Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis

BACKGROUND Osteoporosis is an extrahepatic complication of primary biliary cholangitis(PBC)that increases the risk of fractures and mortality.However,Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack.AIM To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC.METHODS This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density(BMD)assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021.We defined subjects with T-scores≤-2.5 in any sites(L1 to L4,femoral neck,or total hip)as having osteoporosis.Demographic,serological,clinical,and histological data were collected.Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis.RESULTS A total of 268 patients with PBC[236 women(88.1%);mean age,56.7±10.6 years;163 liver biopsies(60.8%)]were included.The overall prevalence of osteoporosis in patients with PBC was 45.5%(122/268),with the prevalence of osteoporosis in women and men being 47.0%and 34.4%,respectively.The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women(56.3%vs 21.0%,P<0.001).Osteoporosis in patients with PBC is associated with age,fatigue,menopausal status,previous steroid therapy,body mass index(BMI),splenomegaly,gastroesophageal varices,ascites,Mayo risk score,histological stage,alanine aminotransferase,albumin,bilirubin,platelet and prothrombin activity.Multivariate regression analysis identified that older age,lower BMI,previous steroid therapy,higher Mayo risk score,and advanced histological stage as the main independent risk factors for osteoporosis in PBC.CONCLUSION Osteoporosis is very common in Chinese patients with PBC,allowing for prior screening of BMD in those PBC patients with older age,lower BMI,previous steroid therapy and advanced liver disease.

Bone mineral density in lifelong trained male football players compared with young and elderly untrained men

Purpose: The purpose of the present controlled cross-sectional study was to investigate proximal femur and whole-body bone mineral density(BMD), as well as bone turnover profile, in lifelong trained elderly male football players and young elite football players compared with untrained age-matched men.Methods: One hundred and forty healthy, non-smoking men participated in the study, including lifelong trained football players(FTE, n = 35)aged 65—80 years, elite football players(FTY, n = 35) aged 18—30 years, as well as untrained age-matched elderly(UE, n = 35) and young(UY,n = 35) men. All participants underwent a regional dual-energy X-ray Absorptiometry(DXA) scan of the proximal femur and a whole-body DXA scan to determine BMD. From a resting blood sample, the bone turnover markers(BTMs) osteocalcin, carboxy-terminal type-1 collagen crosslinks(CTX-1), procollagen type-1 amino-terminal propeptide(P1NP), and sclerostin were measured.Results: FTE had 7.3%—12.9% higher(p < 0.05) BMD of the femoral neck, wards, shaft, and total proximal femur in both legs compared to UE,and 9.3%—9.7% higher(p < 0.05) BMD in femoral trochanter in both legs compared to UY. FTY had 24.3%—37.4% higher(p < 0.001) BMD in all femoral regions and total proximal femur in both legs compared to UY. The whole-body DXA scan confirmed these results, with FTE showing similar whole-body BMD and 7.9% higher(p < 0.05) leg BMD compared to UY, and with FTY having 9.6% higher(p < 0.001) wholebody BMD and 18.2% higher(p < 0.001) leg BMD compared to UY. The plasma concentration of osteocalcin, CTX-1, and P1NP were 29%,53%, and 52% higher(p < 0.01), respectively, in FTY compared to UY.Conclusion: BMD of the proximal femur and whole-body BMD are markedly higher in lifelong trained male football players aged 65—80 years and young elite football players aged 18—30 years compared to age-matched untrained men. Elderly football players even show higher BMD in femoral trochanter and leg BMD than untrained young despite an age difference of 47 years.

Risk assessment instruments for screening bone mineral density in a Mediterranean population

AIM To evaluate the power of six osteoporosis-screening instruments in women in a Mediterranean country.METHODS Data concerning several osteoporosis risk factors were prospectively collected from 1000 postmenopausal women aged 42-87 years who underwent dual-energy X-ray absorptiometry(DEXA) screening. Six osteoporosis risk factor screening tools were applied to this sample to evaluate their performance and choose the most appropriate tool for the study population.RESULTS The most important screening tool for osteoporosis status was the Simple Calculated Osteoporosis Risk Estimation, which had an area under the curve(AUC)of 0.678, a sensitivity of 72%, and a specificity of 72%, with a cut-off point of 20.75. The most important screening tool for osteoporosis risk was the Osteoporosis Self-assessment Tool, which had an AUC of 0.643, a sensitivity of 77%, and a specificity of 46%,with a cut-off point of-2.9.CONCLUSION Some commonly used clinical risk instruments demonstrate high sensitivity for distinguishing individuals with DEXA-ascertained osteoporosis or reduced bone mineral density.

