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Objective:To analyze the bone turnover markers in systemic lupus erythematosus (SLE) patients with different disease activity and the risk factors of osteoporosis.Methods:In this retrospective study, a total of 417 SLE inpatients were enrolled from the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xi′an Jiaotong University, from March 2019 to June 2020. According to SLEDAI score, the patients were divided into 3 groups: 281 patients disease with inactive disease group; 99 patients with mild active disease group; and 37 patients with moderate/severe active disease. ANOVA test was used to compare the differences in serum bone turnover markers (PTH, NOST, VITDT, β-crossl, TP1NP, Ca and P) and bone density (Spine L 1~4 and left femur) among the three groups, and Tukey's method was used for the two groups comparison. Logistic regression analysis was used to investigate the risk factors of osteoporosis. Results:Serum VITDT, β-crossl and Ca levels were significantly different among the 3 groups ( F=11.66, P<0.001; F=7.22, P<0.001; F=29.38, P<0.001). Compared with patients in the inactive group, patients with both the mild disease group (VITDT: t=3.94, P<0.001; Ca: t=5.10, P<0.001) and the moderate/severe disease group (VITDT: t=3.33, P<0.001; Ca: t=7.19, P<0.001) had lower VITDT levels [(20.3±9.7) ng/ml vs. (15.9±9.3) ng/ml vs. (14.8±7.4) ng/ml] and serum Ca levels [(2.19±0.15)mmol/L vs. (2.09±0.21)mmol/L vs. (2.00±0.16)mmol/L]. Moreover, the moderate/severe disease group patients had much lower serum Ca levels ( t=2.36, P<0.05), compared with patients with the mild disease group. Compared with the patients with inactive group, both the mild activey group ( t=3.06, P<0.01) and the moderate/severe activie group ( t=2.99, P<0.01) patients had higher serum β-crossl levels [(419±316) pg/ml vs. (543±424) pg/ml vs. (586±343) pg/ml]. Compared with patients with the inactive disease group both patienes with the mild active group and the moderate/severe disease group patients had significantly decreased spine BMD ( t=2.75, P<0.01; t=2.71, P<0.01), Z-score ( t=5.65, P<0.001; t=4.70, P<0.001), T-score ( t=3.02, P<0.01; t=3.37, P<0.001), whereas, no difference was found between the mild disease group and moderate/severe disease group. Compared with the inactive group patients, both the mild active group and moderate/severe disease group patients had lower left femur BMD levels ( t=2.83, P<0.001; t=2.65, P<0.001) and T-score ( t=2.24, P<0.05; t=1.977, P<0.05) and no difference was found between the mild disease group and the moderate/severe disease group. Logistic regression analysis showed that age [ HR (95% CI)=1.080 (1.052, 1.109), P<0.001], BMI [ HR (95% CI)=0.801 (0.704, 0.911), P<0.001], SLEDAI score [ HR (95% CI)=1.047 (1.025, 1.076), P<0.05] and cumulative glucocorticoids dose [1.046 (1.006, 1.087), P<0.05] were associated with osteoporosis of SLE patients. Conclusion:Abnormal bone metabolism and decreased bone density are associated with SLE disease activity in SLE patients, especially in those with advanced age, low BMI and receiving high cumulative dose of glucocorticoids. Osteoporosis should be proactively prevented in the SLE patients.
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The pedicle screw internal fixation system plays a crucial role in spinal surgery, with the advantage of enhancing spinal stability. However, potential complications such as internal fixation loosening and screw pullout still exist clinically. Currently, pullout of strength is commonly used to evaluate the short-term biomechanical properties of internal fixation, fatigue test is performed to evaluate the long-term biomechanical properties of internal fixation, and torque is used to evaluate the interaction between screws and spinal bone. Factors that influence the biomechanical properties of pedicle screws include spine-related factors (bone density) and screw-related factors (screw size, screw design, and screw augmentation materials). In bones with high bone density, pullout of strength is significantly increased, and fixation strength can also be improved by increasing screw diameter and length, improving screw design, and using screw augmentation materials. Biomechanical research on pedicle screw internal fixation provides key information for achieving individualized and functional optimal channel selection. Designing screw channels with optimal fixation strength is expected to reduce the risk of screw loosening and the occurrence of surgical complications, and improve surgical effects.
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Objective To evaluate the effects of puerarin on bone density in rats and mice through a meta-analysis. Methods The databases, including CNKI, SinoMed, Wanfang data, VIP, PubMed, EMBase, Web of Science, the Cochrane Library, and Scopus from their inception to November 6, 2023, were searched for literature on the effects of puerarin treatment on bone density in rats and mice. Inclusion criteria for the literature were randomized controlled trials with a placebo or blank control group; the subject animals were rats or mice; the intervention was puerarin; and the results included bone density measurements. Exclusion criteria included combination therapy with puerarin; lack of original research data; unpublished studies; and using mandible as the measurement site for bone density. Risks of bias were assessed using SYRCLE's RoB tool. Data analysis was conducted with Stata 16.0 and Rev Man 5.3 software. Results After applying the inclusion and exclusion criteria, a total of 429 records were identified and 42 articles covering 41 studies were ultimately included. 925 animals were involved and the data analysis results indicated that puerarin improved bone density in rats and mice compared to the control group: femur [37 studies, n=824, standardized mean difference （SMD)=2.12, 95% confidence interval (CI)=1.69-2.54, P < 0.000 1], lumbar spine (13 studies, n=271, SMD=2.25, 95% CI=1.49-3.01, P < 0.000 1), tibia (4 studies, n=95, SMD=0.94, 95% CI=0.05-1.83, P=0.04), and the whole body (4 studies, n=94, SMD=1.89, 95% CI=0.50-3.29, P=0.008), with all inter-group differences in bone density being statistically significant. Conclusion Puerarin can improve bone density in rats and mice. This study provides a valuable reference for clinical studies on the prevention and treatment of osteoporosis with puerarin.
