A Silent Threat of Emerging Resistance Based on Antifungal Susceptibility Pattern of Filamentous Fungi by Microdilution, E Test and, Disc Diffusion Method: A Critical Constructive Analysis

For more than two decades, antifungal susceptibility testing and interpretation haunted the medical professionals in diagnostics and management. This article mainly focuses on the three most widely used methods: broth microdilution, E test, and disc diffusion. It also focuses on the fact that clinicians should switch from empirical treatment to susceptible drugs as early as possible to combat antifungal resistance and newer mutations that horrify us every single day with poor patient outcomes. Many factors need to be taken into account during the interpretation of results but the positive side of the story is that they have been well documented in the literature. Though many methods have come up in testing antifungal susceptibility, still there is a scope for a rapid yet accurate testing modality to flourish and take the lead

Anogenital index and bone mineral density associations after natural and surgical menopause: a preliminary study

SUMMARY OBJECTIVE: The aim of this study was to evaluate postmenopausal women to determine whether an anogenital index (AGI) is associated with bone mineral density (BMD) based on the hypothesis that the effects of menopause are similar for both. METHODS: A total of 338 generally healthy postmenopausal women who were referred for a routine annual check and 140 women who met the inclusion criteria were enrolled in the study. Based on the menopausal status, the women were classified into natural menopause and surgical menopause. AGI was calculated by dividing anogenital distance by body mass index. The BMD of the femoral neck, body of the femur, and lumbar spine (L1 and L2) was measured using dual-energy x-ray absorptiometry. RESULTS: There was a statistically significant and same-directional correlation between age and AGI for all cases (r=0.234 and p=0.005). The AGI level decreased as the parity increased (r=-0.582 and p<0.001). The AGI level decreased significantly as the menopause duration was prolonged (r=0.288 and p<0.001). While there was no statistically significant correlation between L2-L4 BMD and AGI (p=0.128), as the femur and femoral neck BMD levels increased, the AGI level increased statistically significantly (r=0.330 and p<0.001, r=0.292 and p<0.001). CONCLUSION: The AGI levels in healthy postmenopausal women give preliminary information about their BMD status. A decrease in AGI levels may predict lower BMD in postmenopausal women. Further larger and well-controlled studies may be required to determine the relationship between AGI and BMD in the future.

Impacto del tratamiento de adultos mayores con ISRS y su relación con los tratamientos odontológicos / The impact of treating older adults with SSRI and its relationship with dental treatments

La población mayor de 60 años es el grupo etario de mayor crecimiento en el mundo. Debido a que la depresión es una patología frecuente en la persona adulta mayor y anciana, los inhibidores de la recap- tación de la serotonina (ISRS) son el tratamiento de primera línea de elección. Este trabajo referencia la asociación del consumo de estos fármacos con la disminución de la densidad ósea mineral (DMO), el riesgo de fracturas y su repercusión en la atención odontológica. Además, incluye una breve descripción de la homeostasis ósea y la relación depresión-carga alostática. El trabajo interdisciplinario y una correcta anamnesis pueden detectar posibles complicaciones y riesgos vinculados con este tipo de medicamen- tos. Ello facilitaría un mejor manejo, más aún en el adulto mayor, donde una pequeña variable puede repercutir en su integridad (AU)

The population over 60 is the fastest growing age group in the world. Depression is a frequent pathology in the elderly and the elderly, with serotonin reuptake inhibitors (SSRI) being the 1st line treatment of choice. The association of the consumption of this drug with a decrease in bone mineral density (BMD), risk of fractures and its impact on dental care are referenced in this work. In addition, it includes a brief description of bone homeostasis and the depression-allostatic load relationship. Interdisciplinary work and a correct anamnesis can detect possible complications and risks linked to this type of medication, facilitating better management and even more so in the elderly, where a small variable can affect their integrity (AU)

Evaluation of Comprehensive Management Protocol for Reduction of the Risk of Fragility Fractures Among Osteoporosis Individuals, Visiting Teaching Hospital, Kolkata

