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Seminars in Arthritis and Rheumatism Feb 2024Axial spondyloarthritis (axSpA) presents a complex scenario where both new bone formation in entheseal tissues and significant trabecular bone loss coexist, emphasizing... (Review)
Review
INTRODUCTION
Axial spondyloarthritis (axSpA) presents a complex scenario where both new bone formation in entheseal tissues and significant trabecular bone loss coexist, emphasizing the intricate nature of bone dynamics in this context.
METHODS
A search of the literature was conducted to compose a narrative review exploring the pathogenesis, possible assessment methods, and potential management options for axSpA.
RESULTS
While chronic systemic and local inflammation contribute to bone loss, the mechanisms behind axSpA-associated bone loss exhibit distinct characteristics influenced by factors like mechanical stress and the gut microbiome. These factors directly or indirectly stimulate osteoclast differentiation and activation through the RANK-RANKL axis, while simultaneously impeding osteoblast differentiation via negative regulation of bone anabolic pathways, including the Wnt signaling pathway. This disruption in the balance between bone-resorbing osteoclasts and bone-forming osteoblasts contributes to overall bone loss in axSpA. Early evaluation at diagnosis is prudent for detecting bone changes. While traditional dual x-ray absorptiometry (DXA) has limitations due to potential overestimation from spinal new bone formation, alternative methods like trabecular bone score (TBS), quantitative CT (QCT), and quantitative ultrasound (QUS) show promise. However, their integration into routine clinical practice remains limited. In addition to approved anti-inflammatory drugs, lifestyle adjustments like regular exercise play a key role in preserving bone health. Tailoring interventions based on individual risk profiles holds potential for mitigating bone loss progression.
CONCLUSION
Recognizing the pivotal role of bone loss in axSpA underscores the importance of integrating regular assessments and effective management strategies into clinical practice. Given the multifaceted contributors to bone loss in axSpA, a multidisciplinary approach is essential.
Topics: Humans; Osteoclasts; Osteoblasts; Absorptiometry, Photon; Inflammation; Axial Spondyloarthritis
PubMed: 38103486
DOI: 10.1016/j.semarthrit.2023.152345 -
The Journal of Sports Medicine and... Nov 2023This study aimed to compare the relationships between bone and body composition parameters, and isometric maximal voluntary contraction (MVC) force of knee extensor (KE)...
BACKGROUND
This study aimed to compare the relationships between bone and body composition parameters, and isometric maximal voluntary contraction (MVC) force of knee extensor (KE) muscles in road cyclists and untrained controls.
METHODS
Twelve male road cyclists and 12 controls aged 20-34 years participated. The isometric MVC force of the KE muscles was assessed by a custom-made dynamometer. Bone mineral content (BMC), bone mineral density (BMD), and body composition were assessed using Dual-Energy X-ray Absorptiometry.
RESULTS
No differences were found in body mass, lean body mass, leg lean mass, MVC, whole body, and leg BMD and BMC between cyclists and controls. Controls had a significantly greater (P<0.001) body mass index (BMI), whole body (P<0.01), and leg fat (P<0.001) mass than athletes. In road cyclists, BMC correlated positively with body mass (r=0.73; P<0.01) and BMI (r=0.65; P<0.05), body (r=0.85; P<0.001) and leg lean mass (r=0.81; P<0.001); BMD correlated positively with lean body mass (r=0.60; P<0.05), leg lean mass (r=0.65 and r=0.60; P<0.05). MVC of KE muscles correlated positively with bone parameters (P<0.01) and lean mass (P<0.05) only in controls.
CONCLUSIONS
Regular cycling training was associated with lower BMI, and body and leg fat mass. There were no significant differences in bone parameters, body and leg lean mass, and isometric MVC force of KE muscle variables between road cyclists and controls. In road cyclists, bone parameters are associated with body mass, and body and leg lean mass, but not with the isometric strength of KE muscles.
