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Zemel BS, Shepherd JA, Kazemi L, Kelly A, Stallings VA, Kecskemethy H, Weber DR, Wasserman H, Kalkwarf HJ. Pediatric Lateral Distal Femur Reference Ranges for Ages 1 to 18 years. J Clin Densitom 2025; 28:101594. [PMID: 40413854 DOI: 10.1016/j.jocd.2025.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 03/20/2025] [Accepted: 04/30/2025] [Indexed: 05/27/2025]
Abstract
INTRODUCTION Many children with musculoskeletal disorders are at high risk of fracture, and the lateral distal femur (LDF) may be the only feasible site to measure bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA). Pediatric reference ranges and adjustment for linear growth are needed to interpret BMD results. METHODS Lateral distal femur scans by DXA were obtained on children, ages 1 to 18 y, from two clinical centers. Precision in young children was estimated from duplicate scans. Smoothed reference ranges for three regions of the LDF were generated. Prediction equations were developed to account for the effects of short or tall stature on BMD. RESULTS We obtained >2400 measurements on 1,245 children and generated reference ranges for three LDF BMD regions. Precision of BMD was similar (% CV of 1.33 to 2.42 %) to estimates reported at other skeletal sites. Modest sex differences were observed, with females having greater BMD than males at older ages. Children identified as Black had greater BMD than children identified as Non-Black. Height-for-age Z-scores were associated with BMD-for-age Z-scores in pre- and peri-pubertal children, and adjustment equations were generated. CONCLUSIONS This study fills substantial gaps in pediatric bone health assessment for children with musculoskeletal disorders who are at high-risk of fracture by providing smoothed reference ranges for ages 1 to 18 y and equations to estimate the impact of small body size on BMD-for-age Z-scores.
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Affiliation(s)
- Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| | | | - Laila Kazemi
- Cancer Center, University of Hawaii, Honolulu, HI, USA
| | - Andrea Kelly
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Virginia A Stallings
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
| | - Heidi Kecskemethy
- Department of Radiology, Nemours Children's Health, Wilmington, DE, USA
| | - David R Weber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Halley Wasserman
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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Ma G, Xu B, Zhang D, Zhu L, Zhang Y, Yang B, Qin X, Yin H, Wei X. Association between weight-adjusted waist index and bone mineral density in adolescents. Sci Rep 2024; 14:16509. [PMID: 39019936 PMCID: PMC11255232 DOI: 10.1038/s41598-024-66565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 07/02/2024] [Indexed: 07/19/2024] Open
Abstract
The negative effects of obesity and excess body fat on bone mineral density (BMD) have been widely reported. As opposed to waist circumference (WC) or body mass index (BMI), weight-adjusted waist index (WWI) is a superior method for assessing obesity. WWI also indicates centripetal obesity independently of the weight of the individual. An investigation of WWI and adolescents' BMD was conducted in this study. The National Health and Nutrition Examination Survey (NHANES) 2011-2018 provided the data for this cross-sectional investigation. In this study, weighted multivariate logit models were employed to assess the correlation between teenage BMD and WWI. Additionally, we conducted interaction tests and subgroup analysis. Through multivariate linear regression, we discovered that WWI was negatively linked with lumbar, trunk, and total BMD but not pelvis BMD in this study, which included 6828 subjects. We found that each unit increase in WWI resulted in a lumbar BMD decline of 0.04 g/cm2 (95%CI -0.04, -0.04), a trunk BMD decrease of 0.03 g/cm2 (95%CI -0.03, -0.02), and a total BMD decrease of 0.02 g/cm2 (95%CI -0.02, -0.02). In conclusion, in US teenagers, there were negative connections discovered between WWI and lumbar, trunk, and total BMD, but not pelvis BMD.
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Affiliation(s)
- Guoliang Ma
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Bo Xu
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Dian Zhang
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Liguo Zhu
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
- Beijing Key Laboratory of Bone Setting Technology of Traditional Chinese Medicine, Beijing, 100700, China
| | - Yili Zhang
- School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Bowen Yang
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - Xiaokuan Qin
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China
| | - He Yin
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China.
| | - Xu Wei
- Wangjing Hospital, China Academy of Traditional Chinese Medicine, No. 6, Zhonghuan South Road, Chaoyang District, Beijing, 100102, China.
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Sigvaldsen A, Frederiksen H, Højsager FD, Andersson AM, Juul A, Boye H, Andersen MS, Jensen TK. Prenatal and childhood exposure to bisphenols and bone mineral density in 7-year-old children from the Odense Child Cohort. Int J Hyg Environ Health 2024; 260:114408. [PMID: 38896984 DOI: 10.1016/j.ijheh.2024.114408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/30/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Bisphenol A (BPA) is a well-known endocrine disrupter used in several consumer products. Restricted use of BPA has led to increased use of bisphenol F (BPF) and bisphenol S (BPS). While previous studies found no associations between prenatal BPA and BPF exposure and bone mineral density (BMD), two recent cohort studies found that prenatal BPS exposure was negatively associated with bone mineral density in the offspring. AIM To determine possible associations between maternal and child urinary bisphenol concentrations, BMD and bone mineral content (BMC) in 7-year-old healthy children. METHODS Pregnant women were recruited in 2010-2012 to participate in the Odense Child Cohort (OCC), Denmark. Maternal urine samples were collected in gestational week 28 and urinary BPA concentration was measured by isotope diluted LC-MS/MS. The children delivered a urine sample at age 7 years in which BPA, BPF and BPS were measured by an extended LS-MS/MS method based on the original method. At age 7 years DXA scans were performed and BMC and Z-score for BMD calculated. Associations between osmolality adjusted urinary maternal BPA and child BPA, BPF and BPS concentrations and BMC and BMD Z-score were examined by multiple linear regression analysis adjusted for potential confounders. Additionally, a combined effect of the bisphenols were evaluated by including the sum of child urinary BPA, BPF and BPS concentrations in the statistical analyses. RESULTS A total of 546 mothers and 453 children aged 7 years participated. BPA was detected in 84% and 96% of the maternal and child urine samples, respectively. We found no significant association between maternal urinary BPA concentration during pregnancy and BMC and BMD Z-score in 7-year-old children. In addition, no association between current bisphenol exposure in tertiles and bone density was found, interestingly, current BPA and summed bisphenol exposure in the highest 10% was associated with lower BMD Z-score at age 7-years, statistically significant for boys. CONCLUSION In these low exposed children we found no association between prenatal or current bisphenol exposure in tertiles and BMD in healthy children, however, the highest 10% exposed children had lower BMD, significant for boys, suggesting a negative impact with high bisphenol exposure. The short half-lives of bisphenols and the cross-sectional nature of the child exposure prompt more longitudinal studies to further clarify this topic.
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Affiliation(s)
- Annika Sigvaldsen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Hanne Frederiksen
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male, Reproduction and Child Health (EDMaRC), Copenhagen, Denmark
| | - Frederik Damsgaard Højsager
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anna-Maria Andersson
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male, Reproduction and Child Health (EDMaRC), Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male, Reproduction and Child Health (EDMaRC), Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Boye
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network (OPEN), Odense, Denmark
| | | | - Tina Kold Jensen
- Department of Clinical Pharmacology, Pharmacy and Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark; Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark; Open Patient Data Explorative Network (OPEN), Odense, Denmark
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Besor O, Redlich N, Constantini N, Weiler-Sagie M, Monsonego Ornan E, Lieberman S, Bentur L, Bar-Yoseph R. Assessment of Relative Energy Deficiency in Sport (REDs) Risk among Adolescent Acrobatic Gymnasts. J Pers Med 2024; 14:363. [PMID: 38672990 PMCID: PMC11051467 DOI: 10.3390/jpm14040363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
Energy imbalance exposes athletes to relative energy deficiency in sports (REDs) syndrome. Data on energy consumption, REDs, and bone mineral density (BMD) in adolescent acrobatic gymnasts, especially in males, are scarce. Our aim was to examine the eating habits, energy balance, body composition, and BMD of these athletes. In this study, 18 healthy adolescents participating in competitive acrobatic gymnastics completed a questionnaire, underwent a dual-energy X-ray absorptiometry scan (DXA), received a food log, and had their activities monitored for 3 days. Eighteen acrobats were enrolled (mean age: 14.3 ± 1.2 years; males: 6/18). The mean total body BMD Z-score was 0.4 ± 1.0. Top-position acrobats (7/18) had significantly lower total body BMD Z-scores than base-positioned acrobats (-0.2 ± 0.3 vs. 0.8 ± 0.3, p = 0.032), though their forearms were not significantly different (0.2 ± 0.5 vs. 0.8 ± 0.7, p = 0.331). No sex differences were found for BMD Z-scores, BMI, or energy availability. The BMD parameters of the acrobats were within the normal range for a healthy pediatric population, although three had low BMDs (<-1 SD) for healthy athletes. Total body and LS BMD Z-scores were significantly lower in top-position athletes compared to base-position athletes. These findings suggest personalized (top vs. base) training programs (high-impact training) that may achieve better health outcomes.
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Affiliation(s)
- Omri Besor
- Department of Family Medicine, Maccabi Healthcare Services, Tel Aviv 6812509, Israel
| | - Noam Redlich
- Heidi Rothberg Sports Medicine Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University, Jerusalem 9103102, Israel
- Institute of Biochemistry and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot 7610001, Israel
| | - Naama Constantini
- Heidi Rothberg Sports Medicine Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University, Jerusalem 9103102, Israel
| | - Michal Weiler-Sagie
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Efrat Monsonego Ornan
- Institute of Biochemistry and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University, Rehovot 7610001, Israel
| | - Shira Lieberman
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Lea Bentur
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
- Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Ronen Bar-Yoseph
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
- Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa 3109601, Israel
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Pehlivanturk Kizilkan M, Akgul S, Kanbur N, Gungoren O, Derman O. Problematic video gaming is negatively associated with bone mineral density in adolescents. Eur J Pediatr 2024; 183:1455-1467. [PMID: 38165466 DOI: 10.1007/s00431-023-05399-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores. Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.
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Affiliation(s)
| | - Sinem Akgul
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
| | - Nuray Kanbur
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
| | - Orhan Gungoren
- Deparment of Family Medicine, Hacettepe University, Ankara, Turkey
| | - Orhan Derman
- Department of Pediatrics, Division of Adolescent Medicine, Hacettepe University, Ankara, Turkey
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Patil SH, Kumar V, Nandan D. Effect of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma: a cross-sectional study. J Asthma 2023; 60:2130-2136. [PMID: 37294051 DOI: 10.1080/02770903.2023.2220815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The objective of this study was to examine the impact of long-term medium to high-dose inhaled budesonide on bone mineral density in children with asthma. METHODS We conducted a cross-sectional study in children aged 7-17 years with asthma, who received long-term (≥2 years), medium to high-dose inhaled budesonide (≥400μg/day in 6-11 years old; ≥800 μg/day in >11 years old). We measured bone mineral density (BMD) using dual-energy X-ray absorptiometry and compared it with reference Indian normative values. RESULTS Thirty-five children with moderate to severe asthma receiving long-term medium to high-dose inhaled budesonide, were included in the study. We found a significantly low lumbar-spine BMD in the study population compared to reference Indian values (p-value 0.002). Eight cases had short stature. Despite the adjustment for height-age in these short-stature cases, lumbar-spine BMD remained significantly low in the study population (p-value 0.020). No significant difference was found in 25-hydroxy vitamin D levels between subjects with "low BMD" and "BMD z-score > -2". CONCLUSIONS The findings of this study suggest that long-term medium to high-dose inhaled budesonide treatment in children with asthma is associated with decreased BMD. However, further investigation with a larger sample size is necessary to confirm this relationship.
