Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

The Role of Vestibular Physiological Function in Adaptation to Special Gravity Environment / 医用生物力学

The peripheral vestibular organs are sensors for linear acceleration (gravity and head tilt) and rotation,and turn them into nerve signals that travel to the central nervous system to regulate physiological functions, which play an important role in regulating body stability, ocular movement, autonomic nerve activity, arterial pressure, body temperature, as well as muscle and bone metabolism. The effect of gravity on these functions can be attributed to high plasticity of the vestibular system. In this review, changes in vestibular-related physiological functions induced by the hypergravity and microgravity were introduced, including arterial pressure,muscle and bone metabolism, feeding behavior and body temperature, with the aim to better understand the physiological function of vestibular in adaption to special gravity environment.

Intravenous zoledronate for postmenopausal women with osteopenia and osteoporosis: a systematic review and metanalysis

ABSTRACT BACKGROUND: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures. OBJECTIVES: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis. DESIGN AND SETTINGS A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo. METHODS: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD). RESULTS: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24-0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25-0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80-3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91-1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women. CONCLUSION: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years. PROSPERO REGISTRATION NUMBER: CRD42022309708, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708.

Efeitos de probióticos e posbióticos na saúde óssea / Effects of probiotics and postbiotics in bone health

O envelhecimento da população tem sido acompanhado por um aumento significativo nas doenças crônicas, com destaque para a osteoporose. A busca por tratamentos alternativos tem levado ao estudo dos probióticos para prevenção e tratamento da perda óssea pós-menopáusica, com resultados encorajadores. Embora os benefícios dos probióticos sejam numerosos, eles são bactérias vivas e a administração de organismos vivos não é isenta de riscos. Os posbióticos são probióticos inativados ou seus produtos, e poucos são os estudos que avaliam seus efeitos ósseos. Nós revisamos a literatura sobre probióticos e posbióticos na saúde óssea e avaliamos os efeitos de Limosilactobacillus reuteri 6475 viável e inativado por calor em camundongos ovariectomizados. Mecanismos de ação semelhantes, como modulação da expressão de citocinas e ativação de sistemas de sinalização celular, são observados em probióticos e posbióticos, e os últimos têm vantagens como maior estabilidade e facilidade de incorporação em alimentos, embora seus efeitos a longo prazo, estabilidade e modo de ação ainda precisem ser estudados. Para que estas terapias sejam validadas clinicamente, é fundamental padronizar metodologias, aumentar o tamanho das amostras, realizar estudos randomizados e cegos, e definir detalhes como cepa, dose e duração do tratamento. Em um estudo in vivo, avaliamos os efeitos de L. reuteri (ATCC PTA 6475), e sua forma inativada (heat-killed) na perda óssea induzida por ovariectomia (ovx). Camundongos adultos, fêmeas, foram divididos aleatoriamente em quatro grupos: controle (sham); Ovx; Ovx + posbiótico; Ovx + probiótico. L. reuteri foi administrado aos grupos (109 UFC/dia) por gavagem. O tratamento se iniciou uma semana após a ovx e teve duração de 28 dias. Na análise por microscopia eletrônica de varredura, o probiótico manteve sua estrutura intacta, e no posbiótico foram observados alguns rompimentos na superfície celular. Foi avaliada a microarquitetura de fêmur, utilizando microtomografia computadorizada. Análise de expressão gênica em íleo foi feita para avaliar junções intercelulares intestinais e citocinas pró-inflamatórias, por meio dos marcadores Ocludina, Tnf-α e Il6. Os dados foram submetidos ao teste estatístico mais conveniente (α = 0,05). Os grupos Ovx apresentaram menor porcentagem de volume ósseo (BV/TV), menor número de trabéculas ósseas e maior porosidade total, em comparação ao grupo controle, porém os grupos que receberam L. reuteri apresentaram maior BV/TV quando comparados ao grupo Ovx. O tratamento com L. reuteri em suas duas formas levou à maior espessura trabecular, quando comparados ao controle e ao grupo Ovx. Todos apresentaram semelhança na expressão gênica da Ocludina, Tnf-α e Il-6 em intestino. Ambas as formas, viável e inativada por calor, preveniram a perda óssea induzida por depleção de estrógeno (AU)

