scholarly journals Bone mineral density and osteoporosis risk in young adults with atopic dermatitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sooyoung Kim ◽  
Jimi Choi ◽  
Moon Kyun Cho ◽  
Nam Hoon Kim ◽  
Sin Gon Kim ◽  
...  

AbstractAtopic dermatitis (AD) has been increasing worldwide over the past few decades. AD has been reported to be associated with an increased risk of osteoporosis and fractures in adult AD patients. The aim of this study was to investigate the bone mineral density (BMD) to evaluate osteoporosis risk in young adults with AD by sex. This was a case–control cohort study using a national dataset from the Korea National Health and Nutrition Examination Survey 2007–2009. We included young adult AD patients (men aged 19 ≤ and < 50 years, premenopausal women aged 19 ≤ and < 50 years) and 1:5 propensity score weighting controls by age, sex, body mass index (BMI), vitamin D level, and alcohol/smoking status. BMD was measured by double energy X-ray absorptiometry at the lumbar spine, femur neck, and total femur. The prevalence of low BMD, defined by a Z-score ≤  − 2.0, was compared between AD and without AD. We analyzed 311 (weighted n = 817,014) AD patients and 8,972 (weighted n = 20,880,643) controls. BMD at the lumbar spine was significantly lower in the male AD group than in the male control group (mean ± SE, 0.954 ± 0.016 vs. 0.989 ± 0.002, P = 0.03). The prevalence of low BMD (Z-score) did not significantly differ between AD and non-AD subjects in both men (3.8% vs. 2.7%, P = 0.56) and women (6.4% vs. 3.3%, P = 0.40). Among AD patients, early age at diagnosis of AD, longer duration of AD, lower BMI, rural residence (for men), less education, low vitamin D level, late menarche, and more pregnancies (for women) were associated with low BMD. In conclusion, low BMD did not occur more frequently in young adults with AD than in non-AD controls. However, early-onset/longer AD duration and lower BMI were associated with low BMD among young adult patients with AD.

2018 ◽  
Vol 21 (1) ◽  
pp. 10-16
Author(s):  
Tatiana V. Novikova ◽  
Lubov V. Kuznetsova ◽  
Natalia Yu. Yakovleva ◽  
Irina E. Zazerskaya

Background: Osteopenia is a common condition. Therefore, identification of groups for prevention of osteoporosis and restoration of bone mineral density (BMD) remains relevant. Aim: to assess the factors contributing to development of osteopenia in puerperas. Methods: prospective cross-sectional study. We examined 112 patients aged 20-35, 3-5 days after delivery. To assess possible factors for BMD decrease, we analyzed medical history, lifestyle, nutrition, anthropometric data, obstetric and gynecological history, and pregnancy course. We also assessed serum levels of 25-hydroxycalciferol (25-OH-D) and PTH. BMD was measured by dual energy x-ray osteodensitometry. We considered Z-score from -1 to -2.5SD as osteopenia, below -2.5 SD-as osteoporosis. Results: based on Z-score values, two groups were formed: 1 (n=70) - puerperas with osteopenia, 2 (n=42) - puerperas with normal BMD. In the first group, osteopenia in the distal radius was observed in 48%, in the lumbar spine in 16% and in the proximal femur in 36%. Influence of the following possible factors in group 1 was established: BMI in 15-20 years ≤ 18 kg/m2 (p<0.013), BMI ≥ 25 kg/m2 (p<0.018), 25-OH-D less than 25 ng / ml (p < 0.0018), calcium intake less than 800 mg/day (p<0.041). Menstrual disorders (p<0.052) and preeclapsia (p < 0.042) affected lumbar spine BMD. In group 1, vitamin D deficiency was detected in 82% of women, 18% showed vitamin D insufficiency; in group 2, vitamin D deficiency was found in 16%, deficiency in 70%, in 14% vitamin D was normal. In women with a combination of factors such as BMI≤ 18 kg/m; calcium intake lower than 800 mg/day, menstrual cycle disorders, vitamin D deficiency - osteopenia in the distal radius occured 11 times more often (OR=11,47059; CI 95%=[4,0326; 32,627]). Conclusion: most significant impact on BMD decrease in puerperas can be expected if patient has the following risk factors: BMI≤18 kg/m2; 25-OH- D<25 ng/ml ; nutrition with calcium intake <800 mg per day, preeclampsia. Combination of these factors may increase the risk of osteopenia in the distal radius.


