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Pituitary Dec 2022Vertebral fractures (VFs) are a potential complication in acromegaly. However, the etiology of this skeletal fragility is unknown. This review aimed to evaluate the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Vertebral fractures (VFs) are a potential complication in acromegaly. However, the etiology of this skeletal fragility is unknown. This review aimed to evaluate the effect of acromegaly on VFs, bone turnover, areal bone mineral density (aBMD), and bone quality/microarchitecture. The effect of disease activity and gonadal status in these determinants of skeletal fragility was also evaluated.
METHODS
Articles published in English until September 6, 2020 on PubMed and Embase that reported at least one determinant of skeletal fragility in acromegalic patients, were included. Odds ratio (OR) to evaluate the risk of VFs and the standardized mean difference (SMD) to evaluate bone turnover, aBMD and bone quality/microarchitecture were calculated.
RESULTS
Fifty-eight studies met eligibility criteria, assembling a total of 2412 acromegalic patients. Of these, 49 studies were included in the meta-analysis. Acromegalic patients, when compared to non-acromegalic patients, had higher risk of VFs [OR 7.00; 95% confidence interval (CI) 2.80-17.52; p < 0.0001], higher bone formation (SMD 1.14; 95% CI 0.69-1.59; p < 0.00001), higher bone resorption (SMD 0.60; 95% CI 0.09-1.10; p = 0.02) and higher aBMD at the femoral neck (SMD 0.36; 95% CI 0.15-0.57; p = 0.0009). No significant differences were found regarding aBMD at lumbar spine. Considering the results of the different techniques evaluating bone quality/microarchitecture, the main reported alterations were a decrease in trabecular bone thickness and density, and an increase in trabecular separation. The presence of active disease and/or hypogonadism were associated with worst results.
CONCLUSION
Patients with acromegaly are at increased risk of VFs, mainly because of deterioration in bone microarchitecture.
Topics: Humans; Acromegaly; Bone Density; Spinal Fractures; Lumbar Vertebrae; Hypogonadism; Absorptiometry, Photon
PubMed: 35867180
DOI: 10.1007/s11102-022-01256-6 -
Advances in Nutrition (Bethesda, Md.) Sep 2017We analyzed the discriminatory capacity of anthropometric indicators for body fat in children and adolescents. This systematic review and meta-analysis included... (Meta-Analysis)
Meta-Analysis Review
We analyzed the discriminatory capacity of anthropometric indicators for body fat in children and adolescents. This systematic review and meta-analysis included cross-sectional and clinical studies comprising children and adolescents aged 2-19 y that tested the discriminatory value for body fat measured by anthropometric methods or indexes generated by anthropometric variables compared with precision methods in the diagnosis of body fat [dual-energy X-ray absorptiometry (DXA), computed tomography, air displacement plethysmography (ADP), or MRI]. Five studies met the eligibility criteria and presented high methodologic quality. The anthropometric indicators that had high discriminatory power to identify high body fat were body mass index (BMI) in males [area under the curve (AUC): 0.975] and females (AUC: 0.947), waist circumference (WC) in males (AUC: 0.975) and females (AUC: 0.959), and the waist-to-height ratio (WTHR) in males (AUC: 0.897) and females (AUC: 0.914). BMI, WC, and WTHR can be used by health professionals to assess body fat in children and adolescents.
Topics: Absorptiometry, Photon; Adipose Tissue; Adiposity; Adolescent; Body Composition; Body Mass Index; Body Weight; Child; Child, Preschool; Female; Humans; Male; Waist Circumference; Young Adult
PubMed: 28916572
DOI: 10.3945/an.117.015446 -
Journal of Clinical Densitometry : the... 2020Celiac disease is characterized by deficits in bone mineral accrual and longitudinal growth. (Meta-Analysis)
Meta-Analysis
CONTEXT
Celiac disease is characterized by deficits in bone mineral accrual and longitudinal growth.
OBJECTIVE
The purpose of this study was to determine the differences in bone health and stature among children and adolescents with celiac disease versus healthy controls.
DATA SOURCES
Articles published before February 27, 2018 were located using searches of the Physical Education Index (n = 186), PubMed (n = 180), Scopus (n = 3), SPORTDiscus (n = 3), and Web of Science (n = 4).
STUDY SELECTION
Bone mineral content (BMC) and areal bone mineral density (aBMD) were assessed via dual-energy X-ray absorptiometry, and height was measured using a stadiometer.
