Association of body fat distribution with depression and social anxiety in children and adolescents: A cross-sectional study based on dual-energy X-ray detection / 北京大学学报(医学版)

OBJECTIVE@#To investigate the status of depression and social anxiety in children and adolescents, and to analyze the association between body fat distribution and depression, social anxiety in children and adolescents.@*METHODS@#A total of 1 412 children aged 7 to 18 years in Beijing were included by stratified cluster random sampling method. Body fat distribution, including total body fat percentage (total BF%), Android BF%, Gynoid BF% and Android-to-Gynoid fat ratio (AOI), were obtained by dual-energy X-ray absorption method. Depression and social anxiety were evaluated by Children Depression Inventory and Social Anxiety Scale for Children. Multivariate linear regression and restricted cubic spline analysis were used to estimate the linear and non-linear correlation between body fat distribution and depression and social anxiety.@*RESULTS@#13.1% and 31.1% of the children and adolescents had depressive symptoms and social anxiety symptoms respectively, and the detection rate of depression and social anxiety in the boys and young groups was significantly lower than those in the girls and old groups. There was no significant linear correlation between total BF%, Android BF%, Gynoid BF%, AOI and depression and social anxiety in the children and adolescents. However, total BF% and Gynoid BF% had significant nonlinear correlation with depression, showing an inverted U-shaped curve relationship with the tangent points of 26.8% and 30.9%, respectively. In terms of the nonlinear association of total BF%, Android BF%, Gynoid BF% and AOI with depression and social anxiety, the change trends of the boys and girls, low age group and high age group were consistent. The overall anxiety risk HR of body fat distribution in the boys was significantly higher than that in the girls, and the risk HR of depression and social anxiety were significantly higher in the high age group than those in the low age group.@*CONCLUSION@#There was no significant linear correlation between body fat distribution and depression and social anxiety in children and adolescents. Total BF% and depression showed an inverted U-shaped curve, mainly manifested in Gynoid BF%, and this trend was consistent in different genders and different age groups. Maintaining children and adolescents' body fat distribution at an appropriate level is the future direction of the prevention and control of depression and social anxiety in children and adolescents.

El FRAX como herramienta para evaluar el riesgo de fracturas en población general y grupos especiales de riesgo / FRAX as a tool to assess the risk of fractures in the general population and special risk groups

El FRAX es una herramienta que mide el riesgo de fractura y cuenta con un algoritmo computarizado desarrollado por la Organización Mundial de la Salud, basado en modelos globales de cohortes de población, combinados con factores de riesgo clínico. La herramienta fue diseñada inicialmente para su aplicación por los médicos de atención primaria en mujeres posmenopáusicas y hombres sobre 50 años, aunque es válida en general entre 40-90 años. Nos propusimos desarrollar un estudio epidemiológico-clínico sobre osteoporosis y fracturas en la población general y algunos grupos especiales de riesgo que incluyen mujeres posmenopáusicas, pacientes con afecciones reumáticas, endocrinas, cáncer y con infección por VIH, así como describir el papel desempeñado por FRAX como herramienta de medición del riesgo de fractura a los 10 años de ocurrida. Asimismo, constituye un gran reto conocer e identificar los principales grupos vulnerables o de riesgo para osteoporosis y fracturas en la población cubana. Esta aplicación nos resulta prioritaria en los grupos identificados, pues permitirá conocer los riesgos de fracturas a corto y largo plazos e implementar correcta y racionalmente los estudios DXA, disponibles en el país para la toma de decisiones terapéuticas(AU)

The FRAX is a tool that has a computerized algorithm developed by the World Health Organization, based on global models of population cohorts, combined with clinical risk factors, which measures the risk of fracture. The tool was initially designed for use by primary care physicians in postmenopausal women and men over 50 years of age, although it is generally valid between 40-90 years. We set out to develop a clinical epidemiological study on osteoporosis and fractures in the general population and some special risk groups that include post-menopausal women, patients with rheumatic, endocrine, cancer and HIV-infected conditions, as well as the role played by FRAX as a measurement tool. The ten-year risk of fracture related to the importance of knowing and identifying the main vulnerable or risk groups for osteoporosis and fractures in the Cuban population constitutes a great challenge. This application is a priority for those groups previously identified as it will allow us to know the short and long-term risks of fractures and implement the correct use of DXA studies, available in the country with a rational use and therapeutic decision-making(AU)

Does height catch-up in schoolchildren have an effect on bone mass in adolescents? Analysis in a Brazilian birth cohort / Catch-up de estatura em escolares tem efeito sobre massa óssea em adolescentes? Análise em uma coorte brasileira de nascimento

Abstract Objective: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. Methods: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents' bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. Results: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was −0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff = 0.598; 95% CI −0.117 to 1.313; p = 0.101). Conclusion: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size.

