Densidad mineral ósea y composición corporal en mujeres transgénero previamente al tratamiento hormonal cruzado: ¿hay diferencias con hombres cisgénero? / Bone mineral density and body composition in transgender females prior to cross-sex hormone treatment: is there any difference with cisgender males?

Se denomina transgénero mujer (TM) a un varón biológico con identidad de género femenina. El tratamiento hormonal cruzado (THC) es una de las opciones para lograr caracteres sexuales del género autopercibido. Realizamos un estudio de diseño transversal, observacional y analítico para evaluar la densidad mineral ósea, composición corporal y fuerza muscular antes de iniciar la hormonización. Un total de 26 TM en condiciones de ingresar en el estudio fueron comparadas con hombres cisgénero de similar edad (mediana 23,5 vs. 25,5 años). Basalmente, las TM presentaron menor densidad ósea en columna lumbar (1,040 vs. 1,280 g/cm2; p=0,01), cadera total (0,970 vs. 1,070 g/cm2; p=0,01) y cuerpo entero (1,080 vs. 1,220 g/cm2; p<0,01). Observamos, además, menor masa muscular en brazos (5,033 vs. 6,212 kg; p<0,01) y piernas (16,343 vs. 18,404 kg; p=0,02), acompañada de menor fuerza muscular de puño (p<0,01). Concluimos que las TM presentaron características diferentes de la biología masculina aun sin haber iniciado el THC. Sugerimos incluir la evaluación de la densidad mineral ósea en la evaluación inicial de esta población, dados los hallazgos identificados. (AU)

A trans-woman (TW) is a biologically male person with female gender identity. Cisgender denotes a person whose sense of personal identity and gender corresponds with its birth sex. Cross-sex hormone therapy (CSHT) is one of the options to achieve secondary characteristics of the self-perceived gender. We performed a cross-sectional study. Bone mineral density (BMD), body composition, and muscle strength before starting CSHT were assessed. Twenty-six TW (median age 23.5 years) and cisgender males (median age 25.5 years) were matched for age. TW had less BMD at the lumbar spine (1.040 vs 1.280 g/cm2; p=0.01), total hip (0.970 vs 1.070 g/cm2; p=0.01), and total body (1.080 vs 1.220 g/cm2; p<0.01). They also had less skeletal muscle mass in the arms (5.033 vs 6.212 kg; p<0.01) and legs (16.343 vs 18.404 kg; p=0.02), associated with lower grip strength (p<0.01). It appears that bone and muscle characteristics of TW before starting CSHT differ from cisgender men. Taking these findings into account, we suggest the inclusion of BMD in the initial evaluation of TW. (AU)

Risk factors and magnitude of osteoporosis among attendants at Banha university hospital

This work was conducted among three hundred and twenty attendants of the outpatient clinics in Banha University Hospital, with ages >/= 40 years, they were selected by systematic random sampling to clarify the magnitude of osteoporosis and its associated risk factors. Anthropometric measurements were done for each subject including. weight, height and BMI [Wt [Kg] / ht [m[2]]]. Also, bone density was measured using the densitometry, Dual energy X-ray absorptiometry [DEXA] scan for spines, hip and forearm at wrist joint was done for each subject. This research revealed that the prevalence of osteoporosis was 69.4% among the attendants and it increased significantly with increasing age [p<0,001]. Osteoporosis was significantly more prevalent among females [81.2%] than males [45.8%] [p<0.001]. Also, it was more encountered among subjects with low-weight [<60 Kg], height [>170cm] and low BMI [<25 Kg/m[2]]. The results illustrated that the significant life style and dietary risk factors of osteoporosis were: sedentary life, smoking, excessive tea and coffee intake and low milk consumption. Hypertension rheumatoid arthritis, calcium and vitamin D deficiency and using corticosteroids were the medical risk factors associated significantly with osteoporosis [p<0.001]. Late menarche, postmenopausal >/= 5 years and never using hormonal contraceptive or replacement therapy were the significant evident reproductive risk factors among females in this study. There is an association between the prevalence of osteoporosis and sedentary life style, dietary risk factors, medical risk factors and reproductive risk factors. Integrated health education programs with primary health care activities were recommended to increase awareness of adults about the major risk factors of osteoporosis and its important preventive measures

Assessment of balance in osteoporotic postmenopausal women: effect of spinal proprioceptive extension program

