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.

Evaluation value of three-dimensional finite element model analysis for bone mineral density and bone metabolism activity in patients with osteoporosis

Objective: To study the evaluation value of three-dimensional finite element model analysis for bone mineral density (BMD) and bone metabolism activity in patients with osteoporosis. Methods: A total of 218 patients who were diagnosed with osteoporosis in the hospital between February 2014 and January 2017 were collected as observation group, and 100 healthy volunteers who received physical examination in the hospital during the same period were selected as normal control group. The femoral head of the two groups was analyzed by three-dimensional finite element model, and the femoral head BMD levels and serum bone metabolism index contents were measured. Pearson test was used to evaluate the evaluation value of femoral head three-dimensional finite element model for osteoporosis. Results: The cancellous bone and cortical bone Von Mises stress value of observation group were lower than those of normal control group, and femoral neck BMD value of observation group was lower than that of normal control group;serum bone metabolism index BGP content was lower than that of normal control group while NBAP, TRACP-5b and CTX-1 contents were higher than those of normal control group. Pearson test showed that the cancellous bone and cortical bone Von Mises stress value of patients with osteoporosis were directly correlated with BMD value and bone metabolism index contents. Conclusion: The three-dimensional finite element model analysis resultsof patients with osteoporosis can objectively reflect the femoral headBMD value and bone metabolism activity, and is a reliable way to evaluate the risk of long-term fractures.

Relatively High Bone Mineral Density in Chinese Adolescent Dancers Despite Lower Energy Intake and Menstrual Disorder

Objective The effect of dietary restriction, intense exercise and menstrual dysfunction on bone mineral density remains controversial. The aim of this study was to assess the skeletal health status and relationship between bone mineral density and nutrient intake, menstrual status, estrogen level and other factos in Chinese adolescent dancers. Methods Sixty dancers and 77 healthy controls underwent measurements of bone density, body composition, and estrogen level. Nutrient intake, menstrual status and physical activity were assessed with questionnaires. The correlation between these factors were analyzed. Results The dancers under study had a significantly lean body mass index （18.3±1.4 kg/m^2 vs. 21.7±3.1 kg/m^2）, lower percentage of body fat （0.25±0.05 vs. 0.34±0.04） and later age at menarche （14.0±0.9 y vs. 13.0±1.3 y）, and the estrogen level, daily calorie and fat intake in them were also lower than in the controls. All the dancers undertook intensive physical activity every day and up to 69% of them suffered from irregular menarche. Yet they had relatively high BMD and BMC of the total body and legs than the controls after adjusting for BM1 and age. Site-specific BMD was positively correlated to BMI, body composition and training hours per week and negatively correlated to the age at menarche and menstrual frequency. Conclusions The relatively high BMD and BMC of the dancers at the total body and legs were probably caused by high levels of weight-bearing physical activity. To ameliorate disordered eating, especially low energy intake might be helpful to prevent the Triad and to improve the bone health in adolescent dancers.

Effect of Gengnianchun Recipe (更年春方) on Bone Mineral Density, Bone Biomechanical Parameters and Serum Lipid Level in Ovariectomized Rats

Objective： To observe the effect of Gengnianchun Recipe （更年春方, GNC） on bone mineral density （BMD）, bone biomechanical parameters and serum lipid level in the bilaterally ovariectomized （OVX） rats and to explore the prophylactic and therapeutic action of GNC on ovariectomy induced osteoporosis and hyperlipidemia. Methods： OVX SD rats, 10- 12 months old, were divided into different groups and fed with GNC 2 g/d, GNC 1 g/d and Nilestriol 0. 125 mg/week, respectively for 4 months to observe the change of BMD and bone biomechanical parameters of the lumbar vertebrae, and the serum levels of total cholesterol （TO）, triglyceride（TG）, high-density lipoprotein cholesterol （HDL-C） and low-density lipoprotein cholesterol （LDL-C）, and to compare the effect of the two drugs on the morphology of the uterus. Results： There was marked reduction in BMD and biomechanical parameters in lumbar vertebrae （ P〈0. 01 ） and increase of serum TO and LDL-C levels （ P〈0. 01 ） in rats after OVX. GNC or Nilestriol significantly improved the decreased BMD and biomechanical parameters of the lumbar vertebrae （ P〈0.05 or P〈0. 01 ）, and reduced the serum TO and LDL-C levels （ P〈0. 01 ）. In the Nilestriol group, the wet weight of uterus got increased obviously （ P〈0.01 ）, the number of uterine glands increased, uterine columnar epithelium thickened, and the mitotic figures in the epithelial stroma and myointimal cells augmented. But no such effect in wet weight and morphology of uterus was found in the GNC group. Conclusion： GNC could increase the BMD and biomechanical parameters of the lumbar vertebrae, reduce the serum TO and LDL-C levels, yet produce no adverse reaction in stimulating proliferation and hypertrophy of uterus.