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Affiliation(s)
- Sumanth H Patil
- Department of Pediatrics, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Vishal Kumar
- Department of Pediatrics, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Devki Nandan
- Department of Pediatrics, ABVIMS & Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Bennett JP, Quon BK, Fan B, Liu E, Kazemi L, Villegas-Valle RC, Ahgun R, Wu XP, Zhou HD, Lu Y, Shepherd JA. Visceral adipose tissue reference data computed for GE HealthCare DXA from the National Health and Nutrition Examination Survey data set. Obesity (Silver Spring) 2023; 31:2947-2959. [PMID: 37795576 DOI: 10.1002/oby.23888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The National Health and Nutrition Examination Survey (NHANES) characterizes body composition representative of the US population using dual-energy x-ray absorptiometry (DXA) scans. These population-level trends of abdominal subcutaneous and visceral adipose tissue (SAT and VAT) are useful for identifying measures associated with increased disease risk. Recently, VAT and SAT data collected by Hologic DXA in NHANES were published online; however, there are known differences in the absolute calibration of DXA systems by make. The purpose of this study was to create reference tables suitable for calculating z scores and percentile values for GE HealthCare (GEHC) DXA systems. METHODS DXA scans were acquired on participants aged 8 to 59 years using Hologic systems. DXA measures were converted to GEHC and described using the least median squares curve fitting method in pediatrics (aged <20 years) and adults (aged 20-59 years). RESULTS A total of 11,972 adults and 7298 pediatrics were included for this analysis. Adult and pediatric curves were generated by sex and by ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian, Other) and were derived as a function of age. CONCLUSIONS These results show the ability to generate VAT and SAT reference data for GEHC systems using Hologic DXA data representative of the US youth and adult population.
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Affiliation(s)
| | - Brandon K Quon
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Bo Fan
- Department of Radiology and Bioimaging, University of California San Francisco, San Francisco, California, USA
| | - En Liu
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Leila Kazemi
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Rosa C Villegas-Valle
- Graduate Program on Chemical and Biological Sciences, University of Sonora, Sonora, Mexico
| | - Raj Ahgun
- J. Nehru Hospital, Rose Belle, Mauritius
| | - Xian-Pin Wu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Chansha, China
| | - Hou-De Zhou
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Chansha, China
| | - Ying Lu
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA
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Zemel BS, Shepherd JA, Grant SFA, Lappe JM, Oberfield SE, Mitchell JA, Winer KK, Kelly A, Kalkwarf HJ. Reference ranges for body composition indices by dual energy X-ray absorptiometry from the Bone Mineral Density in Childhood Study Cohort. Am J Clin Nutr 2023; 118:792-803. [PMID: 37598746 PMCID: PMC10579045 DOI: 10.1016/j.ajcnut.2023.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Body composition assessment aids evaluation of energy stores and the impact of diseases and interventions on child growth. Current United States pediatric reference ranges from the National Health and Nutrition Examination Survey (NHANES) include 20% of children with obesity, body mass index of ≥95th percentile. OBJECTIVES This study aimed to develop dual energy X-ray absorptiometry (DXA) based reference ranges in a diverse cohort with low-obesity prevalence from the Bone Mineral Density in Childhood Study (BMDCS). METHODS This is a secondary analysis of a longitudinal, prospective, observational cohort. Healthy children (height and BMI within 3rd to 97th percentiles, ages 5-19 y at enrollment), from 5 United States centers were measured annually for ≤7 visits. Whole body scans were acquired using Hologic scanners. A subsample underwent repeat measurements to determine precision. We generated reference ranges for appendicular and total lean soft tissue mass index (LSTM Index), fat mass index (FMI), and other body composition measures. Resulting curves were compared to NHANES and across subgroups. Sex and age-specific equations were developed to adjust body composition Z-scores for height Z score. RESULTS We obtained 9846 scans of 2011 participants (51% female, 22% Black, 17% Hispanic, 48% White, 7% Asian/Pacific Islander, and 6% with obesity). Precision (percent coefficient of variation) ranged from 0.7% to 1.96%. Median and-2 standard deviation curves for BMDCS and NHANES were similar, but NHANES +2 standard deviation LSTM Index and FMI curves were distinctly greater than the respective BMDCS curves. Subgroup differences were more extreme for appendicular LSTM Index-Z (mean ± SD: Asian -0.52 ± 0.93 compared with Black 0.77 ± 0.87) than for FMI-Z (Hispanic 0.29 ± 0.98 compared with Black -0.14 ± 1.1) and were smaller for Z-scores adjusted for height Z-score. CONCLUSIONS These reference ranges add to sparse normative data regarding body composition in children and adolescents and are based on a cohort with an obesity prevalence similar to current BMI charts. Awareness of subgroup differences aids in interpreting results.
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Affiliation(s)
- Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - John A Shepherd
- Cancer Center, University of Hawaii, Honolulu, HI, United States
| | - Struan F A Grant
- Division of Human Genetics, The Children's Hospital of Philadelphia, Department of Pediatrics, and Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Joan M Lappe
- Department of Medicine, Creighton University, Omaha, NB, United States
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Andrea Kelly
- Division of Pediatric Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, United States
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Sidiqi A, Fariha F, Shanta SS, Dasiewicz A, Mahmud AA, Moore DR, Shankaran M, Hellerstein MK, Evans WJ, Gernand AD, Islam MM, Abrams SA, Harrington J, Nyangau E, Roth DE, O'Callaghan KM. Estimation of skeletal muscle mass in 4-year-old children using the D 3-creatine dilution method. Pediatr Res 2023; 94:1195-1202. [PMID: 37037953 PMCID: PMC10444613 DOI: 10.1038/s41390-023-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Given limited experience in applying the creatine-(methyl-D3) (D3Cr) dilution method to measure skeletal muscle mass (SMM) in young children, the feasibility of deployment in a fielding setting and performance of the method was assessed in a cohort of 4-year-old children in Dhaka, Bangladesh. METHODS Following D3Cr oral dose (10 mg) administration, single fasting urine samples were collected at 2-4 days (n = 100). Twenty-four-hour post-dose collections and serial spot urine samples on days 2, 3 and 4 were obtained in a subset of participants (n = 10). Urinary creatine, creatinine, D3Cr and D3-creatinine enrichment were analyzed by liquid chromatography-tandem mass spectrometry. Appendicular lean mass (ALM) was measured by dual-energy x-ray absorptiometry and grip strength was measured by a hand-held dynamometer. RESULTS SMM was measured successfully in 91% of participants, and there were no adverse events. Mean ± SD SMM was greater than ALM (4.5 ± 0.4 and 3.2 ± 0.6 kg, respectively). Precision of SMM was low (intraclass correlation = 0.20; 95% CI: 0.02, 0.75; n = 10). Grip strength was not associated with SMM in multivariable analysis (0.004 kg per 100 g of SMM; 95% CI: -0.031, 0.038; n = 91). CONCLUSIONS The D3Cr dilution method was feasible in a community setting. However, high within-child variability in SMM estimates suggests the need for further optimization of this approach. IMPACT The D3-creatine (D3Cr) stable isotope dilution method was considered a feasible method for the estimation of skeletal muscle mass (SMM) in young children in a community setting and was well accepted among participants. SMM was weakly associated with both dual-energy x-ray absorptiometry-derived values of appendicular lean mass and grip strength. High within-child variability in estimated values of SMM suggests that further optimization of the D3Cr stable isotope dilution method is required prior to implementation in community research settings.
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Affiliation(s)
- Aysha Sidiqi
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alison Dasiewicz
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel R Moore
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Mahalakshmi Shankaran
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Marc K Hellerstein
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Jennifer Harrington
- Department of Pediatrics, Women's and Children's Health Network and University of Adelaide, Adelaide, SA, Australia
| | - Edna Nyangau
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA, USA
| | - Daniel E Roth
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Karen M O'Callaghan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Nutritional Sciences, King's College London, London, UK.
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10
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Shepherd JA. Positions of The International Society for Clinical Densitometry and Their Etiology: A Scoping Review. J Clin Densitom 2023; 26:101369. [PMID: 37127451 DOI: 10.1016/j.jocd.2023.101369] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
The International Society for Clinical Densitometry convenes a Position Development Conference (PDC) every 2 to 3 years to make recommendations for guidelines and standards in the field of musculoskeletal measurement and assessment. The recommendations pertain to clinically relevant issues regarding the acquisition, quality control, interpretation, and reporting of measures of various aspects of musculoskeletal health. These PDCs have been meeting since 2002 and have generated 214 Adult, 26 FRAX, 41 pediatric, and 9 general nomenclature consideration positions, for a total of 290 positions. All positions are justified by detailed documents that present the background and rationale for each position. However, the linkage to these publications is not maintained by the ISCD or any other publication such that physicians cannot easily understand the etiology of the positions. Further, the wording of many positions has changed over the years after being reviewed by subsequent PDCs. This scoping review captures the references, changes, and timeline associated with each position through the 2019 PDC. It is meant to serve as a guide to clinicians and researchers for intelligent use and application of the positions.
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Affiliation(s)
- John A Shepherd
- Department of Epidemiology and Population Sciences, University of Hawaii Cancer Center, 701 Ilalo Street, Suite 522, Honolulu, HI, 96813, USA.
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11
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Yao W, Luo J, Ao L, Cheng H, Lu S, Liu J, Lu K, Mi J, Yang Y, Liu L. Association of total body fat and fat distribution with bone mineral density among children and adolescents aged 6-17 years from Guangzhou, China. Eur J Pediatr 2023; 182:1115-1126. [PMID: 36580174 DOI: 10.1007/s00431-022-04727-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/04/2022] [Accepted: 11/18/2022] [Indexed: 12/30/2022]
Abstract
This study aimed to assess the associations of total body fat and fat distribution with bone mineral density (BMD) among children and adolescents in this cross-sectional study. A total of 1032 boys and 897 girls aged 6-17 years were enrolled between May 2019 and June 2019 in Guangzhou, China. BMD, total body fat (fat mass index [FMI] and body fat percentage [BF%]), and fat distribution (trunk-to-limb and android-to-gynoid ratios) were measured by dual-energy X-ray absorptiometry. Inverse probability of treatment weighting regression was used to explore the association between fat and BMD. Traditional regression of covariate adjustment was applied as sensitivity analysis. Regression with inverse probability weighting suggested BF% and android-to-gynoid ratio were negatively associated with BMD in boys (β = - 0.12 and - 0.16, respectively; P < 0.05). Android-to-gynoid ratio was also inversely associated with BMD in girls (β = - 0.08, P < 0.05). When stratified by age, the negative associations were retained in boys aged 12-17 years (β = - 0.23 and - 0.25, respectively; P < 0.001). But for girls, it showed a positive association of FMI with BMD in the 6-9 years group (β = 0.33, P < 0.001) and a negative association between the android-to-gynoid ratio and BMD in the 10-17 years group (β = - 0.10, P < 0.05). Traditional regression supported the robustness of the results. Conclusion: Total body fat is positively associated with BMD in younger girls but inversely associated in older boys. As for abdominal adipose, it is associated with lower BMD in both older boys and girls. What is Known: • The lean mass has been consistently positively associated with bone mineral density (BMD) among children and adolescents. However, the impact of fat mass on BMD remained controversial. • Beyond total body fat, site-specific fat mass, especially abdominal adiposity, might impede bone formation. What is New: • The associations of total body fat and fat distribution with BMD in children and adolescents were gender- and age-specific. • More attention should be paid to the abdominal fat accumulation to promote bone health in older children.
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Affiliation(s)
- Wanwen Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China
| | - Jiepeng Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China
| | - Liping Ao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China
| | - Hong Cheng
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Shuang Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China
| | - Junting Liu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Keyuan Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China
| | - Jie Mi
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China.
- Department of Non-communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China.
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, China.
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Antoniou G, Masouros P, Papadopoulos DV, Soultanis KC, Krallis P, Babis G, Nikolaou VS. A Scoping Review of the Recent Clinical Practice Regarding the Evaluation of Bone Mineral Density in Children and Adolescents with Neuromuscular Diseases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:312. [PMID: 36837513 PMCID: PMC9967238 DOI: 10.3390/medicina59020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/22/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Introduction: Neuromuscular Diseases (NMD) are associated with decreased bone strength due to altered muscle-bone interaction. However, the evaluation of bone quality remains a certain challenge in these patients. The purpose of this scoping review is to investigate the recent literature regarding the assessment of Bone Mineral Density (BMD) in this population. Methods: An electronic search of the PubMed and Scopus database was performed considering studies published in the English literature after 2007 that evaluated BMD in pediatric and adolescent patients with NMD. We excluded studies that evaluated patients > 20 years, studies not involving humans, and studies investigating bone mineral density in various pediatric conditions, but without specific data on NMD. Results: Overall, 19 studies were included that evaluated BMD in 1983 patients with NMD. Duchenne Muscular Dystrophy was the most widely studied disease (n = 11 studies). Dual energy X-ray absorptiometry (DEXA) was the most common diagnostic modality for BMD evaluation, while the most frequent site for BMD measurement was the lumbar spine (89.4%, n = 17 studies), followed by total body BMD (68.4%, n = 13 studies). Low BMD in children with NMD was demonstrated in all studies, especially after loss of ambulation. Moreover, a positive correlation between lower BMD and older age was shown. Conclusions: BMD evaluation in NMD remains a clinical challenge, as indicated by the high heterogeneity regarding the optimal site and technique for the evaluation of bone quality in these patients. Although DXA is currently the diagnostic modality of choice, a consensus regarding the optimal site for BMD measurement, and the adjustment method for its obtained measurements for parameters such as age and height is needed.