@#Introduction: Fragility fracture from osteoporosis is a major challenging health problem in aging population in developing countries. In order to reduce the risk of development of osteoporotic fragility fractures authors made a study with high risk individuals, divided into two groups and a comprehensive management protocol had been offered in one group where as conventional management protocol had been offered in other to see the efficacy of such comprehensive management protocol to reduce the risk of occurring fragility fracture over at least three months period among the patients, attended in orthopaedic out patient department of state medical college, West Bengal. Methods: The authors selected 30 diagnosed osteoporosis clients of 50 to 90 years age as per inclusion and exclusion criteria, who attended in orthopaedic OPD in SSKM Hospital, Kolkata, West Bengal, India from 2021April to July2021, carrying highest risk factors of developing osteoporosis. Results: In experimental group, mean post test BMD score is higher than the mean pre test BMD, which is statistically significant as calculated t value is 3.666 at 14 df at 0.05 (p<0.05) level of significances. It indicates that comprehensive management protocol is effective to increase the bone strength. Conclusion: The study of comparison of mean difference values of two groups conclude that comprehensive management protocol can reduce the risk of osteoporotic fracture much efficiently in compared to standard pharmaceutical treatment in a short span of time which is applicable for long term management of osteoporosis.

Use of aromatase inhibitors in patients with breast cancer is associated with deterioration of bone microarchitecture and density

ABSTRACT Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.

The Effect of Materials and Porosity on Bone Formation of Degradable Scaffolds / 医用生物力学

Objective To study the effect of different materials and porosities on bone formation in the scaffold after implantation of the degradable bone scaffold into human body. Methods According to natural reaction mechanism of fracture healing, the finite element method was used, combined with geometry of the scaffold, to establish a computationally coupled model based on material degradation curve and bone reconstruction control equation. Through this platform, representative volume elements of the scaffold with five kinds of materials and four types of porosities were selected for calculation and analysis, and dynamic process was reflected by bone mineral density (BMD) and maximum stress of the scaffold. Results The elastic modulus of the materials had a greater influence on growth of bone tissues in the scaffold. The smaller elastic modulus of the materials would lead to the greater amount of bone formation, but it would also have a greater impact on mechanical properties of the scaffold. The scaffold with higher porosity had lower rigidity, which could better promote formation of bone tissues, meanwhile it would also destroy mechanical stability of the scaffold. Conclusions According to performance requirements for different age, gender and location of bone tissues, personalized reference and calculation basis for selection of materials and porosity, structural design and clinical application of degradable porous bone scaffolds can be provided.

Adjuvant therapy of acupuncture for elderly patients of primary osteoporosis with intestinal dysfunction: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture on bone mineral density (BMD), bone metabolism and intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.@*METHODS@#A total of 128 elderly patients of primary osteoporosis with intestinal dysfunction were randomly divided into an observation group and a control group, 64 cases in each group. Patients in the control group were treated with oral administration of vitamin D calcium chewable tablets (0.6 g, once a day) and calcitriol capsules (0.25 μg, three times a day); the treatment was given for 6 months. On the basis of the treatment in the control group, patients in the observation group were additionally treated with acupuncture at Shenshu (BL 23), Mingmen (GV 4), Pishu (BL 20), Dachangshu (BL 25), Tianshu (ST 25) and Zusanli (ST 36), etc. for 30 min each time, once a day. After 1-week treatment, the patients took a rest for 2 days; the treatment was given for 6 months. Before and after treatment, the BMD of lumbar spine, femoral neck and femoral trochanter was detected by dual energy X-ray absorptiometry, and the serum levels of bone alkaline phosphatase (NBAP), osteocalcin (OC), matrix metalloproteinase-2 (MMP-2) and calcitonin (CT) were detected by ELISA method. The primary symptom scores of intestinal function, serum diamine oxidase (DAO) and D-lactic acid (D-Lac) levels were compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated.@*RESULTS@#The total effective rate was 85.9% (55/64) in the observation group, which was higher than 71.9% (46/64) in the control group (<0.05). After treatment, BMD were increased (<0.05), and serum bone metabolism indexes were improved in the two groups (<0.05); the BMD and serum bone metabolism indexes in the observation group were better than those in the control group (<0.05). After treatment, the primary symptom scores of intestinal function, serum DAO and D-Lac levels in the observation group were decreased (<0.05), and the indexes in the observation group were lower than those in the control group (<0.05).@*CONCLUSION@#The adjuvant therapy of acupuncture could increase BMD, improve bone metabolism and regulate intestinal function in elderly patients of primary osteoporosis with intestinal dysfunction.

