Comparison of bone mineral density between female amateur triathletes and nonathletes: A cross-sectional study.

PURPOSE: Physical inactivity is considered an important risk factor for osteoporosis, however, some athletes performing extremely high training volumes can also develop bone mass loss. Moreover, the effect of total body mass or body surface area on bone mineral density remains controversial. Therefore, the aim of this study was to compare the absolute bone mineral density and bone mineral density adjusted to body surface area between amateur triathletes and nonactive women. METHODS: Forty-two healthy women (23 amateur triathletes and 19 nonactive individuals) were evaluated for body composition using a dual-energy X-ray absorptiometry system. RESULTS: Compared to nonactive women, amateur triathletes exhibited lower body mass index (p < 0.001), lower bone mineral density (p < 0.001), and body surface area (p < 0.001). However, bone mineral density adjusted by body surface area in the triathletes was higher than in the nonactive women (p = 0.03). CONCLUSION: These findings showed that amateur triathles presented lower absolute bone mineral density, but higher bone mineral density adjusted to body surface area. Future studies are recommended to identify if the higher bone mineral density adjusted to body surface area are associated with a lower bone fragility.

Upper and lower limb bone mass accrual in adolescent footballers across a short period of training and competition

Abstract Objectives: To analyze bone mineral content (BMC) and area bone mineral density (aBMD) accrual in adolescent male footballers who started their first football season. Methods: 17 athletes (14.8 ± 0.4 years) were monitored across 15 weeks of football training. Participants were evaluated for somatic maturation (HPHV), BMC, and aBMD at three time points: before (M1) and after (M2) a preparatory phase, and at the end of the competitive phase (M3). BMC and aBMD were measured using DXA scans. Participants were divided into groups according to maturation status (circa-PHV and post-PHV), and the amount of accumulated training load (median split). Results: A significant effect (12.1 g/week, standard error (SE) = 2.6 g/week) was observed for lower limbs BMC across the three time points. There were no significant effects of time for upper limbs BMC. There was a significant effect of time for total body aBMD (0.007, SE = 0.003 g/cm2/week) across the three time points. Adolescents at post-PHV had a significant 245.6 g (SE = 56.1 g) higher BMC compared to adolescents at circa-PHV. No significant effects were observed for the accumulated training load. Conclusion: Systematic football training, even during the growth spurt, has a positive impact on adolescent bone markers despite the accumulated training load and maturation.

Fracture Risk Assessment Tool-Based Screening for Osteoporosis in Older Adults in Resource-Limited Settings.

PURPOSE: Osteoporosis is a pressing public health concern among older adults, contributing to substantial mortality and morbidity rates. Low- to middle-income countries (LMICs) often grapple with limited access to dual-energy X-ray absorptiometry (DXA), the gold standard for early osteoporosis detection. This study aims to assess the performance of the FRAX® score as a population-wide screening tool for predicting osteoporosis risk, rather than fracture, in individuals aged 50 and above within an LMIC context. METHODS: This retrospective cohort study (n=864) assessed the performance of the FRAX® score for predicting osteoporosis risk using comparative c-statistics from Receiver Operating Characteristic (ROC) curves. Hazard ratios (HR) and 95 % confidence intervals (CI) were calculated, with p-values <0.05 indicating statistically significant. RESULTS: The 10-year FRAX® probability for hip fracture, calculated without bone mass density (BMD), exhibited significantly superior performance compared to the 10-year FRAX® probability for major fracture in predicting osteoporosis risk (AUROC: 0.71 versus 0.67, p<0.001). Within 2 to 10 years of follow-up, the 10-year FRAX® probability for hip fracture showed both greater predictive performance and net benefit in the decision curve compared to the FRAX® 10-year probability for major fracture. A newly established cutoff of 1.9 % yielded a negative predictive value of 92.9 % (95 %CI: 90.4-94.8 %) for the 10-year FRAX® probability for hip fracture. CONCLUSION: The 10-year FRAX® probability for hip fracture estimated without BMD emerges as an effective 10-year screening tool for identifying osteoporosis risk in aged 50 and older, especially when confronted with limited access to DXA scans in LMICs. MINI ABSTRACT: The Fracture Risk Assessment Tool score performance as an osteoporosis screening tool was assessed in areas with limited dual-energy X-ray access. The hip fracture probability showed better performance than major fracture probability within 2 to 10 years. The tool emerges as effective for screening osteoporosis risk in individuals over 50.

Effects of exercise training on bone health in adults living with HIV: a systematic review with meta-analysis.

