Correlation between DKK-1 Level and Bone Density Status in Children on Maintenance Haemodialysis

Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.

Maternal dietary patterns associated with bone density in Chinese lactating women and infants at 6 months postpartum:a prospective study using data from 2018-2019

This cohort study was designed to explore the relationship between maternal dietary patterns(DPs)and bone health in Chinese lactating mothers and infants.We recruited 150 lactating women at 1-month postpartum.The estimated bone mineral density(eBMD)of subjects’calcanei and the information on dietary intake were collected.After 5-month follow-up,the eBMD of mothers and their infants were measured again.Factor analysis was applied to determine maternal DPs.General linear models were used to evaluate the association between maternal DPs and maternal eBMD loss or infants’eBMD.With all potential covariates adjusted,Factor 2(high intake of whole grains,tubers,mixed beans,soybeans and soybean products,seaweeds,and nuts)showed a positive association with the changes of maternal eBMD(β=0.16,95%CI:0.005,0.310).Factor 3(high intake of soft drinks,fried foods,and puffed foods)was inversely correlated with the changes of maternal eBMD(β=-0.22,95%CI:-0.44,0.00).The changes of maternal eBMD were positively associated with 6-month infants’eBMD(β=0.34,95%CI:0.017,0.652).In conclusion,Factor 2 might contribute to the maintenance of eBMD in lactating women,while Factor 3 could exacerbate maternal eBMD loss.Additionally,the changes of maternal eBMD presented a positive correlation with 6-month infants’eBMD.

Clinical efficacy,bone density,and follow-up in implant and orthodontic treatment for inclined adjacent teeth

BACKGROUND Tooth defects can cause elongation of occlusal teeth,leading to insufficient repair space.The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant therapeutic effect.AIM To explore clinical efficacy,bone density,and follow-up of implant and orthodontic treatment for patients with inclined adjacent teeth.METHODS In total,98 patients with oblique adjacent teeth were randomly assigned to implant restoration combined with orthodontic treatment(group A,n=49)or to receive implant restoration alone(group B,n=49).Changes in alveolar ridge bone density and apical bone density were observed before and after treatment in the two groups.Changes in chewing function and language function were compared between the two groups of patients.Follow-up lasted for 12 mo after repair to observe any adverse reactions in the oral cavity.RESULTS The clinical effective rates of group A and group B were 97.96%and 85.71%,respectively,with group A having a higher clinical effective rate than group B.After treatment,the bone density of the alveolar ridge and apical bone in both groups decreased compared to before treatment,while the chewing and language functions improved.The changes in various indicators in group A were more significant.After treatment,the satisfaction rate of group A(97.96%)was higher than that of group B(79.59%).The incidence of adverse reactions in group A(2.04%)was lower than that in group B(24.49%).CONCLUSION The amalgamation of implant restoration and orthodontic treatment for adjacent tilted teeth demonstrates notable clinical efficacy,diminishes alveolar bone resorption,and fosters patient functional rehabilitation while exhibiting negligible adverse reactions.

Bone Density and Mechanical Properties in Femoral Bone of Swim Loaded Aged Mice

Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments.The results of this study indicated that (i) the hady weight was significantly (P<0.05) lower in the swimming groups than in the control groups in boh sexes. (ii) The bone density was significantly higher (P <0.05) in the swimming groups than in the control groups in boh sexes. However, there was no sighficant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimndng and the contro groups in beth sexes. However, the elasticity of the bone of the female hoce in the swimming group was significantly higher (P<0.05) than that of the control group.These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.

Bone density, microarchitecture and stiffness in Caucasian and Caribbean Hispanic postmenopausal American women

Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density （aBMD）. At the radius by high-resolution peripheral quantitative computed tomography （HR-pQCT）, there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation （ITS） analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate-plate, plate-rod and rod-rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.

