Influence factors of bone mineral density and its correlation with insulin resistance in obese children in Qianjiang area / 公共卫生与预防医学

Objective To explore the influencing factors of bone mineral density (BMD) in obese children in Qianjiang area and analyze the correlation between BMD and insulin resistance. Methods The data on pediatric cases from the outpatient department of Jianghan Oilfield General Hospital in Qianjiang from January 2018 to December 2022 were collected. A total of 183 obese children who met the inclusion and exclusion criteria were included in the study and selected in the observation group. A total of 352 children undergoing physical examination during the same period were selected as the control group. Results The body mass, waist circumference, waist to hip ratio, and BMI of obese children were significantly higher than those of the control group (P<0.001). Biochemical indexes including FBG, FINS, Home-IR, ALP, and LDL-C in obese children were significantly higher than those in the control group (P<0.05), while bone mineral density, Ca, P, sOC and HDL-C were significantly lower than those in the control group (P<0.001). The bone mineral density of obese children was significantly correlated with their exercise intensity, sunshine exposure duration, sitting time, intake of milk and dairy products, intake of sweets, supplementation of trace elements, BMI, Home-IR, and sex (all P<0.05). BMI, Home-IR, sex, exercise intensity, and sunshine exposure length were independent risk factors affecting bone mineral density of obese children (all P<0.05). Bone mineral density was negatively correlated with BMI and Home-IR (P=0.028 and0.017, respectively), and positive correlation with exercise intensity and sunlight exposure (P=0.033). Conclusion BMD of obese children in Qianjiang area is affected by gender, body mass index, diet, vitamin intake, and physical activity, and is negatively correlated with insulin resistance. Home-IR can be used as a reference for screening BMD of obese children.

Morin Mediates Protective Effects on Bone in Aged Rats by Inhibiting ERK1/2-p38 Signaling Pathway / 中山大学学报(医学科学版)

ObjectiveTo investigate the effects of morin treatment on bone metabolism and bone mass in aged rats， and to clarify the possible mechanism. MethodsTen young female Sprague-Dawley rats （3 months old） and 20 old female Sprague-Dawley rats （24 months old） were randomly divided into three groups： Control group （CON， 10 young rats）； Model group （MOD， 10 young rats）； 10 old rats and SangHuangSu Group （SSS， 10 old rats）. During the experiment， the SSS group received intraperitoneal injection of morin （10 mg / kg） daily. The treatment lasted for 12 weeks. After treatment， Micro-CT， HE stained sections， serological tests and Western blot were used to observe the treatment effect and possible mechanism. ResultsAfter 12 weeks of treatment， compared with MOD group， the number and density of bone trabeculae in SSS group were significantly improved. The BMD， Conn. D， Tb. N， Tb.Th and Tb.Sp of the left femur in the SSS group were significantly better than those in the MOD group（P <0.05）. After 12 weeks of treatment， the levels of CTX-1， osteocalcin， TRACP-5b and PINP in SSS group were significantly lower than those in MOD group（P <0.05）. Compared with the MOD group， the ERK1/2-p38 signal pathway was significantly inhibited and the levels of ERK1/2 and p38 were significantly decreased in the SSS group（P <0.05）. ConclusionMorin pigment mediates the protective effect on the bones of aged rats by inhibiting the ERK1/2-p38 signaling pathway and reducing bone turnover.

Osteoprotective Effect and Mechanisms of Taxillus chinensis from Different Hosts on Ovariectomized Osteoporotic Rats / 中国实验方剂学杂志

ObjectiveTo compare the effects of Taxillus chinensis from different hosts with different meridian affinity on bone microstructure and bone metabolism in ovariectomized osteoporotic rats， and investigate its mechanism of action. MethodEighty-eight specific-pathogen-free （SPF）-grade female Sprague-Dawley （SD） rats were selected and randomly divided into 11 groups： sham-operated group， model group， low-， medium- and high-dose groups of T. chinensis from Morus alba （2.5， 5， and 10 g·kg-1）， low-， medium- and high-dose groups of T. chinensis from Cinnamomum cassia （2.5， 5， and 10 g·kg-1）， and low-， medium- and high-dose groups of T. chinensis from C. burmannii （2.5， 5， and 10 g·kg-1）. After 12 weeks of drug intervention， the rats were examined for proximal femur bone density and bone microstructure using dual-energy X-ray absorptiometry （DXA） and micro-computed tomography （Micro-CT）. Histopathological changes in rat femur were observed by the hematoxylin-eosin staining （HE）. Contents of serum estradiol （E2）， bone Gla protein （BGP）， bone alkaline phosphatase （BALP）， tartrate-resistant acid phosphatase 5b （TRACP-5b） and pre-collagen type Ⅰ amino-terminal protopeptide （PINP） were measured by the enzyme-linked immunosorbent assay （ELISA）. Real-time quantitative polymerase chain reaction （Real-time PCR） was employed to detect the messenger ribonucleic acid （mRNA） expressions of bone morphogenetic protein-2 （BMP-2）， Smad1， Smad9 and recombinant runt-related transcription factor 2 （Runx2） in rat humerus. Western blot was used to detect the protein expressions of BMP-2， p-Smad1/5/9 and Runx2 in rat humerus. ResultCompared with that in the sham-operated group， the femur microstructure of rats in the model group was significantly disrupted， with significant decreases in bone mineral density （BMD） value， bone volume fraction （BV/TV）， trabecular number （Tb.N）， and trabecular thickness （Tb.Th） （P<0.01）， and significant increases in trabecular separation （Tb.Sp） and structure model index （SMI） （P<0.01）. The serum levels of BGP， BALP， TRACP-5b and PINP were significantly increased （P<0.05， P<0.01）， and E2 levels were significantly decreased （P<0.01）. The mRNA expressions of BMP-2， Smad1， Smad9， and Runx2 were significantly decreased in rat humerus （P<0.01）， and the protein expressions of BMP-2， p-Smad1/5/9， and Runx2 were significantly reduced （P<0.01）. Compared with the model group， the administration groups of T. chinensis from different hosts all elevated the BMD， BV/TV， Tb.N， Tb.Th， Tb.Sp， and SMI levels in the femur， improved bone microstructure， increased serum E2 levels （P<0.05， P<0.01）， lowered the levels of serum BGP， BALP， TRACP-5b， and PINP， upregulated the mRNA expression of BMP-2， Smad1， and Runx2 and upregulated the mRNA expression levels of Smad9 （P<0.05， P<0.01）， and upregulated the protein expressions levels of BMP-2， p-Smad1/5/9， and Runx2 （P<0.01）. The best effect was observed in the group of T. chinensis from C. cassia. ConclusionT. chinensis from different hosts improved osteoporosis in ovariectomized rats， with the group of T. chinensis from C. cassia being the most potent among the administered groups， and its treatment of osteoporosis may regulate the balance of bone conversion by regulating BMP/Smad signaling pathway.