We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane Library, and ScienceDirect databases were searched for trials investigating exercise training-induced changes in BMD of PLHIV at baseline vs. post-intervention assessed by dual-energy X-ray absorptiometry (DXA). Hedge effect sizes (ES) were calculated incorporating fixed effects for BMD variation assumptions. Disaggregated comparisons were performed for trials with more than one intervention or BMD site assessment. Seven trials included 210 PLHIV and 35 non-HIV-infected controls. Methodological quality evaluated using the Physiotherapy Evidence Database (PEDro) scale ranged from poor to moderate. Interventions applied isolated resistance, combined aerobic and resistance, and multimodal exercise protocols performed 3 d/wk for 12-to 104 week. One controlled and another uncontrolled trial presented significant effects, reporting improvements at the femoral neck and total (ES 2.14 and 0.49, respectively). Magnitude of those specific ES influenced the overall effect (controlled and uncontrolled trials), which was small but significant (k = 12, ES 0.277, 95% confidence interval 0.120-0.434). Resistance training may promote favorable adaptations in BMD of PLHIV, particularly in femur. Future research should elucidate the optimal dose-response relationship and physiological mechanisms underlying exercise-induced adaptations on the BMD of PLHIV.

[Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society]. / Valoración de la densidad mineral ósea en personas transgénero. Posicionamiento de la Sociedad Argentina de Osteoporosis.

The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

La Sociedad Argentina de Osteoporosis convocó a especialistas reconocidos en la atención de personas transgénero para la elaboración del primer posicionamiento local sobre la evaluación de la salud ósea en esta población. La ley 26.743 de "Identidad de género" reconoce todas las identidades y garantiza su atención de manera gratuita en el sistema de salud. El impacto de los diferentes tratamientos de afirmación de género sobre la masa ósea ha sido tópico de debate internacional. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo, creemos relevante mencionar nuestra experiencia plasmando mediante este documento una serie de sugerencias para ser utilizadas en la atención médica.

Upper and lower limb bone mass accrual in adolescent footballers across a short period of training and competition.

OBJECTIVES: To analyze bone mineral content (BMC) and area bone mineral density (aBMD) accrual in adolescent male footballers who started their first football season. METHODS: 17 athletes (14.8 ± 0.4 years) were monitored across 15 weeks of football training. Participants were evaluated for somatic maturation (HPHV), BMC, and aBMD at three time points: before (M1) and after (M2) a preparatory phase, and at the end of the competitive phase (M3). BMC and aBMD were measured using DXA scans. Participants were divided into groups according to maturation status (circa-PHV and post-PHV), and the amount of accumulated training load (median split). RESULTS: A significant effect (12.1 g/week, standard error (SE) = 2.6 g/week) was observed for lower limbs BMC across the three time points. There were no significant effects of time for upper limbs BMC. There was a significant effect of time for total body aBMD (0.007, SE = 0.003 g/cm2/week) across the three time points. Adolescents at post-PHV had a significant 245.6 g (SE = 56.1 g) higher BMC compared to adolescents at circa-PHV. No significant effects were observed for the accumulated training load. CONCLUSION: Systematic football training, even during the growth spurt, has a positive impact on adolescent bone markers despite the accumulated training load and maturation.

Valoración de la densidad mineral ósea en personas transgénero posicionamiento de la Sociedad Argentina de Osteoporosis / Evaluation of bone health in transgender people. Position of the Argentine Osteoporosis Society

Resumen La Sociedad Argentina de Osteoporosis convocó a especialistas reconocidos en la atención de personas transgénero para la elaboración del primer posiciona miento local sobre la evaluación de la salud ósea en esta población. La ley 26.743 de "Identidad de género" reco noce todas las identidades y garantiza su atención de manera gratuita en el sistema de salud. El impacto de los diferentes tratamientos de afirmación de género sobre la masa ósea ha sido tópico de debate internacional. Hasta la fecha la evidencia sigue siendo limitada y diferentes sociedades han emitido sugerencias y recomendaciones. Por tal motivo, creemos relevante mencionar nuestra experiencia plasmando mediante este documento una serie de sugerencias para ser utilizadas en la atención médica.

Abstract The Argentine Osteoporosis Society convened renowned specialists in the care of transgender people to prepare the first local position on the evaluation of bone health in this population. Law 26.743 on "Gender Identity" recognize all identities and guarantees free care throughout the health system. The impact of different gender affirmation treatments on bone mass has been topic of international debate. To date the evidence remains limited and different societies have issued suggestions and recommendations. For this reason, we believe it is relevant to mention our experience, capturing through this document a series of suggestions to be used in medical care.

Trabecular bone score (TBS) and bone mineral density (BMD) analysis by dual X-ray absorptiometry (DXA) in healthy Brazilian children and adolescents: normative data.

