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This study compared the bone parameters of adolescents with persistent cow's milk allergy (CMA) with those of healthy adolescents. Adolescents with CMA had compromised bone parameters (lower bone mineral density, impaired trabecular microarchitecture, and lower bone strength). Partial exclusion diet was associated with better bone parameters than total exclusion diet. BACKGROUND: Persistent immunoglobulin E (IgE)-mediated cow's milk allergy (CMA) may impair bone parameters and increase the risk of fractures. High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel methodology that not only assesses trabecular and cortical bone compartments and volumetric density measurements, but also evaluates bone microarchitecture and estimates biomechanical properties through finite element analysis (FEA). Both HR-pQCT and bone strength parameters derived from FEA have shown a strong correlation with fracture risk. PURPOSE: To assess the bone density, microarchitecture, and bone strength of adolescents with persistent IgE-mediated CMA (IgE-CMA). METHODS: This was an observational, cross-sectional study with female adolescents with persistent IgE-CMA and healthy control participants matched by female sex and sexual maturation. Bone parameters were assessed by areal bone mineral density (aBMD) through dual-energy X-ray absorptiometry (DXA), bone microarchitecture by HR-pQCT at the radius and tibia, and laboratory markers related to bone metabolism. RESULTS: The median age of adolescents with persistent IgE-CMA (n = 26) was 13.0 years (interquartile range (IQR) 11.4-14.7) and of healthy control participants (n = 28) was 13.6 years (IQR 11.9-14.9). Adolescents with IgE-CMA ingested 27.4% less calcium (p = 0.012) and 28.8% less phosphorus (p = 0.009) than controls. Adolescents with IgE-CMA had lower bone mineral content (BMC) (38.83 g vs. 44.50 g) and aBMD (0.796 g/cm2 vs. 0.872 g/cm2) at lumbar spine, and lower BMC (1.11 kg vs. 1.27 kg) and aBMD (0.823 g/cm2 vs. 0.877 g/cm2) at total body less head (TBLH) (p < 0.05). However, Z-scores BMC and Z-scores aBMD at lumbar spine and TBLH, when adjusted for Z-score height/age, were not significantly different between the groups. Moreover, CMA adolescents had lower bone strength at the distal tibia (S 169 kN/mm vs. 194 kN/mm; F Load 8030 N vs. 9223 N) (p < 0.05). Pairing of groups by the presence of menarche showed compromised parameters at the tibia-lower total volumetric BMD (Tt.vBMD) (293.9 mg HA/cm3 vs. 325.9 mg HA/cm3) and trabecular vBMD (Tb.vBMD) (170.8 mg HA/cm3 vs. 192.2 mg HA/cm3), along with lower cortical thickness (Ct.th) (1.02 mm vs. 1.16 mm) and bone strength (S 174 kN vs. 210 kN; F Load 8301 N vs. 9950 N)-and at the radius (S 61 kN/mm vs. 71 kN/mm; F Load 2920 N vs. 3398 N) (p < 0.05) among adolescents with IgE-CMA. Adolescents with IgE-CMA on a total exclusion diet (n = 12) showed greater impairment of bone features than those on a partial exclusion diet (n = 14), with lower lumbar spine Z-score BMC (- 0.65 vs. 0.18; p = 0.013), lumbar spine trabecular bone score (TBS) (1.268 vs. 1.383; p = 0.005), Z-score TBS (0.03 vs. 1.14; p = 0.020), TBLH Z-score BMC (- 1.17 vs. - 0.35; p = 0.012), TBLH Z-score aBMD (- 1.13 vs. - 0.33; p = 0.027), Tt.vBMD at the tibia (259.0 mg HA/cm3 vs. 298.7 mg HA/cm3; p = 0.021), Ct.th at the tibia (0.77 mm vs. 1.04 mm; p = 0.015) and Ct.th at the radius (0.16 mm vs. 0.56 mm; p = 0.033). CONCLUSION: Adolescents with persistent IgE-CMA had lower aBMD and compromised microarchitecture (impaired trabecular microarchitecture and lower bone strength). Adolescents on a partial exclusion diet had better bone parameters than those on a total exclusion diet.
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Densidade Óssea , Imunoglobulina E , Hipersensibilidade a Leite , Humanos , Feminino , Adolescente , Imunoglobulina E/sangue , Estudos Transversais , Hipersensibilidade a Leite/fisiopatologia , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/diagnóstico por imagem , Criança , Tomografia Computadorizada por Raios X , Absorciometria de Fóton , Estudos de Casos e Controles , Animais , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologiaRESUMO
PURPOSE: This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT). METHODS: Twenty-seven women with postsurgical hypoPT and 44 age-matched healthy women were included. Dual-energy X-ray absorptiometry was used to evaluate areal BMD and vertebral fracture assessment. High-resolution peripheral quantitative computed tomography assessed microarchitecture and volumetric BMD at the distal radius and tibia. Biochemical parameters, including fibroblast growth factor 23, C-terminal cross-linking telopeptide of type I collagen (ICTP), and procollagen type I N-terminal propeptide (P1NP), were also measured. Previous low-impact fractures were assessed and the 10-year fracture risk was estimated using the FRAX tool for the Brazilian population. RESULTS: No participant had prevalent clinical fractures, and both groups showed low risk for major and hip based on FRAX tool, but two hypoPT patients had moderate to severe morphometric vertebral fractures. Women with hypoPT had increased aBMD in the lumbar spine, femoral neck and total hip (p < 0.05) and higher cortical vBMD in the radius (p = 0.020) and tibia (p < 0.001). Trabecular bone was not affected. Both P1NP and ICTP suggested low bone turnover rates, but no significant correlation was observed between bone density or microstructure and any of the biochemical parameters. CONCLUSIONS: The prevalence of fragility fractures was low in HypoPT women and compatible with low fracture risk estimated by the FRAX tool. Patients had a higher aBMD and cortical vBMD than those of healthy control women, but the association with decreased bone turnover remains unclear.