Alimentación basada en plantas y su efecto sobre la salud ósea: del mito a la evidencia Plant-based diets and its effects on bone health: from myth to evidence

Resumen Introducción: la alimentación es uno de los factores modificables más importantes que participa en la salud ósea. Contribuye a ésta, una adecuada ingesta de calcio, vitamina D y proteínas, como así también otros nutrientes. A la alimentación basada en plantas (ABP) se le ha atribuido importantes beneficios para la salud en general, pero mal planificada podría tener efectos deletéreos sobre la salud ósea. Materiales y método: revisión narrativa con búsqueda en el sistema digital de recopilación de información biomédica PubMed cuyo objetivo fue analizar la evidencia científica disponible en la actualidad sobre el efecto de la ABP sobre la salud ósea. Resultados: dentro de los patrones de consumo de la ABP, los veganos que exhiben un consumo de calcio inferior a 525 mg/día presentan mayor riesgo de fractura por fragilidad ósea [incidencia de fractura: 1.37 (IC95%: 1,07; 1,74)]. En cambio, el papel de la hiperhomocisteinemia (HHcy) secundaria al déficit de vitamina B12 y riesgo de fractura continúa siendo controvertido en esta población. Si bien, in vitro la HHcy puede incrementar la actividad de los osteoclastos, en estudios clínicos no se observaron diferencias estadísticamente significativas en los niveles de crosslaps sérico (marcador de resorción ósea) en los consumidores de ABP (vegetarianos) comparados con los omnívoros. Conclusión: una ABP bien planificada, óptima y adecuada, que cubra los requerimientos diarios de calcio, vitamina D, vitamina B12 y proteínas aportará importantes beneficios para la salud general sin afectar la salud ósea en particular, aunque se requiere de futuros estudios para una mejor comprensión de su efecto sobre aspectos específicos del sistema musculo esquelético.

Abstract Introduction: diet is one of the most significant and modifiable factors involved in bone health, as an appropriate intake of calcium, vitamin D and proteins, as well as other nutrients, contributes to this. Significant overall health benefits have been attributed to plant-based diets (PBD); however, poorly planned PBD could have detrimental effects on bone health. Materials and Method: a narrative review through a search in the digital biomedical data collection system PubMed whose objective was to analyze currently available scientific evidence about the effects of PBD on bone health. Results: within the PBD intake patterns, vegans exhibiting calcium intakes below 525mg/day are at a higher risk of fracture due to bone fragility [incidence of fracture: 1.37 (95% CI: 1.07; 1.74)]. In contrast, the role of hyperhomocysteinemia (HHcy) secondary to vitamin B12 deficiency and fracture risk remains controversial in this population. While in vitro HHcy osteoclast activity may increase, in clinical studies no statistically significant differences in serum crosslaps levels (bone resorption marker) were observed in PBD consumers (vegetarians) when compared to omnivores. Conclusion: a well-planned, optimal and adequate PBD, covering daily calcium, vitamin D, vitamin B12 and proteins requirements, will provide significant benefits to the overall health condition without affecting bone health in particular, although future studies are required in order to better understand its effects on specific aspects of the musculoskeletal system.

Ingesta de calcio y densidad mineral ósea en adolescentes chilenos con desarrollo puberal completo

Introducción: La cantidad diaria recomendada (RDA) de calcio en adolescentes es de 1.300 mg/día. La última Encuesta Nacional de Consumo Alimentario de Chile, mostró que la mediana de ingesta total de calcio fue menos de la mitad de la RDA. Una ingesta insuficiente de calcio puede impactar negativamente la mineralización ósea. Objetivo: Determinar el efecto de la ingesta de calcio y estado nutricional sobre la densidad mineral ósea (DMO) de adolescentes con desarrollo puberal completo. Métodos: Estudio de corte transversal. Participaron n= 79 adolescentes de ambos sexos de entre 17 y 18 años elegidos al azar, aparentemente sanos, estadio Tanner 5 e IMC-1 DE). Según estado nutricional, no hubo diferencias significativas en la ingesta de nutrientes, pero sí en la DMO. En media, la DMO estandarizada (puntaje Z) fue normal para ambos sexos (>-1 DE); los adolescentes con obesidad presentaron una DMO estandarizada significativamente mayor que los adolescentes de peso normal (1,05±0,85 vs 0.33±0,86; P= 0,04). La ingesta de calcio no se relacionó con la masa ósea total ni con la DMO estandarizada. Conclusión: En adolescentes con desarrollo puberal completo no hubo relación entre la ingesta de calcio y los niveles de mineralización ósea. Sí hubo relación entre mineralización ósea y estado nutricional, siendo mayor la DMO en los individuos con obesidad.