Resumo: Objetivo: Analisar o efeito do catch-up de estatura na idade escolar na massa óssea em adolescentes em uma coorte brasileira de nascimento. Métodos: Estudo de coorte, utilizando dados dos três momentos (nascimento, aos 7/9 anos e 18/19 anos) da pesquisa Coortes-RPS. Catch-up de estatura foi definida a partir da diferença entre o Z-score do escolar e Z-score do nascimento. Para a análise da massa óssea em adolescentes foi utilizado o índice Z-score da coluna lombar medido pela densitometria por dupla emissão de raio X. Para análise proposta, foi construído modelo teórico usando os gráficos acíclicos direcionados e pareado por escore de propensão do tipo vizinho mais próximo utilizando o software STATA versão 14.0. O nível de significância adotado foi de 5%. Resultados: Das 297 crianças, 24,58% realizaram o catch-up estatural. Massa óssea abaixo do esperado para a idade foi de 5,39%. O Z-score médio da coluna lombar foi −0,34 (± 1,01). Após ajuste, não foi observado efeito entre catch-up de estatura na idade escolar e massa óssea no adolescente (Coef = 0,598; IC 95% −0,117-1,313; p = 0,101). Conclusão: Mesmo com os gráficos acíclicos direcionados e o método de inferência causal por ajuste do escore de propensão, o catch-up de estatura parece não afetar a massa óssea em adolescentes, resultado talvez relacionado ao tamanho da amostra.

Body composition indices in Brazilian adults: age-specific and sex-specific percentile curves

ABSTRACT Objective To establish percentile curves for measures and indices of body composition by age and sex and compare them with data from other ethnic groups. Subjects and methods Cross-sectional, population-based study with adults aged 20-59 years (n = 689). Percentile curves adjusted by a third degree polynomial function were constructed for skeletal mass index (SMI), fat mass index, body fat, and load-capacity metabolic indices (LCMI) based on dual-energy X-ray absorptiometry (DXA). Results SMIweight and SMIBMI showed decline from the third decade of life in both sexes, whereas SMIheight was not able to identify lean mass loss over the ages studied. There was a slight drop at the end of the fifth decade (50-59 years) in men. Among Americans and Chinese, the 50th percentile curve of SMIheight showed an earlier decline. The estimates of adiposity and LCMI curves peaked between 40-49 years and Americans and Chinese maintained an upward curve throughout adulthood. Conclusion The data and curves showed that the SMI adjusted for BMI and body weight were more adequate in detecting the decline of lean mass in adults due to aging. In contrast, SMIheight had a positive correlation with age and its curve increased throughout the evaluated age groups. The results contribute to the evaluation to the nutritional status of adults and to the prevention and treatment of outcomes related to adiposity and deficit lean mass.

Association of Severity of Coronary Lesions with Bone Mineral Density in Postmenopausal Women / Associação entre Gravidade das Lesões Coronarianas e Densidade Mineral Óssea em Mulheres Pós-Menopausa

Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.

Resumo Fundamento: A doença arterial coronariana (DAC) e a osteoporose são doenças comuns em mulheres pós-menopausa. Tanto em estudos transversais como em estudos epidemiológicos longitudinais, a massa óssea diminuída foi relacionada à frequência aumentada de DAC. No entanto, dados disponíveis sobre a relação entre densidade mineral óssea (DMO) e gravidade das lesões coronarianas são limitados. Objetivo: Investigar a associação entre DMO e gravidade das lesões coronarianas avaliadas pelo escore de Gensini em mulheres pós-menopausa. Métodos: Este estudo incluiu 122 mulheres pós-menopausa diagnosticadas com DAC. As pacientes foram divididas em dois grupos de acordo com a gravidade das lesões coronarianas avaliada pelo escore de Gensini - pacientes com lesões coronarianas leves (escore de Gensini < 25) e pacientes com lesões coronarianas graves (escore de Gensini ≥ 25). A densidade mineral do colo femoral foi medida por absorção de raios-X de dupla energia (DXA). Resultados: O estudo incluiu mulheres pós-menopausa com idade de 64,31 ± 4,71 anos, 85 delas (69,7%) com lesões coronarianas graves. Pacientes com lesões coronarianas graves apresentaram um escore T mais elevado que aquelas com lesões coronarianas leves no colo femoral (p < 0,05). O escore T médio foi -0,84 ± 1,01 no grupo com lesões leves, e -1,42 ± 1,39 no grupo com lesões graves (p < 0,05). A análise de regressão logística multivariada mostrou que a osteopenia-osteoporose no colo femoral (odds ratio 2,73; intervalo de confiança de 95% 1,06 - 6,13) esteve associada com um risco aumentado de se desenvolver lesões coronarianas graves. O modelo de regressão múltipla mostrou que os escores T (b = -0,407; EP= 0,151; p = 0,007) foram preditores independentes do escore de Gensini. Conclusão: Encontrou-se uma relação significativa entre a gravidade das lesões coronarianas e a DMO em mulheres pós-menopausa. DMO, uma técnica de baixo custo que envolve mínima exposição à radiação, e amplamente utilizada no rastreamento de osteoporose, é um marcador promissor da gravidade de lesões coronarianas graves.

