Background The performance of computed tomography X-ray absorptiometry （CTXA） against the dual energy X-ray absorptiometry （DXA） as standard has not been studied in Chinese population. The aim of this study was to...Background The performance of computed tomography X-ray absorptiometry （CTXA） against the dual energy X-ray absorptiometry （DXA） as standard has not been studied in Chinese population. The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography （QCT） by comparing CTXA results with DXA results in an elderly Chinese population. Methods One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study. All subjects underwent hip scans by both QCT and DXA on the same day. For precision determination, 30 subjects had duplicate DXA hip scans. The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time. The inter- and intra-observer variations of CTXA measurement were assessed, and the difference and correlation between CTXA and DXA results were analyzed. Results The inter- and intra-observer variations of CTXA were 0.070 and 0.024 g/cm^2 in the femoral neck （FN）, and 0.030 and 0.012 g/cm2 in the total hip （TH）, which were comparable to the DXA inter-scan variations （0.013 g/cm2 for FN and 0.014 g/cm2 for TH）. The results of CTXA bone mineral density （BMD） were highly correlated with those of DXA （R2 = 0.810 for FN and R2 = 0.878 for TH）. The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0% and 17.8% （P〈0.05）, respectively. However, after appropriate transformation, the difference was eliminated and a comparable T score could be obtained. Conclusions CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur, which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis.展开更多
The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of b...The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.展开更多
AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein...AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1-to 1-basis) with thecases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMDZ-scores were calcu- lated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMDZ-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248;P < 0.05) and fat mass (standardized β coefficient, -0.224;P < 0.05). CONCLUSION: This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD.展开更多
目的建立女性前臂骨不同测量部位的峰值骨量和标准差值,并探讨其可能影响因素,为周围型DEXA测定开展OP研究提供基础数据。方法对上海市区365例21～59岁社区女性健康志愿者,采用美国NORLAND-Stratec周围型双能X线骨矿测量仪(pDEXA)测量...目的建立女性前臂骨不同测量部位的峰值骨量和标准差值,并探讨其可能影响因素,为周围型DEXA测定开展OP研究提供基础数据。方法对上海市区365例21～59岁社区女性健康志愿者,采用美国NORLAND-Stratec周围型双能X线骨矿测量仪(pDEXA)测量了非优势侧(左侧)前臂远端桡骨和尺骨(Distal radius and ulna,Dist.R+U)、近端桡骨和尺骨(Proximal radius and ulna,Prox.R+U)和近端桡骨(Proximal radius,Prox.R)的BMD值,并分析了其年龄分布,建立了女性前臂骨不同测量部位的峰值骨量和标准差值。同时,以问卷调查了可能影响因素。结果前臂骨各部位的BMD值均符合正态分布,可以采用均数±标准差(-x±s)的形式表示,OP的骨量诊断标准也可以用骨量峰值的算术均数降低标准差的形式建立。45岁以前女性前臂骨不同测量部位的BMD值均随年龄增加而逐步上升,但不同年龄段BMD值的差异并不显著(P>0.05),45岁以后BMD值明显下降。前臂骨不同测量部位的骨量峰值均出现在40～44岁年龄段,前臂远端桡+尺骨(Dist.R+U)、近端桡+尺骨(Prox.R+U)和近端桡骨(Prox.R)的骨量峰值及标准差分别为(0.3717±0.0423)g/cm2、(0.7958±0.0771)g/cm2和(0.7802±0.0671)g/cm2。此外,体重和怀孕次数对峰值骨量的形成有较大影响,体重过轻和怀孕次数过多均不利于峰值骨量的形成。结论建立女性前臂骨不同部位的骨量峰值和标准差,可为周围型DEXA测定开展OP研究提供基础数据,尤其是用于高危人群筛查以确定是否需进一步开展中轴骨测量或进行药物干预。展开更多
Purpose： To investigate the link between peak oxygen uptake and regional body composition by dual energy X-ray absorptiometry （DEXA） in Japanese subjects. Methods： A total of 93 men （42.2 ± 12.3 years old） ...Purpose： To investigate the link between peak oxygen uptake and regional body composition by dual energy X-ray absorptiometry （DEXA） in Japanese subjects. Methods： A total of 93 men （42.2 ± 12.3 years old） and 106 women （43.5 ± 12.3 years old） were enrolled in this cross-sectional investigation study. Peak oxygen uptake was measured by the breath-by-breath method. Regional body composition i.e., body fat mass, lean body mass, and body fat percentage was evaluated using DEXA. In addition, metabolic risk parameters were also evaluated. Results： Peak oxygen uptake was 37.6± 8.7 mL/kg/min in men and 31.1 ± 6.4 mL/kg/min in women, and decreased with age in both genders. Peak oxygen uptake was significantly correlated with total body fat percentage （men： r = -0.684, p 〈 0.0001; women： r = -0.681, p 〈 0.0001）. These associations remained even after adjusting for age and total lean body mass. However, peak work rate was positively and significantly correlated with leg lean body mass. Conclusion： Peak oxygen uptake was closely correlated with total body fat percentage in both genders. Aerobic exercise as well as leg resistance training might be useful for improving peak oxygen uptake in Japanese subjects. Copyright展开更多