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Fraturas Ósseas , Hipoparatireoidismo , Fraturas da Coluna Vertebral , Humanos , Feminino , Estudos Transversais , Densidade Óssea , Fraturas Ósseas/epidemiologia , Absorciometria de Fóton , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X/métodos , Rádio (Anatomia)/diagnóstico por imagem , Hipoparatireoidismo/diagnóstico por imagem , Hipoparatireoidismo/epidemiologia , Osso CorticalRESUMO
Higher sclerostin levels in postmenopausal women are associated with improved bone microarchitecture, areal and volumetric bone mineral density, and bone strength. However, the serum sclerostin level had no independent associations with the prevalence of morphometric vertebral fractures in this population after multivariable adjustment. PURPOSE: We aim to investigate the associations between serum sclerostin levels and morphometric vertebral fractures (VFs) prevalence, bone mineral density (BMD), and bone microarchitecture in postmenopausal women. METHODS: A total of 274 community-dwelling postmenopausal women were randomized enrolled. We collected general information and measured the serum sclerostin level. Morphometric VFs were assessed on the lateral thoracic and lumbar spine X-rays. Areal BMD and calculated trabecular bone score (TBS) were detected by dual-energy X-ray absorptiometry, and volumetric BMD and bone microarchitecture data were acquired from high-resolution peripheral quantitative computed tomography. RESULTS: The prevalence of morphometric VFs was 18.6% in the cohort, and it was significantly higher in the lowest quartile of the sclerostin group than that in the highest quartile of the sclerostin group (27.9% vs. 11.8%, p<0.05). But the serum sclerostin had no independent association with the prevalence of morphometric VFs after adjusting by age, body mass index, BMD at the lumbar vertebrae 1-4, and fragility fracture history after 50 years old (odds ratio: 0.995, 95% confidence interval: 0.987-1.003, p=0.239). The serum sclerostin level positively correlated with the areal, volumetric BMDs, and TBS. It also had significant positive associations with Tb.BV/TV, Tb.N, Tb.Th, and Ct.Th, and negative associations with Tb.Sp and Tb.1/N.SD. CONCLUSION: Chinese postmenopausal women with higher serum sclerostin levels had a lower prevalence of morphometric VFs, higher BMDs, and better bone microarchitecture. Nevertheless, the serum sclerostin level had no independent association with the prevalence of morphometric VFs.
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Fraturas Ósseas , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Feminino , Pessoa de Meia-Idade , Densidade Óssea , Pós-Menopausa , Osso e Ossos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas Ósseas/complicações , Absorciometria de Fóton/métodos , Fraturas por Osteoporose/complicações , Vértebras Lombares/diagnóstico por imagemRESUMO
Resumen: Introducción: la mayoría de las fracturas por fragilidad ocurren en rango densitométrico de osteopenia, la escala ósea trabecular (TBS) permite valorar aspectos de la microarquitectura que influyen en la resistencia ósea. Objetivo: describir las características clínicas y los hallazgos de la microarquitectura ósea aplicando TBS combinado con densitometría ósea (DXA) en un grupo de pacientes. Material y métodos: estudio descriptivo, de recolección retrospectiva. Se incluyen los pacientes a los que se les realizó DXA con TBS en el INRU en julio y agosto de 2020. Resultados: se analizaron 194 pacientes, 173 (89%) de sexo femenino y 21 (11%) de sexo masculino. El 36,1% (70 pacientes) en rango de osteopenia, 36,1 (70 pacientes) en rango de osteoporosis. El 32,9% (23 pacientes) con osteopenia y el 47,1% (33 pacientes) con osteoporosis tenían microarquitectura degradada. 76,9% de los pacientes con artritis reumatoidea y 45,8% de los que tenían espondiloartritis presentaban microarquitectura alterada. Conclusiones: el TBS permitió reestratificar el riesgo de fractura en un número importante de pacientes, mostrándose como una herramienta muy útil en la valoración complementaria de la salud ósea.
Summary: Introduction: most fractures that result from bone fragility occur in the osteopenia range The trabecular bone score (TBS) enables the assessment of microarchitecture aspects that impact bone resistance. Objective: to describe the clinical characteristics and findings of bone microarchitecture, by applying TBS and bone densitometry in a group of patients. Method: descriptive study of retrospective collection. Patients who were included in the study underwent a Dual-energy X-ray Absorptiometry (DXA) with TBS at the National Rheumatology Service between July and August, 2020. Results: 94 patients were analysed, 173 (89%) were female and 21 (11%) were male. 36.1% (70 patients) lay in the osteopenia range, 36.1 (70 patients) in the osteoporotic range. 32.9% (23 patients) with osteopenia and 47.1% (33 patients) with osteoporosis evidenced a degraded bone microarchitecture. 76.9 % of patients with rheumatoid arthritis and 45.8 % of patients with spondyloarthritis respectively evidenced altered bone microarchitecture. Conclusions: TBS allowed stratification of fracture risk in a significant number of patients, which may suggest it is a useful tool for complementary assessment of bone health.
Resumo: Introdução: a maioria das fraturas por fragilidade ocorre na faixa densitométrica da osteopenia; o escore de osso trabecular (TBS) permite avaliar aspectos da microarquitetura que influenciam a resistência óssea. Objetivo: descrever as características clínicas e os achados da microarquitetura óssea aplicando TBS combinado com densitometria óssea (DMO) em um grupo de pacientes. Material e métodos: estudo descritivo, retrospectivo, incluindo pacientes que realizaram DXA (absorciometria de raios-X de dupla energia) com TBS no INRU em julho e agosto de 2020. Resultados: foram analisados 194 pacientes, 173 (89%) mulheres e 21 (11%) homens. 36,1% (70 pacientes) na faixa de osteopenia, 36,1 (70 pacientes) na faixa de osteoporose. 32,9% (23 pacientes) com osteopenia e 47,1% (33 pacientes) com osteoporose tinham microarquitetura degradada. Nos pacientes com artrite reumatoide 76,9% e nas espondiloartrite 45,8% apresentaram microarquitetura alterada, respectivamente. Conclusões: a TBS permitiu fazer uma nova estratificação do risco de fratura em um número significativo de pacientes, mostrando-se uma ferramenta muito útil na avaliação complementar da saúde óssea.
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Densidade Óssea , Fraturas por Osteoporose/diagnóstico por imagem , Doenças Ósseas Metabólicas/diagnóstico por imagem , Absorciometria de FótonRESUMO
INTRODUCTION: Tumour-induced osteomalacia (TIO) is a rare paraneoplastic condition characterised by decreased tubular phosphate reabsorption. The purpose of this study is to evaluate bone mineral density (BMD) and microarchitecture in six TIO patients, compared with 18 healthy controls. METHODS: Volumetric BMD and microarchitecture were evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT), and areal BMD by dual-energy X-ray absorptiometry (DXA). Differences between groups were significant for p < .05. RESULTS: All TIO subjects were healthy until the development of diffuse bone pain and multiple skeletal fractures and deformities. At baseline, sPi and TmPi/GFR were low and patients were on vitamin D and phosphate replacement at the study. Compared with controls, TIO patients had lower aBMD at lumbar spine and hip, and lower vBMD at trabecular, cortical and entire bone, at distal radius (R) and distal tibia (T): trabecular vBMD (R = 118.3 × 177.1; T = 72.3 × 161.3 gHA/cm3 ); cortical vBMD (R = 782.3 × 866.5; T = 789.1 × 900.9 gHA/cm3 ); total region vBMD (R = 234.5 × 317; T = 167.1 × 295.8 gHA/cm3 ). Bone microarchitecture was very heterogeneous among patients and significantly different from controls: lower cortical thickness (R = 0.59 × 0.80; T = 0.90 × 1.31 mm), bone volume-to-total volume ratio (R = 0.09 × 0.14; T = 0.06 × 0.13) and Tb.N (R = 1.46 × 2.10; T = 0.93 × 1.96 mm-1 ) and also higher Tb.Sp (R = 0.70 × 0.41; T = 1.28 × 0.45 mm) and Tb.1/N.SD (R = 0.42 × 0.18; T = 0.87 × 0.20 mm). CONCLUSION: In this original study of TIO patients, DXA and HR-pQCT evaluation identified lower areal and volumetric BMD and severely impaired microarchitecture at cortical and trabecular bones, which probably contribute to bone fragility and fractures.