Childhood and adolescence are crucial periods for healthy bone development throughout life. This study aims to establish normative data for trabecular bone score (TBS) and bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DXA) in healthy Brazilian children and adolescents. PURPOSE: To establish normative data for trabecular bone score (TBS) and bone mineral density (BMD) measurements using dual energy X-ray absorptiometry (DXA) in healthy Brazilian children and adolescents. METHODS: Healthy children and adolescents, aged 5 to 19 years, underwent medical interview, physical examination with anthropometric measurement, pubertal stage evaluation, and bone densitometry by DXA (Hologic QDR 4500). Boys and girls were divided into 2 age groups: 5-9 years old (children) and 10-19 years old (adolescents). BMD and bone mineral content (BMC) were measured following standard procedures. TBS measurements were performed using the TBS Insight ® v3.0.3.0 software. RESULTS: A total of 349 volunteers were enrolled in this cross-sectional study. Reference values were defined for each group of children and adolescents divided into 3-year age groups. Girls had lower values of TBS compared to boys (1.356 ± 0.116 and 1.380 ± 0.086 respectively, p = 0.029). For both boys and girls, BMC and spine BMD measurements were significantly higher in adolescent than in children (p = 0.0001; p = 0.0001; p = 0.0001, p = 0.0001, respectively). TBS range increased as pubertal development progressed. In both girls and boys, a 1-year increase in age was associated to a 0.013 increase in TBS. Body mass was a significant determinant for TBS. In girls, a 1 kg/m2 increase in BMI was associated to an average TBS increase of 0.008. CONCLUSION: Our findings reinforce the evidence that TBS varies according to age, sex, and pubertal stage in healthy children and adolescents. This study established reference values for TBS in healthy Brazilian children and adolescents which can be used as normative data for this population.

Evaluación de la densidad mineral ósea en adultos de 40 años y más, Honduras 2022

El objetivo de esta investigación fue evaluar la densidad de masa ósea (DMO), la situación nutricional, la ingesta de nutrientes y el nivel de actividad física, por medio de un estudio descriptivo, transversal, en una universidad internacional ubicada en Honduras cuyo universo es 376 empleados, con edad de 40 años y más. La muestra de 50 empleados fue estimada usando la fórmula para poblaciones finitas con una probabilidad de 90% y un error de 10%. Se tomaron medidas antropométricas con equipo SECA; densidad mineral ósea con equipo de ultrasonido en radio Sunlight MiniOmni™. Se aplicó un recordatorio de alimentos consumidos en las últimas 24 horas y el cuestionario Internacional de Actividad Física (IPAQ). Los datos se analizaron en EPI INFO v 7.2.5. El promedio de edad fue 48,9 años con 58% de mujeres participantes. El 90% tuvo sobrepeso y obesidad. Se identificaron 14 casos de DMO no normal, de éstos, uno fue osteoporosis (mujer, de 50 años y más); 93% de los casos tuvieron sobrepeso y obesidad, 43% se identificaron en personas de 40 a 49 años y 71% fueron mujeres. La actividad física fue 48% baja. El promedio de calorías consumidas/día/persona fue de 2.517; con 21% de adecuación de vitamina D, 87% de calcio, 275% de fósforo, 166,69 mg de cafeína. Se concluye que se requiere el control del sobrepeso y obesidad, así como el diagnóstico temprano de los cambios en la densidad mineral ósea, particularmente en las mujeres.

The objective of this research was to evaluate bone mass density(BMD), nutritional status, nutrient intake, and physical activity level, through a cross-sectional descriptive study, in an international university located in Honduras with a universe of 376 employees, aged 40 and over. The sample of 50 was estimated with the formula for finite population with a 90% probability and an error of 10%. Anthropometric measurements were taken with SECA equipment; bone mineral density with Sunlight MiniOmni™ radio ultrasound equipment. A 24-hour dietary recall method and the International Physical Activity Questionnaire (IPAQ) were applied. The data was analyzed in EPI INFO v 7.2.5. The average age of the people in the sample was 48,9 years with 58% of women. 90% were overweight and obese. 14 cases of non-normal BMD were identified, of these, one was osteoporosis (woman, 50 years of age and over); 93% of the cases were overweight and obese, 43% were identified in people between 40 and 49 years of age, and 71% were women. Physical activity was 48% low. The average number of calories consumed/day/person was 2.517; 21% adequacy of vitamin D, 87% of calcium, 275% of phosphorus, 166.69 mg of caffeine. It is concluded that control of overweight and obese is required, and the early diagnosis of changes in bone mass density, particularly in women.

Chronic arthritides and bone structure: focus on rheumatoid arthritis-an update.

Normal bone remodeling depends of a balance between bone forming cells, osteoblasts and bone resorbing cells, the osteoclasts. In chronic arthritides and some inflammatory and autoimmune diseases such as rheumatoid arthritis, there is a great constellation of cytokines produced by pannus that impair bone formation and stimulate bone resorption by inducing osteoclast differentiation and inhibiting osteoblast maturation. Patients with chronic inflammation have multiple causes that lead to low bone mineral density, osteoporosis and a high risk of fracture including circulating cytokines, impaired mobility, chronic administration of glucocorticoids, low vitamin D levels and post-menopausal status in women, among others. Biologic agents and other therapeutic measures to reach prompt remission might ameliorate these deleterious effects. In many cases, bone acting agents need to be added to conventional treatment to reduce the risk of fractures and to preserve articular integrity and independency for daily living activities. A limited number of studies related to fractures in chronic arthritides were published, and future investigation is needed to determine the risk of fractures and the protective effects of different treatments to reduce this risk.