DATA EXTRACTION
Effect sizes (ES) were calculated as follows: the mean difference of the celiac disease group and healthy control group, divided by the pooled standard deviation. The inverse variance weight was used to calculate the overall mean ES. Random-effects models were used to aggregate a mean ES, 95% confidence intervals (CIs) and to identify potential moderators.
RESULTS
The results of 30 effects gathered from 12 studies published between 1996 and 2017 indicated BMC (ES = -0.54, 95% CI: -0.69 to -0.40; p < 0.0001) and aBMD (ES = 0.72, 95% CI: -0.96 to -0.47; p < 0.0001) were lower in youth with celiac disease.
LIMITATIONS
These results were limited to only cross-sectional and baseline data from longitudinal studies reporting BMC and BMD, however did not assess changes in bone health over time.
CONCLUSION
Children and adolescents with celiac disease have suboptimal bone health and shorter stature.
Topics: Absorptiometry, Photon; Adolescent; Body Height; Body Weight; Bone Density; Calcification, Physiologic; Celiac Disease; Child; Humans
PubMed: 30833087
DOI: 10.1016/j.jocd.2019.02.003 -
Current Osteoporosis Reports Apr 2024Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T-score of - 2.0 in patients with diabetes... (Review)
Review
PURPOSE OF REVIEW
Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T-score of - 2.0 in patients with diabetes should be interpreted as equivalent to - 2.5 in people without diabetes. We aimed to evaluate the most recent findings concerning the bone mineral density (BMD)-derived T-score and risk of fractures related to osteoporosis in subjects with diabetes.
RECENT FINDINGS
The dual-energy X-ray absorptiometry (DXA) scan is the golden standard for evaluating BMD. The BMD-derived T-score is central to fracture prediction and signifies both diagnosis and treatment for osteoporosis. However, the increased fracture risk in diabetes is not sufficiently explained by the T-score, complicating the identification and management of fracture risk in these patients. Recent findings agree that subjects with type 2 diabetes (T2D) have a higher T-score and higher fracture risk compared with subjects without diabetes. However, the actual number of studies evaluating the direct association of higher fracture risk at higher T-score levels is scant. Some studies support the adjustment based on the 0.5 BMD T-score difference between subjects with T2D and subjects without diabetes. However, further data from longitudinal studies is warranted to validate if the T-score treatment threshold necessitates modification to prevent fractures in subjects with diabetes.
Topics: Humans; Bone Density; Osteoporosis; Absorptiometry, Photon; Diabetes Mellitus, Type 2; Osteoporotic Fractures; Risk Factors
PubMed: 38509440
DOI: 10.1007/s11914-024-00867-1 -
Osteoporosis International : a Journal... Jul 2011This study aims to determine osteoporosis (OP) investigation and treatment within post-fracture initiatives conducted in fracture clinics and other orthopedic... (Review)
Review
This study aims to determine osteoporosis (OP) investigation and treatment within post-fracture initiatives conducted in fracture clinics and other orthopedic environments. A systematic review was conducted. Eligibility criteria were: hip fracture patients plus all other fracture patients presenting with a fragility fracture, orthopedic setting where orthopedic physicians/staff were involved, intervention to improve OP management, primary data on ≥20 patients from randomized controlled trials (RCTs) and other study designs. We calculated outcome data within 6 months of screening from an intention-to-treat principle to derive an equated proportion (EP) across interventions. Outcomes were: (1) proportion of patients investigated with bone densitometry, (2) proportion of patients initiating OP medication, and (3) proportion of patients taking OP medication. We identified 2,259 citations, of which 57 articles that included 64 intervention groups were eligible. The median EP for patients investigated was 43% and the 75th percentile was 71%. The median EP for medication initiation was 22% and the 75th percentile was 34%. The median EP for medication taking was 27.5% and the 75th percentile was 43%. The EPs for all outcomes were higher for interventions with dedicated personnel to implement the intervention and those within which bone mineral density testing and/or treatment were included. In studies with an EP, up to 71% of patients were investigated for OP, but <35% initiated medication, and <45% were taking medication within 6 months of screening. Calculating an EP allowed us to compare outcomes across the studies, therefore capturing both RCTs and other study designs typical of real-world settings.
Topics: Bone Density; Densitometry; Fractures, Spontaneous; Humans; Orthopedics; Osteoporosis; Osteoporotic Fractures; Patient Compliance; Secondary Prevention; Treatment Outcome
PubMed: 21607808
DOI: 10.1007/s00198-011-1544-y -
Journal of Pediatric Orthopedics. Part B May 2024Osteogenesis imperfecta is an inherited clinically heterogeneous disorder of bone metabolism characterized by bone and skeletal fragility and an increased risk of...