The Relationship between Bone Mineral Density and Obesity in Women

The aim of this study was to determine the relationship between obesity and osteoporosis. A total of 30 Saudi women, aged between 20 and 50 years, were selected randomly. We calculated each subject’s body mass index (BMI) and determined their lumbar and femur bone mineral densities using dual-energy X-ray absorptiometry (DXA). We examined the interaction between obesity and bone mineral density (BMD) using logistic regression, after adjusting for age, family history of osteoporosis, maternal fractures, smoking, and any sedentary lifestyles. BMI was shown to be the most effective independent variable with respect to bone density. We evaluated the Pearson correlation coefficients of BMI, BMD of the lumbar spine, and BMD of the femoral neck with reference to the variables of the study, and found a significant correlation (P 30 kg/m2) were at increased risk of osteoporosis at the femoral neck and severe osteopenia in the lumbar spine.

Mutifactorial analysis of risk factors for reduced bone mineral density in patients with Crohn’s disease

AIM: To determine the prevalence of osteoporosis in a cohort of patients with Crohn’s disease (CD) and to identify the relative significance of risk factors for osteoporosis. METHODS: Two hundred and fifty-eight unselected patients (92 M, 166 F) with CD were studied. Bone mineral density (BMD) was measured at the lumbar spine and hip by dual X-ray absorptiometry. Bone formation was assessed by measuring bone specific alkaline phosphatase (BSAP) and bone resorption by measuring urinary excretion of deoxypyridinoline (DPD) and N-telopeptide (NTX). RESULTS: Between 11.6%-13.6% patients were osteoporotic (T score < -2.5) at the lumbar spine and/or hip. NTX levels were significantly higher in the patients with osteoporosis (P < 0.05) but BSAP and DPD levels were not significantly different. Independent risk factors for osteoporosis at either the lumbar spine or hip were a low body mass index (P < 0.001), increasing corticosteroid use (P < 0.005), and male sex (P < 0.01). These factors combined accounted for 23% and 37% of the reduction in BMD at the lumbar spine and hip respectively. CONCLUSION: Our results confirm that osteoporosis is common in patients with CD and suggest that increased bone resorption is the mechanism responsible for thebone loss. However, less than half of the reduction in BMD can be attributed to risk factors such as corticosteroid use and low BMI and therefore remains unexplained.

Updated bone mineral density status in Saudi patients with inflammatory bowel disease

BACKGROUND Little is known about inflammatory bowel disease(IBD)burden and its impact on bone mineral density(BMD)among adult patients in Saudi Arabia.To the best of our knowledge,our study is the only study to give an update about this health problem in adult Saudi patients with IBD.IBD is a great risk factor for reduced BMD due to its associated chronic inflammation,malabsorption,weight loss and medication side effects.Consequently,screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients.AIM To assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD.METHODS Ninety adult patients with IBD-62 Crohn’s disease(CD)and 28 ulcerative colitis(UC)-were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah,Al-Qassim.All enrolled patients were interviewed for their demographic information and for IBD-and BMD-related clinical data.All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status.Patients were divided into two groups(CD and UC)to explore their clinical characteristics and possible risk factors for reduced BMD.RESULTS The CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group;44%of the CD patients had normal BMD,19%had osteopenia,and 37%had osteoporosis,while 78%of the UC patients had normal BMD,7%had osteopenia,and 25%had osteoporosis(P value<0.05).In the CD group,the lowest t-score showed a statistically significant correlation with body mass index(BMI)(r=0.45,P<0.001),lumbar z-score(r=0.77,P<0.05)and femur z-score(r=0.85,P<0.05).In the UC group,the lowest t-score showed only statistically significant correlation with the lumbar z-score(r=0.82,P<0.05)and femur z-score(r=0.80,P<0.05).The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at≤23.43(m/kg2);area under the curve was 0.73(95%CI:0.59–0.84),with a sensitivity of 77%,and a specificity of 63%.CONCLUSION Saudi patients with IBD still have an increased risk of reduced BMD,more in CD patients.Low BMI is a significant risk factor for reduced BMD in CD patients.

