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Blood lipid levels in patients with osteopenia and osteoporosis:a systematic review and meta-analysis.
Zhao, H, Li, Y, Zhang, M, Qi, L, Tang, Y
Journal of bone and mineral metabolism. 2021;(3):510-520
Abstract
INTRODUCTION Considering the controversial relationship between blood lipid levels and osteopenia and osteoporosis (OP), we performed this meta-analysis. MATERIALS AND METHODS Using specific keywords and related words, we searched PubMed, Embase, and Cochrane Library databases. The Newcastle-Ottawa Scale form was used to evaluate the quality of the literature. According to the inclusion and exclusion criteria, we systematically screened the literature to extract relevant information and data. ReVman 5.3 and Stata 13.0 software were used for statistical analysis. Results were expressed as the mean difference (MD) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I2 and Q tests. Egger's test was used to quantitatively evaluate publication bias. RESULTS This analysis involved 12 studies (12,395 subjects). The quality of the literature was acceptable. Among subjects who were not taking lipid-lowering drugs, total cholesterol (TC) (MD = 0.11 mmol/L, 95%CI: - 0.03, 0.25; I2 = 21%; P = 0.36), triglycerides (TG) (MD = - 0.01 mmol/L, 95%CI: - 0.09, 0.07; I2 = 6%; P = 0.34), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.10 mmol/L, 95%CI: 0.00, 0.19; I2 = 0%; P = 0.74) in the osteopenia were not significantly increased/decreased. There were no significant differences in LDL-C (MD = 0.02 mmol/L, 95%CI: - 0.09, 0.13; I2 = 0%; P = 0.74) in postmenopausal women in osteopenia. TG (MD = - 0.04 mmol/L, 95%CI: - 0.14,0.07; I2 = 49%; P = 0.07) was unchanged in the osteoporosis (OP) group in subjects without taking lipid-lowering drugs. HDL-C was elevated in OP group (MD = 0.05 mmol/L, 95%CI: 0.03, 0.07; I2 = 31%; P = 0.15) but not in osteopenia group (MD = 0.01 mmol/L, 95%CI: - 0.01, 0.02; I2 = 38%; P = 0.14) in all subjects. CONCLUSION HDL-C was elevated in patients with OP.
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Creatine Supplementation (3 g/d) and Bone Health in Older Women: A 2-Year, Randomized, Placebo-Controlled Trial.
Sales, LP, Pinto, AJ, Rodrigues, SF, Alvarenga, JC, Gonçalves, N, Sampaio-Barros, MM, Benatti, FB, Gualano, B, Rodrigues Pereira, RM
The journals of gerontology. Series A, Biological sciences and medical sciences. 2020;(5):931-938
Abstract
BACKGROUND Creatine supplementation could be a nonexpensive, safe, and effective dietary intervention to counteract bone loss. The aim of this study was to investigate whether long-term creatine supplementation can improve bone health in older, postmenopausal women. METHODS A double-blind, placebo-controlled, parallel-group, randomized trial was conducted between November 2011 and December 2017 in Sao Paulo, Brazil. Two hundred postmenopausal women with osteopenia were randomly allocated to receive either creatine monohydrate (3 g/d) or placebo for 2 years. At baseline and after 12 and 24 months, we assessed areal bone mineral density (aBMD; primary outcome), lean and fat mass (through dual X-ray absorptiometry), volumetric BMD and bone microarchitecture parameters, biochemical bone markers, physical function and strength, and the number of falls and fractures. Possible adverse effects were self-reported. RESULTS Lumbar spine (p < .001), femoral neck (p < .001), and total femur aBMD (p = .032) decreased across time; however, no interaction effect was observed (all p > .050). Bone markers, microarchitecture parameters, and the number of falls/fractures were not changed with creatine (all p > .050). Lean mass and appendicular skeletal muscle mass increased throughout the intervention (p < .001), with no additive effect of creatine (p = .731 and p = .397, respectively). Creatine did not affect health-related laboratory parameters. CONCLUSION Creatine supplementation more than 2 years did not improve bone health in older, postmenopausal women with osteopenia, nor did it affect lean mass or muscle function in this population. This refutes the long-lasting notion that this dietary supplement alone has osteogenic or anabolic properties in the long run. CLINICAL TRIAL REGISTRY Clinicaltrials.gov: NCT: 01472393.