Topics: Male; Humans; Body Composition; Bone and Bones; Bone Density; Absorptiometry, Photon; Lower Extremity
PubMed: 37486254
DOI: 10.23736/S0022-4707.23.15067-5 -
The Journal of Clinical Endocrinology... Oct 2023Fragility fracture is a significant public health problem because it is associated with increased mortality. We want to find out whether the risk of fracture can be...
CONTEXT
Fragility fracture is a significant public health problem because it is associated with increased mortality. We want to find out whether the risk of fracture can be predicted from the time of birth.
OBJECTIVE
To examine the association between a polygenic risk score (PRS) and lifetime fracture risk.
METHODS
This population-based prospective study involved 3515 community-dwelling individuals aged 60+ years who have been followed for up to 20 years. Femoral neck bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry. A PRS was created by summing the weighted number of risk alleles for each single nucleotide polymorphism using BMD-associated coefficients. Fragility fractures were radiologically ascertained, whereas mortality was ascertained through a state registry. Residual lifetime risk of fracture (RLRF) was estimated by survival analysis.
RESULTS
The mortality-adjusted RLRF for women and men was 36% (95% CI, 34%-39%) and 21% (18%-24%), respectively. Individuals with PRS > 4.24 (median) had a greater risk (1.2-fold in women and 1.1-fold in men) than the population average risk. For hip fracture, the average RLRF was 10% (95% CI, 8%-12%) for women and ∼5% (3%-7%) for men; however, the risk was significantly increased by 1.5-fold and 1.3-fold for women and men with high PRS, respectively.
CONCLUSION
A genetic profiling of BMD-associated genetic variants is associated with the residual lifetime risk of fracture, suggesting the potential for incorporating the polygenic risk score in personalized fracture risk assessment.
Topics: Male; Female; Humans; Osteoporosis; Bone Density; Prospective Studies; Hip Fractures; Absorptiometry, Photon; Risk Factors; Risk Assessment; Osteoporotic Fractures
PubMed: 37165700
DOI: 10.1210/clinem/dgad254 -
Journal of Bone and Mineral Research :... Aug 2023Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population...
Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population by a one-time multisite magnetic resonance imaging (MRI) more than 1 year following leukemia therapy. MRI findings were evaluated in relationship to clinical factors (including longitudinal changes in bone mineral density [BMD]). Eighty-six children enrolled in the Steroid Associated Osteoporosis in the Pediatric Population (STOPP) study were evaluated for ON at 3.1 ± 1.3 years following therapy. Thirty children had a total of 150 confirmed ON lesions (35%). Lumbar spine (LS) BMD Z-scores (mean ± SD) were low at diagnosis and similar between patients with and without ON (-1.09 ± 1.53 versus -1.27 ± 1.25, p = 0.549). LS BMD Z-scores declined from baseline to 12 months in children with ON (-0.31 ± 1.02) but not in those without (0.13 ± 0.82, p = 0.035); the hip BMD Z-scores from baseline to 24 months declined in both groups, but to a greater extent in those with ON (-1.77 ± 1.22) compared to those without (-1.03 ± 1.07, p = 0.045). At the time of the MRI, mean total hip and total body (TB) BMD Z-scores were lower in children with ON (hip -0.98 ± 0.95 versus -0.28 ± 1.06, p = 0.010; TB -1.36 ± 1.10 versus -0.48 ± 1.50, p = 0.018). Pain occurred in 11/30 (37%) with ON versus 20/56 (36%) without, p = 0.841. In multivariable models, older age at diagnosis (odds ratio [OR] 1.57; 95% confidence interval [CI], 1.15-2.13; p = 0.004), and hip BMD Z-score at MRI (OR 2.23; 95% CI, 1.02-4.87; p = 0.046) were independently associated with ON. Overall, one-third of children demonstrated ON after leukemia therapy. Those with ON had greater reductions in spine and hip BMD Z-scores in the first 1 and 2 years of therapy, respectively. Older age and lower hip BMD Z-scores at MRI were significantly associated with prevalent, off-therapy ON. These data assist in identifying children at risk of ON. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Topics: Humans; Child; Bone Density; Osteoporosis; Lumbar Vertebrae; Leukemia; Osteonecrosis; Absorptiometry, Photon
PubMed: 37326443
DOI: 10.1002/jbmr.4870 -
Revista Paulista de Pediatria : Orgao... 2023To analyze the bone health of pediatric patients with short bowel syndrome intestinal failure (SBS-IF). (Review)
Review
OBJECTIVE
To analyze the bone health of pediatric patients with short bowel syndrome intestinal failure (SBS-IF).