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.

Height and weight are correlated with lumbar spinal bone mineral contents and densities in Chinese adolescents with early ankylosing spondylitis

Objective: To explore the possible factors influencing lumbar spinal bone mineral contents and bone mineral densities in Chinese adolescents with early ankylosing spondylitis(AS). Methods: Thirty-one male Chinese adolescent outpatients with early AS were included and compared with 31 age-matched male controls. Age (year), height (cm), total body weight (kg) together with body mass index (BMI, kg/m 2) of all subjects and disease duration (month), BASMI, BASFI, BASDAI, SASSS as well as ESR (mm/h) of AS patients were obtained. Lumbar 2-4 bone mineral content (L 2-4BMC, g) and lumbar 2-4 areal bone mineral density (L 2-4 BMD, g/cm 2) were evaluated using dual-energy X-ray absorptiometry (DEXA) with Lunar DPX-IQ device and lumbar 2-4 volumetric bone mineral apparent density (L 2-4 BMAD, g/cm 3) was subsequently calculated. Correlation and multiple regression analyses were performed. Results: Compared with 31 age-matched male controls, AS patients had significantly lower L 2-4BMD [(0.984±0.142) g/cm 2 vs (1.055±0.137) g/cm 2, P=0.049] and L 2-4BMAD [(0.1527±0.0173) g/cm 3 vs (0.1630±0.0195) g/cm 3, P=0.032]. In AS patients, multiple regression analysis identified that only the factor of height was significantly correlated with L 2-4BMC (R=0.673, P=0.000) and the factor of weight had predominant influences on L 2-4BMD (R=0.620, P=0.000) as well as L 2-4BMAD (R=0.510, P=0.003). Conclusion: The young patients with early AS had marked reduction in lumbar spine bone mineral densities, which indicated an important primary event leading to osteoporosis. Positive effects of height and weight on lumbar spine bone mass and densities could expectantly make favorable contributions to early prevention of AS associated bone loss and subsequent osteoporosis.

Study of bone mineral density in Chinese patients with complete androgen insensitivity syndrome

Objective:To explore the characteristics of bone mineral density(BMD)and treatment inChinese patients with complete androgen insensitivity syndrome(CAIS).Methods:Fourteen cases of CAIS were studied retrospectively through analyzing and compa-ring BMD of pre-and post-gonadectomy with healthy Chinese men and women.BMD at the lum-bar spine and the femur were measured by dual energy X-ray absorptiometry(DXA).Results:There were 10 cases of CAIS having pre-gonadectomy DXA,in which 6 cases hadvery significantly reduced lumbar 2-4 BMD[(0.92±0.08)g/cm^2]comparing with both healthymen and women(P<0.01),5 cases had significantly reduced femur neck BMD[(0.89±0.12)g/cm^2]comparing with healthy men(P<0.05).There were 7 cases having 12 post-gonadectomyDXA,in which all lumbar 2-4 BMD[(0.954-0.06)g/cm^2]were reduced very significantly com-paring with both healthy men and women(P<0.01),femur neck BMD[(0.91±0.08)g/cm^2]were also reduced significantly comparing with healthy men(P<0.01)and women(P<0.05).Conclusion:There were different degrees of osteopenia in patients of CAIS,especially inlumbar vertebra.This suggests that both estrogen and androgen play important roles in the ac-quirement and maintenance of peak bone mass.

Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

BACKGROUND Osteoporosis and type 2 diabetes(T2D)have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden.In T2D,bone mineral density(BMD)may underestimate the risk of low-energy fractures as bone quality is reduced.It was hypothesized that a decrease in the trabecular bone score(TBS),a parameter assessing bone microarchitecture,may be an early marker of impaired bone health in women with T2D.AIM To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.METHODS A non-interventional cross-sectional comparative study was conducted.Potentially eligible subjects were screened at tertiary referral center.Postmenopausal women with T2D,aged 50-75 years,with no established risk factors for secondary osteoporosis,were included.BMD,TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry.In women with normal BMD,a wide range of anthropometric,general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic(ROC)curves.RESULTS Three hundred twelve women were initially screened,176 of them met the inclusion criteria and underwent dual X-ray absorptiometry.Those with reduced BMD were subsequently excluded;96 women with normal BMD were included in final analysis.Among them,43 women(44.8%)showed decreased TBS values(≤1.31).Women with TBS≤1.31 were taller and had a lower body mass index(BMI)when compared to those with normal TBS(Р=0.008 and P=0.007 respectively).No significant differences in HbA1c,renal function,calcium,phosphorus,alkaline phosphatase,PTH and 25(ОН)D levels were found.In a model of multivariate linear regression analysis,TBS was positively associated with gynoid fat mass,whereas the height and androgen fat mass were associated negatively(all P<0.001).In a multiple logistic regression,TBS≤1.31 was associated with lower gynoid fat mass(adjusted odd ratio[OR],0.9,95%confidence interval[CI],0.85-0.94,P<0.001),higher android fat mass(adjusted OR,1.13,95%CI,1.03-1.24,P=0.008)and height(adjusted OR,1.13,95%CI,1.05-1.20,P<0.001).In ROC-curve analysis,height≥162.5 cm(P=0.04),body mass index≤33.85 kg/m2(P=0.002),gynoid fat mass≤5.41 kg(P=0.03)and android/gynoid fat mass ratio≥1.145(P<0.001)were identified as the risk factors for TBS reduction.CONCLUSION In postmenopausal women with T2D and normal BMD,greater height and central adiposity are associated with impaired bone microarchitecture.

