Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This stu...Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.展开更多
BACKGROUND Tooth defects can cause elongation of occlusal teeth,leading to insufficient repair space.The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant ...BACKGROUND Tooth defects can cause elongation of occlusal teeth,leading to insufficient repair space.The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant therapeutic effect.AIM To explore clinical efficacy,bone density,and follow-up of implant and orthodontic treatment for patients with inclined adjacent teeth.METHODS In total,98 patients with oblique adjacent teeth were randomly assigned to implant restoration combined with orthodontic treatment(group A,n=49)or to receive implant restoration alone(group B,n=49).Changes in alveolar ridge bone density and apical bone density were observed before and after treatment in the two groups.Changes in chewing function and language function were compared between the two groups of patients.Follow-up lasted for 12 mo after repair to observe any adverse reactions in the oral cavity.RESULTS The clinical effective rates of group A and group B were 97.96%and 85.71%,respectively,with group A having a higher clinical effective rate than group B.After treatment,the bone density of the alveolar ridge and apical bone in both groups decreased compared to before treatment,while the chewing and language functions improved.The changes in various indicators in group A were more significant.After treatment,the satisfaction rate of group A(97.96%)was higher than that of group B(79.59%).The incidence of adverse reactions in group A(2.04%)was lower than that in group B(24.49%).CONCLUSION The amalgamation of implant restoration and orthodontic treatment for adjacent tilted teeth demonstrates notable clinical efficacy,diminishes alveolar bone resorption,and fosters patient functional rehabilitation while exhibiting negligible adverse reactions.展开更多
This cohort study was designed to explore the relationship between maternal dietary patterns(DPs)and bone health in Chinese lactating mothers and infants.We recruited 150 lactating women at 1-month postpartum.The esti...This cohort study was designed to explore the relationship between maternal dietary patterns(DPs)and bone health in Chinese lactating mothers and infants.We recruited 150 lactating women at 1-month postpartum.The estimated bone mineral density(eBMD)of subjects’calcanei and the information on dietary intake were collected.After 5-month follow-up,the eBMD of mothers and their infants were measured again.Factor analysis was applied to determine maternal DPs.General linear models were used to evaluate the association between maternal DPs and maternal eBMD loss or infants’eBMD.With all potential covariates adjusted,Factor 2(high intake of whole grains,tubers,mixed beans,soybeans and soybean products,seaweeds,and nuts)showed a positive association with the changes of maternal eBMD(β=0.16,95%CI:0.005,0.310).Factor 3(high intake of soft drinks,fried foods,and puffed foods)was inversely correlated with the changes of maternal eBMD(β=-0.22,95%CI:-0.44,0.00).The changes of maternal eBMD were positively associated with 6-month infants’eBMD(β=0.34,95%CI:0.017,0.652).In conclusion,Factor 2 might contribute to the maintenance of eBMD in lactating women,while Factor 3 could exacerbate maternal eBMD loss.Additionally,the changes of maternal eBMD presented a positive correlation with 6-month infants’eBMD.展开更多
Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of mal...Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments.The results of this study indicated that (i) the hady weight was significantly (P<0.05) lower in the swimming groups than in the control groups in boh sexes. (ii) The bone density was significantly higher (P <0.05) in the swimming groups than in the control groups in boh sexes. However, there was no sighficant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimndng and the contro groups in beth sexes. However, the elasticity of the bone of the female hoce in the swimming group was significantly higher (P<0.05) than that of the control group.These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.展开更多
Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aim...Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density （aBMD）. At the radius by high-resolution peripheral quantitative computed tomography （HR-pQCT）, there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation （ITS） analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate-plate, plate-rod and rod-rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.展开更多
Objective: To investigate the occurrence pattern of abnormal bone density in male long-distance runners from several different regions of China, and provide a basis for elucidating the influences of geo-environmental ...Objective: To investigate the occurrence pattern of abnormal bone density in male long-distance runners from several different regions of China, and provide a basis for elucidating the influences of geo-environmental differences on bone density. Methods: We employed a set of well-designed exclusion-inclusion criteria to recruit study subjects, in which compounding factors were managed and regional environmental traits were fully incorporated. WHO (World Health Organization) criteria for the diagnosis of osteoporosis were then used to examine the subjects to determine occurrence of abnormal bone density. The resulting data were analyzed using methods of spatial statistics, which included several approaches, such as spatial autocorrelation, hot spot analysis, and Geodetector Software analysis, to depict and analyze the spatial distribution of abnormal bone density in male athletes from different regions in China, thereby investigating the influences of geo-environmental factors (e.g., temperature, humidity, and altitude) on bone density. Results: A total of 685 subjects were effectively examined in this study, including 486 with normal bone density, 185 with osteopenia, and 14 with osteoporosis. Spatial distribution analysis revealed that the distribution of subjects with abnormal bone density overall exhibited a pattern indicating that the level of abnormal bone density in the eastern regions was higher than that in the western regions and that the levels of abnormal bone density in the southern and northern regions were higher than that in the middle regions. Spatial autocorrelation analysis revealed a Moran’s I = 0.136, Z-score = 1.114, and P value = 0.265 and indicated that the athletes with abnormal bone density were randomly distributed in each region. Hot spot analysis revealed that Tibet and Qinghai displayed distributions of cold spots. Geodetector Software analysis yielded a Q value for annual average temperature of 1.000 and a corresponding P value of 0.000, and the results revealed that temperature significantly affected bone density and that altitude, relative humidity, sunlight hours, and temperature variations displayed synergistic effects on bone density and could diminish the influences of temperature on bone density. Conclusion: Our data revealed that different regions displayed different distribution patterns of abnormal bone density such that the level in the eastern regions was higher than that in the western ones and that the levels in the southern and northern regions were higher than that in the middle regions;specifically, the provinces of Yunnan, Heilongjiang, Hainan, and Inner Mongolia had high rates of abnormal bone density, whereas Tibet and Qinghai had relatively good conditions of bone density. Our data suggested that suitable temperature changes and appropriate levels of temperature variations can decrease the occurrence rates of osteopenia and osteoporosis.展开更多