Association between dietary intake and bone density among female Students at Imam Abdulrahman Bin Faisal University, Saudi Arabia

Background: Recently, new studies have shown that the prevalence of osteoporosis and related fractures has been increased among young females. This study aimed at finding out the association between dietary intake and bone mineral density (BMD) among university Saudi female students at Imam Abdulrahman Bin Faisal University.Methods: A cross sectional study was carried out on 104 females’ students aged 18-24 years taken randomly from Rakkah campus. Dual X-ray absorptiometry was used to evaluate BMD and body composition. A complete and valid questionnaire was used to collect the required information about socio-economic status, lifestyle, body measurements, health history data, and food habits as well as food frequency questionnaire was also used. The results were statically analyzed (SPSS, 2015 V, 23) and descriptive statistics Chi-square test and independent samples t- test were used for the statistical analysis.Results: The results demonstrated that the majority (65%) of students have normal body mass index (18.5-24.9 kg/m2), 58% normal BMD (>-1.0 SD) and 42% have low BMD. Among the low BMD students, 4% having osteoporosis (<-2.5 SD). In the present study, 36.5%, 30.8%, 37.5% and 36.5 % of student with high BMD consumed full fat dairy products, milk, yogurt, laben, cheese, respectively, compared with 21.2%, 19.2%, 245, 29.8% of students with low BMD.Conclusions: Higher intakes in dairy products were associated with students’ bone health. Therefore, students should be more aware of their bone health and increase their knowledge regarding protective dietary foods for bone development.

Risk Assessment of Furan Exposure in the Norwegian Population

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has on request of The Norwegian Food Safety Authority performed a risk assessment of furan intake in the Norwegian population based on the most recent national food consumption surveys. National occurrence data of furan concentrations in food were preferentially used in the risk assessment. When national data were lacking, VKM has used occurrence data of furan from other countries. The assessment has been performed by the VKM Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics and the VKM Panel on Contaminants. Furan is a volatile and lipophilic compound formed in a variety of heat-treated commercial foods and contributes to the sensory properties of the product. The substance has been found in a number of foods such as coffee, canned and jarred foods including baby food containing meat and various vegetables. High concentrations of furan have been found in coffee and the presence of furan in jarred baby food and infant formulae has received much attention since such products may be the sole diet for many infants. The occurrence of furan in a variety of foods suggests that there are multiple routes of furan formation rather than a single mechanism. The Norwegian Food Safety Authority has in 2008 and 2009 collected data on furan concentrations in different food products sold on the Norwegian market (Norwegian Food Safety Authority, 2008). In 2011, the Norwegian Food Safety Authority also decided to analyse commercial porridges for infants and children sold on the Norwegian market, to see if furan could be detected in such products. The calculated furan exposures from food and beverages are based on data from the nationally representative food consumption surveys; Spedkost, Småbarnskost, Ungkost and Norkost. The consumption for each relevant food or food category in the dietary surveys were multiplied with the corresponding mean furan concentrations and totalled for each individual. The liver is the main target organ for furan toxicity both in mice and rats, but the rat is the most sensitive species. A dose-dependent increase in hepatocellular adenomas and carcinomas was observed in mice and rats, and an increase in the incidence of cholangiocarcinomas was observed in rat liver. Cholangiocarcinomas in male and female rats were the most sensitive toxicological end point observed in rodents. On the basis of the available data, VKM considers that rat cholangiocarcinomas may be relevant for assessing human risk from furan. Available in vivo data with furan indicate that a reactive metabolite, most likely cis-2-butene1,4-dial (BDA), is formed and that this metabolite can react with DNA and induce mutations. To VKM’s knowledge, no in vivo studies on genotoxicity of BDA have been performed, but BDA was found to be genotoxic in several in vitro tests. VKM therefore considers that a genotoxic mechanism in furan-induced carcinogenesis cannot be excluded and the substance was assessed as a genotoxic carcinogen. VKM used the Margin of Exposure (MOE) approach in this risk assessment. The suitability of different studies on cholangiocarcinomas for dose-response modelling was considered. The 9-month interim evaluation of a 2-year study from NTP (1993) was chosen because it demonstrates a dose-response relationship. From this study, a point of departure of 0.02 mg/kg bw/day was chosen, based on a benchmark dose lower bound (BMDL10) of 0.14 mg furan/kg bw/day and a correction factor of 7 for shorter than full life-time (2 years) study duration. For 6-, 12- and 24-month-old children, the main source of furan exposure is jarred baby food. For 4-, 9- and 13-year-old children, the major food source to the furan exposure is breakfast cereals. In adults, the major contribution to the furan exposure is coffee. The highest furan exposure was calculated for 12-month-old infants and ranged from 0.62-1.51 µg/kg bw/day. In adults the furan exposure ranged from 0.27-0.82 µg/kg bw/day. For mean exposure among infants, children and adolescents, the MOE-values ranged from 29 in 12-month-infants to 2000 in the 13-year-old adolescents. Among high consumers in these groups, the MOE-values ranged from 13 to 400. In adults, the corresponding MOE-values ranged from 59 to 74 for mean furan exposure and from 24 to 26 for high exposure. It should be noted that this risk assessment of furan contains notable uncertainties and limitations. The use of the 9-month interim study in rats including a correction factor of 7 to derive a point of departure, instead of a full life-time study (2-year) study, likely overestimates the hazard of furan. A possible over-diagnosis of the cholangiocarcinomas, due to the similarities in histopathology between cholangiofibrosis and cholangiocarcinomas in rats, may overestimate the hazard. There are also limitations in assessing food consumption and furan content in foods, leading to uncertainties in estimation of furan exposure. VKM considers that the current exposure to furan in all age groups, particularly among infants and children, is of health concern.