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_5) ◽  
Author(s):  
Radwa Helmy Shalaby ◽  
Elham Mohamed Kassem ◽  
Nagat Mohamed El-Gazzar ◽  
Sahar Ahmed Fathy Hammoudah ◽  
Amal Mohamed El-Barbary

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic arthropathy of childhood and is associated with low bone mass, and may hasten the onset of osteoporosis later in life1. Bone loss occurs because of an imbalance between osteoclasts-activating factors like receptor activator of nuclear factor-κB ligand (RANKL) and its inhibitor osteoprotegerin (OPG) 2. Dual energy X-ray absorptiometry (DXA) is the preferred method for measuring bone mineral density (BMD) in children and to identify and follow individuals at risk for fracture 3. The objective is the Evaluation of serum levels of osteoprotegerin and RANKL and their correlation with BMD in JIA patients. Methods Forty JIA patients (according to the revised classification criteria of ILAR) and 40 healthy children individually matched for age, sex and race were included in this study. Children excluded from the study were those with primary and secondary causes of osteoporosis (such as chronic illness). All patients were assessed clinically by: age, sex, body mass index, type of JIA, disease duration and disease activity (by Juvenile Arthritis Disease Activity Score; JADAS 10). The functional disability was assessed by the Childhood Health Assessment Questionnaire (CHAQ). Blood samples were collected from JIA patients and healthy controls to determine serum levels of OPG and RANKL by ELISA. DXA scans were done using GE Healthcare Lunar DPX, Madison, Wisconsin. Bone mineral density of the L1-L4 lumbar spine and total body less head (TBLH) was evaluated in g/cm2 and expressed as Z score for age, sex according to the reference data given for this equipment. Results The study included 40 patients (25 females) with a mean age of 11.14 years and median disease duration of 2.5 years. As regard JIA type, 45% of patients were oligoarticular, 32.5% were polyarticular, and 22.5% were systemic JIA. Median JADAS 10 was 13.95. Patients (especially polyarticular JIA) had significantly higher serum RANKL levels and lower serum OPG and OPG/RANKL ratio when compared with controls (with p-value &lt;0.001, 0.032 and &lt;0.001 respectively). A diagnosis of low BMD (BMD Z-score ≤ -2) was given in 25% of patients (15% polyarticular and 10% systemic) by DXA of lumbar spine, and 20% (10% polyarticular and 10% systemic) by DXA of TBLH. On the other hand, no patient was given a diagnosis of osteoporosis (BMD Z-score ≤ -2 and a significant fracture history). Low BMD at lumbar spine and TBLH was negatively correlated with serum RANKL while positively correlated with OPG/RANKL ratio. Moreover, low BMD at lumbar spine was positively correlated with serum OPG level Conclusion High RANKL and low OPG levels appear to be associated with low bone mass in JIA patients. Patients with JIA (especially polyarticular and systemic subtype) are at increased risk of low bone mineral mass. Disclosure of Interests None declared


The Lancet ◽  
1995 ◽  
Vol 345 (8947) ◽  
pp. 423-424 ◽  
Author(s):  
S. Ferrari ◽  
R. Rizzoli ◽  
T. Chevalley ◽  
J.A. Eisman ◽  
J-P. Bonjour ◽  
...  

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yuri Battaglia ◽  
Michele Provenzano ◽  
Francesco Tondolo ◽  
Antonio Bellasi ◽  
Pasquale Esposito ◽  
...  