Background: In adolescents, the recommended daily intake (RDI) of calcium is 1,300 mg. In Chile, the latest National Survey of Food Consumption showed that the median total calcium intake was less than half of the RDI. An adequate intake of calcium in adolescence negatively affects BMD. Aim: To determine the association of calcium intake and nutritional status with bone mineral density (BMD) in male and female adolescents with completed pubertal development (Tanner 5). Methods: Cross-sectional study in a random sample of 79 male and female adolescents, ages 17-18. Participants were healthy, Tanner stage 5, and BMI −1 SD. BMD was higher in obese participants compared to normal-weight adolescents (1.05±0.85 vs 0.33±0.86; P= 0.04), although no differences in nutrients and food intake. Calcium intake was unrelated to total bone mass and unstandardized BMD. Conclusions: In our sample of adolescents with complete pubertal development, there was no relationship between calcium intake and bone mineralization levels. There was a significant relationship between bone mineralization and nutritional status, with BMD being higher in adolescents with obesity.

Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood

Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring

The Relationship between Bone Mineral Densitometry and Visceral Adiposity Index in Postmenopausal Women / A relação entre a densitometria mineral óssea e o índice de adiposidade visceral em mulheres na pós-menopausa

Abstract Objective It was aimed to compare visceral adiposity index (VAI) levels in patients with normal bone mineral density (BMD), osteopenia, and osteoporosis. Methods One hundred twenty postmenopausal women (40 with normal BMD, 40 with osteopenia, and 40 with osteoporosis) between the ages of 50 to 70 years were included in the study. For females, the VAI was calculated using the formula (waist circumference [WC]/[36.58 + (1.89 x body mass index (BMI))]) x (1.52/High-density lipoprotein [HDL]-cholesterol [mmol/L]) x (triglyceride [TG]/0.81 [mmol/L]). Results The time of menopause from the beginning was similar in all groups. Waist circumference was found to be higher in those with normal BMD than in the osteopenic and osteoporotic groups (p = 0.018 and p < 0.001, respectively), and it was also higher in the osteopenic group than in the osteoporotic group (p = 0.003). Height and body weight, BMI, blood pressure, insulin, glucose, HDL-cholesterol, and homeostasis model assessment-insulin resistance (HOMA-IR) levels were similar in all groups. Triglyceride levels were found to be higher in the normal BMD group, compared with the osteoporotic group (p = 0.005). The level of VAI was detected as higher in those with normal BMD, compared with the women with osteoporosis (p = 0.002). Additionally, the correlation analysis showed a positive correlation between dual-energy X-ray absorptiometry (DXA) spine T-scores, WC, VAI, and a negative correlation between DXA spine T-scores and age. Conclusion In our study, we found higher VAI levels in those with normal BMD, compared with women with osteoporosis. We consider that further studies with a larger sample size will be beneficial in elucidating the entity.

Resumo Objetivo O objetivo foi comparar os níveis de índice de adiposidade visceral (IVA) em pacientes com densidade mineral óssea (DMO) normal osteopenia e osteoporose. Métodos Cento e vinte mulheres na pós-menopausa (40 com DMO normal 40 com osteopenia e 40 com osteoporose) com idades entre 50 e 70 anos foram incluídas no estudo. Para o sexo feminino o VAI foi calculado pela fórmula (circunferência da cintura [CC]/[36 58 + (1 89 x índice de massa corporal (IMC))]) x (1 52/lipoproteína de alta densidade [HDL]-colesterol [mmol/L]) x (triglicerídeo [TG]/0 81 [mmol/L]). Resultados O tempo de menopausa desde o início foi semelhante em todos os grupos. A circunferência da cintura foi maior naqueles com DMO normal do que nos grupos osteopênicos e osteoporóticos (p = 0 018 e p < 0 001 respectivamente) e também foi maior no grupo osteopênico do que no grupo osteoporótico (p = 0 003) . Altura e peso corporal IMC pressão arterial insulina glicose HDL-colesterol e os níveis de avaliação do modelo de homeostase-resistência à insulina (HOMA-IR) foram semelhantes em todos os grupos. Os níveis de triglicerídeos foram maiores no grupo DMO normal em comparação com o grupo osteoporótico (p = 0 005). O nível de VAI foi detectado como maior naquelas com DMO normal em comparação com as mulheres com osteoporose (p = 0 002). Além disso a análise de correlação mostrou uma correlação positiva entre a absorciometria de raios-X de dupla energia (DXA) nas pontuações T da coluna CC VAI e uma correlação negativa entre as pontuações T da coluna DXA e a idade. Conclusão Em nosso estudo encontramos níveis mais elevados de VAI naquelas com DMO normal em comparação com mulheres com osteoporose. Consideramos que novos estudos com maior tamanho amostral serão benéficos na elucidação da entidade.

The bone mineral density and isokinetic knee strength in amputee soccer players

SUMMARY OBJECTIVE: The aim of this study was to examine the isokinetic knee strength, H/Q ratio (%), and bone mineral density values between amputees (n=14; amputee soccer players) and healthy football players (n=14; non-amputee soccer players). METHODS: A total of 28 amputee soccer players and non-amputee soccer players participated in the study. An isokinetic dynamometer was used to determine the knee flexion/extension forces of the dominant legs of the athletes at 60, 180, and 240°/s. Bone mineral density scans were performed using dual-energy X-ray absorptiometry. RESULTS: H/Q ratio and 60º/s flexion and 180 and 240º/s flexion/extension strength (p<0.05) were found to be high (180º/s, p=0.03; 240º/s, p=0.048) in the non-amputee soccer player group. Accordingly, the bone mineral density values of the lumbar vertebra, femoral neck, proximal metaphysis of the femur (p<0.01), tibia/fibula proximal metaphysis, and tibia/fibula distal metaphysis (p<0.05) were found to be high. A correlation was observed between the 60º/s knee extension strength and tibia/fibula diaphyseal bone mineral density (p=0.025; r=0.594) and tibia/fibula distal metaphysis bone mineral density (p=0.017; r=0.623) values in the amputee soccer players group. The Z-scores of the amputee soccer players and non-amputee soccer players were in the expected range according to age (>-2). CONCLUSION: The bone mineral density, H/Q ratio, and all measured angular velocities of isokinetic strength were high in non-amputee soccer players. This finding made us think that lower extremity amputation may also be associated with losing strength. However, it was observed that the relationship between strength and bone mineral density in amputee athletes might vary according to different angular velocities. It is recommended that isokinetic strength measurement can be evaluated together with bone mineral density in athletes.