To assess the balance in osteoporotic patients with kyphosis and the effect of intervention with a spinal proprioceptive extension exercise on the risk of fall in these patients. This study included 20 postmenopausal osteoporotic women with kyphosis and ten controls. Patients had to be physically active, and older than 60 years. Clinical assessment was performed by physical activity score fall efficacy scale and pain scale. Balance assessment was done by computerized dynamic posturography [CDP]. Each patient underwent a program of back extension exercise using one kg of weight suspended between T10 to L4 through fitted harness. Patients were instructed to use this harness two hours twice daily for 4 weeks. Then they were reassessed clinically and by CDP. There was a significantly decreased balance score in osteoporotic kyphotic women compared to controls. There was a significant inverse correlation between balance score and the fall efficacy scale [r=-0.53] and positive correlation between balance score and the physical activity score [r=0.55]. In clinical reassessment, patients showed a significant increase in the physical activity score [5.55 +/- 0.75] compared to pre-intervention values [4.4 +/- 0.68]. Also they had a significant decrease in the fall efficacy scale and pain scale compared to their baseline data. In balance reassessment, patients showed a significant increase in the balance score [75.5 +/- 8.50] compared to their baseline data [63.7 +/- 9.72] [p<0.001]] Osteoporotic postmenopausal women with kyphosis had significantly greater balance abnormalities which plays an important role in increasing their risk of falls. This study suggests that proprioceptive back extension exercise could reduce the risk of fall and improve the pain and physical activity in these patients

Tumor necrosis factor-alpha and tumor necrosis factor receptor-1 in postmenopausal osteoporosis: relation to serum estradiol

To measure serum levels of TNF-alpha and TNFR-1 in women with postmenopausal osteoporosis and correlate them with serum level of estradiol. This study was conducted on 26 postmenopausal females. They were divided according to their BMD into two groups. Group [I] consisted of 16 patients with osteoporosis [T score < -2.5] and group [II] consisted of 10 patients with osteopenia [T score -1 to -2.5]. Ten healthy postmenopausal women with normal range of BMD [T score >-1] served as control group. The serum levels of TNF-alpha TNFR-1 were measured with ELISA and serum estradiol was determined with electrochemiluminescence immunoassay [ECLIA]. Bone mineral density was measured with dual-energy x-ray absorptiometry. Serum estradiol level was significantly lower in both osteoporotic [7.88 +/- 3.14pg/ml] and osteopenic patients [8.54 +/- 3.99 pg/ml] as compared to controls [13.62 +/- 4.57 pg/ml]. Serum level of TNF-alpha and TNFR-1 were insignificantly highest among osteoporotic patients as compared to osteopenic patients and controls. There was no significant correlation between estradiol and TNF-alpha or TNFR-1 [r=0.12, p>0.05 and r=0.07, p>0.05] respectively. A significant negative correlation was found between femoral BMD of patients and serum TNF-alpha [r=-0.43, p<0.05] and TNFR-1 [r=-0.47, p<0.05]. TNF-alpha also showed significant positive correlation with weight [r= 0.41, p<0.05] as well as the BMI [r=0.44, p<0.05]. TNF-alpha has a role in the pathogenesis of postmenopausal osteoporosis, which seems to be independent of estradiol and may thus be a novel target for therapy in resistant cases of postmenopausal osteoporosis

[Renal transplantation in children with cystinosis]

Cystinosis is an inherited metabolic disease in which transfer of cystine out of lysosome is impaired. This phenomenon leads to accumulation of cystine in different organs and causes organ dysfunction. Growth retardation is seen in these patients and later they go on to develop renal failure needing dialysis or renal transplantation. The aim of this study was to evaluate the outcome and complications of renal transplantation in patients with cystinosis. In this case series study in years 1996-2006 all patients with renal failure due to cystinosis who received renal transplantation, were followed for 43 +/- 1/1 months, Before operation, all patients were examined to determine if they are appropriate candidate for renal transplantation and after operation DPTA scan was performed to evaluate graft function and in later follow up necessary lab tests were done. All patients received triple immunosuppressive therapy including cyclosporine, prednisolone and Mycophenolate Mofetil. In the presence of rejection symptoms such as fever and a rise in creatinine, graft rejection was confirmed by DPTA scan and sonography of transplanted kidney. Patient survival was 100% and 4 years graft survival was 86.7%. Mean creatinine level before operation was 5.44 +/- 2.58 and post operation was 0.86 +/- 1.03 and at the last follow-up was 1.51 +/- 1.45 mg/dl, mean GFR at the last follow-up was 54.1 +/- 31.2 ml/min/1.73m2. Six [40%] patients were on dialysis before operation, 5 [33%] had acute rejection and 5 [33%] suffered from UTI after the operation. Growth retardation was seen in all of patients. Thirteen patients [86%] were affected by CMV infection and 6 [40%] by CMV disease; that were treated successfully by Ganciclovir for 2 weeks. One patient was affected by vessel thrombosis in post operation period and one patient had graft loss due to kink of vessel after operation. Renal transplantation in patients with cystinosis has favorable outcome. It is the treatment of choice for patients with cystinosis and End Stage Renal Failure [ESRF]

