score, and bone marrow density (BMD) were determined by dual energy X-ray absorptiometry (DXA) at lumbar spine and femur. Correlation co-efficients were, then, measured for the relationship between bone density and the intended factors. Results: BMI presented significant positive relationships with T score and BMD of spine and BMD, T score, and Z score of femur, whereas age, the number of years since menopause, and the serum level of testosterone had negative relationships with T score and BMD of spine. The serum level of testosterone showed a negative relationship with Z score reduction in spine. The number of years since menopause had a positive relationship with reductions in Z score and BMD of femur. In addition, significant positive relationships were observed between the number of reproductive years and T score and BMD of spine. Conclusion: Bone loss in postmenopausal women is intensified with increases in age, the number of years since menopause, and the serum level of testosterone, whereas BMI has a bone-protective effect. [ABSTRACT FROM AUTHOR]

Hypophosphatemic rickets (HR) is a group of rare disorders caused by excessive renal phosphate wasting. The purpose of this cross-sectional study of 38 HR patients was to characterize the phenotype of adult HR patients. Moreover, skeletal and endodontic severity scores were defined to assess possible gender differences in disease severity in patients with genetically verified X-linked HR. Compared to normal reference data, i.e., z = 0, HR patients had significantly lower final height, with a mean difference in z-score of -1.9 (95% CI -2.4 to -1.4, P < 0.001). Compared to paired z-scores of final height, z-scores of leg length were significantly lower and those of sitting height were significantly higher (P < 0.001), resulting in disproportion as indicated by the significantly elevated sitting height ratio, mean difference in z-score of 2.6 (95% CI 2.1-3.1, P < 0.001). Z-scores of head circumference (median 1.4, range -0.4 to 5.5, P < 0.001) and z-scores of bone mineral density (BMD) of the lumbar spine (median 1.9, range -1.5 to 8.6, P < 0.001) were significantly elevated compared to normal reference data. The relative risk (RR) of fracture was reduced (RR = 0.34, 95% CI 0.20-0.57, P < 0.001). The skeletal severity score tended to be higher in males compared to females (P = 0.07), and no gender difference in endodontic severity was found. In conclusion, adult HR patients were characterized by short stature and were disproportioned. They had elevated BMD of the lumbar spine and a reduced risk of fractures. We found a tendency for males to be more severely affected than females. [ABSTRACT FROM AUTHOR]

Abstract: Because osteoporosis is common and usually managed in primary care, there is a requirement for cheap and convenient methods of measuring bone mineral density (BMD). AccuDEXA (Lone Oak Medical Technologies, Doylestown, PA) is a tabletop dual-energy X-ray absorptiometry (DXA) device that performs BMD measurements of the hand in the middle phalanges of the third finger. The aims of this study were to (1) evaluate the use of AccuDEXA in UK women; (2) investigate the concordance between AccuDEXA T-scores and DXA T-scores for central (spine and hip) sites; (3) investigate the comparative response of AccuDEXA measurements to clinical risk factors for osteoporosis. Measurements of phalangeal and central BMD were performed in 620 women referred by their family doctors for bone densitometry (group 1) and 159 healthy female volunteers (group 2). For 65 women in group 2, aged 39yr or younger, the mean Z-scores for AccuDEXA and the central sites calculated from US reference ranges were consistent with the expected value of 0, whereas for the 62 group 2 women, aged 50yr or older, the mean Z-scores for AccuDEXA and the central sites were in the range 0.4–0.7 and were statistically significantly different from 0. In both group 1 and group 2, the AccuDEXA T-scores in older and younger women were systematically higher than those in the central sites by up to 1 unit. Of the 157 women aged 50yr or older, with osteoporosis, based on their central DXA results, only 34 (22%) had an AccuDEXA T-score less than or equal to −2.5, whereas 76 (48%) had osteopenia and 47 (30%) were normal based on their AccuDEXA T-scores. When assessed by the effect of clinical risk factors on Z-scores, both AccuDEXA and central BMD were affected to a similar extent. We conclude that the conventional World Health Organisation T-score criteria for the diagnosis of osteoporosis should not be applied to AccuDEXA measurements in UK women. Clinical risk factors for low BMD were found to affect AccuDEXA measurements to a similar extent as central BMD measurements. AccuDEXA measurements could, therefore, provide an alternative method for identifying individuals with low bone mass, provided care is taken in interpreting T-scores, perhaps, through the use of device-specific thresholds. [Copyright &y& Elsevier]

