Bone Mineral
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2021 ◽  
Vol 12 ◽  
Frederick Vogel ◽  
Leah Braun ◽  
German Rubinstein ◽  
Stephanie Zopp ◽  
Andrea Oßwald ◽  

ContextGlucocorticoid excess exhibits multiple detrimental effects by its catabolic properties. Metformin was recently suggested to protect from adverse metabolic side-effects of glucocorticoid treatment. Whether metformin is beneficial in patients with endogenous glucocorticoid excess has not been clarified.ObjectiveTo evaluate the phenotype in patients with endogenous Cushing’s syndrome (CS) treated with metformin at the time of diagnosis.Patients and MethodsAs part of the German Cushing’s Registry we selected from our prospective cohort of 96 patients all 10 patients who had been on pre-existing metformin treatment at time of diagnosis (CS-MET). These 10 patients were matched for age, sex and BMI with 16 patients without metformin treatment (CS-NOMET). All patients had florid CS at time of diagnosis. We analyzed body composition, metabolic parameters, bone mineral density and bone remodeling markers, muscle function and quality of life.ResultsAs expected, diabetes was more prevalent in the CS-MET group, and HbA1c was higher. In terms of comorbidities and the degree of hypercortisolism, the two groups were comparable. We did not observe differences in terms of muscle function or body composition. In contrast, bone mineral density in metformin-treated patients was superior to the CS-NOMET group at time of diagnosis (median T-Score -0.8 versus -1.4, p = 0.030). CS-MET patients showed decreased β-CTX levels at baseline (p = 0.041), suggesting reduced bone resorption under metformin treatment during glucocorticoid excess.ConclusionThis retrospective cohort study supports potential protective effects of metformin in patients with endogenous glucocorticoid excess, in particular on bone metabolism.

2021 ◽  
Vol 11 (1) ◽  
Hsueh-Kuan Lu ◽  
Chung-Liang Lai ◽  
Li-Wen Lee ◽  
Lee-Ping Chu ◽  
Kuen-Chang Hsieh

AbstractThis study aimed to investigate the relationship between bone mineral density (BMD) and height-adjusted resistance (R/H), reactance (Xc/H) and phase angle (PhA). A total of 61 male and 64 female subjects aged over 60 years were recruited from middle Taiwan. The R and Xc were measured using Bodystat Quadscan 4000 at a frequency of 50 kHz. BMD at the whole body, L2–L4 spine, and dual femur neck (DFN), denoted as BMDTotal, BMDL2–L4, and BMDDFN, were calculated using a Hologic DXA scanner. The R-Xc graph was used to assess vector shift among different levels of BMD. BMD was positively correlated with Xc/H and negatively correlated with R/H (p < 0.001). The General Linear Model (GLM) regression results were as follows: BMDTotal = 1.473–0.002 R/H + 0.007 Xc/H, r = 0.684; BMDL2–L4 = 1.526–0.002 R/H + 0.012 Xc/H, r = 0.655; BMDDFN = 1.304–0.002 R/H + Xc/H, r = 0.680; p < 0.0001. Distribution of vector in the R-Xc graph was significantly different for different levels of BMDTotal, BMDL2–L4 and BMDDFN. R/H and Xc/H were correlated with BMD in the elderly. The linear combination of R/H and Xc/H can effectively predict the BMD of the whole body, spine and proximal femur, indicating that BIVA may be used in clinical and home-use monitoring tool for screening BMD in the elderly in the future.

2021 ◽  
Zhang-Xin Wen ◽  
Yong-Fang Li ◽  
Lu-Lu Xu ◽  
Chun Yue ◽  
Qin-Yi Wang ◽  

Abstract Purpose: This study aimed to investigate the relationship of triglyceride glucose-body mass index (TyG-BMI) with bone mineral density, femoral neck geometry, and risk of fracture in middle-aged and elderly Chinese individuals. Methods: A total of 832 nondiabetic individuals (474 men aged ≥50 years and 358 postmenopausal women) were selected from the prospective population-based HOPE cohort. All individuals underwent dual-energy X-ray absorptiometry for assessment of bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, as well as femoral neck geometry. The 10-year probabilities of major osteoporotic fractures (MOFs) and hip fractures (HFs) were calculated. Correlations of TyG-BMI with BMD at different sites, femoral neck geometry, and risk of fractures were examined in men and women. Results: Cortical thickness (CT), compression strength index (CSI), cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (SM), and 25(OH)D levels were significantly lower in women (all P < 0.001). The presence of osteoporosis was related to age, BMI, BMD and femoral neck geometry, TyG-BMI index and TyG index, MOF and HF in both sex. TyG-BMI was positively correlated with BMD at femoral neck, lumber spine, and total hip and with femoral neck geometry parameters in men, Similar significant association was also present in women. In men, TyG-BMI showed significant negative correlation with HF but not with MOF. In women, TyG-BMI showed significant negative correlation with both factors only after adjusting for other variable. The various geometric indices of the femoral neck were 3 significantly impaired in individuals with low TyG-BMI. the TyG-BMI index was found to be significantly associated with osteoporosis after adjusting for confounders. Conclusion: TyG-BMI is positively associated with BMD and femoral neck geometry, and negatively associated with risk of fracture in nondiabetic middle-aged and elderly Chinese men and women.