Osteogenesis imperfecta is an inherited clinically heterogeneous disorder of bone metabolism characterized by bone and skeletal fragility and an increased risk of fractures. Pamidronate infusion was the standard treatment, but zoledronic acid is increasingly used to treat children with osteogenesis imperfecta. We conducted a systematic literature review to evaluate the efficacy and safety of intravenous zoledronic acid in the treatment of osteogenesis imperfecta in pediatric patients. A systematic review of the published literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible articles were clinical trials and observational studies including pediatric patients (<16 years) with osteogenesis imperfecta treated with zoledronic acid. We selected articles published during the 20 past years. The selected languages were English and French. We included articles with a minimum sample size of five patients. Six articles fulfilled the selection criteria. The majority of patients were Chinese (58%). The predominant sex was male (65%), and the age of included patients ranged from 2.5 weeks to 16.8 years. For all patients, zoledronic infusions were administrated intravenously. The zoledronic treatment duration ranged from 1 to 3 years. Densitometry parameters before and after zoledronic treatment were evaluated and showed significant improvement both in lumbar spine-bone mineral density Z -score and femoral neck-bone mineral density Z -scores. A significant decrease in fracture rate has also been noted both in vertebral and nonvertebral fracture incidence. The two most common side effects were fever and flu-like reactions. None of the patients presented severe adverse events. Zoledronic acid appeared to be well-tolerated and effective in the treatment of pediatric osteogenesis imperfecta.
Topics: Humans; Osteogenesis Imperfecta; Zoledronic Acid; Bone Density Conservation Agents; Child; Treatment Outcome; Child, Preschool; Infant; Adolescent; Male; Infusions, Intravenous; Diphosphonates; Bone Density; Administration, Intravenous; Female
PubMed: 37339526
DOI: 10.1097/BPB.0000000000001104 -
Osteoporosis International : a Journal... Feb 2015The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in... (Meta-Analysis)
Meta-Analysis Review
SUMMARY
The utility of bone mineral density (BMD) testing in chronic kidney disease (CKD) is not known. We performed a meta-analysis of studies reporting on BMD and fracture in CKD. All but one study was cross-sectional. BMD was lower in those with CKD and fractures compared to those without fractures.
INTRODUCTION
CKD is associated with an increased risk of fracture. The utility of dual energy X-ray absorptiometry (DXA) to assess fracture risk in CKD is unknown.
METHODS
We performed an updated meta-analysis and systematic review of published studies that reported on the association between DXA and fracture (morphometric spine or clinical nonspine) in predialysis and dialysis CKD. We identified 2,894 potential publications, retrieved 292 for detailed review, and included 13. All but one study was cross-sectional and three reported on the ability of DXA to discriminate fracture status in predialysis CKD. Results were pooled using a random effects model and statistical heterogeneity was assessed using the I2 statistic.
RESULTS
BMD was statistically significantly lower at the femoral neck, lumbar spine, the 1/3 and ultradistal radius in subjects with fractures compared to those without regardless of dialysis status. For example, femoral neck BMD was 0.06 g/cm2 lower in dialysis subjects and 0.102 g/cm2 lower in predialysis subjects with fractures compared to those without. Lumbar spine BMD was 0.05 g/cm2 lower in dialysis subjects and 0.108 g/cm2 lower in predialysis subjects with fractures compared to those without. Our meta-analysis was limited to studies with small numbers of subjects and even smaller numbers of fractures. All of the studies were observational and only one was prospective. There was statistical heterogeneity at the lumbar spine, 1/3 and ultradistal radius.
CONCLUSIONS
Our findings suggest that BMD can discriminate fracture status in predialysis and dialysis CKD. Larger, prospective studies are needed.
Topics: Absorptiometry, Photon; Aged; Bone Density; Bone and Bones; Humans; Middle Aged; Osteoporotic Fractures; Renal Insufficiency, Chronic; Risk Factors
PubMed: 25477230
DOI: 10.1007/s00198-014-2813-3 -
European Spine Journal : Official... Nov 2023This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and... (Meta-Analysis)
Meta-Analysis Review
The correlation between osteoporotic vertebrae fracture risk and bone mineral density measured by quantitative computed tomography and dual energy X-ray absorptiometry: a systematic review and meta-analysis.
UNLABELLED
This paper presents a comparison of quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) in osteoporosis with vertebral fracture and osteoporosis without fracture. It has been proved that the volumetric bone mineral density (vBMD) measured by QCT exhibits a stronger correlation with fracture risk than areal bone mineral density (aBMD) measured by DXA.