The bone resistance largely depends on the bone mineral density. Osteoporosis is a disease in which the bone resistance is affected, and establishing a diagnostic of certainty can be achieved by determining the bone mineral density. The present paper is based on the analysis of the results of the osteodensitometric investigation conducted on 361 patients who had been diagnosed with primary or secondary osteoporosis. The investigation took into account the hip bone and the vertebral column, and the following parameters have been analyzed: bone mineral content, bone mineral density, T-score and Z-score. We analyzed the evolution of the bone mineral density with increasing age, the existence of a connection between the bone mineral density determined at the vertebral column and at the hip, the connection between the T- and Z-score and age at the population we took into account, as well as the existence and the type of discordance in diagnosis for the two points of determination. We found out that there is a decrease in the bone mineral density above the age of 40; concerning the T-score, there is an obvious decrease tendency with ageing, both at the vertebral column and at the hip, while in the case of the Z-score, the tendency is that of increasing with age. The most frequent discordance in diagnosis found in the population we analyzed is the minor one. The axial skeleton is preponderantly affected. [ABSTRACT FROM AUTHOR]

Objective P-DEXA calcaneus bone mineral density measurement is widely accepted as a screening tool for osteoporosis but it's utility in evaluating determinants of bone mineral density (BMD) is inconclusive. We evaluated the utility of calcaneus p-DEXA scan in assessing the age-related changes in BMD. Methods This study was a hospital based cross- sectional study done in 106 females and 67 males. The age of study subjects ranged from 19~80 years. BMD of heel was measured by p-DEXA technique. T-score was estimated by plotting the BMD value against the subject's age. Osteoporosis was considered when t-score was less than-1. 6. Statistical tests applied were Pearson correlation,student's t,one-way ANOVA and ? 2 tests. P value less than 0. 05 was considered significant. Results In females significant negative correlation was found between age and BMD (r =-0. 3,P<0. 01),mean BMD of above 50 years was significantly less compared to below 50 years age group (P<0. 005),there was significant difference in BMD between 10 years class intervals of age. In combined male and female group,frequency of osteoporosis was significantly higher in above 50 years age group compared to below 50 years (χ2 = 11. 506, P<0. 001). Among the osteoporotic subjects aged above 50 years,70. 83% were females. In males,association between age and BMD was insignificant. Conclusion Our data suggests that the p-DEXA measurement of calcaneus is an effective tool in evaluating age-related changes in bone mineral density in females. [ABSTRACT FROM AUTHOR]

There is a well documented association between coeliac disease and reduced bone mineral density (BMD). Osteopenia and osteoporosis are both preventable and treatable. There are clear clinical recommendations available for measuring BMD in subgroups of patients with coeliac disease. However, it is suspected that within the practice population these standards are not being achieved. This suspicion is based on routine clinical encounters with patients with coeliac disease. [ABSTRACT FROM PUBLISHER]