Bone mineral density value dependence on bone width

Dual x-ray absorptiometry [DXA] is the most widely used measurement for the assessment of bone mass in osteoporosis. In clinical measurement, bone width can affect bone mineral parameters. The purpose of this study was to examine the dependence of bone mineral parameters on bone width. In this study, DXA measurements were conducted on rabbit bone in vivo using clinical instruments. We have selected rabbit's bones that have low BMD and more collagen tissue to predict structure not only measures BMD, but is also sensitive to the structure of the bone. To investigate the effect of bone width on the measured parameters, three regions of femur and tibia bones [N = 132] were processed: upper [1/3 of length], middle [1/2 of length] and lower [2/3 of length] for BMC, areal BMD and volumetric BMD. The ANOVA analysis of bone mineral extracted by DXA showed significant differences [P < 0.05] between BMC, BMD[a] and BMD[V] of six groups of upper, middle and lower parts of the femur and the tibia. It shows that BMC and BMD correlate well with the bone width, but BMDV inversely correlates with bone width. Linear and nonlinear regression analyses were used to examine the relationship between DXA characteristics with bone width and the regression function for each parameter is given. We concluded that BMC, areal BMD, and volumetric BMD in rabbit's bone with collagen fibers more than bone mineral are dependent on bone width. This result may be at least in part due to large precision error measurement of the bone width, in vivo

Modified OSTA index for referring women for DEXA measurement.

A retrospective study of 696 postmenopausal women with hip measurement by Dual-energy X-ray absorptionmetry (DEXA) from Sapphasittprasong Hospital, Ubon Rahatani and Srinagarind Hospital, Khon Kaen University. All variables: T-score, age and weight were collected and calculated by the original OSTA index and modified OSTA index. Thai osteoporosis foundation recognized Original OSTA index the cut point below or equal 4 as high risk of osteoporosis. The authors used the modified OSTA index for calculation without truncate, the authors found that the cut off point was <-3.5 making 79% sensitivity and 58.7% specificity while the original OSTA gave 73%, 62% respectively. The authors proposed modified OSTA index as a making-decision tool before sending the patient for bone mass measurement. That saves the expense of further investigation.

cut-off point of dual energy X ray and laser [DXL] of calcaneus osteoporosis diagnosis in postmenopausal women

Dual X-Ray energy Absorptiometry [DXA] is a method that can be used extensively for bone mineral densitometry [BMD]. A newer method is called DXL, associates dual X ray absorptiometry assisted by laserX-ray absorptiometry to the measures of heel thickness with a laser beam. In this study the cut off points for DXL of calcaneus in the diagnosis of osteoporosis in different bone regions in postmenopausal women were determined. In 268 postmenopausal women, BMD of the spinal and femoral regions was measured by DXA and the value for the heel calcaneous was measured by DXL. The agreement of the two methods in diagnosis of osteoporosis and optimal cut-off point for DXL in defining osteoporosis was obtained. DXA showed osteoporosis in 40.7% of cases with 35.2% in L2-L4, 16.2% in the femoral neck, and 11.7% for the femoral total region. The DXL found osteoporosis, considering -2.5 SD as a threshold, in 26.1% of cases. According to WHO criteria, agreementAgreement of the two methods in the diagnosis of osteoporosis [Kappa score] was 0.443 for the lumbar region, 0.464 for the neck, and, 0.421 for total femur regions [all P values were significant]. Using Receiver Operating Characteristic [ROC] curves, it was found that a T-score of -2.1, -2.6 and -2.4 as the optimal cut-off point of DXL in the diagnosis of osteoporosis in the lumbar spine, the neck and total region of femur, respectively. The results of this study showed a moderate agreement of the two methods in the diagnosis of osteoporosis. It seems that the DXL cannot be used as a substitute for the DXA method, but it can be used as a screening method for finding osteoporosis

Estudio comparativo entre densitometria osea por foton dual y por ultrasonido: correlacion entre densidad osea, velocidad del sonido, y dureza osea / Comparative study between ultrasound densitometry and dual energy x-ray absorsiometry> correlation between osseus density, speed of sound and stiffness index

