Between a Rock and a Short Place-The Impact of Nephrolithiasis on Skeletal Growth and Development Across the Lifespan.

PURPOSE OF REVIEW: The impact of nephrolithiasis on skeletal growth and bone health across the life span of kidney stone formers is reviewed. MAIN FINDINGS: Bone disease is an early event among kidney stone formers (SF), with distinct phenotypes according to each age, sex, menopausal status, dietary, hormonal and genetic factors. Nephrolithiasis-associated bone disorder is characterized by reduced bone mineral density (BMD) and histologically discloses low bone formation, high bone resorption and abnormal mineralization. Although hypercalciuria has been presumed to be pathogenic for bone loss in SF, the association of BMD with urinary calcium is not uniform in all studies. Hypocitraturia, metabolic disturbances, cytokines and receptors, growth factors and acid-base status may all influence skeletal outcomes. The potential link of bone disease with vascular calcification and cardiovascular disease among SF is discussed. The unique vulnerability of the younger skeleton to the effects of nephrolithiasis on attainment of peak bone mass and strength is highlighted and the association of bone loss with kidney stone formation early in life indicate the opportunity for intervention to reduce the risk of future bone fractures.

Características sociodemográficas y salud ósea en adultos argentinos con alimentación basada en plantas / Sociodemographic characteristics and bone health in argentine adults with a plant-based diet

RESUMEN Objetivo: Analizar las características sociodemográficas y salud ósea en consumidores adultos de alimentación basada en plantas (ABP). Método: Se invitó a individuos entre 18 a 75 años a realizar una encuesta autoadministrada a través de una plataforma digital. Resultados : Un total de 1151 participantes completaron la encuesta; la mayoría fueron mujeres [n=958 (83,2%)], jóvenes [edad (años): 18-25: 35,8%; 26-35:39,8% y 36-45:17,4%] y solteras (67,1%). El patrón de consumo de ABP estuvo representado, principalmente, por vegano (54,0%) seguido por lacto-ovo-vegetariano (27,7%), la principal razón de su elección alimentaria fue el cuidado de la vida animal (83,5%). La adherencia a la ABP, en función del tiempo (años), fue <1: 12,3%; 1-5: 67,4%; 10-15:14,8% y>15:5,5%. 16 % de los veganos refirió haber sufrido fracturas y el 5,1 % refirió haberse realizado una densitometría. De ellos el 88,1 % respondió resultados normales y el 11,8 % presentó osteopenia. No se registró en la encuesta ningún caso de osteoporosis. La vitamina B12 fue el suplemento predominante entre los consumidores de ABP (61,4%). Conclusiones: Los consumidores de ABP constituyen una minoría importante en nuestro país, compuesta predominantemente por mujeres menores de 35 años, con proyección a aumentar en los próximos años.

ABSTRACT Objetive: To analyze the sociodemographic characteristics and bone health in adult consumers of plant-based diets (PBL). Method: Individuals between 18 and 75 years old were invited to complete a self-administered survey through a digital platform. Results: A total of 1,151 participants completed the survey; the majority were women [n=958 (83.2%)], young [age (years): 18-25: 35.8%; 26-35:39.8% and 36-45:17.4%] and single (67.1%). The ABP consumption pattern was mainly represented by vegans (54.0%) followed by lacto-ovo-vegetarians (27.7%), the main reason for their food choice was the care of animal life (83, 5%). Adherence to ABP, as a function of time (years), was <1: 12.3%; 1-5: 67.4%; 10-15:14.8% and>15:5.5%. 16% of vegans reported having suffered fractures and 5.1% reported having had a densitometry. Of them, 88.1% responded with normal results and 11.8% presented osteopenia. No cases of osteoporosis were recorded in the survey. Vitamin B12 was the predominant supplement among ABP consumers (61.4%). Conclusions: PBL consumers constitute an important minority in our country, predominantly composed of women under 35 years of age, with a projection to increase in the coming years.

The microarchitecture and chemical composition of the femur neck of senescent female rats after different physical training protocols.

A sedentary lifestyle, coupled with a decrease in estrogen, impairs bone homeostasis, favoring to the development of osteopenia and osteoporosis, both recognized as risk factors for fractures. Here, we investigated the quality of the femur, particularly the femur neck region, and the ambulation performance of senescent rats subjected to three different physical training protocols during the periestropause period. Forty-eight female rats, 18 months of age, were subjected to a 120-day training period, three times a week. The rats were distributed into four groups: aerobic training (AT), strength training (ST), concurrent training (CT), or no training (NT). After the experimental period, at 21 months of age, ambulation performance and femur were analyzed using microtomography, Raman stereology, densitometry, and mechanical strength tests. The results demonstrated greater remodeling activity and improvement in resistance and bone microarchitecture in the femur neck of senescent female rats after undergoing physical training. Our verified higher intensities of bands related to collagen, phosphate, amide III, and amide I. Furthermore, the analysis of the secondary collagen structures indicated alterations in the collagen network due to the exercise, resulting in increased bone strength. Both AT and strength-based training proved beneficial, with AT showing greater adaptations in bone density and stiffness in the femur, while strength-based training greater adaptations in trabecular and cortical structure. These insights contribute to the understanding of the potential interventions for preventing osteopenia and osteoporosis, which are critical risk factors for fractures.

