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Nephrology, Dialysis, Transplantation :... Sep 2023Vitamin K deficiency is highly prevalent in patients on dialysis and may contribute to their low bone mineral density (BMD) and increased risk of fracture. This study... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Vitamin K deficiency is highly prevalent in patients on dialysis and may contribute to their low bone mineral density (BMD) and increased risk of fracture. This study investigated the effect of menaquinone-7 (MK-7) supplementation on BMD in patients on chronic dialysis.
METHODS
In a multicentre, double-blind, placebo-controlled intervention trial, 123 patients on chronic dialysis were randomised to a daily oral supplement of either MK-7 360 µg or placebo for 2 years. BMD of the distal radius (1/3, mid, ultradistal and total), femoral neck, lumbar spine (L1-L4) and whole body was assessed by dual-energy X-ray absorptiometry. Serum levels of vitamin K1 and MK-7 and plasma levels of total osteocalcin, dephosphorylated-uncarboxylated matrix Gla protein and protein induced by vitamin K absence II were measured to assess vitamin K status.
RESULTS
After 2 years, an accelerated BMD loss of the 1/3 distal radius was found with MK-7 supplementation {mean difference of changes relative to placebo -0.023 g/cm2 [95% confidence interval (CI) -0.039 to -0.008]}, whereas the decrease in lumbar spine BMD seen in the placebo group was prevented [mean difference of changes between groups 0.050 g/cm2 (95% CI 0.015-0.085)]. No significant effects were observed at the remaining skeletal sites. Vitamin K status strongly improved in MK-7-supplemented participants.
CONCLUSION
Compared with placebo, an accelerated BMD loss of the 1/3 distal radius was found after 2 years of MK-7 supplementation, whereas a decline in lumbar spine BMD was prevented. As such, MK-7 supplementation might modify BMD site-specifically in patients on dialysis. In aggregate, our findings do not support MK-7 supplementation to preserve bone in patients on dialysis.
Topics: Humans; Bone Density; Vitamin K; Renal Dialysis; Absorptiometry, Photon; Vitamin K 2; Dietary Supplements; Double-Blind Method
PubMed: 36460034
DOI: 10.1093/ndt/gfac315 -
Radiology Case Reports Aug 2023Phosphaturic mesenchymal tumor is a rare tumor characterized by paraneoplastic osteomalacia. The diagnosis is often delayed because of nonspecific symptoms and...
Phosphaturic mesenchymal tumor is a rare tumor characterized by paraneoplastic osteomalacia. The diagnosis is often delayed because of nonspecific symptoms and difficulty to localize the tumor. In this study we report a case of PMT of the left femur detected by Ga-68-DOTATATE PET-CT with radiological features mimicking osteoid osteoma. We report a 31-year-old female patient who presented to our hospital for evaluation due to progressive bone pain and muscle weakness. Her laboratory data showed hypophosphatemia and increased fibroblast growth factor 23 (FGF-23) together with reduced bone mineral density on bone densitometry. The diagnosis of PMT was suspected and the tumor was identified on Ga-68-DOTATATE PET-CT as a focal uptake in a lucent lesion of the left femoral head with a central sclerotic dot mimicking a nidus as seen in osteoid osteoma. The lesion was treated with percutaneous radiofrequency ablation. Laboratory tests and bone densitometry rapidly improved post-treatment. The present case emphasizes the difficulty to diagnose PMT due to its nonspecific biochemical and clinical presentation and the relevance of functional imaging for locating these tumors despite different radiological presentation.
PubMed: 37304318
DOI: 10.1016/j.radcr.2023.05.008 -
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 -
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 -
JMIR Public Health and Surveillance Apr 2024Osteopenia and osteoporosis are posing a long-term influence on the aging population's health contributing to a higher risk of mortality, loss of autonomy,...
BACKGROUND
Osteopenia and osteoporosis are posing a long-term influence on the aging population's health contributing to a higher risk of mortality, loss of autonomy, hospitalization, and huge health system costs and social burden. Therefore, more pertinent data are needed to demonstrate the current state of osteoporosis.
