Bone effects of epidural and intra-articular glucocorticoids: a systematic literature review / Efectos óseos de los glucocorticoides epidurales e intraarticulares: revisión sistemática de la literatura

Osteoporosis and vertebral and non-vertebral fractures are common in glucocorticoids (GC) treated patients. Oral GC treatment leads to bone loss, particularly of trabecular bone. The benefits of GC used in rheumatological and traumatological disorders are known but they would have possible negative effects on bone. This systematic review aimed to evaluate the effects of epidural steroid injections (ESI), and intra-articular and intramuscular GC administration on bone mineral density (BMD) and fragility fractures. A systematic review of Medline/PubMed, Cochrane, and LILACS up to November 2020 was conducted. Meta-analyses, systematic reviews, randomized and non-randomized controlled trials, and prospective and retrospective studies comparing the effect of ESI, intra-articular or intramuscular GC used compared to a control group or baseline measurements were included. Results: A total of 8272 individuals were included among the 13 selected articles (10 about ESI and 3 about intra-articular GC; no article was found evaluating intramuscular GC). Only a few studies showed a negative effect of ESI on bone in the qualitative analysis considering osteopenia and osteoporosis in lumbar spine, femoral neck and total hip and BMD as surrogate outcomes. On the other hand, the qualitative analysis showed that most studies found an increased risk of fragility fracture. However, only two studies could be included in the quantitative analysis, in which there were no differences between patients exposed to ESI versus controls in all evaluated regions. In conclusion, there was insufficient evidence to suggest that ESI and intra-articular GC, unlike oral GC, negatively affect bone mass. Longitudinal studies are needed to obtain more knowledge regarding the effect of ESI or intra-articular GC on BMD and fragility fractures. (AU)

La osteoporosis y las fracturas vertebrales y no vertebrales son comunes en pacientes tratados con glucocorticoides (GC). El tratamiento oral con GC conduce a la pérdida ósea, particularmente del hueso trabecular. Los beneficios de los GC utilizados en patologías reumatológicas y traumatológicas son conocidos, pero tendrían posibles efectos negativos sobre el hueso. Esta revisión sistemática tuvo como objetivo evaluar los efectos de las inyecciones epidurales de esteroides (ESI), GC intraarticulares e intramusculares sobre la densidad mineral ósea (DMO) y las fracturas por fragilidad. Se realizó una revisión sistemática de Medline/PubMed, Cochrane y LILACS hasta noviembre de 2020. Se incluyeron metanálisis, revisiones sistemáticas, ensayos controlados aleatorizados y no aleatorizados, estudios prospectivos y retrospectivos que compararon el efecto de ESI, GC intraarticular o intramuscular utilizado en comparación con un grupo de control o mediciones iniciales. Resultados: Se incluyeron un total de 8272 individuos entre los 13 artículos seleccionados (10 sobre ESI y 3 sobre GC intraarticular; no se encontró ningún artículo que evaluara GC intramuscular). Solo unos pocos estudios mostraron un efecto negativo del ESI sobre el hueso en el análisis cualitativo considerando la osteopenia y la osteoporosis en la columna lumbar, el cuello femoral y la cadera total y la DMO como un resultado indirecto. Por otro lado, el análisis cualitativo mostró que la mayoría de los estudios encontraron un mayor riesgo de fractura por fragilidad. Sin embargo, solo dos estudios pudieron incluirse en el análisis cuantitativo, en los que no hubo diferencias entre los pacientes expuestos a ESI versus los controles en todas las regiones evaluadas. En conclusión, no hallamos datos suficientes para sugerir que la ESI y los GC intraarticulares, a diferencia de los GC orales, afectan negativamente a la pérdida ósea. Se necesitan estudios longitudinales para obtener más conocimiento sobre el efecto de ESI o GC intraarticular en la DMO y las fracturas por fragilidad. (AU)

Resveratrol Modulates Bone Mineral Density and Bone Mineral Content in A Rat Model of Male Hypogonadism / 中国结合医学杂志

OBJECTIVE@#To determine whether resveratrol (Res) can correct osteoporosis induced in a rat model of male hypogonadism.@*METHODS@#Thirty-two rats were randomly divided into 4 groups, 8 in each group; 1) a control sham group: underwent a similar surgical procedure for induction of orchiectomy (ORCD) without ligation of any arteries or veins or removal of the testis and epididymis; 2) a control + Res-treated group (Con+Res): underwent sham surgery similar to the control, but was then treated with Res, as described below; 3) an ORCD-induced group: bilateral ORCD surgery as described above, and 4) a ORCD+Res-treated group: bilateral ORCD surgery followed by Res treatment. Res treatment began 4 weeks after ORCD and continued for 12 weeks. After 12 weeks, bone mineral density (BMD) and bone mineral content (BMC) were measured in the tibia and femur of each rat's right hind leg. Blood levels of bone turnover indicators such as deoxypyridinoline (Dpd), N-telopeptide of type I collagen (NTX I), alkaline phosphatase (ALP), and osteocalcin (OC), as well as receptor activator of nuclear factor kappa B (RANK) and osteoprotegerin (OPG) were assessed.@*RESULTS@#ORCD significantly decreased BMD (P<0.01) and significantly increased bone resorption, manifested by increased RANK. In addition, it inhibited serum levels of OPG and OC. Res treatment after ORCD effectively increased serum levels of bone formation markers such as OPG and OC, compared with testisectomized rats (P<0.05).@*CONCLUSION@#Res could ameliorate bone loss induced by male hypogonadism, possible via restoration of the normal balance between RANK and OPG.

Guidelines for diagnosis and treatment of glucocorticoid-induced osteoporosis / 中华内科杂志

Glucocorticoid-induced osteoporosis (GIOP) is a skeletal disease characterized by decreased bone strength and increased fracture risk associated with long-term glucocorticoid use. GIOP is the most common secondary osteoporosis that critically affects the quality of life of patients. Currently, the incidence of GIOP in China remains high, with insufficient awareness and lack of prevention and treatment norms. Therefore, the Chinese Rheumatology Association has established this standard based on domestic and international experience, with the aim of raising awareness of prevention and treatment among clinicians, guiding the standardized diagnosis and treatment of this disease, and improving the overall prognosis of patients with GIOP.