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Densidade Óssea , Rádio (Anatomia) , Absorciometria de Fóton , Humanos , Osteomalacia , Síndromes Paraneoplásicas , Tomografia Computadorizada por Raios XRESUMO
CONTEXT: Pregnancy- and lactation-associated osteoporosis (PLO) is a rare condition characterized by fragility fractures, mostly vertebral, during the third trimester of pregnancy or the early postpartum period. OBJECTIVE: The aim of this study was to evaluate bone microarchitecture in women with PLO to better understand the pathophysiology of this disease. METHODS: In this retrospective study, we included women with PLO referred to our bone center between November 2007 and July 2012. We assessed bone mineral density (BMD) by dual-energy x-ray absorptiometry, bone turnover markers, and bone microarchitecture by high-resolution peripheral quantitative computed tomography. Results were compared with a control group of healthy lactating women. RESULTS: Of the 7 primiparous patients with PLO, 6 suffered vertebral fractures and 1 developed a hip fracture during the seventh month of gestation. Fractures occurred within the eighth month of pregnancy and the fourth month post partum; vertebral fractures were multiple in 85.7%. Major or minor risk factors for osteoporosis were present in 86% of our patients. Trabecular density, number, and thickness were 34%, 20% and 22% lower than controls (Pâ <â .01, Pâ =â .01, and Pâ =â .01, respectively). Cortical parameters were also deteriorated but to a lesser extent. CONCLUSION: In comparison with healthy lactating women, patients with PLO presented severe deterioration of bone trabecular and cortical microarchitecture. This significant compromise may explain the occurrence of multiple fractures in these otherwise healthy young women. Further prospective studies are needed to determine whether bone microarchitecture might be able to be restored in the future.
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CONTEXT: Acromegaly can impair bone integrity, increasing the risk of vertebral fractures (VFs). OBJECTIVE: To evaluate the impact of isolated GH/IGF-I hypersecretion on bone turnover markers, Wnt inhibitors, bone mineral density (BMD), microarchitecture, bone strength and vertebral fractures in female patients with acromegaly (Acro), compared with healthy control group (HC). DESIGN, SETTING, AND PATIENTS: Cross-sectional study including 83 premenopausal women without any pituitary deficiency:18 acromegaly in remission (AcroR), 12 in group with active acromegaly (AcroA), and 53 HC. Serum procollagen type 1 N-terminal propeptide, ß-carboxy-terminal crosslinked telopeptide of type 1 collagen, osteocalcin, sclerostin, and DKK1 were measured in blood samples. dual-energy X-ray absorptiometry, high-resolution peripheral quantitative computed tomography (HR-pQCT) and vertebral fractures evaluation were also assessed simultaneously. MAIN OUTCOME AND RESULTS: AcroA showed significantly lower sclerostin and higher DKK1 compared with HC. On HR-pQCT of tibia and radius, Acro showed impairment of trabecular (area and trabecular number), increased cortical porosity, and increased cortical area and cortical thickness compared with HC. The only significant correlation found with HR-pQCT parameters was a positive correlation between cortical porosity and serum DKK1 (Râ =â 0.45, Pâ =â 0.044). Mild VFs were present in approximately 30% of patients. CONCLUSIONS: Eugonadal women with acromegaly without any pituitary deficiency showed increased cortical BMD, impairment of trabecular bone microstructure, and increased VF. Sclerostin was not correlated with any HR-pQCT parameters; however, DKK1 was correlated with cortical porosity in tibia (Pâ =â 0.027). Additional studies are needed to clarify the role of Wnt inhibitors on bone microarchitecture impairment in acromegaly.
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Acromegalia/patologia , Osso e Ossos/ultraestrutura , Via de Sinalização Wnt/fisiologia , Adulto , Densidade Óssea , Osso e Ossos/metabolismo , Estudos Transversais , Feminino , Análise de Elementos Finitos , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Pessoa de Meia-Idade , Pré-Menopausa , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologiaRESUMO
CONTEXT: Data regarding high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with adrenal incidentaloma (AI) are unknown. PURPOSE: To evaluate the areal bone mineral density (aBMD), microstructure, and fractures in patients with nonfunctioning AI (NFAI) and autonomous cortisol secretion (ACS). METHODS: We evaluated 45 patients with NFAI (1 mg dexamethasone suppression test [DST] ≤1.8 µg/dL) and 30 patients with ACS (1 mg DST 1.9-5.0 µg/dL). aBMD was measured using dual-energy X-ray absorptiometry; vertebral fracture by spine X-ray; and bone geometry, volumetric bone mineral density (vBMD), and microstructure by HR-pQCT. RESULTS: Patients with ACS showed lower aBMD values at the spine, femoral neck, and radius 33% than those with NFAI. Osteoporosis was frequent in both groups: NFAI (64.9%) and ACS (75%). Parameters at the distal radius by HR-pQCT were decreased in patients with ACS compared to those with NFAI: trabecular vBMD (Tb.vBMD, P = 0.03), inner zone of the trabecular region (Inn.Tb.vBMD, P = 0.01), the bone volume/tissue volume ratio (BV/TV, P = 0.03) and trabecular thickness (P = 0.04). As consequence, a higher ratio of the outer zone of the trabecular region/inner zone vBMD (Meta/Inn.vBMD, P = 0.003) was observed. A correlation between the cortisol levels after 1 mg DST and Meta/Inn.vBMD ratio was found (r = 0.29; P = 0.01). The fracture frequency was 73.7% in patients with ACS vs 55.6% in patients with NFAI (P = 0.24). CONCLUSION: Our findings point to an association between trabecular bone microarchitectural derangement at the distal radius and ACS. Our data suggest that AI have a negative impact on bone when assessed by HR-pQCT, probably associated to subclinical hypercortisolism.