Context: The erratic lifestyle of resident doctors may affect their serum 25-hydroxy vitamin D [25-(OH)D] levels and bone mineral density (BMD). Aim: To study BMD and the effect of environmental factors on it in resident doctors. Settings and Design: Prospective, cross-sectional study conducted in a tertiary healthcare centre. Materials and Methods: BMD was obtained by dual-energy X-ray absorptiometry and was correlated with various factors including weight, height, body mass index (BMI), sun exposure, physical activity, parathyroid hormone, 25-(OH)D, dietary factors. Statistical Analysis: SPSS software Version 10 (Unpaired t test was used to compare BMD of different groups and Pearson's correlation coefficient was used to calculate correlation). Results: Two hundred and fourteen apparently healthy resident doctors were enrolled in the study. Based on Caucasian normative data, osteopenia was noted in 104 (59.7%) males and 27 (67.5%) females. Thirty-two (18.39%) males and five (12.5%) females had osteoporosis. The BMD values of males were 0.947±0.086, 0.911±0.129 and 1.016±0.133 at lumbar spine, femur neck and total hip while those in females were 0.981±0.092, 0.850±0.101 and 0.957±0.103 respectively. BMD of our cohort was lesser by 12.5-18.2% and 4.2-14.5% than the Caucasian and available Indian figures, respectively. BMD had significant positive correlation with weight, height, BMI, physical activity, and dietary calcium phosphorus ratio. 25-(OH)D levels were insufficient in 175 (87.5%) subjects but had no correlation with BMD. Conclusions: Young healthy resident doctors had significantly lower BMD, contributors being lower BMI, lower height, reduced bioavailability of dietary calcium and inadequate physical activity. Deficiency of vitamin D did not contribute to low BMD. [ABSTRACT FROM AUTHOR]

Many osteoporotic vertebral fractures are not clinically recognized but increase fracture risk. We hypothesized that a newer generation densitometer increases the number of evaluable vertebrae and vertebral fractures detected. We also explored the impact of reader experience on vertebral fracture assessment (VFA) interpretation. VFA images obtained using Prodigy and iDXA densitometers in 103 older adults were evaluated for vertebral visualization and fracture presence in the T4–L5 region. A “true” read for each densitometer was achieved by consensus. If readers disagreed, the evaluation of a third expert physician was taken as true. Main outcomes were evaluable vertebrae, vertebral fractures, and intrareader/interreader reproducibility. Using the “true” reads, 92% of vertebrae were visualized on iDXA and 76% on Prodigy. Numerically, more fractures were identified with iDXA; the “true” reads found 43 fractures on iDXA and 21 on Prodigy. The experienced reader had better intrareader and interreader reproducibility than the inexperienced reader when compared with the “true” read. Using the newer iDXA densitometer for VFA analysis improves vertebral body visualization and fracture detection. Training and experience enhance result reproducibility. [ABSTRACT FROM AUTHOR]

Although osteoporosis in men is an increasing health problem, studies on osteoporosis in males are still scarce. The aim of our study was to determine the characteristics of bone tissue and bone turnover in men with idiopathic osteoporosis. Transiliac crest bone samples were histomorphometrically analyzed after double tetracycline labeling in 32 men aged 37–65 years who were diagnosed with idiopathic osteoporosis by densitometry of the lumbar spine and hip. Bone volume, osteoid surface, osteoblast surface, eroded surface, osteoid thickness, trabecular thickness, trabecular number, trabecular separation, and mineral apposition rate (MAR) were determined in all trabecular bone specimens. Bone volume and structural parameters indicated trabecular bone loss in most patients. Cellular parameters and MAR indicated variations in bone cell actions. No age-related decrease in histomorphometric parameters was found. After the patients were grouped according to MAR values, osteoblast and eroded surfaces were found to be lower in the group with decreased MAR values and elevated in the group of patients with increased MAR parameter. Trabecular thickness was greater in patients with lower than normal MAR, due to reduced resorption and probably loss of very thin trabeculae. Our results suggest that idiopathic osteoporosis in man resembles many characteristics of postmenopausal osteoporosis in women resulting in impaired trabecular structure due to unbalanced cellular activity and bone turnover rate. [ABSTRACT FROM AUTHOR]