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Affiliation(s)
- Georgia Antoniou
- Department of Orthopedic Surgery, “Nicosia” General Hospital, 2029 Nicosia, Cyprus
| | - Panagiotis Masouros
- Department of Orthopedic Surgery and Traumatology, “Evaggelismos” General Hospital, 10676 Athens, Greece
| | - Dimitrios V. Papadopoulos
- 2nd Department of Orthopaedic Surgery, “Konstantopouleio” General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece
| | - Konstantinos C. Soultanis
- 1st Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panagiotis Krallis
- 2nd Department of Orthopedic Surgery, “Agia Sofia” General Children’s Hospital, 11527 Athens, Greece
| | - George Babis
- 2nd Department of Orthopaedic Surgery, “Konstantopouleio” General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece
| | - Vasileios S. Nikolaou
- 2nd Department of Orthopaedic Surgery, “Konstantopouleio” General Hospital, National and Kapodistrian University of Athens, 14233 Athens, Greece
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13
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Ma CM, Lu N, Zhang MM, Kong FS, Lu Q, Yin FZ, Zhang X, Wang R. The relationship between obesity and bone mineral density in children and adolescents: analysis of the National Health and Nutrition Examination Survey. Arch Osteoporos 2023; 18:25. [PMID: 36689089 DOI: 10.1007/s11657-022-01208-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023]
Abstract
Childhood and puberty are important period for the skeleton grows. Fat mass, especially visceral adipose tissue, was negatively correlated with areal bone mineral density in children and adolescents. The present study suggests that fat mass, especially visceral adipose tissue, has a slightly negative association with bone development in children and adolescents. PURPOSE This study observed the relationship between fat mass and distribution, and areal bone mineral density (aBMD) in children and adolescents. METHODS A retrospective study was conducted on US children and adolescents aged 8-19 years. Whole body (less head) aBMD was evaluated. Height (Ht) adjusted Z-scores for aBMD were calculated. RESULTS After controlling for age, gender, race, and lean body mass index (LBMI) Z-score, there were significant negative associations between fat mass index (FMI) Z-score and aBMD Ht-Z-adjusted Z-score (β = - 0.272, P < 0.001, R2 = 0.033). In the linear regression models with aBMD Ht-Z-adjusted Z-score as the dependent variable, the regression coefficients of android fat mass were - 0.241 (P < 0.05, R2 = 0.002), - 0.473 (P < 0.001, R2 = 0.036), and - 0.474 (P < 0.001, R2 = 0.038) for healthy weight, overweight, and obesity group, respectively. The regression coefficients of visceral adipose tissue (VAT) mass were - 0.218 (P > 0.05, R2 = 0.001), - 2.025 (P < 0.001, R2 = 0.044), and - 1.826 (P < 0.001, R2 = 0.039), and the regression coefficients of subcutaneous adipose tissue (SAT) mass were - 0.467 (P < 0.001, R2 = 0.004), - 0.339 (P < 0.01, R2 = 0.024), and - 0.347 (P < 0.001, R2 = 0.018) for healthy weight, overweight, and obesity group, respectively. CONCLUSIONS The present study suggests that fat mass has a slightly negative association with bone development in children and adolescents. Trunk fat accumulation, especially visceral adipose tissue, was correlated with the lower level of aBMD. This association was obvious in overweight and obese children.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Na Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Meng-Meng Zhang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Fan-Shuo Kong
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Xu Zhang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Qinhuangdao, 066000, Hebei Province, China.
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Dural O, Ulusoy HE, Tikiz MA, Gurbanova T, Yasa C, Ugurlucan FG, Akhan SE. Effects of Hormone Replacement Therapy on Low Bone Mineral Density in Adolescents and Young Women with Hypogonadism: Comparison of Oral and Transdermal 17 Beta-Estradiol Administration. J Pediatr Adolesc Gynecol 2022; 35:634-637. [PMID: 35644512 DOI: 10.1016/j.jpag.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate the effects of physiological dose 17 beta-estradiol (E2) replacement on low bone mineral density (BMD) and compare the results of oral and transdermal (TD) E2 administration in adolescents and young women with hypogonadism DESIGN, SETTING, AND PARTICIPANTS: We retrospectively reviewed the medical records of patients aged 15 to 24 years who were diagnosed with hypogonadism, who had begun receiving oral or TD E2 replacement, and whose initial dual-energy X-ray absorptiometry scan detected a lumbar spine BMD Z-score of -1 or lower between 2014 and 2018. The patients were divided into 2 groups according to the E2 route of administration as those who received 2 mg orally (Group 1) and 0.1 mg TD (Group 2). INTERVENTIONS None MAIN OUTCOME MEASURE: BMD scans of the patients at baseline and repeated within 2 years after E2 replacement RESULTS: In total, 43 patients who met the inclusion criteria were included in the study. Two groups did not differ for BMD scores at baseline. A significant improvement in BMD was observed with physiological dose E2 replacement in both groups. Mean BMD Z-score increased by +0.7 (95% CI, 0.47-0.93) in response to TD E2 administration, compared with +0.41 (95% CI, 0.25-0.58) during oral E2 replacement (P = .037). CONCLUSION We conclude that physiological dose E2 replacement, even within a short period of 2 years, has a significant beneficial effect on bone mass acquisition on the lumbar spine. Our study also demonstrates the possible superiority of TD E2 replacement over the oral route in increasing lumbar spine BMD.
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Affiliation(s)
- Ozlem Dural
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey.
| | - Hevra Ekin Ulusoy
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey
| | - Muge Ates Tikiz
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey
| | - Turkane Gurbanova
- Medical Park Gebze Hospital, Section of Obstetrics and Gynecology, Gebze, Kocaeli, Turkey
| | - Cenk Yasa
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey
| | - Suleyman Engin Akhan
- Istanbul University, Faculty of Medicine, Department of Obstetrics and Gynecology, Fatih, Istanbul, Turkey
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Ayaz E, Bozaci AE. Radiographic Findings of Mucopolysaccharidosis and Comparison with Bone Mineral Density: A Study from Southeastern Turkey. J Clin Densitom 2022; 25:475-484. [PMID: 36100508 DOI: 10.1016/j.jocd.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/23/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The first aim of this study is to define the severity of radiologic features according to mucopolysaccharidosis (MPS) type. The second aim is to compare spine radiographs with dual-energy X-ray absorptiometry (DXA) scores. METHODOLOGY A total of 64 MPS children were enrolled between January 2017 and March 2021. Patients with a history of surgery, fracture or improper radiographs were excluded. Finally, 48 cases (20 MPS VI, 12 MPS IVA, 7 MPS IIIA, 4 MPS IIIB, 3 MPS II, 2 MPS I) were yielded. Among them, 38 had DXA performed in the same week with radiographs. Demographic and radiographic features and the hip acetabular index were noted. T12-L5 vertebral body heights were measured from lateral spine radiographs and divided by patient height. DXA measurements, bone mineral density and Z-scores were also recorded. RESULTS Spine and hip findings were most frequently seen in MPS VI and IVA. Oar-shaped ribs were more common in MPS VI, whereas anteromedial beaking of vertebra was predominantly seen in MPS IVA. Femoral head dysplasia is most common in MPS IVA, VI and I. The highest mean acetabular was observed in MPS I. The mean Z-score of L1-L4 vertebrae was low for MPS I (-3.8), IVA (-3.79) and VI (-3.73), but normal for MPS II (0.6) and IIIA (0.23). Correlation between the Z-score and vertebral index was highest in the L1 vertebral body. CONCLUSION Interpreting the characteristic radiographic features of different MPS types is important. In addition to dysostosis multiplex, quantitative measurements from radiographs may be beneficial in evaluating disease progression.
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Affiliation(s)
- Ercan Ayaz
- Department of Radiology, Diyarbakir Children's Hospital, Diyarbakır, Turkey.
| | - Ayse Ergul Bozaci
- Department of Pediatric Nutrition and Metabolism, Diyarbakir Children's Hospital, Diyarbakır, Turkey
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16
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Zanlorenci S, Martins PC, Alves CAS, de Castro JAC, de Lima LRA, Petroski EL, Silva DAS. Association between bone mineral density and content and physical growth parameters among children and adolescents diagnosed with HIV: a cross-sectional study. SAO PAULO MED J 2022; 140:682-690. [PMID: 35920531 PMCID: PMC9514865 DOI: 10.1590/1516-3180.2021.0549.r1.03012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND During childhood and adolescence, there are significant increases in bone mineral content (BMC) and bone mineral density (BMD). OBJECTIVE To investigate physical growth parameters associated with BMD and BMC among children and adolescents diagnosed with human immunodeficiency virus (HIV). DESIGN AND SETTING Cross-sectional study conducted in Florianópolis, Brazil, among 63 children and adolescents (aged 8-15 years) diagnosed with HIV. METHOD BMD, BMC and fat percentage z score were evaluated using dual X-ray absorptiometry. Age/height z score and body mass index (BMI)/age z score were obtained in accordance with international recommendations, and bone age was obtained through hand-wrist radiography. Sex, family income, information on HIV infection (T CD4+ lymphocyte count, viral load and type of antiretroviral therapy, moderate-vigorous physical activity and sedentary behavior) were used as adjustment variables in the analyses. Simple and multiple linear regression analyses were performed, with a significance level of P ≤ 0.05. RESULTS Subtotal BMD (without the head region) was directly associated with bone age, BMI/age z score and fat percentage z score, even after adjusting for covariates. Subtotal BMC/height was directly associated with bone age, height/age z score, BMI/age z score and fat percentage z score, even after adjusting for covariates. CONCLUSION Subtotal BMD and subtotal BMC/height were directly associated with physical growth indicators among children and adolescents diagnosed with HIV.
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Affiliation(s)
- Suellem Zanlorenci
- BSc. Master’s Student in Physical Activity and Health, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano (NUCIDH), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - Priscila Custódio Martins
- MSc. Doctoral Student, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano (NUCIDH), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - Carlos Alencar Souza Alves
- MSc. Doctoral Student, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano (NUCIDH), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - João Antônio Chula de Castro
- MSc. Doctoral Student, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano (NUCIDH), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - Luiz Rodrigo Augustemak de Lima
- PhD. Adjunct Professor, Instituto de Educação Física e Esporte (IEFE), Universidade Federal de Alagoas (UFAL), Maceió (AL), Brazil
| | - Edio Luiz Petroski
- PhD. Associate Professor, Department of Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil; and Researcher, Núcleo de Pesquisa em Cineantropometria e Desempenho Humano (NUCIDH), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | - Diego Augusto Santos Silva
- PhD. Associate Professor, Department of Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil; and Researcher, Research Center in Kinanthropometry and Human Performance, Florianópolis (SC), Brazil
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Kalkwarf HJ, Shepherd JA, Fan B, Sahay RD, Ittenbach RF, Kelly A, Yolton K, Zemel BS. Reference Ranges for Bone Mineral Content and Density by Dual Energy X-Ray Absorptiometry for Young Children. J Clin Endocrinol Metab 2022; 107:e3887-e3900. [PMID: 35587453 PMCID: PMC9387715 DOI: 10.1210/clinem/dgac323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assessment of bone health in young children has been hampered by limited reference values for bone mineral content (BMC) and areal bone mineral density (aBMD) by dual energy X-ray absorptiometry (DXA). OBJECTIVES To identify age, sex, and population ancestry effects on BMC and aBMD and develop smoothed reference ranges for BMC and aBMD in young children. To quantify precision of bone measurements and influence of height-for-age Z-scores on bone Z-scores. METHODS We recruited 484 healthy children ages 1 to 2 years or 4.5 to 5 years at 2 clinical centers, who were seen once or up to 7 times over a 3-year period. Lumbar spine, distal forearm, and whole-body subtotal (ages ≥ 3 years) BMC and aBMD were measured by DXA. These data were combined with data from the Bone Mineral Density in Childhood Study from children ages 5 to 8.9 years to create the smoothed reference curves. RESULTS For 1- to 5-year-olds, BMC and aBMD at all skeletal sites increased with age. Age trends differed by sex for BMC and aBMD of the spine, distal one-third radius, ultradistal radius, and by ancestry (Black vs non-Black) for all measures. BMC and aBMD precision (% coefficient of variation) ranged from 1.0% to 4.4%. Height Z-scores were positively associated with bone Z-scores and accounted for 4% to 45% of the variance. CONCLUSIONS We demonstrate the feasibility of bone density measurements in young children and provide robust reference ranges and stature adjustments for calculation of bone Z-scores at multiple skeletal sites to enable bone health assessments.
