Journal of Bone Metabolism最新文献

Romosozumab, which is approved for the treatment of osteoporosis, has a dual-action mechanism that promotes bone formation and inhibits bone resorption. However, its association with an increased risk of major adverse cardiovascular events, as highlighted in the ARCH I study, raises concerns. The underlying pathophysiological mechanisms, possibly involving changes in platelet dynamics, are yet to be fully elucidated. Herein, we present a case of a 60-year-old Korean woman diagnosed with immune thrombocytopenic purpura and new-onset osteoporosis, who was treated with romosozumab. Subsequent to the administration of romosozumab, there was a notable elevation in her platelet count. This observation warrants further investigation into the off-target effects of romosozumab, especially its impact on hematopoietic stem cell function and platelet dynamics. This case accentuates the imperative for more comprehensive research into the systemic effects of romosozumab, particularly its involvement in hematopoiesis and cardiovascular risk, to thoroughly understand its extensive implications for patient health.

Background: Osteoporosis is a significant global public health issue, increasingly affecting younger individuals and placing substantial economic burdens on society. Risk factors vary, with non-modifiable ones like age and ethnicity, as well as modifiable factors including corticosteroid use, caffeine intake, and reduced exercise. This study examines the relationship between bone density, body components, and physical activity (PA) in enhancing bone health, particularly in obese athletes.

Methods: The 66 participants aged 18 to 30 were classified into two groups: 34 obese and 32 athletes. Measured parameters included body composition through bioelectrical impedance analysis, and bone mineral density (BMD) via quantitative ultrasound, while PA was assessed using the International PA Questionnaire.

Results: Our findings revealed a significant positive correlation between BMD and PA (r=0.284, P=0.023). Additionally, PA demonstrated strong negative correlations with body mass index (BMI), fat mass, and visceral fat (r=-0.738, r=-0.733, and r=-0.704 respectively, all P<0.001). In contrast, no significant correlation was observed between PA and lean mass (r=0.065, P=0.609). BMD was negatively associated with BMI and visceral fat, while a robust correlation between basal metabolic rate and lean mass was evident.

Conclusions: A study comparing athletes involved in high-impact sports indicated that these athletes maintained adequate BMD for their chronological age (Z-score≥-2.0). Moreover, a significant difference in BMD was observed when comparing the athletes to the obese group(P=0.018).

Background: There are age- and sex-related increases in the prevalence of osteoporosis. Bone densitometry based on dual energy X-ray absorptiometry (DXA) is the gold standard for the assessment of bone mineral density (BMD). Three-dimensional (3D) analysis of the proximal femur (3D-DXA) allows discrimination between cortical and trabecular compartments, and it has shown a good correlation with computed tomography. We aimed to assess age- and sex-related volumetric density differences in trabecular and cortical bone using 3D-DXA and determine the reference intervals for integral volumetric (v)BMD within the Argentine population.

Methods: Healthy female and male adult subjects (N=1,354) from Argentina were included. Hip BMD was measured using DXA, and 3D analysis was performed using 3D-Shaper software. The integral vBMD, cortical surface BMD, and trabecular vBMD (trab vBMD) were measured.

Results: The study population included 73.9% women (N=1,001) and 26.13% men (N=353). We found a significant decrease in integral vBMD between 20 and 90 years in both sexes (women, -23.1%; men, -16.6%). Bone loss indicated in the integral vBMD results was mainly due to a decrease in trabecular bone in both sexes (women, -33.4%; men, -27.7%). The age-related loss of cortical bone density was less and was limited to the female population, without no age-related differences in men. Moreover, 3D-DXA allowed us to propose reference intervals for integral vBMD.

Conclusions: We found age- and sex-related bone loss between 20 and 90 years in an Argentine cohort via integral vBMD measurements using 3D-DXA, mainly due to decreases in trabecular bone in both sexes. The age-related loss of cortical bone density was less and was limited to the female population.

Background: This review explores the discriminative ability of fracture risk assessment tool (FRAX) in major osteoporotic fracture (MOF) and hip fracture (HF) risk prediction and the densitometric diagnosis of osteoporosis in Asian populations.