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Neoplasias das Glândulas Suprarrenais/complicações , Osso Esponjoso/patologia , Síndrome de Cushing/diagnóstico , Fraturas Espontâneas/diagnóstico , Processamento de Imagem Assistida por Computador , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Absorciometria de Fóton , Córtex Suprarrenal/patologia , Neoplasias das Glândulas Suprarrenais/sangue , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Idoso , Densidade Óssea , Osso Esponjoso/diagnóstico por imagem , Estudos Transversais , Síndrome de Cushing/sangue , Síndrome de Cushing/etiologia , Feminino , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/patologia , Humanos , Hidrocortisona/sangue , Hidrocortisona/metabolismo , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/patologiaRESUMO
BACKGROUND: Many vertebral fractures (VF) occur in individuals classified by DXA as being at low risk of fragility fractures. The aim of this study was to verify the association between VF and peripheral bone microarchitecture and strength parameters (SP) using, in addition to DXA, high-resolution peripheral quantitative computed tomography (HR-pQCT) and axial bone microarchitecture using the trabecular bone score (TBS). STUDY DESIGN: Cross-sectional study of 276 community-dwelling subjects aged ≥65 years from the SPAH study cohort. METHODS: Lateral DXA scans of the spine were analyzed to assess VF. HR-pQCT was performed at the radius and tibia. TBS was determined using DXA. RESULTS: VF was observed in 42.6% of women and 28% of men. At the tibia, women with moderate/severe VF had lower volumetric bone density (vBMD), trabecular number (Tb.N), and SP, and higher trabecular separation (Tb.Sp); and men with VF had lower Tb.N and SP, and higher Tb.Sp. At the radius, women with moderate/severe VF had lower vBMD, trabecular and cortical thickness and SP; and men with VF had lower trabecular vBMD and SP. No associations between TBS and VF were observed in either gender. Logistic regression analysis revealed that trabecular vBMD at the tibia in women (OR:0.980, 95%CI:0.963-0.997, p = 0.022) and femoral neck aBMD in men (OR:0.445, 95%CI:0.212-0.935, p = 0.033) were independently associated with VF. CONCLUSION: HR-pQCT images detected differences in bone microstructure in older women with VF independent of aBMD and TBS by DXA, and HR-pQCT could be a useful tool to assess fracture risk. In men, femoral neck aBMD was associated with VF, and DXA continues to be an important tool for predicting VF.
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Densidade Óssea , Osso Esponjoso/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Rádio (Anatomia)/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Medição de Risco , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND/AIMS: Osteoporosis is a bone metabolic disease that affects mostly post-menopausal women. There has been shown that vitamin K (VK) supplementation during menopause may decrease bone loss as well as risk of bone breaking. Aiming to clarify the beneficial role of VK in bone metabolism during menopause, we investigated mineral metabolism and bone ultrastructure of ovariectomized (OVX) mice. METHODS: To determine the effects chronic use of VK in bone structure and mineral metabolism in OVX mice, we used several methods, such as DXA, µCTScan, and SEM as well as biomolecular techniques, such as ELISA and qRT-PCR. In addition, complete analysis of serum hormonal and other molecules associated to bone and lipid metabolism were evaluated overview the effects of VK in menopause murine model. RESULTS: VK treatment significantly affects Pi metabolism independently of OVX, changing Pi plasma, urinary output, balance, and Pi bone mass. Interestingly, VK also increased VLDL in mice independently of castration. In addition, VK increased compact bone mass in OVX mice when we evaluated it by DXA, histomorphometry, µCTScanning. VK increased bone formation markers, osteocalcin, HYP- osteocalcin, and AP whereas it decreased bone resorption markers, such as urinary DPD/creatinine ratio and plasmatic TRAP. Surprisingly, SEM images revealed that VK treatment led to amelioration of microfractures observed in OVX untreated controls. In addition, SHAM operated VK treated mice exhibited higher number of migrating osteoblasts and in situ secretion of AP. OVX led to decreased to in situ secretion of AP that was restored by VK treatment. Moreover, VK treatment increased mRNA expression of bone Calbindin 28KDa independently of OVX. CONCLUSION: VK treatment in OVX mice exhibited beneficial effects on bone ultrastructure, mostly by altering osteoblastic function and secretion of organic bone matrix. Therefore, VK could be useful to treat osteopenic/osteoporotic patients.
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Densidade Óssea/efeitos dos fármacos , Osso e Ossos/metabolismo , Vitamina K/farmacologia , Fosfatase Alcalina/sangue , Animais , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/ultraestrutura , Calbindinas/genética , Calbindinas/metabolismo , Creatinina/urina , Suplementos Nutricionais , Modelos Animais de Doenças , Feminino , Metabolismo dos Lipídeos , Camundongos , Camundongos Endogâmicos C57BL , Microscopia Eletrônica de Varredura , Osteocalcina/sangue , Osteoporose/metabolismo , Osteoporose/patologia , Ovariectomia , Hormônio Paratireóideo/sangue , Coluna Vertebral/diagnóstico por imagem , Microtomografia por Raio-XRESUMO
In this randomized double-blind placebo-controlled 24-week trial, cholecalciferol supplementation at 50,000 IU/week effectively improved bone microarchitecture parameters in juvenile-onset systemic lupus erythematosus (JoSLE) patients, as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at tibia site. An increase in the trabecular number and a decrease in the trabecular separation were observed, suggesting that vitamin D supplementation may be recommended for JoSLE patients with its deficiency. INTRODUCTION: Vitamin D has an important effect on bone but there are no trials that directly address the boosting of serum levels of 25-hydroxyvitamin D (25OHD) in bone microarchitecture in JoSLE patients. The aim of this study was to evaluate the effect of vitamin D supplementation on bone microarchitecture parameters using HR-pQCT in JoSLE patients. METHODS: This study was a randomized double-blind placebo-controlled 24-week trial. Forty female JoSLE patients were randomized (1:1) to receive oral cholecalciferol at 50,000 IU/week (JoSLE-VitD) or placebo (JoSLE-PL). The medications remained stable throughout the study. Serum levels of 25OHD were measured using a radioimmunoassay. The bone microarchitecture and volumetric bone density were analyzed using HR-pQCT at tibia site. RESULTS: At baseline, the groups were similar with respect to their age, body mass index, organ involvement, glucocorticoid dose, immunosuppressant use, serum 25OHD levels, and HR-pQCT parameters. After 24 weeks, higher 25OHD levels were observed in the JoSLE-VitD group compared to the JoSLE-PL group [31.3 (8.6) vs. 16.5 (5.8) ng/mL, p < 0.001]. An increase in the trabecular number [∆Tb.N 0.16 (0.24) vs. 0.03 (0.19) 1/mm, p = 0.024] and a decrease in the trabecular separation [∆ThSp -0.045 (0.067) vs. 0.001 (0.009) mm, p = 0.017] were found in the JoSLE-VitD group compared to the JoSLE-PL group at tibia site. No differences were observed in other structural parameters [trabecular (Tb.Th) or cortical thickness (Ct.Th)], volumetric bone mineral densities, cortical porosity, and biomechanical parameters (p > 0.05). CONCLUSION: This study suggests that cholecalciferol supplementation for 24 weeks effectively improved the bone microarchitecture parameters, mainly the trabecular number, in JoSLE patients. TRIAL REGISTRATION: NCT01892748.