BACKGROUND The association between body mass index(BMI)and bone mineral density(BMD)has shown inconsistent results,varying by sex and skeletal site.Despite normal or elevated bone mass,individuals with type 2 diabetes...BACKGROUND The association between body mass index(BMI)and bone mineral density(BMD)has shown inconsistent results,varying by sex and skeletal site.Despite normal or elevated bone mass,individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.AIM To assess lumbar spine trabecular volumetric BMD(vBMD)across different BMI categories in individuals with and without diabetes.METHODS This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study.The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography.Total adipose tissue,subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),and lumbar skeletal muscle area were also quantified.RESULTS In men with obesity(P=0.038)and overweight(P=0.032),vBMD was significantly higher in the diabetes group compared to non-diabetic men.After adjusting for age and sex,no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes.However,a BMI threshold of 22.33 kg/m²indicated a saturation point for vBMD in nondiabetic men.Independent predictors of vBMD in men included age(r=-0.387,P<0.001),BMI(r=0.130,P=0.004),and VAT(r=-0.145,P=0.001).For women,significant predictors were age(r=-0.594,P<0.001),BMI(r=0.157,P=0.004),VAT(r=-0.112,P=0.001),and SAT(r=-0.068,P=0.035).CONCLUSION The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes.Overweight and obese men with diabetes exhibit higher vBMD.展开更多
Objective To observe the value of artificial intelligence(AI)models based on non-contrast chest CT for measuring bone mineral density(BMD).Methods Totally 380 subjects who underwent both non-contrast chest CT and quan...Objective To observe the value of artificial intelligence(AI)models based on non-contrast chest CT for measuring bone mineral density(BMD).Methods Totally 380 subjects who underwent both non-contrast chest CT and quantitative CT(QCT)BMD examination were retrospectively enrolled and divided into training set(n=304)and test set(n=76)at a ratio of 8∶2.The mean BMD of L1—L3 vertebrae were measured based on QCT.Spongy bones of T5—T10 vertebrae were segmented as ROI,radiomics(Rad)features were extracted,and machine learning(ML),Rad and deep learning(DL)models were constructed for classification of osteoporosis(OP)and evaluating BMD,respectively.Receiver operating characteristic curves were drawn,and area under the curves(AUC)were calculated to evaluate the efficacy of each model for classification of OP.Bland-Altman analysis and Pearson correlation analysis were performed to explore the consistency and correlation of each model with QCT for measuring BMD.Results Among ML and Rad models,ML Bagging-OP and Rad Bagging-OP had the best performances for classification of OP.In test set,AUC of ML Bagging-OP,Rad Bagging-OP and DL OP for classification of OP was 0.943,0.944 and 0.947,respectively,with no significant difference(all P>0.05).BMD obtained with all the above models had good consistency with those measured with QCT(most of the differences were within the range of Ax-G±1.96 s),which were highly positively correlated(r=0.910—0.974,all P<0.001).Conclusion AI models based on non-contrast chest CT had high efficacy for classification of OP,and good consistency of BMD measurements were found between AI models and QCT.展开更多
Age-related osteoporosis poses a significant challenge in musculoskeletal health;a condition characterized by reduced bone density and increased fracture susceptibility in older individuals necessitates a better under...Age-related osteoporosis poses a significant challenge in musculoskeletal health;a condition characterized by reduced bone density and increased fracture susceptibility in older individuals necessitates a better understanding of underlying molecular and cellular mechanisms.Emerging evidence suggests that osteocytes are the pivotal orchestrators of bone remodeling and represent novel therapeutic targets for age-related bone loss.Our study uses the prematurely aged PolgD257A/D257A(PolgA)mouse model to scrutinize age-and sex-related alterations in musculoskeletal health parameters(frailty,grip strength,gait data),bone and particularly the osteocyte lacuno-canalicular network(LCN).Moreover,a new quantitative in silico image analysis pipeline is used to evaluate the alterations in the osteocyte network with aging.Our findings underscore the pronounced degenerative changes in the musculoskeletal health parameters,bone,and osteocyte LCN in PolgA mice as early as 40 weeks,with more prominent alterations evident in aged males.Our findings suggest that the PolgA mouse model serves as a valuable model for studying the cellular mechanisms underlying age-related bone loss,given the comparable aging signs and age-related degeneration of the bone and the osteocyte network observed in naturally aging mice and elderly humans.展开更多
Objective:To analyze the clinical characteristics of bone loss in hospitalized patients with Graves’disease.Methods:The clinical data of hospitalized patients with Graves’disease were collected.According to the resu...Objective:To analyze the clinical characteristics of bone loss in hospitalized patients with Graves’disease.Methods:The clinical data of hospitalized patients with Graves’disease were collected.According to the results of bone density examinations,they were divided into a normal bone density group,a low bone mass group,and an osteoporosis group.The normal bone density group was used as the control group to analyze the clinical characteristics of bone loss.Results:The incidence of bone loss in patients with Graves’disease was 80.72%,with osteoporosis accounting for 39.16%and low bone mass accounting for 41.57%.The incidences of hyperthyroid heart disease,Graves’ophthalmopathy,and leukopenia in the osteoporosis group and the low bone mass group were significantly higher than those in the normal bone density group,reaching 84.62%,60.87%,and 34.38%,respectively(P<0.05).The age of the osteoporosis group with Graves’disease was 50.88±12.03 years old,which was higher than that of the normal bone density group(40.03±12.58 years old).The disease course was 55.66±14.21 days,longer than that of the normal bone density group(43.38±8.55 days).FT4 was 61.69±8.42 pmol/L,higher than that of the normal bone density group(51.01±6.77 pmol/L),while TSH was 0.08±0.51μIU/ml,lower than that of the normal bone density group(0.22±0.55μIU/ml).The blood phosphorus was 1.25±0.29 mmol/L,lower than that of the normal bone density group(1.34±0.27 mmol/L),with statistical significance(P<0.05).In the low bone mass group,FT3(13.08±9.05 pmol/L)and FT4(46.14±3.46 pmol/L)were lower than those in the normal bone density group,with statistical significance(P<0.05).Logistic regression analysis revealed that age,disease course,and TSH were contributing factors to bone loss.Conclusion:Patients with Graves’disease are prone to bone loss,and age,disease course,and TSH are contributing factors to bone loss.展开更多