Analysis of the Spatial Distribution Characteristics of Abnormal Bone Density in Male Long-Distance Runners from Different Regions in China

Objective: To investigate the occurrence pattern of abnormal bone density in male long-distance runners from several different regions of China, and provide a basis for elucidating the influences of geo-environmental differences on bone density. Methods: We employed a set of well-designed exclusion-inclusion criteria to recruit study subjects, in which compounding factors were managed and regional environmental traits were fully incorporated. WHO (World Health Organization) criteria for the diagnosis of osteoporosis were then used to examine the subjects to determine occurrence of abnormal bone density. The resulting data were analyzed using methods of spatial statistics, which included several approaches, such as spatial autocorrelation, hot spot analysis, and Geodetector Software analysis, to depict and analyze the spatial distribution of abnormal bone density in male athletes from different regions in China, thereby investigating the influences of geo-environmental factors (e.g., temperature, humidity, and altitude) on bone density. Results: A total of 685 subjects were effectively examined in this study, including 486 with normal bone density, 185 with osteopenia, and 14 with osteoporosis. Spatial distribution analysis revealed that the distribution of subjects with abnormal bone density overall exhibited a pattern indicating that the level of abnormal bone density in the eastern regions was higher than that in the western regions and that the levels of abnormal bone density in the southern and northern regions were higher than that in the middle regions. Spatial autocorrelation analysis revealed a Moran’s I = 0.136, Z-score = 1.114, and P value = 0.265 and indicated that the athletes with abnormal bone density were randomly distributed in each region. Hot spot analysis revealed that Tibet and Qinghai displayed distributions of cold spots. Geodetector Software analysis yielded a Q value for annual average temperature of 1.000 and a corresponding P value of 0.000, and the results revealed that temperature significantly affected bone density and that altitude, relative humidity, sunlight hours, and temperature variations displayed synergistic effects on bone density and could diminish the influences of temperature on bone density. Conclusion: Our data revealed that different regions displayed different distribution patterns of abnormal bone density such that the level in the eastern regions was higher than that in the western ones and that the levels in the southern and northern regions were higher than that in the middle regions;specifically, the provinces of Yunnan, Heilongjiang, Hainan, and Inner Mongolia had high rates of abnormal bone density, whereas Tibet and Qinghai had relatively good conditions of bone density. Our data suggested that suitable temperature changes and appropriate levels of temperature variations can decrease the occurrence rates of osteopenia and osteoporosis.

Artificial intelligence models based on non-contrast chest CT for measuring bone mineral density

Objective To observe the value of artificial intelligence(AI)models based on non-contrast chest CT for measuring bone mineral density(BMD).Methods Totally 380 subjects who underwent both non-contrast chest CT and quantitative CT(QCT)BMD examination were retrospectively enrolled and divided into training set(n=304)and test set(n=76)at a ratio of 8∶2.The mean BMD of L1—L3 vertebrae were measured based on QCT.Spongy bones of T5—T10 vertebrae were segmented as ROI,radiomics(Rad)features were extracted,and machine learning(ML),Rad and deep learning(DL)models were constructed for classification of osteoporosis(OP)and evaluating BMD,respectively.Receiver operating characteristic curves were drawn,and area under the curves(AUC)were calculated to evaluate the efficacy of each model for classification of OP.Bland-Altman analysis and Pearson correlation analysis were performed to explore the consistency and correlation of each model with QCT for measuring BMD.Results Among ML and Rad models,ML Bagging-OP and Rad Bagging-OP had the best performances for classification of OP.In test set,AUC of ML Bagging-OP,Rad Bagging-OP and DL OP for classification of OP was 0.943,0.944 and 0.947,respectively,with no significant difference(all P>0.05).BMD obtained with all the above models had good consistency with those measured with QCT(most of the differences were within the range of Ax-G±1.96 s),which were highly positively correlated(r=0.910—0.974,all P<0.001).Conclusion AI models based on non-contrast chest CT had high efficacy for classification of OP,and good consistency of BMD measurements were found between AI models and QCT.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Anisotropy of Trabecular Bone from Ultra-Distal Radius Digital X-Ray Imaging: Effects on Bone Mineral Density and Age

Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBSx, and along the direction parallel to the forearm, TBSy, were calculated respectively. The statistics of TBSx and TBSy were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBSy to TBSx and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBSx and TBSy was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.