Methods: We systematically searched the EMBASE, Cochrane, and PubMed databases from the earliest indexing date to January 2024. Studies were included if FRAX was used to identify future osteoporotic fractures or a densitometric diagnosis of osteoporosis in an Asian population and reported the area under the curve (AUC) values. Meta-analyses were conducted after quality assessment for AUC with 95% confidence intervals across the following categories: standard FRAX without/with bone mineral density (BMD), adjusted FRAX, and BMD alone for fracture prediction, as well as standard FRAX for densitometric diagnosis of osteoporosis.

Results: A total of 42 studies were included. The AUC values for predicting fracture risk using FRAX-MOF with BMD (0.73 [0.70-0.77]) was highest compared to FRAX-MOF without BMD (0.72 [0.66-0.77]), and adjusted FRAX-MOF (0.71 [0.65-0.77]). The AUC values for predicting fracture risk using FRAX-HF with BMD (0.77 [0.71-0.83]) was highest compared to FRAX-HF without BMD (0.72 [0.65-0.80]), and adjusted FRAX-HF (0.75 [0.63-0.86]). The AUC values for BMD alone (0.68 [0.62-0.73]) was lowest for fracture prediction. The AUC values for identifying a densitometric diagnosis of osteoporosis was 0.77 [0.70-0.84] and 0.76 [0.67-0.86] using FRAX-MOF and FRAX-HF, respectively.

Conclusions: FRAX with BMD tends to perform more reliably in predicting HF compared to MOF in Asia. However, its accuracy in predicting fracture risk in Asian populations can be improved through region-specific, long-term epidemiological data.

Background: Osteogenesis imperfecta (OI) is a rare disease with an estimated incidence of between 1/25,000 and 1/10,000 globally. The main treatment for OI is the administration of bisphosphonate drugs. Research on clinical, radiographic, and biochemical markers to monitor patients with OI treated with zoledronate can be challenging in countries in which patients have limited national health insurance. We aimed to examine patients with OI treated in Indonesia with a minimum follow-up period of 2 years.

Methods: An observational study was conducted of all patients with OI treated with zoledronate between 2021 and 2023 at a tertiary hospital in Indonesia. We evaluated the paediatric quality of life (PedsQL), bone mineral density (BMD), and alkaline phosphatase (ALP) level before and after zoledronate treatment. To monitor safety, serum creatinine and calcium levels were also measured.

Results: Eleven boys (55%) and nine girls (45%), with an average age of 6.9 years (range, 4-17 years), were included. After 2 years of zoledronate treatment, the total PedsQL score increased from 66.7 to 76.9 (P=0.0001) and the mean lumbar and total body BMD increased from 0.467 and 0.501 to 0.599 g/cm2, and 0.626 g/cm2 (P=0.001), respectively. The ALP level decreased from 310.6 to 186.4 mg/mL (P=0.0001). Neither serum creatinine (P=0.586) nor calcium (P=0.53) levels changed from the pre-treatment to 2 years post-treatment time points.

Conclusions: Zoledronate was safe and effective for the treatment of OI. There were significant improvements in the quality of life and BMD in patients with OI. The ALP level decreased, but serum creatinine and calcium levels were not affected by zoledronate.

Chronic kidney disease (CKD) often leads to mineral and bone disorders (CKD-MBDs), which are nearly universal in patients undergoing dialysis. CKD-MBD includes abnormal calcium-phosphate metabolism, vascular and soft tissue calcification, and bone abnormalities (renal osteodystrophy [ROD]). Bone fragility in CKD occurs due to low bone mass and poor bone quality, and patients with CKD have higher fracture and mortality rates. Bone histomorphometry is the gold standard for ROD diagnosis; however, it is labor-intensive and expensive. The Kidney Disease Improving Global Outcomes clinical practice guidelines on CKD-MBD suggest serum parathyroid hormone (PTH) and bone-specific alkaline phosphatase (bone ALP) for predicting bone turnover in ROD. In this review, we focus on the role of PTH and bone turnover markers, intact procollagen type N-terminal propeptide of type I collagen, bone ALP, and tartrate-resistant acid phosphatase 5b in diagnosing ROD, predicting fractures, and guiding treatment in patients with CKD.