BACKGROUND Chronic hyperglycemia can damage the microcirculation,which impairs the function of various organs and tissues and predisposes individuals to chronic complications.Sarcopenia(SP)is the age-related decline i...BACKGROUND Chronic hyperglycemia can damage the microcirculation,which impairs the function of various organs and tissues and predisposes individuals to chronic complications.Sarcopenia(SP)is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes.In particular,diabetic patients are at higher risk of SP because of insulin resistance,chronic inflam-mation,and decreased physical activity.METHODS A retrospective analysis was conducted on 196 middle-aged and elderly male T2DM inpatients in the First Affiliated Hospital of Chongqing Medical University between June 2021 and June 2023,with 60 concurrent healthy individuals as the control group.Differences in general information,blood biochemistry,glyco-sylated hemoglobin,muscle strength,and detection rate of SP were compared between groups.The BMD,appendicular skeletal muscle(ASM),and fat mass,as well as grip strength and gait speed,were determined for each patient,and the ASM index(ASMI)was counted.The quantitative data were subjected to cor-relation and logistic regression analyses to identify risk factors for SP.RESULTS Fifty-one of the 196 middle-aged and elderly male T2DM patients were diagnosed with SP,which accounted for 26.02%.The middle-aged and elderly T2DM patients with SP exhibited a longer diabetes mellitus(DM)course and a lower body mass index(BMI)and 25(OH)D3 compared with the non-SP patients.The T2DM+SP patients exhibited lower BMI,ASM,ASMI,left-and right-hand grip strength,gait speed,and muscle and fat mass of the upper and lower limbs compared with the diabetic non-SP patients.The femoral neck,total hip,and lumbar spine L1-4 BMD were markedly lower in T2DM+SP patients compared with those in the non-SP diabetics.Long-term DM course,low BMI,and low BMD of the femoral neck,lumbar spine L1-4,and total hip were identified as risk factors for the development of SP.CONCLUSION T2DM patients are at risk for SP;however,measures can be taken to prevent the related risk factors.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patie...BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.展开更多
Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions...Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.展开更多
Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objec...Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objective of the study is to estimate the prevalence of osteoporosis and osteopenia among patients with fragility fractures. Results: The result of the study revealed that the mean age of patients included in the study was 65.11 ± 10.17 and the majority (77.3%) were females. The most common sites of fractures were the femur, radius and vertebra (30.7%, 17.0% and 14.8% respectively). Moreover, more than 95% of patients with fragility fracture who underwent BMD testing had low bone mineral density. In female with fragility fracture the prevalence of osteoporosis was higher in comparison to male (58.8% and 45.0% respectively). Conclusion: Our data showed that low BMD measurement is prevalent in patient with fragility fracture. It also highlighted the importance of implementation of Fracture liaison service, to reduce the gap between fragility fracture and osteoporosis treatment.展开更多
BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney transplantation.Immunosuppressive treatment contributes to the patho-genesis of this disease.Bisphosphonate treatment...BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney transplantation.Immunosuppressive treatment contributes to the patho-genesis of this disease.Bisphosphonate treatments have shown positive but inde-finite results.AIM To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year later.We also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the study.Bisphosphonates were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no treatment.BMD improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after surgery.Kidney function was not affected by bisphosphonate treatment.In KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone mass.CONCLUSION In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.展开更多
Diabetic osteoporosis(DOP)is a common complication in diabetes,driven by hyperglycemia-induced metabolic disturbances,chronic inflammation,and oxi-dative stress.This review describes the critical role of iron metaboli...Diabetic osteoporosis(DOP)is a common complication in diabetes,driven by hyperglycemia-induced metabolic disturbances,chronic inflammation,and oxi-dative stress.This review describes the critical role of iron metabolism dysregu-lation in DOP pathogenesis,focusing on ferroptosis,a novel iron-dependent cell death pathway characterized by lipid peroxidation and reactive oxygen species(ROS)overproduction.Diabetic conditions exacerbate iron overload,impairing osteoblast function and enhancing osteoclast activity,while triggering ferroptosis in bone cells.Ferroptosis not only accelerates osteoblast apoptosis but also amplifies osteoclast-mediated bone resorption,synergistically promoting bone loss.Furthermore,chronic inflammation and oxidative stress disrupt the balance between bone formation and resorption,with elevated pro-inflammatory cyto-kines(e.g.,tumor necrosis factor-α,interleukin-6)and ROS exacerbating cellular dysfunction.Therapeutic strategies targeting iron metabolism(e.g.,deferoxamine)and ferroptosis inhibition(e.g.,nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathway activation,antioxidants like melatonin)demonstrate potential to mitigate DOP progression.Future research should prioritize personalized interventions,clinical trials of iron chelators and antioxidants,and mechanistic studies to refine therapeutic approaches.This review provides a comprehensive framework for understanding DOP pathogenesis and highlights innovative strategies to improve bone health in diabetic patients.展开更多
BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in pati...BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in patients with ACS using a continuous glucose monitoring system(CGMS)and dual-energy X-ray absorptiometry(DXA).METHODS Patients diagnosed with ACS,including Cushing syndrome,mild ACS(MACS),and nonfunctional adrenal incidentaloma(NFAI),were recruited for this study.Glucose variability and glycemic status were assessed using CGMS.Regional bone mineral content(BMC),bone mineral density(BMD),and bone area(BA)were evaluated using DXA.CGMS-and DXA-derived parameters were compared across the subgroups of ACS.Correlation analysis was performed to examine relationships between varying degrees of cortisol secretion,measured by cortisol after 1 mg overnight dexamethasone suppression test(DST)or 24-hour urine free cortisol(24h UFC),and CGMS-or DXA-derived parameters.RESULTS A total of 64 patients with ACS were included in this study:19 with Cushing syndrome,11 with MACS,and 34 with NFAI.Glucose variability,time above range(TAR),and time in range(TIR)along with specific areal BMC,BMD,and BA,differed significantly between groups of Cushing syndrome and NFAI.A significant positive correlation was observed between glucose variability or TAR and cortisol after 1 mg overnight DST or 24h UFC.By contrast,TIR,along with regional BMC,BMD,and BA,were negatively correlated with varying degrees of cortisol secretion.CONCLUSION Glucose and bone metabolism impairments are on a continuum alteration from NFAI to MACS and Cushing syndrome.Prompt attention should be given to these patients with ACS,especially those with mild hormone secretion.Parameters of glucose variability and glycemic status along with bone condition in regions rich in cancellous bone will provide valuable information.展开更多
The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is la...The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is largely unknown.In patients who underwent discontinuation after multiple injections of denosumab,the levels of tartrate-resistant acid phosphatase 5b increased compared to pretreatment levels,indicating a phenomenon known as“overshoot.”The rate of decrease in bone mineral density during the withdrawal period was higher than the rate of decrease associated with aging,suggesting that the physiological bone metabolism had broken down.Overshoot and significant bone loss were also observed in mice receiving continuous administration of anti-RANKL antibody after treatment was interrupted,resembling the original pathology.In mice long out of overshoot,bone resorption recovered,but osteoblast numbers and bone formation remained markedly reduced.The bone marrow exhibited a significant reduction in stem cell(SC)antigen 1-and platelet-derived growth factor receptor alpha-expressing osteoblast progenitors(PαS cells)and alkaline phosphatase-positive early osteoblasts.Just before the overshoot phase,the osteoclast precursor cell population expands and RANKL-bearing extracellular vesicles(EVs)became abundant in the serum,leading to robust osteoclastogenesis after cessation of anti-RANKL treatment.Thus,accelerated bone resorption due to the accumulation of RANKLbearing EVs and long-term suppression of bone formation uncoupled from bone resorption leads to the severe bone loss characteristic of denosumab discontinuation.展开更多
This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participa...This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.展开更多
AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known abo...AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers. METHODS: Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30) or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured. RESULTS: BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN; 0.76 (0.53-0.99); LS: 0.96 (0.62-1.23) g/cm2). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P= 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P= 0.09). CONCLUSION: There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.展开更多
文摘Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.
基金the Review Committee of General Hospital of Central Theater Command(Approval No.05901).
文摘BACKGROUND Tooth defects can cause elongation of occlusal teeth,leading to insufficient repair space.The combination of dental implant restoration and orthodontic treatment of oblique adjacent teeth has a significant therapeutic effect.AIM To explore clinical efficacy,bone density,and follow-up of implant and orthodontic treatment for patients with inclined adjacent teeth.METHODS In total,98 patients with oblique adjacent teeth were randomly assigned to implant restoration combined with orthodontic treatment(group A,n=49)or to receive implant restoration alone(group B,n=49).Changes in alveolar ridge bone density and apical bone density were observed before and after treatment in the two groups.Changes in chewing function and language function were compared between the two groups of patients.Follow-up lasted for 12 mo after repair to observe any adverse reactions in the oral cavity.RESULTS The clinical effective rates of group A and group B were 97.96%and 85.71%,respectively,with group A having a higher clinical effective rate than group B.After treatment,the bone density of the alveolar ridge and apical bone in both groups decreased compared to before treatment,while the chewing and language functions improved.The changes in various indicators in group A were more significant.After treatment,the satisfaction rate of group A(97.96%)was higher than that of group B(79.59%).The incidence of adverse reactions in group A(2.04%)was lower than that in group B(24.49%).CONCLUSION The amalgamation of implant restoration and orthodontic treatment for adjacent tilted teeth demonstrates notable clinical efficacy,diminishes alveolar bone resorption,and fosters patient functional rehabilitation while exhibiting negligible adverse reactions.
基金NSFC and CNS for funding the projectfunded by the National Natural Science Foundation of China(NSFC,82173500)“CNS-ZD Tizhi and Health Fund”(CNS-ZD2020-163).
文摘This cohort study was designed to explore the relationship between maternal dietary patterns(DPs)and bone health in Chinese lactating mothers and infants.We recruited 150 lactating women at 1-month postpartum.The estimated bone mineral density(eBMD)of subjects’calcanei and the information on dietary intake were collected.After 5-month follow-up,the eBMD of mothers and their infants were measured again.Factor analysis was applied to determine maternal DPs.General linear models were used to evaluate the association between maternal DPs and maternal eBMD loss or infants’eBMD.With all potential covariates adjusted,Factor 2(high intake of whole grains,tubers,mixed beans,soybeans and soybean products,seaweeds,and nuts)showed a positive association with the changes of maternal eBMD(β=0.16,95%CI:0.005,0.310).Factor 3(high intake of soft drinks,fried foods,and puffed foods)was inversely correlated with the changes of maternal eBMD(β=-0.22,95%CI:-0.44,0.00).The changes of maternal eBMD were positively associated with 6-month infants’eBMD(β=0.34,95%CI:0.017,0.652).In conclusion,Factor 2 might contribute to the maintenance of eBMD in lactating women,while Factor 3 could exacerbate maternal eBMD loss.Additionally,the changes of maternal eBMD presented a positive correlation with 6-month infants’eBMD.