Iron accumulation and its impact on osteoporotic fractures in postmenopausal women / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Postmenopausal osteoporosis is a kind of degenerative disease, also described as "invisible killer." Estrogen is generally considered as the key hormone for women to maintain bone mineral content during their lives. Iron accumulation refers to a state of human serum ferritin that is higher than the normal value but less than 1000 μg/L. It has been found that iron accumulation and osteoporosis could occur simultaneously with the decrease in estrogen level after menopause. In recent years, many studies indicated that iron accumulation plays a vital role in postmenopausal osteoporosis, and a significant correlation has been found between iron accumulation and fragility fractures. In this review, we summarize and analyze the relevant literature including randomized controlled trials, systematic reviews, and meta-analyses between January 1996 and July 2022. We investigate the mechanism of the effect of iron accumulation on bone metabolism and discuss the relationship of iron accumulation, osteoporosis, and postmenopausal fragility fractures, as well as the main clinical treatment strategies. We conclude that it is necessary to pay attention to the phenomenon of iron accumulation in postmenopausal women with osteoporosis and explore the in-depth mechanism of abnormal bone metabolism caused by iron accumulation, in order to facilitate the discovery of effective therapeutic targets for postmenopausal osteoporosis.

Systematic review and Meta-analysis of Gusongbao preparation in treatment of primary osteoporosis / 中国中药杂志

This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P<0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P<0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P<0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.

Birth weight and bone mineral density at 18-19 years: birth cohort 1997-1998 / Peso ao nascer e densidade mineral óssea aos 18-19 anos: coorte de nascimentos 1997-1998

ABSTRACT OBJECTIVE To analyze the association between birth weight and bone mineral density (BMD) in adolescence. METHODS A birth cohort study in São Luís, Maranhão, using data from two moments: at birth and at 18-19 years. Exposure was the birth weight in grams, continuously analyzed. The outcome was BMD, using the Z-score index (whole body) measured by double X-ray densitometry (Dexa). A theoretical model was constructed in acyclic graphs to identify the minimum set of adjustment variables - household income, the mother knowing how to read and write at the time of birth, prenatal care, tobacco use during pregnancy, and parity — to evaluate the association between birth weight and bone mineral density in adolescence. Multiple linear regression was used in Stata 14.0 software. A 5% significance level was adopted. RESULTS From 2,112 adolescents, 8.2% had low birth weight and 2.8% had a low BMD for their age. The mean full-body Z-score was 0.19 (± 1.00). The highest birth weight was directly and linearly associated with BMD values in adolescence (Coef.: 0.10; 95%CI: 0.02-0.18), even after adjustment for the variables household income (Coef.: -0.33; 95%CI: -0.66-0.33) and the mother knowing how to read and write (Coef.: 0.23%; 95%CI: 0.03-0.43). CONCLUSION Although after adjusting the variables the association attenuated, birth weight positively and linearly relates to BMD in adolescence.

RESUMO OBJETIVO Analisar a associação entre o peso ao nascer e a densidade mineral óssea (DMO) na adolescência. MÉTODOS Estudo de coorte de nascimentos em São Luís, Maranhão, utilizando dados de dois momentos: ao nascimento e aos 18-19 anos. A exposição foi o peso ao nascer em gramas, analisado de forma contínua. O desfecho foi a DMO, utilizando o índice Z-escore (corpo inteiro) medido pela densitometria por dupla emissão de raios X (DEXA). Foi construído modelo teórico em gráficos acíclicos direcionados para identificar o conjunto mínimo de variáveis de ajuste - renda familiar, a mãe saber ler e escrever à época do nascimento, realização de pré-natal, tabagismo durante a gestação e paridade - para avaliar a associação entre o peso ao nascer e a densidade mineral óssea na adolescência. Utilizou-se regressão linear múltipla no software Stata 14.0. O nível de significância adotado foi de 5%. RESULTADOS Dos 2.112 adolescentes, 8,2% apresentaram baixo peso ao nascer e 2,8% apresentaram DMO considerada baixa para a idade. O Z-escore médio de corpo inteiro foi de 0,19 (± 1,00). O maior peso ao nascer foi associado de forma linear e direta aos valores de DMO na adolescência (Coef.: 0,10; IC95% 0,02-0,18), mesmo após ajuste para as variáveis renda familiar (Coef.: -0,33; IC95% -0,66-0,33) e a mãe saber ler e escrever (Coef.: 0,23; IC95% 0,03-0,43). CONCLUSÕES Apesar de a associação ter sido atenuada após ajuste das variáveis, o peso ao nascer está associado de forma positiva e linear à DMO na adolescência.

Bone density and implant stability with advanced platelet-rich fibrin in immediately loaded- implant assisted mandibular overdentures / Densidade óssea e estabilidade dos implantes com fibrina rica em plaquetas avançada em overdentures mandibulares com carga imediata

ABSTRACT Objective: The aim of this study is to determine the effect of Advanced Platelet-Rich Fibrin on bone density and implant stability in immediately loaded- implant-assisted mandibular overdentures (Split-mouth study). Material and Methods: Ten completely edentulous patients received two implants in the mandibular canine region and locator attachments were used to retain immediately loaded- implant mandibular overdentures. Each patient served in two Groups, one Group for each side. One side of the mandible received an implant with topical application of Advanced Platelet-Rich Fibrin in the implant osteotomy site (Group I) and the other site received an implant without application of Advanced platelet-rich fibrin (Group II). Each patient was examined clinically for implant stability using Osstell Mentor device and radiographically by ultra-low dose CT scan to measure bone density around the implant at baseline, three, six months, and one year. Results: There were no statistically significant differences (P>.05) in bone density and implant stability among the studied Groups during one year follow-up period. Conclusion : Advanced Platelet-Rich Fibrin has no effect on bone density and implant stability in immediately loaded implant-assisted mandibular overdenture.(AU)