DATA SOURCE
An integrative literature review was performed using the data published in the MEDLINE-PubMed and Scientific Electronic Library Online (SciELO) databases between January 2010 and April 2021, and through a manual search of the reference lists of relevant studies. Studies were included if they assessed bone mineral density by the Dual X-Ray Absorptiometry (DXA) technique, incorporated pediatric patients (up to 20 years of age) with SBS under parenteral nutrition (PN) and were written in English. Eleven primary sources met the inclusion criteria for this study.
DATA SYNTHESIS
Pediatric patients with SBS-IF under long-term parenteral nutrition experienced frequent changes in bone metabolism, leading to osteoporotic fractures and growth failure. These patients have deficiencies in multiple nutrients, such as calcium, magnesium, phosphorus, and vitamin D. Consequently, there are variations in the secretion and regulation of the parathyroid hormone. In addition, the pharmacotechnical limitations related to calcium and phosphorus in the PN solution, use of glucocorticoids, and difficulty performing physical activity are risk factors for the development of metabolic bone disease in pediatric patients with SBS-IF.
CONCLUSIONS
Low bone mineral density was associated with a high risk of developing osteoporosis, fractures, and growth deficiency in pediatric patients with SBS-IF on PN therapy in the long term.
Topics: Humans; Child; Absorptiometry, Photon; Calcium; Short Bowel Syndrome; Bone Density; Phosphorus
PubMed: 38126603
DOI: 10.1590/1984-0462/2024/42/2023064 -
PloS One 2023The trabecular bone score (TBS) indirectly estimates bone quality and predicts low-impact fractures independently of bone mineral density (BMD). However, there is still...
BACKGROUND
The trabecular bone score (TBS) indirectly estimates bone quality and predicts low-impact fractures independently of bone mineral density (BMD). However, there is still a paucity of data linking bone and heart diseases, mainly with gaps in the TBS analysis.
METHODS
In this cross-sectional study, we evaluated TBS, BMD, and fractures in patients with heart failure with reduced ejection fraction (HFrEF) and in sex-, BMI- and age-matched controls, and we assessed the fracture probability using the FRAX tool, considering active search for fractures by vertebral fracture assessment (VFA) and the adjustment for the TBS.
RESULTS
TBS values were 1.296 ± 0.14 in 85 patients (43.5% women; age 65 ± 13 years) and 1.320 ± 0.11 in 142 controls (P = 0.07), being reduced (< 1.31) in 51.8% and 46.1% of them, respectively (P = 0.12). TBS was lower in patients than in the controls when BMD was normal (P = 0.04) and when the BMI was 15-37 kg/m2 (P = 0.03). Age (odds ratio [OR] 1.05; P = 0.026), albumin (OR 0.12; P = 0.046), statin use (OR 0.27; P = 0.03), and energy intake (OR 1.03; P = 0.014) were associated with reduced TBS. Fractures on VFA occurred in 42.4% of the patients, and VFA and TBS adjustment increased the fracture risk by 16%-23%.
CONCLUSION
Patients with HFrEF had poor bone quality, with a better discriminating impact of the TBS assessment when BMD was normal, and BMI was suitable for densitometric analysis. Variables related to the prognosis, severity, and treatment of HFrEF were associated with reduced TBS. VFA and TBS adjustment increased fracture risk.