Abstract Background and Aims In the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT). Method This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (&lt; 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score &lt; −1 and &gt; −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution. Results Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p&lt;0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia Conclusion Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
PRASHANT MALVIYA ◽  
Soma Sekhar Mudigonda

Abstract Background and Aims Chronic kidney disease patients get affected by mineral bone disease in view of changes in various biochemical parameters. After transplantation there are changes in these parameters with additional effect of immunosuppression on bone mineral density. My study was to observe changes in biochemical parameters like calcium, phosphorus, vitamin D, parathyroid hormone, alkaline phosphatase and compare bone mineral density with the help of DEXA scan post renal transplantation after 3 and 6 months. It was a prospective observational comparative study. Aim of my study is to evaluate changes in Bone Mineral Density post renal transplantation Method Study was conducted at Apollo Tertiary care Hospital, Hyderabad which caters to rural as well as urban population in southern parts of India. This study was carried out form June 2017 to Dec 2018. Total 40 patients were included in study and they were followed up for the period of 6 months and underwent sets of investigations to assess their bone mineral density. Biochemical variables consist of calcium, phosphorus, alkaline phosphatase, vitamin D level and iPTH. Biochemical variables were classified into hypo, normal or hyper based on their lab values. iPTH values were considered high if value was nine times the upper limit of normal or low if value was less than two times the upper limit of normal. DEXA scan results were classified into normal, osteopenia and osteoporosis based on their t value. Results Study showed that patients who got admitted for transplant belong to age group of 31 – 50 yrs (39.8 +/- 12.8 yrs) predominantly male patients 30 (75%). In 25% patients (10) we were unable to find out native kidney disease shown as CKD (u). Other common causes were DM, ADPKD, CGN or CIN. Most patients were undergoing dialysis for more than 1 year, 47.5% (19) had significant loss of BMD as compared to patients whose dialysis was &lt;1 year (p value 0.498 and 0.05). Hypocalcemia was predominantly seen in pretransplant period 26 (65%) but as the patient followed up level improved with few developing hypercalcemia 4 (10%) after 6 months. Hyperphosphotemia was seen in 19 (47.5%) patients before transplant while hypophosphatemia in 4 (10%) patients 6 months post transplantation, others had normal phosphorus level. Patients were on calcium and vitamin D supplements developed sufficiency to high level of vitamin D 33 (82.5%) patients 6 months post renal transplant. In iPTH around 12 (30%) of patients were having iPTH &gt;150 pg/dl after 6 months of transplant. Majority presented for transplant detected to have osteoporosis and osteopenia at lumbar spine 31 (77.5%) and hip joint 27 (67.5%) with fracture risk 4 to 8 times of normal population. There was 8% and 10% increase in number of patients having osteoporosis at lumbar spine and hip joint respectively post-transplant. There was loss of 5.5% (mean t score at 0 month -1.98 and at 6 month -2.09) BMD at lumbar spine and 1.7% (mean t score at 0 month -1.83 and at 6 month -1.9) BMD at hip joint. Net loss of BMD was 3.6% over the period of 6 months. This accounts to increased risk of fractures post renal transplant. Biochemical variable in the form of iPTH has shown to have significant association with DEXA scan at lumbar spine (p value 0.01) and hip joint (p value 0.00) before and after transplant (p value of 0.01 and 0.00) though there was fall in iPTH level. Conclusion Pretransplant bone disease remains predominant cause of post-transplant bone disease with significant association with iPTH. Hypophosphatemia, hypercalcemia and high Vitamin D level are common findings in post-transplant period upto 6 months. Early use of DEXA scan along with follow up of biochemical variables can help to prognosticate and decide treatment strategies to reduce fracture risk in renal transplant recipients.