Subclinical Hypothyroidism is Not Associated with Femoral Osteoporosis in Individuals Aged 50 Years or Older.

BACKGROUND: Thyroid dysfunction and osteoporosis are conditions strongly associated with aging, and the prevalence of both conditions is expected to increase in the coming decades. Thyroid hormones regulate bone metabolism, and the role of subclinical hypothyroidism on bone mineral density (BMD) is still controversial. Hence, this study aims to assess the association of subclinical hypothyroidism with femoral osteopenia and osteoporosis in individuals aged 50 years or older. METHODOLOGY: This retrospective cohort study was carried out with 864 outpatients having at least one result for TSH levels before the first record of dual-energy X-ray absorptiometry (DXA). The primary endpoints were osteopenia (-2.5 standard deviation (SD)

Osteopenia en una adolescente blanca hispana: reporte de caso / Osteopenia in a white, hispanic, adolescent female: a case report

Introducción. Un estilo de vida poco saludable (malos hábitos alimentarios y sedentarismo), deficiencia de vitamina D, y la ingesta inadecuada de calcio, pueden contribuir a desarrollar osteopenia grave en la infancia, condicionando el riesgo futuro a sufrir fracturas y osteoporosis. Materiales y métodos. Presentamos un caso de osteopenia en una niña blanca, hispana y premenárquica de 13 años quien completó la visita basal del estudio de MetA-Bone. Evaluamos el contenido de masa ósea, la densidad de masa ósea corporal total y de la columna y la composición corporal mediante densitometría ósea (DXA). Abarcamos el historial de salud, antecedentes familiares, desarrollo puberal, actividad física, sueño, ingesta de nutrientes, antropometría, biomarcadores óseos y metabólicos. Resultados. La niña tiene antecedentes familiares de osteoporosis y no reporta fracturas previas. Muestra una actividad moderada al aire libre <1 hora/día 3 veces/semana con 8 horas/día de sueño. El consumo de productos lácteos y vegetales fue <1 ración/día. Presenta deficiencia de vitamina D (25(OH)D: 9 ng/mL) e hiperfosfatemia (5,2 mg/dL). El Z-score del DXA fue -2,1 DE (indicativo de osteopenia por edad y sexo). La niña fue referida a un pediatra, quien confirmó los hallazgos e indicó un suplemento diario con 2000 UI de vitamina D y 1000 mg de calcio. Conclusiones. El aislamiento durante la pandemia de COVID pudo haber contribuido a la gravedad de los hallazgos. Por lo tanto, recomendamos realizar pruebas de detección de vitamina D, calcio y hábitos de vida a los niños que experimentaron crecimiento acelerado durante y después de la pandemia(AU)

Introduction. Poor lifestyle habits, vitamin D deficiency, and inadequate calcium intake, particularly during the COVID-19 pandemic, may contribute to severe osteopenia in childhood, increasing future fractures and osteoporosis risk. Materials and methodology. We here present a case of osteopenia in a 13-year-old white, Hispanic, premenarchal girl who completed the baseline visit of the MetA-Bone Trial during the COVID-19 pandemic. Using a dual-energy X-ray absorptiometry, we assessed bone mass content (BMC), total body and spine bone mass density (BMD), and body composition. We cover the girl's health history and family history, pubertal development, intensity, duration, and frequency of physical activity and sleep, and nutrient intake (calcium and vitamin D), as well as anthropometric parameters, and bone and metabolic biomarkers. Results. The girl has a family history of osteoporosis (maternal grandfather) but no previous fractures; moderate outdoor activity was <1 hour/day 3 times/week with 8 hours/day of sleep. Consumption of dairy products and vegetables was <1 serving/day. Lab blood tests confirmed vitamin D deficiency (serum 25(OH) D: 9 ng/ml) and hyperphosphatemia (5.2 mg/dL); other tests were normal. DXA scan Z-score was -2.1 SD (indicative of osteopenia by age and sex). The girl was referred to a pediatrician, who confirmed the results, and prescribed a daily supplement with 2000 IU of vitamin D and 1000 mg of calcium. Conclusions. Seclusion during the COVID pandemic may have contributed to the severity of the findings. Therefore, we recommend screening children undergoing growth spurts for vitamin D, calcium, and poor lifestyle habits during and after the pandemic(AU)

Absorción mineral y retención ósea en ratas normales en crecimiento por el consumo de un yogur experimental reducido en lactosa que contiene galactooligosacáridos (GOS) / Mineral absorption and bone retention in normal growing rats by consumption of an experimental lactose-reduced yogurt containing galactooligosaccharides (GOS)