PURPOSE
This study aims to systematically evaluate the ability of QCT and DXA to distinguish between osteoporosis with vertebral fracture and osteoporosis without fracture according to vBMD and aBMD.
METHODS
We conducted a primary literature search of the online databases up to 3 July, 2022, in both English and Chinese publications, combining synonyms for "QCT", "DXA" and "osteoporosis". The Newcastle-Ottawa scale (NOS) was employed to evaluate the quality of the selected articles. vBMD obtained through QCT and aBMD obtained through DXA were extracted, and were analyzed by Review Manager 5.4 and RStudio.
RESULTS
Six studies with 610 individuals aged 45 to 90, of which 179 had vertebral fractures, were included in the final analysis. The weighted mean difference (WMD) between osteoporosis with vertebral fracture and osteoporosis without fracture for vBMD was - 27.08 (95% CI - 31.24 to - 22.92), while for aBMD was - 0.05 (95% CI - 0.08 to - 0.03).
CONCLUSIONS
Both vBMD detected by QCT and aBMD detected by DXA could discriminate fracture status in the spine, and vBMD performed a stronger correlation with fracture risk.
TRIAL REGISTRATION
PROSPERO 2022 CRD42022349185.
Topics: Humans; Bone Density; Absorptiometry, Photon; Spinal Fractures; Osteoporotic Fractures; Osteoporosis; Spine; Tomography, X-Ray Computed; Lumbar Vertebrae
PubMed: 37740786
DOI: 10.1007/s00586-023-07917-9 -
Rheumatology (Oxford, England) Jan 2024The aim of this systematic review and meta-analysis was to summarize current evidence regarding body composition (BC) in SSc in order to gain new insights and improve... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this systematic review and meta-analysis was to summarize current evidence regarding body composition (BC) in SSc in order to gain new insights and improve clinical care in the context of the nutritional status of SSc patients.
METHODS
The databases Web of Science, PubMed, Scopus and Cochrane Library were searched on 4 January 2023. Studies were included if they provided data regarding BC obtained by dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) in patients with SSc and healthy controls (HC). The study design criteria for inclusion were cohort and observational studies. The risk of bias assessment was performed using the Newcastle-Ottawa scale. For meta-analysis, mean difference with a 95% confidence interval was obtained and all results were depicted as forest plots.
RESULTS
The number of retrieved publications was 593, of which nine were included in a random-effects meta-analysis totalling 489 SSc patients and 404 HC. Overall, significantly lower body mass index, lean mass (LM), fat mass (FM) and phase angle values were found in SSc patients when compared with HC. Furthermore, FM and LM were significantly lower in SSc patients when the DXA method was applied, whereas the same parameters were comparable between two groups of participants when BIA was applied.
CONCLUSION
Altered BC is characteristic of SSc patients indicating the need for regular nutritional status assessment in order to improve the quality of life and clinical care of patients with SSc.
Topics: Humans; Quality of Life; Body Composition; Nutritional Status; Absorptiometry, Photon; Body Mass Index; Scleroderma, Systemic; Electric Impedance
PubMed: 37647631
DOI: 10.1093/rheumatology/kead418 -
Journal of Bone and Mineral Metabolism Jan 2018Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship... (Meta-Analysis)
Meta-Analysis Review
Given the rise in pediatric obesity, clarifications on the relationship between obesity and bone health and on the impact of structured intervention on this relationship are needed. This systematic review and meta-analysis investigated the effect of obesity on bone health and assessed the effect of structured intervention in children and adolescents with obesity. Medline complete, OVID, CINAHL, EMBASE and PubMed databases were searched for studies on obesity and bone health variables up to September 2016, then an update occurred in March 2016. Search items included obesity, childhood, dual energy X-ray absorptiometry and peripheral quantitative computed tomography. Twenty-three studies (14 cross-sectional and nine longitudinal) matched the inclusion criteria. Results from the meta-analysis (cross-sectional studies) confirmed that children and adolescents with obesity have higher bone content and density than their normal weight peers. Results from longitudinal studies remain inconclusive as only 50% of the included studies reported a positive effect of a structured intervention program on bone health. As such, the meta-analysis reported that structured intervention did not influence bone markers despite having beneficial effects on general health in youth with obesity.
Topics: Absorptiometry, Photon; Adolescent; Bone and Bones; Child; Cross-Sectional Studies; Exercise; Female; Humans; Longitudinal Studies; Male; Pediatric Obesity; Regression Analysis
PubMed: 28779404
DOI: 10.1007/s00774-017-0858-z