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Conservadores da Densidade Óssea/uso terapêutico , Colecalciferol/uso terapêutico , Suplementos Nutricionais , Lúpus Eritematoso Sistêmico/complicações , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/etiologia , Adolescente , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/administração & dosagem , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/efeitos dos fármacos , Colecalciferol/administração & dosagem , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/fisiopatologia , Adulto JovemRESUMO
El score de hueso trabecular (TBS, Trabecular Bone Score) es una medición de la textura de los grises derivada de la evaluación del raquis por DXA y proporciona un índice de la microarquitectura ósea. Se ha demostrado que los valores bajos presentan capacidad para predecir fracturas. Nuestro objetivo fue evaluar si existían diferencias entre los valores de TBS de pacientes con fracturas frente a no fracturadas. Materiales y métodos: se revisaron 159 historias clínicas de mujeres menopáusicas que consultaron para evaluación de su salud ósea. Se consideraron los antecedentes autorreferidos de fracturas (Fx), la DMO de raquis, cuello femoral y fémur total y TBS. Resultados: treinta pacientes (18,9%) presentaron fracturas y en ellas se observó menor TBS (con Fx: 1,295±83 vs. sin Fx: 1,366±84, p<0,0001), menor índice de masa corporal (IMC) (con Fx: 23,7±1,9 vs. sin Fx: 25,7±4,2, p=0,02), sin diferencias en la edad (p=0,39), ni en valores de DMO (L1-L4 p=0,11, cuello femoral p=0,20 y fémur total p= 0,12). Muchas de las fracturas ocurrieron en pacientes sin osteoporosis por DXA. Conclusiones: el TBS aumentaría la capacidad de DXA para identificar a mujeres argentinas en riesgo de padecer fracturas sin tener osteoporosis densitométrica. Este es el primer trabajo realizado en la Argentina con medición de TBS. (AU)
Trabecular Bone Score (TBS) is a measure of the grey scale derived from DXA lumbar image and provides information about microarchitecture. It has been shown that low TBS values can predict fractures. Our objective was to evaluate if there are any differences between the TBS values in patients with fractures vs. non-fractures. Materials and methods: We reviewed 159 medical records of menopausal women who consulted for evaluation of their bone health. Self-reported fractures (Fx), spine BMD, femoral neck and total femur and TBS were evaluated. Results: thirty patients (18.9%) presented fractures and they showed lower TBS (with Fx: 1,295±0,083 vs. without Fx: 1,366±0,084, p<0.0001), lower body mass index (BMI) (with Fx: 23.7±1.9 vs. without Fx 25.7±4.2, p=0.02), without differences in ages (p=0.39) or in BMD values (L1-L4 p=0.11, femoral neck p=0.20 and total femur p=0.12). Some fractures occurred in patients without osteoporosis, as determined by DXA. Conclusions: TBS would increase the ability of DXA to identify Argentine women at risk for fractures without densitometric osteoporosis. This is the first work done in Argentina with TBS measurement. (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Osso e Ossos/diagnóstico por imagem , Fraturas de Estresse/prevenção & controle , Densitometria/métodos , Fraturas por Osteoporose/prevenção & controle , Osteoporose/fisiopatologia , Argentina , Osso e Ossos/fisiopatologia , Menopausa , Índice de Massa Corporal , Densidade Óssea , Fraturas de Estresse/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Estudos de Coortes , Fêmur/fisiopatologia , Fêmur/diagnóstico por imagem , Fraturas por Osteoporose/diagnóstico por imagemRESUMO
PURPOSE: To determine which features of the bone microarchitecture are affected by established diabetes mellitus (DM) and the effectiveness of glycemic control in the protection of bone tissue. MATERIAL AND METHODS: Sixty juvenile Wistar male rats were divided into three groups of 20 animals: a control group (C) that included healthy animals, a diabetic group (D) that included animals with induced diabetes, and a controlled diabetic group (CD) that included animals with induced diabetes that were treated with insulin. The animals were euthanized at the periods of 6 and 8 weeks after the induction of diabetes (10 animals per group/period). Vertebral L4 specimens were submitted to µCT analysis to assess the following parameters of the bone microarchitecture: bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular spacing (Tb.Sp). RESULTS: The D group exhibited lower values of BV/TV (%) and numbers of trabeculae compared with the C group at 6 and 8 weeks and compared with the CD group at 8 weeks. The CD group exhibited higher trabecular thickness values compared with the D group at 8 weeks. There were no differences between the groups regarding the spaces between the trabeculae. CONCLUSION: Induced diabetes affected the microarchitecture of the trabecular bone of the vertebrae by reducing the values of the majority of the parameters in relation to those of the control group. Glycemic control with insulin appears to protect bones from the effects of the hyperglycemia.
Assuntos
Doenças Ósseas/prevenção & controle , Osso Esponjoso/diagnóstico por imagem , Diabetes Mellitus Experimental/tratamento farmacológico , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Animais , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/etiologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/diagnóstico por imagem , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Masculino , Ratos , Ratos WistarRESUMO
In X-linked hypophosphatemic (XLH) rickets, dual-energy X-ray absorptiometry (DXA) measurements must be analyzed with caution. High-resolution peripheral quantitative computed tomography (HR-pQCT) analysis suggested that XLH primarily affects the cancellous compartment, with the tibia more affected than the radius. Effective treatment of XLH appears to positively affect bone mineralization, mainly in the bone cortex. INTRODUCTION: The purpose of this study is to evaluate bone mineral density (BMD) and microarchitecture in 37 patients (13 children and 24 adults) with XLH confirmed by PHEX mutations from a tertiary center compared to healthy controls. METHODS: Areal BMD (aBMD) was evaluated by DXA, whereas volumetric BMD (vBMD) and microarchitectural parameters were analyzed by HR-pQCT. RESULTS: Adult XLH patients had higher lumbar aBMD (p < 0.01) than the controls. At the radius, the vBMD was similar between XLH patients and controls. At the tibia, XLH patients had lower total vBMD (p = 0.04), likely resulting from decreased trabecular vBMD (p < 0.01), and this difference was observed in the children and adult groups. Analysis based on metabolic status showed that the adult XLH patients with non-compensated disease had lower cortical vBMD at the tibia than the compensated XLH patients (p = 0.03). The microarchitectural differences at the radius and tibia included lower trabecular number (p < 0.01), greater trabecular separation (p < 0.01), and higher trabecular network inhomogeneity (p < 0.01) in XLH patients compared to their controls. At the radius, adults exhibited greater trabecular deficits than were seen in children. CONCLUSIONS: In XLH patients, DXA measurements must be analyzed with caution due to the interference of anatomic and anthropometric factors. HR-pQCT analysis suggested that XLH primarily affects the cancellous compartment, with the tibia more affected than the radius. Effective treatment of XLH appears to positively affect bone mineralization, mainly in the bone cortex.