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ABSTRACT Objective: This study aimed to verify the association between childhood anthropometric indicators and areal bone mineral density (aBMD) in adulthood. Methods: Repeated measures of 137 subjects (68 females) were obtained in childhood (9.2±1.5 years of age) and adulthood (22.3±1.7 years of age). aBMD (g/cm2) was assessed for whole body, lumbar spine, upper and lower limbs, and femoral neck in adulthood using dual-energy X-ray absorptiometry. Anthropometric measurements of body weight (BW), height, triceps and subscapular skinfolds were obtained in childhood. The anthropometric indicators used were BW, body mass index (BMI), and sum of skinfolds (ΣSF). Simple linear regression was used to assess the association between childhood anthropometric indicators and aBMD in adulthood, controlled by chronological age and stratified by sex, with 5% statistical significance. Results: In females, multiple associations were observed between anthropometric indicators and aBMD, with higher coefficients for BMI (β=0.020; R2=0.20; p<0.01 for right femoral neck to β=0.008; R2=0.16; p<0.01 for upper limbs), followed by BW (β=0.003; R2=0.21; p<0.01 for upper limbs to β=0.008; R2=0.20; p<0.01 for right femoral neck) and ΣSF (β=0.001; R2=0.06; p<0.01 for upper limbs to β=0.005; R2=0.12; p<0.01 for right femoral neck). In males, associations were observed only for the lumbar spine region (β=0.016; R2=0.09 for BMI to β=0.004; R2=0.06; p<0.01 for ΣSF). Conclusions: Anthropometric indicators of childhood proved to be sensitive predictors of aBMD in adulthood, especially in females. BMI indicated a greater association with aBMD in both sexes.
RESUMO Objetivo: O objetivo do estudo foi verificar a associação entre os indicadores antropométricos da infância com a área da densidade mineral óssea (aDMO) na idade adulta. Métodos: Medidas repetidas de 137 sujeitos (68 do sexo feminino) foram obtidos na infância (9,2±1,5 anos de idade) e idade adulta (22,3±1,7 anos de idade). A aDMO (g/cm2) foi avaliada para todo o corpo, coluna lombar, membros superiores e inferiores e colo do fêmur na idade adulta usando a absorciometria radiológica de dupla energia (DXA). Medidas antropométricas de peso corporal, estatura e dobras cutâneas das regiões tricipital e subescapular foram obtidas na infância. Os indicadores antropométricos utilizados para as análises foram o peso corporal (PC), o índice de massa corporal (IMC) e o somatório de dobras cutâneas (ΣDC). Regressão linear simples controlada pela idade e estratificada por sexo foi empregada para avaliar a associação entre os indicadores antropométricos do período da infância na aDMO na idade adulta, com significância estatística de 5%. Resultados: No sexo feminino, múltiplas associações foram observadas entre os indicadores antropométricos e a aDMO, com maiores coeficientes para IMC (β=0,020; R2=0,20; p<0.01 para colo do fêmur direito a β=0,008; R2=0,16; p<0,01 para membros superiores), seguido da PC (β=0,003; r2=0,21; p<0,01 para membros superiores a β=0,008; r2=0,20; p<0,01 para colo do fêmur direito) e ΣDC (β=0,001; R2=0,06; p<0,01 para membros superiores a β=0,005; R2=0,12; p<0,01 para colo do fêmur direito). No sexo masculino, associações ocorreram apenas na região da coluna (β=0,016; R2=0,09 para IMC a β=0,004; R2=0,06; p<0,01 para ΣDC). Conclusões: Indicadores antropométricos da infância mostraram ser sensíveis preditores da aDMO na idade adulta, especialmente no sexo feminino. O IMC indicou maior associação com a aDMO em ambos os sexos.
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ABSTRACT Objective: To investigate the impact of tenofovir disoproxil fumarate on bone mineral density and bone mineral content in children and adolescents infected with the human immunodeficiency virus. Data source: The search procedure was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The search was carried out until April 2022 in Medical Literature Analysis and Retrieval System Online (Medline), Embase, Cochrane Central, Latin American and Caribbean Health Sciences Literature, Web of Science, Scopus, and MedRxiv. The combination of terms used was: (Children OR Youth OR Teenagers) AND HIV AND (Tenofovir OR "Antiretroviral therapy") AND ("Bone density" OR Osteoporosis OR Osteopenia). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022312851) Data synthesis: The initial searches resulted in 1156 papers. After the exclusion of duplicate studies, three blinded reviewers analyzed the title and abstract of 563 papers, of which 57 remained to be read in full. Only nine papers met the eligibility criteria and were included in descriptive and risk-of-bias analyses. Regarding study design, four were cross-sectional, three were longitudinal before-after studies without a control group, and two were prospective cohorts. Among these nine papers, seven showed no significant association between tenofovir disoproxil fumarate use and reduced bone mass in young people. However, these papers did not have high methodological quality. Conclusions: Although most of the selected papers found no harmful effect of tenofovir disoproxil fumarate on bone mass, further primary research with higher methodological quality is needed so robust scientific evidences can be obtained.