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Affiliation(s)
- Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Bo Fan
- University of California, San Francisco, San Francisco, CA, USA
| | - Rashmi D Sahay
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrea Kelly
- Division of Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kimberly Yolton
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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18
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Schafmeyer L, Al-Monajjed M, Linden T, Wunram HL, Semler O, Schoenau E, Duran I. Diagnostic Evaluation of the Functional Muscle-Bone Unit in Children With Cerebral Palsy With and Without Low Trauma Fractures. J Clin Densitom 2022; 25:334-342. [PMID: 35168895 DOI: 10.1016/j.jocd.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/20/2021] [Accepted: 01/04/2022] [Indexed: 11/17/2022]
Abstract
Children and adolescents with cerebral palsy (CP) are at increased risk of low trauma fractures (LTF) due to low bone mineral content (BMC). The risk of LTFs might be overestimated by only age - and sex adjusted Z-scores for BMC because Z-score based DXA techniques do not take into account other relevant parameters like height, muscle and fat mass. This study aimed to present an update of the functional muscle-bone unit-algorithm (uFMBU-A) to evaluate bone health in children with CP in order to predict the risk of LTF taking into account the parameters sex, age, height, muscle and fat mass. We performed a monocentric retrospective analysis of 177 DXA-scans of children and adolescents with CP aged 8-19. Six of these 177 patients had sustained at least 1 LTF. Age-, sex- and size adjusted Z-scores of total body less head (TBLH)-BMC, lean body mass and fat mass were calculated. The uFMBU-A was applied to the study group and results were compared with established Z-score based DXA-measurements and algorithm based diagnostic techniques concerning the prediction of LTF risk. The uFMBU-A had the greatest diagnostic odds ratio (13.3 [95% CI 2.41; 72.9]) of the evaluated predictors with a sensitivity of 50.0% (95% CI 11.8; 88.2), specifity of 93% (95% CI 88.1; 96.3). The uFMBU-A was the most accurate method of the evaluated parameters to predict LTF in children with CP and is recommended when evaluating bone health.
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Affiliation(s)
- Leonie Schafmeyer
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Neuropediatrics, University Children's Hospital, Klinikum Oldenburg, Oldenburg, Germany.
| | - Mike Al-Monajjed
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany
| | - Tobias Linden
- Department of Neuropediatrics, University Children's Hospital, Klinikum Oldenburg, Oldenburg, Germany
| | - Heidrun Lioba Wunram
- Department of Psychiatry, Psychosomatics and Psychotherapy for Children and Adolescents, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Oliver Semler
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Eckhard Schoenau
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany; Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany
| | - Ibrahim Duran
- Center of Prevention and Rehabilitation, UniReha, Cologne, Germany, University of Cologne, Medical Faculty and University Hospital Cologne, Germany
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19
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Mansukoski L, Qamar H, Perumal N, Aimone A, Bassani DG, Roth DE. Growth delay: an alternative measure of population health based on child height distributions. Ann Hum Biol 2022; 49:100-108. [PMID: 35736806 DOI: 10.1080/03014460.2022.2091794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Indicators of child height, such as mean height-for-age Z-scores (HAZ), height-for-age difference (HAD) and stunting prevalence, do not account for differences in population-average bone developmental stage. AIM Propose a measure of child height that conveys the dependency of linear growth on stage rather than chronological age. SUBJECTS AND METHODS Using Demographic and Health Surveys (2000-2018; 64 countries), we generated: 1) predicted HAZ at specific ages (HAZ regressed on age); 2) height-age (age at which mean height matches the WHO Growth Standards median); 3) Growth delay (GD), the difference between chronological age and height-age; 4) HAD; and 5) stunting prevalence. Metrics were compared based on secular trends within countries and age-related trajectories within surveys. RESULTS In the most recent surveys (N = 64), GDs ranged from 1.9 to 19.1 months at 60 months chronological age. Cross-sectionally, HAZ, HAD and GD were perfectly correlated, and showed similar secular trends. However, age-related trajectories differed across metrics. Accumulating GD with age demonstrated growth faltering as slower than expected growth for children of the same height-age. Resumption of growth at the median for height-age was rarely observed. CONCLUSION GD is a population-level measure of child health that reflects the role of delayed skeletal development in linear growth faltering.
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Affiliation(s)
- Liina Mansukoski
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Huma Qamar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Nandita Perumal
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Ashley Aimone
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Diego G Bassani
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Daniel E Roth
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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20
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Di Marcello F, Di Donato G, d’Angelo DM, Breda L, Chiarelli F. Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management. Int J Mol Sci 2022; 23:ijms23105725. [PMID: 35628529 PMCID: PMC9143357 DOI: 10.3390/ijms23105725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Bone is an extremely dynamic and adaptive tissue, whose metabolism and homeostasis is influenced by many different hormonal, mechanical, nutritional, immunological and pharmacological stimuli. Genetic factors significantly affect bone health, through their influence on bone cells function, cartilage quality, calcium and vitamin D homeostasis, sex hormone metabolism and pubertal timing. In addition, optimal nutrition and physical activity contribute to bone mass acquisition in the growing age. All these factors influence the attainment of peak bone mass, a critical determinant of bone health and fracture risk in adulthood. Secondary osteoporosis is an important issue of clinical care in children with acute and chronic diseases. Systemic autoimmune disorders, like juvenile idiopathic arthritis, can affect the skeletal system, causing reduced bone mineral density and high risk of fragility fractures during childhood. In these patients, multiple factors contribute to reduce bone strength, including systemic inflammation with elevated cytokines, reduced physical activity, malabsorption and nutritional deficiency, inadequate daily calcium and vitamin D intake, use of glucocorticoids, poor growth and pubertal delay. In juvenile arthritis, osteoporosis is more prominent at the femoral neck and radius compared to the lumbar spine. Nevertheless, vertebral fractures are an important, often asymptomatic manifestation, especially in glucocorticoid-treated patients. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis, therapy and follow up, is therefore mandatory in at risk children. Here we discuss the molecular mechanisms involved in skeletal homeostasis and the influence of inflammation and chronic disease on bone metabolism.
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21
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Kuniyil A, Pal S, Sachdev N, Yadav TP. Effect of 2-6 weeks of systemic steroids on bone mineral density in children. Clin Exp Pediatr 2022; 65:254-261. [PMID: 34793668 PMCID: PMC9082250 DOI: 10.3345/cep.2021.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown. PURPOSE To determine the effect of the use of systemic steroids for 2-6 weeks on BMD and BMC in pediatric patients. METHODS Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2-6 weeks and 25 age- and sexmatched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction. RESULTS Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose. CONCLUSION The use of systemic steroids for 2-6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.
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Affiliation(s)
- Athira Kuniyil
- Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Somdipa Pal
- Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Namrita Sachdev
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Tribhuvan Pal Yadav
- Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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22
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Kalkwarf HJ, Shepherd JA, Hans D, Gonzalez Rodriguez E, Kindler J, Lappe JM, Oberfield S, Winer KK, Zemel BS. Trabecular Bone Score Reference Values for Children and Adolescents According to Age, Sex, and Ancestry. J Bone Miner Res 2022; 37:776-785. [PMID: 35118727 PMCID: PMC9018558 DOI: 10.1002/jbmr.4520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022]
Abstract
Trabecular bone score (TBS) is used for fracture prediction in adults, but its utility in children is limited by absence of appropriate reference values. We aimed to develop reference ranges for TBS by age, sex, and population ancestry for youth ages 5 to 20 years. We also investigated the association between height, body mass index (BMI), and TBS, agreement between TBS and lumbar spine areal bone mineral density (aBMD) and bone mineral apparent density (BMAD) Z-scores, tracking of TBS Z-scores over time, and precision of TBS measurements. We performed secondary analysis of spine dual-energy X-ray absorptiometry (DXA) scans from the Bone Mineral Density in Childhood Study (BMDCS), a mixed longitudinal cohort of healthy children (n = 2014) evaluated at five US centers. TBS was derived using a dedicated TBS algorithm accounting for tissue thickness rather than BMI. TBS increased only during ages corresponding to pubertal development with an earlier increase in females than males. There were no differences in TBS between African Americans and non-African Americans. We provide sex-specific TBS reference ranges and LMS values for calculation of TBS Z-scores by age and means and SD for calculation of Z-scores by pubertal stage. TBS Z-scores were positively associated with height Z-scores at some ages. TBS Z-scores explained only 27% and 17% of the variance of spine aBMD and BMAD Z-scores. Tracking of TBS Z-scores over 6 years was lower (r = 0.47) than for aBMD or BMAD Z-scores (r = 0.74 to 0.79), and precision error of TBS (2.87%) was greater than for aBMD (0.85%) and BMAD (1.22%). In sum, TBS Z-scores provide information distinct from spine aBMD and BMAD Z-scores. Our robust reference ranges for TBS in a well-characterized pediatric cohort and precision error estimates provide essential tools for clinical assessment using TBS and determination of its value in predicting bone fragility in childhood and adolescence. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Heidi J. Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | - Didier Hans
- Interdisciplinary Center for Bone Diseases, Bone and Joint Department, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center for Bone Diseases, Bone and Joint Department, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland
| | - Joseph Kindler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, USA
| | - Joan M. Lappe
- Department of Medicine, Creighton University, Omaha, NB, USA
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York; NY, USA
| | - Karen K. Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Babette S. Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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23
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Lisboa SC, Vieira A, Teodoro JL, Costa R, Boeno FP, Farinha J, Bracht CG, Reischak-Oliveira Á, dos Santos Cunha G. Cardiometabolic health profile of young girls with aesthetic professions. BMC Womens Health 2022; 22:15. [PMID: 35034662 PMCID: PMC8762858 DOI: 10.1186/s12905-022-01599-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the literature, professions that impose body standards for daily performance are designated as non-conventional professions (i.e. models, athletes, ballet dancers), with great emphasis on the female population. More than a job, it becomes a lifestyle to those inserted in this environment, thus, thousands of children and adolescents seek inclusion and success in these professions due to financial and media gains. Such professions are associated with several health-related risk factors. The purpose of this study was to identify and compare among physical fitness levels, cardiometabolic health markers, mental health and dietary habits in non-conventional professions. METHODS The sample consisted of 41 female individuals aged between 14 and 24 years, allocated into four groups, control group composed by university students (UG = 11), models (MG = 11), ballet dancers (BG = 11), and athletes' group (AG = 8). Physical fitness outcomes (cardiorespiratory fitness, flexibility, maximal dynamic strength, muscular endurance and body composition); biochemical outcomes (high-density lipoprotein [HDL], low-density lipoprotein [LDL], total cholesterol [TC], fasting glucose [FG], fasting insulin [FI], C-reactive protein [CRP]), diet quality and mental health were evaluated. RESULTS No impairments were observed in the health markers evaluated among groups, both for health-related physical fitness and biochemical outcomes. However, low levels of bone mineral density (BMD) were observed. Even with statistically significant differences between the groups for chronological age (p = 0.002), menarche (p = 0.004), career length (p = 0.001), height (p = 0.001), body mass index (p = 0.018), waist-to-height ratio (p < 0.001), %Fat (p = 0.020), VO2peak (p = 0.020), maximal dynamic strength of knee extensors (p = 0.031) and elbow flexors (p = 0,001) and flexibility (p < 0.001), all these values are within the normal range for health. CONCLUSION The professions analyzed do not seem to interfere in the physical fitness and cardiometabolic health of the girls assessed. However, we identified that exposure to these profession can impair mental health (depressive symptoms in 100% of participants) and body composition (BMD 63% of participants).