Features of lumbar spine texture extracted from routine MRI correlate with bone mineral density and can potentially differentiate patients with and without fragility fractures in the spine

The use of routine magnetic resonance imaging (MRI) to potentially assess skeletal fragility has been widely studied in osteoporosis. The aim of this study was to evaluate bone texture attributes (TA) from routine lumbar spine (LS) MRI and their correlation with vertebral fragility fractures (VFF) and bone mineral density (BMD). Sixty-four post-menopausal women were submitted to LS densitometry, total spine radiographs, and routine T2-weighted LS MRI. Twenty-two TA were extracted with the platform IBEX from L3 vertebra. The statistical difference was evaluated using ANOVA and Duncan's post-test. Correlation analyses were performed using Spearman's coefficient. Statistical significance was considered when P<0.05. The results did not show a significant difference in BMD between the women with and without fractures. Two bone TA (cluster tendency and variance) were significantly lower in the fracture group. Cluster tendency with VFF in osteopenia was 1.54±1.37 and in osteoporosis was 1.11±58. Cluster tendency without VFF in osteopenia was 2.23±1.38 and in osteoporosis was 1.88±1.14). Variance with VFF in osteopenia was 1.44±1.37 and in osteoporosis was 1.13±59. Variance without VFF in osteopenia was 2.34±1.38 and in osteoporosis was 1.89±1.14. There was a significant correlation between BMD and cluster prominence (r=0.409), cluster tendency (r=0.345), correlation (r=0.570), entropy (r=0.364), information measure corr1 (r=0.378), inverse variance (r=0.449), sum entropy (r=0.320), variance (r=0.338), sum average (r=-0.274), and sum variance (r=-0.266). Our results demonstrated the potential use of TA extracted from routine MRI as a biomarker to assess osteoporosis and identify the tendency of skeletal fragility vertebral fractures.

Concentrations of total, bioavailable, and free 25OHD in individuals with and without primary hyperparathyroidism and their correlations to DXA and trabecular bone score

ABSTRACT Objective: This study aimed to investigate the association between 25OHD (total, bioavailable and free) with bone mass and microarchitecture among primary hyperparathyroidism (PHPT) patients and controls. Subjects and methods: Sixty-four patients in the preoperative period of PHPT and 63 matched controls, who had not taken vitamin D in the last three months. To calculate the bioavailable and free 25OHD, the genetic variants of the vitamin D-binding protein (DBP) were determined. Bone mineral density (BMD) was determined by dual-energy X-ray absorptiometry (DXA). The distributions of total, bioavailable and free 25OHD and their correlation with TBS and DXA were evaluated. Results: PHPT showed BMD and TBS values lower than CTRL in all locations (p < 0.05). There were no statistical differences in the levels of free, bioavailable and total 25OHD between the PHPT and CTRL groups [mean, min-max: 3.4 (1.4-8.6) vs. 3.1 (1.0-9.8) pg/mL, 1.51 (0.43-3.58) vs. 1.41 (0.38-3.48) ng/mL, 22.6 (11.0-39.9) vs. 20.6 (8.9-35.3) ng/dL, respectively; (p > 0.05). The distribution of DBP haplotypes was similar between groups. DXA showed no correlation with any form of 25OHD in both groups. TBS presented a weak correlation with the total 25OHD in PHPT (r = 0.28; p = 0.02) and a moderate correlation with the total, free and bioavailable 25OHD in CTRL (r = 0.42; r = 0.42; r = 0.43; respectively, p < 0.01). Conclusion: The concentrations of total, free and bioavailable 25OHD were similar in both the PHPT and control groups. 25OHD concentrations correlated positively with TBS and not with DXA, especially in controls, suggesting that this method may be more sensitive to assessing the consequences of vitamin D deficiency on bone quality in individuals without PHPT.

Effect of walking with blood flow restriction in elderly women with osteoporosis/osteopenia / Efeito da caminhada com restrição do fluxo sanguíneo em idosas com osteoporose/osteopenia

Abstract Introduction The preservation of bone mass in elderly women is associated with better levels of practice of systematic physical exercises. Aerobic training combined with blood flow restriction seems to be a new alternative that determines this process, but knowledge gaps are still observed when referring to exercise associated with blood flow restriction (BFR) and adaptations on bone variables. Objective To analyze the chronic effects of aerobic training with and without BFR on bone mineral density and bone biomarker osteocalcin concentrations in older women. Methods Thirty women were randomized into the following groups: walking on a treadmill at low intensity with BFR; moderate treadmill walking with no BFR; only BFR (no exercise) for 20 minutes, twice a week, for 24 weeks. Bone mineral density was measured before and 24 weeks after intervention. Blood serum osteocalcin concentrations were measured before, 12 and 24 weeks after intervention. Results There were no differences between groups in bone mineral density (femoral neck, p = 0.31; total femur, p = 0.17; lumbar spin, p = 0.06) and osteocalcine (W(2) = 0.27; p = 0.87) ouctomes after 24 weeks of intervention. Conclusion There was no difference between walking training, blood flow restriction only, or walking+blood flow restriction on bone mineral density and osteocalcin concentrations after 24-weeks of intervention in older women with osteopenia/osteoporosis.