Risk Assessment of Coumarin Intake in the Norwegian Population

The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has at the request of the Norwegian Food Safety Authority (Mattilsynet) conducted a risk assessment of the coumarin intake in the Norwegian population. VKM was asked to assess if any part of the population has a total intake of coumarin that will exceed the tolerable daily intake (TDI). It should further be considered whether an intake of coumarin exceeding TDI 1-2 times a week for several years would represent a risk to the health of the consumer. The assessment has been performed by the VKM Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics (Panel 4). Coumarin is a naturally flavouring substance in cinnamon and occurs in many plants. The substance can be found in different types of cinnamon to a varying degree. The two main types are Ceylon (Cinnamomum zeylandicum) and Cassia cinnamon (Cinnamomum aromaticum). Cassia cinnamon, which currently is most frequently used in food products on the Norwegian market, contains more coumarin than the lesser used Ceylon cinnamon. Oral intake of coumarin is mostly related to consumption of cinnamon-containing foods or cinnamon as a spice. This includes both direct addition of cinnamon to foods as well as the use of cinnamon oils and other cinnamon extracts by the food industry. Other important sources of exposure could be food supplements based on cinnamon or the use of cosmetic products through dermal exposure, as synthetic coumarin is added as a fragrance ingredient to perfumes, skin gels, lotions and deodorants. It is known from animal experiments that coumarin can cause liver toxicity. It is considered as a non-genotoxic carcinogen in mice and rats. In 2004, the European Food Safety Authority (EFSA) established a TDI of 0.1 mg coumarin/kg body weight (bw), based on a no observed adverse effect level (NOAEL) for liver toxicity in a 2-year dog study. This TDI was maintained when the substance was re-evaluated in 2008. EFSA further concluded that exposure to coumarin resulting in an intake 3 times higher than the TDI for 1-2 weeks was not of safety concern. In order to answer the second question as stated in the terms of reference, the VKM Panel on Food Additives, Flavourings, Processing Aids, Materials in Contact with Food and Cosmetics found it necessary to further examine the data on toxicity of coumarin, which were the basis for the TDI established by EFSA. The most significant hazards of coumarin appears to be liver toxicity, which is well documented, and demonstrated in mice, rats, dogs, baboons and humans, and kidney adenomas in male rats. In a review of human case reports, a small subgroup of the human population appears for unknown reasons to be more susceptible to medical treatment with coumarin. The lowest reported dose of coumarin associated with liver toxicity in humans is around 0.4 mg/kg bw/day. It should be noted that the liver toxicity of coumarin in humans usually is reversible. Since there were no dose-response data for humans, animal data were used in the hazard characterisation. The VKM Panel decided to use the benchmark dose (BMD) approach to determine a point of departure for adverse effects of coumarin. The 2-year chronic toxicity/carcinogenicity study in rats by the US National Toxicology Program (NTP) was chosen for model simulation and BMD/BMDL (benchmark dose lower confidence limit) calculations. The best model fit of the dose-response data combined with the lowest BMDL05 (dose where the response is likely to be smaller than 5%) was seen for increased relative liver weight in female rats, which gave a BMDL05 of 7 mg/kg bw/day (converted from 10 mg/kg bw, 5 times per week). The VKM Panel used the BMDL05 for relative increase in liver weight in female rats to establish a TDI of 0.07 mg/kg bw/day using an uncertainty factor of 100 to account for interand intraspecies variation. The intake calculations for coumarin from food and drinks in this opinion are based on both data from the nationally representative food consumption surveys Norkost, Ungkost, Småbarnskost and Spedkost, as well as on assumed worst intake scenarios of different cinnamon-containing food products. The average coumarin levels found in cinnamoncontaining food categories such as ginger bread, cinnamon buns and similar bakery products, cinnamon-containing cakes, thin pastry with cinnamon and cinnamon-based tea sold on the Norwegian market, were used to calculate the total coumarin