Study on Bone Mineral Density and its Influencing Factors among 1214 Older Adults in Xuhui District,Shanghai

Objective To understand the status of the forearm bone mineral density （BMD） in older adults, and to identify the potentialfactors influencing BMD. Methods A total of 1 214 older adults were examined, in Tianlin, Fenglin and Xietu sub-districts, of Xuhui district, Shanghai. BMD was tested at the left forearm, including distal radius and ulna 1/3 total, distal radius where the distance of radius and ulna is 8 mm, ultra-distal radius, by single energy X-ray densitometer. Results The BMD at all of the four sites decreased with the age increased. The average BMD was higher in male than in female for the same age and measured site. Distal radius 1/3 total had the highest BMD among the four sites. The incidence of low BMD and osteoporosis in distal forearm 1/3 radius total ascended with the age increased. Multiplied logistic regression showed that males had a lower risk to be low BMD （OR=0. 19） compared with female. Compared with the group aged from 50 to 54, the odds ratio in the group aged from 55 to 59, 60 to 64, and 65 to 70 were respectively 3.17, 5.13, 15.03. Compared with those whose monthly salary was less than 1 000, the odds ratio was O. 70 in those whose salary was more than 1 000. Conclusion The incidence of low BMD was high in older adults, and it is related with sex, age, monthly salary.

Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques

Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinicallyavailable diagnostic methods are mainly based on the use of either X-rays or ultrasound(US). All X-ray based methods provide a measure of bone mineral density(BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry(DXA) is considered the current 'gold standard' for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations(e.g., use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population screenings and primary care diagnosis. This has resulted in an increasing interest in developing reliable pre-screening tools for osteoporosis such as quantitative ultrasound(QUS) scanners, which do not involve ionizing radiation exposure and represent a cheaper solution exploiting portable and widely available devices. Furthermore, the usefulness of QUS techniques in fracture risk prediction has been proven and, with the last developments, they are also becoming a more and more reliable approach for assessing bone quality. However, the US assessment of osteoporosis is currently used only as a pre-screening tool, requiring a subsequent diagnosis confirmation by means of a DXA evaluation. Here we illustrate the state of art in the early diagnosis of this 'silent disease' and show up recent advances for its prevention and improved management through early diagnosis.

Managing osteoporosis in ulcerative colitis: Something new?

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® 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.

Efficacy of weight adjusted bone mineral content in osteoporosis diagnosis in Chinese female population

Background:Areal bone mineral density(aBMD)applied for osteoporosis diagnosis unavoidably results in the missingdiagnosis in patients with large bones and misdiagnosis in those with small bones.Therefore,we try to find a new adjusted index of bone mineral content(BMC)to make up shortcomings of aBMD in osteoporosis diagnosis.Methods:In this multi-center epidemiological study,BMC and aBMD of lumbar spines(n=5510)and proximal femurs(n=4710)were measured with dual energy X-ray absorptiometry(DXA).We analyzed the correlation between the bone mass and body weight in all subjects including four age groups(<19 years,20-39 years,40-49 years,>50 years).And then the body weight was used for standardizing BMC(named wBMC)and applied for the epidemiological analysis of osteoporosis?Results:The correlation of body weight and BMC is 0.839 to 0.931 of lumbar vertebra 1-4(Li_4),and 0.71 to 0.95 of femoral neck in different age groups.When aBMD was applied for diagnosing osteoporosis,the prevalence was 7.55%,16.39%,and 25.83%in patients with a high,intermediate,and low body weight respectively.However,the prevalence was 21.8%,18.03%,and 11.64%by wBMC applied for diagnosing osteoporosis.Moreover,the prevalence of osteoporosis increased by 3.76%by wBMC with the body weight increased by 5 kg.The prevalence decreased by 1.94%when the body weight decreased by 5 kg.Conclusions:wBMC can reduce the missed diagnosis in patients with large body weight and reduce misdiagnosis in those with small body weight.Including children,wBMC may be feasible for osteoporosis diagnosis individuals at any age.

Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population

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.