RESUMO Objetivo: Investigar o impacto do tenofovir disoproxil fumarato sobre a densidade mineral óssea e o conteúdo mineral ósseo em crianças e adolescentes infectados pelo vírus da imunodeficiência humana. Fontes de dados: O procedimento de busca foi executado de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. A busca foi realizada até abril de 2022 nas seguintes bases de dados: Medical Literature Analysis and Retrieval System Online (Medline), Embase, Cochrane Central, Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Web of Science, Scopus, and MedRxiv. A combinação de termos utilizada foi: (Children OR Youth OR Teenagers) AND HIV AND (Tenofovir OR "Antiretroviral therapy") AND ("Bone density" OR Osteoporosis OR Osteopenia). O protocolo foi registrado na base International Prospective Register of Systematic Reviews — PROSPERO (CRD42022312851). Síntese dos dados: As pesquisas iniciais resultaram em 1.156 artigos. Após a exclusão dos estudos duplicados, três revisores cegos analisaram título e resumo de 563 estudos, dos quais 57 permaneceram para leitura na íntegra. Somente nove artigos atenderam aos critérios de elegibilidade e foram incluídos para análises descritivas e de risco de viés. Com relação ao desenho dos estudos, quatro foram transversais, três foram estudos longitudinais antes-depois sem grupo controle e dois foram coortes prospectivas. Dos nove artigos, sete não mostraram associação significativa entre uso de TDF e redução de massa óssea em pessoas jovens. Entretanto, esses estudos não tiveram alta qualidade metodológica. Conclusões: Embora a maioria dos estudos selecionados não tenha encontrado efeito prejudicial do TDF sobre massa óssea, novas pesquisas primárias com maior qualidade metodológica são necessárias para que sejam obtidas evidências científicas robustas.
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ABSTRACT Objective: To investigate associations/correlations between bone alterations and vitamin D status in children through data mining analyses based on observational studies. Material and Methods: Searches in PubMed, Scopus, Web of Science, and Embase databases were performed to recover studies, published until October 2022, with healthy children, which investigated the vitamin D status, related or not to undesirable bone alterations linked to bone quality (bone mineral density and bone mineral content), fracture or anthropometry. Country, study design, area of expertise (medicine, nutrition, dentistry, others), bone outcome, 25-hydroxyvitamin D data (serum or intake levels), the exams for bone diagnosis, and the results were analyzed in the VantagePointTM software. Results: Of 20,583 studies, 27 were included. The USA (n=9; 33.3%) had the highest number of publications. Cross-sectional (n=11; 40.7%), case-control (n=9; 33.3%), and cohort studies (n=7; 25.9%) contemplated the medicine and nutritional areas without any study in dentistry. Studies about bone quality (n=21; 77.8%), analyzed through dual-energy X-ray absorptiometry (DXA; n=14; 51.8%), with association (n=16; 59.2%) between the low serum levels of 25-hydroxyvitamin D and undesirable bone alterations (n=14; 51.8%) were the most prevalent. Conclusion: Most studies were conducted in the medical area and showed an association between low bone quality and low levels of 25-hydroxyvitamin D, verified through DXA.
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SUMMARY OBJECTIVE: Osteoporosis, defined as a systemic skeletal disease, is characterized by increased bone fragility and fracture risk. Studies have shown that dysregulation of the functions of miRNAs or the mechanisms they mediate may be an important pathological factor in bone degeneration. Therefore, the aim of the study was to determine the role of miRNAs, which are thought to play a role in bone metabolism, in osteoporosis. METHODS: The study included 48 patients who were diagnosed with osteoporosis according to the results of a bone mineral density assessment by quantitative computed tomography and 36 healthy individuals. MiRNAs from plasma samples obtained from blood samples taken into ethylenediaminetetraacetic acid (EDTA) tubes were isolated with the miRNA isolation kit and converted to cDNA. Expression analysis of miR-21-5p, miR-34a-5p, miR-210, miR-122-5p, miR-125b-5p, miR-133a, miR-143-3p, miR-146a, miR-155-5p, and miR-223 was performed on the real-time PCR (RT-PCR) device. RESULTS: When miRNA expression levels in the patient group were compared with the control group, all miRNAs were found to be downregulated in the patients. When fold changes in expression levels in the patient group were examined, significant differences were found in miR-21-5p, miR-133a, mir143-3p, miR-210, and miR-223. In the receiver operating curve analysis, area under the curve=0.882 for the combination of miR-34, miR-125, miR-133, and miR-210. CONCLUSION: In this study, it was determined that the combined effects of miRNAs, as well as their single effects, were effective in the development of osteoporosis. Therefore, a miRNA panel to be created can make a significant contribution to the development of novel diagnostic and treatment approaches for this disease.
