Journal of Clinical Densitometry最新文献

The purpose of this study was to explore the influence of a 12-month high-impact physical training program (descending stairs) on bone health in a group of young obese women who had undergone bariatric surgery (type sleeve). Fifty-two premenopausal women with a body mass index (BMI) > 35 kg/m² (range: 35.06-60.97 kg/m²), aged 19-47 years old were included in this study. Patients were randomized to either exercise group (EG), control group (CG) or observational group (OG). 2 to 3 weeks post-bariatric surgery (BS), EG underwent a 12-month semi-supervised high impact (descending stairs) exercise program, CG performed a 12-month oriental dance activity while the third OG received only standard medical care. Patients were assessed before BS and 12 months post-BS for body composition, bone mineral density (BMD) and femoral neck geometry. Bone parameters were evaluated by DXA. At baseline, there were no significant differences among the three groups in the clinical characteristics and the bone variables. 12 months after the surgery, there were some group*time interactions. The 3 groups showed significantly lower whole body BMD (-1.8; -2.9; -4.2 % respectively for EG; CG and OG). The EG showed a significant increase of the femoral neck BMD (+1.4 %; p < 0.05), the femoral neck cross-sectional area (+4.6 %; p < 0.05), and the femoral neck cross-sectional moment of inertia (+15.7 %; p < 0.01) while all these values decreased significantly in the 2 other groups. The total hip BMD decreased in all groups, but the EG showed less significant total hip variation, and lumbar spine BMD decreased significantly only in the OG. This study mainly shows that the stair descent can be considered as an effective high-impact physical exercise for obese women who have undergone bariatric surgery. This kind of exercise has significant effects in maintaining or reducing the loss of BMD at the femoral neck and the total hip. Finally, since the EG group showed significant increases in femoral neck geometry variables, this study suggests that this kind of training could be efficient at reducing the hip fracture risk.

Bone Health ECHO (Extension of Community Healthcare Outcomes) is a growing family of online educational programs. Its mission is to enhance delivery of best practice skeletal healthcare worldwide. Each program typically consists of a didactic lecture and discussion of clinical cases with diagnostic and treatment dilemmas. Here we present a Bone Health ECHO case of a 39-year-old man who has received hemodialysis for 12 years. This case is characterized by the development of chronic kidney disease - mineral and bone disorder (CKD-MBD) which was managed using conservative treatment to maintain phosphate and calcium levels within the reference range in spite of severe secondary hyperparathyroidism, after the patient declined parathyroidectomy. Although this patient had multiple vertebral fractures with height loss, his bone mineral density was higher than expected for his age and gradually increased over the period of observation. Whole-exome sequencing showed a heterozygous, likely pathogenic variant in LEMD3 gene (13 exon HG38, chr12:65246271dup, с.2682dup in a heterozygous state), which may explain the high bone mass phenotype. As a result of the ECHO presentation, we decided that successful treatment of CKD-MBD would be the most effective approach to managing his bone fragility. His high bone mass phenotype was most likely associated with LEMD3 gene variant. This patient does not require any specific anti-osteoporotic treatment at this time; however, he is likely to benefit from parathyroid surgery.

This study aimed to assess the calcaneal bone mineral density (BMD) of elite female trail runners and evaluate its reliability using a novel DXA method. It also examined the relationship between calcaneal BMD and other regions of interest to better understand bone health in this specific population. A cross-sectional study was conducted with 35 elite female trail runners from the Spanish national team. BMD was measured at six anatomical regions using DXA, with particular focus on the calcaneus. Intra- and inter-rater reliability were evaluated using intraclass correlation coefficients (ICC). Descriptive statistics and correlations between calcaneal BMD and other anatomical sites, such as the lumbar spine and femoral neck, were analyzed. Calcaneal BMD showed excellent reliability (ICC = 0.95-0.98), confirming the robustness of the proposed measurement method. The mean calcaneal BMD (0.660 ± 0.105 g·cm²) was higher than that of non-athletes but lower than athletes from other endurance sports, such as road running. Significant correlations were found between calcaneal BMD and other regions, including the femoral neck (r = 0.58) and lumbar spine (r = 0.50), indicating that calcaneal BMD may provide complementary information for assessing bone health. The study confirms the reliability of calcaneal BMD measurement in elite female trail runners and highlights its potential as a useful complementary tool for monitoring bone health. Further longitudinal studies are needed to determine whether calcaneal BMD can serve as an indicator for stress fractures and other bone-related injuries in endurance athletes.

Purpose: The aim of this study was to investigate the correlations between areal bone mineral density (aBMD) and body composition measured by two dual-energy X-ray absorptiometers (DXA), the DMS Stratos® (STR) and the Hologic Horizon A® (HRZ), and then generate cross-calibration equations between the two scanners.