Computational Analysis of the Influence of Menopause and Ageing on Bone Mineral Density, Exploring the Impact of Bone Turnover and Focal Bone Balance-A Study on Overload and Underload Scenarios.

This study aims to investigate the impact of hormonal imbalances during menopause, compounded by the natural ageing process, on bone health. Specifically, it examines the effects of increased bone turnover and focal bone balance on bone mass. A three-dimensional computational bone remodeling model was employed to simulate the response of the femur to habitual loads over a 19-year period, spanning premenopause, menopause, and postmenopause. The model was calibrated using experimental bone mineral density data from the literature to ensure accurate simulations. The study reveals that individual alterations in bone turnover or focal bone balance do not fully account for the observed experimental outcomes. Instead, simultaneous changes in both factors provide a more comprehensive explanation, leading to increased porosity while maintaining the material-to-apparent density ratio. Additionally, different load scenarios were tested, demonstrating that reaching the clinical osteoporosis threshold is independent of the timing of load changes. However, underload scenarios resulted in the threshold being reached approximately 6 years earlier than overload scenarios. These findings hold significant implications for strategies aimed at delaying the onset of osteoporosis and minimizing fracture risks through targeted mechanical stimulation during the early stages of menopause.

Programas de educação sobre saúde óssea para idosos: uma revisão integrativa / Bone health education programs for older people: an integrative review

Resumo A osteoporose é uma doença sistêmica caracterizada pela redução da densidade mineral óssea. A difusão do conhecimento sobre à doença, pode ser uma alternativa viável para atitudes preventivas e de autocuidado. Dessa forma, esse artigo procura identificar como são os programas sobre saúde óssea para idosos. Trata-se de uma revisão integrativa de estudos publicados entre 2011 e 2022 nas bases de dados Periódicos Capes, Web of Science, PubMed e Google Scholar em inglês. Foram encontrados 10.093 estudos, sendo selecionados 7 depois dos critérios de inclusão. Foi possível verificar que os programas de educação para saúde óssea possuem o objetivo de empoderar o idoso pelo aumento do conhecimento sobre a doença, conscientizar sobre o consumo de cálcio e vitamina D ou de medicamentos para osteoporose, mudanças de hábitos e a prática de exercícios físicos. Os programas geralmente são realizados com reuniões em grupo ou individualizados, com sessões de 50 a 60 minutos, podendo ou não, delimitar o número de indivíduos em cada uma delas. Nota-se que acompanhar a evolução do processo educativo também é importante. A contextualização dos temas junto a realidade e interesse dos idosos, parece ser outra forma positiva para despertar atitudes de autocuidado.

Abstract Osteoporosis is a systemic disease characterized by a reduction in bone mineral density. The dissemination of knowledge about the disease can be a viable alternative for promoting preventive behavior and self-care. This study sought to identify the main characteristics of bone health programs for older persons. We conducted an integrative review, searching for studies published between 2011 and 2022 in the CAPES periodicals database, Web of Science, PubMed, and Google Scholar using English descriptors. A total of 10,093 studies were retrieved, seven of which were selected after applying the inclusion criteria. The findings show that bone health education programs aim to empower older people by increasing knowledge about the disease and raising awareness about calcium and vitamin D intake, osteoporosis medications, and the importance of changing habits and exercise. Programs generally consist of group or individual meetings, with sessions lasting 50 to 60 minutes. Class sizes may be limited or unrestricted. Follow-up during the educational process was also found to be important. Tailoring topics to the reality and interests of participants appears to be another positive way of promoting the adoption of self-care practices.

Commentary: Aldehyde dehydrogenase, redox balance and exercise physiology: What is missing?