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Affiliation(s)
- Salime Chedid Lisboa
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandra Vieira
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rochelle Costa
- Faculdade Sogipa, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Juliano Farinha
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cláudia Gomes Bracht
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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25
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Slim M, Vanstone CA, Morin SN, Rahme E, Bacon SL, Weiler HA. Evaluation of Increasing Dairy Intake on Bone Density in Post-pubertal Youth: A Randomized Controlled Trial Using Motivational Interviewing. J Nutr 2022; 152:1031-1041. [PMID: 36967160 DOI: 10.1093/jn/nxab385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/22/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adequate nutrition is important for bone health, especially for bone mineral accretion. OBJECTIVE The primary objective tested whether increasing dairy intake using the motivational interviewing technique (MInt) improves lumbar spine (LS) bone mineral density (BMD) after 2 years in post-pubertal adolescents with habitual dairy intake of < 2 dairy servings/day. DESIGN Participants (14-18.9 y) were randomized to: Group 1 (control), group 2 (target of 3 dairy servings/d), or group 3 (target of ≥ 4 dairy servings/d) for 12 months with groups 2 and 3 using MInt, with an additional 12-month non-intervention follow-up. The primay outcome was LS BMD, and secondary outcomes: whole body (WB), total hip (TH), and 33% distal radius BMD using dual-energy x-ray absorptiometry, bone geometry using peripheral quantitative computed tomography, and bone biomarkers. RESULTS Ninety-four adolescents (16.6 ± 1.5 y) were recruited. Seventy-six (80.9%) completed the 12-month assessments. From baseline to 12 months, dairy intake in female groups 2 and 3 increased by 107% and 208%, respectively; and by 48% and 153% in males of group 2 and 3, respectively. In females, group 3 had greater increases in THBMD (4.3 to 7.5%) compared to control (3.7 to 4.9%, P = 0.04) and group 2 (0.0 to 1.7%, P = 0.04) at 12 and 24 months. No effects due to dairy intake were observed for DXA outcomes in males or radial and tibial volumetric BMD in both sexes. None of the bone biomarkers were different among the dairy groups in females or males. CONCLUSION MInt effectively increased dairy intake with benefits to bone health only in female adolescents with previously low calcium intake who consumed 4 dairy serving or more/day for 12 months. Larger studies are required to explain the lack of intervention effect in males.This trial was registered at ClinicalTrials.gov as. NCT02236871.
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Affiliation(s)
- May Slim
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC
| | | | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, QC
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC
| | - Simon L Bacon
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC.,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, QC
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC
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26
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Pelegrini A, Bim MA, Alves AD, Scarabelot KS, Claumann GS, Fernandes RA, de Angelo HCC, Pinto ADA. Relationship Between Muscle Strength, Body Composition and Bone Mineral Density in Adolescents. J Clin Densitom 2022; 25:54-60. [PMID: 34756705 DOI: 10.1016/j.jocd.2021.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/19/2022]
Abstract
Adolescence is an important period for the acquisition of bone mass, which can be enhanced by several factors. This study aimed examine the relationships of handgrip strength, free-fat mass, and fat mass with bone mineral density in adolescents. 118 adolescents (60 girls), aged 10 to 14 years, participated in the study. Information on sex, age, handgrip strength, free-fat mass, fat mass and bone mineral density were collected. Multiple linear regression analyses were conducted to examine possible relationships between bone mineral density and handgrip strength, free-fat mass and fat mass. There was a relation between handgrip strength and free-fat mass with bone mineral density in both sexes. Fat mass was correlated with bone mineral density only in girls (r= 0.314, p< 0.014). The final models, adjusted for sexual maturation, included free-fat mass (girls - β= 0.419, p< 0.001; boys - β= 0.455; p< 0.001) and handgrip strength (girls - β= 0.358, p< 0.05; boys - β= 0.325; p< 0.05) and these variables together explained 51.8% and 62.9% of the variation of bone mineral density, in girls and boys, respectively. Handgrip strength and free-fat mass were positively associated with bone mineral density. A sex-specific difference indicated that higher levels of free-fat mass are of paramount importance for both sexes.
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Affiliation(s)
- Andreia Pelegrini
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil.
| | - Mateus Augusto Bim
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Agnes Day Alves
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Karoline Sousa Scarabelot
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Gaia Salvador Claumann
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
| | - Rômulo Araújo Fernandes
- Physical Education Department, São Paulo State University, Presidente Prudente, São Paulo, Brazil
| | | | - André de Araújo Pinto
- Physical Education Department, Santa Catarina State University, Florianópolis, Santa Catarina, Brazil
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27
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Schafmeyer L, Linden T, Sill H, Rehberg M, Schoenau E, Duran I. Pediatric Reference Centiles of Bone Mineral Density and Body Composition of Lower Limbs. J Clin Densitom 2022; 25:73-80. [PMID: 34456143 DOI: 10.1016/j.jocd.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/27/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
Localized neurological diseases such as spina bifida are often accompanied by normal upper limb and spinal bone mineral density (BMD), whereas regional BMD of the lower limbs may be decreased. Therefore, regional BMD measurements may be more accurate to quantify regional bone health. Until now, no pediatric reference centiles of bone mineral density and body composition of the lower extremities are available for Hologic DXA systems. The objective was to generate age-and sex specific reference centiles of DXA scans of lower limbs for Hologic DXA systems. Data from the National Health and Nutrition Examination Survey of the period 1999-2004 (age 8 - 20 years) were used to generate age-specific and sex-specific reference centiles for the non-Hispanic Black, non-Hispanic White and Mexican-American NHANES study population. The LMS method was used to calculate the reference centiles. Data of DXA scans of 2233 non-Hispanic black children (880 females), 1869 non-Hispanic white children (803 females) and 2350 Mexican American children (925 females) were used to create age-specific and sex-specific reference curves. We presented age-and sex-specific reference centiles for regional bone mineral density, bone mineral content, lean body mass and fat mass at the lower limbs for children and adolescents which were ethnicity specific and directly applicable to Hologic QDR-4500A fan-beam densitometer.
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Affiliation(s)
- Leonie Schafmeyer
- Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, University of Cologne, Cologne, Germany; University Children's Hospital Klinikum Oldenburg, Department of Neuropediatrics, Oldenburg, Germany.
| | - Tobias Linden
- University Children's Hospital Klinikum Oldenburg, Department of Neuropediatrics, Oldenburg, Germany
| | - Helge Sill
- Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, University of Cologne, Cologne, Germany; Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Mirko Rehberg
- Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Eckhard Schoenau
- Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, University of Cologne, Cologne, Germany; Medical Faculty and University Hospital, Department of Pediatrics, University of Cologne, Cologne, Germany
| | - Ibrahim Duran
- Medical Faculty and University Hospital, Center of Prevention and Rehabilitation, UniReha, University of Cologne, Cologne, Germany
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O'Callaghan KM, Shanta SS, Fariha F, Harrington J, Mahmud AA, Emdin AL, Gernand AD, Ahmed T, Abrams SA, Moore DR, Roth DE. Effect of maternal prenatal and postpartum vitamin D supplementation on offspring bone mass and muscle strength in early childhood: follow-up of a randomized controlled trial. Am J Clin Nutr 2021; 115:770-780. [PMID: 34849536 PMCID: PMC8895216 DOI: 10.1093/ajcn/nqab396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maternal vitamin D status during pregnancy and lactation is a modifiable factor that may influence offspring musculoskeletal outcomes. However, few randomized trials have tested the effects of prenatal or postpartum vitamin D supplementation on offspring bone and muscle development. OBJECTIVES The aim was to examine hypothesized effects of improvements in early-life vitamin D status on childhood musculoskeletal health in Dhaka, Bangladesh. METHODS In a previously completed, double-blind, dose-ranging trial, healthy pregnant women (n = 1300) were recruited at 17-24 weeks' gestation and randomly assigned to a prenatal/postpartum regimen of 0/0, 4200/0, 16,800/0, 28,000/0, or 28,000/28,000 IU cholecalciferol (vitamin D3)/wk until 26 wk postpartum. In this new report, we describe additional follow-up at 4 y of age (n = 642) for longer-term outcomes. Bone mineral content (BMC) and areal bone mineral density (aBMD) were measured by DXA. Grip strength was tested using a hand-held dynamometer. The primary comparison was children of women assigned to 28,000 IU/wk prenatally compared with placebo. Differences are expressed as means and 95% CIs. RESULTS Total-body-less-head (TBLH) BMC, TBLH aBMD, and grip strength were similar in the combined high-dose prenatal (28,000/0 and 28,000/28,000 IU/wk) compared with placebo groups (mean difference [95% CI] = 0.61 g [-10.90, 12.13], 0.0004 g/cm2 [-0.0089, 0.0097], and 0.02 kg [-0.26, 0.31], respectively). In dose-ranging analyses, TBLH BMC and aBMD, whole-body BMC and aBMD, and grip strength in each of the prenatal vitamin D groups were not significantly different from placebo (P > 0.05 for all comparisons). Only head aBMD was greater in children of women assigned to the 28,000/28,000-IU regimen compared with placebo (mean difference [95% CI] = 0.024 g/cm2 [0.0009, 0.047], P = 0.042); the effect was attenuated upon adjustment for child height, weight, and sex (P = 0.11). CONCLUSIONS Maternal prenatal, with or without postpartum, vitamin D supplementation does not improve child BMC, aBMD, or grip strength at 4 y of age. The MDIG trial and present follow-up study were registered prospectively at www.clinicaltrials.gov as NCT01924013 and NCT03537443, respectively.
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Affiliation(s)
- Karen M O'Callaghan
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shaila S Shanta
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Farzana Fariha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jennifer Harrington
- Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Al Mahmud
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abby L Emdin
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Steven A Abrams
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | | | - Daniel E Roth
- Centre for Global Child Health and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Penido MGMG, Tavares MDS. Should pediatric idiopathic hypercalciuria be treated with hypocalciuric agents? World J Nephrol 2021; 10:47-58. [PMID: 34430384 PMCID: PMC8353600 DOI: 10.5527/wjn.v10.i4.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/18/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypercalciuria is the most common metabolic risk factor for calcium urolithiasis and is associated with bone loss in adult patients. Reduced bone mineral density (BMD) was already described in idiopathic hypercalciuria (IH) children, but the precise mechanisms of bone loss or inadequate bone mass gain remain unknown. Life-long hypercalciuria might be considered a risk to change bone structure and determine low bone mass throughout life. The peak of bone mass should occur without interferences. A beneficial effect of citrate formulations and thiazides on bone mass in adult and pediatric patients with IH have been shown.
AIM To evaluate whether pharmacological therapy has a beneficial effect on bone mass in children and adolescents with IH.
METHODS This retrospective cohort study evaluated 40 hypercalciuric children non-responsive to lifestyle and diet changes. After a 2-mo run-in period of citrate formulation (Kcitrate) usage, the first bone densitometry (DXA) was ordered. In patients with sustained hypercalciuria, a thiazide diuretic was prescribed. The second DXA was performed after 12 mo. Bone densitometry was performed by DXA at lumbar spine (L2-L4). A 24-h urine (calcium, citrate, creatinine) and blood samples (urea, creatinine, uric acid, calcium, phosphorus, magnesium, chloride, hemoglobin) were obtained. Clinical data included age, gender, weight, height and body mass index.
RESULTS Forty IH children; median age 10.5 year and median time follow-up 6.0 year were evaluated. Nine patients were treated with Kcitrate (G1) and 31 with Kcitrate + thiazide (G2). There were no differences in age, gender, body mass index z-score and biochemical parameters between G1 and G2. There were no increases in total cholesterol, kalemia and magnesemia. Calciuria decreased in both groups after treatment. Lumbar spine BMD z-score increased after thiazide treatment in G2. There was no improvement in G1.
CONCLUSION Results point to a beneficial effect of thiazide on lumbar spine BMD z-score in children with IH. Further studies are necessary to confirm the results of the present study.
