Risk factors of osteoporosis and osteopenia in postmenopausal women based on the L2-L4 BMD T score of the lumbar spine: a study in Iran.

OBJECTIVE: To determine the risk factors of osteoporosis and osteopenia of the spine in postmenopausal women. METHOD: An analytical cross-sectional study was performed on postmenopausal women. The T-score of the lumbar spine (L2-L4) was measured by densitometry and compared between osteoporotic, osteopenia, and normal women. RESULTS: One thousand three hundred fify-nine postmenopausal women were evaluated. The prevalence of osteopenia and osteoporosis was 58.2% and 12.8% respectively. Age, BMI, parity, total breastfeeding years, dairy use, calcium-D supplements, and regular exercise were significantly different in women with osteoporosis, osteopenia, and normal women. Ethnicity, diabetes, and previous fracture history were only other among women with osteoporosis (not osteopenia) and normal women. For osteopenia of the spine, age [AOR 1.08 (1.05-1.11; p < .001)] was the risk factor, and BMI = >30 [AOR 0.36 (0.28-0.58; p < .001)] and BMI 25-<30 [AOR 0.55 (0.34-0.88; p = .012)] were protective factors. Hyperthyroidism (AOR 23.43, p = .010), Kurdish ethnicity (AOR 2.96, p = .009), not having regular exercise (AOR 2.22, p = .012), previous fracture history (AOR 2.15, p = .041)], and age (AOR 1.14, p < .001)], were risk factors for osteoporosis, while BMI ≥30 [AOR 0.09, p < .001], BMI 25-<30 [AOR 0.28, p = .001], and diabetes [AOR 0.41, p = .038] were protective factors for osteoporosis of the spine. CONCLUSION: Hyperthyroidism, low BMI <25, parity ≥ 6, Kurdish ethnicity, not having regular exercise, history of previous fracture, and age, were risk factors for osteoporosis of the spine respectively, while low BMI and age were risk factors for osteopenia.

The Impact of Cholecaciferol Supplementation on Bone Mineral Density in Long-Term Kidney Transplant Recipients.

Although reduced bone mineral density (BMD) is associated with a higher risk of fractures, morbidity, and mortality in kidney transplant patients (KTRs), there is no consensus on optimal treatment for the alterations of BMD in this population. This study aims at assessing the effect of cholecalciferol supplementation on BMD over a follow-up period of 2 years in a cohort of long-term KTRs. Patients with age ≥ 18 years were included and divided into two subgroups based on treatment with bisphosphonate and/or calcimimetics and/or active vitamin D sterols (KTRs-treated) or never treated with the above medications (KTRs-free). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral neck (FN) with standard DEXA at the beginning and end of the study. According to World Health Organization (WHO) criteria, results were expressed as T-score and Z-score. Osteoporosis and osteopenia were defined as T score ≤ -2.5 SD and T score < -1 and >-2.5 SD, respectively. Cholecalciferol was supplemented at a dose of 25,000 IU/week over 12 weeks followed by 1500 IU/day. KTRs-free (n. 69) and KTRs-treated (n. 49) consecutive outpatients entered the study. KTRs-free were younger (p < 0.05), with a lower prevalence of diabetes (p < 0.05) and of osteopenia at FN (46.3 % vs. 61.2 %) compared to KTRs-treated. At the entry none of the study subjects had a sufficient level of cholecalciferol; Z-score and T-score at LV and FN were not different between groups. At the end of the study period, serum cholecalciferol concentration was significantly increased in both groups (p < 0.001); the KTRs-free group presented an improvement in both T-score and Z-score at LV (p < 0.05) as well as a lower prevalence of osteoporotic cases (21.7% vs. 15.9%); in contrast, no changes were recorded in KTR-treated individuals. In conclusion, supplementation with cholecalciferol ameliorated Z-score and T-score at LV in long-term KTRs who had been never treated with active or inactive vitamin D sterols, bisphosphonates, and calcimimetics. Future endeavours are needed to confirm these preliminary findings.

Bone Mineral Density Changes in Long-Term Kidney Transplant Recipients: A Real-Life Cohort Study of Native Vitamin D Supplementation.