Aldehyde dehydrogenase 2 (ALDH2) is a mitochondrial enzyme involved in reactive aldehyde detoxification. Approximately 560 million people (about 8% of the world's population) carry a point mutation in the aldehyde dehydrogenase 2 gene (ALDH2), identified as ALDH2*2, which leads to decreased ALDH2 catalytic activity. ALDH2*2 variant is associated with an accumulation of toxic reactive aldehydes and consequent disruption of cellular metabolism, which contributes to the establishment and progression of several degenerative diseases. Consequences of aldehyde accumulation include impaired mitochondrial functional, hindered anabolic signaling in the skeletal muscle, impaired cardiovascular and pulmonary function, and reduced osteoblastogenesis. Considering that aldehydes are endogenously produced through redox processes, it is expected that conditions that have a high energy demand, such as exercise, might be affected by impaired aldehyde clearance in ALDH2*2 individuals. Despite the large body of evidence supporting the importance of ALDH2 to ethanol metabolism, redox homeostasis and overall health, specific research investigating the impact of ALDH2*2 on phenotypes relevant to exercise performance are notoriously scarce. In this commentary, we highlight the consolidated knowledge on the impact of ALDH2*2 on physiological processes that are relevant to exercise.

Performance and bone quality of broilers fed diets containing different levels of phosphorus and supplemented with phytase / Rendimiento y calidad ósea de pollos de engorde alimentados con dietas que contienen diferentes niveles de fósforo y suplementadas con fitasa / Desempenho e qualidade óssea de frangos de corte alimentados com dietas com diferentes níveis de fósforo e suplementadas com fitase

Abstract Background: Although phytase has been widely used in poultry nutrition, the effects of the enzyme on broilers fed low levels of phosphorus are poorly understood. Objective: To evaluate the effects of two commercial phytases on live performance and bone quality of broilers fed diets with normal and reduced levels of phosphorus. Methods: Two experiments were conducted with four treatments and six repetitions with 30 birds each, for a total of 24 groups. The first experiment (Exp. I) used a reference level of available phosphorus (AP) with four treatments, as follows: Positive control= 0.45% AP starter diet/0.40% AP grower diet without phytase; Phytase X= 0.35% AP starter diet/0.30% AP grower diet + Phytase X; Phytase Y= 0.35% AP starter diet/0.30% AP grower diet + Phytase Y; and Negative control= 0.35% AP starter diet/0.30% AP grower diet, without phytase. In experiment II (Exp. II) the same treatments were used, but AP levels were reduced by 0.10%. The variables analyzed were: performance from one to 35 days, and bone quality at 35 days of age. Both experiments were analyzed using a completely randomized design. Results: In Exp. I, the positive control resulted in greater body weight gain (2,558 g; p<0,05) compared to Phytase Y (2,470 g) and negative control (2,472 g), and better feed conversion ratio (1.48; p<0,05) than the negative control (1.51). However, when phosphorus was reduced in Exp. II, the positive control and treatments with Phytase X showed better results (p<0.01) for feed intake (3,608 g and 3,593 g, respectively) and weight gain (2,430 g and 2,400 g, respectively) compared to the negative control (2,889 g of feed intake and 1,915 g of weight gain; p<0.01), which also presented low bone ash (36.8%) and phosphorus in the tibia (5.48%; p<0.01). Conclusion: Reducing AP concentration in diets not added with phytase negatively affects weight gain and feed intake of broilers.

Resumen Antecedentes: Aunque la fitasa ha sido ampliamente utilizada en nutrición aviar, sus efectos en pollos de engorde alimentados con bajos niveles de fósforo son poco comprendidos. Objetivo: Evaluar el efecto de dos fitasas comerciales sobre el desempeño y la calidad ósea de pollos de engorde alimentados con dietas con niveles normales y reducidos de fósforo. Métodos: Se realizaron dos experimentos con cuatro tratamientos y seis repeticiones de 30 aves cada una, totalizando 24 grupos. En el primero (Exp. I) se utilizó el nivel de referencia de fósforo disponible (Pd) con cuatro tratamientos, así: Control positivo= 0,45% Pd dieta inicial/0,40% Pd dieta de engorde, sin fitasa; Fitasa X= 0,35% Pd dieta inicial/0,30% Pd dieta engorde + Fitasa X; Fitasa Y= 0,35% Pd dieta inicial/0,30% Pd dieta engorde + Fitasa Y; finalmente, Control negativo= 0,35% Pd dieta inicial/0,30% Pd dieta engorde, sin fitasa. En el segundo experimento (Exp. II) se utilizaron los mismos tratamientos, pero reduciendo en 0,10% el nivel de Pd. Las variables analizadas fueron: desempeño de uno a siete días y de uno a 35 días y calidad ósea a los 35 días de edad. Ambos experimentos se analizaron mediante un diseño completamente aleatorizado. Resultados: En el Exp. I, control positivo presentó una mayor ganancia de peso corporal (2.558 g; p<0,05) en comparación con la Fitasa Y (2.470 g) y el control negativo (2.472 g), y mejor índice de conversión alimenticia (1,48; p<0,05) que el control negativo (1,51). Sin embargo, cuando se redujo el nivel de fósforo en el Exp. II, el control positivo y los tratamientos con Fitasa X mostraron mejores resultados (p<0,01) para el consumo de alimento (3.608 g y 3.593 g, respectivamente) y la ganancia de peso (2.430 g y 2.400 g, respectivamente) en comparación con el control negativo (2.889 g de consumo de alimento y 1.915 g de ganancia de peso; p<0,01), el cual también presentó baja concentración de cenizas óseas (36,8%) y fósforo en tibia (5,48%; p<0,01). Conclusión: La reducción de la concentración de Pd en dietas no aditivadas con fitasa afecta negativamente la ganancia de peso y el consumo de alimento del pollo de engorde.