Introducción: Los GOS son prebióticos naturales presentes en la leche materna que pue-den obtenerse enzimáticamente a partir de la lactosa de leche de vaca durante la fabricación de yogur. El producto lácteo resultante será reducido en lactosa y contendrá prebióticos y bacterias potencialmente probióticas. Sin embargo, mantendrá la baja relación Ca/Pi que aporta la leche de vaca, lo que podría alterar el remodelamiento óseo y la mineralización. Objetivo: comparar si un yogur reducido en lactosa que contiene GOS (YE) ofrece ventajas adicionales respecto de un yogur regular sin GOS (YR) sobre las absorciones (Abs) de Ca y Pi, retención y calidad ósea durante el crecimiento normal. Al destete, ratas machos fueron divididas en 3 grupos alimentados con AIN ́93-G (C), YE o YR durante 28 días. Resultados: YE mostró el mayor aumento de lactobacilos fecales; producción de ácidos grasos de cadena corta especialmente p, profundidad de las criptas colónicas y menor pH cecal. El %AbsCa y %AbsPi aumentó en el siguiente órden: YE> YR> C (p < 0,05). El contenido de Ca y Pi en fémur, la densidad y contenido mineral óseos y los parámetros biomecánicos fueron similares en YE y C, mientras que YR mostró valores significativa-mente menores (p < 0,05). Conclusiones: YE aumentó las Abs y biodisponibilidad de minerales, alcanzando la retención y calidad ósea de C. El aumento en las Abs observado en YR no logró obtener la retención y calidad ósea de C. Conclusión: YE habría contrarrestado el efecto negativo del mayor aporte de Pi de la leche de vaca y sería una buena estrategia para lograr el pico de masa ósea y calidad del hueso adecuados, especialmente en individuos intolerantes a la lactosa. (AU)

Breast milk contains an optimal calcium/phosphate (Ca/Pi) ratio and GOS. These natural prebiotics can be enzymatically produced via cow's milk lactose inyogurt manufacture. This milk product is low in lactose and contains prebiotics and potentially probiotic bacteria but maintains a low Ca/Pi ratio that could alter bone remodeling and mineralization. We evaluated if a lactose-reduced yogurt containing GOS (YE) offers additional advantages over regular yogurt without GOS (YR) on Ca and Pi absorption (Abs), bone retention and quality during normal growth. Weaning male rats were divided into 3 groups fed AIN'93-G (C), YE or YR for 28 days. Results: YE showed the highest increase in fecal lactobacilli; short-chain fatty acids production, especially propionate and butyrate; intestine crypt depth, and the lowest cecal pH. AbsCa% and AbsPi% increased in this order: YE> YR> C (p <0.05). Ca and Pi content in femur, bone density and mineral content, and biomechanical parameters were similar in YE and C, while YR showed the significantly lowest value (p < 0.05). Conclusions: YE increased mineral Abs reaching the retention and bone quality of C. Although YR increased Abs, bone retention and quality did not achieve C values. Seemingly, YE compensated for the negative effect of the higher Pi supply and would be a good strategy to achieve adequate peak bone mass and bone quality, especially in lactose intolerant individuals. (AU)

Relationship between postural changes, osteoarthritis and bone mineral density in postmenopausal women.

OBJECTIVES: To assess the relationship between postural changes, osteoarthritis (OA) and bone mineral density (BMD) in postmenopausal women. METHODS: A total of 127 Brazilian women, aged 45 years or older, were included in this retrospective study. Subjects were divided in two groups: study group with postural changes (SG) and control group without postural changes (CG). Possible postural changes considered were scoliosis, kyphosis and lordosis. All women underwent BMD assessment and OA was identified at the region of the hip and lumbar spine by dual energy X-ray absorptiometry (DXA) analysis. RESULTS: SG was older (66.0 ± 7.3 years) than the CG (61.0 ± 8.6 years). In the entire sample we found thirteen women with OA and low BMD. Overall, the lumbar spine area was more affected by OA than the hip. The value of BMD T-score accounted for up to 77% of the changes observed in the SG group. CONCLUSION: Postural changes identified in women are directly related to aging and associated with bone loss and joint degeneration. Postural changes may be the primary sign of frailty as a result of body adaptation to pain related to musculoskeletal diseases.

Adolescent female handball players present greater bone mass content than soccer players: A cross-sectional study.