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ABSTRACT BACKGROUND: Osteoporosis, characterized by decreased bone density and increased fracture risk, imposes significant physical, psychosocial, and financial burdens. Early detection and prevention are crucial for managing osteoporosis and reducing the risk of fractures. OBJECTIVES: To investigate the relationship between Hepatitis A seropositivity and bone mineral density (BMD) in adolescents and adults and to explore the potential link between Hepatitis A infection and osteoporosis risk. DESIGN AND SETTING: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 to evaluate the association between hepatitis A seropositivity and BMD in 15,693 participants. METHODS: Multivariable regression analysis was used to calculate the mean BMD and standard error for adolescents and adults, followed by an independent z-test to determine whether there was a significant difference between the seropositive and seronegative groups. RESULTS: Hepatitis A seropositive adolescents and adults had lower BMD than their seronegative counterparts, with significant differences in lumber spine (mean difference = -0.03 g/cm2, P < 0.01 for both age groups) and pelvis BMDs (mean difference = -0.02 g/cm2, P < 0.01 for the adult age groups), after adjusting for various covariates. CONCLUSIONS: This study confirmed that both adolescent and adult individuals seropositive for Hepatitis A antibodies had reduced BMD among both adolescents and adults, especially in the adult group. This finding suggests a possible link between Hepatitis A infection and risk of osteoporosis.
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Resumo: Este estudo avaliou a associação do peso ao nascer, idade gestacional e crescimento intrauterino com a densidade mineral óssea (DMO) aos 22 e 30 anos, nas coortes de nascimentos de 1982 e 1993 de Pelotas, Rio Grande do Sul, Brasil. A DMO foi medida por absorciometria por raios X com dupla energia (DXA), a associação foi avaliada usando análise de variância e a regressão linear múltipla para o controle de confundimento por: sexo, renda familiar ao nascer, tabagismo materno na gestação, escolaridade materna, cor da pele materna e índice de massa corporal pré-gestacional. Foi testado se a gordura corporal na vida adulta era mediadora da associação analisada, por meio da G-computation Formula. Foram avaliados 6.803 participantes das coortes de 1982 e 1993, aos 30 e 22 anos, respectivamente. O peso ao nascer teve associação com a DMO em todos os sítios, com maior diferença no colo femoral. Os nascidos com menos de 2.000g apresentaram, em média, -0,036g/cm2 (IC95%: -0,064; -0,008) de DMO no colo femoral em comparação àqueles com mais de 3.500g. Aqueles com escore-z de crescimento intrauterino com pelo menos 1,28 desvio padrão abaixo da média apresentaram, em média, -0,013g/cm2 (IC95%: -0,024; -0,002) de DMO na coluna lombar, em relação aos com escore-z acima da média. A análise de mediação mostrou que gordura corporal na idade adulta não mediou a associação. As condições de nascimento foram associadas com a densidade mineral óssea na vida adulta, e a identificação dos fatores precoces relacionados à perda de DMO é essencial devido à inversão demográfica em progresso em países de média e baixa renda.
Abstract: This study assessed the association of birth weight, gestational age, and intrauterine growth with bone mineral density (BMD) at 22 and 30 years of age in the 1982 and 1993 birth cohorts in Pelotas, Rio Grande do Sul State, Brazil. BMD was measured by dual-energy X-ray absorptiometry (DXA) and the association was assessed using analysis of variance. Multiple linear regression was used to control for confounding factors: sex; household income at birth; maternal smoking during pregnancy; maternal schooling; maternal ethnicity/skin color; and pre-pregnancy body mass index. The study tested whether body fat in adulthood was a mediator of the association analyzed, using the G-computation Formula. A total of 6,803 participants from the 1982 and 1993 cohorts were evaluated at 30 and 22 years of age, respectively. Birth weight was associated with BMD at all sites, with a greater difference at the femoral neck. Individuals born weighing less than 2,000g had on average -0.036g/cm2 (95%CI: -0.064; -0.008) of BMD in the femoral neck than individuals weighing more than 3,500g. Individuals with an intrauterine growth z-score at least 1.28 standard deviation below the mean had an average of -0.013g/cm2 (95%CI: -0.024; -0.002) of BMD in the lumbar spine compared with individuals with an above-average z-score. The mediation analysis showed that body fat in adulthood did not mediate the association. Birth conditions have been associated with BMD in adulthood and the identification of early factors related to bone loss is essential due to the demographic inversion that has been taking place in low- and middle-income countries.
Resumen: Este estudio evaluó la asociación del peso al nacer, la edad gestacional y el crecimiento intrauterino con la densidad mineral ósea (DMO) a los 22 y 30 años de edad, en las Cohortes de Nacimiento de 1982 y 1993 de Pelotas, Rio Grande do Sul, Brasil. La DMO se midió mediante absorciometría de rayos X de doble emisión (DXA), y la asociación se evaluó mediante ANOVA y regresión lineal múltiple para controlar la confusión por sexo, ingresos familiares al nacer, tabaquismo materno durante el embarazo, escolaridad materna, color de piel materno e índice de masa corporal antes del embarazo. Se comprobó si la grasa corporal en la edad adulta era un mediador de la asociación analizada, utilizando G-computation Formula. Se evaluaron 6.803 participantes de las cohortes 82 y 93, de 30 y 22 años, respectivamente. El peso al nacer se asoció con la DMO en todos los sitios, con la mayor diferencia en el cuello femoral. Los nacidos con un peso inferior a 2.000g tuvieron una media de -0,036g/cm2 (IC95%: -0,064; -0,008) de DMO en el cuello femoral, que aquellos con más de 3.500g. Aquellos con una puntuación z de crecimiento intrauterino de al menos 1,28 desviaciones estándar por debajo de la media presentaron un promedio de -0,013g/cm2 (IC95%: -0,024; -0,002) de DMO en la columna lumbar, con relación a aquellos con un puntaje z superior a la media. El análisis de mediación mostró que la grasa corporal en la edad adulta no medió la asociación. Las condiciones de nacimiento se asociaron con la DMO en la edad adulta, y la identificación temprana de factores relacionados con la pérdida de DMO es esencial debido a la inversión demográfica que ha estado ocurriendo en los países de ingresos medios y bajos.