Resumo Antecedentes: A fitase é uma enzima amplamente utilizada na nutrição de frangos de corte. No entanto existem várias opções comerciais e seus efeitos com níveis reduzidos de fósforo, são pouco avaliados. Objetivo: Avaliar o efeito da suplementação de fitases comerciais no desempenho e na qualidade óssea de frangos de corte, alimentados com níveis normais e reduzidos de fósforo. Métodos: Dois experimentos foram conduzidos com quatro tratamentos e seis repetições, com 30 aves em cada, totalizando 24 grupos. No primeiro (I) utilizou o nível de referência de fósforo disponível (Pd), totalizando quatro tratamentos: controle positivo= 0,45% Pd dieta inicial/0,40% Pd dieta crescimento, sem fitase; tratamento fitase X= 0,35% Pd dieta inicial/0,30% Pd dieta crescimento + Fitase X; tratamento fitase Y= 0,35% Pd dieta inicial/0,30% Pd dieta de crescimento + Fitase Y; e controle negativo 0,35% Pd dieta inicial/0,30% Pd dieta crescimento, sem fitase. O segundo experimento utilizou os mesmos tratamentos, reduzindo 0,10% o nível de Pd. As variáveis ​​analisadas foram: desempenho de um a sete dias e de sete a 35 dias e qualidade óssea aos 35 dias. Ambos os experimentos foram analisados usando um delineamento inteiramente casualizado. Resultados: No Experimento I, o tratamento controle positivo apresentou maior ganho de peso corporal (2.557,86 g; p<0,05) em relação a fitase Y (2.470,27 g) e o controle negativo (2.471,73 g) e melhor índice de conversão alimentar (1,48; p<0,05) do que o tratamento controle negativo (1,51). Porém, quando o nível de fósforo foi reduzido no Experimento II, o controle positivo e os tratamentos com fitase X apresentaram os melhores resultados (p<0,01) para consumo de ração (3.608,0 g e 3.593,1 g, respectivamente) e ganho de peso corporal (2.429,8 g e 2.399,9 g, respectivamente) em comparação ao tratamento controle negativo (2.889,0 g de ingestão de ração e 1.915,3 g de ganho de peso corporal; p<0,01) que também apresentou baixa concentração de cinzas ósseas (36,8%) e fósforo na tíbia (5,48%; p<0,01). Conclusões. A redução da concentração de AP sem o uso de fitase reduz o ganho de peso corporal e o consumo de ração de frangos de corte.

Effects of dietary copper and zinc hydroxychloride supplementation on bone development, skin quality and hematological parameters of broilers chickens.

This study was carried out to evaluate the effects of supplementation with different levels of copper (Cu) and zinc (Zn), using two mineral sources (sulphate and hydroxy forms), on the bone characteristics, skin strength/elasticity, and haematological parameters of broilers. A total of 1792 1-day-old male Cobb-500 broiler chickens were randomly distributed among eight dietary treatments, using Cu sulphate (CSM) or hydroxychloride (CHC), and Zn sulphate (ZSM) or hydroxychloride (ZHC). The dietary treatments were as follows: (1) low-CSM/high-ZSM, (2) high-CSM/high-ZSM, (3) low-CHC/low-ZHC, (4) low-CHC/medium-ZHC, (5) low-CHC/high-ZHC, (6) high-CHC/low-ZHC, (7) high-CHC/medium-ZHC, and (8) high-CHC/high-ZHC. On Day 42, blood samples were collected from one bird/pen to analyze the haematological parameters. Finally, two birds/pen were slaughtered, and the tibia and femur were collected to analyze the quality of bone and skin. The means were subjected to ANOVA and, when significant, compared by Tukey's test (p < 0.05) or Dunnett's (p < 0.05) test. The haematological parameters were not influenced by mineral supplementation. However, the inclusion of low ZHC enhanced the skin strength compared to high ZHC (p = 0.046). Furthermore, the bone mineral density of the tibia proximal epiphysis, tibia ash and tibia mineral content were positively improved with supplementation of low-CHC/medium-ZHC compared to high-CHC/medium-ZHC. This study demonstrated that hydroxy compounds are potential alternatives for replacing sulphate supplements in broiler diets. Moreover, among the Cu and Zn levels, the low CHC (15 mg/kg) and medium ZHC (100 mg/kg) improved bone development and skin integrity, suggesting that the combination of Cu and Zn can be a nutritional strategy to prevent the incidence of leg disorders in broilers.