intake in different age groups in the population. For the calculation of the coumarin intake from cinnamon powder sprinkled on oatmeal porridge and rice porridge, a coumarin level of 3000 mg/kg in cinnamon powder was used. The frequency of consumption and the amount of cinnamon powder (from ¼ - 1 teaspoon) sprinkled on the porridge were taken into account in the calculations. To assess if any part of the Norwegian population has an intake of coumarin that will exceed the TDI, the different intake scenarios presented in the opinion have been compared with the TDI of 0.07 mg/kg bw/day established by VKM. The main conclusions from the VKM Panel were: The total estimated intake of coumarin for mean and high consumers of cinnamon-containing foods are below the TDI for all age groups when consumption of cinnamon-based tea and porridge with cinnamon was excluded. Children and adults who regularly consume oatmeal porridge sprinkled with cinnamon may exceed the TDI by several folds depending on the frequency of consumption and the amount of cinnamon used. Small children (1- and 2-years old) who have a mean or high consumption of oatmeal porridge may exceed the TDI even if they use moderate amounts of cinnamon powder on the porridge. In a worst case scenario with high consumption of porridge and use of high amounts of cinnamon powder, the estimated coumarin intake could exceed the TDI by about 20-fold. This intake is similar to dose levels of coumarin used in medical treatment of adults and where cases of liver toxicity have been reported. Drinking of cinnamon-based tea, which may have a high content of coumarin, can also result in a total intake of coumarin that exceeds the TDI both for children and adults. Other relevant sources of coumarin are cosmetics and food supplements with cinnamon. The recommended dose of two cinnamon supplements sold on the Norwegian market can lead to an exceedance of TDI in adults. It is not anticipated that children will consume supplements with cinnamon. Cosmetic products (shower gels, body lotions, deodorants and oils) are important sources of coumarin exposure both for children and adults, but quantification of the coumarin exposure from cosmetics was not possible due to lack of data. The VKM Panel concludes that based on the available data, the possibility of an adverse health effect by exceeding the TDI 3-fold for 1-2 times per week for several years cannot be assessed. Generally, a minor or an occasional exceedance of TDI is not considered to increase the risk of adverse health effects. The coumarin intake could exceed the TDI by 7-20 fold in some instances. Liver toxicity may occur shortly after the start of coumarin exposure. Such large daily exceedances of TDI, even for a limited time period of 1-2 weeks, cause concern of adverse health effects.

Efectos de las plataformas vibratorias en la salud ósea en mujeres posmenopáusicas / Effects of Vibratory Platforms on Bone Health in Postmenopausal Women

Estudios recientes han sugerido que los estímulos mecánicos (vibraciones) de alta frecuencia y baja magnitud pueden ejercer un efecto positivo sobre la morfología ósea y beneficiar su cantidad y calidad. La plataforma vibratoria es una máquina popular que se introdujo en la última década como una nueva promesa contra el tratamiento de la osteoporosis. Actualmente, en el mundo hay más de 200 millones de mujeres posmenopáusicas que sufren osteoporosis. Esta enfermedad es una de las más comunes y costosas de la salud pública. El ejercicio físico complementado con el tratamiento vibratorio puede que sea considerado como una estrategia efectiva para la prevención y tratamiento de la osteoporosis posmenopáusica. Esta revisión ofrece una visión general de cuestiones significativas relacionadas con la terapia con la plataforma vibratoria para la prevención y tratamiento de la osteoporosis en mujeres postmenopáusicas. El objetivo de esta revisión ha sido conocer los últimos avances de entrenamiento con plataformas vibratorias para la mejoría de la masa ósea en mujeres posmenopáusicas. Existe una gran discrepancia respecto al uso de estas como tratamiento osteoporósico, uso de diferentes tipos de plataformas, distintas frecuencias, amplitud, aceleración o duración del tratamiento. La escasa literatura estableció que la plataforma vibratoria Galileo es la que más se utiliza en dicha población, pero se necesitan más intervenciones para concretar los beneficios y daños de este tratamiento en mujeres postmenopáusicas(AU)