Oral bisphosphonates improve the bone mineral density in men with diabetes with or without thiazolidinediones

Objective: Osteoporosis and type 2 diabetes mellitus (DM) two of the most common chronic conditions and represent major public health burdens. Epidemiological and observational studies indicate that thiazolidinedione (TZD) therapy with rosiglitazone and pioglitazone is associated with an increased risk of fractures and decreased bone mineral density (BMD). To our knowledge, no data are available to evaluate bisphosphonate therapy in thiazolidinedione-treated patients. The aim of this study was to investigate the benefit of bisphosphonates to improve changes in BMD in subjects with DM associated with TZDs. Methods: In a cross-sectional observational study using a retrospective review of electronic medical records, the changes in BMD in subjects with type 2 DM. The study subjects were divided into four groups. First group with DM receiving both TZDs and BPs;second group neither;third group receiving only TZDs and the fourth only BPs. The comparison of annual percent changes in BMD between the groups were carried out. Results: Decreased BMD noted in subjects with DM on TZDs. Bisphosphonates improved BMD in subjects with DM on TZDs. BMD improved in subjects with DM in those not receiving TZDs also. Conclusion: We conclude that concomitant treatment with bisphosphonates improves BMD in subjects with diabetes and on TZDs.

Bone Mineral Density in Patients with Newly Diagnosed Inflammatory Bowel Disease: Frequency and Risk Factors in Tunisian Population. Results of a Prospective Study

Background and Aims: Osteopenia and osteoporosis are frequently encountered with Inflammatory Bowel Disease (IBD). Our aims were to determine the prevalence of low bone mineral density (BMD) in patients with recently diagnosed IBD, and to assess predictive factors of reduced BMD. Patients and Methods: Prospective study conducted from January 2008 to December 2012 and involved patients with IBD treated in the Department of Gastroenterology of the Internal Security Forces Hospital. The data collected included: age, gender, body mass index (BMI), diagnostic delay, disease activity, and disease localization. Laboratory findings included serum calcium, phosphate, albumin, hemoglobin, and C-reactive protein. BMD was assessed by dual energy X-ray absorptiometry (DEXA) of the lumber spine and femoral neck. According to WHO criteria, osteopenia was defined as a T-score between -1 and -2 SD, and osteoporosis as a T-score less than -2 SD. Results: A total of 34 patients (17 men, 17 women) were enrolled. Mean age was 37.1 ± 13.8 years (range 16 - 62). Twenty-two patients (65%) had Crohn’s disease (CD) and 12 patients (35%) had ulcerative colitis (UC). Mean BMI was 20.5 ± 4 kg/m2. Low BMD occurred in 50% of patients (12 CD, 5 UC). Thirteen patients (38.2%) exhibited osteopenia and 4 patients (10.8%) showed osteoporosis. Mean vertebral T-score was -0.933 ± 1.41 (range -4.1 to 1.7) and BMD in this site was 1.079 ± 0.17 g/cm2 (range 0.674 to 1.380). Mean femoral T-score was -0.398 ± 1.2 (range -3.1 to 2.4) and BMD in this site was 0.990 ± 0.173 g/cm2 (range 0.633 to 1.600). There was a positive correlation between T-score and albuminemia. Low BMI was found to be predictive factor of reduced BMD at the moment of IBD diagnosis. However, no correlation was found between BMD and the other studied variables (age, gender, smoking, history of fracture, disease location, duration of disease, activity, small bowel resection, serum calcium level, phosphate, C-reactive protein and hemoglobin). Conclusion: Our study showed that the half of patients with IBD had a low BMD in newly diagnosed IBD patients. Low BMI and hypoalbuminemia were the major factors affecting BMD in these patients. Bone density measurement should be performed in all patients with IBD in an early stage of the disease.