Índice de masa corporal y masa ósea en mujeres postmenopáusicas: dilema en la práctica clínica / Body mass index and bone mass in postmenopausal women: a dilemma in clinical practice

Introducción: En mujeres postmenopáusicas el bajo peso y la obesidad son factores de riesgo para la Osteoporosis; sin embargo, está por definir la influencia de su cambio en la respuesta terapéutica con bisfosfonatos para la prevención de la fractura. Objetivo: Describir asociación entre índice de masa corporal (IMC) y masa ósea en mujeres en post menopausia, así como identificar las variaciones en peso e IMC durante el tratamiento con bisfosfonatos. Material y Métodos: En 296 mujeres quienes entre 2009-2014 concurrieron consecutivamente a la Clínica de Climaterio y Osteoporosis (ClimOS) La Habana (n=103), y al Departamento de Enfermedades Metabólicas Óseas de la Fundación Jiménez Díaz, Madrid (n=193) se determinó peso, talla, IMC, y mediante DXA la densidad mineral ósea en columna lumbar y cadera. En 80 de ellas se evaluó la influencia del peso corporal inicial y su variación temporal durante el uso de bisfosfonatos. Análisis estadístico: Promedio y desviación estándar para variables cuantitativas, frecuencias para las variables cualitativas y las Pruebas T Students y X2 para diferencias entre ellas. Correlación de Pearson para precisar influencia del peso inicial y el IMC y su diferencia en la respuesta a los bisfosfonatos. Se utilizó valor p<0,05 para la significación estadística. Resultados: Bajo peso se identificó 4/296, más de la mitad presentaron sobrepeso/obesidad. Las mujeres evaluadas en la ClimOs presentaron peor estatus óseo en cadera. No se encontró asociación del peso corporal ni del IMC sobre la respuesta al tratamiento con BPS. Conclusiones: La influencia del peso corporal sobre una nueva fractura fue controversial, se sugiere incluir la variación ponderal como parte del tratamiento para la osteoporosis(AU)

Introduction: Low weight and obesity are risk factors for osteoporosis in postmenopausal women; however, the influence of its change on a therapeutic response to biophosphonates for the prevention of fractures has not been defined yet. Objective:To describe the association between the body mass index (BMI) and bone mass in postmenopausal women, as well as to identify changes in weight and BMI during the treatment with biophosphonates. Material and methods: Weight, height, and BMI was determined in 296 women who came consecutively to the Climateric and Osteoporosis Clinic (ClimOS) in Havana from 2009 to 2014 (n=103), and to the Department of Metabolic Bone Diseases, Jiménez Díaz Foundation, Madrid (n=193); also, bone mineral density in lumbar spine and hip was measured by DXA. The influence of initial body weight and its temporal variation with the use of biophosphonates (BPS) was evaluated in 80 of them. Statistical analysis: standard statistical average for qualitative variables, frequencies for the qualitative variables, Student´s t-Tests, and X2 test for differences among them. Pearson´s correlation to specify the influence of the initial weight and BMI, and their differences in the response to biophosphonates. Besides, p<0,05 value was used for statistical significance. Results:Low weight was identified 4/296; more than half of them were overweight or obese. Women who were evaluated in ClimOs, presented a worse bone status on the hip. Neither association of body weight nor BMI was found on the response to treatment with (BPS). Conclusions: The influence of body weight on a new fracture was controversial; it is suggested to include ponderal variation as part of the treatment for osteoporosis(AU)

Diagnostic property of anthropometric indicators in the prediction of high body fat estimated by DXA in hypertensive women / Propriedade diagnostica dos indicadores antropométricos na predição do excesso de gordura corporal estimado por meio do DXA em mulheres hipertensas

Abstract Excess body fat is an important risk factor for the development of arterial hypertension. he aim of this study was to verify the diagnostic performance of anthropometric indicators in the prediction of excess body fat estimated by Dual-energy Radiometric Absorptiometry (DXA) in hypertensive women. A cross-sectional study with 71 hypertensive women (57.9 ± 10.1 years; 77.8 ± 15.1 kg; 156.8 ± 5.2 cm) was carried out. he anthropometric indicators analyzed were: Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR) and Conicity Index (C Index). Body fat measured by DXA was used as the reference method. Descriptive statistics and ROC curve were used for data analysis. Comparing the anthropometric indicators with the percentage of total fat estimated by DXA, significant differences were observed in BMI, WC and WHR (P <0.05). In relation to the percentage of trunk fat, a difference was identified in BMI and WC (P <0.05). Among the anthropometric indicators analyzed, BMI (0.83), WC (0.79) and WHtR (0.80) had the largest areas under the ROC curve in relation to excess body fat determined by DXA. he cutoff points were conservative in relation to those suggested in literature. Anthropometric indicators BMI (24.72 kg/m2), WC (87.81 cm) and WHtR (0.55) can be adopted in the evaluation of excess body fat in hypertensive women, since they demonstrated to be good predictors when confronted with DXA.