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Metabolic Bone Disease of Prematurity: Risk Factors and Associated Short-Term Outcomes.
Avila-Alvarez, A, Urisarri, A, Fuentes-Carballal, J, Mandiá, N, Sucasas-Alonso, A, Couce, ML
Nutrients. 2020;(12)
Abstract
Despite the importance of early recognition of metabolic bone disease (MBD) of prematurity, there is still significant variability in screening practices across institutions. We conducted an observational study of infants born at ≤32 weeks of gestation with a birth weight of ≤1500 g (n = 218) to identify clinical factors associated with biochemical indicators of MBD. Bone mineral status was assessed by measuring alkaline phosphatase and phosphate levels between weeks 3 and 5 of life. Two comparisons were performed after classifying infants as either MBD (cases) or non-MBD (controls), and as either high or low risk for MBD, as determined based on the results of MBD screening. In total, 27 infants (12.3%) were classified as cases and 96 (44%) as high-risk. Compared with controls, MBD infants had a significantly lower gestational age and birth weight, and a longer duration of parenteral nutrition and hospital stay. Respiratory outcomes were significantly poorer in high- versus low-risk infants. Multivariate logistic regression showed that birth weight was the only independent risk factor for MBD (odds ratio [OR]/100 g, 0.811; confidence interval [CI95%], 0.656-0.992; p = 0.045) and that birth weight (OR/100 g, 0.853; CI95%, 0.731-0.991; p = 0.039) and red blood cell transfusion (OR, 2.661; CI95%, 1.308-5.467; p = 0.007) were independent risk factors for high risk of MBD. Our findings provide evidence of risk factors for MBD that could help clinicians to individualize perinatal management. The association of red blood cell transfusion with MBD is a novel finding that may be related to iron overload and that merits further study.
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Current status in therapeutic interventions of neonatal bone mineral metabolic disorders.
Chinoy, A, Mughal, MZ, Padidela, R
Seminars in fetal & neonatal medicine. 2020;(1):101075
Abstract
Neonatal care has significantly improved in the past decade with improved survival of preterm and sick neonates. Similarly, the field of bone and mineral disorders is continuing to accelerate with better understanding of pathophysiology and genetic basis of diseases, as well as availability of newer diagnostic and therapeutic modalities. In this extensive and rapidly expanding field, metabolic bone disease specialists are frequently called upon to translate progress into better care for neonates with bone and mineral disorders. Accordingly, this chapter provides a review of clinical manifestations and evidence-based investigation and management (where available) of common, rare and ultra-rare disorders of bone and mineral metabolism manifesting in the neonatal period. Besides medical treatment we emphasise the crucial role of the multidisciplinary team, which include physical therapists, occupational therapists and dieticians, in the care of neonates with bone disorders such as osteogenesis imperfecta and achondroplasia.
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Celiac Disease and Its Role in the Development of Metabolic Bone Disease.
Micic, D, Rao, VL, Semrad, CE
Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry. 2020;(2):190-199
Abstract
Celiac disease (CD) is an immune-mediated enteropathy that occurs in genetically susceptible hosts with the ingestion of gluten-containing products. Ongoing gluten consumption leads to intestinal damage, characterized by villous blunting and increased intraepithelial lymphocytes, resulting in malabsorption. Pertinent to the development of bone disease, malabsorption of calcium and vitamin D leads to secondary hyperparathyroidism and metabolic bone disease among individuals with CD. In this article, we review the pathogenesis of CD and the effects of malabsorption on bone health. Imbalances in bone resorption and formation particularly in individuals with CD and persistent disease activity ultimately lead to a state of bone loss and impaired mineralization. Initiation of a gluten-free diet is critical in the management of CD-related metabolic bone disease, demonstrating improvements in bone mineral density within the first year of dietary adherence.
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Fall Prevention and Anti-Osteoporosis in Osteopenia Patients of 80 Years of Age and Older: A Randomized Controlled Study.