Resumo Introdução A preservação da massa óssea em mulheres idosas está associada a melhores níveis de prática de exercícios físicos sistemáticos. O treinamento aeróbico combinado com restrição de fluxo sanguíneo (RFS) parece ser uma nova alternativa que determina esse processo, mas ainda são observadas lacunas de conhecimento quando se refere ao exercício associado à RFS e adaptações nas variáveis ósseas. Objetivo Analisar os efeitos crônicos do treinamento aeróbico com e sem RFS na densidade mineral óssea e nas concentrações do biomarcador ósseo osteocalcina em mulheres idosas. Métodos Trinta mulheres foram randomizadas nos seguintes grupos: caminhada em esteira de baixa intensidade com RFS; caminhada moderada em esteira sem RFS; apenas RFS (sem exercícios) por 20 minutos, duas vezes por semana, durante 24 semanas. A densidade mineral óssea foi medida antes e 24 semanas após a intervenção. As concentrações séricas de osteocalcina no sangue foram medidas antes, 12 e 24 semanas após a intervenção. Resultados Não houve diferenças entre os grupos na densidade mineral óssea (colo do fêmur, p = 0,31; fêmur total, p = 0,17; giro lombar, p = 0,06) e osteocalcina (W(2) = 0,27; p = 0,87) após 24 semanas de intervenção. Conclusão Não houve diferença entre treinamento de caminhada, apenas restrição de fluxo sanguíneo ou caminhada + restrição de fluxo sanguíneo na densidade mineral óssea e nas concentrações de osteocalcina após 24 semanas de intervenção em mulheres idosas com osteopenia/osteoporose.

Influence of tai chi softball on body composition and bone density / Influência do tai chi softball sobre a composição corporal e a densidade óssea / Influencia del tai chi softball en la composición corporal y la densidad ósea

ABSTRACT Introduction Tai Chi Softball fully reflects the most complete and coherent concept of Tai Chi exercise, round and smooth, natural and continuous, and is very suitable for the daily exercise of middle-aged and elderly people. Objective Explore the effect of Tai Chi Softball exercise on body shape and bone mineral density of middle-aged and elderly women. Methods 45 volunteers were recruited and divided into a Tai Chi Softball group and a control group; the Tai Chi Softball group was guided by professional trainers to perform Tai Chi Softball exercises for six months. The control group did not perform Tai Chi Softball exercises and tested various physical indicators for comparison. Results The weight and BMI of middle-aged and elderly women showed a decreasing trend. The abdominal and arm skinfold measurements were significantly different from those before the experiment (P < 0.01). Body fat percentage decreased significantly, and muscle weight increased, showing statistical significance (P < 0.05). Conclusion Tai Chi Softball exercise can alleviate the rapid decline in bone mineral density and bone mineral content in middle-aged and elderly women. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução O Tai Chi Softball reflete integralmente o conceito mais completo e coerente do exercício de Tai Chi, redondo e suave, natural e contínuo, sendo muito adequado para o exercício diário de pessoas de meia-idade e idosas. Objetivo Explorar o efeito do exercício de Tai Chi Soft Ball na composição corporal e densidade mineral óssea de mulheres de meia-idade e idosas. Métodos 45 voluntários foram recrutados e divididos em um grupo de Tai Chi Softball e um grupo de controle, o grupo de Tai Chi Softball foi orientado por treinadores profissionais para realizar exercícios de Tai Chi Softball por 6 meses. O grupo de controle não realizou o exercício de Tai Chi Softball, e testou vários indicadores físicos para comparação. Resultados O peso e o IMC das mulheres de meia-idade e idosas mostraram uma tendência decrescente. Entre elas, as medidas de dobra cutânea do abdômen e braço foram significativamente diferentes daquelas anteriores à experiência (P < 0,01). O percentual de gordura corporal diminuiu significativamente e o peso muscular aumentou, apresentando significância estatística (P<0,05). Conclusão O exercício de Tai Chi Softball pode aliviar o rápido declínio da densidade mineral óssea e do conteúdo mineral ósseo em mulheres de meia-idade e idosas. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción El Tai Chi Softball refleja plenamente el concepto más completo y coherente del ejercicio de Tai Chi, redondo y suave, natural y continuo, y es muy adecuado para el ejercicio diario de las personas de mediana edad y mayores. Objetivo Explorar el efecto del ejercicio de Tai Chi Softball sobre la composición corporal y la densidad mineral ósea de mujeres de mediana edad y mayores. Métodos Se reclutaron 45 voluntarias y se dividieron en un grupo de Tai Chi Softball y un grupo de control, el grupo de Tai Chi Softball fue guiado por entrenadores profesionales para realizar ejercicios de Tai Chi Softball durante 6 meses. El grupo de control no realizó el ejercicio, y se sometió a varios indicadores físicos para su comparación. Resultados El peso y el IMC de las mujeres de mediana edad y de edad avanzada mostraron una tendencia a la baja. Entre ellos, las medidas de los pliegues cutáneos abdominales y del brazo fueron significativamente diferentes de las anteriores al experimento (P < 0,01). El porcentaje de grasa corporal disminuyó significativamente y el peso muscular aumentó, mostrando significancia estadística (P < 0,05). Conclusión El ejercicio de Tai Chi Softball puede aliviar el rápido descenso de la densidad mineral ósea y del contenido mineral óseo en mujeres de mediana edad y mayores. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Comparison on Performance of Quantitative Ultrasound and Dual-Energy X-ray Absorptiometry in Evaluating Bone Health of Adults Aged 18-40 Years / 中国医学科学院学报