Vitamin D insufficiency has been associated with reduced bone mineral density (BMD) in kidney transplant patients (KTRs). However, the efficacy of vitamin D supplementation on BMD remains poorly defined, especially for long-term KTRs. We aimed to investigate the effect of native vitamin D supplementation on the BMD of KTRs during a 2-year follow-up. Demographic, clinical, and laboratory data were collected. BMD was evaluated with standard DEXA that was performed at baseline (before vitamin D supplementation) and at the end of study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. According to WHO criteria, results were expressed as the T-score (standard deviation (SD) relative to young healthy adults) and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as a T-score ≤ -2.5 SD and a T-score < -1 and a > -2.5 SD, respectively. Based on plasma levels, 25-OH-vitamin D (25-OH-D) was supplemented as recommended for the general population. Data from 100 KTRs were analyzed. The mean study period was 27.7 ± 3.4 months. At study inception, 25-OH-D insufficiency and deficiency were recorded in 65 and 35 patients. At the basal DEXA, the percentage of osteopenia and osteoporosis was 43.3% and 18.6% at LV and 54.1% and 12.2% at FN, respectively. At the end of the study, no differences in the Z-score and T-score gains were observed. During linear mixed model analysis, native vitamin D supplementation was found to have a negative nitration with Z-score changes at the right femoral neck in KTRs (p < 0.05). The mean dose of administered cholecalciferol was 13.396 ± 7.537 UI per week; increased 25-OH-D levels were found (p < 0.0001). Either low BMD or 25-OH-vitamin D concentration was observed in long-term KTRs. Prolonged supplementation with 25-OH-D did not modify BMD, Z-score, or T-score.

Bone Health Assessed by Calcaneal Quantitative Ultrasound among Cohort of Pregnant Egyptian Women.

AIM: The aim was to assess the risk of osteopenia and osteoporosis and to identify possible risk factors affecting bone density (BD) during pregnancy as parity, body mass index (BMI), Vitamin D, and calcium supplementation using quantitative ultrasound (QUS) of the calcaneus among first- and third-trimester pregnant women. METHODS: It is a case-control study conducted at Ain Shams Maternity Hospital, Egypt, from May 7 to December 14, 2015. One hundred and thirty-two women in the third trimester and 33 matched controls in the first trimester were screened for BD at the calcaneus by QUS. Stiffness index (SI), QUS-T, and Z scores were measured. RESULTS: Comparing both the groups regarding QUS-T score, Z score, and SI showed a statistically significant difference between both groups. Third-trimester participants had lower scores (-0.72 ± 1.0, -0.63 ± 0.99, and 88.53 ± 14.81, respectively) compared to their matched controls (1.05 ± 0.89, 1.16 ± 0.91, and 113.79 ± 12.49, respectively). According to QUS-T scores, 82 women (62.1%) in the third-trimester group were assessed as having normal BD, whereas 47 women (35.6%) were at risk of being osteopenic and 3 women (2.3%) were at risk of being osteoporotic. All women of the first trimester were assessed as having normal BD. Logistic regression was performed to identify possible risk factors affecting BD among third-trimester patients. BMI was the only statistically significant predictor for changes in bone health in those women (P = 0.001, odds ratio: 0.857, 95% confidence interval: 0.786-0.936). CONCLUSION: With one-unit rise in BMI, a 14% reduction in risk of decreased bone health is obtained.

T Scores, FRAX, Frailty Phenotype, Falls, and Its Relationship to Fractures in Patients on Maintenance Hemodialysis.

BACKGROUND: Despite the magnitude of fracture and the consequences in patients receiving hemodialysis, optimal risk assessment tools in this population are not well explored. Frailty and falls-known risk factors for fracture in chronic kidney disease (CKD) and non-CKD populations-are common in patients receiving hemodialysis (HD) therapy. While the relationship between T scores in relation to fractures in patients receiving HD is recognized, there is a paucity of data to the additional contributions of fracture assessment tool (FRAX), frailty status, and falls in its relationship with fracture. OBJECTIVES: To evaluate the clinical utility of adding FRAX, frailty status, and falls to T scores at the femoral neck to determine whether it enhances fracture discrimination in patients on maintenance HD. DESIGN: A cross-sectional observational study. SETTING: Two main dialysis units in Regina, Saskatchewan, Canada. PATIENTS: A total of 109 patients on maintenance HD at two dialysis units from January 1, 2017, to December 31, 2018, were included in the study. MEASUREMENTS: Fracture (the main outcome) was documented based on the review of medical charts, self-recall, and additionally vertebral fractures were identified by an x-ray. Areal bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). FRAX score was calculated using an online algorithm based on 11 clinical risk factors. We calculated the FRAX score for hip fracture and major osteoprotoic fracture with and without the inclusion of BMD. Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Patients were enquired about the history and frequency of falls. METHODS: A total of 131 patients underwent frailty assessments at the two dialysis units during the dialysis treatment. Following frailty assessments, they were referred for DXA scans and upon receipt of the results undertook FRAX questionnaires. They were additionally sent for lumbar x-rays and contacted for a history of falls. Association between the BMD-T score, FRAX, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. Differences were considered statistically significant at P values <.05. RESULTS: A total of 109 patients were included in the data analysis. The composite of fracture occurred in 37.6% of patients. About 59.3% were identified as frail, and 29% of the participants had at least one fall in the last year. On multivariate regression analysis, each lower standard deviation (SD) in femoral neck T score was associated with 48% higher odds of fracture (odds ratio [OR] = 1.48; 95% confidence interval [CI] 1.20-1.68, P = .005). With the inclusion for FRAX scores (hip), the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04-1.63, P = .043). The addition of frailty status and history of falls did not further improve the model. Low T score and FRAX were both independent risk factors in patients on HD therapy. LIMITATIONS: This is a single-center study with a small sample size which limits the generalizability of the findings. Due to the cross-sectional study, associations identified may be difficult to interpret. CONCLUSIONS: Both BMD measurements by DXA and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Larger prospective studies are needed to determine whether the inclusion of frailty and falls to the conventional models will improve fracture assessment in the population receiving HD. TRIAL REGISTRATION: The study was not registered on a publicly accessible registry as it did not involve health care intervention on human participants.