Resumo O excesso de gordura corporal é importante fator de risco para o desenvolvimento e agravamento da hipertensão arterial. Objetivou-se verificar o desempenho diagnóstico dos indicadores antropométricos na predição de excesso de gordura corporal estimado por meio do absortometria radiológica de dupla energia (DXA) em mulheres hipertensas. Realizou-se estudo transversal com 71 mulheres hipertensas (57,9 ± 10,1 anos; 77,8 ± 15,1 kg; 156,8 ± 5,2 cm). Os indicadores antropométricos analisados foram: Índice de Massa Corporal (IMC), Circunferência da Cintura (CC), Relação Cintura-Quadril (RCQ), Relação Cintura-Estatura (RCEst) e Índice de Conicidade (IC). A gordura corporal mensurada por meio da DXA foi utilizada como método de referência. Utilizou-se estatística descritiva e curva ROC para a análise dos dados. Comparando os indicadores antropométricos com o percentual de gordura total estimado pelo DXA, observou-se diferenças significativas no IMC, na CC e na RCEst (P < 0,05). Em relação ao percentual de gordura de tronco, identificou-se diferença no IMC e na CC (P < 0,05). Dos indicadores antropométricos estudados, o IMC (0,83), a CC (0,79) e a RCEst (0,80) tiveram as maiores áreas sob a curva ROC quando comparados a RCQ (0,50) e ao IC (0,55). Os pontos de corte se mostraram conservadores em relação àqueles sugeridos pela literatura. Os indicadores antropométricos IMC (24,72 kg/m2), CC (87,81 cm) e RCEst (0,55) podem ser adotados na avaliação do excesso de gordura corporal em mulheres hipertensas, uma vez que demonstraram ser bons preditores quando confrontados com DXA.

Somatic maturation and the relationship between bone mineral variables and types of sports among adolescents: cross-sectional study / Maturação somática e o relacionamento entre variáveis minerais ósseas e modalidades esportivas em adolescentes: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Peak height velocity (PHV) is an important maturational event during adolescence that affects skeleton size. The objective here was to compare bone variables in adolescents who practiced different types of sports, and to identify whether differences in bone variables attributed to sports practice were dependent on somatic maturation status. DESIGN AND SETTING: Cross-sectional study, São Paulo State University (UNESP). METHODS: The study was composed of 93 adolescents (12 to 16.5 years old), divided into three groups: no-sport group (n = 42), soccer/basketball group (n = 26) and swimming group (n = 25). Bone mineral density and content were measured using dual-energy x-ray absorptiometry and somatic maturation was estimated through using peak height velocity. Data on training load were provided by the coaches. RESULTS: Adolescents whose PHV occurred at an older age presented higher bone mineral density in their upper limbs (P = 0.018). After adjustments for confounders, such as somatic maturation, the swimmers presented lower values for bone mineral density in their lower limbs, spine and whole body. Only the bone mineral density in the upper limbs was similar between the groups. There was a negative relationship between whole-body bone mineral content and the weekly training hours (β: -1563.967; 95% confidence interval, CI: -2916.484 to -211.450). CONCLUSION: The differences in bone variables attributed to sport practice occurred independently of maturation, while high training load in situations of hypogravity seemed to be related to lower bone mass in swimmers.

RESUMO CONTEXTO E OBJETIVO: O pico de velocidade de crescimento (PVC) constitui importante evento maturacional durante a adolescência, afetando o tamanho do esqueleto. O objetivo do estudo foi comparar variáveis ósseas em adolescentes praticantes de diferentes modalidades esportivas, bem como identificar se diferenças nas variáveis ósseas atribuídas à prática esportiva são dependentes do estado da maturação somática. DESENHO E LOCAL: Estudo transversal, Universidade Estadual Paulista (UNESP). MÉTODOS: O estudo foi constituído por 93 adolescentes (12 a 16,5 anos), divididos em três grupos: grupo sem envolvimento esportivo (n = 42), futebol/basquete (n = 26) e natação (n = 25). A densidade e conteúdo mineral ósseo foram mensurados utilizando absortiometria de raio-x de dupla energia e a maturação somática foi estimada através do uso do PVC. Informações sobre volume de treinamento foram fornecidas pelos treinadores. RESULTADOS: Adolescentes com idade tardia no PVC apresentaram maiores valores de densidade mineral óssea em membros superiores (P = 0,018). Após ajustes por variáveis de confusão, como a maturação somática, os nadadores apresentaram menores valores de densidade mineral óssea em membros inferiores, coluna e corpo inteiro. Apenas a densidade mineral óssea de membros superiores foi similar entre os grupos. Existiu relação negativa entre conteúdo mineral ósseo de corpo inteiro e tempo de treino semanal (β: -1563.967; 95% intervalo de confiança, IC: -2916.484 a -211.450). CONCLUSÃO: As diferenças em variáveis ósseas atribuídas à prática esportiva ocorrem independentemente da maturação, enquanto elevada quantidade de treinamento em situações de hipogravidade parece estar relacionada com menor massa óssea em nadadores.

The Effect of FRAX on the Prediction of Osteoporotic Fractures in Urban Middle-aged and Elderly Healthy Chinese Adults

OBJECTIVE: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.

Is handgrip strength normalized to body weight a useful tool to identify dynapenia and functional incapacity in post-menopausal women?