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Affiliation(s)
- Maria Goretti Moreira Guimarães Penido
- Pediatric Nephrology Unit, Nephrology Center of Santa Casa de Belo Horizonte, Belo Horizonte 30150320, Minas Gerais, Brazil
- Federal University of Minas Gerais, Faculty of Medicine, Department of Pediatrics, Pediatric Nephrology Unit, Belo Horizonte 30130100, Minas Gerais, Brazil
| | - Marcelo de Sousa Tavares
- Pediatric Nephrology Unit, Nephrology Center of Santa Casa de Belo Horizonte, Belo Horizonte 30150320, Minas Gerais, Brazil
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Stojanović E, Jakovljević V, Scanlan AT, Dalbo VJ, Radovanović D. Vitamin D 3 supplementation reduces serum markers of bone resorption and muscle damage in female basketball players with vitamin D inadequacy. Eur J Sport Sci 2021; 22:1532-1542. [PMID: 34240659 DOI: 10.1080/17461391.2021.1953153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study aimed to investigate the effect of vitamin D3 supplementation at a dose of 4,000 IU/day for 6 weeks on serum levels of: 25-hydroxyvitamin D [25(OH)D], bone turnover [osteocalcin and carboxy-terminal telopeptides of crosslinks of type I collagen (CTx-I)], and muscle damage [lactate dehydrogenase (LDH) and creatine kinase (CK)] in middle adolescent (15-18 years) and late-adolescent to early adulthood (19-30 years) female basketball players with inadequate vitamin D status. Participants (N=24) were randomly assigned in a double-blind manner into a vitamin D or placebo group. Data were analyzed using separate 2×2x2 mixed ANOVAs with one within-subjects factor (time) and two between-subjects factors (condition and age). When a significant interaction was observed, the intra-group changes were assessed using paired t tests and Hedge's g. Paired t-tests comparing intra-group changes in the vitamin D condition revealed a non-significant large improvement in 25(OH)D (p = 0.06; g = 0.86), non-significant small decreases in CTx-I (p = 0.13; g = -0.22) and CK (p = 0.07; g = -0.26), as well as a significant moderate decrease in LDH (p = 0.004; g = -0.74). Paired t-tests comparing intra-group changes in the placebo condition revealed a significant moderate decline in 25(OH)D (p <0.001; g = -0.77), as well as significant small increases in CTx-I (p = 0.04; g = 0.47) and CK (p = 0.04; g = 0.36). Vitamin D3 supplementation at 4,000 IU/day could be effective in reducing bone resorption and muscle damage in female basketball players with inadequate baseline vitamin D, irrespective of age.
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Affiliation(s)
- Emilija Stojanović
- Faculty of Sport and Physical Education, University of Niš, Niš, Serbia.,Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Jakovljević
- Faculty of Medical Sciences, Department of Physiology, University of Kragujevac, Kragujevac, Serbia.,Department of Human Pathology, Moscow State Medical University IM Sechenov, Moscow, Russia
| | - Aaron T Scanlan
- Human Exercise and Training Laboratory, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Vincent J Dalbo
- Human Exercise and Training Laboratory, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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31
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Chun LF, Yu EL, Sawh MC, Bross C, Nichols J, Polgreen L, Knott C, Schlein A, Sirlin CB, Middleton MS, Kado DM, Schwimmer JB. Hepatic Steatosis is Negatively Associated with Bone Mineral Density in Children. J Pediatr 2021; 233:105-111.e3. [PMID: 33545191 PMCID: PMC8154638 DOI: 10.1016/j.jpeds.2021.01.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relationship between hepatic steatosis and bone mineral density (BMD) in children. In addition, to assess 25-hydroxyvitamin D levels in the relationship between hepatic steatosis and BMD. STUDY DESIGN A community-based sample of 235 children was assessed for hepatic steatosis, BMD, and serum 25-hydroxyvitamin D. Hepatic steatosis was measured by liver magnetic resonance imaging proton density fat fraction (MRI-PDFF). BMD was measured by whole-body dual-energy x-ray absorptiometry. RESULTS The mean age of the study population was 12.5 years (SD 2.5 years). Liver MRI-PDFF ranged from 1.1% to 40.1% with a mean of 9.3% (SD 8.5%). Across this broad spectrum of hepatic fat content, there was a significant negative relationship between liver MRI-PDFF and BMD z score (R = -0.421, P < .001). Across the states of sufficiency, insufficiency, and deficiency, there was a significant negative association between 25-hydroxyvitamin D and liver MRI-PDFF (P < .05); however, there was no significant association between vitamin D status and BMD z score (P = .94). Finally, children with clinically low BMD z scores were found to have higher alanine aminotransferase (P < .05) and gamma-glutamyl transferase (P < .05) levels compared with children with normal BMD z scores. CONCLUSIONS Across the full range of liver MRI-PDFF, there was a strong negative relationship between hepatic steatosis and BMD z score. Given the prevalence of nonalcoholic fatty liver disease and the critical importance of childhood bone mineralization in protecting against osteoporosis, clinicians should prioritize supporting bone development in children with nonalcoholic fatty liver disease.
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Affiliation(s)
- Lauren F. Chun
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California
| | - Elizabeth L. Yu
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Mary Catherine Sawh
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
| | - Craig Bross
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California
| | - Jeanne Nichols
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California,Graduate School of Public Health, San Diego State University, San Diego, California
| | - Lynda Polgreen
- Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Cynthia Knott
- Altman Clinical and Translational Research Institute, School of Medicine, University of California San Diego School of Medicine, Ja Jolla, California
| | - Alexandra Schlein
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Claude B. Sirlin
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Michael S. Middleton
- Liver Imaging Group, Department of Radiology, University of California San Diego School of Medicine, La Jolla, California
| | - Deborah M. Kado
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California,Department of Internal Medicine, University of California San Diego, La Jolla, California
| | - Jeffrey B. Schwimmer
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, University of California San Diego School of Medicine, La Jolla, California,Department of Gastroenterology, Rady Children’s Hospital, San Diego, California
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32
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Wibowo T, Nurani N, Hastuti J, Anggraini A, Susilowati R, Hakimi M, Julia M, Van Weissenbruch M. Maternal and Neonatal Factors Affecting Bone Mineral Content of Indonesian Term Newborns. Front Pediatr 2021; 9:680869. [PMID: 34113592 PMCID: PMC8185158 DOI: 10.3389/fped.2021.680869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Interactions between the genome and intrauterine environment can affect bone mineralization in newborns and even in adult life. Several studies show that intrauterine fetal bone mineralization or early postnatal bone condition influences the risk of osteoporosis in later life. Objectives: To determine whole body bone mineral content (WB BMC) and factors that influence neonatal WB BMC in Indonesian term newborns. Subjects/Methods: A cross-sectional study was conducted in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. A total of 45 term, appropriate for gestational age (AGA) newborns were included in this study. BMC was assessed by dual-energy x-ray absorptiometry (DXA) in the first week of life. Weight (g), length (cm) and head circumference (cm) were measured at birth. Data on maternal characteristics were obtained from the maternal health records or reported by the mothers. Results: WB BMC measured in the present study (mean ± SD: 33.2 ± 9.3 g) was lower than WB BMC of similar populations in developed countries. Multiple linear regression showed that birth weight, birth length, and gestational age had a positive association with WB BMC (p = 0.048, 0.017, and <0.001, respectively), while maternal cigarette exposure had a negative association with WB BMC (p = 0.012). Male infants had significantly higher of WB BMC than female (p = 0.025). These determinants contribute to 55% variability of WB BMC. Conclusions: WB BMC in Indonesian term newborns is lower than populations in developed countries. Birth weight, length, gestational age, sex, and maternal cigarette exposure during pregnancy are significantly associated with WB BMC observed in Indonesian newborns.
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Affiliation(s)
- Tunjung Wibowo
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Neti Nurani
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Janatin Hastuti
- Department of Health Nutrition, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Alifah Anggraini
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Rina Susilowati
- Department of Histology and Molecular Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Mirjam Van Weissenbruch
- Department of Neonatology, Amsterdam University Medical Center Location VU University Medical Center, Emma Children's Hospital, VU University Amsterdam, Amsterdam, Netherlands
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Abstract
Bone mass is a key determinant of osteoporosis and fragility fractures. Epidemiologic studies have shown that a 10% increase in peak bone mass (PBM) at the population level reduces the risk of fracture later in life by 50%. Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood. Race, gender, and family history (genetics) are responsible for the majority of PBM, but other factors, such as physical activity, calcium and vitamin D intake, weight, smoking and alcohol consumption, socioeconomic status, age at menarche, and other secondary causes (diseases and medications), play important roles in PBM gain during childhood and adolescence. Hence, the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people, and thus to reduce the low bone mass or osteoporosis risk in later life. This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.
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Affiliation(s)
- Xiaowei Zhu
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Houfeng Zheng
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China.
- School of Life Sciences, Fudan University, Shanghai, 200433, China.
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34
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Lopez-Gonzalez D, Wells JC, Cortina-Borja M, Fewtrell M, Partida-Gaytán A, Clark P. Reference values for bone mineral density in healthy Mexican children and adolescents. Bone 2021; 142:115734. [PMID: 33166709 DOI: 10.1016/j.bone.2020.115734] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Clinical assessment of bone health by Dual-Energy X-ray Absorptiometry (DXA) in the paediatric population requires robust reference values. The International Society for Clinical Densitometry (ISCD) recommends that country/regional reference values ideally should be used to improve precision in bone health assessment. OBJECTIVE The aim of this study was to provide reference values for relevant bone health variables for healthy Mexican children and adolescents aged 5 to 18 years. METHODS This was a cross-sectional, stratified and population-based study, that measured a representative sample of healthy Mexican children and adolescents with DXA. We constructed age- and sex-smoothed reference values for areal bone mineral density (aBMD) of total body less head (TBLH), total body (TB), lumbar spine (LS), and bone mineral apparent density (BMAD) for LS, by means of Generalized Additive Models for Location, Scale and Shape (GAMLSS). RESULTS Reference data including the 3th, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th centiles, along with lambda (L), mu (M) and sigma (S) values, are given for each variable of interest for each sex at 0.25 years intervals. Reference values relative to height and Tanner-stage for both sexes are also provided. Finally, formulas to enable Z score estimation for clinical use are also presented CONCLUSIONS: The sex, age, height, Tanner-stage and ethnic-specific reference data provided in this study should enable more precise assessment of bone health in the Mexican paediatric population. The data presented may also allow for future evaluation of potential similarities and differences across different ethnic groups.
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Affiliation(s)
- Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autonoma de México, Mexico City, Mexico.
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | | | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autonoma de México, Mexico City, Mexico.
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Khalatbari H, Binkovitz LA, Parisi MT. Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update. Pediatr Radiol 2021; 51:25-39. [PMID: 32857206 DOI: 10.1007/s00247-020-04756-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/13/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
The assessment of pediatric bone mineral content and density is an evolving field. In this manuscript we provide a practical review and update on the interpretation of dual-energy X-ray absorptiometry (DXA) in pediatrics including historical perspectives as well as a discussion of the recently published 2019 Official Position Statements of the International Society of Clinical Densitometry (ISCD) that apply to children.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Larry A Binkovitz
- Department of Radiology, Divisions of Pediatric Radiology and Nuclear Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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36
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Leiva C, Bravo P, Arias C, Cabello J, Leal-Witt M, Salazar F, Cornejo V. 25 Hydroxy Vitamin D Level, Bone Health, Vitamin D and Calcium Intake in Chilean Patients with Phenylketonuria and Hyperphenylalaninemias. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2021. [DOI: 10.1590/2326-4594-jiems-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C. Leiva
- Pontificia Universidad Católica de Chile, Chile
| | - P. Bravo
- Clínica Universidad de los Andes, Chile
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Athale UH, Marriott CJC, Cranston A, McDonald P, Webber CE, Farncombe TH, Barr RD. Relationships of Bone Mineral Density to Whole Body Mass, Fat Mass and Fat-free Mass in Long-term Survivors of Acute Lymphoblastic Leukemia in Childhood. J Pediatr Hematol Oncol 2021; 43:12-17. [PMID: 32675554 DOI: 10.1097/mph.0000000000001863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Body size influences bone mineral density (BMD) in health. Relationships of BMD with body mass index, fat mass (FM), fat-free mass, and appendicular lean mass were explored in acute lymphoblastic leukemia (ALL) survivors (n=75; 41 males; 45 standard risk ALL) >10 years from diagnosis. Dual energy radiograph absorptiometry performed body composition analysis. Relationships were assessed by regression analyses and Pearson correlation coefficients (r). Twenty subjects (26.3%) were osteopenic; lumbar spine (LS) BMD Z score <-1.00. Age at diagnosis, sex, ALL risk-category, type of post-induction steroid or cranial radiation did not correlate with LS or whole body (WB) BMD. Body mass index correlated significantly with LS BMD (r=0.333, P=0.004) and WB BMD (r=0.271, P=0.033). FM index (FM/height²) Z score showed no significant correlation with LS or WB BMD. Fat-free mass index Z score correlated strongly with LS BMD (r=0.386, P=0.013) and WB BMD (r=0.605, P<0.001) in males but not in females. The appendicular lean mass index, a surrogate for skeletal muscle mass, correlated significantly with LS BMD (r=0.367, P=0.018) and WB BMD (r=0.604, P<0.001) in males but not in females. Future studies to evaluate interventions to enhance BMD focused on improving body composition particularly skeletal muscle mass are warranted.