CONTEXTE: Les outils permettant une évaluation optimale du risque de fractures chez les patients hémodialysés demeurent sous-examinés malgré le nombre de fractures et leurs conséquences dans cette population. La fragilité et les chutes ­ des facteurs de risque connus de fracture chez les patients atteints ou non d'insuffisance rénale chronique (IRC) ­ sont fréquentes chez les patients hémodialysés. Bien qu'un lien entre les scores T et les fractures soit reconnu chez les patients hémodialysés, très peu de données existent sur les contributions supplémentaires de l'outil d'évaluation des fractures (FRAX), de l'état de fragilité des patients et des antécédents de chutes dans leur lien avec les fractures. OBJECTIF: Évaluer l'utilité clinique d'ajouter le FRAX, l'état de fragilité et les chutes aux scores T du col fémoral pour déterminer s'ils améliorent la discrimination des fractures chez les patients suivant des traitements d'hémodialyse d'entretien. TYPE D'ÉTUDE: Étude transversale et observationnelle. CADRE: Les deux principales unités de dialyse de Régina (Saskatchewan) au Canada. SUJETS: Ont été inclus 109 patients suivant des traitements d'hémodialyse d'entretien dans les deux unités de dialyse entre le 1er janvier 2017 et le 31 décembre 2018. MESURES: L'auto-rappel et l'examen du dossier médical ont permis de documenter les fractures (principal résultat); les fractures vertébrales ont été confirmées par radiographie. La densité minérale osseuse (DMO) de surface a été mesurée par absorptiométrie double énergie à rayons X (DEXA). Le score FRAX a été calculé avec un algorithme en ligne selon 11 facteurs de risque cliniques. Le score FRAX pour les fractures de la hanche a été calculé avec et sans la DMO. La fragilité a été évaluée selon les critères de Fried, lesquels comprenaient l'évaluation d'une perte de poids involontaire, de la faiblesse (force de préhension) et de la lenteur (vitesse de marche), et à l'aide d'un questionnaire évaluant l'activité physique et le niveau d'épuisement perçu. Les patients ont été questionnés sur leurs antécédents de chutes et sur leur fréquence. MÉTHODOLOGIE: Au total, dans les deux unités de dialyse, 131 patients ont subi une évaluation de la fragilité pendant leurs traitements. Après l'évaluation, les patients ont été aiguillés pour un examen par DEXA et, à la réception des résultats, ont répondu à des questionnaires FRAX. Ils ont également passé une radiographie lombaire et ont été contactés pour discuter de leurs antécédents de chutes. L'association entre une fracture et le score BMD-T, le FRAX, l'état de fragilité et les chutes a été examinée à l'aide de modèles séquentiels de régression logistique multivariée. Les différences ont été considérées comme statistiquement significatives à des valeurs de P supérieures à 0,05. RÉSULTATS: L'analyse porte sur un total de 109 patients. Un critère combiné associant une fracture était présent chez 37,6 % des sujets; 59,3 % des patients ont été jugés fragiles et 29 % avaient chuté au moins une fois au cours de la dernière année. Dans l'analyse de régression multivariée, chaque valeur inférieure d'écart-type (É-T) pour le score T du col fémoral a été associée à un risque 48 % plus élevé de fracture (rapport de cote [RC] = 1,48; IC à 95 %: 1,20-1,68; P = 0,005). En incluant les scores FRAX (hanche), le rapport de cote pour la fracture est demeuré significatif à 1,38 (RC = 1,38; IC à 95 %: 1,04-1,63; P = 0,043). L'ajout de l'état de fragilité et des antécédents de chutes n'a pas amélioré le modèle. Un faible score T et un faible score FRAX se sont tous deux avérés un facteur de risque indépendant chez les patients hémodialysés. LIMITES: L'étude est monocentrique et l'échantillon est de faible taille, ce qui limite la généralisation des résultats. Les associations identifiées peuvent être difficiles à interpréter en raison de la nature transversale de l'étude. CONCLUSION: Les mesures de la DMO, qu'elles soient faites par DEXA ou par FRAX, sont des outils utiles pour évaluer les fractures chez les patients hémodialysés. L'ajout de l'état de fragilité et des antécédents de chutes n'a pas été associé aux fractures dans cette population. Des études prospectives de plus grande envergure sont nécessaires pour déterminer si l'inclusion de l'état de fragilité et des antécédents de chutes dans les modèles classiques améliorerait l'évaluation des fractures chez les patients hémodialysés. ENREGISTREMENT DE L'ESSAI: L'étude n'a pas été inscrite dans un registre accessible au public puisqu'elle n'implique aucune intervention sur les participants.