Recent studies have suggested that mechanical stimuli (vibrations) of high frequency and low magnitude can exert a positive effect on bone morphology and benefit quantity and quality. The vibrating platform is a popular machine introduced in the last decade as a new promise against the treatment of osteoporosis. Currently, there are more than 200 million postmenopausal women in the world suffering from osteoporosis. This disease is one of the most common and expensive in public health. Physical exercise supplemented with vibrational treatment may be considered an effective strategy for the prevention and treatment of postmenopausal osteoporosis. This review offers an overview of significant issues related to therapy with the vibration platform for the prevention and treatment of osteoporosis in postmenopausal women. The objective of this review is to know the latest advances in vibratory platforms training for the improvement of bone mass in postmenopausal women. There is a great discrepancy regarding the use of vibratory platforms as osteoporosis treatment, the use of different types of platforms, different frequencies, amplitude, acceleration or duration of treatment. The limited literature established that Galileo vibration platform is the most used in this population, but more interventions are needed to grasp the benefits and harms of this treatment in postmenopausal women(AU)

Prevalence and awareness of osteopenia in perimenopausal women in Navi Mumbai, Maharashtra, India

Background: Osteopenia is considered as precursor of osteoporosis. Osteoporosis is a major public health problem associated with substantial morbidity and socio-economic burden worldwide. Osteopenia occurs more frequently in most menopausal women. Early detection of the same can be beneficial to control prevalence of osteoporosis and also to reduce the fracture rates.Methods: A cross-sectional quantitative study using DEXA (Dual Energy X-ray Absorptiometry) was conducted on 80 women. A self-structured questionnaire was used to evaluate the level of awareness among the study subjects. The data was analyzed using statistical tests such as Chi-Square test for association. The level of significance was set at 5%.Results: The prevalence of osteopenia in the studied population was 63.75%. The mean age was recorded to be 40.35 years. The mean age of women with menopause in this study is 50.62 years. Out of the 51(63.75%) women diagnosed with osteopenia, 5.9% were underweight, 33.3% were normal and 49% were obese. Of the diseased, 37.3% experienced adequate amount sunlight exposure required while 62.7% did not. Out of the 80 women interviewed 43.75% were aware about osteopenia, its causes and complications; which 56.25% were unaware about the same.Conclusions: Women were screened for osteopenia with the help of DEXA scan according to the (World Health Organization) WHO, T-Score criteria-which may go undiagnosed otherwise and may experience the risk and complications of osteoporosis.

Comparision of Effect of Teriparatide and Alendronate Sodium on the Bone Mineral Density in Post-Menopausal Women

Aim: Purpose of this study was to know which one is better modality of treatment for osteoporosis in postmenopausal women – enhancing bone formation or reducing bone resorption. Methods: Total 120 patients were included in this study and randomly divided in two groups. Group A patients were given teriparatide injection and Group B patients were given alendronate sodium tablet. Both groups were given Calcium supplement, and vitamin D supplement along with therapy. Bone mineral density (BMD) at the spine and hip was assessed by dual-energy x-ray absorptiometry (DEXA) scan before and after the therapy. Results: Average Bone mineral density (BMD) in teriparatide group was - 2.77 in pretreatment and – 1.8767 after one year follow up. Average BMD in alendronate sodium group was -2.78 in pretreatment and – 2.00 after one year follow up. Avearage gain in BMD in Group A was – 0.8933 and in group B was –0.78. Conclusion: Teriparatide seems to be better treatment for oeteoporosis as compared to alendronate therapy.

Advances in Predicting Fracture Risk Based on Hip Bone Properties / 医用生物力学

With the increasing life span of the population and the increasing proportion of the elderly population, the elderly with osteoporosis are prone to hip fractures, which brings heavy economic burdens to the family and society. The progress in predicting hip fractures from the aspects of the proximal femur geometry, bone mineral density (BMD), fracture risk assessment tool (FRAX) and finite element analysis (FEA) based on computed tomography (CT) imaging was reviewed, in order to understand the influencing factors of fracture risk, improve the accuracy of hip fracture risk prediction for the elderly, detect the high fracture risk group at an early stage, and hence to reduce the occurrence of fractures with appropriate preventing measures, and provide theoretical references for the prevention and treatment of hip fractures.