ABSTRACT Objective To investigate whether handgrip strength normalized to body weight could be a useful clinical tool to identify dynapenia and assess functional capacity in post-menopausal women. Method A total of 136 postmenopausal women were recruited. Body composition (Dual Energy X-ray Absorptiometry [DEXA], Bio-electrical Impedence Analysis [BIA]), grip strength (dynamometer) and functional capacity (senior fitness tests) were evaluated. Dynapenia was established according to a handgrip strength index (handgrip strength divided by body weight (BW) in Kg/KgBW) obtained from a reference population of young women: Type I dynapenic (<0.44 kg/KgBW) and type II dynapenic (<0.35 kg/KgBW). Results The results show a positive correlation between handgrip strength index (in kg/KgBW) and alternate-step test (r=0.30, p<0.001), chair-stand test (r=0.25, p<0.005) and one-leg stance test (r=0.335, p<0.001). The results also showed a significant difference in non-dynapenic compared to type I dynapenic and type II dynapenic for the chair-stand test (Non-dynapenic: 12.0±3.0; Type I: 11.7±2.5; Type II: 10.3±3.0) (p=0.037 and p=0.005, respectively) and the one-leg stance test (Non-dynapenic: 54.2±14.2; Type I: 43.8±21.4; Type II: 35.0±21.8) (p=0.030 and p=0.004, respectively). Finally, a significant difference was observed between type II dynapenic and non-dynapenic for the chair-stand test (p=0.032), but not with type I dynapenic. Conclusion The results showed that handgrip strength was positively correlated with functional capacity. In addition, non-dynapenic women displayed a better functional status when compared to type I and type II dynapenic women. Thus, the determination of the handgrip strength thresholds could be an accessible and affordable clinical tool to identify people at risk of autonomy loss.

Assessment of adiposity in psoriatic patients by dual energy X-ray absorptiometry compared to conventional methods

Abstract BACKGROUND: Obesity is considered a chronic low-grade inflammatory disease that shares mediators of inflammation with psoriasis, such as TNF-α and IL-6. The relationship between these two conditions involves factors such as predisposition and response to therapy, in addition to an association with cardiovascular disease. OBJECTIVES: The aim of the present study was to investigate the prevalence of adiposity as determined by body mass index (BMI), waist circumference (WC), and dual energy X-ray absorptiometry (DXA) evaluation in patients with psoriasis. METHODS: BMI, WC and body composition by DXA were measured in 42 psoriatic patients without joint complaints and in 41 control patients using standard procedures. In the comparison between cases and controls, we used Pearson’s Χ2 test or Fisher’s exact test, and the nonparametric Mann-Whitney test. The difference between the diverse classification methods for obesity was evaluated using McNemar’s test. To test the level of agreement between those variables, we used the weighted kappa coefficient. RESULTS: There was no difference in the prevalence of obesity among cases and controls. Both BMI and WC had low agreement with measures of body fat evaluated by DXA. With the use of DXA scanning, prevalence of overweight and obesity in patients with psoriasis was 83.3%, which constitutes a strong evidence of the need for intervention on this metabolic parameter. CONCLUSION: Dual energy X-ray absorptiometry was more capable of identifying obesity compared with BMI and WC both in psoriatic and control patients.

Densitometría mineral ósea por tomografía computada / Bone mineral densitometry by computed tomography

La tomografía computarizada cuantitativa (QCT) es una técnica de medición real de la densidad ósea (DMO), en forma volumétrica (g/cm3) mediante ROI (región de interés), sin interferencias propias ni externas en el esqueleto axial o periférico. Otros métodos, tales como DXA (de las siglas inglesas Dual Energy X-ray Absorptiometry) sólo proporcionan estimaciones en proyección de la densidad ósea, generando sus resultados en proyección de área (g/cm3), no proporcionando un verdadero valor de la profundidad de la región. La atenuación ultrasónica, tasa de transmisión del ultrasonido (US) sólo pueden reflejar la arquitectura ósea. Esto concluye que la tomografía computarizada cuantitativa (QCT) proporciona predicciones válidas de la masa ósea trabecular, cortical y volumétrica, y de la capacidad mecánica del hueso, con la posibilidad de medición muscular regional (LRM) de gran importancia para la evaluación de la relación músculo/hueso.

Estudio densitométrico de diez años de remodelación femoral tras la implantación de un vástago anatómico / Étude densitométrique de dix ans d'un remodelage fémoral après implantation d'une tige anatomique / A Ten-Year sensitometric study of femoral remodeling after implantation of an anatomical stem

Introducción: la absorciometría dual con rayos X es comúnmente utilizada para cuantificar la remodelación ósea periprotésico, normalmente en seguimientos a corto plazo. Objetivo: determinar los patrones de remodelado producidos por vástago anatómico, mediante la cuantificación de cambios en la densidad mineral ósea en las 7 zonas de Gruen, durante el seguimiento, así como analizar la influencia de otros factores en el remodelado óseo. Métodos: se realizó un estudio prospectivo (10 años de seguimiento) a un grupo de 39 pacientes a los que se implantó una prótesis total de cadera no cementada. Se utilizó la cadera sana contralateral como control. Para cuantificar la remodelación femoral periprotésica se utilizó la absorciometría dual con rayos X en las 7 zonas de Gruen. Las mediciones de masa ósea se realizaron a los 15 días, 1, 3 y 10 años tras la intervención en la cadera no operada y a los 15 días, 1, 3, 5 y 10 años de la operación en la cadera protetizada. Se analizó también la influencia de otros factores en el remodelado óseo (sexo, índice de masa corporal y masa ósea preoperatoria). Resultados: se halló un descenso de la densidad mineral ósea del 7 por ciento en la zona 1 de Gruen y del 24,1 por ciento en la zona 7 de Gruen al final del décimo año. El sexo, el índice de masa corporal y la masa ósea preoperatoria no fueron estadísticamente relevantes en su influencia sobre el remodelado óseo. Conclusión: la remodelación ósea periprotésica depende en su mayor parte del implante, no se halló correlación con sexo, índice de masa corporal o masa ósea preoperatoria(AU)