Impact of bisphosphonate treatment on bone mineral density after kidney transplant

BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney transplantation.Immunosuppressive treatment contributes to the patho-genesis of this disease.Bisphosphonate treatments have shown positive but inde-finite results.AIM To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year later.We also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the study.Bisphosphonates were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no treatment.BMD improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after surgery.Kidney function was not affected by bisphosphonate treatment.In KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone mass.CONCLUSION In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.

Relationship between Waist Circumference, Waist-Height Ratio, Body Fat Percentage, Visceral Fat and Bone Mineral Density in Middle-Aged and Elderly Zhuang of China

Objective: To understand the correlation between different degrees of obesity and bone mineral density (BMD). Methods: 772 cases (300 men and 472 females) of Zhuang over 40 years old were randomly selected. The BMD and T score were calculated by measuring the right heel bone using a quantitative-ultrasound densitometer. Body composition index of body weight, waist circumference (WC), waist height ratio (WtHR), body fat percentage (BFP) and visceral fat (VF) were measured using a bioelectrical impedance method. Results: The BMI, WC, and WtHR of the male osteoporosis group were lower than those of the normal bone mass (NBM) group (P Conclusion: BMI is positively correlated with BMD in Zhuang. BFP has a greater correlation with female BMD, and a small reduction in BFP can result in a significant decrease in BMD. BMD of male was positively correlated with abdominal obesity indicators (WC, WtHR, VF). However, abdominal obesity has no obvious effect on the promotion of BMD in women, and increased WtHR can lead to a decrease in BMD. Zhuang can appropriately increase the amount of fat within the normal weight range. At the same time, reasonable exercise and balanced nutrition to avoid excessive obesity or low body weight can reduce the incidence of osteoporosis and osteoporosis fractures.

Analysis of Regional Differences in Bone Mineral Density Acquisition Factors in Young Women

Purpose: Obtaining high peak bone mass (PBM) and maintaining bone mass is important for the prevention of osteoporosis. This study aimed to examine the regional differences in bone mineral density and factors associated with its acquisition from exercise. Design: The study population included 75 women of 18 - 22 years of age in East Japan and 104 women of 18 - 27 years of age in West Japan. The speed of sound (SOS) of the calcaneus was measured, and the young adult mean (%YAM) was calculated from the SOS. The subjects’ medical history, family history of osteoporosis, and exercise habits were examined using a self-administered questionnaire. Results: There were a significantly greater number of subjects with low %YAM in West Japan. The exercise history and exercise time were significantly higher in West Japan, and the exercise intensity score tended to be higher in East Japan during junior high and high school. A multiple regression analysis by region revealed that the following factors had a significant positive association with the SOS: exercise intensity at elementary school and outdoor sports at junior high school in East Japan;and exercise time at elementary school, muscle mass, and outdoor sports at junior high school in West Japan. On the other hand, exercise time in junior high school in West Japan showed a negative association with the SOS. Conclusions: Regional differences in bone mineral density existed, suggesting a trend toward lower bone mineral density in West Japan. Exercise history and time tended to be higher in West Japan, and exercise intensity scores tended to be higher in East Japan, suggesting that exercise intensity may be more important than exercise time for obtaining bone mineral density.

Reduced bone mineral density and altered bone turnover markers in patients with non-cirrhotic chronic hepatitis B or C infection

AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers. METHODS: Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30) or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured. RESULTS: BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN; 0.76 (0.53-0.99); LS: 0.96 (0.62-1.23) g/cm2). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P= 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P= 0.09). CONCLUSION: There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.