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Yaqin Geng ◽  
Ting Liu ◽  
Yu Ding ◽  
Wei Liu ◽  
Jiayi Ye ◽  

To explore the application of self-efficacy in X-ray image analysis based on deep convolutional neural network (DCNN) in the care and treatment of osteoporosis patients with rheumatoid arthritis. In this study, 90 patients with osteoporosis were divided into the control group and the experimental group for DCNN combined with X-ray diagnosis. Patients in the control group were given routine nursing care, and those in the experimental group were given comprehensive nursing care. The bone mineral content, self-efficacy, anxiety, and depression in the femur and lumbar spine after care were compared. The results showed that the accuracy, sensitivity, and false-negative rate of X-ray image recognition of osteoporosis based on DCNN were 91%, 98%, and 2%, respectively. The bone mineral contents of femur and lumbar vertebra in the experimental group were significantly higher than those in the control group ( P < 0.05 ). The anxiety, depression, and self-efficacy scores of patients in the experimental group were significantly higher than those in the control group ( P < 0.05 ). In conclusion, the accuracy rate of DCNN combined with X-ray plain film imaging in the detection of osteoporosis is high. Comprehensive nursing intervention can improve the curative effect and self-efficacy of patients. The improvement of self-efficacy is a related factor for the improvement of patients’ negative emotions and quality of life.

2021 ◽  
Vol 218 (12) ◽  
Peter Geon Kim ◽  
Abhishek Niroula ◽  
Veronica Shkolnik ◽  
Marie McConkey ◽  
Amy E. Lin ◽  

Osteoporosis is caused by an imbalance of osteoclasts and osteoblasts, occurring in close proximity to hematopoietic cells in the bone marrow. Recurrent somatic mutations that lead to an expanded population of mutant blood cells is termed clonal hematopoiesis of indeterminate potential (CHIP). Analyzing exome sequencing data from the UK Biobank, we found CHIP to be associated with increased incident osteoporosis diagnoses and decreased bone mineral density. In murine models, hematopoietic-specific mutations in Dnmt3a, the most commonly mutated gene in CHIP, decreased bone mass via increased osteoclastogenesis. Dnmt3a−/− demethylation opened chromatin and altered activity of inflammatory transcription factors. Bone loss was driven by proinflammatory cytokines, including Irf3-NF-κB–mediated IL-20 expression from Dnmt3a mutant macrophages. Increased osteoclastogenesis due to the Dnmt3a mutations was ameliorated by alendronate or IL-20 neutralization. These results demonstrate a novel source of osteoporosis-inducing inflammation.

2021 ◽  
Vol 12 ◽  
Chun-Ming Ma ◽  
Fu-Zai Yin

ObjectiveThe purpose of this study was to observe the relationship between impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and bone mineral density (BMD) in different sites in adolescents.MethodsA retrospective study was conducted on adolescents age 12–19 years of the United States. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, and 2009–2010 cycles. IFG was defined as fasting plasma glucose (FPG) levels that were ≥5.6 and &lt;7.0 mmol/L. IGT was defined as 2-h plasma glucose levels that were ≥7.8 and &lt;11.1 mmol/L after the oral glucose tolerance test (OGTT).ResultsAfter controlling for age, gender, race, and body mass index (BMI) Z-score, adolescents in different categories of IGT had significantly different levels of areal BMD (aBMD) and bone mineral apparent density (BMAD) (IGT main effect: P &lt; 0.05 for all, two-way ANOVA). There was no main effect between different categories of IFG with regard to aBMD and BMAD (P &gt; 0.05). There was no interaction between IFG and IGT with regard to aBMD and BMAD (P &gt; 0.05). In multiple regression analysis, the 2-h plasma glucose maintained an independent association with femoral neck aBMD (β = −0.011, 95% CI: −0.017~−0.006, P &lt; 0.001, R2 = 0.012), total femur aBMD (β = −0.015, 95% CI: −0.021~−0.009, P &lt; 0.001, R2 = 0.018), total spine aBMD (β = −0.015, 95% CI: −0.020~−0.010, P &lt; 0.001, R2 = 0.018), and total spine BMAD (β = −0.002, 95% CI: −0.003~0.000, P = 0.006, R2 = 0.003).ConclusionThe present study demonstrates that BMD was decreased in adolescents with IGT. Two-hour plasma glucose, not FPG, negatively correlated with BMD. The effect of 2-h plasma glucose was consistent across the sites of bone.

2021 ◽  
pp. 014556132110533
Vojtěch Peřina ◽  
Richard Salzman ◽  
Jana Treglerová

Background: Antiresorptive drugs are widely used to reduce bone mineral loss in patients with osteoporosis and to prevent skeletal-related events in patients with metastatic cancers and multiple myeloma (MM). Both the bisphosphonates (BP) and denosumab typically used in this indication were shown to be effective and relatively safe. Obviously, this medication could have some adverse effects; one of them is osteonecrosis of the external auditory canal. Only sporadic cases of external auditory canal osteonecrosis have been published yet. Here, we provide a case of denosumab-related osteonecrosis of the external auditory canal successfully treated surgically in the early stage of the disease. Case report: A 68-year-old patient with breast cancer underwent comprehensive oncological treatment, including denosumab administration. She was diagnosed with osteonecroses in the jaw and ear canal. The necrotic bones in both regions were resected with primary wound closure. Both affected sites healed well with no signs of necrosis recurrence. Conclusions: Osteonecrosis of the external auditory canal is a rare but probably underdiagnosed complication of antiresorptive medication. It has a negative impact on patient quality of life if left untreated. Early surgical treatment appears to be effective. The authors highlight several similarities with medication-related osteonecrosis of the jaw. Therefore, an analogous disease staging and treatment rationale is suggested.

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