BACKGROUND: Osteoporosis is a systemic disease affecting half of women over the age of 50 years. Considering that almost 90% of peak of bone mass is achieved until the second decade of life, ensuring a maximal bone mineral content acquisition may compensate for age-associated bone loss. Among several other factors, physical activity has been recommended to improve bone mass acquisition. However, it is unknown whether athletes involved with sports with different impact loading characteristics differ in regards to bone mass measurements. AIM: To compare the bone mass content, bone mass density and lean mass of young female soccer players (odd-impact loading exercise), handball players (high-impact loading exercises) and non-athletes. METHODS: A total of 115 female handball players (15.5 ± 1.3 years, 165.2 ± 5.6 cm and 61.9 ± 9.3 kg) and 142 soccer players (15.5 ± 1.5 years, 163.7 ± 6.6 cm and 56.5 ± 7.7 kg) were evaluated for body composition using a dual-emission X-ray absorptiometry system, and 136 female non-athletes (data from NHANES) (15.1 ± 1.32 years, 163.5 ± 5.8 cm and 67.2 ± 19.4 kg) were considered as the control. RESULTS: Handball players presented higher bone mass content values than soccer players for upper limbs (294.8 ± 40.2 g and 270.7 ± 45.7 g, p < 0.001), lower limbs (1011.6 ± 145.5 g and 967.7 ± 144.3 g, p = 0.035), trunk (911.1 ± 182.5 g and 841.6 ± 163.7 g, p = 0.001), ribs (312.4 ± 69.9 g and 272.9 ± 58.0 g, p < 0.001), spine (245.1 ± 46.8 g and 222.0 ± 45.1 g, p < 0.001) and total bone mass (2708.7 ± 384.1 g and 2534.8 ± 386.0 g, p < 0.001). Moreover, non-athletes presented lower bone mass content for lower limbs (740.6 ± 132.3 g, p < 0.001), trunk (539.7 ± 98.6 g, p < 0.001), ribs (138.2 ± 29.9 g, p < 0.001), pelvis (238.9 ± 54.6 g, p < 0.001), spine (152.8 ± 26.4 g, p < 0.001) and total bone mass (1987.5 ± 311.3 g, p < 0.001) than both handball and soccer players. Handball players also presented higher bone mass density values than soccer players for trunk, ribs and spine (p < 0.05) and handball and soccer players presented higher bone mass density than non-athletes for all measurements (p < 0.005). Finally, the non-athletes' lower limb lean mass was lower than soccer and handball players values (p < 0.05). CONCLUSION: Adolescent females engaged in handball training for at least one year present higher bone mass contents than those who are engaged in soccer training, which, in turn, present higher bone mass contents than non-athletes. These results might be used by physicians and healthcare providers to justify the choice of a particular sport to enhance bone mass gain in female adolescents.

Normal bone health in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy.

It is of great importance to investigate any potential detrimental effect on bone health in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy. This study demonstrated normal bone health in well-controlled patients. Additionally, glucocorticoid dose may play an important role in the mineral density of femoral neck region. PURPOSE: To compare regional bone mineral densities (BMDs) and bone statuses of young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency with a control group. The duration and dose of glucocorticoid therapy and relative skeletal muscle index (an indicator of sarcopenia) were also analyzed as parameters to predict bone health. METHODS: This case-control study included 23 patients (7 male and 16 female) and 20 controls (8 male and 12 female) matched by age range (18 to 31 years). Dual energy X-ray absorptiometry and phalangeal quantitative ultrasound (QUS) were used to estimate BMD and bone status, respectively. RESULTS: No difference was observed between patients and controls (of both sexes) in absolute values of BMD and Z-scores for the total body, lumbar spine, and femoral neck; or the bone status (estimated by phalangeal QUS). Multiple linear regression analysis demonstrated that relative skeletal muscle index independently correlated with BMD of the entire body (ß: 0.67, P = 0.007), the lumbar spine (ß: 0.73, P = 0.005), and the femoral neck (ß: 0.67, P = 0.007). However, the dose of glucocorticoids (ß: - 0.38, P = 0.028) independently correlated with BMD in the femoral neck region alone. CONCLUSION: No signs of change in bone health were observed in patients with CAH when compared to the reference group. Additionally, a marker of sarcopenia was demonstrated to have a role in mineral density mechanisms in all analyzed bone sites. Only the femoral neck BMD seemed to be significantly dependent on glucocorticoid dose.

Serum Metabolite Profile Associated with Sex-Dependent Visceral Adiposity Index and Low Bone Mineral Density in a Mexican Population.

Recent evidence shows that obesity correlates negatively with bone mass. However, traditional anthropometric measures such as body mass index could not discriminate visceral adipose tissue from subcutaneous adipose tissue. The visceral adiposity index (VAI) is a reliable sex-specified indicator of visceral adipose distribution and function. Thus, we aimed to identify metabolomic profiles associated with VAI and low bone mineral density (BMD). A total of 602 individuals from the Health Workers Cohort Study were included. Forty serum metabolites were measured using the targeted metabolomics approach, and multivariate regression models were used to test associations of metabolomic profiles with anthropometric, clinical, and biochemical parameters. The analysis showed a serum amino acid signature composed of glycine, leucine, arginine, valine, and acylcarnitines associated with high VAI and low BMD. In addition, we found a sex-dependent VAI in pathways related to primary bile acid biosynthesis, branched-chain amino acids, and the biosynthesis of pantothenate and coenzyme A (CoA). In conclusion, a metabolic profile differs by VAI and BMD status, and these changes are gender-dependent.