The aging of the population has been accompanied by a significant increase in chronic diseases, with osteoporosis standing out. The search for alternative treatments has led to the study of probiotics for the prevention and treatment of postmenopausal bone loss, with encouraging results. Although the benefits of probiotics are numerous, they are live bacteria, and the administration of live organisms is not risk-free. Postbiotics are inactivated probiotics or their products, and few studies have evaluated their bone effects. We reviewed the literature on probiotics and postbiotics in bone health and assessed the effects of both viable and heat-killed Limosilactobacillus reuteri 6475 in ovariectomized mice. Similar mechanisms of action, such as the modulation of cytokine expression and activation of cellular signaling pathways, are observed in probiotics and postbiotics, and the latter have advantages such as greater stability and ease of incorporation into food, although their long-term effects, stability, and mode of action still need to be studied. To clinically validate these therapies, it is crucial to standardize methodologies, increase sample sizes, conduct randomized and blinded studies, and define details such as strain, dosage, and treatment duration. In an in vivo study, we evaluated the effects of L. reuteri (ATCC PTA 6475) and its heat-killed form on ovariectomy (ovx)-induced bone loss. Adult female mice were randomly divided into four groups: control (sham); OVX; OVX + postbiotic; OVX + probiotic. L. reuteri was administered to the groups (109 CFU/day) by gavage. Treatment began one week after ovx and lasted for 28 days. Scanning electron microscopy analysis showed that the probiotic maintained its intact structure, while some cell surface disruptions were observed in the postbiotic. Femur microarchitecture was evaluated using computerized microtomography. Gene expression analysis in the ileum was performed to assess intestinal intercellular junctions and pro-inflammatory cytokines, using markers Ocludin, Tnf-α, and Il-6. The data were subjected to the most appropriate statistical test (α = 0.05). The Ovx groups showed a lower percentage of bone volume (BV/TV), a lower number of trabecular bones, and greater total porosity compared to the control group. However, the groups that received L. reuteri showed higher BV/TV compared to the Ovx group. Treatment with both forms of L. reuteri led to greater trabecular thickness compared to the control and Ovx groups. All groups exhibited similarity in the gene expression of Ocludin, Tnf-α, and Il-6 in the intestine. Both viable and heatkilled forms prevented estrogen depletion-induced bone loss (AU)

Correlation between serum non-high density lipoprotein cholesterol and bone mass levels in different body parts in physical examination population / 中华健康管理学杂志

Objective:To compare the relationship between non-high-density lipoprotein cholesterol (non-HDL-C) and bone mass in different body parts in the physical examination population.Methods:It was a cross-sectional study. The data of 595 physical examiners who visited the Institute of Health Management, PLA General Hospital from June to September 2016 were retrospectively analyzed. The bone mass levels of lumbar 1-4 vertebral body (spine) and femur, average bone density were measured by double light energy X-ray bone density instrument. The basic information and biochemical indices of the physical examiners were collected. The difference between blood lipid components (including Non-HDL-C) and bone mass level of each body part were analyzed.Results:According to blood lipid stratification, there were significant differences in spine T value (T-spine) between triglyceride (TG) groups (-0.15±1.41 vs -0.38±1.3), Non-HDL-C groups (-1.01±0.74 vs -1.21±0.59, -1.04±0.73 vs -1.30±0.45,-1.07±0.71 vs -1.30±0.26) and low-density lipoprotein cholesterol (LDL-C) groups (-1.01±0.71 vs -1.32±0.56)(all P<0.05). There was no statistically significant difference in other lipid groups and femoral T values in each component′s blood lipids. The T-spine decreased significantly in the LDL-C≥3.4 mmol/L group, and the differences were all significant among the Non-HDL-C group (all P<0.05). In binary logistic regression analysis, LDL-C≥3.4 mmol/L ( OR=3.961,95% CI:1.310-11.974) and Non-HDL-C>4.1 mmol/L ( OR=3.600,95% CI:1.035-12.524) were risk factors for vertebral bone mass loss (both P<0.05). Conclusion:People with elevated serum TG, Non-HDL-C and LDL-C in the physical examination population are prone to bone abnormalities. Non-HDL-C≥4.1 mmol/L and LDL-C≥3.4 mmol/L are more closely related to the vertebral bone mass loss and are the risk factors for vertebral bone mass loss.