2019 ◽  
Vol 49 (4) ◽  
pp. 292-298
Author(s):  
Indar K Sharawat ◽  
Lesa Dawman ◽  
Merabhai V Kumkhaniya ◽  
Kusum Devpura ◽  
Amarjeet Mehta

Glucocorticoids are first-line therapy for children with idiopathic nephrotic syndrome (INS). These children are at risk of deranged bone metabolism and low bone mineral density (BMD). We studied 60 children with INS and divided them into two groups. Group 1 included 21 children (initial and infrequent relapsing) and group 2 included 39 children (frequent relapsing, steroid dependent and steroid resistant). Dual-energy X-ray absorptiometry of the lumbar spine was performed to assess BMD. Mean BMD Z-score was compared in both groups; this correlated significantly on univariate analysis with cumulative steroid dose, serum vitamin D levels and calcium supplementation. However, on multivariate analysis, serum vitamin D level was the only factor significantly predictive of low z-score.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 106-106
Author(s):  
Ashutosh Lal ◽  
Ellen Fung ◽  
Bamidele Kammen ◽  
Zahra Pakbaz ◽  
Nancy Sweeters ◽  
...  

Abstract Background : Reduced bone mineral density (BMD) has been reported in adults and children with sickle cell anemia (SCA). Dual energy x-ray absorptiometry (DXA) is routinely used for measuring BMD because of less radiation exposure and lower cost. However, changes in vertebral body shape, marrow hyperplasia and bone infarction due to SCA may affect the evaluation of BMD with DXA. Hence, we compared DXA with quantitative computerized tomography (QCT), which measures true volumetric density, and may be less influenced by bone changes. Methods : The study enrolled children between 9–19 years of age with SCA, and one or more severe manifestations: &gt;2 hospital admissions/year, growth failure, avascular necrosis, or regular red cell transfusions for sickle cell-related complications. BMD of lumbar spine was determined by performing DXA of lumbar spine (Hologic Delphi-A, Bedford, MA). The apparent volumetric bone mineral density (BMAD) was calculated from bone mineral content, and compared to age, sex and ethnicity-matched reference data. BMD of the lumbar spine was also measured by QCT (Mindways Software, San Francisco, CA), and compared to age and sex-appropriate reference data. Results : The study has enrolled 25 patients (13 females and 12 males), of which 16 were younger than 14 years. In 6 children the height was &lt;10th centile for age. Thirteen patients were on regular transfusions for &gt;6 months, including 10 who had been transfused for &gt;2 years. Calcium intake, assessed by a standardized questionnaire, was less than recommended dietary allowance in 13 patients. The z-score for BMAD determined by DXA was &gt; −1.0 in 8, between −1.0 and −2.0 in 5, and &lt; −2.0 in 12 patients. The z-score for lumbar spine by QCT was &gt; −1.0 in 20, between −1.0 and −2.0 in 1 and &lt; −2.0 in 4 patients. DXA-derived BMD (areal density) and BMAD (apparent volumetric density) z-scores did not differ significantly (p=0.16). On the other hand, the paired values of z-scores by DXA (BMAD) and QCT were significantly different (p=.002). When z-scores were categorized as greater or less than −1.0, the results were concordant in 13 (both DXA and QCT normal in 8, and both DXA and QCT abnormal in 5), and discordant in 12 cases (abnormal DXA with normal QCT in every case). Among patients in discordant group, 9/12 had been on regular red cell transfusions for &gt;6 months, compared to 4/13 with concordant results (p=.047). There was no difference in the serum ferritin values between the two groups (p=.685). No significant difference in the prevalence of low BMAD z-scores was detected between groups based upon age, calcium intake, or growth failure. Five out of the 12 patients with BMAD z-score &lt; −2.0 were not on regular transfusion program. Conclusions : Almost half of the children with SCA had BMD below −2 standard deviations compared to age-matched controls. Low BMD was observed in chronically transfused as well as non-transfused children. In comparison, 16% of the patients were classified as low BMD (z &lt; −2.0) by QCT. The paired DXA/QCT results were discordant in half of the sample, with patients on regular transfusions for &gt;6 months more likely to have normal QCT results. It is likely that the reduction in marrow hyperplasia following initiation of regular transfusions may disproportionately affect the trabecular BMD measured by QCT. Longitudinal evaluation of BMD in patients starting on transfusion program could help to define the effect of transfusions on measures of BMD in SCA.