Relation of bone mineral density with severity of liver cirrhosis

Background: Osteoporosis is commonly associated with chronic liver disease. Pathologic fracture in osteoporotic patients affects quality of life as well as decrease life expectancy. Around 40% of patients with chronic liver disease may experience osteoporotic fracture. The present study was undertaken to observe the relation of bone mineral density (BMD) with severity of liver cirrhosis along with effects of smoking and alcohol.Methods: A total of 187 liver cirrhosis patients who were admitted in SMS Hospital were taken for study and were classified into class A, B, C as per Child Turcot Pugh’s classification, after applying inclusion and exclusion criteria. All patients underwent standard laboratory testing and bone densitometric studies of the lumbar spine using dual X-ray absorptiometry (DEXA) scan. Statistical analysis done.Results: The bone mineral density was significantly low in Class C. Class C have 41 patients of osteoporosis out of 62 whereas only 16 patients have osteoporosis in Class B and only 1 case of osteoporosis in class A. Hypocalcemia and hypophosphatemia were more in class C as in comparison to class A and B. Also, chronic smoking and alcohol intake were strongly associated with the severity of cirrhosis.Conclusions: The prevalence of osteopenia and osteoporosis is higher in cirrhotic patients and significantly increases with severity. Hypocalcemia and hypophosphatemia are also associated with the cirrhosis. Thus, patients should undergo routine bone densitometry assessment and, if necessary, to be treated for osteoporosis

Effects of Different Landing Postures on Bone Mineral Density and Content During High-Impact Exercises / 医用生物力学

Objective To study effects of different types of high-impact exercises on the increment of bone mineral density (BMD) and bone mineral content (BMC) . Methods Thirty-nine male volunteers, including 13 hoopsters, 13 paratroopers, and 13 common college students as the control, were recruited and divided into two subgroups (subgroup 1:20-22 years old; subgroup 2:23-25 years old). Their BMDs and BMCs on calcaneus, first through fifth metatarsus, hip, and lumbar spine (L1-4) were evaluated. Results The BMC of calcaneus, the first and second metatarsals, total lumbar spine, and total hip in the hoopster group was significantly higher than that in the control group and paratrooper group. The hoopster group obtained statistically higher BMD at the lumbar spine, hip, and femoral neck than the other two groups. However, the BMCs and BMDs of the paratrooper group and control group had no significant differences at almost all measured anatomical locations. Conclusions BMC and BMD are not always in positive correlation with vertical ground reaction forces during normal exercises. Compared with parachuting training, playing basketball as a kind of variable load exercise can effectively increase BMC and BMD, and is more beneficial for reducing the risk of osteoporotic fracture.

Calculation of free and bioavailable vitamin D and its association with bone mineral density in Malaysian women with rheumatoid arthritis

@#Introduction: Low 25-hydroxyvitamin D [25(OH)D] levels have not been consistently associated with bone mineral density (BMD). It has been suggested that calculation of the free/bioavailable 25(OH)D may correlate better with BMD. We examined this hypothesis in a cohort of Malaysian women. Materials and Methods: A cross-sectional study of 77 patients with rheumatoid arthritis (RA) and 29 controls was performed. Serum 25(OH)D was measured using the Roche Cobas E170 immunoassay. Serum vitamin D binding protein (VDBP) was measured using a monoclonal enzymelinked immunosorbent assay (ELISA). Free/bioavailable 25(OH)D were calculated using both the modified Vermuelen and Bikle formulae. Results: Since there were no significant differences between RA patients and controls for VDBP and 25(OH)D, the dataset was analysed as a whole. Calculated free 25(OH)D by Vermeulen was strongly correlated with Bikle (r = 1.00, p < 0.001). A significant positive correlation was noted between measured total 25(OH)D with free/bioavailable 25(OH) D (r = 0.607, r = 0.637, respectively, p < 0.001). Median free/bioavailable 25(OH)D values were significantly higher in Chinese compared with Malays and Indians, consistent with their median total 25(OH)D. Similar to total 25(OH)D, the free/bioavailable 25(OH)D did not correlate with BMD. Conclusion: In this first study of a multiethnic female Malaysian population, free/bioavailable 25(OH)D were found to reflect total 25(OH)D, and was not superior to total 25(OH)D in its correlation with BMD. Should they need to be calculated, the Bikle formula is easier to use but only calculates free 25(OH)D. The Vermuelen formula calculates both free/bioavailable 25(OH)D but is more complex to use.

