Comparison of femur stiffness measured from DXA and QCT for assessment of hip fracture risk.

Femur stiffness, for example axial and bending stiffness, integrates both geometric and material information of the bone, and thus can be an effective indicator of bone strength and hip fracture risk. Femur stiffness is ideally measured from quantitative computed tomography (QCT), but QCT is not recommended for routine clinical use due to the public concern about exposure to high-dosage radiation. Dual energy X-ray absorptiometry (DXA) is currently the primary imaging modality in clinic. However, DXA is two-dimensional and it is not clear whether DXA-estimated stiffness has adequate accuracy to replace its QCT counterpart for clinical application. This study investigated the accuracy of femur stiffness (axial and bending) estimated from CTXA (computed tomography X-ray absorptiometry) and DXA against those directly measured from QCT. Proximal-femur QCT and DXA from 67 subjects were acquired. For each femur, the QCT dataset was projected into CTXA using CTXA-Hip (Mindways Software, Inc., USA). Femur stiffness at the femoral neck and intertrochanter were then calculated from QCT, CTXA and DXA, respectively, and different elasticity-density relationships were considered in the calculation. Pearson correlations between QCT and CTXA/DXA measured stiffness were studied. The results showed that there were strong correlations between QCT and CTXA derived stiffness, although the correlations were affected by the adopted elasticity-density relationship. Correlations between QCT and DXA derived stiffness were much less strong, mainly caused by the inconsistence of femur orientation in QCT projection and in DXA positioning. Our preliminary clinical study showed that femur stiffness had slightly better performance than femur geometry in discrimination of hip fracture cases from controls.

Effects of edaravone on testicular torsion-detorsion injury in rats.

BACKGROUND AND OBJECTIVE: This study aimed to assess the protective ability of edaravone on testicular torsion-detorsion injury in rats. METHODS: Eighteen adult male Sprague-Dawley rats were randomly divided into three groups: Sham group (control, n = 6); testicular torsion/detorsion (T/D group, n = 6) and T/D+edaravone (T/D+E group, n = 6). The spermatic cords of rats of the T/D group and the T/D+E group were rotated 720° in a clockwise direction and maintained for 120 min in this torsion position. Around 90 min after the torsion, edaravone at a dose of 10 mg/kg dissolved in saline was administered IP to the T/D+E group. The testicle was counter-rotated to its normal position to allow reperfusion for 4 h. Left testes of each animal were excised 240 min after beginning of reperfusion. Oxidative stress markers (TAS, TOS, SOD, and MDA) and apoptotic pathways (Caspase 3, Caspase 8, Caspase 9, Bcl-2, and Bax,) were assessed by ELISA methods. Also, testicles were subjected to the histopathologic and ultrasound examinations. RESULTS: Ultrasound imaging showed that edaravone reduced the surface area and increased vascularization in testicles with T/D (p < 0.0001, p < 0.05, respectively). Edaravone pretreatment markedly decreased the levels of MDA, TOS, Bcl-2, Bax, Caspase 3, Caspase 8, and Caspase 9 (p < 0.0001). Also, it increased significantly TAS levels (p < 0.0001) and reduced insignificantly SOD activity. Histopathologic examinations demonstrated that edaravone significantly attenuated the histological damage caused by T/D in testicles. CONCLUSION: Taken together, the findings indicate that pretreatment of edaravone has protective effect against testicular T/D injury.

Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study.

Background: Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed. Methods: Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab. Results: A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups. Conclusions: Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.

Bone mineral density and hip structure changes over one-year in collegiate distance runners and non-athlete controls.

Modification of bone is continuous throughout life and influenced by many factors, including physical activity. This study investigated changes in areal bone mineral density (aBMD) and hip structure among male and female collegiate distance runners and non-athlete controls over 12 months. Using dual-energy x-ray absorptiometry (DXA) and hip structure analysis (HSA) software, aBMD at the posterior-anterior (PA) and lateral spine, femoral neck, total hip (TH), whole body (WB), and bone geometry at the narrow neck (NN) of the femur was measured three times over 12 months. HSA included cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and Z-section modulus (Z). Male runners had significantly higher aBMD at TH and WB and greater CSA, CSMI, and Z than male controls at the end of 12 months. Female controls had higher aBMD at the PA spine than female runners at the end of 12 months. Male runners had significant increases in aBMD at the PA (p = 0.003) and lateral spine (p = 0.002), and TH (p = 0.002), female runners had significant decreases in aBMD at TH (p = 0.015) and WB (p = 0.002), male controls had significant increases in aBMD at the PA spine (p < 0.001) and WB (p < 0.001), and female controls had significant decreases in aBMD at lateral spine and TH (p = 0.008) over the year. When applying covariates of bone-free lean mass and vitamin D, male distance runners demonstrated significant improvement in CSA (3.602 ± 0.139 vs. 3.675 ± 0.122 cm2, p = 0.05), CSMI (3.324 ± 0.200 to 3.467 ± 0.212 cm4, p < 0.05), and Z (1.81 ± 0.08 to 1.87 ± 0.08 cm3, p = 0.05) during the study. No other changes in hip structure occurred over the year. Distance running may be beneficial to aBMD and hip structure in college-age males but not females. Further research is needed on potential influences of weight-bearing activity, energy availability, and hormonal status on aBMD and hip structure in males and females.