Bone mass in axial spondyloarthritis:A literature review

AIM: To review the published literature reporting bone loss in patients with axial spondyloarthritis(SpA) particularly those studies using dual X-ray absorptiometry(DXA) methods. METHODS: This literature review examines the reported bone mass in patients with ax-SpA, particularly those using the DXA methods. The MEDLINE, Web of Science and Scopus databases were searched for relevant articles published between September 1992 and November 2013. Some of used search terms were ankylosing spondylitis(AS), SpA, spondyloarthropathy, bone loss, bone mass, osteopenia, bone mineraldensity, osteoporosis(OP), densitometry. Studies in which bone loss was investigated by using DXA in patients with Sp A were eligible. Each article was reviewed and the key elements were noted.RESULTS: There were 286 hits on MEDLINE, 200 on Web of Science and 476 on Scopus. After applying inclusion and exclusion criteria, we identified 55 articles in our systematic search. The sample size of the studies varied from 14 to 332 patients with SpA. The reported age range varied from 25 to 56 years in the reviewed studies. The symptom duration of patients with axS pA varied from 1.6 to 49 years. There were more males than females in these studies. Most of the recruited females were premenopausal women. Reported HLA-B27 positivity changed between 19% to 95%. The prevalence of OP and osteopenia in patients with Sp A varied from 3%-47% to 5%-88%, respectively, in the included studies. In particular, the prevalence of OP and osteopenia ranged from 2.0%-47.0% and 5.0%-78.3%, respectively, in patients with AS. There are conflicting results regarding the relationship among disease activity, acute phase response and bone mass. Some studies suggest good correlation of bone mass with disease activity and acute phase reactants.CONCLUSION: Bone loss may be determined in patients with ax Sp A at the lumbar spine or proximal femur even in the early phase of the disease and may be associated with inflammation(bone marrow edema) at the vertebral colon.

双能X线吸收仪测定骨密度对骨质疏松症的诊断价值

目的:应用双能X线吸收仪(DEXA)测定腰椎L2～4前后位(anterior鄄post,A鄄P正位)和侧位的骨密度(BMD),以界定L2～4前后位和侧位男、女患者骨质疏松症(OP)的诊断临界值。方法:测定2115例患者L2～4的BMD,其中前后位1018例,侧位1097例。以T值≤-2.0s和≤-2.5s为诊断标准进行OP检出率分析。结果:按T值≤-2.0s、≤-2.5s计算,其中女性L2～4前后位的OP检出率分别为32.5%和14.5%,侧位分别为59.0%和33.4%;男性L2～4的前后位OP检出率分别为17.6%和6.4%,侧位分别为45.9%和17.8%。无论男女,以T值≤-2.0s为标准时,L2～4前后位与侧位的OP检出率差异显著(P<0.01)。L2～4前后位以T值≤-2.0s为标准的OP检出率和侧位以T值≤-2.5s为标准的OP检出率一致(P>0.05)。结论:男、女性L2～4前后位BMD测定可参考以T值≤-2.0s作为OP的诊断标准,侧位可参考以T值≤-2.5s作为诊断标准。

应用双能X线骨密度仪测定131名健康妇女骨密度变化

应用双能X线骨密度仪 (DEXA)测定 1 3 1名不同年龄和绝经年限妇女骨密度 (BMD)变化 ,并观察外周血液中雌二醇 (E2 )、卵泡刺激素 (FSH)、碱性磷酸酶 (AKP)、骨钙素 (BGP)、血钙、血磷等指标 ,探讨BMD和E2 、AKP、BGP、Ca、P的相互关系。结果表明 ,妇女随着年龄及绝经年限增加 ,BMD及E2 水平逐年下降 ,BMD和E2 呈正相关 ;绝经后各组BGP和AKP明显高于绝经前各组 ,BMD和AKP、BGP呈负相关 ;血钙水平于绝经早期有一过性增加 ,以后略有下降 ,并保持在一相对稳定水平 ;血磷各组变化不大。由此可见 ,DEXA是一种理想的骨密度测定仪。BMD测定和E2 、AKP、BGP等生化指标可以早期诊断绝经后骨质疏松症 。

Graves病患者单能X射线测定骨密度研究

目的 研究Graves病对患者骨密度的影响。方法 用单能X射线骨密度仪测定 146例年龄 2 1～ 60岁Graves病 (GD)患者右跟骨骨密度 ,并以 12 0例年龄、性别相匹配的健康者作为对照组。结果 GD组BMD与对照组比较 ,P <0 0 0 1,二组差异有非常显著性 ;GD组骨量减少的发病率为78 0 8% ,对照组为 47 5 0 % ,P <0 0 0 1,二组差异有非常显著性 ;GD组BMD减少两性差异无显著性。GD组骨质疏松 (OP)发病率为 3 3 5 0 % ,对照组为 7 5 0 % ,P <0 0 0 1,二组差异有非常显著性。GD组OP男女二组差异无显著性。GD组和对照组男女各按每 10岁为一年龄段再分亚组进行BMD及T Score的比较 ,除 5 1～ 60岁亚组差异无显著性外 ,其余各年龄段亚组均有显著性差异或非常显著性差异 ;对GD患者性别、年龄、居住地 (农村或城市 )、甲亢是否控制及病程与BMD作Logistic回归相关分析 ,仅提示甲亢病情是否控制与BMD降低有关 ,OR =2 8676(95 %CI 1 0 993～ 7 5 2 16)。结论 GD患者BMD明显减低 ,骨量减少、OP发病率明显增高 ,并且无性别差异 ;