Assessment of Body Composition and Dietary Intake in Nursing-Home Residents: Could Lessons Learned from the COVID-19 Pandemic Be Used to Prevent Future Casualties in Older Individuals?

The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3-95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using "Nutrition" software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.

Hounsfield units value is a better predictor of pedicle screw loosening than the T-score of DXA in patients with lumbar degenerative diseases.

PURPOSE: To compare the performance of using Hounsfield units (HU) value derived from computed tomography and T-score of dual-energy X-ray absorptiometry (DXA) to predict pedicle screw loosening. METHODS: We reviewed 253 patients aged ≥ 50 years undergoing pedicle screw fixation for lumbar degenerative diseases (LDD). The evaluation of screw loosening: radiolucent zones of ≥ 1 mm thick in X-ray. The criterion for osteoporosis: the lowest T-score ≤ - 2.5. The average HU value of L1-L4 was used to represent lumbar bone mineral density (BMD). The area under receiver operating characteristics curve (AUC) was used to evaluate the performance of predicting screw loosening. RESULTS: One patient underwent reoperation for screw loosening at 9 months follow-up. At 12 months follow-up, the loosening rate was 30.6% (77/252) in the remaining 252 patients. Osteoporotic patients had higher loosening rate than non-osteoporotic patients (39.3% vs. 25.8%, P = 0.026). The T-score showed no significant difference between loosening group and non-loosening group (- 2.1 ± 1.5 vs. - 1.7 ± 1.6, P = 0.074), and so is the lowest lumbar BMD of DXA (0.83 ± 0.16 g/cm2 vs. 0.88 ± 0.19 g/cm2, P = 0.054). The HU value was lower in the loosening group (106.8 ± 34.4 vs. 129.8 ± 45.7, P < 0.001). The HU value (OR, 0.980; 95%CI 0.968-0.993; P = 0.002) was the independent influencing factor of screw loosening. The AUC of predicting screw loosening was 0.666 (P < 0.001) for HU value and 0.574 (P = 0.062) for T-score. CONCLUSIONS: HU value is a better predictor of pedicle screw loosening than T-score of DXA in patients aged ≥ 50 years with LDD. We should not only focus on the DXA measurements when making surgical plans concerning lumbar fixation. These slides can be retrieved under Electronic Supplementary Material.

Correlation study between osteoporosis and hematopoiesis in the context of adjuvant chemotherapy for breast cancer.

This retrospective study attempts to establish if a correlation exists between osteoporosis and hematopoiesis before and after adjuvant chemotherapy in the context of non-metastatic breast cancer. Osteoporosis is interpreted both as a direct marker of osteoblastic decline and as an indirect marker of increased bone marrow adiposity within the hematopoietic microenvironment. Patients from the "Centre du Sein" at CHUV (Centre Hospitalier Universitaire Vaudois) undergoing adjuvant chemotherapy were included in this study. Evolution of blood counts was studied in correlation with the osteoporosis status. Toxicity of chemotherapy was coded according to published probability of febrile neutropenia. One hundred forty-three women were included: mean age 52.1 ± 12.5 years, mean BMI (body mass index) 24.4 ± 4.1. BMD (bone mineral density) scored osteoporotic in 32% and osteopenic in 45%. Prior to chemotherapy, BMD was positively correlated with neutrophil (p < 0.001) and thrombocyte (p = 0.01) count; TBS (trabecular bone score) was not correlated with blood count. After the first cycle of chemotherapy, an increase of one point in TBS correlated with a decrease of 57% on the time to reach leucocyte nadir (p = 0.004). There was a positive correlation between BMD and risk of infection (p < 0.001). Our data demonstrates an association between osteoporosis and lower blood counts in a younger cohort than previously published, extending it for the first time to neutrophil counts in females. Our results suggest that the healthier the bone, the earlier the lowest leucocyte count value, prompting further research on this area.