文摘Effects of swirnming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments.The results of this study indicated that (i) the hady weight was significantly (P<0.05) lower in the swimming groups than in the control groups in boh sexes. (ii) The bone density was significantly higher (P <0.05) in the swimming groups than in the control groups in boh sexes. However, there was no sighficant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimndng and the contro groups in beth sexes. However, the elasticity of the bone of the female hoce in the swimming group was significantly higher (P<0.05) than that of the control group.These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.
基金supported by NIH Grants R01 AR051376 (XEG), NIH R01 AR058004 (XEG, ES), NIH U01 AR055968 (ES)the Thomas L.Kempner and Katheryn C.Patterson Foundation
文摘Hispanic Americans of Caribbean origin are a fast-growing subset of the US population, but there are no studies on bone density, microstructure and biomechanical integrity in this minority group. In this study, we aimed to compare Caucasian and Caribbean Hispanic postmenopausal American women with respect to these characteristics. Thirty-three Caribbean Hispanics were age-matched to thirty-three Caucasian postmenopausal women. At the lumbar spine, the Hispanic women had significantly lower areal bone mineral density （aBMD）. At the radius by high-resolution peripheral quantitative computed tomography （HR-pQCT）, there were minimal differences between Hispanic and Caucasian women. At the tibia, Hispanic women had lower trabecular volumetric bone density and trabecular number, and higher trabecular separation. Individual trabecula segmentation （ITS） analyses indicated that at the tibia, Hispanic women not only had significantly lower bone volume fraction, but also had significantly lower rod bone volume fraction, plate trabecular number, rod trabecular number and lower plate-plate, plate-rod and rod-rod junction densities compared to Caucasian women. The differences in bone quantity and quality contributed to lower whole bone stiffness at the radius, and both whole bone and trabecular bone stiffness at the tibia in Hispanic women. In conclusion, Hispanic women had poorer bone mechanical and microarchitectural properties than Caucasian women, especially at the load-bearing distal tibia.
文摘Objective: To investigate the occurrence pattern of abnormal bone density in male long-distance runners from several different regions of China, and provide a basis for elucidating the influences of geo-environmental differences on bone density. Methods: We employed a set of well-designed exclusion-inclusion criteria to recruit study subjects, in which compounding factors were managed and regional environmental traits were fully incorporated. WHO (World Health Organization) criteria for the diagnosis of osteoporosis were then used to examine the subjects to determine occurrence of abnormal bone density. The resulting data were analyzed using methods of spatial statistics, which included several approaches, such as spatial autocorrelation, hot spot analysis, and Geodetector Software analysis, to depict and analyze the spatial distribution of abnormal bone density in male athletes from different regions in China, thereby investigating the influences of geo-environmental factors (e.g., temperature, humidity, and altitude) on bone density. Results: A total of 685 subjects were effectively examined in this study, including 486 with normal bone density, 185 with osteopenia, and 14 with osteoporosis. Spatial distribution analysis revealed that the distribution of subjects with abnormal bone density overall exhibited a pattern indicating that the level of abnormal bone density in the eastern regions was higher than that in the western regions and that the levels of abnormal bone density in the southern and northern regions were higher than that in the middle regions. Spatial autocorrelation analysis revealed a Moran’s I = 0.136, Z-score = 1.114, and P value = 0.265 and indicated that the athletes with abnormal bone density were randomly distributed in each region. Hot spot analysis revealed that Tibet and Qinghai displayed distributions of cold spots. Geodetector Software analysis yielded a Q value for annual average temperature of 1.000 and a corresponding P value of 0.000, and the results revealed that temperature significantly affected bone density and that altitude, relative humidity, sunlight hours, and temperature variations displayed synergistic effects on bone density and could diminish the influences of temperature on bone density. Conclusion: Our data revealed that different regions displayed different distribution patterns of abnormal bone density such that the level in the eastern regions was higher than that in the western ones and that the levels in the southern and northern regions were higher than that in the middle regions;specifically, the provinces of Yunnan, Heilongjiang, Hainan, and Inner Mongolia had high rates of abnormal bone density, whereas Tibet and Qinghai had relatively good conditions of bone density. Our data suggested that suitable temperature changes and appropriate levels of temperature variations can decrease the occurrence rates of osteopenia and osteoporosis.
基金National Natural Science Foundation of China,No.81970698 and No.81900805Peking University People's Hospital Research and Development Funds,No.Project RS2022-03。
文摘BACKGROUND The association between body mass index(BMI)and bone mineral density(BMD)has shown inconsistent results,varying by sex and skeletal site.Despite normal or elevated bone mass,individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.AIM To assess lumbar spine trabecular volumetric BMD(vBMD)across different BMI categories in individuals with and without diabetes.METHODS This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study.The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography.Total adipose tissue,subcutaneous adipose tissue(SAT),visceral adipose tissue(VAT),and lumbar skeletal muscle area were also quantified.RESULTS In men with obesity(P=0.038)and overweight(P=0.032),vBMD was significantly higher in the diabetes group compared to non-diabetic men.After adjusting for age and sex,no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes.However,a BMI threshold of 22.33 kg/m²indicated a saturation point for vBMD in nondiabetic men.Independent predictors of vBMD in men included age(r=-0.387,P<0.001),BMI(r=0.130,P=0.004),and VAT(r=-0.145,P=0.001).For women,significant predictors were age(r=-0.594,P<0.001),BMI(r=0.157,P=0.004),VAT(r=-0.112,P=0.001),and SAT(r=-0.068,P=0.035).CONCLUSION The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes.Overweight and obese men with diabetes exhibit higher vBMD.