Zhou, J, Liu, B, Qin, MZ, Liu, JP
Orthopaedic surgery. 2020;(3):890-899
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Abstract
UNLABELLED To evaluate the effects of two fall-prevention and anti-osteoporotic protocols in elderly patients with osteopenia (OPA). METHODS The present randomized controlled study included patients with OPA (n =123). The age of these patients was ≥80 years old, with the mean age of 83.54 ± 2.99 years, and the male-to-female ratio was 2.97:1.00. Fall-prevention guidance was given to all patients. Patients in the experiment group (n = 62) orally received 600 mg/d of calcium carbonate, 0.5 μg/d of alfacalcidol, and 70 mg/week of alendronate, while patients in the control group (n = 61) orally received 600 mg/d of calcium carbonate and 0.5 μg/d of alfacalcidol for 18 months. The grip strength, gait speed, bone turnover markers, serum calcium, serum phosphorus, parathyroid hormone (PTH), and bone mineral density were measured, and the Timed Up and Go (TUG) test and the chair rising test (CRT) were performed. Falls, fragility fractures, medication compliance, and side effects of the drugs were recorded. RESULTS The serum levels of bone turnover markers (type I procollagen amino-terminal peptide [P1NP], type I collagen carboxyl terminal peptide [β-CTx], and osteocalcin [OC]) decreased, while the bone mineral density of the lumbar spine and bilateral femoral neck increased after treatment in the experiment group (P < 0.05, P < 0.01). The rate of change in bone mineral density of the bilateral femoral neck was higher in the experiment group than the control group (3.43% vs 0.03%, P < 0.05; 2.86% vs -0.02%, P < 0.01). After treatment, the proportion of patients with increased hip T scores in the experiment group (66.1%, 41/62) was significantly higher than the proportion (35.0%, 21/60) in the control group (P = 0.001). The incidence of fall decreased in both groups after treatment compared to that before treatment (54.8% vs 33.9% and 54.1% vs 36.7%, respectively; P < 0.05). The incidence of fragility fractures was lower in the experiment group than the control group (8.1% vs 20.0%, P = 0.057). During the intervention period, the incidence of fragility fractures in patients who did not fall (3.8%, 3/79) was significantly lower than that in patients who fell (32.6%, 14/43) (P = 0.000). The risk of fragility fractures was significantly lower in patients who did not fall compared to patients who fell (relative risk: 0.117, 95% confidence interval: 0.035-0.384). CONCLUSION The combination of alendronate sodium with alfacalcidol and calcium can significantly improve the bone mineral density of the lumbar spine and femoral neck. For older patients with OPA, subjectively paying attention to avoiding falls can significantly reduce the risk of fragility fractures.
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History, epidemiology and prevalence of neonatal bone mineral metabolic disorders.
Schulz, EV, Wagner, CL
Seminars in fetal & neonatal medicine. 2020;(1):101069
Abstract
The evolutionary patterns of human migration and historical pre/post-industrial revolution have changed the face of bone metabolic disease through past centuries. Cultural, religious, and lifestyle practices continue to alter nutritional recommendations for this expanding diagnosis. Likewise, modern advancements in the field of neonatology and, more specifically, aggressive nutritional management of premature infants have shaped the epidemiology of neonatal bone metabolism over the past two decades. Decreased use of long-term parenteral nutrition, early fortification of enteral nutrition, and stringent American Academy of Pediatrics (AAP) practice guidelines instituting early supplementation of vitamin D have attributed to improved bone mineralization outcomes in both term and preterm infants. Nevertheless, neonatal bone mineral metabolic disorders remain prevalent. In this review, we provide an in-depth look at the diagnoses, therapeutics, and subset populations-both genetic and non-genetic-affected by neonatal bone mineral metabolic disorders.
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Surgical Considerations in Managing Osteoporosis, Osteopenia, and Vitamin D Deficiency During Arthroscopic Rotator Cuff Repair.
Entezari, V, Lazarus, M
The Orthopedic clinics of North America. 2019;(2):233-243
Abstract
Osteopenia and osteoporosis are common in older adults and are associated with increased risk of fragility fractures. Vitamin D deficiency caused by chronic disease, poor nutrition, and inadequate sun exposure affects bone quality. Chronic rotator cuff tears can deteriorate the bone mineral density of the greater tuberosity and have been linked to reduced anchor pullout strength and high re-tear rate after repair especially in older patients with larger tear size. This article summarizes the current evidence on rotator cuff tear and bone quality and provides treatment strategies for rotator cuff repair in patients with poor bone quality.