Introduction: Dual X-ray absorptiometry is commonly used to quantify periprosthetic bone remodeling, usually for short-term follow up. Objective: determine patterns of remodeling caused by anatomical stem, by quantifying changes in bone mineral density in the 7 Gruen zones during follow up and analyze the influence of other factors in bone remodeling. Methods: a prospective study (10 year follow-up) was performed to a group of 39 patients undergoing uncemented total hip prosthesis. The healthy hip was used as control. Dual X-ray absorptiometry in Gruen zones 7 was used to quantify the femoral periprosthetic remodeling. Bone mass measurements were performed at 15 days, 1, 3 and 10 years after surgery on the non-operated hip, and at 15 days, 1, 3, 5 and 10 years of operation in the prosthetic hip. The influence of other factors in bone remodeling (sex, body mass index, and preoperative bone mass) was also analyzed. Results: 7 percent of decrease in bone mineral density was found in Gruen zone 1 and 24.1 percent was found in Gruen zone 7 at the end of the tenth year of follow up. Sex, body mass index and preoperative bone density were not statistically significant in its influence on bone remodeling. Conclusions: periprosthetic bone remodeling depends mainly on the implant. No correlation has been found with sex, body mass index and preoperative preoperative bone density(AU)

Introduction: l'absorptiométrie biphotonique à rayons X est fréquemment utilisée pour évaluer le remodelage osseux péri-prothétique, notamment par des suivis à court terme. Objectif: le but de cette étude est de déterminer les standards du remodelage osseux péri-prothétique produits par une tige anatomique, et d'analyser également l'influence d'autres facteurs sur le remodelage osseux. Méthodes: une étude prospective (suivi de 10 ans) d'un groupe de 39 patients, ayant subi une implantation de prothèse de hanche sans ciment, a été réalisée. Afin d'évaluer le remodelage fémoral périprothétique, on a effectué une absorptiométrie biphotonique à rayons X dans les 7 zones de Gruen. On a mesuré la DMO de la hanche non-opérée aux 15 jours et 1, 3, et 10 ans après la chirurgie, ainsi que la DMO de la hanche opérée aux 15 jours et 1, 3, 5, et 10 ans après la chirurgie. On a également analysé le retentissement d'autres facteurs (sexe, indice de masse corporelle, densité osseuse préopératoire) sur le remodelage osseux. Résultats: à la fin de la dixième année, on a trouvé une perte de la DMO de 7 pourcent dans la zone 1, et de 24.1 pourcent dans la zone 7. Le sexe, l'indice de masse corporelle et la masse osseuse préopératoire n'ont pas statistiquement influé sur le remodelage osseux. Conclusions: le remodelage osseux péri-prothétique dépend notamment de l'implant ; on n'a pas trouvé de corrélation avec le sexe, l'indice de masse corporelle ou la densité osseuse préopératoire(AU)

Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life / Densitometria óssea de dupla absorção de raio-X (DXA) em crianças nascidas pré-termo comparada com seus pares a termo nos primeiros 6 meses

OBJECTIVES: To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age. METHODS: A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank. RESULTS: All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p < 0.001, p < 0.001, p = 0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age. CONCLUSIONS: This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs. .

OBJETIVOS: Avaliar longitudinalmente o conteúdo mineral ósseo (CMO), a densidade mineral óssea (DMO) e a massa magra do corpo inteiro obtidos através da densitometria óssea de dupla absorção de Raios-X (DXA) em recém-nascidos pré-termo (RNPT) e comparar com seus pares a termo (RNT) desde o nascimento até 6 meses de idade pós-natal corrigida. MÉTODOS: Foram estudados 28 recém-nascidos adequados para a idade gestacional: 14 recém-nascidos pré-termo e 14 recém-nascidos a termo. Utilizando-se a DXA, foram determinados CMO, DMO e massa magra em três momentos: 40 semanas de idade pós-concepcional corrigida, 3 e 6 meses de idade pós-natal corrigida. Os recém-nascidos pré-termo apresentavam ao nascimento uma idade gestacional igual ou inferior a 32 semanas e receberam leite da própria mãe ou leite humano de banco. RESULTADOS: Todos os recém-nascidos apresentaram um aumento nos valores de CMO, DMO e massa magra durante o estudo. Os recém-nascidos pré-termo apresentaram menor CMO, DMO e massa magra, com 40 semanas de idade pós-concepcional corrigida, em relação aos recém-nascidos a termo (p < 0,001, p < 0,001, e p = 0,047, respectivamente). Entretanto, houve uma aceleração no processo de mineralização nos pré-termos, suficiente para atingirem os valores normais do recém-nascidos a termo aos 6 meses de idade corrigida. CONCLUSÕES: Este estudo sugere que a densitometria óssea de dupla absorção de Raios-X constitui um bom método para a avaliação dos parâmetros de composição corporal no início e no seguimento destes recém-nascidos pré-termo. .

Trabecular bone score: perspectives of an imaging technology coming of age / Escore de osso trabecular: perspectivas de um método de imagem em aprimoramento

The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross-sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology.