Bone Mineral Density in an Urban Hospital in Dhaka City of Bangladesh

Background: Osteoporosis behaves as a silent killer. Therefore, a high percentage of the affected people are not aware they have this chronic condition. In this way, the burden of osteoporosis is the burden of its clinical outcome: osteoporotic fractures, which are generally characterized by low-trauma fractures resulting from low bone mineral density (BMD). Objectives: The present study aimed to assess BMD distribution among urban and rural subjects and its relationship with key foods.Material & Methods:In this study, a total of 140 subjects were studied from the study BMD lab of the study hospital. Data were analyzed using Mean, SD, % and correlation by SPSS 24.Results:Mean盨D value of age (yr), BMI, WHR, Lumber-T score, Lumber-BMD, Right Femur -T score, Right Femur-BMD, Left Femur-T score, Left Femur-BMD, Supplementation of the study participants were 54�, 25� 1.0�25, -1.0�0, 1.0�2, -1� 1�2, -1� 1�15.Age (yrs), BMI, waist (cm), hip (cm), WHR, Lumber T-score, Lumber Z-score, Lumber BMD (g/cm�), Rt. Fem Neck T-score,Rt. Fem Neck Z-score, Rt. Fem Neck BMD (g/cm�), Lt. Fem Neck T-score,Lt. Fem Neck Z-score, Lt. Fem Neck BMD (g/cm�) of the urban study participants were 51�, 30� 88�, 95�, 1�, -1.6�6, -1�6, 0.9�2, -0.9�3, -0.2�9, 0.9�2, -1�2, -0.3� 0.8�1 respectively and for rural participants the values were 54�, 25�5, 86� 92�, 1�2, -2.4�5, 0.8�2, -1.5�3, -0.6� 0.7�2, -1.6�2, -0.7�and 0.8�respectively. About 48.18% rural subjects had osteoporosis, 34.54% had osteopenia and 17.27% had normal bone health. Again, 28.57% of the urban subjects had osteoporosis, 41.40% had osteopenia and 30% had normal bone density. Fish, egg and meat were associated with BMD. Fish intake had a positive association with lumber T score (r=0.194, p=0.009), LumZ (r=0.016, p=0.031), Lumber BMD (r=0.183, p=0.014). Milk intake has positive association with Lumber t and Lumber BMD (p=0.027, 0.049). Similarly, egg intake has positive association with Lumber BMD, Rt BMD, Lt BMD (p= 0.035, 0.01, 0.019).Conclusions:Nearly 48.18% rural subjects have osteoporosis, 34.54% have osteopenia and 17.27% have normal bone health. Again, 28.57% urban subjects have osteoporosis, 41.40% have osteopenia and 30% have normal bone density. The prevalence of osteoporosis is higher in rural area than urban peopleand osteopenia is higher in urban area than rural area. Fish, milk and egg consumption positivelyassociated with BMD.

Noninvasive screening of osteoporosis using bio-impedance and quantitative ultrasound

Bone mineral loss is a serious health issue all over the globe resulting in osteoporosis, without showing any pre-indication of its occurrence. Dual Energy X-ray Absorptiometry test is a widely accepted method for its diagnosis which gives areal information about the bone mineral. Other methods like Quantitative Computed Tomography (QCT) and Peripheral QCT give volumetric information. Application of these methods for mass screening is not recommended due to the use of ionizing radiations. Few non-ionizing methods, namely Bioelectric Impedance Analysis and Quantitative Ultrasound, have evolved in the past few decades. Bioelectric Impedance Analysis, a non-invasive and low-cost tool, has been immensely recognized for its promising use in estimating body composition and body fluids. Similarly, Quantitative Ultrasound is another non-invasive technique for determining bone density at fixed locations, making noninvasive assessment much faster, easier to use, and portable. A multi-parametric approach combining these two modalities has yielded higher efficiency for the detection of bone mineral loss. These developments are briefly reviewed in this paper.