Objective To compare the consistency of quantitative ultrasound(QUS)and dual-energy X-ray absorptiometry(DXA)in measuring bone mineral density(BMD)of adults aged 18-40 years in Guangzhou and evaluate the diagnostic value of QUS for identifying low bone mass.Methods DXA was employed to measure the BMD and QUS to measure the speed of sound(SOS)in 731 participants.The Bland-Altman analysis was performed to evaluate the consistency of Z scores between SOS and BMD.With the BMD Z ≤-2.00 as the diagnostic criterion for low bone mass,the receiver operating characteristics curve of QUS was established,and the area under the curve(AUC)and the sensitivity,specificity,and correct diagnostic index for the optimal cut-off of SOS Z score were calculated.Results The results of Bland-Altman analysis showed that the mean differences in the Z scores of SOS and BMD in males and females were 1.27(-0.94 to 3.47)and 0.93(-1.33 to 3.18),respectively.The AUC of SOS Z score in the diagnosis of low bone mass in males and females was 0.734(95%CI=0.380-0.788)and 0.679(95%CI=0.625-0.732),respectively.In males,the optimal cut-off of SOS Z score for low bone mass was -0.35,with the sensitivity,specificity,and correct diagnostic index of 64.1%,68.6%,and 0.327,respectively.In females,the optimal cut-off value of SOS Z scores for low bone mass was -1.14,with the sensitivity,specificity,and correct index of 73.9%,54.8%,and 0.285,respectively.Conclusion QUS and DXA show poor consistency in the diagnosis of BMD in the adults aged 18-40 years in Guangzhou,while QUS demonstrates an acceptable value in identifying low bone mass.

Study on correlation between bone marrow edema and osteoporosis in patients with severe knee osteoarthritis / 中国骨伤

OBJECTIVE@#To explore relationship between bone marrow edema(BME) and osteoporosis in patients with severe knee osteoarthritis.@*METHODS@#Unmatched case-control study was conducted. Totally 160 patients with severe knee osteoarthritis who had undergone knee magnetic resonance imaging (MRI) and bone mineral density examination (BMD) from January 2020 to March 2021 were included. Eighty patients complicated with BME were included in BME group, and 80 patients without BME were selected as NBME group. In BME group, there were 12 males and 68 females, aged from 51 to 80 years old with an average of(66.58±8.10) years old;the courses of disease ranged from 5 to 40 months with an average of (15.61±9.25) months;body mass index(BMI) ranged from 21.81 to 34.70 with an average of (27.79±3.00) kg·m-2;25 patients classified to grade Ⅲ and 55 patients grade Ⅳ according to Kellgren- Lawrence(K-L). In NBME group, there were 15 males and 65 females, aged from 50 to 80 years old with an average of(67.82±8.05) years old;the course of disease ranged from 6 to 37 months with an average of(15.75±8.18) months;BMI ranged from 21.39 to 34.46 with an average of (28.26±3.13) kg·m-2;25 patients were K-L Ⅲ and 55 patients with K-L Ⅳ. The degree of bone marrow edema was evaluated by knee whole oragan magnetic resonance imaging score(WORMS). Osteoporosis was diagnosed and BMD was evaluated by DXA T value. To explore the relationship between bone marrow edema and osteoporosis by comparing prevalence rate of osteoporosis between two groups, and to further explore relationship between BME and BMD by Spearman correlation analysis of BME WORMS score and DXA T value in BME group.@*RESULTS@#The complete case data were obtained on the first diagnosis, and there was no significant difference in sex, age, courses of disease and BMI between two groups (P>0.05). The proportion of K-L Ⅳ in BME group was significantly higher than that in NBME (P<0.05). The prevalence rate of osteoporosis in BME group was significantly higher than in NBME group with the same K-L grade (P<0.001), and there was a strong negative correlation between BME WORMS score and DXA BMD T value (r=-0.812, |r|=0.812 >0.8, P<0.001).@*CONCLUSION@#Osteoporosis is one of the risk factors of bone marrow edema in patients with severe knee osteoarthritis, and the lower the bone mineral density is, the easier it is to be complicated with bone marrow edema.

Association of non-alcoholic fatty liver disease and advanced liver fibrosis with osteoporosis in type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective:To study the association of non-alcoholic fatty liver disease(NAFLD) and advanced liver fibrosis with osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods:Data was collected from 391 in-patients with type 2 diabetes mellitus(T2DM) from September 2019 to September 2020 at the Department of Endocrinology and Geriatric Medicine, Affiliated Huai′an First Hospital of Nanjing Medical University in this cross-sectional study. Participants were divided into T2DM with coexistent NAFLD(TCN) and with no NAFLD(TON) group via liver B-mode ultrasound.Also, the patients were divided into low and middle-high risk group via fibrosis index based on 4 factors index(FIB-4). Participant characteristics, laboratory results, and dual energy x-ray absorptiometry were obtained and analyzed. Multivariable logistic regression models were used to evaluate the association of NAFLD and advanced liver fibrosis with osteoporosis in T2DM. Interaction and stratified analyses were conducted according to age, sex, body mass index(BMI) and duration of diabetes(DD).Results:There was no significant difference in risk of osteoporosis and bone mineral density(BMD) loss between TCN and TON group(all P>0.05). After adjusting for age, sex, BMI, and DD, total hip BMD( β=-0.044, 95% CI -0.087--0.001, P=0.046) and lumbar L 1-L 4BMD( β=-0.044, 95% CI -0.087--0.002, P=0.044) were significantly reduced, and the risk of osteoporosis was significantly increased( OR=2.428, 95% CI 1.124-5.244, P=0.024) in FIB-4 middle-high risk group compared with low risk group. The subgroup analysis showed that overweight patients with T2DM had a significantly increased risk of osteoporosis( OR=4.240, 95% CI 1.637-10.987, interaction P=0.018) in FIB-4 middle-high risk group compared with low risk group. Conclusion:There was no significant difference in risk of osteoporosis and BMD loss between TCN and TON group. However, among T2DM patients who were overweight, NAFLD-related progressive liver fibrosis emerged as an independent risk factor for both BMD decline and the development of osteoporosis.