Quality of Life and Osteoporotic Alterations in Patients with and without Low Bone Mineral Density:A Retrospective Study

Purpose:The objectives of this investigation were to compare the World Health Organization abbreviated instrument for quality of life assessment(WHOQOL-bref)scores of osteoporotic and non-osteoporotic Brazilian patients and to evaluate the correlation between mandibular cortical index(MCI)and bone densitometry(DXA)results in both groups.Methods:This research was conducted with an initial sample of 74 female participants who underwent panoramic radiography and forearm densitometry.Participants were divided into two groups:osteoporotic and non-osteoporotic patients.A quality of life assessment questionnaire was administered.The scores from the questionnaire were compared between the two groups and the correlation between DXA and MCI was analyzed.Results:Psychological and social domains in osteoporotic patients presented lower scores(12.65 and 6.00 respectively)when compared to non-osteoporotic patients(14.70 and 13.97 respectively).MCI was inversely correlated with DXA.Conclusions:According to WHOQOL-bref,osteoporotic patients may have lower quality of life scores when considering psychological and social relationships.MCI is inversely correlated with T-scores but demonstrates greater correlation when considering non-osteoporotic patients with higher T-score values.

Bone mineral density in fracture neck of femur patients:What's the significance?

BACKGROUND The National Institute for Health and Care Excellence(NICE)guidelines have advised further research is required into investigating the added prognostic value of bone mineral density(BMD)in the assessment of fracture risk with the Fracture Risk Assessment Tool(FRAX)score.AIM To investigate the significance of BMD in fracture neck of femur patients and compare it to the outcome of the FRAX score.METHODS Inclusion criteria for this study were all patients who underwent dual-energy Xray absorptiometry(DXA)scan following fracture neck of femur between 2015 and 2017.Analysis of BMD,FRAX scores and patient demographic data was undertaken.RESULTS A total of 69 patients were included in the study,mean age 74.1 years.There was no significant difference between mean BMD of the femoral neck in males(0.65)as compared to females(0.61)(P=0.364).Analyses showed no significant correlation between BMD and menopause age(rs=-0.28,P=0.090).A significant difference was seen of the femoral neck BMD between the different fracture pattern types(P=0.026).A stronger correlation was observed between BMD of femoral neck and FRAX major score(rs=-0.64,P<0.001)than with BMD of lumbar spine and FRAX major score(rs=-0.37,P=0.003).CONCLUSION This study demonstrated that BMD of the femoral neck measured by DXA scan is of added prognostic value when assessing patients for risk of fracture neck of femur in combination with the FRAX predictive scoring system.

Serum Ferritin: Is It an Independent Predictor of Reduced Bone Mineral Density among Elderly Women?

Aim: In vitro studies have shown that iron promotes osteoclast differentiation and bone-resorbing activity by enhancing mitochondrial biogenesis, whereas it suppresses osteoblastogenesis. In postmenopausal women, serum ferritin increases by 2 - 3 times due to the lack of a major mechanism of iron excretion, while menstrual blood decreases. Based on this observation, it has been hypothesized that in addition to estrogen deficiency, increased iron as a result of menopause could contribute to bone loss in postmenopausal women. So our aim was to investigate the association between serum ferritin levels and bone mineral density (BMD) in elderly women at various skeletal sites. Methods: Retrospective analysis of the medical records of 71 postmenopausal women having a mean age of (66 ± 7) years (range 60 - 83 years) was done. The collected data included age of menopause, past medical history, smoking habits, physical activity, and medication use. BMD was measured at the lumbar spine and femur by dual-energy X-ray absorptiometry, and other biochemical markers including, serum ferritin, 25 hydroxyvitamin D3, serum alkaline phosphatase, and parathyroid hormone were assayed. Results: We found that serum ferritin levels are significantly related to BMD of the total hip and lumbar vertebrae [with a p value of (0.01) and ( Conclusion: This study suggests a positive association between serum ferritin levels and BMD in elderly women without hematologic disorders. Further study is warranted to verify the effects of iron on bone metabolism.