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Affiliation(s)
- Uma H Athale
- Departments of Pediatrics
- McMaster Children's Hospital
| | - Christopher J C Marriott
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | | | - Colin E Webber
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Troy H Farncombe
- Radiology, McMaster University
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Ronald D Barr
- Departments of Pediatrics
- McMaster Children's Hospital
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Kang M, Chen JSC, Radjenovic M, Yang A, Feng GHY, Murrell DF. An analysis of the prevalence of osteoporosis and osteopenia in patients with epidermolysis bullosa: A cross-sectional study. Exp Dermatol 2020; 30:1675-1685. [PMID: 33347654 DOI: 10.1111/exd.14252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/07/2020] [Accepted: 11/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) patients have multiple risk factors for osteoporosis. There is limited literature describing the prevalence of bone health in EB, particularly in adults and less severe EB types. OBJECTIVES To investigate the prevalence of osteopenia or osteoporosis in EB patients from the Australasian Epidermolysis Bullosa Registry (AEBR). METHODS Of 417 AEBR patients, 72 underwent a dual energy X-ray absorptiometry scan. Bone mineral density (BMD) T and Z-scores, EB Disease Activity and Scarring Index (EBDASI), and Quality of Life in EB (QOLEB) scores were obtained. RESULTS T-scores of RDEB patients were significantly lower than the diagnostic cut-off value for osteopenia. EBDASI and QOLEB scores were inversely correlated with Z-scores. The prevalence of osteoporosis in adults was 75% in severe EB types (RDEB and JEB). In adults with less severe types (EBS and DDEB), the prevalence of osteopenia was 50% and 33%, respectively. CONCLUSIONS This is the largest study of osteoporosis in EB to date and the first to include adult patients with EBS. The high prevalence of osteoporosis and osteopenia identified in these patients warrants larger, collaborative international studies. Nevertheless, EB patients with high disease severity and QOL scores, irrespective of type, should receive early osteoporosis screening and prophylaxis.
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Affiliation(s)
- Mina Kang
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jessica S C Chen
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Melissa Radjenovic
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Dermatology, St George Hospital, Sydney, NSW, Australia
| | - Anes Yang
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Dermatology, St George Hospital, Sydney, NSW, Australia
| | - Grant H Y Feng
- School of Mathematics and Statistics, University of Sydney, NSW, Australia
| | - Dedee F Murrell
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Department of Dermatology, St George Hospital, Sydney, NSW, Australia
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Zemel BS, Wasserman H, Kelly A, Fan B, Shepherd J, Lappe J, Gilsanz V, Oberfield S, Winer KK, Kalkwarf HJ. Intermachine differences in DXA measurements vary by skeletal site, and impact the assessment of low bone density in children. Bone 2020; 141:115581. [PMID: 32795677 PMCID: PMC7680379 DOI: 10.1016/j.bone.2020.115581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bone mineral content (BMC) and areal-bone mineral density (aBMD) measurements of the lumbar spine (LS) and whole body less head (WBLH) by dual energy X-ray absorptiometry (DXA) are recommended for bone health assessment in children. Intermachine differences were not considered previously in formulating these recommendations. METHODOLOGY DXA measurements of the LS, WBLH, total hip, femoral neck and distal 1/3 radius from the Bone Mineral Density in Childhood Study were examined. Healthy children, ages 6 to 16 years, from five clinical centers participated. The same spine, whole body, and femur phantoms were measured on each Center's DXA machine. Percentage of individuals with low BMC or aBMD (Z-score < -1.5) was determined. Clinical center differences were evaluated by analysis of covariance adjusting for height and BMI Z-score, calcium intake, physical activity, Tanner stage and bone age. Logistic regression assessed odds of low BMC or aBMD across clinical centers. RESULTS Significant differences among Clinical Centers (p < 0.05) were evident in adjusted mean BMC and aBMD Z-scores (n = 1503) for all skeletal sites. WBLH BMC and aBMD Z-scores had the greatest range across centers (-0.13 to 0.24, and -0.17 to 0.56, respectively). The percentage of children with Z-scores less than -1.5 varied among Clinical Centers from 1.9 [95%CI 0.8, 4.5] to 8.1 [95%CI 5.7, 11.3] for WBLH BMC, 1.1 [95%CI 0.4, 3.5] to 6.3 [95%CI 3.8, 10.1] for WBLH aBMD, and from 4.4 [95%CI 2.8, 7.0] to 12.6 [95%CI 9.3, 16.9] for distal 1/3 radius aBMD. For each skeletal site except total hip aBMD and femoral neck BMC, at least one center had significantly lower odds of low bone density. CONCLUSIONS By design, our reference ranges capture intermachine variability. Most clinical centers don't know where their machine falls within the range of intermachine variability, and this may affect diagnosis of children evaluated for conditions that threaten bone health. Total hip scans showed the least, and whole body scans showed the most intermachine variability. Pediatric bone health assessment recommendations should recognize intermachine differences and address this important issue.
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Affiliation(s)
- Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America.
| | - Halley Wasserman
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, United States of America
| | - Andrea Kelly
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, United States of America
| | - Bo Fan
- Department of Radiology, University of California San Francisco, San Francisco, United States of America
| | - John Shepherd
- University of Hawaii Cancer Center, University of Hawaii (Manoa), United States of America
| | - Joan Lappe
- Division of Endocrinology, Department of Medicine, Creighton University, Omaha, United States of America
| | - Vicente Gilsanz
- Departments of Orthopaedic Surgery and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, United States of America
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, United States of America
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40
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Kindler JM, Mitchell EL, Piccoli DA, Grimberg A, Leonard MB, Loomes KM, Zemel BS. Bone geometry and microarchitecture deficits in children with Alagille syndrome. Bone 2020; 141:115576. [PMID: 32791330 PMCID: PMC7680312 DOI: 10.1016/j.bone.2020.115576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 06/30/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
Alagille syndrome (ALGS) is an autosomal dominant disorder attributed to mutations in the Notch signaling pathway. Children with ALGS are at increased risk for fragility fracture of unknown etiology. Our objective was to characterize bone mass, geometry, and microarchitecture in children with ALGS. This was a cross-sectional study of 10 children (9 females), ages 8-18 years, with a clinical diagnosis of ALGS. Bone density was assessed via DXA (Hologic Discovery A) at several skeletal regions. Tibia trabecular and cortical bone was assessed via pQCT (Stratec XCT 2000) at the distal 3% and 38% sites, respectively. Tibia bone microarchitecture was assessed via HR-pQCT (Scanco XtremeCT II) at an ultradistal site located at 4% of tibia length and a cortical site at 30% of tibia length. Z-scores were calculated for DXA and pQCT measures. In the absence of XtremeCT II HR-pQCT reference data, these outcome measures were descriptively compared to a sample of healthy children ages 5-20 years (n = 247). Anthropometrics and labs were also collected. Based on one-sample t-tests, mean Z-scores for height and weight (both p < .05), were significantly less than zero. DXA bone Z-scores were not significantly different from zero, but were highly variable. For pQCT bone measures, Z-scores for total bone mineral content at the distal 3% site and cortical bone mineral content, cortical area, and cortical thickness at the distal 38% site were significantly less than zero (all p < .05). There was good correspondence between pQCT measures of cortical thickness Z-scores and DXA Z-scores for aBMD at the whole body less head, 1/3 radius, and femoral neck (all p < .05). Compared to healthy children, those with ALGS generally had lower trabecular number and greater trabecular separation despite having greater trabecular thickness (measured via HR-pQCT). Bilirubin and bile acids, markers of hepatic cholestasis, were associated with poorer bone measures. For example, greater bilirubin was associated with lower trabecular number (Spearman's rho [ρ] = -0.82, p = .023) and greater trabecular separation (ρ = 0.82, p = .023) measured via HR-pQCT, and greater bile acids were associated with lower cortical area measured via pQCT (ρ = -0.78, p = .041) and lower serum insulin-like growth factor-1 (ρ = -0.86, p = .002). In summary, deficits in cortical bone size and trabecular bone microarchitecture were evident in children with ALGS. Further investigation is needed to understand the factors contributing to these skeletal inadequacies, and the manner in which these deficits contribute to increased fracture risk.
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Affiliation(s)
- Joseph M Kindler
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Ellen L Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, St. Christopher's Hospital for Children, Philadelphia, PA, United States of America; Department of Pediatrics, Drexel School of Medicine, Drexel University, Philadelphia, PA, United States of America
| | - David A Piccoli
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Adda Grimberg
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Mary B Leonard
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, United States of America
| | - Kathleen M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
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Abstract
Many children with chronic disease are now surviving into adulthood. As a result, there is a growing interest in optimizing bone health early in the disease course with the dual goals of improving quality of life during childhood and reducing life-long fracture risk. Risk factors for impaired bone health in these children include immobility, nutritional deficiency, exposure to bone toxic therapies, hormonal deficiencies affecting growth and pubertal development, and chronic inflammation. This review focuses on the chronic diseases of childhood most commonly associated with impaired bone health. Recent research findings and clinical practice recommendations, when available, for specific disorders are summarized.
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Affiliation(s)
- David R Weber
- Department of Pediatrics - Endocrinology, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
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Gómez-Bruton A, Marín-Puyalto J, Muñiz-Pardos B, Lozano-Berges G, Cadenas-Sanchez C, Matute-Llorente A, Gómez-Cabello A, Moreno LA, Gonzalez-Agüero A, Casajus JA, Vicente-Rodríguez G. Association Between Physical Fitness and Bone Strength and Structure in 3- to 5-Year-Old Children. Sports Health 2020; 12:431-440. [PMID: 32442050 DOI: 10.1177/1941738120913645] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The positive association between physical fitness and bone structure has been widely investigated in children and adolescents, yet no studies have evaluated this influence in young children (ie, preschoolers). HYPOTHESIS Fit children will present improved bone variables when compared with unfit children, and no sex-based differences will emerge in the sample. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 3. METHODS Handgrip strength, standing long jump (SLJ), speed/agility, balance, and cardiorespiratory fitness (CRF) were assessed using the Assessing FITness levels in PREschoolers (PREFIT) test battery in 92 children (50 boys; age range, 3-5 years). A peripheral quantitative computed tomography scan was performed at 38% of the length of the nondominant tibia. Cluster analysis from handgrip strength, SLJ, speed/agility, and CRF was developed to identify fitness groups. Bone variables were compared between sexes and between cluster groups. The association between individual physical fitness components and different bone variables was also tested. RESULTS Three cluster groups emerged: fit (high values on all included physical fitness variables), strong (high strength values and low speed/agility and CRF), and unfit (low strength, speed/agility, and CRF). The fit group presented higher values than the strong and unfit groups for total and cortical bone mineral content, cortical area, and polar strength strain index (all P < 0.05). The fit group also presented a higher cortical thickness when compared with the unfit group (P < 0.05). Handgrip, SLJ, and speed/agility predicted all bone variables except for total and cortical volumetric bone mineral density. No differences were found for bone variables between sexes. CONCLUSION The results suggest that global fitness in preschoolers is a key determinant for bone structure and strength but not volumetric bone mineral density. CLINICAL RELEVANCE Physical fitness is a determinant for tibial bone mineral content, structure, and strength in very young children. Performing physical fitness tests could provide useful information related to bone health in preschoolers.