How is the phase angle associated with total and regional bone mineral density in university athletes?

Objective.To investigate how phase angle (PhA) is associated with total and regional bone mineral density (BMD) (femur and lumbar spine) in university athletes.Approach.This cross-sectional study was conducted in Florianópolis, Brazil, with 167 university athletes from different sports (92 males). The PhA was obtained through electrical bioimpedance and BMD was obtained through dual x-ray absorptiometry (DXA). Data on the covariables age, time involved in the sport, type of sport (low, medium and high impact), daily use of oral contraceptives, and vitamin D calcium and/or protein supplementation were obtained through anamnesis, while fat mass and fat- and bone-free mass were obtained through DXA. Simple linear regression and a 5% significance level were used.Main results. In female athletes, PhA was directly associated with total BMD (ß: 2.20; 95% CI: 0.43; 3.96) and BMD in the femur (ß0.85; 95% CI: -0.23; 1.94) and lumbar spine (ß: 1.45; 95% CI: 0.44; 2.46), even after adjusting for the covariates. In male athletes, although PhA was directly associated with regional BMD (femur [ß: 0.63; 95% CI: 0.04; 1.22] and lumbar spine [ß: 0.64; 95% CI: -0.01; 1.31]) in simple linear regression, this association disappeared when the covariates were added.Significance. PhA was directly associated with total BMD and lumbar spine in female, but not male, athletes.

Hyperkyphosis is not dependent on bone mass and quality in the mouse model of Marfan syndrome.

Marfan syndrome (MFS) is an autosomal dominant disease affecting cardiovascular, ocular and skeletal systems. It is caused by mutations in the fibrillin-1 (FBN1) gene, leading to structural defects of connective tissue and increased activation of TGF-ß. Angiotensin II (ang-II) is involved in TGF-ß activity and in bone mass regulation. Inhibition of TGF-ß signaling by blockage of the ang-II receptor 1 (AT1R) via losartan administration leads to improvement of cardiovascular and pulmonary phenotypes, but has no effect on skeletal phenotype in the haploinsufficient mouse model of MFS mgR, suggesting a distinct mechanism of pathogenesis in the skeletal system. Here we characterized the skeletal phenotypes of the dominant-negative model for MFS mgΔlpn and tested the effect of inhibition of ang-II signaling in improving those phenotypes. As previously shown, heterozygous mice present hyperkyphosis, however we now show that only males also present osteopenia. Inhibition of ang-II production by ramipril minimized the kyphotic deformity, but had no effect on bone microstructure in male mutant animals. Histological analysis revealed increased thickness of the anterior longitudinal ligament (ALL) of the spine in mutant animals (25.8 ± 6.3 vs. 29.7 ± 7.7 µm), coupled with a reduction in type I (164.1 ± 8.7 vs. 139.0 ± 4.4) and increase in type III (86.5 ± 10.2 vs. 140.4 ± 5.6) collagen in the extracellular matrix of this ligament. In addition, we identified in the MFS mice alterations in the erector spinae muscles which presented thinner muscle fibers (1035.0 ± 420.6 vs. 655.6 ± 239.5 µm2) surrounded by increased area of connective tissue (58.17 ± 6.52 vs. 105.0 ± 44.54 µm2). Interestingly, these phenotypes were ameliorated by ramipril treatment. Our results reveal a sex-dependency of bone phenotype in MFS, where females do not present alterations in bone microstructure. More importantly, they indicate that hyperkyphosis is not a result of osteopenia in the MFS mouse model, and suggest that incompetent spine ligaments and muscles are responsible for the development of that phenotype.

Factores de riesgo de baja masa ósea en mujeres premenopáusicas con lupus eritematoso sistémico / Risk factors for low bone mass in premenopausal women with systemic lupus erythematosus