Assuntos
Densidade Óssea/fisiologia , Raquitismo Hipofosfatêmico Familiar/fisiopatologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Raquitismo Hipofosfatêmico Familiar/diagnóstico por imagem , Raquitismo Hipofosfatêmico Familiar/patologia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/patologia , Rádio (Anatomia)/fisiopatologia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
Hypoparathyroidism (HypoPT) is an uncommon endocrine disorder characterized by chronic deficiency or absence of parathyroid hormone (PTH), which leads to a profound reduction in bone remodeling. Subjects with HypoPT typically have bone mineral densities (BMDs) by dual-energy X-ray absorptiometry (DXA) above average at all skeletal sites, with greatest scores observed at the lumbar spine. Trabecular bone score (TBS), an indirect measure of bone microarchitecture, also appears to be normal in HypoPT. By peripheral quantitative computed tomography (pQCT) of the radius, volumetric BMD at cancellous and cortical compartments, as well as cortical area and thickness, are greater in hypoparathyroid subjects than in controls. The use of high-resolution pQCT (HRpQCT) confirmed the increase in cortical volumetric BMD but demonstrated reduced cortical thickness, associated with lower cortical porosity in HypoPT. Trabeculae tend to be more numerous but thinner in hypoparathyroid subjects. It is not clear whether these structural and the dynamic skeletal abnormalities in HypoPT affect bone strength or fracture risk. Treatment of HypoPT with PTH leads to improvement in bone remodeling rate, variable changes in bone density, and a transient increase in estimated bone strength. The effect of PTH therapy on fracture risk remains unknown. This article reviews skeletal involvement and the effect of PTH treatment in patients with HypoPT, as assessed by DXA, TBS, QCT, and HRpQCT. Data on bone strength and fracture risk in HypoPT are also reviewed here.
Assuntos
Densidade Óssea/fisiologia , Hipoparatireoidismo/fisiopatologia , Absorciometria de Fóton/métodos , Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Remodelação Óssea/fisiologia , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/fisiopatologia , Humanos , Hipoparatireoidismo/diagnóstico por imagem , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/epidemiologia , Fraturas por Osteoporose/epidemiologia , Proteína Relacionada ao Hormônio Paratireóideo/farmacologia , Proteína Relacionada ao Hormônio Paratireóideo/uso terapêutico , Fragmentos de Peptídeos/farmacologia , Fragmentos de Peptídeos/uso terapêutico , Tomografia Computadorizada por Raios X/métodosRESUMO
We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
Assuntos
Osso e Ossos/patologia , Doença Celíaca/dietoterapia , Doença Celíaca/patologia , Dieta Livre de Glúten , Absorciometria de Fóton , Adulto , Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Cálcio/metabolismo , Estudos de Casos e Controles , Demografia , Suplementos Nutricionais , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Vitamina D/uso terapêutico , Adulto JovemRESUMO
A diminuição de massa óssea concomitante à progressão da idade resulta em maior incidência de fraturas, devido a mudanças microarquiteturais que são determinantes importantes para a qualidade óssea. Concomitantemente, mecanismos moleculares que agem na manutenção celular como a autofagia podem estar relacionados ao "turnover" ósseo no período do envelhecimento, sendo estes mecanismos relacionados ao processo de osteopenia/osteoporose. Neste estudo foram avaliados os efeitos do treinamento de força (TF) na microestrutura do colo do fêmur de ratas Wistar adultas (7 meses) e velhas (21 meses) submetidas ou não ao programa de exercício físico e distribuídas nos grupos: adultas não exercitadas (A/NEX); adultas exercitadas (A/EX); velhas não exercitadas (V/NEX) e velhas exercitadas (V/EX). O treinamento de força foi realizado utilizando-se escada com carga atrelada à cauda dos animais; 3 vezes por semana durante período de 120 dias. Resultados obtidos por microtomografia computadorizada (µCT) após este período demonstraram que o TF foi capaz de aumentar a espessura (Ct. Th (mm); V/EX vs A/EX p = 0,7863), momento polar de inércia médio (pMOI (mm4 ); A/NEX vs A/EX p = 0,0362; V/NEX vs V/EX p = 0,0032) e reduzir a porosidade da região cortical do colo do fêmur (Ct. Po (%); V/NEX vs V/EX p = 0,0406), causando aumento na área cortical total (Tt.Ar (mm²); V/NEX vs V/EX p = 0,0406). No osso trabecular notou-se maior fração do volume ósseo (BV/TV (%); V/NEX vs V/EX p = 0,006); espessura trabecular (Tb.Th (mm); V/NEX vs V/EX p = 0,0069; V/EX vs A/EX p<0,0001); número de trabéculas (Tb.N (1/mm) V/NEX vs V/EX p = 0,0004) e grau de anisotropia ( DA V/NEX vs V/EX p = 0,0088). Estas modificações resultaram em redução do espaçamento trabecular (Tb.Sp (mm) V/EX vs A/EX p = 0,0382) e porosidade trabecular (Tb.Po (%) V/NEX vs V/EX p = 0,0006). Além destes parâmetros da estrutura cortical e trabecular, foram avaliados: capacidade de carregamento voluntário máximo (CCVM); peso corporal, do útero e do tecido adiposo retroperitoneal; biomarcadores para fosfatase alcalina plasmática (FAL) e fosfatase ácida resistente à tartarato sérica (TRAP); densidade mineral óssea areal (DMOa), Western blot para beclina-1, LC3, sequestossoma-1/p62 (SQSTM-1/p62), AKT, ERK1//2, pAKT (Ser473), pERK (Thr202/ Tyr204); e imunoistoquímica (IHQ) para RUNX-2, FAL, TRAP, Osteocalcina (OCN) e beclina-1. As dosagens plasmáticas evidenciaram aumento na atividade da FAL após a realização do TF (A/NEX vs A/EX p = 0,0002). Concentrações plasmáticas de TRAP não apresentaram alterações significantes. Análises de marcadores autofágicos mostraram maior expressão para beclina-1 em A/EX e V/EX. LC3 também obteve elevada expressão em A/EX, mas em V/EX sua expressão foi menor. A expressão de SQSTM1/p62 foi reduzida após a realização do TF nas ratas A/EX e V/EX. AKT total (t-AKT) e AKT fosforilada (pAKT-Ser473) demonstrou expressão mais alta em A/EX comparados à A/NEX. Por outro lado, em V/EX, a fosforilação foi reduzida em Ser473 quando comparados à V/NEX, mas t-AKT permaneceu inalterada em ambos. Resultados