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Impact of Bariatric Surgery on Bone Mineral Density: Observational Study of 110 Patients Followed up in a Specialized Center for the Treatment of Obesity in France.
Geoffroy, M, Charlot-Lambrecht, I, Chrusciel, J, Gaubil-Kaladjian, I, Diaz-Cives, A, Eschard, JP, Salmon, JH
Obesity surgery. 2019;(6):1765-1772
Abstract
INTRODUCTION Bariatric surgery is used to treat severe obesity. We aimed to investigate the incidence of clinically significant bone mineral density (BMD) loss at 6 and 12 months after bariatric surgery. METHODS Observational study performed in a specialized center for the treatment of obesity at the University Hospital of Reims, France. Surface BMD was measured by dual x-ray absorptiometry (DEXA). A reduction of > 0.03 g/cm2 was considered clinically significant. RESULTS A total of 110 patients were included. A clinically significant reduction in BMD was observed in 62.1% of patients at 6 months, and in 71.6% at 12 months after surgery. No case of osteoporosis was observed. There were four cases of osteopenia and one fracture post-surgery. BMD loss was related by univariate analysis to the reduction in body mass index (BMI) (p < 0.01), weight loss (p < 0.01), fat mass (p < 0.01), and lean mass (p < 0.01). Multivariable analysis found a significant association between the reduction in BMD and the excess weight loss percentage (odds ratio 1.11, 95% confidence interval (1.05-1.18), p < 0.001). CONCLUSION There was a clinically significant reduction in BMD at 6 months after surgery in over 60% of patients undergoing bariatric surgery. BMD loss is persistent over time and predominantly situated at the femoral level, and strongly associated with weight loss. Systematic vitamin and calcium supplementation, as well as follow-up by DEXA scan seems appropriate. Systematic DEXA scan pre- and post-surgery, and annually thereafter until weight has stabilized seems appropriate.
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Dietary Patterns in Relation to Low Bone Mineral Density and Fracture Risk: A Systematic Review and Meta-Analysis.
Fabiani, R, Naldini, G, Chiavarini, M
Advances in nutrition (Bethesda, Md.). 2019;(2):219-236
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Abstract
Low bone mineral density (BMD) and osteoporosis-related fractures constitute a considerable public health burden. Several studies have demonstrated the association between diet and bone health. We performed a systematic review to provide an estimate of the association between different dietary patterns defined through the use of a posteriori methods and fracture or low BMD risk. A literature search on PubMed, Web of Science, and Scopus databases, up to March 2018, was performed to identify all eligible case-control, prospective, or cross-sectional studies involving subjects of both sexes and any age. Random-effects models were used. Heterogeneity and publication bias were evaluated. Stratified analyses were conducted on study characteristics. The meta-analysis includes 20 studies and identifies 3 prevalent dietary patterns: "Healthy," "Milk/dairy," and "Meat/Western." From the 10 studies on fracture, adherence to the "Healthy" pattern reduced the risk, particularly in older people (OR: 0.79; 95% CI: 0.66, 0.95; P = 0.011) and in Eastern countries (OR: 0.64; 95% CI: 0.43, 0.97; P = 0.037), whereas the risk increased with the "Meat/Western" pattern, especially for older people (OR: 1.11; 95% CI: 1.04, 1.18, P = 0.001), in those with hip fractures (OR: 1.15; 95% CI: 1.05, 1.25; P = 0.002), and in Western countries (OR: 1.10; 95% CI: 1.07, 1.14; P < 0.0001). Analyses on low BMD showed a reduced risk in the "Healthy" pattern, particularly for younger people (OR: 0.62; 95% CI: 0.44, 0.89; P = 0.009). The "Meat/Western" pattern increased low BMD risk, especially in older people (OR: 1.31; 95% CI: 1.05, 1.64; P = 0.015). The "Milk/dairy" pattern resulted in the strongest reduction in low BMD risk; when stratifying, this effect remained significant (e.g., older women-OR: 0.57; 95% CI: 0.46, 0.70; P < 0.0001). Nutrition is an important modifiable factor affecting bone health. The "Healthy" and "Milk/dairy" patterns are associated with a reduced risk of low BMD and fracture. In contrast, the "Western" pattern is inversely associated.