Use of factor analysis to model relationships between bone mass and physical, dietary, and metabolic factors in frail and pre-frail older adults.

Bone mass and quality decline with age, and can culminate in osteoporosis and increased fracture risk. This investigation modeled associations between bone and physical, dietary, and metabolic factors in a group of 200 pre-frail/frail older adults using factor analysis and structural equation modeling (SEM). Exploratory (EFA) and confirmatory factor analysis (CFA) were conducted to compose factors and to assess their robustness. SEM was used to quantify associations between bone and the other factors. Factors arising from EFA and CFA were: bone (whole body, lumbar and femur bone mineral density, and trabecular bone score; good fit), body composition - lean (lean mass, body mass, vastus lateralis, and femoral cross-sectional area; good fit), body composition - fat (total fat mass, gynoid, android, and visceral fat; acceptable fit), strength (bench and leg press, handgrip, and knee extension peak torque; good fit), dietary intake (kilocalories, carbohydrate, protein, and fat; acceptable fit), and metabolic status (cortisol, insulin-like growth factor 1 (IGF-1), growth hormone (GH), and free testosterone; poor fit). SEM using isolated factors showed that body composition (lean) (ß = 0.66, P < 0.001), body composition (fat) (ß = 0.36, P < 0.001), and strength (ß = 0.74, P < 0.001) positively associated with bone. Dietary intake relative to body mass negatively associated with bone (ß = -0.28, P = 0.001), whereas in absolute terms, it showed no association (ß = 0.01, P = 0.911). In a multivariable model, only strength (ß = 0.38, P = 0.023) and body composition (lean) (ß = 0.34, P = 0.045) associated with bone. Resistance training programs that focus on improving lean mass and strength in older individuals may benefit bone in this population.NEW & NOTEWORTHY We used factor analysis and structural equation modeling, which are rarely used in nutrition or exercise science, but constitute powerful tools that may overcome limitations of traditional analyses, combining individual related variables into factors or constructs of interest. Our investigation represents a starting point on this progressive pathway, providing useful insight and a working model for researchers and practitioners who wish to tackle complex problems such as the multifactorial causes of bone loss in older adults.

Interrelationship between muscle fitness in childhood and bone mineral density in adulthood: mediation analysis of muscle fitness in adulthood.

BACKGROUND: This study was aimed to examine the relationship between muscular fitness indicators in childhood and areal bone mineral density (aBMD) in adulthood and to verify whether the relationship is mediated by performance on muscular fitness indicators in adulthood. METHODS: A sample of 138 healthy adults (69 males; 22.3 years) were followed after a previous assessment at the age of 7-10 years. Stature, body mass and muscular fitness indicators (handgrip strength, standing long jump and sit-ups tests) were assessed in childhood and adulthood. Additionally, total body, upper limbs, lower limbs, right femoral neck and lumbar spine aBMD was assessed in adulthood using dual X-ray absorptiometry. Analysis included descriptive statistics; t-test or Mann-Whitney U-test for comparison between males and females, multiple linear regression for the prediction aBMD from muscular fitness indicators in childhood, mediation analysis of the respective muscular fitness indicators in adulthood and the relationship between muscular fitness indicators in childhood and aBMD. RESULTS: Males were stronger compared to females regarding muscular fitness indicators in childhood and adulthood, and presented higher mean values for aBMD in adulthood, except for lumbar spine (p < 0.05). Regression analysis revealed that some muscular fitness indicators in childhood showed significant positive relationship with bone health indicators in adulthood, such as: handgrip strength and total body aBMD (ß = 0.005; R2 = 0.35; p = 0.040) and upper limbs aBMD (ß = 0.005; R2 = 0.55; p = 0.019); and sit-ups test was a significant predictors of lumbar spine BMD (ß = 0.003; R2 = 0.06; p = 0.039). Mediation analysis pointed out the following: adulthood handgrip strength mediated relationships between childhood handgrip strength and total aBMD (indirect effect (IE) = 0.0025; 95%CI = 0.0005-0.0048), and upper limbs aBMD (IE = 0.0040; 95%CI = 0.0017-0.0069). CONCLUSIONS: Muscular fitness indicators in childhood showed significant relationship with bone health indicators in adulthood and the sit-ups test in childhood had direct effect on lumbar spine aBMD in adulthood. Adulthood handgrip strength mediated the relationship between childhood handgrip strength and total body and upper limb aBMD, pointing out that muscular fitness in childhood may be a aBMD determinant in adulthood, especially when higher muscle fitness performance is maintained in adulthood.