文摘Objective To observe the value of artificial intelligence(AI)models based on non-contrast chest CT for measuring bone mineral density(BMD).Methods Totally 380 subjects who underwent both non-contrast chest CT and quantitative CT(QCT)BMD examination were retrospectively enrolled and divided into training set(n=304)and test set(n=76)at a ratio of 8∶2.The mean BMD of L1—L3 vertebrae were measured based on QCT.Spongy bones of T5—T10 vertebrae were segmented as ROI,radiomics(Rad)features were extracted,and machine learning(ML),Rad and deep learning(DL)models were constructed for classification of osteoporosis(OP)and evaluating BMD,respectively.Receiver operating characteristic curves were drawn,and area under the curves(AUC)were calculated to evaluate the efficacy of each model for classification of OP.Bland-Altman analysis and Pearson correlation analysis were performed to explore the consistency and correlation of each model with QCT for measuring BMD.Results Among ML and Rad models,ML Bagging-OP and Rad Bagging-OP had the best performances for classification of OP.In test set,AUC of ML Bagging-OP,Rad Bagging-OP and DL OP for classification of OP was 0.943,0.944 and 0.947,respectively,with no significant difference(all P>0.05).BMD obtained with all the above models had good consistency with those measured with QCT(most of the differences were within the range of Ax-G±1.96 s),which were highly positively correlated(r=0.910—0.974,all P<0.001).Conclusion AI models based on non-contrast chest CT had high efficacy for classification of OP,and good consistency of BMD measurements were found between AI models and QCT.
基金the European Research Council(ERC Advanced MechAGE-ERC-2016-ADG-741883)the Swiss National Science Foundation(no.188522).
文摘Age-related osteoporosis poses a significant challenge in musculoskeletal health;a condition characterized by reduced bone density and increased fracture susceptibility in older individuals necessitates a better understanding of underlying molecular and cellular mechanisms.Emerging evidence suggests that osteocytes are the pivotal orchestrators of bone remodeling and represent novel therapeutic targets for age-related bone loss.Our study uses the prematurely aged PolgD257A/D257A(PolgA)mouse model to scrutinize age-and sex-related alterations in musculoskeletal health parameters(frailty,grip strength,gait data),bone and particularly the osteocyte lacuno-canalicular network(LCN).Moreover,a new quantitative in silico image analysis pipeline is used to evaluate the alterations in the osteocyte network with aging.Our findings underscore the pronounced degenerative changes in the musculoskeletal health parameters,bone,and osteocyte LCN in PolgA mice as early as 40 weeks,with more prominent alterations evident in aged males.Our findings suggest that the PolgA mouse model serves as a valuable model for studying the cellular mechanisms underlying age-related bone loss,given the comparable aging signs and age-related degeneration of the bone and the osteocyte network observed in naturally aging mice and elderly humans.
文摘Objective:To analyze the clinical characteristics of bone loss in hospitalized patients with Graves’disease.Methods:The clinical data of hospitalized patients with Graves’disease were collected.According to the results of bone density examinations,they were divided into a normal bone density group,a low bone mass group,and an osteoporosis group.The normal bone density group was used as the control group to analyze the clinical characteristics of bone loss.Results:The incidence of bone loss in patients with Graves’disease was 80.72%,with osteoporosis accounting for 39.16%and low bone mass accounting for 41.57%.The incidences of hyperthyroid heart disease,Graves’ophthalmopathy,and leukopenia in the osteoporosis group and the low bone mass group were significantly higher than those in the normal bone density group,reaching 84.62%,60.87%,and 34.38%,respectively(P<0.05).The age of the osteoporosis group with Graves’disease was 50.88±12.03 years old,which was higher than that of the normal bone density group(40.03±12.58 years old).The disease course was 55.66±14.21 days,longer than that of the normal bone density group(43.38±8.55 days).FT4 was 61.69±8.42 pmol/L,higher than that of the normal bone density group(51.01±6.77 pmol/L),while TSH was 0.08±0.51μIU/ml,lower than that of the normal bone density group(0.22±0.55μIU/ml).The blood phosphorus was 1.25±0.29 mmol/L,lower than that of the normal bone density group(1.34±0.27 mmol/L),with statistical significance(P<0.05).In the low bone mass group,FT3(13.08±9.05 pmol/L)and FT4(46.14±3.46 pmol/L)were lower than those in the normal bone density group,with statistical significance(P<0.05).Logistic regression analysis revealed that age,disease course,and TSH were contributing factors to bone loss.Conclusion:Patients with Graves’disease are prone to bone loss,and age,disease course,and TSH are contributing factors to bone loss.
基金Supported by Chongqing Postgraduate Scientific Research Innovation Project,No.CYB22200.
文摘BACKGROUND Chronic hyperglycemia can damage the microcirculation,which impairs the function of various organs and tissues and predisposes individuals to chronic complications.Sarcopenia(SP)is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes.In particular,diabetic patients are at higher risk of SP because of insulin resistance,chronic inflam-mation,and decreased physical activity.METHODS A retrospective analysis was conducted on 196 middle-aged and elderly male T2DM inpatients in the First Affiliated Hospital of Chongqing Medical University between June 2021 and June 2023,with 60 concurrent healthy individuals as the control group.Differences in general information,blood biochemistry,glyco-sylated hemoglobin,muscle strength,and detection rate of SP were compared between groups.The BMD,appendicular skeletal muscle(ASM),and fat mass,as well as grip strength and gait speed,were determined for each patient,and the ASM index(ASMI)was counted.The quantitative data were subjected to cor-relation and logistic regression analyses to identify risk factors for SP.RESULTS Fifty-one of the 196 middle-aged and elderly male T2DM patients were diagnosed with SP,which accounted for 26.02%.The middle-aged and elderly T2DM patients with SP exhibited a longer diabetes mellitus(DM)course and a lower body mass index(BMI)and 25(OH)D3 compared with the non-SP patients.The T2DM+SP patients exhibited lower BMI,ASM,ASMI,left-and right-hand grip strength,gait speed,and muscle and fat mass of the upper and lower limbs compared with the diabetic non-SP patients.The femoral neck,total hip,and lumbar spine L1-4 BMD were markedly lower in T2DM+SP patients compared with those in the non-SP diabetics.Long-term DM course,low BMI,and low BMD of the femoral neck,lumbar spine L1-4,and total hip were identified as risk factors for the development of SP.CONCLUSION T2DM patients are at risk for SP;however,measures can be taken to prevent the related risk factors.