Topics: Humans; Female; Middle Aged; Aged; Male; Heart Failure; Cross-Sectional Studies; Lumbar Vertebrae; Stroke Volume; Bone Density; Spinal Fractures; Cancellous Bone; Minerals; Osteoporotic Fractures; Absorptiometry, Photon
PubMed: 37922295
DOI: 10.1371/journal.pone.0293903 -
Bone Jan 2024Several new peripheral dual-energy X-ray absorptiometry (DXA) devices designed for assessment of bone and body composition in rodents have been developed. We compared...
Several new peripheral dual-energy X-ray absorptiometry (DXA) devices designed for assessment of bone and body composition in rodents have been developed. We compared the performance (accuracy and precision) of two of these devices, the InAlyzer and the iNSiGHT, to those of an established device, the PIXImus. We measured total body bone mineral content (BMC), bone mineral density (BMD), and body composition (lean and fat mass) on the three DXA devices in 18 male C57Bl/6 J mice (6 each of ages 8, 14, and 24 weeks, weighing 22 to 33 g). DXA body composition measures were compared to whole-body nuclear magnetic resonance (NMR) outcomes. BMC of the femur was also compared to ex vivo micro-computed tomography (microCT). Total body BMD from the InAlyzer and iNSiGHT devices was strongly correlated to that from PIXImus (R = 0.83 and 0.82, respectively), but was ~25 % higher than PIXImus. Total body BMC measures by InAlyzer were strongly associated with those from PIXImus (R = 0.86), whereas those from iNSiGHT were only weakly correlated (R = 0.29). Femur BMC from InAlyzer was strongly correlated with microCT outcomes, whereas iNSiGHT was only weakly correlated. InAlyzer and iNSiGHT fat mass measures were very strongly correlated with PIXImus and NMR outcomes (R = 0.91 to 0.97), with slightly weaker associations for lean mass (R = 0.81 to 0.76). Short-term precision of InAlyzer and iNSiGHT measurements were excellent, and akin to those from the PIXImus for both body composition and bone measures, ranging between 0.39 and 3.2 %. With faster scan times, closed X-ray source and excellent precision, the new devices are both satisfactory replacements for the now discontinued PIXImus system. However, given the accuracy of the bone and body composition measures, the InAlyzer may be preferable for studies where musculoskeletal changes are the main interest.
Topics: Mice; Animals; Male; Absorptiometry, Photon; X-Ray Microtomography; Bone Density; Bone and Bones; Radiography; Body Composition; Mice, Inbred C57BL
PubMed: 37778596
DOI: 10.1016/j.bone.2023.116923 -
Journal of Orthopaedic Surgery and... Nov 2023This study aimed to investigate the association between blood trace elements and bone mineral density (BMD) and to determine the association between blood trace elements...
BACKGROUND
This study aimed to investigate the association between blood trace elements and bone mineral density (BMD) and to determine the association between blood trace elements and the risk of low BMD/osteoporosis among US adults.
METHODS
We performed a cross-sectional study using data from National Health and Nutrition Examination Survey (NHANES, 2011-2016). Multivariable linear regression models were employed to assess the associations of BMD in lumbar spine (LS-BMD), pelvic (PV-BMD) and total femur (TF-BMD) with blood trace elements, including Fe, Zn, Cu, Se, Mn, Cd, Pb, Hg. Additionally, the associations of low BMD/osteoporosis with blood trace elements were also evaluated using multivariable logistic regression.
RESULTS
Higher blood Pb levels were found associated with decreased LS-BMD (p for trend < 0.001), PV-BMD (p for trend = 0.007), and TF-BMD (p for trend = 0.003) in female, while higher blood Se levels were associated with increased PV-BMD in female (p for trend = 0.042); no linear association between BMD and other blood trace element was observed. Also, significant associations were found between Pb levels and the prevalence of low BMD (p for trend = 0.030) and the prevalence of osteoporosis (p for trend = 0.036), while association between other blood trace elements and low BMD/osteoporosis was not observed.