Bone mineral density of the spine and femur in healthy Chinese men

Aim:To establish bone mineral density(BMD)reference database in healthy Chinese men of Han ethnicity,and to estimate the prevalence of osteoporosis in the population.Methods:The BMD in the lumbar spine 1-4(L1-4)and proximal femur was measured using dual energy X-ray absorptiometry in a total of 1385 healthy Chinese men of Han ethnicity aged 20-89 years old in Shanghai.Results:The highly significant negative correlation between age and BMD at any sites of proximal femur was found in the studied population,wheras no correlation between age and BMD at lumbar spine was observed.The peak BMD of the lumbar spine and any sites of hip in Chinese men was defined as the mean BMD for the subjects aged 20-39 years.According to World Health Organization(WHO)criteria,the BMD cut-off values for osteoporosis of the L1-4,total hip,femoral neck,trochanter and intertrochanter in Chinese men are 0.719,0.638,0.575,0.437 and 0.725 g/cm^2,respectively.Using the current Chinese reference data,the prevalence of osteoporosis at the L1-4,total hip,femoral neck,trochanter and intertrochanter is 5.4%,3.8%,6.3%, 1.8% and 2.8% in 1084 men aged 50 years or older,respectively.However,using a database for US non-Hispanic white men(NHANES Ⅲ),the prevalence of osteoporosis or osteopenia at any sites of the hip was significantly higher than that while using the current Chinese reference data.Conclusion:The BMD reference database was established in healthy Chinese men of Han ethnicity,and will facilitate more accurate diagnosis of osteoporosis in Chinese men. (Asian J Androl 2006 Jul;8:419-427)

VITAMIN-D RECEPTOR GENE POLYMORPHISM AND ITS RELATIONSHIP WITH BONE MINERAL DENSITY IN POSTMENOPAUSAL OSTEOPOROTIC WOMEN IN SHANGHAI

Objective To examine the relationship between the vitamin D receptor(VDR) gene polymorphism and osteoporosis in postmenopausal women in Shanghai. Methods 102 postmenopausal women recruited from Ruijin Hospital were osteoporotic. We measured the lumbar vertebrae and femur of all patients with a modal dual-energy X-ray absorptionmetry, and also the serum osteocalcin by ELISA. The VDR gene was amplified using a polymerase chain reaction (PCR). The VDR genotypes were determined by the PCR-RFLP. Results bb, aa and TT genotype were found mainly in these osteoporosis patients, only one BB and two tt were found among these patients. No significant association was observed among three subgroups of bb, Bb and BB. Conclusion The rareness of B and t alleles suggested that it is unlikely that they are important factors for the heredity of osteoporosis in Chinese women. Thus VDR gene typing may be of little value in assessing the osteoporosis risk in Chinese population.

Association of CA Repeat Polymorphism in Estrogen Receptor β Gene with Postmenopausal Osteoporosis in Chinese

Postmenopausal osteoporosis （PMO） is considered a polygenic disease. The estrogen receptor β （ESR2） gene is a candidate mediating the genetic influence on bone mass and the risk of osteoporosis. The aim of this study is to investigate the association of a cytosine-adenine （CA） repeat polymorphism in the fifth intron of the ESR2 gene with PMO in Chinese Han population. The CA repeat polymorphism was genotyped in a case-control study, involving 78 femoral neck PMO patients vs. 122 controls and 108 lumbar spine （L2-4） PMO patients vs. 92 controls. The （CA）n〈22 and （CA）n≥22 alleles were designated short （S） and long （L）, respectively. ESR2 genotype was categorically defined as SS （2 S alleles）, SL （having the mixed S and L alleles）, and LL （2 L alleles）. At both the femoral neck and the L2-4 region, LL genotype and L allele frequencies of the PMO group were significantly higher than those of the control group （P〈0.01）. The subjects with the SL, the LL, and the combined SL and LL genotype had a significant increased risk of PMO when compared with those with the SS genotype （P〈0.05）. After adjustments for age, years since menopause, menopausal age, and body mass index, logistic regression analysis showed that the subjects with the combined SL and LL genotype had increased risk of PMO when compared with those with the SS genotype both at the femoral neck （adjusted OR 4.923, 95% CI 1.986-12.203 , P=0.001） and the L2-4 （adjusted OR 2.267, 95% CI 1.121-4.598, P=0.023）. This extensive association study has identified the ESR2 CA repeat polymorphism to be independently associated with PMO at the femoral neck and the L2-4 in Chinese Han population. The data also suggested that the presence of the L allele may dominantly increase the risk of PMO at the two regions.