RESUMO Objetivo: O objetivo deste estudo é determinar o efeito da Fibrina Rica em Plaquetas Avançada na densidade óssea e estabilidade dos implantes em Overdentures mandibulares com carga imediata (estudo de boca dividida). Material e Métodos: Dez pacientes edêntulos foram submetidos à instalação de dois implantes mandibulares na região dos caninos e pilares locator foram utilizados como sistema de retenção para as overdentures mandibulares com carga imediata. Cada paciente participou nos dois grupos, sendo um grupo para cada lado. Um lado da mandíbula recebeu implante com aplicação tópica de Fibrina Rica em Plaquetas Avançada no local do sítio cirúrgico do implante (Grupo I) e o outro local recebeu implante sem aplicação de Fibrina Rica em Plaquetas Avançada (Grupo II). Cada paciente foi examinado clinicamente quanto à estabilidade do implante usando o dispositivo Osstell Mentor e radiograficamente por tomografia computadorizada de ultrabaixa dose para medir a densidade óssea ao redor do implante no início do estudo, três, seis meses e um ano. Resultados: Não houve diferenças estatisticamente significativas (P>0,05) na densidade óssea e na estabilidade do implante entre os grupos estudados durante o período de acompanhamento de um ano. Conclusão: A Fibrina Rica em Plaquetas Avançada não tem efeito na densidade óssea e na estabilidade de implantes em Overdentures mandibulares com carga imediata (AU)

Influence of sports injuries and resistance training on skiers' bone mass / Influência de lesões esportivas e treinamento de resistência na massa óssea de esquiadores / Influencia de las lesiones deportivas y del entrenamiento de resistencia en la masa ósea de los esquiadores

ABSTRACT Introduction: With the preparation and development of the Winter Olympic Games, there has been an increase in the popularity of skiing. Driven by this demand, the professional development of coaches requires updates in the analysis of skiers' sports injuries, elaboration of corresponding prevention and treatment strategies, and resistance training to promote the development of athletes' physical quality, such as bone mass and mineral density. Objective: Study the sports injuries of skiers and explore needs and ways of applying resistance training in skiing. Methods: The questionnaire survey was used to explore the main types of injuries and their influencing factors. Then, 20 volunteers were selected for the resistance training experiment; each group of 10 people included five men and five women. The control group maintained a normal daily life, while resistance training was added to the experimental group three times a week, based on the control group. Results: The research results showed that the current proportion of skiing injuries was relatively high, mainly in mild injuries. After nine weeks in the experimental resistance training group, both men and women had positive bone mass development. Conclusion: Resistance training can improve physical quality and reduce the occurrence of sports injuries, demonstrating the benefits of its implementation in endurance training for skiers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com a preparação e desenvolvimento dos Jogos Olímpicos de Inverno, houve um aumento da popularidade do esqui. Impulsionados por essa demanda, o desenvolvimento profissional dos treinadores requer atualizações nas análises de lesões esportivas dos esquiadores, elaboração de estratégias de prevenção e tratamento correspondentes, além de treinamentos de resistência de modo a promover o desenvolvimento da qualidade física dos atletas, como a massa óssea e sua densidade mineral. Objetivo: Estudar as lesões esportivas dos esquiadores e explorar necessidades e modos de aplicação do treino de resistência no esqui. Métodos: O método de pesquisa por questionário foi utilizado para explorar os principais tipos de lesões e seus fatores influenciadores. Em seguida, 20 voluntários foram selecionados para o experimento de treinamento de resistência, cada grupo de 10 pessoas incluiu 5 homens e 5 mulheres. O grupo controle manteve uma vida diária normal, enquanto ao grupo experimental foi adicionado um treinamento de resistência, três vezes por semana, com base no grupo controle. Resultados: Os resultados da pesquisa mostraram que a proporção atual de lesões por esqui foi relativamente alta, principalmente em lesões leves. Após 9 semanas no grupo experimental de treinamento de resistência, tanto homens quanto mulheres tiveram desenvolvimento positivo de massa óssea. Conclusão: O treinamento de resistência pode não só melhorar a qualidade física, mas também reduzir a ocorrência de lesões esportivas, demonstrando os benefícios de sua implementação no treinamento de resistência dos esquiadores. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con la preparación y el desarrollo de los Juegos Olímpicos de Invierno, ha aumentado la popularidad del esquí. Impulsado por esta demanda, el desarrollo profesional de los entrenadores requiere actualizaciones en el análisis de las lesiones deportivas de los esquiadores, la elaboración de las correspondientes estrategias de prevención y tratamiento, así como el entrenamiento de la resistencia para promover el desarrollo de la calidad física de los atletas, como la masa ósea y la densidad mineral. Objetivo: Estudiar las lesiones deportivas de los esquiadores y explorar las necesidades y formas de aplicar el entrenamiento de resistencia en el esquí. Métodos: Se utilizó el método de encuesta por cuestionario para explorar los principales tipos de lesiones y sus factores de influencia. A continuación, se seleccionaron 20 voluntarios para el experimento de entrenamiento de resistencia, cada grupo de 10 personas incluía 5 hombres y 5 mujeres. El grupo de control mantuvo una vida diaria normal, mientras que al grupo experimental se le añadió un entrenamiento de resistencia, tres veces por semana, basado en el grupo de control. Resultados: Los resultados de la investigación mostraron que la proporción actual de lesiones de esquí era relativamente alta, principalmente en las lesiones leves. Después de 9 semanas en el grupo experimental de entrenamiento de resistencia, tanto los hombres como las mujeres tuvieron un desarrollo positivo de la masa ósea. Conclusión: El entrenamiento de resistencia no sólo puede mejorar la calidad física, sino también reducir la aparición de lesiones deportivas, lo que demuestra los beneficios de su aplicación en el entrenamiento de resistencia de los esquiadores. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Absorción mineral y retención ósea en ratas normales en crecimiento por el consumo de un yogur experimental reducido en lactosa que contiene galactooligosacáridos (GOS) / Mineral absorption and bone retention in normal growing rats by consumption of an experimental lactose-reduced yogurt containing galactooligosaccharides (GOS)