基金Supported by Social Development Projects of Nantong,No.MS22021008 and No.QNZ2022005.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.
文摘Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.
文摘Background: Reduced bone density is a major risk factor for fragility fracture. Previous studies reported, that 69% to 100% of patients with fragility fractures had low bone mineral density (BMD). Objective: The objective of the study is to estimate the prevalence of osteoporosis and osteopenia among patients with fragility fractures. Results: The result of the study revealed that the mean age of patients included in the study was 65.11 ± 10.17 and the majority (77.3%) were females. The most common sites of fractures were the femur, radius and vertebra (30.7%, 17.0% and 14.8% respectively). Moreover, more than 95% of patients with fragility fracture who underwent BMD testing had low bone mineral density. In female with fragility fracture the prevalence of osteoporosis was higher in comparison to male (58.8% and 45.0% respectively). Conclusion: Our data showed that low BMD measurement is prevalent in patient with fragility fracture. It also highlighted the importance of implementation of Fracture liaison service, to reduce the gap between fragility fracture and osteoporosis treatment.
文摘BACKGROUND Mineral bone disease is associated with chronic kidney disease and persists after kidney transplantation.Immunosuppressive treatment contributes to the patho-genesis of this disease.Bisphosphonate treatments have shown positive but inde-finite results.AIM To evaluate the effectiveness and safety of bisphosphonate treatment on post kidney transplantation bone mineral density(BMD).METHODS We included kidney transplant recipients(KTRs)whose BMD was measured after the operation but before the initiation of treatment and their BMD was measured at least one year later.We also evaluated the BMD of KTRs using two valid mea-surements after transplantation who received no treatment(control group).RESULTS Out of 254 KTRs,62(39 men)were included in the study.Bisphosphonates were initiated in 35 KTRs in total(20 men),1.1±2.4 years after operation and for a period of 3.9±2.3 years while 27(19 men)received no treatment.BMD improved significantly in KTRs who received bisphosphonate treatments(from-2.29±1.07 to-1.66±1.09,P<0.0001).The control group showed a non-significant decrease in BMD after 4.2±1.4 years of follow-up after surgery.Kidney function was not affected by bisphosphonate treatment.In KTRs with established osteoporosis,active treatment had a similar and significant effect on those with osteopenia or normal bone mass.CONCLUSION In this retrospective study of KTRs receiving bisphosphonate treatment,we showed that active treatment is effective in preventing bone loss irrespective of baseline BMD.
基金Supported by Henan Province Key Research and Development Program,No.231111311000Henan Provincial Science and Technology Research Project,No.232102310411+2 种基金Henan Province Medical Science and Technology Key Project,No.LHGJ20220566 and No.LHGJ20240365Henan Province Medical Education Research Project,No.WJLX2023079Zhengzhou Medical and Health Technology Innovation Guidance Program,No.2024YLZDJH022.
文摘Diabetic osteoporosis(DOP)is a common complication in diabetes,driven by hyperglycemia-induced metabolic disturbances,chronic inflammation,and oxi-dative stress.This review describes the critical role of iron metabolism dysregu-lation in DOP pathogenesis,focusing on ferroptosis,a novel iron-dependent cell death pathway characterized by lipid peroxidation and reactive oxygen species(ROS)overproduction.Diabetic conditions exacerbate iron overload,impairing osteoblast function and enhancing osteoclast activity,while triggering ferroptosis in bone cells.Ferroptosis not only accelerates osteoblast apoptosis but also amplifies osteoclast-mediated bone resorption,synergistically promoting bone loss.Furthermore,chronic inflammation and oxidative stress disrupt the balance between bone formation and resorption,with elevated pro-inflammatory cyto-kines(e.g.,tumor necrosis factor-α,interleukin-6)and ROS exacerbating cellular dysfunction.Therapeutic strategies targeting iron metabolism(e.g.,deferoxamine)and ferroptosis inhibition(e.g.,nuclear factor erythroid 2-related factor 2/heme oxygenase-1 pathway activation,antioxidants like melatonin)demonstrate potential to mitigate DOP progression.Future research should prioritize personalized interventions,clinical trials of iron chelators and antioxidants,and mechanistic studies to refine therapeutic approaches.This review provides a comprehensive framework for understanding DOP pathogenesis and highlights innovative strategies to improve bone health in diabetic patients.
基金Supported by National Natural Science Foundation of China(General Program),No.82073909Four‘Batches’Innovation Project of Invigorating Medical through Science and Technology of Shanxi Province,No.2023XM022The Shanxi Provincial Central Leading Local Science and Technology Development Fund Project,No.YDZJSX2022A059 and No.YDZJSX20231A059。
文摘BACKGROUND Autonomous cortisol secretion(ACS)is linked to a higher prevalence of metabolic abnormalities and an increased risk of major adverse cardiovascular events.AIM To evaluate glucose and bone metabolism in patients with ACS using a continuous glucose monitoring system(CGMS)and dual-energy X-ray absorptiometry(DXA).METHODS Patients diagnosed with ACS,including Cushing syndrome,mild ACS(MACS),and nonfunctional adrenal incidentaloma(NFAI),were recruited for this study.Glucose variability and glycemic status were assessed using CGMS.Regional bone mineral content(BMC),bone mineral density(BMD),and bone area(BA)were evaluated using DXA.CGMS-and DXA-derived parameters were compared across the subgroups of ACS.Correlation analysis was performed to examine relationships between varying degrees of cortisol secretion,measured by cortisol after 1 mg overnight dexamethasone suppression test(DST)or 24-hour urine free cortisol(24h UFC),and CGMS-or DXA-derived parameters.RESULTS A total of 64 patients with ACS were included in this study:19 with Cushing syndrome,11 with MACS,and 34 with NFAI.Glucose variability,time above range(TAR),and time in range(TIR)along with specific areal BMC,BMD,and BA,differed significantly between groups of Cushing syndrome and NFAI.A significant positive correlation was observed between glucose variability or TAR and cortisol after 1 mg overnight DST or 24h UFC.By contrast,TIR,along with regional BMC,BMD,and BA,were negatively correlated with varying degrees of cortisol secretion.CONCLUSION Glucose and bone metabolism impairments are on a continuum alteration from NFAI to MACS and Cushing syndrome.Prompt attention should be given to these patients with ACS,especially those with mild hormone secretion.Parameters of glucose variability and glycemic status along with bone condition in regions rich in cancellous bone will provide valuable information.