Prevention and treatment of parathyroid hyperfunction or hyperparathyroidism associated osteoporosis / 中华内分泌外科杂志

Osteoporosis (OP) is a common systemic bone disease which has become a serious public health problem in China. In clinical practice, we found that some primary osteoporosis may be due to parathyroid hyperfunction (subclinical hyperparathyroidism) or hyperparathyroidism which is the result of negative calcium balance and hypocalcemia caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency, which is preventable and controllable. Therefore, we call this kind of osteoporosis parathyroid hyperfunction or hyperparathyroidism associated osteoporosis. The daily calcium intake of Chinese people is generally insufficient, and vitamin D deficiency/insufficiency is also a worldwide public health problem. Parathyroid hyperfunction or hyperparathyroidism associated osteopenia and osteoporosis which are results of hypocalcemia and negative calcium balance caused by long-term insufficient calcium intake and/or vitamin D deficiency/insufficiency exist extensively in clinical practice. Its prevention and treatment can effectively prevent and treat osteopenia and osteoporosis, so as to effectively prevent and treat diseases such as short stature, rachiokyphosis, backache, fatigue, bone pain, fracture, metastatic vascular calcification and systemic calcinosis, improve people’s health and help achieve the goal of "Healthy China 2030" .

Prevalencia de bajos niveles de vitamina D en pacientes con osteopenia y osteoporosis. Popayán, Colombia / Prevalence of low levels of Vitamin D in patients with osteopenia and osteoporosis. Popayán, Colombia

Resumen Introducción: Actualmente la vitamina D ha ganado importancia, por ser considerada una hormona y porque sus bajos niveles están asociados con diferentes patologías, especialmente alteraciones de la masa ósea. Objetivo: Determinar la prevalencia de bajos niveles de vitamina D en pacientes adultos con osteopenia y osteoporosis, atendidos en consulta externa de endocrinología en Popayán Cauca. Materiales y métodos: Estudio descriptivo y retrospectivo que incluyó pacientes con diagnóstico de osteopenia y osteoporosis realizado por densitometría ósea entre los años 2013 y 2016, que tenían reporte de niveles de vitamina D obtenidos por cualquier método. Se describieron características sociodemográficas, resultados de densitometría ósea, niveles vitamina D, hormona paratiroidea y calcio iónico. Resultados: Se incluyeron 300 pacientes con diagnóstico de osteopenia y osteoporosis de los cuales 211 tenían bajos niveles de vitamina D, para una prevalencia del 71,3%, el nivel promedio de 25 hidroxivitamina D fue de 24,35ng/ml. Conclusiones: La alta prevalencia de bajos niveles de vitamina D en pacientes con osteopenia y osteoporosis hace indispensable la medición de 25 hidroxivitamina D en esta población, esto con el fin de realizar una intervención terapéutica apropiada.

Abstract Introduction: Vitamin D has gained interest because it is a hormone whose low levels are associated with different pathologies such as bone mass disorders. Objective: To determine the prevalence of low levels of vitamin D in adult patients with osteopenia and osteoporosis who received care at an outpatient endocrinology clinic in Popayan, Cauca. Materials and methods: A retrospective and descriptive study that included patients diagnosed with osteopenia and osteoporosis through bone densitometry between 2013 and 2016, who also had their vitamin D levels measured by means of any laboratory method. Sociodemographic characteristics, bone densitometry results as well as vitamin D, parathormone and ionic calcium levels were described. Results: A total of 300 patients with osteopenia and osteoporosis were included in the study, of which 211 had low levels of vitamin D, representing a prevalence of 71.3%. Finally, the average level of 25-hydroxyvitamin D was 24.35 ng/ml. Conclusion: The high prevalence of low levels of vitamin D in patients with osteopenia and osteoporosis highlights the importance to measure 25-hydroxyvitamin D levels in this population in order to carry out an appropriate therapeutic intervention.