Recientemente se ha introducido la utilizacion de la densitometria por ultrasonido del calcaneo (DUC) como metodo de tamizaje en la valoracion de osteoporosis en mujeres post-menopausicas. Mediante la DUC se determinan tres parametros: la velocidad del sonido (SOS), atenuacion de la banda de ultrasonido (BUA) y el indice de dureza (stiffness). No existen estudios conclusivos de la correlacion de estos parametros ultrasonograficos con la densidad osea mineral establecida por densitometria por foton dual (DEXA). En el presente estudio se valoraron 110 pacientes, la mayoria de sexo femenino (97 por ciento ), entre los 36 años y los 96 años, en quienes el mismo dia se les realizo osteodensitometria por DEXA del esqueleto axial (Columna lumbar de L1 a LS) y apendicular (femur proximal) y DUC. Se realizo un analisis de regresion lineal utilizando multiples pares de variables para buscar los coeficientes de correlacion de Pearson entre los parametros de la DUC y de la DEXA. Se encontro que en general existen correlacio-nes positivas pero entre leves y moderadas entre los dos metodos de medicion, con coeficientes de correlacion que fluctuaron en-tre r= 0.37 y r= 0.62. En conclusion si se considera que la densidad mineral osea (DMO) es un parametro fundamental de la fortaleza osea, la correlacion baja o moderada de las mediciones por ultrasonido con respecto a la medicion de la DMO por DEXA, hacen cuestionar el valor predictivo de la DUC para establecer riesgos de fractura en pacientes con osteoporosis

Utilizaçäo dos marcadores biológicos de turnover ósseo no diagnóstico e acompanhamento da osteoporose primária / The use of the biological markers of bony turnover in the diagnosis and accompaniment of the primary osteoporosis

A osteoporose acomete em torno de 20 por cento das mulheres após os 40 anos, e 10 por cento dos homens após os 65 anos, resultando em fraturas vertebrais e do terço inferior do rádio e superior do fêmur, causando, muitaas vezes, deformidades posturais. Isto justificou a procura por um controle da terapêutica que possibilitasse avaliar sua resposta, um período mais curto do que o utilizado na densiometria óssea. Os marcadores ósses apresentam boa sensibilidade e fácil utilizaçäo, podendo sinalizar a indicaçäo de tratamento da osteoporose primária e fazer o controle da resposta terapêutica após um a três meses, o que será consolidado pela densitometria óssea, ao término de um ano de tratamento.

Factores determinates de la densidad mineral ósea de niños y adolescentes / Determinant factors of bone mineral density for children and adolescents

Introducción: El objetivo del presente estudio fue definir los factores individuales que ejercen mayor influencia en la determinación de la masa ósea en niños y adolescentes. Material y métodos: La densidad mineral ósea (DMO) se midió por absorciometría de rayos X de doble energía (DXA) en cuerpo entero, Columna lumbar (en proyecciones anteroposterior y lateral) y en cadera (cuello del fémur, trocánter mayor y triángulo de Ward) en 778 personas sanas (433 mujeres y 345 varones) de 2 a 20 años de edad. Se confeccionó en cada caso una historia clínica completa, incluyendo mediciones de peso, talla, índice de masa corporal (IMC; peso en kg, dividido por el cuadrado de la talla en metros) y el estadio puberal de Tanner. Se determinaron cuatro niveles de actividad física, definidos por cuestionario. Se obtuvieron radiografías de mano y muñeca izquierdas para el cálculo de la edad ósea en todos los casos. Utilizando los parámetros mencionados se realizó un análisis de regresión múltiple para los datos densitométricos en cada región de interés. Resultados: El análisis de los datos obtenidos mostró que el peso fue el factor con mayor influencia en el contenido mineral óseo (CMO) de cuerpo entero (mujeres r²=0,992 p<0,001; varones r²=0,990 p<0,001) y la talla fue el factor estadísticamente más significativo en la determinación de la DMO en las diferentes regiones estudiadas (mujeres DMO cuello femoral r²=0,985; DMO columna lumbar r²=0,985; varones DMO cuello femoral r²=0,987; DMO columna lumbar r²=0,983, p<0,001). Cuando se consideró el tipo de tejido óseo (cortical y trabecular), la talla fue el factor más importante en la determinación de ambos tipos de tejido. Conclusión: La talla debería ser tenida en cuenta en el análisis de la densidad mineral ósea en niños y adolescentes