Nutrient Patterns and Risk of Osteopenia in Postmenopausal Women.

Nutrient patterns (NPs) and the synergistic effect between nutrients have been shown to be associated with changes in bone mineral density (BMD). This study aimed to identify NPs and to associate them with BMD categories in postmenopausal women. This cross-sectional, observational, analytical study was carried out with women in menopause for at least 12 months, aged ≥50 years. Sociodemographic, lifestyle, and clinical variables were investigated. BMD was assessed using dual energy X-ray absorptiometry. A dietary assessment was conducted using a food frequency questionnaire, and three nutrient patterns (NP1, NP2, and NP3) were extracted from the principal component analysis. Multivariate logistic regression was applied to investigate the association between BMD classifications and NP consumption. A total of 124 women, aged on average, 66.8 ± 6.1 years, were evaluated. Of these, 41.9% had osteopenia and 36.3% had osteoporosis. The NP1 (OR: 6.64, [CI95%: 1.56-28.16]; p = 0.010), characterized by vitamin B12, pantothenic acid, phosphorus, riboflavin, protein (total and animal), vitamin B6, potassium, vitamin D, vitamin E, calcium, cholesterol, ß-carotene, omega 3, magnesium, zinc, niacin, and selenium; and the NP2 (OR: 5.03, [CI95%: 1.25-20.32]; p = 0.023), characterized by iron, vegetable protein, thiamine, folate, fibers (soluble and insoluble), PUFA, vitamin A, vitamin K, alpha-tocopherol, copper, sodium, and retinol, was inversely associated with osteopenia. The lower consumption of NP1 and NP2 by postmenopausal women was associated with a higher risk of osteopenia, but not osteoporosis.

Determinant factors of bone health after long-term of Roux-en-Y gastric bypass surgery: A cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate bone health and the potential influencing factors of bone metabolism disorders in adults ≥5 y after Roux-en-Y gastric bypass (RYGB) surgery. METHODS: In this cross-sectional study, patients who were ≥5 y post-RYGB were invited. Bone health considered as bone mineral content (BMC) and bone mineral density (BMD) in this study was assessed by dual x-ray absorptiometry. We also assessed 25-hydroxy-vitamin D concentrations, individual ultraviolet B radiation levels, serum ionized calcium, alkaline phosphatase, parathyroid, anthropometric, and body composition. RESULTS: The study evaluated 104 adults (90% women; 49.6 ± 9.1 y old; postoperative period 8.7 ± 2.2 y). Lumbar and femoral BMC and BMD were positively correlated to body mass index (BMI), appendicular lean mass (ALM), and negatively to %excess of weight loss (EWL). Femoral BMD was negatively correlated to age, and both femoral BMD and BMC were positively correlated to weekly exposed body part score. Sex, age, BMI, ALM, and weekly exposed body part score explained 35% and 54% of the total variance of femoral BMD and BMC, respectively. CONCLUSIONS: The present findings suggested that older age, lower BMI, higher %EWL, lower ALM, and lower weekly body part exposure score are important determinants in lowering BMD and BMC parameters in long-term post-bariatric surgery individuals, rather than serum 25-hydroxy-vitamin D and parathyroid.

Prevalence of low bone mineral density (T-score ≤ - 2.5) in the whole spectrum of chronic kidney disease: a systematic review and meta-analysis.

The prevalence of low bone mineral density (LBMD) in people with chronic kidney disease (CKD) remains unknown. We identified a high prevalence of LBMD in CKD population. Thus, public health strategies should include efforts to prevent, early detect, and manage LBMD in CKD patients, especially in patients undergoing kidney replacement therapy. Mineral and bone disorders are common among patients with CKD, which affects bone mineral density. We conducted a systematic review and meta-analysis to estimate the prevalence of low bone mineral density (LBMD) in adults with CKD. We searched MEDLINE, EMBASE, Web of Science, CINAHL, and LILACS databases from inception to February 2021. Observational studies that reported the prevalence of LBMD in adults with CKD stages 3a-5D were included. The LBMD was defined according to the World Health Organization criterion (T-score ≤ - 2.5). Random-effect model meta-analyses were used to estimate the pooled prevalence of LBMD. Meta-regressions and subgroup analyses were conducted for stages of CKD, dialysis modality, gender, bone sites and morphology, and geographical region. This study was registered in PROSPERO, number CRD42020211077. One-hundred and fifty-three studies with 78,092 patients were included. The pooled global prevalence of LBMD in CKD was 24.5% (95% CI, 21.3 - 27.8%). Subgroup analyses indicated a higher prevalence of LBMD in dialysis patients (30%, 95% CI 25 - 35%) compared with non-dialysis CKD patients (12%, 95% CI 8 - 16%), cortical bone sites (28%, 95% CI 23 - 35%) relative to trabecular sites (19%, 95% CI 14 - 24%), while similar estimates in the European and the Asiatic continents (26%, 95% CI 21 - 30% vs 25%, 95% CI 21 - 29). The prevalence of LBMD in CKD patients is high, particularly in those undergoing dialysis and in cortical bone sites. Therefore, efforts to early diagnosis and management strategies should be implemented in clinical routine for an epidemiological control of LBMD in CKD patients.