Effect of a pulse-based diet and aerobic exercise on bone measures and body composition in women with polycystic ovary syndrome: A randomized controlled trial.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with clinical symptoms including menstrual dysfunction and hyperandrogenemia, as well as insulin resistance which is thought to be a key contributing factor to symptoms. Insulin is also thought to positively affect bone while oligo- and amenorrhea are known to negatively affect bone. Lifestyle modification is the first recommendation to treat symptoms of PCOS; however, little is known about the effect of lifestyle interventions on bone measures in this population. Pulses (e.g., chickpeas, beans, split peas, lentils) have been shown to lower fasting insulin, and the objective of this study was to determine the effect of a pulse-based diet compared to the therapeutic lifestyle changes (TLC) diet on bone measures and body composition in women with PCOS. Women aged 18-35 years with PCOS were randomized to either a pulse-based diet or the TLC diet for 16-weeks while following an aerobic exercise program. Thirty-one in the TLC group and 29 in the pulse group completed dual-energy X-ray absorptiometry analysis following the intervention. After 16-weeks, both groups had a lower BMI, whole body fat mass, and % fat (p < 0.005), with no difference in lean mass. In both groups, lumbar spine bone mineral content (BMC) and density were higher following the intervention (p < 0.05) while femoral neck bone mineral density (BMD) was lower (p < 0.05). Intertrochanteric section modulus improved in both groups while there was a group x time interaction in femoral shaft subperiosteal width which was more favorable in the pulse group (p < 0.05). This study demonstrates that the femoral neck may be compromised during a lifestyle intervention in women with PCOS. Research is warranted to preserve bone health during lifestyle change in women with PCOS.

Characteristics of bone strength and metabolism in type 2 diabetic model Tsumura, Suzuki, Obese Diabetes mice.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by hyperglycemia, hyperinsulinemia, and complications such as obesity and osteoporosis. The Tsumura, Suzuki, Obese Diabetes (TSOD) mouse is an animal model of spontaneous obese T2DM. However, bone metabolism in TSOD mice is yet to be investigated. The objective of the present study was to investigate the effects of T2DM on bone mass, metabolism, microstructure, and strength in TSOD mice. METHODS: We determined the following parameters in TSOD mice and Tsumura, Suzuki, Non-obesity (TSNO) mice (as controls): serum glucose levels; serum insulin levels; bone mass; bone microstructure; bone metabolic markers; and bone strength. We also performed the oral glucose tolerance test and examined histological sections of the femur. We compared these data between both groups at pre-diabetic (10 weeks) and established (20 weeks) diabetic conditions. RESULTS: Bone strength, such as extrinsic mechanical properties, increased with age in the TSOD mice and intrinsic material properties decreased at both 10 weeks and 20 weeks. Bone resorption marker levels in TSOD mice were significantly higher than those in the control mice at both ages, but there was no significant difference in bone formation markers between the groups. Bone mass in TSOD mice was lower than that in controls at both ages. The trabecular bone volume at the femoral greater trochanter increased with age in the TSOD mice. The femoral mid-diaphysis in TSOD mice was more slender and thicker than that in TSNO mice at both ages. CONCLUSIONS: Bone mass of the femur was lower in TSOD mice than in TSNO mice because hyperinsulinemia during pre-diabetic and established diabetic conditions enhanced bone resorption due to high bone turnover. In addition, our data suggest that the bone mass of the femur was significantly reduced as a result of chronic hyperglycemia during established diabetic conditions in TSOD mice. We suggest that bone strength in the femur deteriorated due to the reduction of bone mass and because the femoral mid-diaphysis was more slender in TSOD mice.

Effects of 3-year denosumab treatment on hip structure in Japanese postmenopausal women and men with osteoporosis.