文摘Background The performance of computed tomography X-ray absorptiometry （CTXA） against the dual energy X-ray absorptiometry （DXA） as standard has not been studied in Chinese population. The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography （QCT） by comparing CTXA results with DXA results in an elderly Chinese population. Methods One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study. All subjects underwent hip scans by both QCT and DXA on the same day. For precision determination, 30 subjects had duplicate DXA hip scans. The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time. The inter- and intra-observer variations of CTXA measurement were assessed, and the difference and correlation between CTXA and DXA results were analyzed. Results The inter- and intra-observer variations of CTXA were 0.070 and 0.024 g/cm^2 in the femoral neck （FN）, and 0.030 and 0.012 g/cm2 in the total hip （TH）, which were comparable to the DXA inter-scan variations （0.013 g/cm2 for FN and 0.014 g/cm2 for TH）. The results of CTXA bone mineral density （BMD） were highly correlated with those of DXA （R2 = 0.810 for FN and R2 = 0.878 for TH）. The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0% and 17.8% （P〈0.05）, respectively. However, after appropriate transformation, the difference was eliminated and a comparable T score could be obtained. Conclusions CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur, which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis.
文摘The authors revise the latest evidence in the literature regarding managing of osteoporosis in ulcerative colitis (UC), paying particular attention to the latest tendency of the research concerning the management of bone damage in the patient affected by UC. It is wise to assess vitamin D status in ulcerative colitis patients to recognize who is predisposed to low levels of vitamin D, whose deficiency has to be treated with oral or parenteral vitamin D supplementation. An adequate dietary calcium intake or supplementation and physical activity, if possible, should be guaranteed. Osteoporotic risk factors, such as smoking and excessive alcohol intake, must be avoided. Steroid has to be prescribed at the lowest possible dosage and for the shortest possible time. Moreover, conditions favoring falling have to been minimized, like carpets, low illumination, sedatives assumption, vitamin D deficiency. It is advisable to assess the fracture risk in all UC patient by the fracture assessment risk tool (FRAX<sup>®</sup> tool), that calculates the ten years risk of fracture for the population aged from 40 to 90 years in many countries of the world. A high risk value could indicate the necessity of treatment, whereas a low risk value suggests a follow-up only. An intermediate risk supports the decision to prescribe bone mineral density (BMD) assessment and a subsequent patient revaluation for treatment. Dual energy X-ray absorptiometry bone densitometry can be used not only for BMD measurement, but also to collect data about bone quality by the means of trabecular bone score and hip structural analysis assessment. These two indices could represent a method of interesting perspectives in evaluating bone status in patients affected by diseases like UC, which may present an impairment of bone quality as well as of bone quantity. In literature there is no strong evidence for instituting pharmacological therapy of bone impairment in UC patients for clinical indications other than those that are also applied to the patients with osteoporosis. Therefore, a reasonable advice is to consider pharmacological treatment for osteoporosis in those UC patients who already present fragility fractures, which bring a high risk of subsequent fractures. Therapy has also to be considered in patients with a high risk of fracture even if it did not yet happen, and particularly when they had long periods of corticosteroid therapy or cumulative high dosages. In patients without fragility fractures or steroid treatment, a medical decision about treatment could be guided by the FRAX tool to determine the intervention threshold. Among drugs for osteoporosis treatment, the bisphosphonates are the most studied ones, with the best and longest evidence of efficacy and safety. Despite this, several questions are still open, such as the duration of treatment, the necessity to discontinue it, the indication of therapy in young patients, particularly in those without previous fractures. Further, it has to be mentioned that a long-term bisphosphonates use in primary osteoporosis has been associated with an increased incidence of dramatic side-effects, even if uncommon, like osteonecrosis of the jaw and atypical sub-trochanteric and diaphyseal femoral fractures. UC is a long-lasting disease and the majority of patients is relatively young. In this scenario primary prevention of fragility fracture is the best cost-effective strategy. Vitamin D supplementation, adequate calcium intake, suitable physical activity (when possible), removing of risk factors for osteoporosis like smoking, and avoiding falling are the best medical acts.