The inverse relationship between fatness and bone mineral content is mediated by the adolescent appendicular skeletal muscle mass index: The Cogni-Action Project.

Background: Excess adipose tissue negatively influences bone health during childhood, affecting future bone fragility diseases such as osteoporosis. However, little is known about how adolescent appendicular skeletal muscle mass index (ASMI) may mediate the relation between fatness and bone mineral content (BMC). Methods: The sample comprised 1,296 adolescents (50% girls) aged 10-14. A principal component analysis was performed to obtain a factor made up of four fatness indicators (a) neck circumference, (b) kilograms of fat, (c) visceral fat area, and (d) waist-to-height ratio. BMC, kilograms of fat, visceral fat area, and appendicular skeletal muscle mass were obtained by a multi-frequency bioelectrical impedance analyzer. ASMI was calculated as the appendicular skeletal muscle mass divided by height squared (kg/m2). A mediation analysis was performed adjusting by age, sex, maturation, socioeconomic status, physical activity, and adolescents' body weight. We also explore differences by sex and nutritional status. Results: The fatness factor explained 71.5% of the proportion variance. Fatness was inversely associated with the ASMI and BMC, while the ASMI was positively related to BMC. Overall, the inverse relationship between fatness and BMC was partially mediated by the adolescents' ASMI (29.7%, indirect effect: B= -0.048, 95%CI -0.077 to -0.022), being higher in girls than in boys (32.9 vs. 29.2%). Besides, the mediation effect was higher in adolescents with normal body weight than with overweight-obese (37.6 vs 23.9%, respectively). Conclusions: This finding highlighted the relevance of promoting healthy habits to reduce fatness and improve muscle mass in adolescents. Moreover, this highlights the central role of ASMI mediating the inverse association between fatness and BMC in female and male adolescents. Public health strategies should promote bone health in childhood, reducing the incidence of early osteopenia and osteoporosis.

Vitamin D and musculoskeletal health: outstanding aspects to be considered in the light of current evidence.

Vitamin D enhances calcium absorption and bone mineralisation, promotes maintenance of muscle function, and is crucial for musculoskeletal health. Low vitamin D status triggers secondary hyperparathyroidism, increases bone loss, and leads to muscle weakness. The primary physiologic function of vitamin D and its metabolites is maintaining calcium homeostasis for metabolic functioning, signal transduction, and neuromuscular activity. A considerable amount of human evidence supports the well-recognised contribution of adequate serum 25-hydroxyvitamin D concentrations for bone homeostasis maintenance and prevention and treatment strategies for osteoporosis when combined with adequate calcium intake. This paper aimed to review the literature published, mainly in the last 20 years, on the effect of vitamin D and its supplementation for musculoskeletal health in order to identify the aspects that remain unclear or controversial and therefore require further investigation and debate. There is a clear need for consistent data to establish realistic and meaningful recommendations of vitamin D status that consider different population groups and locations. Moreover, there is still a lack of consensus on thresholds for vitamin D deficiency and optimal status as well as toxicity, optimal intake of vitamin D, vitamin D supplement alone as a strategy to prevent fractures and falls, recommended sun exposure at different latitudes and for different skin pigmentations, and the extra skeletal effects of vitamin D.

Effects of physical training on physical and functional fitness, physical activity level, endothelial function, hemodynamic variables, bone metabolism, and quality of life of post-bariatric patients: study protocol for a randomized controlled trial.