Denosumab, a human monoclonal antibody against RANK ligand, is shown to have strong anti-fracture effects in Japanese osteoporosis patients. However, there have been no data showing actions on Japanese bone architecture. Here we show that denosumab continuously improves several geometrical parameters calculated by hip structural analysis for 3 years. Compared to placebo, denosumab significantly increased bone mineral density, cortical thickness and cross sectional area in all of the three analyzed areas: the narrow neck, intertrochanter and femoral shaft. The subsequent derived mechanical parameters, cross-sectional moment of inertia, section modulus and buckling ratio, were also improved by denosumab. In addition, the improvement of these parameters was also observed in the patients that had switched from placebo to denosumab treatment. The present study suggests the structural evidence explaining the strong anti-fracture efficacy of denosumab and its significant effects on cortical bone in Japanese.

Peripubertal female athletes in high-impact sports show improved bone mass acquisition and bone geometry.

OBJECTIVE: Intensive physical training may have a sport-dependent effect on bone mass acquisition. This cross-sectional study evaluated bone mass acquisition in girls practicing sports that put different mechanical loads on bone. MATERIALS/METHODS: Eighty girls from 10.7 to 18.0 years old (mean 13.83 ± 1.97) were recruited: 20 artistic gymnasts (AG; high-impact activity), 20 rhythmic gymnasts (RG; medium-impact activity), 20 swimmers (SW, no-impact activity), and 20 age-matched controls (CON; leisure physical activity <3h/wk). Areal bone mineral density (aBMD) was determined using DEXA. Hip structural analysis applied at the femur evaluated cross-sectional area (CSA, cm(2)), section modulus (Z, cm(3)), and buckling ratio. Bone turnover markers and OPG/RANKL levels were analyzed. RESULTS: AG had higher aBMD than SW and CON at all bone sites and higher values than RG in the lumbar spine and radius. RG had higher aBMD than SW and CON only in the femoral region. CSA and mean cortical thickness were significantly higher and the buckling ratio was significantly lower in both gymnast groups compared with SW and CON. In RG only, endocortical diameter and width were reduced, while Z was only increased in AG compared with SW and CON. Reduced bone remodeling was observed in RG compared with AG only when groups were subdivided according to menarcheal status. All groups showed similar OPG concentrations, while RANKL concentrations increased with age and were decreased in SW. CONCLUSION: High-impact activity clearly had a favorable effect on aBMD and bone geometry during the growth period, although the bone health benefits seem to be more marked after menarche.

Body composition and reproductive function exert unique influences on indices of bone health in exercising women.

Reproductive function, metabolic hormones, and lean mass have been observed to influence bone metabolism and bone mass. It is unclear, however, if reproductive, metabolic and body composition factors play unique roles in the clinical measures of areal bone mineral density (aBMD) and bone geometry in exercising women. This study compares lumbar spine bone mineral apparent density (BMAD) and estimates of femoral neck cross-sectional moment of inertia (CSMI) and cross-sectional area (CSA) between exercising ovulatory (Ov) and amenorrheic (Amen) women. It also explores the respective roles of reproductive function, metabolic status, and body composition on aBMD, lumbar spine BMAD and femoral neck CSMI and CSA, which are surrogate measures of bone strength. Among exercising women aged 18-30 years, body composition, aBMD, and estimates of femoral neck CSMI and CSA were assessed by dual-energy x-ray absorptiometry. Lumbar spine BMAD was calculated from bone mineral content and area. Estrone-1-glucuronide (E1G) and pregnanediol glucuronide were measured in daily urine samples collected for one cycle or monitoring period. Fasting blood samples were collected for measurement of leptin and total triiodothyronine. Ov (n = 37) and Amen (n = 45) women aged 22.3 ± 0.5 years did not differ in body mass, body mass index, and lean mass; however, Ov women had significantly higher percent body fat than Amen women. Lumbar spine aBMD and BMAD were significantly lower in Amen women compared to Ov women (p < 0.001); however, femoral neck CSA and CSMI were not different between groups. E1G cycle mean and age of menarche were the strongest predictors of lumbar spine aBMD and BMAD, together explaining 25.5% and 22.7% of the variance, respectively. Lean mass was the strongest predictor of total hip and femoral neck aBMD as well as femoral neck CSMI and CSA, explaining 8.5-34.8% of the variance. Upon consideration of several potential osteogenic stimuli, reproductive function appears to play a key role in bone mass at a site composed of primarily trabecular bone. However, lean mass is one of the most influential predictors of bone mass and bone geometry at weight-bearing sites, such as the hip.

Effect of aerosol inhalation of Compound Salvia Miltiorrhiza Injection on sputum rheology of postoperative patients after pneumotectomy / 中草药

Object To study the effects of aerosol inhalation of Compound Salvia Miltiorrhiza Injection (CSMI) on the sputum rheology properties in respiratory tract of postoperative patients after pneumotectomy.Methods Patients in control group inhaled distilled water by ultrasonic nebulizer, patients in the experiment group inhaled CSMI by the same ultrasonic nebulizer.Results The sputum viscosity on the first, third, fourth, and fifth day postoperation (P