文摘The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is largely unknown.In patients who underwent discontinuation after multiple injections of denosumab,the levels of tartrate-resistant acid phosphatase 5b increased compared to pretreatment levels,indicating a phenomenon known as“overshoot.”The rate of decrease in bone mineral density during the withdrawal period was higher than the rate of decrease associated with aging,suggesting that the physiological bone metabolism had broken down.Overshoot and significant bone loss were also observed in mice receiving continuous administration of anti-RANKL antibody after treatment was interrupted,resembling the original pathology.In mice long out of overshoot,bone resorption recovered,but osteoblast numbers and bone formation remained markedly reduced.The bone marrow exhibited a significant reduction in stem cell(SC)antigen 1-and platelet-derived growth factor receptor alpha-expressing osteoblast progenitors(PαS cells)and alkaline phosphatase-positive early osteoblasts.Just before the overshoot phase,the osteoclast precursor cell population expands and RANKL-bearing extracellular vesicles(EVs)became abundant in the serum,leading to robust osteoclastogenesis after cessation of anti-RANKL treatment.Thus,accelerated bone resorption due to the accumulation of RANKLbearing EVs and long-term suppression of bone formation uncoupled from bone resorption leads to the severe bone loss characteristic of denosumab discontinuation.
基金supported by the Planned Project Grant(Grant No.3502Z20199064)from the Science and Technology Bureau of Xiamen(CN)the training project(Grant No.2020GGB067)of the youth and middle-aged talents of Fujian Provincial Health Commission(CN).
文摘This study explored the application value of iterative decomposition of water and fatwith echo asymmetry and least-squares estimation(IDEAL-IQ)technology in the early diagnosis of ageing osteoporosis(OP).172 participants were enrolled and underwentmagnetic resonance imaging(MRI)examinations on a 3.0T scanner.100 cases were included in the normal group(50 males and 50 females;mean age:45 years;age range:20e84 years).33 cases were included in the osteopenia group(17 males and 16 females;mean age:55 years;age range:43e83 years).39 caseswere includedintheOP group(19males and20females;meanage:58years;age range:48 e82 years).Conventional T1WI and T2WI were first obtained,followed by 3D-IDEAL-IQ-acqui-sition.Fat fraction(FF)and apparent transverse relaxation rate(R2*)resultswere automatically calculated from IDEAL-IQ-images on the console.Based on T1Wand T2W-images,300 ROIs for each participantweremanually delineated in L1-L5 vertebral bodies of five middle slices.In each age group of all normal subjects,each parameter was significantly correlated with gender.In male participants from the normal,osteopenia,and OP groups,statistical analysis revealed F values of 11319.292 and 180.130 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.906 and 0.950,0.994 and 0.997,0.865 and 0.820,respectively.For R2*,they were 0.665 and 0.616,0.563 and 0.519,0.571 and 0.368,respectively.In female participants from the normal,osteopenia,and OP-groups,statis-tical analysis revealed F values of 12461.658 and 548.274 for comparisons involving FF and R2*values,respectively(all p<0.0001).The sensitivity and specificity of FF values were 0.985 and 0.991,0.996 and 0.996,0.581 and 0.678,respectively.For R2*,they were 0.698 and 0.730,0.603 and 0.665,0.622 and 0.525,respectively.Significant differences were indicated in the quanti-tative values among the three groups.FF value had good performance,while R2*value had poor performance indiscriminatingosteopenia andOP-groups.Overall,the IDEAL-IQ techniqueoffers specific reference indices that enable noninvasive and quantitative assessment of lumbar vertebrae bone metabolism,thereby providing diagnostic information for OP.
文摘AIM: Previous studies suggest that loss of bone mineral density (BMD) frequently occurs in patients with chronic viral liver disease, presenting with histologically proven liver cirrhosis. However, little is known about the occurrence of bone disease in non-cirrhotic patients with chronic hepatitis B or C. Therefore, it was the aim of this study to evaluate this particular population for BMD and bone turnover markers. METHODS: Biochemical markers of bone turnover and BMD were measured in 43 consecutive patients with HCV (n = 30) or HBV (n = 13) infection without histological evidence for liver cirrhosis. Mean age was 49 years (range 26-77 years). BMD was measured by dual X-ray absorptiometry in the femoral neck (FN) and the lumbar spine (LS) region. In addition, bone metabolism markers were measured. RESULTS: BMD was lowered in 25 (58%) of the patients with chronic hepatitis B or C (FN; 0.76 (0.53-0.99); LS: 0.96 (0.62-1.23) g/cm2). Eight (32%) osteopenic patients were diagnosed with osteoporosis. Bone-specific alkaline phosphatase (P= 0.005) and intact parathyroid hormone (iPTH) (P = 0.001) were significantly elevated in the more advanced stages of fibrosis. Mean T-score value was lower in patients with chronic hepatitis C as compared to patients suffering from chronic hepatitis B; however, the difference was not statistically significant (P= 0.09). CONCLUSION: There was a significantly reduced BMD in non-cirrhotic patients with chronic hepatitis B or C infection. Alterations of bone metabolism already occurred in advanced liver fibrosis without cirrhosis. According to our results, these secondary effects of chronic viral hepatitis should be further investigated.