The effects of teriparatide versus alendronate were compared by gender and menopausal status in patients with glucocorticoid-induced osteoporosis. At 18 months, increases in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). In patients with glucocorticoid-induced osteoporosis (GIO), teriparatide significantly increased bone mineral density (BMD) and decreased vertebral fractures compared with alendronate. We examined effects of teriparatide versus alendronate by gender and menopausal status. This was a multicenter, randomized, double-blind study of teriparatide 20 µg/day versus alendronate 10 mg/day in patients with GIO (277 postmenopausal women, 67 premenopausal women, 83 men). Primary outcome was change in lumbar spine BMD. Secondary outcomes included change in hip BMD, change in bone biomarkers, fracture incidence, and safety. At 18 months, mean percent increases from baseline in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03). Radiographic vertebral fractures occurred in one teriparatide (one postmenopausal) and ten alendronate patients (six postmenopausal, four men), and nonvertebral fractures occurred in 12 teriparatide (nine postmenopausal, two premenopausal, one man) and eight alendronate patients (six postmenopausal, two men). The proportion of patients reporting adverse events in teriparatide versus alendronate groups was consistent across subgroups. Among men and pre- and postmenopausal women with GIO, lumbar spine BMD increased more in patients receiving teriparatide compared with alendronate. [ABSTRACT FROM AUTHOR]

In this study, short-term, whole-body vertical vibration at 90 Hz improved trabecular bone quality. There was an improvement of bone quality and density in both osteoporotic and control rats. This treatment may therefore be an attractive option for the treatment of osteoporosis. Aside from pharmacological treatment options, physical exercise is known to augment bone mass. In this study, the effects of whole-body vertical vibration (WBVV) on bone quality and density were evaluated using an osteoporotic rat model. Sixty female Sprague Dawley rats were ovariectomized (C) or sham (SHAM) operated at the age of 3 months. After 3 months, both groups were divided into two subgroups that received either WBVV at 90 Hz for 35 days or no treatment. After sacrificing the rats, we evaluated vertebral bone strength, histomorphometric parameters, and bone mineral density (BMD). Treatment with WBVV resulted in improved biomechanical properties. The yield load after WBVV was significantly enhanced. According to yield load and Young’s modulus, the treated OVX rats reached the level of the untreated SHAM animals. In all measured histomorphometric parameters, WBVV significantly improved bone density. Treatment with WBVV demonstrated greater effects on the trabecular bone compared to the cortical bone. The ash-BMD index showed significant differences between treated and untreated rats. Using WBVV as a non-pharmacological supportive treatment option for osteoporosis demonstrated an enhancement of bone strength and bone mass. This procedure may be an attractive option for the treatment of osteoporosis. [ABSTRACT FROM AUTHOR]

Background: Chronic antiepileptic therapy has been associated with metabolic bone diseases including osteomalacia and osteoporosis. The object of this study was to assess the effect of first line anticonvulsants on bone density and vitamin D levels in Iranian ambulatory patients. Methods: We conducted a cross-sectional study assessing bone density with dual energy Xray absorptiometry at the hip and lumbar spine in 90 outpatients receiving anticonvulsants and 90 normal subjects matched for age, sex, and body mass index. Plasma total calcium, intact parathyroid hormone, total alkaline phosphatase in addition to 25 hydroxy vitamin D were also determined in both groups. Results: The mean (±SD) bone density in patients treated with antiepileptic drugs was lower at the spine (T Score= -084±1.18 vs. -0.5±1.18, P< 0.05) and femoral neck (T Score= -0.83±1.11 vs. -0.46±1.1, P<0.05), compared to the control group of subjects. In addition, serum total alkaline phosphatase was significantly higher in patients (246.5±127 vs. 190±65.3, P=0.004), but the total calcium, parathyroid hormone and 25 hydroxy vitamin D did not differ significantly between patients and controls. Conclusion: Our results suggest that maintenance therapy with antiepileptic drugs may decrease bone mass. These data also suggest a higher bone turnover rate in those receiving anticonvulsants. [ABSTRACT FROM AUTHOR]