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Affiliation(s)
- Alejandro Gómez-Bruton
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Jorge Marín-Puyalto
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Borja Muñiz-Pardos
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Gabriel Lozano-Berges
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Cristina Cadenas-Sanchez
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Angel Matute-Llorente
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Alba Gómez-Cabello
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Centro Universitario de la Defensa, Zaragoza, Spain
| | - Luis A Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Faculty of Health Science (FCS), Universidad de Zaragoza, Zaragoza, Spain
| | - Alex Gonzalez-Agüero
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
| | - Jose A Casajus
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain.,Faculty of Health Science (FCS), Universidad de Zaragoza, Zaragoza, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Zaragoza, Spain.,Faculty of Health and Sport Science (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Huesca, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain.,Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
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Chaplais E, Naughton G, Dutheil F, Masurier J, Greene D, Pereira B, Duclos M, Thivel D, Courteix D. Geometric and Mechanical Bone Response to a Multidisciplinary Weight Loss Intervention in Adolescents With Obesity: The ADIBOX Study. J Clin Densitom 2020; 23:254-263. [PMID: 30076009 DOI: 10.1016/j.jocd.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 01/27/2023]
Abstract
The effectiveness of structured multidisciplinary weight loss (WL) programs combining nutrition and physical activity on bone geometry and strength remains uncertain in adolescents with obesity. The study investigated the impact of a structured WL intervention on bone geometry and strength in adolescents with obesity. Thirty-one adolescents with obesity (mean [standard deviation] 13.61 [1.27] yr, body mass index Z-score 2.26 [0.30]) experienced an 8-mo WL program. A group of 23 maturation-matched controls (mean [standard deviation] 15.90 [0.43] yr, body mass index Z-score -0.12 [0.48]) were recruited for calculating Z-scores. Body composition, bone density, geometry, and mechanical properties were assessed using dual-energy X-ray absorptiometry and dual-energy X-ray absorptiometry-derived hip structural analysis. Plasma concentration of leptin, estradiol, collagen type 1 cross-linked C-telopeptide (CTx), and procollagen type 1 N-terminal propeptide were measured. Longitudinal analysis showed that adolescents with obesity reduced body weight and fat mass (total [g, %; p < 0.007]). After 8 mo, body mineral density at total body less head (Δ 3.22 [3.58] % p < 0.001) and lumbar spine (Δ 3.67 [4.04] % p < 0.001) increased. At the narrow neck (NN) of the femur, lower body mineral density (Δ -7.19 [8.79] % p < 0.001) and higher endocortical diameter and width were observed (NN endocortical diameter Δ 2.85 [0.26] %, NN width Δ 5.48 [10.84] %, respectively). An increased buckling ratio (Δ 8.24 [2.00] % p = 0.005) was also evident. Similar concentration of procollagen type 1 N-terminal propeptide and CTx was seen from baseline to 8 mo. However, at 4 mo, lower CTx levels were observed. The 8-mo WL program was associated with some positive adaptations among bone density parameters for the whole body and spine. However, bone geometry and strength estimates appeared to weaken at the NN. Clinically, the buckling ratio score at the NN was close to the fracture threshold. An "androgynous-like" adaptation was observed with bone geometry changes demonstrating periosteal expansion and endocortical resorption.
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Affiliation(s)
- Elodie Chaplais
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia; Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia.
| | - Geraldine Naughton
- Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia
| | - Frederic Dutheil
- Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia; Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Occupational and Preventive Medicine, WittyFit, Clermont-Ferrand, France
| | | | - David Greene
- School of Exercise Science, Australian Catholic University, Strathfield, NSW, Australia
| | - Bruno Pereira
- CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, the Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Martine Duclos
- Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Sports Medicine, Clermont-Ferrand, France; CRNH Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; CRNH Auvergne, Clermont-Ferrand, France
| | - Daniel Courteix
- Université Clermont Auvergne, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Clermont-Ferrand, France; Faculty of Health, Australian Catholic University, Melbourne, VIC, Australia; CRNH Auvergne, Clermont-Ferrand, France
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Roden RC, Noritz G, McKnight ER, Bonny AE. An exploratory study of depot-medroxyprogesterone acetate and bone mineral density in adolescent and young adult women with cerebral palsy. Contraception 2020; 101:273-275. [DOI: 10.1016/j.contraception.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/05/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
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Baptista F, Lopes E, Matute-Llorente Á, Teles J, Zymbal V. Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA. J Clin Densitom 2020; 23:73-81. [PMID: 30274880 DOI: 10.1016/j.jocd.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Abstract
Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these regions diverge from those defined by the dual-energy X-ray absorptiometry manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA). The participants were 134 young adults divided into 2 groups according to the impact of PA performed in the last 12 mo: high-impact PA and low-impact PA. The aBMD of the proximal femur was assessed by dual-energy X-ray absorptiometry at the standard femoral neck, intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck and intertrochanteric region. The bone-specific physical activity questionnaire was used to estimate the impact load of PA. Comparisons between groups were adjusted for body height and body lean mass. Interaction analysis between sex and PA groups were conducted with analysis of variance. Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures analysis of variance. In the high-impact PA group, men benefit more than women at all bone regions, except the aBMD at intertrochanteric region. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs specific) and PA groups (low vs high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.
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Affiliation(s)
- Fátima Baptista
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
| | - Edgar Lopes
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Ángel Matute-Llorente
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Department of Physiatry and Nursing, Faculty of Health and Sports Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Júlia Teles
- Mathematics Unit, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Vera Zymbal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Khadilkar A, Chiplonkar S, Sanwalka N, Khadilkar V, Mandlik R, Ekbote V. A Cross-Calibration Study of GE Lunar iDXA and GE Lunar DPX Pro for Body Composition Measurements in Children and Adults. J Clin Densitom 2020; 23:128-137. [PMID: 30981615 DOI: 10.1016/j.jocd.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To cross-calibrate dual energy X-ray absorptiometry machines when replacing GE Lunar DPX-Pro with GE Lunar iDXA. METHODS A cross-sectional study was conducted in 126 children (3-19 years) and 135 adults (20-66 years). Phantom cross calibration was carried out using aluminum phantom provided with each of the machines on both machines. Total body less head (TBLH), lumbar spine (L2-L4) and left femoral neck bone mineral density (BMD), bone mineral content (BMC), and bone area were assessed for each patient on both machines. TBLH lean and fat mass were also measured. Bland-Altman analysis, linear regressions, and independent sample t test were performed to evaluate consistency of measurements and to establish cross-calibration equations. RESULTS iDXA measured 0.33% lower BMD and 0.64% lower BMC with iDXA phantom as compared to DPX-Pro phantom (p < 0.001). In children, TBLH-BMC, femoral BMC and area were measured 10%-14% lesser, TBLH area was higher by 1%-2% and L2-L4 area by 10%-14% by iDXA as compared to DPX-Pro. iDXA measured higher TBLH fat [15% (girls), 31% (boys)] than DPX-Pro. In adults, TBLH-BMD (1.7%-3.4%), BMC (6.0%-10.9%) and area (4.2%-7.6%) were measured lesser by iDXA than DPX-Pro. L2-L4 BMD was higher [2.7% (men), 1.8% (women)] by iDXA than DPX-Pro. Femoral BMC was 2.11% higher in men and 4.1% lower in women by iDXA as compared to DPX-Pro. In children, R2 of cross-calibration equations, ranged from 0.91 to 0.96; in adults, it ranged from 0.93 to 0.99 (p < 0.01). After the regression equations were applied, differences in BMD values between both machines were negligible. CONCLUSION A strong agreement for bone mass and body composition was established between both machines. Cross-calibration equations need to be applied to transform DPX-Pro measurements into iDXA measurements to avoid errors in assessment. This study documents a need for use of cross-calibration equations to transform DPX-Pro body composition data into iDXA values for clinical diagnosis.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Shashi Chiplonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | | | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Rubina Mandlik
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Veena Ekbote
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
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Bordbar M, Bozorgi H, Saki F, Haghpanah S, Karimi M, Bazrafshan A, Zekavat OR. Prevalence of endocrine disorders and their associated factors in transfusion-dependent thalassemia patients: a historical cohort study in Southern Iran. J Endocrinol Invest 2019; 42:1467-1476. [PMID: 31228105 DOI: 10.1007/s40618-019-01072-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/08/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Transfusion-dependent beta-thalassemia (TDT) patients suffer from various endocrinopathies. The main contributing factor associated with these complications is iron overload, secondary to frequent blood transfusions. To improve patients' quality of life, we evaluated the prevalence of endocrine disorders while considering the associated factors for further assessment. METHODS Seven hundred thirteen transfusion-dependent thalassemia patients with age range 10-62 years were enrolled in this study. Serum calcium, phosphorous, fast blood sugar, ferritin, 25-OH vitamin D, free thyroxin, thyroid-stimulating hormone and parathyroid hormone were assessed. Bone mineral density was measured by dual-energy X-ray absorptiometry. RESULTS In total, 86.8% of the TDT patients suffered from at least one endocrinopathy. The prevalence of endocrinopathies in descending order of frequency was low bone mass (72.6%), hypogonadism (44.5%), diabetes mellitus (15.9%), hypoparathyroidism (13.2%), and hypothyroidism (10.7%). Age, body mass index and splenectomy were significantly associated with most of the endocrine disorders. CONCLUSION Endocrine complications are frequently observed in TDT patients. Splenectomy is a major risk factor and should be generally avoided unless it is highly indicated. Periodic surveillance of endocrine function and proper management of iron overload are advised.
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Affiliation(s)
- M Bordbar
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
| | - H Bozorgi
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
| | - F Saki
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Haghpanah
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
| | - M Karimi
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
| | - A Bazrafshan
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran
| | - O R Zekavat
- Nemazee Hospital, Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-1135, Iran.
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Affiliation(s)
- Emily Kraus
- Department of Orthopaedic Surgery (E.K.) and Division of Endocrinology, Department of Pediatrics (L.K.B. and M.G.), Stanford University School of Medicine, Stanford, California
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Weber DR, Boyce A, Gordon C, Högler W, Kecskemethy HH, Misra M, Swolin-Eide D, Tebben P, Ward LM, Wasserman H, Shuhart C, Zemel BS. The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position. J Clin Densitom 2019; 22:567-589. [PMID: 31421951 PMCID: PMC7010480 DOI: 10.1016/j.jocd.2019.07.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) is widely used in the evaluation of bone fragility in children. Previous recommendations emphasized total body less head and lumbar spine DXA scans for clinical bone health assessment. However, these scan sites may not be possible or optimal for all groups of children with conditions that threaten bone health. The utility of DXA scans of the proximal femur, forearm, and radius were evaluated for adequacy of reference data, precision, ability of predict fracture, and applicability to all, or select groups of children. In addition, the strengths and limitations of vertebral fracture assessment by DXA were evaluated. The new Pediatric Positions provide guidelines on the use of these additional measures in the assessment of skeletal health in children.
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Affiliation(s)
- David R Weber
- Division of Endocrinology and Diabetes, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Alison Boyce
- Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - Catherine Gordon
- Divisions of Adolescent/Young Adult Medicine and Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, Birmingham Women's and Children's NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, UK
| | - Heidi H Kecskemethy
- Departments of Biomedical Research & Medical Imaging, Nemours/Alfred I. duPont Hospital for Children Wilmington, DE, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Diana Swolin-Eide
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, Sweden
| | - Peter Tebben
- Division of Pediatric Endocrinology, Department of Pediatrics and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Leanne M Ward
- Division of Endocrinology and Metabolism; Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Halley Wasserman
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Babette S Zemel
- Division of GI, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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50
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Pellegrino F, Zatelli MC, Bondanelli M, Carnevale A, Cittanti C, Fortini M, Gamberini MR, Giganti M, Ambrosio MR. Dual-energy X-ray absorptiometry pitfalls in Thalassemia Major. Endocrine 2019; 65:469-482. [PMID: 31300960 DOI: 10.1007/s12020-019-02003-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/01/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Low mineral mass and reduced bone strength with increased fracture risk are the main causes of morbidity in Thalassemia Major (TM). The pathogenesis is multifactorial and includes ineffective erythropoiesis with medullary expansion, multiple endocrine dysfunctions, direct iron bone deposition, deferoxamine-induced bone dysplasia, and reduced physical activity associated with disease complications. Dual-energy X-ray absorptiometry (DXA) is the "gold standard" for bone mineral density (BMD) assessment and for bone strength and quality evaluation. This method identifies patients at greater risk of fragility fractures, guiding treatment and monitoring response to therapy. In TM, DXA shows limitations concerning BMD calculation accuracy and fracture risk prediction. One of the main challenges in the assessment of bone health in patients with TM is the accurate interpretation of densitometric results. PURPOSE This review investigates the major pitfalls in DXA implementation and interpretation in TM. METHODS Available literature has been assessed. CONCLUSIONS DXA shows limitations in assessing bone mineral "status" in TM, especially in the paediatric population, due to the peculiar characteristics of bone architecture and deformities associated with the disease. A radiological technique adjustment in this population is mandatory.
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Affiliation(s)
- Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Marta Bondanelli
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Corrado Cittanti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Monica Fortini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Maria Rita Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of Medicine, Azienda Ospedaliero Universitaria S. Anna, Cona - Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Ferrara, Italy
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal Medicine, University of Ferrara, Ferrara, Italy.
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