para ERK1/2 demonstraram redução na expressão em A/EX comparados à A/NEX, mas em V/EX sua expressão foi melhorada comparados à V/NEX. A fosforilação de ERK em Thr202 foi aumentada em A/EX em relação à A/NEX, mas em ratas velhas não houveram modificações. No sítio Tyr204 também houve elevada fosforilação em A/EX comparados à A/NEX, mas foi reduzida em V/EX comparados à V/NEX. A imunomarcação de RUNX-2, FAL, OCN e beclina-1 foi menor em V/NEX mas em V/EX a marcação aumentou assemelhando -se à A/EX. TRAP, elevada em V/NEX, mostrou -se reduzida em V/EX. Em suma, neste estudo nós demonstramos a atuação do TF no metabolismo ósseo de ratas no período da periestropausa com resposta integrada entre exercício e idade. Este estudo também demonstrou que proteínas importantes relacionadas à regulação autofágica e metabolismo ósseo podem ser potencialmente alteradas pelo TF. Nossos resultados evidenciam atuação do TF na manutenção da massa óssea mostrando que essa modalidade de exercício pode prevenir e/ou diminuir danos causados pela osteoporose durante o estágio do envelhecimento(AU)
The decrease in bone mass concomitant with the progression of age results in a higher incidence of fractures, due to microarchitectural changes that are important determinants of bone quality. Concomitantly, molecular mechanisms that act in cellular maintenance such as autophagy may be related to bone turnover in the aging period, and these mechanisms are related to the osteopenia/osteoporosis process. In this study were evaluated, the effects of strength training (ST) on the femoral neck microstructure of adult (7 months) and old (21 months) female Wistar rats submitted or not to the physical exercise program and distributed in the following groups: nonexercised adult groups (A/NEX); exercised adults (A/EX); non-exercised old (O/NEX) and old exercised (O/EX). Strength training was performed using a ladder with load attached to the tail of the animals; 3 times a week for a period of 120 days. Results obtained by computerized microtomography (µCT) after this period demonstrated that the ST was able to increase the thickness (Ct.Th (mm), O/EX vs A/EX p = 0.7863), mean polar moment of inertia (mm4 ), A/NEX vs A/EX p = 0.0362, O/NEX vs O/EX p = 0.0032) and reduce the porosity of the cortical region of the femoral neck (Ct Po (%); O/NEX vs O/EX p = 0.0406), causing increase in the total cortical area (Tt.Ar (mm²); O/NEX vs O/EX p = 0.0406). In trabecular bone, a higher fraction of bone volume was observed (BV / TV (%), O/NEX vs O/EX p = 0.006); (Tb.Th (mm); O/NEX vs O/EX p = 0.0069; O/EX vs A/EX p <0.0001); number of trabeculae (Tb.N (1/mm) O/NEX vs O/EX p = 0.0004) and degree of anisotropy (DA O/NEX vs O/EX p = 0.0088). These changes resulted in a reduction in trabecular spacing (Tb.Sp (mm) O/EX vs A/EX p = 0.0382) and trabecular porosity (Tb.Po (%) O/NEX vs O/EX p = 0.0006 ). In addition to these parameters of the cortical and trabecular structure, the following were evaluated: maximum voluntary carrying capacity (MVCC); body weight, uterus and retroperitoneal adipose tissue; biomarkers for plasmatic alkaline phosphatase (ALP) and serum tartrate resistant acid phosphatase (TRAP); Western blot for beclin-1, LC3, sequestosome-1/p62 (SQSTM-1 / p62), AKT, ERK1/2, pAKT (Ser473), pERK (Thr202/Tyr204) and immunohistochemistry (IHC) for RUNX-2, ALP, TRAP, osteocalcin (OCN) and beclin-1. Plasma dosages showed an increase in ALP activity after ST (A/NEX vs A/EX p = 0.0002). Plasmatic concentrations of TRAP did not show significant alterations. Analyzes of autophagic markers showed higher expression for beclin-1 in A/EX and O/EX. LC3 also had higher expression in A/EX, but in O/EX its expression was lower. Expression of SQSTM1/p62 was reduced after ST in the A/EX and O/EX rats. Total AKT (t-AKT) and phosphorylated AKT (pAKT-Ser473) demonstrated higher expression in A/EX compared to A/NEX. On the other hand, in O/EX, phosphorylation was reduced in Ser473 when compared to O/NEX, but t-AKT remained unchanged in both. Results for ERK1/2 demonstrated reduction in A/EX expression compared to A/NEX, but in O/EX their expression was improved compared to O/NEX. ERK phosphorylation in Thr202 was increased in A/EX relative to A/NEX, but in old rats there were no changes. At the Tyr204 site there was also high A/EX phosphorylation compared to A/NEX, but was reduced in O/EX compared to O/NEX. Immunostaining of RUNX-2, FAL, OCN and beclin-1 was lower in O/NEX but in O/EX the labeling increased resembling A/EX. TRAP, high in O/NEX, was reduced in O/EX. In summary, in this study we demonstrated the action of ST in bone metabolism of rats in periestropause period with integrated response between exercise and age. This study also demonstrated that important proteins related to autophagic regulation and bone metabolism may be potentially be altered by ST. Our results demonstrate the role of ST in maintaining bone mass, showing that this exercise modality can prevent and/or reduce osteoporosis damage during the aging stage(AU)
Assuntos
Animais , Ratos , Envelhecimento , Autofagia , Exercício Físico , Osteoporose , Osso e Ossos , Doenças Ósseas MetabólicasRESUMO
More than 50% of untreated patients with celiac disease (CD) have bone loss detected by bone densitometry (dual-energy X-ray absorptiometry:DXA). Moreover, patients with CD are more likely to have osteoporosis and fragility fractures, especially of the distal radius. Although still controversial, we recommend DXA screening in all celiac disease patients, particularly in those with symptomatic CD at diagnosis and in those who present risk factors for fracture such as older age, menopausal status, previous fracture history, and familial hip fracture history. Bone microarchitecture, especially the trabecular network, may be deteriorated, explaining the higher fracture risk in these patients. Adequate calcium and vitamin D supplementation are also recommended to optimize bone recovery, especially during the first years of gluten free diet (GFD). If higher fracture risk persists after 1 or 2 years of GFD, specific osteoactive treatment may be necessary to improve bone health.