Methods: Repeat scans were obtained from 251 adults (85 % female), 36 ± 14 years old with mean body mass index (BMI) of 28.7 ± 11.1 kg/m2, using HRZ (fan-beam technology) and STR (pencil-beam technology). aBMD was measured at whole body [WB], femoral neck [FN], total hip [TH], lumbar spine [LS] and radius, while fat mass [FM] and lean tissue mass [LTM] were determined at whole body and at android and gynoid subregions.

Results: Compared to HRZ, STR underestimated both aBMD at WB and radius and LTM at WB and android and gynoid regions. Conversely, STR overestimated aBMD at FN, TH, LS and FM at WB android and gynoid regions. Except for WB bone mineral content (r = 0.87) and WB aBMD (r = 0.84), there were strong correlations of aBMD and body composition between the two DXAs (r > 0.91; p < 0.0001). Several of the parameters that required the determination of specific cross-calibration equations because of the significant bias between the two DXAs were found to be influenced by BMI.

Conclusions: Although the data from the STR and the HRZ were highly correlated for aBMD and body composition parameters, a systematic measurement bias between two DXAs was observed. The development of cross-calibration equations fully corrected these differences and they may thus be useful for multicenter studies when scans are performed with STR and HRZ.

Bone Health ECHO (Extension of Community Healthcare Outcomes) is a virtual community of practice that has been connecting healthcare professionals online once weekly for the past 10 years. A key component of each ECHO session is presentation and discussion of patient cases with diagnostic and treatment dilemmas. Here we present two wheelchair-bound female patients aged 47 years (Patient 1) and 34 years (Patient 2), both with type 1 diabetes mellitus (T1DM). They were admitted to our hospital due to multiple fractures and muscle weakness. Since age 8 years, both women suffered from T1DM. Patient 1 had extremely poor glycemic control over the whole period of diabetes with frequent cases of ketoacidosis (glycated hemoglobin [HbA1c] varied 10.0-14.2 %), with multiple end-stage complications of DM including anuria requiring hemodialysis from age 37 years. Patient 2 had minimal DM complications and maintained HbA1c within an individual goal (5.0-6.1 %). Both patients had low fasting phosphate and elevated alkaline phosphatase on laboratory evaluation. In the patient with anuria (Patient 1), after careful evaluation of all possible causes of hypophosphatemia, we found the most likely cause to be the effects of constantly repeated intracellular phosphate depletion due to poorly compensated T1DM. While achieving stable glucose control in hospital care, her phosphate levels gradually returned within the reference range. In the younger patient (Patient 2), tumor-induced osteomalacia (TIO) was diagnosed. After tumor removal her symptoms and laboratory results normalized. These cases illustrate two different causes of hypophosphatemia in patients with similar skeletal presentations in association with T1DM.

Bone Health ECHO (Extension for Community Healthcare Outcomes) is a virtual community of practice, where healthcare professionals have met via videoconferencing weekly since 2015. This model of learning is focused on short didactics and the presentation of real but de-identified patient cases followed by highly interactive discussions. These are often clinical situations with diagnostic and therapeutic dilemmas that are not readily addressed by randomized placebo-controlled clinical trials and clinical practice guidelines. Here we present the case of a woman with postmenopausal osteoporosis with adverse consequences following discontinuation of denosumab and uncertainties on next steps for management. This case highlights the relevance of selection of the initial bone-targeted medication and the sequence of therapy in osteoporosis management.

Background: Bone mineral density (BMD) is an indicator of bone health that predicts future bone fractures. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is used to assess the severity of symptoms related to pain, stiffness, and function in diseased hip and knee joints. Here we assessed whether BMD measured at specific sites predicts WOMAC scores in healthy individuals whilst controlling for sociodemographic variables.

Methodology: BMD, sociodemographic, and WOMAC data were collected from 1764 healthy adult individuals attending the Qatar Biobank (QBB). Multiple linear regression was used to examine associations between sociodemographic factors, total body BMD and BMD related to specific skeletal sites (including femoral (femoral neck and trochanter), trunk, pelvis and total spine), and the three WOMAC subscales (pain, stiffness, and physical function).

Results: After controlling for sociodemographic variables, total body and specific BMD measures did not predict pain. However, BMD measures significantly contributed to predicting stiffness after controlling for sociodemographic variables (R² = 0.065, ΔF(7, 1724) = 3.34, p = 0.002), with a higher total body BMD associated with increased stiffness and a higher trunk BMD associated with decreased stiffness. Total body BMD measures also significantly contributed to predicting compromised physical function (R² = 0.091, ΔF(7, 1724) = 3.762, p < 0.001) after controlling for sociodemographic variables, with a higher total body BMD associated with an increase in compromised physical function.

Conclusion: Total body BMD seems to be a more important predictor of stiffness and physical function than specific skeletal sites BMD measures. Monitoring BMD may have important implications for osteoarthritis patients.