Introducción: Los GOS son prebióticos naturales presentes en la leche materna que pue-den obtenerse enzimáticamente a partir de la lactosa de leche de vaca durante la fabricación de yogur. El producto lácteo resultante será reducido en lactosa y contendrá prebióticos y bacterias potencialmente probióticas. Sin embargo, mantendrá la baja relación Ca/Pi que aporta la leche de vaca, lo que podría alterar el remodelamiento óseo y la mineralización. Objetivo: comparar si un yogur reducido en lactosa que contiene GOS (YE) ofrece ventajas adicionales respecto de un yogur regular sin GOS (YR) sobre las absorciones (Abs) de Ca y Pi, retención y calidad ósea durante el crecimiento normal. Al destete, ratas machos fueron divididas en 3 grupos alimentados con AIN ́93-G (C), YE o YR durante 28 días. Resultados: YE mostró el mayor aumento de lactobacilos fecales; producción de ácidos grasos de cadena corta especialmente p, profundidad de las criptas colónicas y menor pH cecal. El %AbsCa y %AbsPi aumentó en el siguiente órden: YE> YR> C (p < 0,05). El contenido de Ca y Pi en fémur, la densidad y contenido mineral óseos y los parámetros biomecánicos fueron similares en YE y C, mientras que YR mostró valores significativa-mente menores (p < 0,05). Conclusiones: YE aumentó las Abs y biodisponibilidad de minerales, alcanzando la retención y calidad ósea de C. El aumento en las Abs observado en YR no logró obtener la retención y calidad ósea de C. Conclusión: YE habría contrarrestado el efecto negativo del mayor aporte de Pi de la leche de vaca y sería una buena estrategia para lograr el pico de masa ósea y calidad del hueso adecuados, especialmente en individuos intolerantes a la lactosa. (AU)

Breast milk contains an optimal calcium/phosphate (Ca/Pi) ratio and GOS. These natural prebiotics can be enzymatically produced via cow's milk lactose inyogurt manufacture. This milk product is low in lactose and contains prebiotics and potentially probiotic bacteria but maintains a low Ca/Pi ratio that could alter bone remodeling and mineralization. We evaluated if a lactose-reduced yogurt containing GOS (YE) offers additional advantages over regular yogurt without GOS (YR) on Ca and Pi absorption (Abs), bone retention and quality during normal growth. Weaning male rats were divided into 3 groups fed AIN'93-G (C), YE or YR for 28 days. Results: YE showed the highest increase in fecal lactobacilli; short-chain fatty acids production, especially propionate and butyrate; intestine crypt depth, and the lowest cecal pH. AbsCa% and AbsPi% increased in this order: YE> YR> C (p <0.05). Ca and Pi content in femur, bone density and mineral content, and biomechanical parameters were similar in YE and C, while YR showed the significantly lowest value (p < 0.05). Conclusions: YE increased mineral Abs reaching the retention and bone quality of C. Although YR increased Abs, bone retention and quality did not achieve C values. Seemingly, YE compensated for the negative effect of the higher Pi supply and would be a good strategy to achieve adequate peak bone mass and bone quality, especially in lactose intolerant individuals. (AU)

Ausencia de diferencias relacionadas con el sexo en los valores de los cambios mínimos significativos para composición corporal por DXA en sujetos adultos / Absence of sex-related differences in the values of minimum significant changes for body composition by DXA in adult subjects

Para la evaluación longitudinal de la composición corporal por DXA se deben calcular los cambios mínimos significativos (CMS). No está claro si hay diferencias de género para los CMS de adultos. Con consentimiento informado se realizaron 2 escaneos DXA de cuerpo completo consecutivos, con reposicionamiento entre ellos, en 40 varones y 40 mujeres (rango de edad de 22 a 85 años), con un equipo GE Lunar Prodigy Advance®, siguiendo las pautas de la International Society for Clinical Densitometry (ISCD). Todos los escaneos fueron obtenidos por la misma técnica experta. Los CMS se calcularon de acuerdo con el método propuesto por la ISCD. Los resultados se analizaron con GraphPad® para Windows 6.0, con una significancia fijada en p < 0,05. No hubo diferencias de género para la edad (p = 0,846) o el índice de masa corporal (p = 0,802). La altura, la masa corporal, la masa magra y el contenido mineral óseo (CMO) fueron mayores en los varones (todos p < 0,0001), mientras que la masa grasa fue mayor en las mujeres (p = 0,0036). No hubo diferencias significativas entre géneros para los coeficientes de variación de masa grasa (p = 0,0698), masa magra (p = 0,1483) o CMO (p = 0,5254). Los CMS (para IC de 95%) para la masa grasa fueron 1,780 kg (varones), 1,671 kg (mujeres) y 1,727 kg (ambos sexos); para masa magra, 1,658 kg (varones), 1,644 kg (mujeres) y 1,651 (ambos sexos); y para CMO, 112,2 g (varones), 109,4 (mujeres) y 110,8 g (ambos sexos). Los resultados sugieren que los CMS para la composición corporal de su-jetos adultos pueden calcularse a partir de una muestra de cualquier género o una que incluya sujetos de ambos sexos. (AU)