TBS (do inglês, “trabecular bone score”) é um novo método que estima a microarquitetura óssea a partir de uma imagem de densitometria óssea (DXA) da coluna lombar. Apesar de o TBS não ser uma medida física direta da microarquitetura trabecular, ele correlaciona-se com o volume ósseo, densidade da conectividade trabecular, número de trabéculas e separação trabecular medidos por microtomografia computadorizada (µCT), e com medidas mecânicas da resistência óssea vertebral em estudos ex vivo. Estudos em humanos confirmaram que o TBS associa-se a microarquitetura trabecular e resistência óssea medidas por tomografia computadorizada quantitativa periférica de alta resolução (HRpQCT). Estudos transversais e prospectivos, envolvendo um grande número de indivíduos, mostraram que o TBS é associado com fratura vertebral, de colo de fêmur e com outros tipos de fraturas osteoporóticas em mulheres na pós-menopausa. Dados em homens, apesar de escassos, mostram resultados semelhantes. Além disso, o TBS foi associado a fraturas por fragilidade em indivíduos com diversas causas secundárias de osteoporose e, dados preliminares, sugerem que o uso do TBS pode melhorar a previsão de fratura quando incorporado ao sistema de avaliação de risco de fratura (FRAX). Este artigo faz uma revisão de avanços recentes que têm ajudado a estabelecer esse novo método de imagem.

Radiodensitometric and DXA analyses for the measurement of bone mineral density after systemic alendronate therapy

Precise techniques for the measurement of maxillary bone mineral density (BMD) are useful for the early diagnosis of systemic diseases. The aim of this study was to compare in vivo the efficacy of dual-energy x-ray absorptiometry (DXA) and radiographic densitometry for the measurement of BMD after systemic administration of sodium alendronate. Wistar rats were randomly allocated to a control group (n = 5), which received distilled water, and a sodium alendronate group (n = 8), which received two doses of chemically pure sodium alendronate (1 mg/kg) per week. After 8 weeks, the animals were euthanized, the tibias were removed, and the BMD of the proximal tibial metaphysis was analyzed radiographically and by DXA. The data were subjected to statistical analysis by the Kruskal-Wallis test at a significance level of 5%. Both of the techniques revealed that the alendronate-treated group had a significantly higher BMD (p < 0.05) than the control group after 8 weeks of treatment. Comparing the groups with and without alendronate therapy revealed increases of 14.9% and 29.6% in BMD, as detected radiographically and by DXA, respectively. In conclusion, both of the methods were able to detect an increase in BMD of the proximal tibial metaphysis after alendronate therapy.

Massa óssea em crianças e adolescentes que vivem com vírus da imunodeficiência humana / Bone mass in children and adolescents infected with human immunodeficiency virus

OBJETIVO: Descrever a densidade mineral óssea (DMO) e conteúdo mineral ósseo (CMO) de crianças e adolescentes que vivem com o vírus da imunodeficiência humana e comparar com os dados do National Health and Nutrition Examination Survey IV (NHANES IV). MÉTODO: Participaram do estudo48 crianças e adolescentes (sete a 17 anos de idade) com infecção pelo vírus da imunodeficiência humana adquirida por transmissão vertical. A DMO e o CMO foram mensurados pela absorciometria por dupla emissão de raios-X, calculando-se escores-z com base nos dados do NHANES IV. Nos prontuários médicos foram obtidas as informações dos parâmetros clínicos e laboratoriais da infecção pelo vírus da imunodeficiência humana. Foram ainda avaliada a atividade física, a ingestão de cálcio e a maturação esquelética. Utilizaram-se procedimentos da estatística descritiva e inferencial, estabelecendo níveis de significância de 5%. RESULTADOS :Os pacientes soropositivos demonstraram valores inferiores comparados aos dados do NHANES IV em todos os escores-z da massa óssea (média = -0,52 a -1,22, dp = 0,91 e 0,84, respectivamente). Com base no z-DMOsubtotal, há uma prevalência de 16,7% de crianças e adolescentes com massa óssea reduzida para a idade. Indivíduos que utilizaram inibidores de protease apresentaram um z-DMOtotal inferior, comparado ao grupo que não utilizou (-1,31 vs. -0,79; p = 0,02). Não foram encontradas diferenças na massa óssea em relação ao nível de atividade física e ingestão de cálcio. CONCLUSÕES: Na presente amostra, crianças e adolescentes que vivem com o vírus da imuno deficiência humana possuem baixa massa óssea para idade, e o uso de inibidores de protease parece estar relacionado a tais reduções.

OBJECTIVE: To describe bone mineral density (BMD) and bone mineral content (BMC) in children and adolescents infected with the human immunodeficiency virus (HIV), and to compare them with data from the National Health and Nutrition Examination Survey IV (NHANES IV). METHOD: The study included 48 children and adolescents (7 to 17 years old) infected with HIV through vertical transmission. BMC and BMD were measured by dual energy absorptiometry X-ray, by calculating z-scores based on data from NHANES IV. The information on clinical and laboratory parameters of infection by HIV was obtained from medical records. Physical activity, calcium intake, and skeletal maturation were also assessed. Descriptive and inferential statistical procedures were used, with levels of significance set at 5%. RESULTS: Seropositive patients presented lower values compared to data from NHANES IV in all z-scores of bone mass (mean = -0.52 to -1.22, SD = 0.91 and 0.84, respectively). Based on the subtotal z-BMD, there was a prevalence of 16.7% of children and adolescents with low bone mass for age. Individuals using protease inhibitors presented a lower total z-BMD when compared to the group that did not use (-1.31 vs. -0.79, p = 0.02). There were no bone mass differences in relation to physical activity and calcium intake. CONCLUSIONS: In the present sample children and adolescents living with HIV have low bone mass for age, and the use of protease inhibitors appears to be related to such decreases.