OBJECTIVE
This sampling survey seeks to assess the trends in the prevalence of osteopenia and osteoporosis in a Chinese Han population.
METHODS
A community-based cross-sectional study involving 16,377 participants used a multistage sampling method. Bone mineral density was measured using the quantitative ultrasonic densitometry. Student t test and Mann-Whitney U test were used to test the difference between normally and nonnormally distributed quantitative variables between male and female participants. A chi-square (χ) test was used to compare categorized variables. Stratified analysis was conducted to describe the prevalence rates of osteoporosis (T score ≤-2.5) and osteopenia (T score -2.5 to -1.0) across age, sex, calcium intake, and menopause. A direct standardization method was used to calculate the age-standardized prevalence rates of osteoporosis and osteopenia. T-score was further categorized into quartiles (T1-T4) by age- and sex-specified groups.
RESULTS
The prevalence rates of osteopenia and osteoporosis were 40.5% (6633/16,377) and 7.93% (1299/16,377), respectively, and the age-standardized prevalence rates were 27.32% (287,877,129.4/1,053,861,940) and 3.51% (36,974,582.3/1,053,861,940), respectively. There was an increase in osteopenia and osteoporosis prevalence from 21.47% (120/559) to 56.23% (754/1341) and 0.89% (5/559) to 17.23% (231/1341), respectively, as age increased from 18 years to 75 years old. The prevalence rates of osteopenia and osteoporosis were significantly higher in female participants (4238/9645, 43.94% and 1130/9645, 11.72%) than in male participants (2395/6732, 35.58% and 169/6732, 2.51%; P<.001), and in postmenopausal female participants (3638/7493, 48.55% and 1053/7493, 14.05%) than in premenopausal female participants (538/2026, 26.55% and 53/2026, 2.62%; P<.001). In addition, female participants with a history of calcium intake had a lower osteoporosis prevalence rate than female participants without any history of calcium intake in all age groups (P=.004). From low quartile to high quartile of T-score, the prevalence of diabetes mellitus (752/4037, 18.63%; 779/4029, 19.33%; 769/3894, 19.75%; and 869/3879, 22.4%) and dyslipidemia (2228/4036, 55.2%; 2304/4027, 57.21%; 2306/3891, 59.26%; and 2379/3878, 61.35%) were linearly increased (P<.001), while the prevalence of cancer (112/4037, 2.77%; 110/4029, 2.73%; 103/3894, 2.65%; and 77/3879, 1.99%) was decreased (P=.03).
CONCLUSIONS
Our data imply that as people age, osteopenia and osteoporosis are more common in females than in males, particularly in postmenopausal females than in premenopausal females, and bone mineral density significantly affects the prevalence of chronic diseases. These findings offer information that can be applied to intervention programs meant to prevent or lessen the burden of osteoporosis in China.
Topics: Male; Female; Humans; Aged; Adolescent; Calcium; Cross-Sectional Studies; Prevalence; Osteoporosis; Bone Diseases, Metabolic; Age Factors
PubMed: 38578689
DOI: 10.2196/48947 -
BMC Endocrine Disorders Nov 2023The association between segmental body composition and bone mineral density (BMD) remains uncertain. The primary aim of this cross-sectional investigation was to...
OBJECTIVE
The association between segmental body composition and bone mineral density (BMD) remains uncertain. The primary aim of this cross-sectional investigation was to elucidate the connection between segmental body composition and BMD within the United States adult population.
METHODS
We selected a cohort of 10,096 individuals from the National Health and Nutrition Examination Survey (NHANES) database, with a mean age of 39 years and a mean BMI of 28.5 kg/m². The parameter of segmental body composition was achieved by quantifying body fat and lean mass percentages across various anatomical regions, including the torso, Android, Gynoid, arms and legs. We conducted a weighted multivariate linear regression analysis to investigate the association between segmental body composition and total BMD. Additionally, subgroup analysis was performed based on age and gender.
RESULTS
We found an inverse association between fat proportion in each anatomical region and total BMD, with the arm and leg regions demonstrating the most significant negative correlation. Conversely, a positive correlation was observed between lean mass and BMD across all anatomical regions. These associations remained consistent in subgroup analyses.