The Effect of Acupuncture on Bone Mineral Density in Postmenopausal Women

According to the TCM theory that the kidney is in charge of the bone, the authors carried out a study on the effect of acupuncture on bone mineral density in 40 postmenopausal women with osteoporosis treated by the method of reinforcing the kidney to strengthen the bone, with satisfactory therapeutic results reported as follows.……

Novel Mixture of Materials Produces Bone- and Soft Tissue-Like Imaging Density

The objective of the present study was to access to imaging material density close to or identical density imaging of bone and soft tissue, from raw materials of nature to be used in different model applications and to provide comprehensive evaluation of the imaging system and techniques under realistic conditions in radiology departments for educational purposes. The palm tree of abundance in Saudi Arabia was chosen to study the date’s seeds and palm leaves in terms of photographic density. The results achieved were referring to the lack of imaging density of dates seeds and palm leaves compared to bone density. Thus, it was necessary to use two additional materials: Salt and eggshells in order to find the highest density and graphic approach to bone density. The present preliminary study indicated that the permanent and stable model can be achieved by palm leaves, salt & eggshell powder with imaging material density close to the imaging density of the bone and soft tissue for achieving more clinical skills and medical education.

Assessment of Maxillary and Mandibular Bone Mineral Density in Controlled Type II Diabetes in Completely Edentulous Patients Using Cone-Beam Computed Tomography—A Cross Sectional Study with Comparison Group

This study was undertaken to assess and compare bone mineral density in nondiabetic and controlled diabetic subjects using cone beam computed tomography. A group of 60 completely edentulous patients, comprising of 30 nondiabetic and 30 controlled type 2 diabetics between the age group of 45 - 75 years, were enrolled in the study. Glycemic control of the diabetics was assessed using glycosylated hemoglobin test and level between 6.1% - 8% was considered controlled. A radiographic stent was fabricated for each patient by using chemically cured transparent acrylic resin. Bone densities at trabecular, buccal and lingual cortical regions of maxillary and mandibular ridges were measured by a cone beam tomography machine in Hounsfield units. The data thus obtained at 10 prospective oral implant sites of maxillary and mandibular ridges were tabulated and analyzed using STATA, version 14.0 statistical software. This study results showed no significant changes in the bone mineral density between the nondiabetic and controlled diabetic subjects. Within the limitations of this study, it can be concluded that bone mineral density does not seem to be affected in controlled type 2 diabetic patients.

Pelvic region bone density,soft tissue mass,and injury frequency in female professional ballet dancers and soccer athletes

We recently observed a high prevalence of low pelvic bone mineral density(BMD)in female professional ballet performers.Because this population is susceptible to musculoskeletal overuse injuries,we aimed to determine which regions of the pelvis may be at greatest risk compared to general population females(GENPOP)as well as professional female soccer players(SOCCER,a comparison to other elite athletes regularly subjected to high degrees of loading).Three groups of age-matched females[(GENPOP;n=38,27±1yrs),(BALLET;single com-pany,n=36,26±3yrs),(SOCCER;single NWSL■club,n=34,25±1yrs)]consented to have their BMD and body composition assessed(DEXA,GE■).In addition to soft tissue and total and regional BMD analyses,a segmental analysis of the pelvis was performed to determine site-specific BMD for the iliac fossa,iliac fossa/iliac crest/ilium combined,pubic bone,ischium,and sacrum.A mixed-model ANOVA followed by a Tukey's post-hoc test was used to compare the groups(Type-I error;α=0.05).The BALLET group had lower pelvic BMD for all measures(Avg.%Diff.=15%-27%,p<0.001)compared to the SOCCER group and for the ischium(Avg.%Diff.=8%;p=0.007)and sacrum(Avg.%Diff.=7%;p=0.028)compared to the GENPOP group.The BALLET group had lower lean mass for all measures compared to the other groups(Avg.%Diff.=12%-18%;p<0.01).Professional ballet performers exhibit reduced pelvic region soft tissue and site-specific BMD not previously detected using standard DEXA analyses.These findings highlight which pelvic regions may benefit from preventative strength training and/or nutritional interventions.