Lack of gender-related differences in least significant changes for DXA body composition analysis in adult subjectsFor longitudinal assessment of body composition by DXA, least significant changes (LSCs) should be calculated. It is unclear if there are gender differences for adult LSCs. With informed consent, 2 consecutive total-body DXA scans, with repositioning between them, were performed on 40 males and 40 females (age range 22 to 85 years) with a GE Lunar Prodigy Advance scanner, following the guidelines of the International Society for Clinical Densitometry (ISCD). All scans were obtained by the same skilled technologist. The LSCs were calculated according to the method proposed by the ISCD. Results were analyzed with GraphPad for Windows 6.0, with significance set at p < 0.05. There were no gender differences for age (p = 0.846) or body mass index (p = 0.802). Height, body mass, lean mass, and bone mineral content (BMC) were higher in males (all p < 0.0001), whereas fat mass was higher in females (p = 0.0036). There was no significant difference between genders for the coefficients of variation of fat mass (p = 0.0698), lean mass (p = 0.1483), or BMC (p = 0.5254). The LSCs (for a 95% CI) for fat mass were 1.780 kg (men), 1.671 kg (women), and 1.727 kg (both genders); for lean mass, 1.658 kg (men), 1.644 kg (women) and 1,651 (both genders); and for BMC, 112.2 g (men), 109.4 (women), and 110.8 g (both genders). These results suggest that LSCs for body composition of adult subjects can be calculated from either a sample of each gender or one that includes subjects of both genders. (AU)

Pico de Massa Óssea e Níveis de Exercício Físico em Estudantes Universitários / Peak Bone Mass and Exercise Levels: Comparison between Physical Education and Medical Students

Introdução: Promover um adequado pico de massa óssea (PMO) é uma estratégia de prevenção para a osteoporose. Os estudantes universitários estão em idade de aquisição de massa óssea suscetível à influência dos hábitos do estilo de vida, incluindo a prática de exercícios físicos. Assim sendo, este estudo objetivou avaliar a massa óssea em universitários com diferentes estilos de vida. Métodos: Foram avaliados 142 estudantes, sendo 74 de Medicina (MED) e 68 de Educação Física (EF), com idade média de 22 anos. As variáveis do estudo foram obtidas por meio de anamnese densitométrica. A densidade mineral óssea (DMO) da coluna lombar, corpo inteiro, colo do fêmur e fêmur total foi medida por absorciometria de dupla emissão de raios X. Resultados: Não houve diferenças em relação à idade, sexo, IMC e ingestão de cálcio entre os grupos. Os estudantes de EF praticam mais exercícios que os de MED (481 vs. 128 min/semana). A frequência de exercício físico suficiente (> 150 min/semana) foi maior no grupo EF (91,2% vs. 40,5%; p <0,01). Exercícios que influenciam a DMO foram mais frequentes entre os estudantes de EF (91,2% vs. 63,5%; p <0,01). Baixo PMO foi mais frequente no grupo MED (52,7 vs. 14,7; p<0,01). Observou-se correlação positiva entre a quantidade semanal de exercício físico e DMO. Conclusão: Maiores taxas de prática de exercícios físicos foram associadas com melhor PMO em estudantes do curso de Educação Física.

Introduction: Promoting adequate peak bone mass (PBM) is a prevention strategy for osteoporosis. College students are at the age of bone mass acquisition susceptible to the influence of lifestyle habits, including exercise. Therefore, this study aimed to evaluate bone mass in college students with different lifestyles. Methods: We evaluated 142 students, 74 from Medicine (MED) and 68 from Physical Education (PE), with a mean age of 22 years. The study variables were obtained by densitometric anamnesis. Bone mineral density (BMD) of the lumbar spine, whole body, femoral neck, and total femur was measured by dual emission X-ray absorptiometry. Results: There were no differences in age, gender, BMI, and calcium intake between the groups. PE students exercised more than MED students (481 vs. 128 min/week). The frequency of sufficient exercise (> 150 min/week) was higher in the EF group (91.2% vs. 40.5%; p <0.01). Exercise influencing BMD was more frequent among EF students (91.2% vs. 63.5%; p <0.01). Low PBM was more frequent in the MED group (52.7 vs. 14.7; p<0.01). The study showed a positive correlation between the weekly amount of exercise and BMD. Conclusion: Higher exercise rates were associated with better PBM in physical education students.

Radiografías periapicales y panorámicas como herramientas para la predicción temprana de osteoporosis / Periapical and panoramic radiographs as tools for early prediction of osteoporosis

Introducción: La osteoporosis es una enfermedad del sistema esquelético provocada por una disminución progresiva de la densidad mineral ósea y el deterioro de la microarquitectura, que aumenta el riesgo de fracturas. Por tanto, se hace necesario adoptar medidas de diagnóstico que permitan la detección temprana de alteraciones de la densidad mineral. Dado que las radiografías dentales son rutinarias y permiten examinar las estructuras óseas de los maxilares, se han propuesto como herramientas primarias de diagnóstico de osteoporosis. Objetivo: Examinar la viabilidad y el avance del uso de radiografías periapicales y panorámicas como predictoras tempranas de osteoporosis. Comentarios principales: Fue realizada una revisión bibliográfica sobre cómo las radiografías periapicales y panorámicas, junto con técnicas de aprendizaje automático e índices morfométricos, pueden ser predictores tempranos de osteoporosis. Consideraciones globales: Radiografías panorámicas y periapicales pueden ayudar en la predicción precoz de osteoporosis. Para ello el odontólogo debe contar con amplia experiencia en la interpretación de imágenes radiográficas o ser especialista en radiología oral o cirugía maxilofacial. Por otro lado, existen herramientas computacionales fundamentadas en aprendizaje automático que han mostrado resultados de identificación de osteoporosis comparables a los arrojados por radiólogos. Estas herramientas pueden servir de apoyo a profesionales menos experimentados. Los odontólogos están llamados a ser los primeros inspectores de cambios anómalos en la densidad ósea. Deben remitir oportunamente los pacientes con sospecha de osteoporosis al médico especialista(AU)