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Objective: To analyze the relationship between resistance training and body composition in adolescents. Methods: A longitudinal 12-month follow up of 190 adolescents of both sexes categorized into three groups according to resistance training practice, as nonengagement (n=121), irregular engagement (n=44), and frequent engagement (n=25). The outcomes adopted were bone mineral density (BMD), lean soft tissue (LST), and body fatness (BF). Results: Adolescents frequently engaged in resistance training presented higher gains in mean (95%CI) LST [6.1 (3.7 to 8.5) kg vs 2.4 (1.4 to 3.4) kg; P= 0.027] and BMD-upper limbs [0.096 (0.072 to 0.121) g/cm2 vs 0.046 (0.036 to 0.056) g/cm2; P=0.002] than adolescents who were not engaged in resistance training, respectively. Findings were more consistent for boys than girls (models were not significant among girls: LST P= 0.721; BMD-upper limbs P= 0.053). Conclusion: Regular engagement in resistance training was related to higher gains in muscle mass and bone density, especially among boys.
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Background: Clinical sign of osteoporosis includes fragility fractures or a T-score that is <2.5 SD below the mean as determined by a dual-energy X-ray absorptiometry (DXA) scan of bone mineral density (BMD). People with T-scores of –2.5 have the highest risk of fracture. People with T-scores of –2.5 have the highest risk of fracture. However, maximum fractures are seen in patients with a T-score between –1 and –2.5 because of more people in this category. As there is very little knowledge of osteoporosis in perimenopausal and postmenopausal women in male region, this study will help us to know the current status of osteoporosis in these females. Aims and Objectives: The objective of the present study was to determine the prevalence of osteoporosis in 296 premenopausal, perimenopausal and postmenopausal women of more than 40 years of age attending midlife health clinic at a tertiary care center in Patiala, Punjab and to observe its correlation with age, menopausal status, body mass index, and dietary intake. Materials and Methods: A detailed medical, surgical, obstetrical, gynecological, and drug history were recorded in a pro forma designed for the study after taking the informed consent. Information about history of fracture on a trivial fall, family history suggestive of osteoporosis, socioeconomic status, educational status, and occupation was documented. Women having history of endocrinal disorders (hypo/hyperthyroidism, hypo/hypergonadism, and hypo/hypercalcemia), receiving therapeutic agents (thiazide diuretics, glucocorticoids, and osteoporosis treatment), having restricted mobility issues and with implants (at lumbar spine, hip, and lower limbs) were excluded from the study. Quantitative ultrasound (QUS) measurement of calcaneum was performed that T-score was generated based on the speed of sound and was used to classify the bone health status of the subjects. Results: Out of 296 women, 227 women had a low bone mass density, that is, <–1 SD. We divided all the participants into three groups as shown in Table 1. Group I (n = 69 [23.2%]) having normal BMD, that is, T score >–1 SD; Group II (n = 204 [69.2%]) included women with BMD between –1 and –2.5 SD (Osteopenia); and Group III (n = 23 [7.6%]) included women with BMD <–2.5 SD (Osteoporosis). Most women in perimenopausal (75%) and postmenopausal (64.6%) group were osteopenic (Group I). Out of all women with osteopenia (Group II, n = 204), 113 (52.1%) were postmenopausal and 82 (40.3%) were perimenopausal. All women with osteoporosis were postmenopausal. The difference between BMD categories and menopausal status was statistically significant (P = 0.014). In these women, the BMD was found to decrease with increase in the average number of years since menopause (YSM) (P = 0.06). Conclusion: Menopause is an important event in a woman’s life cycle which affects bone health with the prevalence of osteoporosis and osteopenia increasing with increasing YSM. QUS technology emerges as cost-effective screening tool for the early detection of osteoporosis for a large population in developing country like India.
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Introdução: A osteoporose é uma das principais causas de morbimortalidade, principalmente em idosos e mulheres na pós-menopausa, devido ao aumento da fragilidade óssea e maior suscetibilidade a fraturas. Objetivo: Avaliar a eficácia e segurança do romosozumabe, comparado aos tratamentos farmacológicos atualmente disponíveis no Sistema Único de Saúde para o manejo de mulheres na pós-menopausa com osteoporose grave e alto risco de fraturas. Métodos: Foi realizada uma busca seguida por meta-análises indiretas, por ensaios clínicos randomizados (ECR) nas bases PubMed Central e Medline, Embase e Cochrane Library e por busca manual. O risco de viés (RoB 2.0) e a qualidade da evidência (GRADE) foram analisados. Meta-análises indiretas foram realizadas para desfechos de fraturas, densidade mineral óssea e eventos adversos. Resultados: Sete ECR (n= 19.951 mulheres) foram incluídos nesta revisão. Romosozumabe seguido de alendronato reduziu risco de fraturas não vertebrais em 12 meses (RR: 0,64, IC 95%: 0,49-0,84; alta certeza de evidência) e em 24 meses (RR: 0,52, IC 95%: 0,43-0,64; (alta certeza de evidência) na comparação ao alendronato. Achados semelhantes foram identificados para outros desfechos. Ácido zoledrônico foi associada a maior risco de descontinuação por evento adverso que placebo (RR: 1,02, IC 95%: 1,01-1,03). Conclusão: Foi identificado que romosozumabe ou romosozumabe seguido por alendronato são eficazes e seguros na comparação com alendronato.