CONCLUSION
Our investigation revealed a negative association between adipose levels in various anatomical regions and BMD among Americans aged 20 to 59. Importantly, higher fat proportion in the extremities exerted the most deleterious impact on BMD. Furthermore, an increase in lean mass within each anatomical region was ascertained to confer a positive effect on bone health. Consequently, the evaluation of segmental body composition is well-positioned to predict bone health status.
Topics: Adult; Humans; Bone Density; Nutrition Surveys; Cross-Sectional Studies; Body Composition; Adipose Tissue; Absorptiometry, Photon; Body Mass Index
PubMed: 37940909
DOI: 10.1186/s12902-023-01506-z -
European Journal of Pediatrics Nov 2023The purpose of the study was to conduct a nutritional and metabolic assessment of children with cerebral palsy, including an investigation of liver status, body...
UNLABELLED
The purpose of the study was to conduct a nutritional and metabolic assessment of children with cerebral palsy, including an investigation of liver status, body composition, and bone mineral density. In this cross-sectional study we included 22 children with cerebral palsy. By using ultrasound, transient elastography, dual x-ray absorptiometry (DXA) scan, blood samples, anthropometric measurements, and a three-day diet registration, the nutritional and metabolic status was evaluated. Liver fibrosis and steatosis were found in four patients (18.2%), all with severe motor impairments, low skeletal muscle mass, and epilepsy. All patients with liver involvement had normal liver-related blood samples. Decreased bone mineral density was found in 26.3%, and 91.0% had low skeletal muscle mass. Fat mass and muscle mass were significantly lower in the patients with severe motor impairments compared to the patients with less severe motor impairments. Within the children classified as 'underweight' or 'normal' according to body mass index, body fat determined by DXA scan was normal or high in 50% of these patients.
CONCLUSIONS
This study is the first to report liver fibrosis and steatosis in children with cerebral palsy. Possible causes of liver fibrosis and/or steatosis are altered body composition with low skeletal muscle mass, decreased mobility and medical drug intake. Further investigations of liver involvement and risk factors are needed.
WHAT IS KNOWN
• Children and adolescents with cerebral palsy are at risk of malnutrition and altered body composition, both of which can lead to fatty liver disease. • It is unknown whether children with cerebral palsy are at increased risk of metabolic disturbances such as fatty liver disease.
WHAT IS NEW
• Altered body composition and low skeletal muscle mass, regardless of ambulation is present in 91% of the children with cerebral palsy. • Liver fibrosis and/or steatosis were found in 18.2% of the patients. Possible causes are altered body composition, decreased mobility and medical drug intake.
Topics: Adolescent; Humans; Child; Cerebral Palsy; Cross-Sectional Studies; Bone Density; Absorptiometry, Photon; Liver Cirrhosis; Non-alcoholic Fatty Liver Disease; Muscle, Skeletal
PubMed: 37656239
DOI: 10.1007/s00431-023-05177-9 -
The Journal of Clinical Endocrinology... Nov 2023Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture...
CONTEXT
Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown.
OBJECTIVE
To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs).
METHODS
A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive.
RESULTS
The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively.
CONCLUSION
Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
Topics: Humans; Female; Aged; Bone Density; Cohort Studies; Prospective Studies; Risk Assessment; Osteoporotic Fractures; Risk Factors; Hip Fractures; Absorptiometry, Photon; Pelvic Bones; Anemia
PubMed: 37406247
DOI: 10.1210/clinem/dgad399 -
Scientific Reports Oct 2023A variety of easy-to-use commercial bioelectrical impedance appliances are available. The aim of this study was to examine the usefulness of a commercially available...
Similarities and discrepancies between commercially available bioelectrical impedance analysis system and dual-energy X-ray absorptiometry for body composition assessment in 10-14-year-old children.