BACKGROUND: Evidence of the benefits induced from resistance exercise on health markers of post-bariatric patients is limited. The study will investigate the effects of a resistance training (RT) program on muscle mass and strength, bone metabolism biomarkers, bone mineral density (BMD), bone microarchitecture, and endothelial function of patients subjected to Roux-en-Y gastric bypass. METHODS/DESIGN: This randomized controlled trial will include 60 post-bariatric patients, physically inactive, aging 18 to 50 years, with a post-surgery period ≥ 12 months. They will be randomly assigned into two groups: (i) the non-exercised control group, which will receive the standard clinical follow-up, or (ii) the intervention group which will consist of RT (60 min/session; 3 times/week, for 6 months). The primary outcomes will include muscle mass and strength, bone metabolism biomarkers, BMD, and bone microarchitecture. The secondary outcomes will be anthropometry, hemodynamic measurements, cardiovascular risk factors, health-related quality of life (QoL), and endothelial function. Outcomes will be assessed by blood biomarkers of bone formation and reabsorption, dual X-ray absorptiometry, repetition maximum and handgrip strength tests, high-resolution peripheral quantitative computed tomography, 36-Item Short-Form Health Survey, venous occlusion plethysmography, and nailfold videocapillaroscopy. DISCUSSION: It is expected that there are greater benefits from the RT program, possibly improving muscle mass and strength, bone metabolism, density and microarchitecture, QoL, and cardiovascular risk. TRIAL REGISTRATION: ClinicalTrials.gov NCT04193397. Registered on 7 December 2019.

Adiposity Metabolic Consequences for Adolescent Bone Health.

Infancy and adolescence are crucial periods for bone health, since they are characterized by intense physical growth and bone development. The unsatisfactory acquisition of bone mass in this phase has consequences in adult life and increases the risk of developing bone diseases at more advanced ages. Nutrient deficiencies, especially calcium and vitamin D, associated with a sedentary lifestyle; lack of sun exposure; and epigenetic aspects represent some of the main risk factors for poor bone quality. In addition, recent studies relate childhood obesity to impaired bone health; however, studies on the adiposity effects on bone health are scarce and inconclusive. Another gap concerns the implications of obesity on child sexual maturity, which can jeopardize their genetic potential bone mass and increase fracture risk. Therefore, we reviewed the analyzed factors related to bone health and their association with obesity and metabolic syndrome in adolescents. We concluded that obesity (specifically, accumulated visceral fat) harms bones in the infant-juvenile phase, thereby increasing osteopenia/osteoporosis in adults and the elderly. Thus, it becomes evident that forming and maintaining healthy eating habits is necessary during infancy and adolescence to reduce the risk of fractures caused by bone-metabolic diseases in adulthood and to promote healthy ageing.

Bone loss induced by cancer treatments in breast and prostate cancer patients.

Cancer and cancer therapies are a major factor risk for osteoporosis due to bone loss and deterioration of bone microarchitecture. Both factors contribute to a decrease in bone strength and, consequently, increased bone fragility and risk of fracture. Cancer-associated bone loss is a multifactorial process, and optimal interdisciplinary management of skeletal health, accurate assessment of bone density, and early diagnosis are essential when making decisions aimed at reducing bone loss and fracture risk in patients who have received or are receiving treatment for cancer. In this document, a multidisciplinary group of experts collected the latest evidence on the pathophysiology of osteoporosis and its prevention, diagnosis, and treatment with the support of the Spanish scientific society SEOM. The aim was to provide an up-to-date and in-depth view of osteoporotic risk and its consequences, and to present a series of recommendations aimed at optimizing the management of bone health in the context of cancer.

Therapeutic Effects of Citrus Flavonoids Neohesperidin, Hesperidin and Its Aglycone, Hesperetin on Bone Health.

Flavonoids are natural phytochemicals that have therapeutic effects and act in the prevention of several pathologies. These phytochemicals can be found in seeds, grains, tea, coffee, wine, chocolate, cocoa, vegetables and, mainly, in citrus fruits. Neohesperidin, hesperidin and hesperetin are citrus flavonoids from the flavanones subclass that have anti-inflammatory and antioxidant potential. Neohesperidin, in the form of neohesperidin dihydrochalcone (NHDC), also has dietary properties as a sweetener. In general, these flavanones have been investigated as a strategy to control bone diseases, such as osteoporosis and osteoarthritis. In this literature review, we compiled studies that investigated the effects of neohesperidin, hesperidin and its aglycone, hesperetin, on bone health. In vitro studies showed that these flavanones exerted an antiosteoclastic and anti- inflammatory effects, inhibiting the expression of osteoclastic markers and reducing the levels of reactive oxygen species, proinflammatory cytokines and matrix metalloproteinase levels. Similarly, such studies favored the osteogenic potential of preosteoblastic cells and induced the overexpression of osteogenic markers. In vivo, these flavanones favored the regeneration of bone defects and minimized inflammation in arthritis- and periodontitis-induced models. Additionally, they exerted a significant anticatabolic effect in ovariectomy models, reducing trabecular bone loss and increasing bone mineral density. Although research should advance to the clinical field, these flavanones may have therapeutic potential for controlling the progression of metabolic, autoimmune or inflammatory bone diseases.