Relationship of body mass index with bone mineral density in postmenopausal women: an Indian perspective

Background: Osteoporosis is a common health problem that affects postmenopausal females, leading to increased susceptibility to fractures. Body mass index (BMI) has been shown to be an important predictor of bone mineral density (BMD) with increased body weight correlating with positive influence on bone metabolism. Low BMI predisposes postmenopausal females to rapid bone loss and low bone mass, crucial in the pathogenesis of osteoporosis. However, a specific BMI value chart to accurately predict osteoporosis remains to be fully established. The present study aimed to investigate the relationship of BMI and BMD in postmenopausal Indian females.Methods: 90 healthy postmenopausal females with 1-5 years of menopause were enrolled in the study. Subjects were categorized according to their BMI into normal, overweight and obese. BMD was assessed using dual energy X-ray absorptiometry (DEXA) scan at L1-L4 vertebrae and femoral neck and expressed as T-scores. Quantitative variables were compared using ANOVA/Kruskal Wallis Test.Results: Bone mineral density was significantly higher in the obese group as compared to normal BMI group at both lumbar spine (p=0.001) and femoral neck (p=0.001). BMD at lumbar spine was lower than that at femoral neck across all the three groups of BMI.Conclusions: BMI and body weight are important factors affecting BMD. Postmenopausal females with low BMI are more likely to have osteopenia and osteoporosis and are thus at an increased risk of pathological fractures. Routine BMD monitoring in postmenopausal females with low BMI may be necessary to initiate early clinical interventions for osteoporosis.

Management of pseudohypoparathyroidism in pregnancy: a rare entity

Pseudohypoparathyroidism is a very rare genetic disorder and during pregnancy poses multiple challenges related to its monitoring and management. Authors present the case of a  30year old primigravida who was a diagnosed case of pseudohypoparathyroidism since 22 yrs of age, presented to our obs/gynae OPD at 5+5 wks of POG. She was managed by serial monitoring of serum calcium, phosphate and vitamin D throughout  pregnancy with careful dose modification of calcium from 1gm to 3.5gm daily and vitamin D from  0.5mcg  to 1.5mcg daily. During her course of pregnancy, she developed gestational hypothyroidism, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension which were controlled and managed successfully. She had an elective caesarean section at 37+6 wks POG for transverse lie. Both maternal and perinatal outcome were good. Patient was discharged with advice to continue with her monitoring of serum calcium, phosphate, vitamin D along with supplementation of calcium and vitamin D life long.