A variety of easy-to-use commercial bioelectrical impedance appliances are available. The aim of this study was to examine the usefulness of a commercially available body composition meter using bioelectrical impedance analysis (BIA) by comparing its measurement results with those obtained from dual-energy X-ray absorptiometry (DXA). The participants were 443 children aged from 10 to 14 years (226 boys and 217 girls). Fat mass, fat-free mass, lean body mass, percentage of body fat, and bone mineral contents were evaluated for all participants using BIA and DXA. The agreement in the anthropometric data obtained from both devices was analyzed using correlation analysis, intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), Bland-Altman plots, and ordinary least products regression analysis. Equivalence between both devices was tested by two one-sided t-test. All measured indicators showed strong linear correlations between the two measurement systems (r, 0.853-1.000). Fat mass, fat-free mass, and lean body mass showed absolute concordance (ICC, 0.902-0.972; Lin's CCC, 0.902-0.972). BIA overestimated bone mineral content (62.7-66.5%) and underestimated percentage of body fat (- 8.9 to - 0.8%), lean body mass (- 3.5 to - 1.8%), and body mass (- 0.8 to - 0.5%). For fat mass and fat-free mass, the overestimate or underestimate varied according to the sex and statistical analysis test. Bland-Altman analysis and ordinary least products analysis showed fixed bias and proportional bias in all indicators. Results according to quartiles of body mass index showed poor agreement for fat mass and percentage of body fat in both boys and girls in the lowest body mass index quartile. The present results revealed strong linear correlations between BIA and DXA, which confirmed the validity of the present single-frequency BIA-derived parameters. Our results suggest that BIA cannot provide the exact same values as DXA for some body composition parameters, but that performance is sufficient for longitudinal use within an individual for daily health management and monitoring.
Topics: Male; Female; Humans; Child; Adolescent; Absorptiometry, Photon; Electric Impedance; Body Composition; Adipose Tissue; Anthropometry; Body Mass Index; Breast Neoplasms; Precancerous Conditions
PubMed: 37833453
DOI: 10.1038/s41598-023-44217-0 -
Ecology and Evolution Jul 2023Carnivorous mammals disperse seeds through endozoochory and diploendozoochory. The former consists of ingestion of the fruit, passage through the digestive tract, and...
Carnivorous mammals disperse seeds through endozoochory and diploendozoochory. The former consists of ingestion of the fruit, passage through the digestive tract, and expulsion of the seeds, a process that allows scarification and dispersal of the seeds over long or short distances. The latter is typical of predators that expel seeds that were contained in the prey and the effects of which may differ from those of endozoochory with respect to the retention time of the seeds in the tracts, as well as their scarification and viability. The objective of this study was to conduct an experimental evaluation comparing the capacity of each mammal species in terms of the dispersal of seeds and, at the same time, to compare this capacity through the two dispersal systems: endozoochory and diploendozoochory. We measured dispersal capacity using indices of recovery, viability, changes in testas, and retention time of seeds in the digestive tract. fruits were collected in the Sierra Fría Protected Natural Area in Aguascalientes, Mexico, and were administered in the diet of captive mammals: gray fox (), coati () and domestic rabbits (). These three mammals represented the endozoochoric dispersers. For the diploendozoochoric treatment, seeds excreted by rabbits were incorporated into the diets of captive mammals: bobcat () and cougar (), in a local zoo. Seeds present in the scats were then collected, and recovery rates and retention times were estimated. Viability was estimated by X-ray optical densitometry and testa thicknesses were measured and surfaces checked using scanning electron microscopy. The results showed a recovery of seeds greater than 70% in all the animals. The retention time was <24 h in the endozoochory but longer at 24-96 h in the diploendozoochory ( < .05). Seed viability ( ± SD) was decreased in rabbits (74.0 ± 11.5%), compared to fruits obtained directly from the canopy (89.7 ± 2.0%), while gray fox, coati, bobcat, and cougar did not affect seed viability ( < .05). An increase in the thickness of the testas was also observed in seeds excreted from all mammals ( < .05). Through evaluation, our results suggest that mammalian endozoochory and diploendozoochory contribute to the dispersal of by maintaining viable seeds with adaptive characteristics in the testa to promote forest regeneration and restoration. In particular, feline predators can provide an ecosystem service through scarification and seed dispersal.
PubMed: 37408625
DOI: 10.1002/ece3.10262