Background: Osteoporosis is a major cause of morbidity and mortality, especially in the elderly and postmenopausal women, due to increased bone fragility and greater susceptibility to fractures. Objective: To evaluate the efficacy and safety of romosozumab, compared to pharmacological treatments currently available in the Unified Health System of Brazil for the management of postmenopausal women with severe osteoporosis and high risk of fractures. Methods: A search was carried out followed by indirect meta-analyses, randomized controlled trials (RCTs) in PubMed Central and Medline, EMBASE, and Cochrane Library databases and manual search. Risk of bias (RoB 2.0) and quality of evidence (GRADE) were assessed. Indirect frequentist meta-analyses were carried out for outcomes related to fractures, bone mineral density, and adverse events. Results: Seven RCTs (n= 19,951 woman) were included in this review. Romosozumab followed by alendronate reduced the risk of non-vertebral fractures at 12 months (RR: 0.64, 95% CI: 0.49-0.84; high certainty of evidence) and at 24 months (RR: 0.52, CI 95 %: 0.43-0.64; (high certainty of evidence) in comparison to alendronate. Similar findings were identified for other outcomes. Zoledronic acid was associated with a higher risk of discontinuation due to adverse events than placebo (RR: 1.02, 95% CI: 1.01-1.03). Conclusion: This review identified that romosozumab or romosozumab followed by alendronate are effective and safe compared to alendronate.
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Background: To analyze the effects of oral alkali therapy on renal function, nutritional status and bone density in patients of diabetic kidney disease. Material & Methods: A randomized controlled trial was conducted on 60 patients of age>18 years with diabetic kidney disease who were not on dialysis and had plasma bicarbonate levels between 16 and 20 mmol/l. Patients were randomly divided into two groups: Test group (n=30) which received oral alkali therapy as sodium bicarbonate and control group (n=30) who did not receive oral alkali therapy. The patients were followed for 12 months to compare the improvement. Results: In comparison to controls, test group showed a significant improvement in the Hb (0.7 vs. 0.25, P =0.003), significantly less decrease in eGFR (-2.25 vs. -2.9, P=0.049), non-significant less increase in creatinine (-0.26 ± 0.4 vs. -0.43 ± 0.33, P=0.09), significant improvement in bicarbonate levels (7.5 vs. 1, p<0.0001), significant restoration of albumin (0.32 vs. 0.05, P<.0001), significant fall in iPTH levels (50 vs. 25, p=0.007) and ALP levels (32 vs. 12, p=0.015). Bone density (0.28 ± 0.17 vs. 0.01 ± 0.13, P<.0001) and clinical well-being VAS scores improved significantly among the cases (9.83 ± 5.65 vs. -1.67 ± 7.11, P<.0001). Conclusion: In conclusion, oral alkali therapy slows the rate of decline of renal function and the development of end stage renal disease in patients with advanced stages of CKD. This cheap and simple strategy, which is in line with current renal consensus documents, also improves the nutritional status of patients and bone density.
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ObjectiveTo investigate the influence of sarcopenia on bone mass loss， the risk factors for bone mass loss in liver cirrhosis， and the correlation between body composition and bone mineral density （BMD） by comparing the clinical features of bone mass loss in patients with liver cirrhosis. MethodsA total of 92 patients who were hospitalized and diagnosed with liver cirrhosis in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from April to December of 2022 were enrolled， and based on the results of dual-energy X-ray absorptiometry， they were divided into bone mass loss group （osteopenia/osteoporosis） with 57 patients and normal bone mass group with 35 patients. The two groups were compared in terms of general data， laboratory examination， imaging data， and body composition analysis. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the continuity correction chi-square test was used for comparison of categorical data between two groups； Pearson correlation analysis and Spearman correlation analysis were used to investigate correlation； a binary logistic regression analysis was used to investigate the risk factors for bone mass loss in liver cirrhosis. ResultsCompared with the normal bone mass group， the bone mass loss group had significantly higher age （t=-3.597， P<0.05）， proportion of female patients （χ2=8.393， P<0.05）， N-terminal middle molecular fragment of osteocalcin （N-MID） （Z=-3.068， P<0.05）， β isomer of C-terminal telopeptide of type I collagen （β-CTX） （t=-2.784， P<0.05）， and proportion of patients with sarcopenia （χ2=13.884， P<0.05） and significantly lower calcitonin （CT） （Z=-2.340， P<0.05） and L3 skeletal muscle index （L3-SMI） （t=4.621， P<0.05）. Compared with the normal bone mass group， the bone mass loss group had significantly lower total muscle mass （Z=-2.952， P<0.05）， right upper limb muscle mass （Z=-2.929， P<0.05）， left upper limb muscle mass （Z=-2.680， P<0.05）， right lower limb muscle mass （Z=-3.366， P<0.05）， left lower limb muscle mass （Z=-3.374， P<0.05）， presumed bone mass （t=2.842， P<0.05）， body water mass （Z=-2.779， P<0.05）， basal metabolic rate （BMR） （Z=-3.153， P<0.05）， and BMD of L1— L4 and femoral neck （t=9.789， t=10.280， t=10.832， Z=-7.298， t=8.945， all P<0.05）. Total muscle mass， muscle mass of trunk and limbs， presumed bone mass， BMR， and body water mass in body component analysis were positively correlated with L1 — L4 BMD and femoral neck BMD （all P<0.05）， and fat mass was positively correlated with L1 — L4 BMD （all P<0.05）. Sarcopenia （odds ratio ［OR］=8.737， 95% confidence interval ［CI］： 2.237 — 34.129， P=0.002）， age （OR=1.094， 95%CI： 1.019 — 1.175， P=0.013）， and N-MID （OR=1.095， 95%CI： 1.019 — 1.176， P=0.014） were independent risk factors for bone mass loss in patients with liver cirrhosis. ConclusionOld age， female sex， sarcopenia， elevated N-MID， elevated β-CTX， reduction in CT， low muscle mass， low presumed bone mass， low BMR， and low body water mass are the features of bone mass loss in patients with liver cirrhosis， and sarcopenia， age， and N-MID are independent risk factors for bone mass loss in patients with liver cirrhosis. Detailed assessment of body composition changes can help to identify abnormal BMD in patients with liver cirrhosis.