基金Supported by A Grant from Sapienza University of Rome,Progetti di Ricerca Universitaria 2010-2011
文摘AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1-to 1-basis) with thecases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMDZ-scores were calcu- lated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMDZ-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248;P < 0.05) and fat mass (standardized β coefficient, -0.224;P < 0.05). CONCLUSION: This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD.
文摘目的建立女性前臂骨不同测量部位的峰值骨量和标准差值,并探讨其可能影响因素,为周围型DEXA测定开展OP研究提供基础数据。方法对上海市区365例21～59岁社区女性健康志愿者,采用美国NORLAND-Stratec周围型双能X线骨矿测量仪(pDEXA)测量了非优势侧(左侧)前臂远端桡骨和尺骨(Distal radius and ulna,Dist.R+U)、近端桡骨和尺骨(Proximal radius and ulna,Prox.R+U)和近端桡骨(Proximal radius,Prox.R)的BMD值,并分析了其年龄分布,建立了女性前臂骨不同测量部位的峰值骨量和标准差值。同时,以问卷调查了可能影响因素。结果前臂骨各部位的BMD值均符合正态分布,可以采用均数±标准差(-x±s)的形式表示,OP的骨量诊断标准也可以用骨量峰值的算术均数降低标准差的形式建立。45岁以前女性前臂骨不同测量部位的BMD值均随年龄增加而逐步上升,但不同年龄段BMD值的差异并不显著(P>0.05),45岁以后BMD值明显下降。前臂骨不同测量部位的骨量峰值均出现在40～44岁年龄段,前臂远端桡+尺骨(Dist.R+U)、近端桡+尺骨(Prox.R+U)和近端桡骨(Prox.R)的骨量峰值及标准差分别为(0.3717±0.0423)g/cm2、(0.7958±0.0771)g/cm2和(0.7802±0.0671)g/cm2。此外,体重和怀孕次数对峰值骨量的形成有较大影响,体重过轻和怀孕次数过多均不利于峰值骨量的形成。结论建立女性前臂骨不同部位的骨量峰值和标准差,可为周围型DEXA测定开展OP研究提供基础数据,尤其是用于高危人群筛查以确定是否需进一步开展中轴骨测量或进行药物干预。
基金supported in part by Research Grants from the Ministry of Health,Labour,and Welfare of Japan
文摘Purpose： To investigate the link between peak oxygen uptake and regional body composition by dual energy X-ray absorptiometry （DEXA） in Japanese subjects. Methods： A total of 93 men （42.2 ± 12.3 years old） and 106 women （43.5 ± 12.3 years old） were enrolled in this cross-sectional investigation study. Peak oxygen uptake was measured by the breath-by-breath method. Regional body composition i.e., body fat mass, lean body mass, and body fat percentage was evaluated using DEXA. In addition, metabolic risk parameters were also evaluated. Results： Peak oxygen uptake was 37.6± 8.7 mL/kg/min in men and 31.1 ± 6.4 mL/kg/min in women, and decreased with age in both genders. Peak oxygen uptake was significantly correlated with total body fat percentage （men： r = -0.684, p 〈 0.0001; women： r = -0.681, p 〈 0.0001）. These associations remained even after adjusting for age and total lean body mass. However, peak work rate was positively and significantly correlated with leg lean body mass. Conclusion： Peak oxygen uptake was closely correlated with total body fat percentage in both genders. Aerobic exercise as well as leg resistance training might be useful for improving peak oxygen uptake in Japanese subjects. Copyright