Background: This study aimed to evaluate the influence of physical performance level on patient-reported outcomes after surgery for distal radius fractures (DRF).

Methods: We retrospectively reviewed 157 women with DRF who underwent surgery and completed the short physical performance battery (SPPB) within one month of trauma between January 2019 and August 2022. Patient-reported outcomes were assessed one year postoperatively using the disabilities of the arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) questionnaires. Multivariate linear regression analysis was conducted using patient characteristics, fracture type, treatment-related factors, and SPPB results to evaluate the factors associated with patient-reported outcomes.

Results: Multivariate linear regression model revealed that dominant hand involvement (B=7.329; 95% confidence interval [CI], 2.901-11.757; P=0.001) and lower SPPB scores (B=-2.145; 95% CI, -3.194 to -1.096; P<0.001) were significantly associated with higher DASH and PRWE scores.

Conclusions: Physical performance level evaluated using the SPPB was significantly associated with poor clinical outcomes of DRF after surgery. Physicians should implement a systematic approach to enhance physical performance along with appropriate fracture treatment to improve clinical outcomes following surgery for DRF.

Background: Recent studies have linked sarcopenia development to the hallmarks of diabetes, oxidative stress, and insulin resistance. The anti-oxidant and insulin sensitivityenhancing effects of incretin-based therapies may provide a promising option for the treatment of sarcopenia. This review aimed to unveil the role of oxidative stress and insulin resistance in the pathogenesis of sarcopenia and explore the potential benefits of incretin-based therapies in individuals with sarcopenia.

Methods: PubMed, the Cochrane Library, and Google Scholar databases were searched by applying keywords relevant to the main topic, to identify articles that met our selection criteria.

Results: Incretin-based therapies manifested anti-oxidant effects by increasing the anti-oxidant defense system and decreasing free radical generation or by indirectly minimizing glucotoxicity, which was mainly achieved by improving insulin signaling and glucose homeostasis. Likewise, these drugs exhibit insulin-sensitizing activities by increasing insulin secretion, transduction, and β-cell function or by reducing inflammation and lipotoxicity.

Conclusions: Incretin-based therapies, as modulators of oxidation and insulin resistance, may target the main pathophysiological factors of sarcopenia, thus providing a promising strategy for the treatment of this disease.

Background: Abdominal aortic calcification (AAC) on lateral lumbar radiographs increases the risk of cardiovascular events and mortality. However, data on the association between AAC detected in dual energy X-ray absorptiometry (DXA) and the risk of mortality in the general population are scarce.

Methods: The present study was based on data from participants aged ≥40 years in the National Health and Nutrition Examination Survey (NHANES) cycle of 2013 to 2014. Vertebral assessment of lateral spine DXA scans was used to provide AAC measurements at vertebrae L1-L4. The extent of AAC was defined according to the Kauppila AAC-24 scores (0-1, 2-5, ≥6), and the NHANES 2019 public-use linked mortality files were used to assess mortality status.

Results: Of the 2,962 participants who were included in this study, with a mean age of 57.4 years and a median follow-up of 69.9 months, 252 (8.5%) died. Of the deaths, 84 (33.3%) occurred due to cardiovascular disease. The Cox proportional hazards models revealed that participants with AAC-24 scores ≥6 were 1.7 times more likely to die than those with AAC-24 scores 0-1 (Hazard ratio, 1.75; 95% confidence interval, 1.13-2.71). Moreover, older adults and women with AAC-24 scores ≥6 were 2.8 and 2.4 times more likely to die than their counterparts with AAC-24 scores 0-1, respectively. Conversely, a non-significant risk of cardiovascular mortality was found among participants with AAC-24 scores ≥6.

Conclusions: The extent of AAC detected on vertebral fracture assessment DXA was associated with an increased risk of all-cause mortality in adults, particularly older adults and women.