Introduction: Osteoporosis is a disease of the skeletal system caused by a gradual reduction in bone mineral density and deterioration of the microarchitecture, raising the risk of fracture. It is therefore necessary to implement diagnostic actions allowing early detection of mineral density alterations. Given the fact that dental radiographs are routine practice and make it possible to examine the bone structure of maxillae and mandibles, they have been proposed as primary tools for osteoporosis diagnosis. Objective: Examine the viability of and progress in the use of periapical and panoramic radiographs as early predictors of osteoporosis. Main remarks: A review was conducted about the combined use of panoramic and periapical radiographs. Both are machine learning techniques and morphometric indices. General considerations: Panoramic and periapical radiographs may be useful for early prediction of osteoporosis. To achieve this end, dentists should have broad experience interpreting radiographic images or be specialists in oral radiology or maxillofacial surgery. On the other hand, computer tools based on machine learning are available which have obtained results in osteoporosis identification comparable to those obtained by radiologists. Those tools may support the work of less experienced professionals. Dentists should be the first to detect anomalous bone density changes, timely referring patients suspected of osteoporosis to the corresponding specialist(AU)

Low bone mineral density in pre-menopausal women one year after gastric bypass / Baixa densidade mineral óssea em mulheres pré-menopausadas um ano após bypass gástrico

Introduction: Nutritional deficiencies, hormonal changes and severe weight loss after Roux-en-Y Gastric Bypass (RYGB) can promote changes in bone metabolism which may lead to a reduction in bone mineral density (BMD). Objective: to investigate the prevalence of osteopenia/osteoporosis and factors associated with BMD in pre-menopausal women who underwent RYGB. Methodology: a cross-sectional study conducted with secondary data of patients followed-up in a specialized center for obesity treatment. Variables studied: biochemical and anthropometric data, body composition by multifrequency bioimpedance and BMD of the lumbar spine (LS), total femur (TF) and femur neck (FN) by dual-energy X-ray absorptiometry. For statistical analysis, the SPSS® software and a 5% significance level were utilized. Results: seventy-two (72) pre-menopausal women were evaluated. Mean age, BMI and mean post-surgery time was 38.7±6.5 years, 25.8±2.5 kg/m² and 13.1±1.7 months, respectively. The prevalence of osteopenia in at least one of the densitometry sites was 13.9%, with LS being the most frequent site. A lower LS BMD was associated with greater weight loss, higher percentage of body fat before surgery and lower post-surgery serum vitamin D levels. There was a positive correlation between skeletal muscle mass index adjusted for height in the pre-surgery period and LS BMD (r=0.361; p=0.010) and TF (r=0.404; p=0.004). Conclusion: a relevant prevalence of osteopenia was detected in pre-menopausal women after RYGB, mainly in the LS.

Introdução: o Bypass Gástrico em Y de Roux (BPGYR) pode promover mudanças no metabolismo ósseo decorrentes de deficiências nutricionais, alterações hormonais e perda severa de peso, podendo acarretar redução da Densidade Mineral Óssea (DMO). Objetivo: investigar a prevalência de osteopenia/osteoporose e fatores associados à DMO em mulheres pré-menopausadas submetidas à BPGYR. Metodologia: estudo transversal com dados secundários de pacientes acompanhadas em um serviço especializado no tratamento da obesidade. Variáveis estudadas: dados bioquímicos e antropométricos, composição corporal por bioimpedância multifrequencial e DMO de coluna lombar (CL), fêmur total (FT) e colo do fêmur (CF) por Absorciometria por Dupla Emissão de Raios X. Para análise estatística foi utilizado o programa SPSS®, com o nível de significância de 5%. Resultados: foram avaliadas 72 mulheres pré-menopausadas, com média de idade e de IMC de 38,7±6,5 anos e 25,8±2,5 kg/m², respectivamente, e tempo médio de pós-operatório de 13,1±1,7 meses. A prevalência de osteopenia em pelo menos um dos sítios densitométricos foi de 13,9%, sendo a CL o sítio mais frequente. Uma menor DMO na CL se associou a maior perda de peso, maior percentual de massa gorda antes da cirurgia e níveis séricos menores de vitamina D pós-operatória. Observou-se correlação positiva entre o índice de massa muscular esquelética ajustada pela altura no pré-operatório e a DMO da CL (r=0,361; p=0,010) e do FT (r=0,404; p= 0,004). Conclusão: detectou-se prevalência relevante de osteopenia em mulheres pré-menopausadas após BPGYR, principalmente na CL.

Comparison of femoral neck geometric parameters between Chinese and Japanese females / 中南大学学报(医学版)