Chronic osteo-articular changes in patients with sickle cell disease

Abstract Background: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. Methods: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. Results: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. Conclusions: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.(AU)

Expert consensus on clinical management of metabolic bone disease of prematurity (2021) / 中国当代儿科杂志

Metabolic bone disease of prematurity (MBDP) is a systemic bone disease with a reduction in bone mineral content due to disorder of calcium and phosphorus metabolism. There is still a lack of in-depth research and systematic understanding of MBDP in China, and there are many irregularities in clinical management of this disease. Based on relevant studies in China and overseas, Grading of Recommendations Assessment, Development and Evaluation was used to develop the expert consensus on the clinical management of MBDP, which provides recommendations from the following five aspects: high-risk factors, screening/diagnosis, prevention, treatment, and post-discharge follow-up of MBDP, so as to provide relevant practitioners with recommendations on the clinical management of MBDP to reduce the incidence rate of MBDP and improve its short- and long-term prognosis.

Mechanical Bone Strength in Immobilized Osteopenia：An In Vivo Study / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to evaluate the mechanical strength of immobilized osteopenia using a fixed limb rat model.Methods：Eight-week-old specific-pathogen-free male Wistar rats were divided into two groups, a control group (n＝32) and an immobilized group (n＝32). The hind limbs of the immobilized group were fixed using an orthopedic cast, and the fixation periods were set for 1, 4, 8, and 12 weeks. Feeding and weight-bearing were permitted. After each fixation period, the length of the right femoral bone was measured, and three-point bending at the midshaft and uniaxial compression test at the distal metaphysis were performed with a universal material testing apparatus. The maximum force and breaking force in the bending test and ultimate load in the compression test were statistically analyzed.Results：The values of the maximum force and breaking force in the immobilized group were significantly lower than those in the control group at 4, 8, and 12 weeks (p＜0.05). The ultimate load of the distal metaphysis in the immobilized group decreased from 1 week after fixation, and the gap with the control group widened as the fixation period extended.Conclusion：The results of this study indicate that bone weakness caused by immobilized osteopenia arises after 1 week in the metaphysis and after 4 weeks in the midshaft.

Mechanical Bone Strength in Immobilized Osteopenia：An In Vivo Study / The Japanese Journal of Rehabilitation Medicine

Objective：This study aimed to evaluate the mechanical strength of immobilized osteopenia using a fixed limb rat model.Methods：Eight-week-old specific-pathogen-free male Wistar rats were divided into two groups, a control group (n＝32) and an immobilized group (n＝32). The hind limbs of the immobilized group were fixed using an orthopedic cast, and the fixation periods were set for 1, 4, 8, and 12 weeks. Feeding and weight-bearing were permitted. After each fixation period, the length of the right femoral bone was measured, and three-point bending at the midshaft and uniaxial compression test at the distal metaphysis were performed with a universal material testing apparatus. The maximum force and breaking force in the bending test and ultimate load in the compression test were statistically analyzed.Results：The values of the maximum force and breaking force in the immobilized group were significantly lower than those in the control group at 4, 8, and 12 weeks (p＜0.05). The ultimate load of the distal metaphysis in the immobilized group decreased from 1 week after fixation, and the gap with the control group widened as the fixation period extended.Conclusion：The results of this study indicate that bone weakness caused by immobilized osteopenia arises after 1 week in the metaphysis and after 4 weeks in the midshaft.

Osteopenia and osteoporosis among treatment-experienced people living with HIV

Abstract Introduction Life expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system. Objectives Estimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors. Methods A cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age≥18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration. Results Among 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37-35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94-7.37). Conclusions This study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.

A study on patients with coronary artery disease with special reference to bone mineral density