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Objective To study the short-term variation patterns of graft viscosity after anterior cruciate ligament reconstruction (ACLR) surgery. Methods Six male New Zealand rabbits were selected. The ACLR animal model of unilateral knee was made with Achilles tendon as the graft. The experimental rabbits were euthanized 15 days after ACLR surgery, with removal of the graft, healthy anterior cruciate ligament (ACL) and Achilles tendon. The cross-sectional area and viscosity coefficient of the graft were measured, and the creep experiments were carried out under equilibrium conditions of 0.1 MPa and 1 MPa, respectively. The viscosity coefficent was calculated. Variation patterns of graft viscosity were summarize. The grafts were compared with healthy ACL. Results The cross-sectional area of the graft increased slowly within 15 days after ACLR surgery. The viscosity of ACL and graft changed nonlinearly. The viscosity coefficient was quite different under different stresses. The viscosity coefficient of the graft decreased with the time after ACLR surgery, which was more obviously under the condition of low stress. Conclusions The results are helpful to guide the implementation of early postoperative rehabilitation plan after ACLR surgery .
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Hyperuricemia is closely related to metabolic diseases.With the development of metabolic syndrome(MS),it can change the mechanical load,hormone and biochemical characteristics of patients,thus perform a complex impact on bone health.Although the increased mechanical load and the production of some hormones can prevent os-teoporosis,it can promote inflammation and oxidation in vivo,which may be harmful to bone health,and uric acid may have antioxidant effect to protect bone.Therefore,the influence of increased uric acid on bone in MS patients is still unclear.The present article will further explore this issue.
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Objective To explore the relationship of changes in bone mineral density and bone me-tabolism indicators with osteoporosis in elderly patients with hemiplegia after cerebral infarction.Methods A total of 197 elderly patients suffering post-stroke hemiplegia admitted to our hospital were enrolled between February 2018 and February 2021.Their bone mineral density and bone metabolism indicators were analyzed based on gender,disease course and hemiplegia severity.According to disease severity,they were divided into mild group(112 cases),moderate group(62 cases)and severe group(32 cases).Results Among the 197 elderly patients,83(42.13％)had osteoporosis.The males had significantly higher bone mineral density of proximal femur and levels of bone alkaline phosphatase(BALP)and osteocalcin,and lower levels of serum type Ⅰ collagen(CICP)and C-terminal telopeptides of type Ⅰ collagen(CTXI)than the females(P＜0.01,P＜0.05).Compared with the patients with hemiplegia course for 3-6 months,bone mineral density values of greater trochanter and total hip,and levels of BALP and osteocalcin were obviously de-creased,while levels of CICP and CTXI were notably increased in those with the course of 7-12 months and 13-24 months(P＜0.05).Compared with the mild group,bone mineral density val-ues of greater trochanter and total hip,and levels of BALP and osteocalcin were significantly de-creased,while levels of CICP and CTXI were significantly increased in moderate group and severe group(P＜0.05).Compared with the moderate group,bone mineral density values of greater tro-chanter,intertrochanteric site and total hip were significantly decreased in the severe group(P＜0.05).The bone mineral density of above parts was negatively correlated with CICP levels(r=-0.458,r=-0.403,r=-0.355,r=-0.482,P＜0.01)and CTXI levels(r=-0.305,r=-0.291,r=-0.273,r=-0.384,P＜0.05,P＜0.01),while positively correlated with BGP level(r=0.476,r=0.428,r=0.386,r=0.518,P＜0.01).Conclusion The incidence of osteoporosis is quite higher in the elderly patients with post-stroke hemiplegia.There exist bone mineral density decline and abnormal bone metabolism,and their changes are related to gender,course and severi-ty of hemiplegia.
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Objective:To investigate the clinical application value of modified prescription of Bushen Huoxue Decoction combined with Zhengguling Capsule after surgical treatment of osteoporotic fracture. Methods:Eighty patients undergoing surgical treatment of osteoporotic fractures in Jiamusi Orthopedic Hospital from January 2019 to January 2021 were included in this study. They were randomly divided into a control group ( n = 40, receiving routine western medicine treatment) and a study group ( n = 40, receiving adjuvant treatment with modified prescription of Bushen Huoxue Decoction combined with Zhengguling Capsule based on routine western medicine treatment). All patients were treated for 6 consecutive months. The Fugl-Meyer Assessment scale score of motor function, traditional Chinese medicine symptom score, modified Barthel Index (MBI) score, bone mineral density T value at different treatment time points, clinical efficacy, and incidence of adverse reactions were compared between the two groups before and after treatment. Results:At 1, 2, 3 and 6 months of treatment, the T value of bone mineral density in the study group was significantly higher than that in the control group (all P < 0.001). At the end of treatment, the modified Barthel Index and the Fugl-Meyer Assessment scale score in the study group were (78.05 ± 4.26) points and (88.53 ± 2.35) points, which were significantly greater than (70.02 ± 6.58) points and (82.75 ± 2.44) points in the control group ( t = 6.49, 13.92, both P < 0.05). At the end of treatment, the symptom score in the study group was significantly lower than that in the control group ( P < 0.001). Total response rate in the study group was significantly higher than that in the control group [97.5% (39/40) vs. 80.0% (32/40), χ2 = 6.14, P < 0.05]. There was no significant difference in incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Modified prescription of Bushen Huoxue Decoction combined with Zhengguling Capsule can effectively improve motor ability and increase bone mineral density T value in patients after surgical treatment for osteoporotic fracture.