Bone turnover markers, hip bone geometry parameters and metabolic syndrome in community overweight postmenopausal women / 中华内分泌代谢杂志

Objective:To explore the changes of bone turnover markers and geometric parameters of hip bone in overweight postmenopausal women with metabolic syndrome(MS), as well as the influence of MS components. To analyze the association of these factors with the risk of fracture.Methods:A total of 505 overweight postmenopausal female patients who underwent health check-up in Lianhu Community Service Center, Danyang City, Jiangsu Province from January to December 2017 were selected. According to the MS diagnostic criteria of the International Diabetes Federation(2009), the patients were divided into MS group( n=331)and non-MS group( n=174). Blood samples were collected to determine the level of procollagen type 1 N-terminal propeptide(P1NP)and carboxy-terminal cross-linked telopeptide of type 1 collagen(CTX). Bone mineral density and hip bone geometry parameters were tested with dual-energy X-ray absorptiometry and hip structural analysis software. Results:The incidence of osteoporotic fracture and hip fracture in MS group was significantly higher than that in non-MS group(21.1% vs 13.8%, 4.8% vs 1. 1%, P<0.05). However, the bone mineral density of lumbar vertebra 1-4, femoral neck, and total hip in MS group was significantly higher than that in non-MS group, which remained after adjusting for age( P<0.05), but the difference disappeared after further adjustment for body mass index( P>0.05). The P1NP, CTX, femur strength index(FSI), section modulus(SM), and cross-sectional area(CSA)of MS group were significantly lower than those of non-MS group, the buckling ration(BR)was significantly higher than that in non-MS group, and the differences were still statistically significant after adjusting for age and body mass index( P<0.05). There was no significant difference in bone mineral density of lumbar vertebra 1-4, femoral neck, total hip, P1NP, and CTX between fracture group and non-fracture group in patients with MS. But FSI, SM, cross-sectional moment of inertia(CSMI), and CSA were significantly lower, BR was significantly higher( P<0.05) and femur strength decreased in patients with fracture. Regression analysis showed that high BR was an independent risk factor for fracture risk, while high FSI, SM, CSMI, and CSA were protective factors. Multivariate linear regression analysis showed that wasit circumference, diastolic blood pressure, and fasting plasma glucose were the main MS components affecting bone mineral density, bone turnover indexes, and hip bone geometry parameters. Conclusions:Overweight postmenopausal MS patients had decreased bone turnover rate, femoral strength, and relatively poor bone quality. Hip bone geometry parameters can be used as one of the methods to assess fracture risk in MS patients. Waist circumference, diastolic blood pressure, and fasting blood glucose are the important MS components affecting bone mass and bone quality.

Effect of health management of progressive resistance training on the self-efficacy and bone mineral density improvement in patients with osteoporosis / 中华健康管理学杂志

Objective:To explore the effect of health management of progressive resistance training on self-efficacy and bone mineral density (BMD) improvement in osteoporosis patients.Methods:It was a cross-sectional study. Clinical data of 156 patients with primary osteoporosis treated in Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from September 2019 to March 2022 were analyzed retrospectively. A simple random sampling method was implied, and 78 patients were set as control group, they were treated with conventional osteoporosis drugs and routine health education and peer education. And the other 78 patients were set as observation group, and progressive resistance training was added to the health management program in these patients on the basis of the intervention of the control group. Combined with the 6-month follow-up records of the two groups, the changes of self-efficacy level and the improvement of BMDin the two groups before and after the intervention were analyzed and compared. The above indexes were statistically analyzed with χ2 test or t test. Results:The compliance of diet, psychology, exercise and medication in the observation group was 97.4%, 97.4%, 98.7% and 97.4%, respectively, which were all higher than those in the control group (89.7%, 87.2%, 88.5% and 87.2%). The self-efficacy score before and after intervention in the observation group was 110.09±11.73 and 217.05±8.12, the anxiety score was 46.44±3.17 and 31.92±3.28, the depression score was 51.60±3.42 and 33.32±2.98, the osteoporosis knowledge score was 14.99±2.14 and 24.40±1.28, respectively; and those were 110.81±12.53 and 185.36±12.29, 46.92±2.18 and 36.53±3.54, 51.56±3.93 and 39.02±2.65, 14.76±2.93 and 20.11±1.84 respectively in the control group; and there was no statistically significant difference in above-mentioned indexes between the two groups before the intervention (all P>0.05); but after 6 months of intervention, the above-mentioned scores of the observation group were all significantly superior than those in the control group (all P<0.05). The BMD of lumbar spine L 1-4, femoral trochanter and hip in the observation group before intervention was 0.869±0.127, 0.608±0.110 and 0.740±0.138, respectively, and after the intervention, it was 0.915±0.107, 0.654±0.108 and 0.785±0.134, respectively; the BMD of lumbar spine L 1-4, femoral trochanter and hip in the control group was 0.833±0.126, 0.607±0.114 and 0.738±0.135, respectively before intervention, and it was 0.869±0.114, 0.643±0.114 and 0.748±0.124, respectively after intervention. After intervention, the lumbar L 1-4 bone density in the observation group was higher than that in the control group, the difference was statistically significant ( P<0.05). There was no significant difference in all the BMD before intervention and the BMD of the femoral trochanter and the hip after intervention between the two groups (all P>0.05). Conclusion:The health management of progressive resistance training combined with drug therapy can effectively improve the BMD in patients with osteoporosis.