Osteoporose no climatério I: epidemiologia, definição, rastreio e diagnóstico / Osteoporosis in climacteric I: epidemiology, definition, screening and diagnosis

A osteoporose é um distúrbio osteometabólico caracterizado pela diminuição da densidade mineral óssea (DMO), com deterioração da microarquitetura óssea, levando a um aumento da fragilidade esquelética e do risco de fraturas, pelo comprometimento da resistência e/ou da qualidade óssea. Sua incidência pode variar de 14 a 29% em mulheres acima de 50 anos e chegar até 73% em mulheres acima de 80 anos. O objetivo do nosso artigo é estudar a osteoporose relacionada ao período pós-menopausa, mas vale ressaltar que os riscos de fraturas em algumas condições independem da quantidade de massa óssea mensurada, e sim da qualidade óssea. Atualmente dispomos de uma ferramenta muito útil, denominada FRAXtm (Fracture Risk Assessement tool), para avaliação do risco de fraturas; por meio dela, é possível calcular a probabilidadede, em dez anos, ocorrer fratura no quadril e em outros sítios, não somente pela quantidade de massa óssea, mas pela associação de outros fatores clínicos de risco. Isso poderá nos ajudar a tomar decisões clínicas quanto à prevenção e tratamento da osteoporose na mulher na pós-menopausa, na nossa prática diária, quando validada para uso no Brasil

Osteoporosis is a metabolic disorder characterized by decreased bone mineral density (BMD), with deterioration of bone microarchitecture. It leads to an increase in skeletal fragility and fracture risk, by compromising the strength and/or quality of bone. Its incidence varies from 14 to 29% in women over 50 years and reaches 73% in women over 80 years. The objective of our paper is to study osteoporosis related to post-menopause. But, it is noteworthy that the risk of fractures in some conditions depends on the bone quality. Currently, we have a very useful tool called FRAXtm (Fracture Risk Assessment tool), to evaluate the risk of fractures. The probability to occur hip fracture, or another bone fracture, in ten years is calculated, not only by the amount of bone mass, but by the association of other clinical risk factors. This may help us make clinical decisions about prevention and treatment of osteoporosis in postmenopausal women in our daily practice, when validated for use in Brazil

Comparação preliminar entre ultrassonografia quantitativa de falanges e densitometria óssea na avaliação da massa óssea em adolescentes / Preliminary comparision between phalangeal quantitative ultrassonography and bone densitometry for bone mass evaluation in adolescents

OBJETIVO: Avaliar associação entre ultrassonografia quantitativa de falanges da mão (QUS) e a densitometria por absorção de raio-X de dupla energia (DXA) e desses com os históricos alimentar e de fraturas. SUJEITOS E MÉTODOS: Após dois anos de acompanhamento de 270 escolares, 10 com massa óssea por QUS abaixo de -2 DP foram incluídos no estudo e avaliados com DXA. RESULTADOS: A massa óssea por DXA de L1-L4 variou de -2,8 a -1,1 DP e de corpo inteiro -2,9 e -1,2. Três estudantes apresentaram fraturas. Baixa ingestão de cálcio foi observada nos 10 casos, de fósforo em 6 e de vitamina D em 8. Não houve diferença entre os casos com massa abaixo de -2 DP nos três métodos de avaliação. Não foi observada associação entre as fraturas e o histórico alimentar, nem com os valores de massa óssea. CONCLUSÃO: Neste pequeno grupo de adolescentes houve associação entre QUS e DXA, porém sem associação entre essas avaliações e as fraturas e a ingestão de cálcio, fósforo e vitamina D.

OBJECTIVE: To evaluate the association between quantitative ultrasonography at hand phalanges (QUS) and dual energy X-ray absorptiometry (DXA), and between these methods with food intake and history of bone fractures. SUBJECTS AND METHODS:After two years of follow up of 270 schoolchildren, 10 of them, who showed bone mass below - 2 SD in QUS, were included in the present study. Laboratory results and DXA data were analyzed. RESULTS: Bone mass evaluated by DXA at L1-L4 ranged from -2.8 to -1.1 SDS, and whole body bone mass, from -2.9 to -1.2 SDS. Three children had history of non-pathological bone fractures. Dietary assessment showed low intake of calcium in 10 cases, of phosphorus in 6, and of vitamin D in 8 cases. There were no differences among the cases of bone mass below-2 SD in any of the three used methods. There was no association between history of bone fractures and food intake, and between these evaluations and bone mass. CONCLUSION: In this small group of schoolchildren there was an association between the methods QUS and DXA. However, there was no association between bone mass and the history of bone fractures, or calcium, phosphorus and vitamin D intake.