Background: Osteoporosis and Coronary artery disease are known to share common risk factors, like inflammation, but a direct relationship between the two has not been established. Some of the previous studies showed low BMD (osteoporosis and/orosteopenia) as an independent predictive factor for coronary artery disease in ambulatory patients. However, some reports have failed to demonstrate a direct relationship between low bone mineral density (BMD) and CAD or cardiovascular risk factors. This study was carried out to estimate bone mineral density (BMD) in patients with coronary artery disease (CAD) and also to evaluate the association between bone mineral density and coronary artery disease.Methods: Hospital based prospective observational study, involving 96 consecutive patients who were referred for coronary angiography for the evaluation of established or suspected CAD and also patients who had acute coronary syndrome (ACS) are enrolled in this study. BMD was determined for the lumbar spine (L2-L4) and femoral neck using DXA scan.Results: The total number of subjects was 96. Out of 96, 24 (25%) patients were females and remaining 72 (75%) were males. Coronary angiography was carried out in all patients. 42 patients from the total had coronary angiography proven single vessel disease (SVD), 33 patients had double vessel disease (DVD) and 21 patients had triple vessel disease (TVD). DXA scan was carried out in all patients. T- score of neck of femur region and lumbar spine was calculated. Neither the presence of significant coronary stenoses ≥50% in two or more coronary vessels nor the prevalence of severe coronary stenoses ≥70% differed significantly between patients with normal bone density, osteopenia, or osteoporosis (p<0.05, respectively).Conclusions: The result of this study suggests that in patients undergoing coronary angiography for the evaluation of CAD, the prevalence of low BMD is high; however, there is no statistically significant relationship between osteoporosis, osteopenia and coronary artery disease state.

Association of vitamin D deficiency and bone mass with liver and heart iron overload in transfusion dependent thalassemia

Background: Transfusion dependent thalassemia patients are reported to have Vitamin D insufficiency/deficiency in many countries. Vitamin D hydroxylation occurs in the liver; whether liver iron overload interferes with this step has not been addressed till date. This study helps to establish an association between liver iron concentration (LIC) and heart iron concentration (MIC) with vitamin D levels and Bone Mass Density in these patients.Methods: A cross sectional study was done by including transfusion dependent Thalassemia patients (TM) if they had an assessment of Liver and cardiac iron done by T2*MRI and bone mineral density by DEXA. Clinical data regarding age, gender, type of iron chelation therapy and laboratory data of S. ferritin and Vitamin D was collected. Data was assessed using appropriate statistical methods.Results: Among 40 TM patients were taken and mean age was 17.6 years. Vitamin D deficiency was identified in 26(65%). 20 out of them had an LIC>7mg/g DW and 6 had MIC>1.65mg/g DW. There was a significant association between LIC>7mg/g and vitamin D level<20 ng/ml and a significant inverse correlation between LIC and vitamin D, suggesting that liver iron overload may indeed affect vitamin D metabolism. Osteopenia was present in 32.5% and osteoporosis was present in 27.5 % of all TM patients. Reduced Bone Mass Density was also found to be linked with iron over load.Conclusions: Regular monitoring of vitamin D levels and supplementation is required in patients with severe liver and heart iron load. More studies are needed to confirm these results.

¿A qué pregunta responde "el hueso"?: una cuestión de direccionalidad estructural y organización biológica (hueso y huesos, del big-bang a la osteoporosis) / To which question is 'bone' the answer?: a matter of structural directionality and biological organization (bone and bones, from the big bang to osteoporosis)

La "razón de ser" de nuestros huesos y esqueletos constituye un dilema centralizado en los conceptos biológicos de "estructura" y "organización", cuya solución necesitamos comprender para interpretar, diagnosticar, tratar y monitorear correctamente las osteopatías fragilizantes. Últimamente se ha reunido conocimiento suficiente para proponer aproximaciones razonables a ese objetivo. La que exponemos aquí requiere la aplicación de no menos de 6 criterios congruentes: 1) Un criterio cosmológico, que propone un origen común para todas las cosas; 2) Un criterio biológico, que explica el origen común de todos los huesos; 3) Un enfoque epistemológico, que desafía nuestra capacidad de comprensión del concepto concreto de estructura y del concepto abstracto de organización, focalizada en la noción rectora de direccionalidad espacial; 4) Una visión ecológica, que destaca la importancia del entorno mecánico de cada organismo para la adecuación de la calidad mecánica de sus huesos a las "funciones de sostén" que les adjudicamos; 5) Una correlación entre todo ese conocimiento y el necesario para optimizar nuestra aptitud para resolver los problemas clínicos implicados y 6) Una jerarquización del papel celular en el manejo de las interacciones genético-ambientales necesario para asimilar todo el problema a una simple cuestión de organización direccional de la estructura de cada hueso. Solo aplicando estos 6 criterios estaríamos en condiciones de responder a la incógnita planteada por el título. La conclusión de esta interpretación de la conducta y función de los huesos debería afectar el fundamento de la mayoría de las indicaciones farmacológicas destinadas al tratamiento de la fragilidad ósea. (AU)