Association of serum sRANKL and Omentin-1 levels with bone mineral density and bone metabolism in postmenopausal osteoporosis patients / 中华内分泌外科杂志

Objective:To investigate the relationship between serum soluble receptor activator of nuclear factor-κB ligand (sRANKL), Omentin-1 levels and postmenopausal osteoporosis (PMOP) .Methods:A total of 310 menopausal patients admitted to Qingdao Municipal Hospital from Jun. 2017 to Jul. 2021 were selected, including 165 patients with PMOP and 145 women with simple menopause as the control group. Serum sRANKL and Omentin-1 levels were detected by ELISA. Bone mineral density and bone metabolism indexes [N-terminal propeptide of typeⅠprecollagen (PINP), bone alkaline phosphatase (BALP), β isomer of the C-terminal telopeptide of type Ⅰ collagen (β-CTX) and osteocalcin (OC) ] were compared between the two groups. The correlation between serum sRANKL and Omentin-1 levels and bone mineral density and bone metabolism indexes in PMOP patients was analyzed by Pearson. The predictive value of sRANKL and Omentin-1 to PMOP was analyzed by ROC curve. Logistic regression analysis of the influence of multiple factors on PMOP.Results:Compared with the control group (15.62±4.41) (42.56±8.53), the serum sRANKL level (26.63±8.12) was increased and Omentin-1 level (32.32±5.52) was decreased in PMOP group ( t=14.55, P<0.001; t=12.69, P<0.001). The serum sRANKL in PMOP group was positively correlated with PINP, β-CTX and OC, while the serum Omentin-1 level was negatively correlated with the above indexes by Pearson analysis. ROC curve showed that serum sRANKL and Omentin-1 had important reference significance in predicting PMOP. Logistic regression suggested that increased sRANKL and decreased Omentin-1 were risk factors for PMOP. Conclusion:Serum sRANKL and Omentin-1 in patients with PMOP are correlated with bone mineral density and bone metabolism, and have potential as diagnostic targets of PMOP.

Correlation analysis between renin-angiotensin system and bone mineral density in children with glucocorticoid-induced osteoporosis / 中华内分泌外科杂志

Objective:To investigate the relationship between renin-angiotensin system (RAS) and bone mineral density in children with glucocorticoids-induced osteoporosis (GIOP) .Methods:From Apr. 2020 to May. 2021, 53 children with GIOP were recruited in the Children’s Hospital of Taiyuan Maternal and Child Health Hospital and included in the observation group, and 47 children who received glucocorticoid therapy but did not suffer from GIOP were included in the control group. The levels of serum RAS components and bone mineral density of the two groups of pediatric patients were detected and compared, and the risk clinical indicators affecting bone mineral density and GIOP were analyzed.Results:There were no significant differences between the observation group and the control group in terms of gender, age, BMI, disease type, type of glucocorticoid use, use of anti-osteoporosis (OP) drugs, expression levels of Angiotensin converting enzyme 2 (ACE2) or angiotensin II (Ang Ⅱ) (all P>0.05) . The bone density value of the observation group was lower than those of the control group, and the levels of angiotensin converting enzyme (ACE) (1.19±0.23) , angiotensin receptor 1 (AT1R) (1.24±0.24) , angiotensin receptor 2 (AT2R) (1.14±0.17) , and Mas receptor (MasR) (1.11±0.28) were significantly higher than those of the control group (1.00±0.23, 1.00±0.25, 1.00±0.21, 1.00±0.20) , and the differences were statistically significant (all P<0.05) . Pearson analysis showed that bone mineral density was negatively correlated with the levels of ACE ( r=-0.34, P=0.013) , AT1R ( r=-0.41, P=0.002) and AT2R ( r=-0.34, P=0.014) , and stepwise regression model showed that ACE ( t=-2.21, P=0.032) and AT1R ( t=-2.92, P=0.005) were the main factors affecting bone mineral density. Logistic regression model analysis showed that bone mineral density ( OR=0.85, P<0.001) , Ang Ⅱ ( OR=0.53, P=0.041) and AT2R ( OR=2.00, P=0.024) were independent clinical risk factors affecting GIOP (all P<0.05) . Conclusion:RAS components ACE and AT1R are independent risk factors affecting bone mineral density in children with GIOP, and are significantly correlated with bone mineral density in children.

Biomechanical CT for Assessment of Osteoporotic Vertebral Fracture Risk / 医用生物力学

Osteoporosis is characterized by decreased bone strength and increased fracture risk. The most serious consequence of osteoporosis is fracture, which commonly occurs in vertebrae. Accurate assessment of fracture risk at an earlier stage is the key to identify high-risk population and further prevent osteoporotic fracture. Currently, clinical assessment of vertebral fracture risk mainly relies on measurement of bone mineral density (BMD) based on dual energy X-ray absorptiometry ( DXA) or quantitative computed tomography ( QCT). However, they cannot fully reflect bone strength and resistance to fracture, and it is hard to achieve an accurate assessment. Biomechanical CT (BCT) technology, based on CT digital modeling and finite element analysis, aims at non-invasive calculation of individual bone strength, bridging the gap between biomechanics and clinical evaluation of fracture risk. In vitro mechanical experiment of vertebrae has proved that BCT is more accurate than BMD in evaluating vertebral fracture strength. Clinical studies have also shown that BCT is superior to DXA inidentifying existing fractures and predicting new fractures. In this article, the implementation process of the BCT technology was introduced, as well as critical parameters during each step affecting its result . The research progress of the BCT technique for in vitro validation and in vivo assessment of vertebral fracture risk was also summarized, with the aim to promote the application of BCT technology in clinical assessment of vertebral fracture risk for the Chinese people.