How to read a DXA report

@#Dual-energy X-ray absorptiometry (DXA) is currently the gold standard by which bone mineral density (BMD) is measured. It can be used for the diagnosis, prognosis and monitoring of osteoporosis. Currently, a DXA T-score of ≤ -2.5, or BMD less than or equal to 2.5 standard deviations (SDs) below that of the young-adult mean, is used to diagnose osteoporosis in postmenopausal women and men age 50 years and older. A T-score <-1.0 but >-2.5 signifies Osteopenia or low bone mass, whereas a T-score ≥ -1.0 indicates normal bone density. The relative risk of fracture can be calculated as approximately 2 T-score. When a patient has been treated, the change in BMD can be used to show whether there has been a significant improvement or not. Finally, the Z-score, or number of standard deviations of BMD compared to that of an adult of the same age and sex, if less than -2, can give a clue that there are secondary causes to the bone loss. However, the DXA scan must be done as precisely and accurately as possible, and there may be artefacts that interfere with accurate interpretation.

Determination and comparison of the bone mineral density of different skeletal regions of female Wistar rats at different ages / 中国比较医学杂志

Objective To provide reference values for bone mineral density(BMD)in different skeletal regions of female Wistar rats at different ages. Methods Thirty SPF female Wistar rats were selected. The BMD of different skeletal regions(skull,upper limbs,thighs,trunk,ribs,pelvis,spine and the whole body)was measured by dual energy X-ray absorptiometry(DXA)at 6,10,12,24 and 30 months of age. The bone mineral densities between different age groups and that of different skeletal regions in the same age groups were compared. Results The BMD of the skull,upper limbs,thighs,trunk,ribs,pelvis, spine and the whole body was increased rapidly with age, and reached a peak at 10 months of age. The BMD of the skull,upper limbs,thighs,trunk,ribs were significantly higher than the whole body BMD in the same month-age group(P< 0.05 or P< 0.01). However,there was no significant difference between the pelvic, spine and the whole body BMD(P> 0.05). There was a significant positive correlation among the three correlations(P<0.01). Conclusions Some background data are provided for the bone biology studies of female Wistar rats, and provide useful supplementary reference for the studies of bone metabolism in rats and their application in biomedicine.

Pre-sarcopenia and bone mineral density in adults submitted to hematopoietic stem cell transplantation

Abstract Background: The aim of this study was to evaluate the prevalence of pre-sarcopenia and bone mineral density after hematopoietic stem cell transplantation. Methods: The study group consisted of over 18-year-old patients who had been submitted to allogeneic transplantation at least one year previously. Patients and healthy controls were matched by sex, ethnic background, age, and body mass index. Body composition and bone mineral density were measured by dual-energy X-ray absorptiometry. A 24-h food recall and food frequency survey were performed. The biochemical evaluation included calcium, parathormone and vitamin D. Eighty-seven patients (52 men; age: 37.2 ± 12.7 years; body mass index: 25 ± 4.5 kg/m2) were compared to 68 controls [31 men; age 35.4 ± 15.5 years (p = 0.467); body mass index 25.05 ± 3.7 kg/m2 (p = 0.927)]. Results: There was no significant difference in the dietary intake between patients and controls. The mean levels of vitamin D were 23.5 ± 10.3 ng/mL; 29 patients (41.0%) had insufficient and 26 (37.14%) deficient levels. A higher prevalence of reduced bone mineral density was observed in 24 patients (25%) compared to 12 controls (19.1% - p < 0.001). Pre-sarcopenia was diagnosed in 14 (14.4%) patients and none of the controls (p = 0.05). There was a higher prevalence of pre-sarcopenia (66%) in patients with grades III and IV compared to those with grades 0-II graft-versus-host disease (10.9%) (p = 0.004). Conclusion: patients submitted to transplantation had a higher prevalence of pre-sarcopenia and greater changes in bone mineral density compared to controls; the severity of graft-versus-host disease had an impact on the prevalence of pre-sarcopenia.