CONCLUSION
This study provides comprehensive insight into the association between blood trace elements and BMD and supports a detrimental effect of blood Pb levels on bone mass in women. Considering our analysis from a representative US general population, further study is warranted for the extreme levels of blood trace elements on bone metabolism.
Topics: Humans; Adult; Female; Bone Density; Trace Elements; Nutrition Surveys; Cross-Sectional Studies; Lead; Absorptiometry, Photon; Osteoporosis; Lumbar Vertebrae
PubMed: 37924110
DOI: 10.1186/s13018-023-04329-9 -
Lasers in Medical Science Aug 2023This study aims to investigate the 7-year changes in corneal densitometry (CD) after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ...
This study aims to investigate the 7-year changes in corneal densitometry (CD) after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK). Forty-two eyes undergoing SMILE and thirty-one undergoing FS-LASIK were included in this retrospective study. CD was measured preoperatively and at 3 and 7 years postoperatively. Three concentric radial zones (0-2, 2-6, and 6-10 mm) of three different corneal depths (anterior 120 μm, posterior 60 μm, and central layer) were analyzed. In all three zones of the three corneal layers, no significant difference in CD was found between the two groups preoperatively and at 3 and 7 years postoperatively (all P > 0.05). All CD values in the three zones of the anterior and central layers significantly declined at 3 years postoperatively (all P < 0.001), and then increased at 7 years postoperatively compared to corresponding 3-year values (all P < 0.01). In the posterior layer, CD values in the 0-2-mm and 2-6-mm zones decreased at 3 years postoperatively (all P < 0.01) and continued to decrease at 7 years postoperatively (all P < 0.01). Similar CD trends were observed after SMILE and FS-LASIK. Posterior layer CD showed a decrease throughout the study period. In the anterior and central layers, CD values decreased and then increased at 7 years postoperatively. The transparency changes might have been due to age-related three-dimensional growth of collagen fibers and wound-healing reactions.
Topics: Humans; Keratomileusis, Laser In Situ; Corneal Stroma; Retrospective Studies; Visual Acuity; Myopia; Lasers, Excimer; Prospective Studies; Cornea; Densitometry
PubMed: 37572159
DOI: 10.1007/s10103-023-03850-x -
Journal of Bone and Mineral Metabolism Nov 2023This pre-specified exploratory analysis investigated the effect of denosumab on bone mineral density (BMD) and bone microarchitecture in patients with rheumatoid... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
This pre-specified exploratory analysis investigated the effect of denosumab on bone mineral density (BMD) and bone microarchitecture in patients with rheumatoid arthritis (RA) treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs).
MATERIALS AND METHODS
In this open-label, parallel-group study, patients were randomly assigned (1:1) to continuous treatment with csDMARDs plus denosumab or continuous treatment with csDMARD therapy alone for 12 months. BMD and bone microarchitecture were measured by dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT).
RESULTS
Of 46 patients enrolled in the primary study, 43 were included in the full analysis set. The mean age was 65.3 years, 88.4% were female, and 60.5% had osteoporosis. Areal BMD of the lumbar spine increased from baseline to 6 and 12 months in both groups, but the increase was higher in the csDMARDs plus denosumab group. Areal BMD of the total hip and femoral neck increased from baseline to 6 and 12 months only in the csDMARDs plus denosumab group. Cortical volumetric BMD and cortical thickness of the distal tibia increased in the csDMARDs plus denosumab group at 6 and 12 months but decreased in the csDMARD therapy alone group. Trabecular bone parameters of the distal tibia improved only in the csDMARDs plus denosumab group at 12 months.
CONCLUSION
Denosumab may be recommended for patients with RA treated with csDMARDs to increase BMD and improve bone microarchitecture.
Topics: Humans; Female; Aged; Male; Bone Density; Denosumab; Absorptiometry, Photon; Arthritis, Rheumatoid; Osteoporosis
PubMed: 37480398
DOI: 10.1007/s00774-023-01452-9