The nature of the general behavior of our bones as weight-bearing structures is a matter of two biological concepts, namely, structure and organization, which are relevant to properly interpret, diagnose, treat, and monitor all boneweakening diseases. Different approaches can be proposed to trace the corresponding relationships. The one we present here involves six congruent criteria, namely, 1) a cosmological proposal of a common origin for everything; 2) a biological acknowledgement of a common origin for all bones; 3) the epistemological questioning of our understanding of the concrete concept of structure and the abstract notion of organization, focused on the lead idea of directionality; 4) the ecological insight that emphasizes the relevance of the mechanical environment of every organism to the naturally-selected adjustment of the mechanical properties of their mobile bones to act as struts or levers; 5) The clinical aspects of all the alluded associations; 6) The central role of bone cells to control the genetics/ environment interactions of any individual as needed to optimize the directionality of the structure of each of his/her bones to keep their mechanical ability within physiological limits. From our point of view, we could only solve the riddle posed by the title by addressing all of these six criteria. The striking conclusion of our analysis suggests that the structure (not the mass) of every bone would be controlled not only to take care of its mechanical ability, but also to cope with other properties which show a higher priority concerning natural selection. The matter would be that this interpretation of bone behavior and 'function' should affect the rationales for most pharmacological indications currently made to take care of bone fragility. (AU)

Modelo de indução de osteoporose em coelhas - avaliação radiográfica / Rabbit osteoporosis induction model - radiographic evaluation

In order to establish a bone loss induction model in rabbits to study osteoporosis, 18 rabbits underwent ovariectomy and received methylprednisolone 1mg/kg intramuscularly on alternate days for two weeks. Immediately before ovariectomy up to 42 days after methylprednisolone administration, radiographs of the right olecranon were taken in the mediolateral position to evaluate the radiographic optical density. Before the induction of osteoporosis, rabbits presented mean values of radiographic density of 2.305mm Al and at 42 days of 1.575mm Al. The values obtained were submitted to ANOVA for repeated measures that revealed a significant drop (P< 0.001) in the density over time, proving that the induction was able to trigger bone loss of these animals. With this, it can be affirmed that the adopted protocol was enough to provoke a significant bone loss, characterizing a valid model for the study of new treatments for osteoporosis.(AU)

Study on the Prevalence of Osteoporosis and the Association between the Serum Calcium Levels and the Bone Mineral Density Levels in Postmenopausal Women

Introduction: The prevalence of postmenopausal osteoporosisis increasing day by day in post-menopausal women dueto hormonal imbalance, deficiency or malabsorption ofcalcium which reduces bone mineral density. The presentstudy was aimed to find out the prevalence of osteoporosisin postmenopausal women and the association between theserum calcium levels and the bone mineral density levels.Material and methods: It was a cross sectional studycomprising of 60 post-menopausal women in a range of45 to 58 years. The serum calcium levels were measuredusing COBAS INTEGRA automatic analyzer and the bonemineral density was measured by using Dual energy x – rayabsorptiometry (DEXA). The WHO criteria for osteoporosisusing T score were considered to classify the post-menopausalwomen.Results: The incidence of the bone mineral density changesin post-menopausal women was reported as 1.6% was normal,21.6% were in the stage of osteopenia and 76.66% were inthe stage of osteoporosis. The mean bone mineral density wasobserved as -2.75 ± 1.09. The mean serum calcium levels inpostmenopausal women were reported as 8.47 ± 1.13mg/dl.Weak positive correlation was observed with R value as 0.042,but statistically not significant association was observed.Conclusion: The prevalence of osteoporosis is very high inthe post-menopausal women. The correlation between theserum calcium and the bone mineral density was observed tobe positive but not statistically significant.

Linking of psoriasis with osteopenia and osteoporosis: A cross-sectional study

Background/Purpose: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. Methods: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. Results: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. Limitations: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. Conclusions: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.