Abstract: Twenty-five postmenopausal women with primary hyperparathyroidism (PHPT) and 30 age-matched women with subclinical hyperthyroidism (sHTH) were studied to assess cortical bone loss. One hundred two healthy women were also recruited. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at lumbar spine (LS), femoral neck (FN) and femoral total (FT), and at one-third of the radius (R). Amplitude-dependent speed of sound (ADSoS) and Ultrasound Bone Profile Index (UBPI) were also evaluated using phalangeal quantitative ultrasound (QUS). A significant correlation was found between QUS and BMD at LS (ADSoS, p <0.05) and R (ADSoS and UBPI, p <0.001) in controls. QUS significantly correlated with BMD at LS, FN (p <0.01), and FT (p <0.001) in sHTH. No correlations were found in the PHPT group. Mean T-score values of all parameters were significantly lower in patients compared with controls (p <0.001); however, they did not differ between PHPT and sHTH patients. T-score of R, ADSoS, and UBPI was reduced compared with other sites (p <0.001) in both diseases. In postmenopausal women with PHPT and sHTH, bone loss is mainly detectable at cortical level. However, qualitative and/or structural changes of bone could account for the lack of correlations between these 2 techniques at cortical sites. [Copyright &y& Elsevier]

Aim: The aim of this study is to evaluate the knowledge of osteoporosis (OP) and the sources of information about the disease among medical students and the effect of the medical training on their awareness about the OP. Material and Methods: Two hundred twenty seven students were asked if they knew OP. Two hundred fifteen students reported that they were familiar with OP. Statistical analysis was done among these 215 students. The questionnaire included 7 questions. Participants were divided into three groups: English preparatory year's students (EP), first year's students, second year's students. Results: Most of the students (94.4%, n=203) thought that OP was serious health problem. Two hundred three students (94%) believed that inadequate dietary calcium and vitamin D intake was the cause of OP. Bone densitometry was the mainly chosen (90.1%) diagnostic method. As source of knowledge from television was reported by 63.7% of the students. Number of the students who knew, in which population OP was seen, correctly (p=0.035) and who reported the health professionals as the source of knowledge (p=0.001) were significantly increased in first and second classes when compared with EP class. Conclusions: We observed that medical student who had no lessons of OP, have knowledge about OP by means of television and newspaper. [ABSTRACT FROM AUTHOR]

Abstract: Lateral distal femur (LDF) scans by dual-energy X-ray absorptiometry (DXA) are often feasible in children for whom other sites are not measurable. Pediatric reference data for LDF are not available for more recent DXA technology. The objective of this study was to assess older pediatric LDF reference data, construct new reference curves for LDF bone mineral density (BMD), and demonstrate the comparability of LDF BMD to other measures of BMD and strength assessed by DXA and by peripheral quantitative computed tomography (pQCT). LDF, spine and whole body scans of 821 healthy children, 5–18yr of age, recruited at a single center were obtained using a Hologic Discovery/Delphi system (Hologic, Inc., Bedford, MA). Tibia trabecular and total BMD (3% site), cortical geometry (38% site) (cortical thickness, section modulus, and strain-strength index) were assessed by pQCT. Sex- and race-specific reference curves were generated using LMS Chartmaker (LMS Chartmaker Pro, version 2.3. Tim Cole and Huiqi Pan. Copyright 1997-2006, Medical Research Council, UK) and Z-scores calculated and compared by correlation analysis. Z-scores for LDF BMD based on published findings demonstrated overestimation or underestimation of the prevalence of low BMD-for-age depending on the region of interest considered. Revised LDF reference curves were generated. The new LDF Z-scores were strongly and significantly associated with weight, body mass index, spine and whole body BMD Z-scores, and all pQCT Z-scores. These findings demonstrate the comparability of LDF measurements to other clinical and research bone density assessment modes, and enable assessment of BMD in children with disabilities, who are particularly prone to low trauma fractures of long bones, and for whom traditional DXA measurement sites are not feasible. [Copyright &y& Elsevier]