RESUMEN Introducción: los pacientes con lupus eritematoso sistémico tienen un riesgo elevado de presentar baja masa ósea. La etiología es multifactorial (factores de riesgo tradicionales, propios de la enfermedad, laboratoriales, serológicos, metabólicos y los relacionados al tratamiento). Objetivo: determinar los factores de riesgo de baja masa ósea tradicionales (sedentarismo, tabaquismo, alcohol, baja ingesta láctea, bajo índice de masa corporal), los relacionados con la enfermedad (presentación clínica, laboratoriales), metabólicos y el tratamiento, con la disminución de la densidad mineral ósea en mujeres premenopáusicas con lupus eritematoso sistémico Metodología: estudio observacional de corte transverso prospectivo analítico de mujeres premenopáusicas con lupus eritematoso sistémico, que acudieron al Hospital Nacional en el periodo octubre 2017 - octubre 2019. La densidad mineral ósea se evaluó por densitometría DEXA, y se utilizó el Z score, valores iguales o inferiores a -2,0 DS se consideró como baja masa ósea. Las variables analizadas fueron: factores de riesgo de baja masa ósea tradicionales, relacionados con el lupus, laboratoriales, serológicos, metabólicos y el tratamiento. Análisis estadístico: para la descripción de las variables se utilizaron media y desviación estándar para las variables continuas; y proporciones para las cualitativas. Se establecieron los factores de riesgo para baja masa ósea por la prueba de Chi cuadrado considerándose significativa un valor p ˂0,05, para la comparación de medias se utilizó la prueba t de Student. Resultado: fueron estudiadas 61 mujeres premenopáusicas, con una edad media 25,6 ± 7 años, siendo del interior de país 50,8 % y Central 49,18 %. Tenían estudios secundarios 54,10 %, terciarios 34,43 %, primarios 11,48 %. Eran sedentarias 40,98 %. Presentaron una baja ingesta láctea el 21,31 % y una era fumadora activa 1,64 %. Tenían peso normal 66,2 %, sobrepeso 15,25 %, obesidad 18,33 %, bajo peso 1,64 %. El tiempo de enfermedad, la media fue 50,5 ± 56,4 meses. El índice de actividad de la enfermedad (SLEDAI) fue 6,5 ± 6,5. Presentaron una duración de la enfermedad mayor de 5 años el 31,5 %. Tenían nefritis lúpica 52,54 %, actividad severa 24,5 %, hipocomplementemia 45 %. ANA media 995,5 ± 1164, anti DNA media 274,2 ± 830,8, anti Ro positivo 54,7 %, anti Sm positivo 24,5 %. Vitamina D valor normal 18,5 %, insuficiente 50,9 %, deficiente 32,6 %. Presentaron baja masa ósea 7 pacientes 11,4 %. No se encontró una asociación entre los factores de riesgo tradicionales, los relacionados con la enfermedad (inflamación sistémica, laboratoriales), metabólicos y el tratamiento con una baja masa ósea, (p ≥ 0,05). Conclusión: presentaron una baja masa ósea 11,4 %. Los factores de riesgo tradicionales, los relacionados con la enfermedad, laboratoriales, metabólicos y el tratamiento no presentaron una asociación estadísticamente significativa con la baja masa ósea.

ABSTRACT Introduction: patients with systemic lupus erythematosus have a high risk of presenting low bone mass. The etiology is multifactorial (traditional risk factors, characteristic of the disease, laboratory, serological, metabolic and those related to treatment). Objective: to determine the traditional risk factors for low bone mass (sedentary lifestyle, smoking, alcohol, low milk intake, low body mass index), those related to the disease (clinical presentation, laboratory), metabolic and treatment, with the decrease of bone mineral density in premenopausal women with systemic lupus erythematosus. Methodology: prospective analytical cross-sectional observational study of premenopausal women with systemic lupus erythematosus, who attended the National Hospital in the period October 2017 - October 2019. Bone mineral density was evaluated by DEXA densitometry, and the Z score was used, equal values or lower than -2,0 SD was considered low bone mass. The variables analyzed were: traditional risk factors for low bone mass, related to lupus, laboratory, serological, metabolic and treatment. Statistical analysis: mean and standard deviation for continuous variables were used to describe the variables; and proportions for qualitative ones. The risk factors for low bone mass were established by the Chi square test, considering a p value of ˂0,05 as significant; the Student's t test was used to compare means. Result: 61 premenopausal women were studied, with a mean age 25,6 ± 7 years, being from the interior of the country 50,8 % and Central 49,18 %. They had secondary studies 54,10 %, tertiary 34,43 %, primary 11,48 %. 40,98 % were sedentary. 21,31 % had a low milk intake and 1,64 % was an active smoker. They were 66,2 % normal weight, 15,25 % overweight, 18,33 % obese, 1,64 % underweight. The mean time of illness was 50,5 ± 56,4 months. The disease activity index (SLEDAI) was 6,5 ± 6,5. 31,5 % had a duration of the disease greater than 5 years. They had lupus nephritis 52,54 %, severe activity 24,5 %, hypocomplementemia 45 %. Mean ANA 995,5 ± 1164, mean anti DNA 274,2 ± 830,8, anti Ro positive 54,7 %, anti Sm positive 24,5 %. Vitamin D normal value 18,5 %, insufficient 50,9 %, deficient 32,6 %. 7 patients had low bone mass, 11,4 %. No association was found between traditional risk factors, those related to the disease (systemic inflammation, laboratory), metabolic and treatment with low bone mass, (p ≥ 0,05). Conclusion: they had a low bone mass 11,4 %. The traditional risk factors, those related to the disease, laboratory, metabolic and treatment did not present a statistically significant association with low bone mass.