2013 ◽  
Vol 57 (3) ◽  
pp. 372-376 ◽  
Author(s):  
Agozie C. Ubesie ◽  
James E. Heubi ◽  
Samuel A. Kocoshis ◽  
Carol J. Henderson ◽  
Adam G. Mezoff ◽  
...  

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Aneeta J Joseph ◽  
Jesus L Penabad ◽  
Antonio Pinero-Pilona

Abstract Introduction: Teriparatide, a parathyroid hormone analog, is an important anabolic agent approved by the U.S. Food and Drug Administration to increase bone mineral density in osteoporotic patients. Parathyroid hormone (PTH) regulates calcium, phosphate, and active vitamin-D metabolites.The amino terminal peptide fragments of PTH has been known to increase bone mass and are being used in clinical practice for osteoporosis management (1). Current literature shows the efficacy of teriparatide in increasing bone density of lumbar spine and femoral neck, and decreasing the risk of vertebral and non-vertebral fractures both in postmenopausal women and men. It is also known to prevent fractures in patients with osteoporosis and promote healing of fractures (2). Case Description: A 79-year-old Hispanic female with history of osteopenia and major lumbar spine wedge compression fractures presented to our clinic for consultation. She was on ibandronate for the past four months and was having symptoms of pill esophagitis. Her last bone mineral density done on August 2017 revealed T-score of -2.5 at the lumbar spine, -1.5 at the left femoral neck, and 3.3% bone loss on the left femoral head. Rather than being started on teriparatide, zoledronic acid, or denosumab, she continued ibandronate along with calcium and vitamin D. Two months after the initial consultation, she sustained a traumatic fracture of the posterior arch and body of C2 bilaterally following a motor vehicle accident. There were discussions about starting anabolic treatment, as serial imaging did not show any significant improvement in the healing process despite the use of a collar. Two months after sustaining C2 fracture, she was started on teriparatide. Repeat cervical spine x-ray three months later showed complete healing of the C2 fracture. Discussion: There are a limited number of cases reported in regards to teriparatide induced healing of non-osteoporotic fractures (3). Our case is one of the very few reported to have shown complete radiographic and clinical healing of a traumatic, non-osteoporotic fracture after use of teriparatide for 12 weeks.


2017 ◽  
Vol 98 (3) ◽  
pp. 343-348 ◽  
Author(s):  
L A Fomina ◽  
I A Zyabreva

Aim. To evaluate the state of bone tissue in comparison with calcium balance, to clarify the risk for fracture development in women of different age groups. METHODS. 92 females aged 19 to 89 years were examined clinically with densitometry of lumbar spine and femoral neck and measuring the concentration of total calcium in the blood. RESULTS. In females younger than 50 years decreased bone density according to Z-score was revealed in 30% of cases, among patients with its normal values significant trend to bone rarefaction (-2.0 SD <Z-score ≤-1.5 SD) was registered with the same rate. In the group of females older than 50 years osteopenia was revealed in 46.3% of cases and osteoporosis - in 42.7%, while more significant decrease in bone mineral density was found in the lumbar spine. Past medical history of fractures increased the rate of osteoporosis by 18%. In females older than 50 years compared to younger patients a significant increase of blood calcium concentration was revealed. Besides, statistically significant increase of its level was noted in cases of fractures in the past and osteoporosis. The revealed changes of bone tissue in females below 50 years of age are indicative of increased risk of osteoporosis development in the future. CONCLUSION. High prevalence of osteoporosis and osteopenia is revealed in the examined patients older than 50 years, and bone mineral density parameters were significantly inversely correlated with calcemia; hence, blood calcium level can be one of the criteria of bone tissue state and in combination with other risk factors for osteoporosis should be taken into account during periodic health examination of females older than 50 years.


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