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Objective:To analyze the broadband ultrasound attenuation (BUA), speed of sound (SOS), standard deviation of bone density (T-Score) and stiffness index (SI) with bone mineral density (BMD) in elderly female patients with knee osteoarthritis and their diagnostic efficacy of osteoporosis.Methods:Fifty elderly female patients with knee osteoarthritis admitted o Tangshan People′s Hospital from January 2021 to January 2022 were selected as the observation group, and 40 healthy female patients during the same period were selected as the control group. The results of BUA, SI, T-score and SOS in observation group and control group were analyzed and compared. The BUA, SI, T-score and SOS in elderly women with knee osteoarthritis at different ages and with different bone densities were compared, and the diagnostic value of BUA, SI, T-score and SOS in osteoporosis was analyzed by receiver operating characteristic (ROC) curve.Results:The BUA, SI and T-score of observation group were lower than that in the control group, while SOS was higher than that in the control group (all P<0.05). Among elderly female patients with knee osteoarthritis of different ages, the older the age, the lower the BUA, SI and T-score (all P<0.05), while there was no statistical significance in SOS of elderly female patients with knee osteoarthritis of different ages ( P>0.05). In elderly women with knee osteoarthritis with different BMD grades, the BUA, SI, and T-score in the osteoporosis group were lower than those in the osteopenia group and the normal bone group, and the BUA, SI, and T-score in the osteopenia group were lower than those in the normal bone group; the SOS in the osteoporosis group was higher than those in the osteopenia group and the normal bone group, and the SOS in the osteopenia group was higher than those in the normal bone group (all P<0.05). BUA, SOS, T-score and SI had high sensitivity and specificity in the diagnosis of osteoporosis in elderly women with knee osteoarthritis (all P<0.05). Conclusions:BMD in elderly women with knee osteoarthritis is associated with BUA, SI, T-score, and SOS, and has high diagnostic value for osteoporosis.
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Objective:To evaluate the feasibility of using cortical bone trajectory (CBT) screws in the osteoporotic thoracolumbar fixation by comparing the bone CT values at the bone-screw interface between traditional trajectory (TT) screws and CBT screws in patients with different bone densities.Methods:The high-resolution CT imaging data of thoracolumbar segments following thoracic or lumbar spine fractures from April 2020 to October 2022 were collected at The Second Hospital Affiliated to Wenzhou Medical University for retrospective analysis. They were divided into 3 groups: a normal bone mass group, an osteopenia group and an osteoporosis group. From each group 30 cases were chosen (90 cases in total, 36 males and 54 females). All the data were imported into Mimics 18.0 for three-dimensional bone reconstruction in which placement of TT and CBT screws was simulated on the vertebrae from T10 to L2 (non-fractured vertebrae). Regions of interest (ROI) where each simulated screw intersected the bone were segmented to measure their CT bone values. For each vertebra in each group, the relative difference percentage in average CT value of ROI between TT and CBT screws was calculated. The CT values of ROI were compared in the same group between TT and CBT screws from T10 to L2; the CT values of ROI were compared in the same screws among the 3 groups from T10 to L2; the CT values of ROI were compared between the CBT screws in the osteopenia and osteoporosis groups and the TT screws in the normal bone mass group; the relative difference percentages in average CT value of ROI between CBT and TT screws were compared between the 3 groups from T10 to L2.Results:The average CT value of ROI for CBT screws was significantly higher than that for TT screws from T10 to L2 in every group ( P< 0.001); as for the CT values of ROI for CBT and TT screws from T10 to L2, the osteoporosis group<the osteopenia group<the normal bone mass group ( P<0.001); from T10 to L2, the CT value of ROI for CBT screws in the osteopenia group was significantly higher than that for TT screws in the normal bone mass group ( P<0.001); the CT value of ROI for CBT screws in the osteoporosis group was not significantly different from that for TT screws in the normal bone mass group ( P>0.05). At T10, T12, and L1, the relative difference percentage in average CT value of ROI between CBT and TT screws was significantly higher in the osteopenia and osteoporosis groups than that in the normal bone mass group ( P<0.05), but there was no such a difference between the osteopenia and the osteoporosis groups ( P>0.05). At T11 and L2, there was no significant difference between the 3 groups in the relative difference percentage in average CT value of ROI between CBT and TT screws ( P>0.05). Conclusions:As bone mass decreases, both CBT and TT screws lead to a significant decrease in the bone density at the bone-screw interface. In patients with osteoporosis, CBT screws can still lead to a higher bone density at the bone-screw interface than TT screws, thus providing a higher strength at the bone-screw interface.