OBJECTIVES@#Femoral neck fracture is the most serious osteoporotic fractures that is responsible for high medical costs and high mortality. Femoral neck geometric parameters (FNGPs) are important parameters that reflect the geometrical characteristics of femoral neck, and are closely related to the strength of femoral neck and the risk of fragility fracture.There are differences in the incidence of femoral neck fractures among races. However, whether there is difference in FNGPs among races is unknown.Therefore, this study aims to compare the differences in FNGPs between Chinese and Japanese females.@*METHODS@#This study was a cross-sectional study, in which 3 859 healthy females aged 10-86 (45.7±17.1) years old were recruited from Changsha City of Hunan Province and surrounding areas. The weight and height were measured and recorded, and the body mass index (BMI) was calculated. A dual energy X-ray absorptiometry (DXA) bone densitometer was used to measure femoral neck projective bone area (BA) and bone mineral density (BMD). FNGPs were calculated using the BMD and BA, which included the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compression strength index (CSI). The data of FNGPs in Japanese females was collected from literature. These subjects were grouped by 10-year age. The mean and standard deviation of height, weight, BMI, femoral neck BMD, and FNGPs of each group were calculated. The model with the best goodness-of-fit was selected from various mathematical regression models to analyze the distribution trend and the best fitting curve of FNGPs with age. The differences in FNGPs between Chinese and Japanese females were analyzed by using age-corresponding mean fitting curve for paired t-test, and the relative change rates of FNGPs were compared.@*RESULTS@#The mean values of FNGPs were significantly different among different years old healthy females (all P<0.01). The mean values of OD, CSA, CT, SM, and CSMI in femoral neck were high at 30 to 39 years old, and then they were gradually decreased with age. The CSI reached its peak at 20-29 years old, and it was decreased gradually after 30 years old. ED and BR were at a low level before 40 years old, they were gradually increased after 40 years old, and reached the maximum average value at 80-86 years old. The variations in FNGPs with age were fitted with the best goodness-of-fit by applying the cubic regression model and the determination coefficients of regression equations (R2: 0.062-0.404) were significant (all P<0.01). The distribution trend of FNGPs with age varied with the indices, among which CSA, CT, SM, CSMI and CSI were increased with age before 35 years old, and then they were decreased with age; BR was at a low level in the early stage, and then it was increased with age after about 40 years. There were significant differences in the fitting curves of FNGPs related to age between Chinese and Japanese females (all P<0.01). The fitting curves of OD, ED, BR and SM in Chinese females were significantly higher than those in Japanese females (all P<0.01), while those of CSA and CT in Chinese females were significantly lower than those in Japanese females (all P<0.01). Before the age of 50, the curves of CSMI and CSI of Chinese females were significantly higher than those of Japanese females (all P<0.01), while after the age of 60 the situation was reversed (all P<0.01). Except for SM and CSI, there were significant differences in the rate of OD, CSA, CT, ED, BR and CSMI with age (all P<0.01). By the age of 80 years old, the rates of change in OD, ED, and BR with the age in Chinese females were increased by 0.91%,3.94%, and 47.5%, respectively, while those in Japanese females were increased by 8.57%, 15.8% and 85.3%, respectively；the rates of change of CSA, CT, and CSMI with the age in Chinese females were declined 28.0%, 29.6%, and 25.2%, respectively, while those in Japanese females were declined 29.9%, 36.2%, and 10.9%, respectively. There were significant difference in the rates of change in FNGPs with the age between Chinese and Japanese females (all P<0.01).@*CONCLUSIONS@#The study reveals the variation of FNGPs with age in Chinese, and confirms that there are racial differences in FNGPs between Chinese and Japanese females, which may be one of the important reasons for the difference in the incidence of femoral neck fracture between Chinese and Japanese females.

Effects of 275 nm and 310 nm ultraviolet irradiation on bone metabolism in ovariectomized osteoporotic rats / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effect of 275 nm and 310 nm ultraviolet irradiation on ovariectomized rats' bone metabolism.@*METHODS@#Twenty four 3-month-old female Sprague-Dawley (SD) rat were randomly divided into control group, sham operated group, 275 nm ultraviolet (UV) irradiation group and 310 nm UV irradiation group. Each group contained 6 rats. The rats in the two irradiation groups were treated with bilateral ovariectomy. The rats in sham operated group received sham operation (They were given the same back incision and a bit of par-ovarian fat were removed). Control group received no disposition. About 24 weeks after operation, all the rats received detailed bone mineral density (BMD) detection again. Detection regions include cervical vertebra, lumbar vertebra, proximal femur, mid femur and distal femur. Next, osteopenia rats in 275 nm irradiation group were UV irradiated 275 nm with fixed illumination intensity (15 μW/cm2) everyday for 16 weeks. The osteopenia rats in 310 nm irradiation group were UV irradiated 310 nm with fixed illumination intensity (15 μW/cm2) everyday for 16 weeks. The backs of the rats were shaved regularly as irradiation area (6 cm×8 cm). After 16-week irradiation, all the rats' BMD of cervical vertebra, lumbar vertebra, proximal femur, mid femur and distal femur were measured. At the end of the trial, all the rats' blood specimens were obtained and serum 25(OH)D, procollagen type Ⅰ N-peptide (PINP) and osteocalcin (OC) were measured.@*RESULTS@#Compared with control group [(238.78±26.74) mg/cm3], the BMD of the whole body were significantly lower in 275 nm [(193.34±13.28) mg/cm3] and 310 nm [(191.19±18.48) mg/cm3] irradiation groups (P=0.002, P=0.001). There were no significant difference between sham operated group [(227.20±14.32) mg/cm3] and control group. After 16-week ultraviolet irradiation, the BMD of the whole body were significantly increased in 275 nm [(193.34±13.28) mg/cm3 vs. (221.68±25.52) mg/cm3, P=0.005] and 310 nm groups [(191.19±18.48) mg/cm3 vs. (267.48±20.54) mg/cm3, P < 0.001] after corresponding irradiation. The BMD of the four body regions (lumbar vertebra, proximal femur, mid femur and distal femur) had significantly increased after irradiation in 275 nm irradiation group. For 310 nm irradiation group, the BMD in cervical vertebra, lumbar vertebra, proximal femur, mid femur and distal femur also had increased significantly after 310 nm ultraviolet irradiation. The concentration of serum 25(OH)D and OC was higher in 275 nm irradiation group than in control group [(46.78±5.59) μg/L vs. (21.32±6.65) μg/L, P=0.002;(2.05±0.53) U/L vs. (1.32±0.07) U/L, P=0.022]. Compared with the control, the concentration of serum 25(OH)D [(58.05±12.74) μg/L], OC [(2.04±0.53) U/L] and PINP [(176.16±24.18) U/L] was significantly higher (P < 0.001, P=0.015, P=0.005) in 310 nm irradiation group. However, there were no significantly difference between sham operated group and the control.@*CONCLUSION@#Both 275 nm and 310 nm ultraviolet could improve rats' vitamin D synthesis. Both 275 nm and 310 nm ultraviolet could improve osteopenia rats' bone condition. The irradiation of 310 nm might be more effective on bone condition improvement.