Bone mineral density and nutritional state according to milk consumption in Korean postmenopausal women who drink coffee: Using the 2008~2009 Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: This study investigated bone mineral density and nutritional state according to consumption of milk in Korean postmenopausal women who drink coffee. METHODS: Using the 2008~2009 Korean National Health & Nutrition Examination Survey data, a total of 1,373 postmenopausal females aged 50 yrs and over were analyzed after excluding those with diseases related to bone health. According to coffee and/or milk consumption, subjects were divided into four groups: coffee only, both coffee & milk, milk only, and none of the above. All data were processed after application of weighted values and adjustment of age, body mass index, physical activity, drinking, and smoking using a general linear model. For analysis of nutrient intake and bone density, data were additionally adjusted by total energy and calcium intake. RESULTS: The coffee & milk group had more subjects younger than 65 yrs and higher education, urban residents, and higher income than any other group. The coffee only group showed somewhat similar characteristics as the none of the above group, which showed the highest percentage of subjects older than 65 and in a lower education and socio-economic state. Body weight, height, body mass index, and lean mass were the highest in coffee & milk group and lowest in the none of the above group. On the other hand, the milk only group showed the lowest values for body mass index and waist circumference, whereas percent body fat did not show any difference among the groups. The coffee and milk group showed the highest bone mineral density in the total femur and lumbar spine as well as the highest nutritional state and most food group intakes, followed by the milk only group, coffee only group, and none of the above group. In the assessment of osteoporosis based on T-score of bone mineral density, although not significant, the coffee and milk group and milk only group, which showed a better nutritional state, included more subjects with a normal bone density, whereas the none of the above group included more subjects with osteoporosis than any other group. CONCLUSION: Bone mineral density in postmenopausal women might not be affected by coffee drinking if their diets are accompanied by balanced food and nutrient intake including milk.

"Analysis on Bone Mineral Density and Its Relation to ""Kidney-deficiency, Qi-deficiency and Blood Stasis"" among 392 Cases" / 世界科学技术-中医药现代化

This study was aimed to discuss traditional Chinese medicine (TCM) factors of bone mineral density (BMD) in order to figure out the relation of BMD T-Score to the TCM syndrome of kidney-deficiency, qi-deficiency , and blood-stasis . It may provide the scientific basis for TCM treatment of osteoporosis . Patients were collected from August 2010 to April 2011 at the Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine . The assay of BMD was performed with the U . S . HOLOGIC dual-energy radia-tion . The BMD was measured and recorded in the form . All data were collected into the computer using Epi-Data3 . 02 software . Then , the data was analyzed by the SPSS15 . 0 statistical software . The results showed that through the Mann-Whitney U test , the BMD of patients with kidney-deficiency syndrome was worse compared to patients without kidney-deficiency syndrome ( P < 0 . 01 ); the BMD of patients with q i-deficiency syndrome was worse compared to patients without q i-deficiency syndrome ( P < 0 . 01 ); the BMD of patients with blood-stasis syndrome was worse compared to patients without blood-stasis syndrome ( P < 0 . 01 ) . It showed that the BMD of patients with kidney-deficiency , q i-deficiency and blood-stasis was worse compared to patients with-out syndrome of kidney-deficiency , q i-deficiency and blood-stasis . Under a variety of evidence-based BMD distribution , the chi-square test showed that there was significant difference ( P < 0 . 01 ) . It showed that differ-ent BMD had different TCM syndrome distributions . Among normal BMD cases , distributions of syndrome with-out kidney-deficiency, qi-deficiency and blood-stasis occupied the largest proportion. Among osteoporosis cas-es , the distribution of syndrome of kidney-deficiency , q i-deficiency and blood-stasis occupied the largest pro-portion . It was concluded that the syndrome of kidney-deficiency , q i-deficiency and blood-stasis maybe impor-tant factors to influence BMD . It may also be the risk factor of osteoporosis complication . The BMD are relat-ed to the syndrome of kidney-deficiency , q i-deficiency and blood-stasis and their combinations . Among bone mass reduction and osteoporosis cases , the proportion of combination of two or three types of syndromes was more than single one syndrome . It suggested that the combination of kidney-deficiency , q i-deficiency and blood-stasis had more influence on BMD .