Tea Builds Bone Density

【选注者言:中国是一个饮茶的王国。饮茶究竟对人体有何益?人们早有结论,比如:helping prevent cardiovascular disease(心血管病)and cancer。现在,台湾的学者又有发现:Habitual tea dinking over several years preserves bone density inboth men and women(多年的饮茶习惯能够保持男性和女性的骨密度)】

Bone mineral density and disorders of mineral metabolism in chronic liver disease

AIM： To estimate the prevalence and identify the risk factors for metabolic bone disease in patients with cirrhosis. METHODS： The study was performed on 72 Indian patients with cirrhosis （63 male, 9 female; aged 〈 50 years）. Etiology of cirrhosis was alcoholism （n = 37）, hepatitis B （n = 25） and hepatitis C （n = 10）. Twenty-three patients belonged to Child class A, while 39 were in class B and 10 in class C. Secondary causes for metabolic bone disease and osteoporosis were ruled out. Sunlight exposure, physical activity and dietary constituents were calculated. Complete metabolic profiles were derived, and bone mineral density （BMD） was measured using dual energy X ray absorptiometry. Low BMD was defined as a Z score below -2. RESULTS： Low BMD was found in 68% of patients. Lumbar spine was the most frequently and severely affected site. Risk factors for low BMD included low physical activity, decreased sunlight exposure, and low lean body mass. Calcium intake was adequate, with unfavorable calcium： protein ratio and calcium： phosphorus ratio. Vitamin D deficiency was highly prevalent （92%）. There was a high incidence of hypogonadism （41%）. Serum estradiol level was elevated significantly in patients with normal BMD. Insulin-like growth factor （IGF） 1 and IGF binding protein 3 levels were below the age-related normal range in both groups. IGF-1 was significantly lower in patients with low BMD. Serum osteocalcin level was low （68%） and urinary deoxypyridinoline to creatinine ratio was high （79%）, which demonstrated low bone formation with high resorption. CONCLUSION： Patients with cirrhosis have low BMD. Contributory factors are reduced physical activity, low lean body mass, vitamin D deficiency and hypogonadism and low IGF-1 level.

Systematic review of the prevalence and development of osteoporosis or low bone mineral density and its risk factors in patients with inflammatory bowel disease

BACKGROUND The inflammatory bowel diseases(IBD),Crohn’s disease(CD)and ulcerative colitis(UC)are chronic,immune-mediated disorders of the digestive tract.IBD is considered to be a risk factor for developing osteoporosis;however current literature on this matter is inconsistent.AIM To assess prevalence and development of osteoporosis and low bone mineral density(BMD),and its risk factors,in IBD patients.METHODS Systematic review of population-based studies.Studies were identified by electronic(January 2018)and manual searches(May 2018).Databases searched included EMBASE and PubMed and abstracts from 2014-2018 presented at the United European Gastroenterology Week,the European Crohn’s and Colitis Organisation congress,and Digestive Disease Week were screened.Studies were eligible for inclusion if they investigated either the prevalence of osteoporosis or osteopenia and/or risk factors for osteoporosis or low BMD in IBD patients.Studies on children under the age of 18 were excluded.Only population-based studies were included.All risk factors for osteoporosis and low BMD investigated in any included article were considered.Study quality and the possibility of bias were analysed using the Newcastle-Ottawa scale.RESULTS Twelve studies including 3661 IBD patients and 12789 healthy controls were included.Prevalence of osteoporosis varied between 4%-9%in studies including both CD and UC patients;2%-9% in studies including UC patients, and 7%-15% instudies including CD patients. Among healthy controls, prevalence ofosteoporosis was 3% and 10% in two studies. CD diagnosis, lower body massindex (BMI), and lower body weight were risk factors associated withosteoporosis or low BMD. Findings regarding gender showed inconsistent results.CD patients had an increased risk for osteoporosis or low BMD over time, whileUC patients did not. Increased age was associated with decreased BMD, and therewas a positive association between weight and BMI and BMD over time. Greatheterogeneity was found in the included studies in terms of study methodologies,definitions and the assessment of osteoporosis, and only a small number ofpopulation-based studies was available.CONCLUSIONThis systematic review found a possible increase of prevalence of osteoporosis inCD cohorts when compared to UC and cohorts including both disease types.Lower weight and lower BMI were predictors of osteoporosis or low BMD in IBDpatients. The results varied considerably between studies.