Prevalence of osteoporosis and related factors in postmenopausal women aged 40 and above in China / 中华流行病学杂志

Objective: To understand the prevalence of osteoporosis and related factors in postmenopausal women aged ≥40 years in China and provide scientific evidence for osteoporosis prevention and control. Methods: Data of this study were from the 2018 China Osteoporosis Epidemiological Survey, covering 44 counties (districts) in 11 provinces in China. Related variables were collected by questionnaire survey and physical measurement, and the BMD of lumbar spine and proximal femur was measured by dual-energy X-ray absorption method. The prevalence of osteoporosis and its 95%CI in postmenopausal women aged ≥40 years were estimated with complex sampling weights. Results: A total of 5 728 postmenopausal women aged ≥40 years were included in the analysis and the prevalence of osteoporosis was 32.5% (95%CI: 30.3%-34.7%). The prevalence of osteoporosis in postmenopausal women aged 40-49 years, 50-59 years, 60-69 years, 70-79 years, and ≥80 years were 16.0% (95%CI:4.5%-27.5%), 18.4% (95%CI:15.9%-20.8%), 37.5% (95%CI:34.5%-40.4%), 52.9% (95%CI: 47.5%-58.3%), and 68.0% (95%CI:55.9%-80.1%) respectively. The prevalence of osteoporosis was higher (P<0.001) in those with education level of primary school or below (47.2%, 95%CI: 43.0%-51.3%) and in those with individual annual income less than 10 000 Yuan, (40.3%, 95%CI: 36.9%-43.7%). The prevalence of osteoporosis was 35.1% in rural areas (95%CI: 32.0%-38.1%), which was higher than that in urban areas (P<0.001). The prevalence of osteoporosis in low weight, normal weight, overweight and obese groups were 69.9% (95%CI: 59.0%-80.8%), 42.2% (95%CI: 38.7%-45.7%), 24.2% (95%CI: 21.3%-27.1%) and 14.6% (95%CI: 11.1%-18.0%), respectively. The prevalence of osteoporosis in those with menstrual maintenance years ≤30 years and in those with menopause years ≥11 years were 46.1% (95%CI:40.8%-51.3%) and 48.2% (95%CI:45.0%-51.3%), respectively. Multivariate logistic analysis showed that age ≥60 years, education level of primary school or below, annual household income per capita less than 10 000 Yuan, low body weight, menstrual maintenance years ≤30 years, menopause years ≥11 years were risk factors of osteoporosis in postmenopausal women in China. Conclusions: The prevalence of osteoporosis was high in postmenopausal women aged ≥40 years in China, and there were differences in osteoporosis prevalence among different socioeconomic groups. Effective interventions should be taken for the prevention and control of osteoporosis in key groups in the future.

Reflections on Chinese residents' calcium intake and human health / 中华预防医学杂志

Calcium plays an important role in various physiological activities of the human body, and long-term insufficient or excessive intake of calcium will have a negative impact on the body's health. Existing data show that insufficient dietary calcium intake is closely related to bone health, but the non-bone effects are not clear. Increasing dietary calcium and supplementing calcium (with or without vitamin D) have a certain beneficial effect on the bone mineral density and its peak of adolescents and can delay the bone loss of the elderly, but it can't improve the height and bone mineral density of adults and fracture in the elderly. This article introduces the physiological functions of calcium, dietary sources, human intake, and methods for formulating recommended amounts, and summarizes the relationship between calcium and health effects. It also recommends that when formulating the reference intake of dietary calcium for Chinese residents, more consideration should be given to the data and information of the Chinese population, combined with the characteristics of Chinese residents' genetics, absorption and metabolism.

Síndrome metabólico, metformina y hueso / Metabolic syndrome, metformin and bone

El síndrome metabólico se define como un trastorno heterogéneo y multifactorial con riesgo cardiovascular elevado. Actualmente se encuentra en franco crecimiento debido al sedentarismo y la ingesta rica en grasas y azúcares. Su tratamiento incluye la indicación de cambios en el estilo de vida, con realización de actividad física y una alimentación saludable e hipocalórica. Cuando esto no es eficaz, se pueden utilizar diferentes fármacos, y entre los más prescriptos se encuentra la metformina, caracterizada por su acción insulino-sensibilizante. Numerosos trabajos han estudiado la vinculación del síndrome metabólico con el tejido óseo. Se demostró como resultado general, aunque no concluyente, que dicho síndrome se asocia con una disminución de la densidad mineral ósea y un aumento en la incidencia de fracturas osteoporóticas. Una de las limitaciones de estos estudios clínicos estaría ligada a la gran heterogeneidad de los pacientes con síndrome metabólico. Por otra parte, y dado que diversos estudios preclínicos han sugerido posibles acciones osteogénicas de la metformina, se ha investigado el posible efecto óseo de un tratamiento con este fármaco en personas con hiperglucemia o disglucemia. Varios estudios clínicos muestran que este efecto sería nulo o, en algunos casos, de carácter protector para el sistema óseo. No obstante, se debería tener precaución en el uso de dicho fármaco en pacientes que necesiten dosis altas y/o posean riesgo elevado de fractura, ya que sus altas concentraciones podrían tener consecuencias negativas sobre el metabolismo óseo. (AU)

Metabolic syndrome is defined as a heterogeneous and multifactorial disorder with high cardiovascular risk. Its incidence is currently growing due to sedentary lifestyles and diets with a high intake of fats and sugars. Treatment for metabolic syndrome begins with changes in lifestyle, such as physical activity and a healthy and hypocaloric diet. When this is not effective, different drugs can be used, and one of the most frequently prescribed is the insulin-sensitizer metformin. Numerous investigations have evaluated the possible link between metabolic syndrome and alterations in bone metabolism. Although not conclusive, most clinical studies point to an association between metabolic syndrome, a decrease in bone mineral density and an increase in the incidence of osteoporotic fractures. However, an important limitation of these studies is the great heterogeneity of individuals with metabolic syndrome. In view of preclinical research indicating possible osteogenic actions of metformin, the effects on bone of metformin has been evaluated in patients with hyperglycemia. Most studies have found either no effect on fracture incidence, or a mild protective action. However, since elevated concentrations of metformin might negatively affect bone metabolism, caution should be taken when prescribing this drug for patients who require high doses, and/or have an excess fracture risk. (AU)