Assuntos
Doença Celíaca/complicações , Fraturas Ósseas/epidemiologia , Densidade Óssea , Doenças Ósseas/etiologia , Doenças Ósseas/patologia , Osso e Ossos/patologia , Doença Celíaca/dietoterapia , Dieta Livre de Glúten , Fraturas Ósseas/etiologia , HumanosRESUMO
Intrínsecamente, se acepta el hecho de que definir a la osteoporosis solamente sobre la base de la densidad mineral ósea proyectada (DMO mediante DXA) ha llegado a su límite. De hecho, el aspecto multifactorial de esta enfermedad hace que la definición actual de osteoporosis evolucione hacia un modelo de riesgo complejo basado en el Factor de Riesgo Clínico (FRC) y la DMO. El puntaje óseo trabecular (TBS, Trabecular Bone Score) es una nueva medición de escala de grises que se basa en el uso de variogramas experimentales sobre imágenes en proyección 2D, y que permite diferenciar entre dos microarquitecturas tridimensionales (3D) que presentan la misma densidad ósea pero diferentes características trabeculares. El TBS mide la tasa promedio de variación local en escala de grises sobre imágenes de proyección 2D. Este parámetro se obtiene luego del re-análisis de un examen de DXA, y puede compararse con la DMO dado que ambos evalúan la misma región ósea. El valor agregado del TBS respecto de la densitometría mineral ósea para la evaluación del riesgo de fracturas ha sido documentado en estudios transversales, prospectivos y longitudinales. De hecho, se ha hallado que el TBS: 1) es más bajo en mujeres posmenopáusicas con una fractura osteoporótica previa, comparado con mujeres sin fractura pareadas por edad y DMO; 2) brinda un aumento incremental en el odds ratio para fractura de columna cuando se combina con la DMO de columna; 3) es más bajo en mujeres con fracturas (comparado con aquellas sin fracturas), independientemente de si su DMO reúne los criterios para osteoporosis u osteopenia; 4) predice fracturas en forma prospectiva, tal como lo hace la DMO; 5) rescata alrededor de 1/3 de las fracturas clasificadas de manera errónea según la definición de DMO de la OMS para osteoporosis aislada; y 6) se comporta de manera diferente de acuerdo con el tipo de terapia ósea implementada. El objetivo de esta breve revisión consiste en brindar información acerca de los ensayos clínicos actuales referentes al TBS, además de posicionar a este parámetro en la práctica clínica como complemento de la DMO en vista de su actual validación.
Intrinsically it is accepted that defining osteoporosis on the sole basis of projected bone mineral density (BMD by DXA) has reached its limit. Indeed, the multifactorial aspect of this disease means that the current definition of osteoporosis is evolving towards a complex risk model based on Clinical Risk Factor (CRF) and BMD. The Trabecular Bone Score (TBS) is a novel grey-level texture measurement that is based on the use of experimental variograms of 2D projection images, and is able to differentiate between two 3-dimensional (3D) micro-architectures that exhibit the same bone density, but different trabecular characteristics. TBS measures the mean rate of local variation of grey levels in 2D projection images. The TBS is obtained after re-analysis of a DXA exam, and can be compared with BMD, since both evaluate the same region of bone. The added value of the TBS in bone mineral densitometry for fracture risk assessment has been documented in cross-sectional, prospective and longitudinal studies. Indeed, TBS has been found to: 1) be lower in post-menopausal women with a past osteoporotic fracture compared with age- and BMD-matched women without fracture; 2) give an incremental increase in the odds ratio for spine fracture when combined with spine BMD; 3) be lower in women with (versus without) fractures, irrespective of whether their BMD met the criteria for osteoporosis or osteopenia; 4) prospectively predict facture as well as spine BMD; 5) recapture around 1/3 of mis-classified fractures according to the BMD WHO definition of osteoporosis alone, and 6) react differently according to the type of bone therapy. The aim of this short review is to report the current clinical studies as well as to position TBS in clinical routine to complement BMD in the light of its current validation.
Assuntos
Humanos , Osteoporose , Absorciometria de Fóton , Densidade Óssea/efeitos da radiação , Osso EsponjosoRESUMO
Os bisfosfonatos são medicamentos amplamente e efetivamente utilizados para o tratamento de doenças osteolíticas. Entretanto, na cavidade oral, é de particular relevância, pois possuem como efeito adverso a osteonecrose dos maxilares induzida pelo uso de bisfosfonatos. Sua etiopatogenia ainda não é bem estabelecida, os métodos de detecção são insatisfatórios e as terapias recomendadas são por vezes, medidas paliativas e ineficazes. Pouco ainda é sabido sobre o efeito do Ácido Zoledrônico na microestrutura óssea, portanto, propusemo-nos a realizar um estudo em modelo animal que analisasse o trabeculado ósseo da mandíbula através da Micro-CT. Foram utilizados 24 ratos machos (Rattus novergicus, albinus, Wistar), com 12 semanas de vida, divididos em 2 grupos: grupo controle (cloreto de sódio 0,9%) e grupo ácido zoledrônico (ácido zoledrônico 0,6mg/kg). As substâncias foram administradas via intraperitoneal a cada 28 dias em um total de 5 doses. Após 150 dias do início do experimento, foi realizada a eutanásia dos animais e então as amostras foram preparadas e escaneadas (Skyscan 1174) para análise da microestrutura óssea através da Micro- CT. O teste t-student demonstrou diferença estatisticamente significativa (p<0,05) em todos os fatores: volume ósseo, densidade óssea, fator de padrão trabecular, índice de modelo estrutural, espessura trabecular, separação trabecular, porosidade total exceção de número de trabéculas e volume tecidual, demonstrando que há alterações significativas na estrutura trabecular pelo uso de bisfosfonatos. O grupo medicado com ácido zoledrônico comparado ao grupo controle demonstrou trabéculas mais espessas, menos separadas e com menores ligações...
Bisphosphonates are widely and effectively drugs used for the treatment of osteolytic disorders. However, in the oral cavity, this situation is of particular relevance as it can lead to bisphosphonate related osteonecrosis of the jaws. Its etiopathogenesis is still not established, detection methods are unsatisfactory and recommended therapies are sometimes palliative and often ineffective. Little is known about the effect of zoledronic acid on the quality of trabecular bone, therefore, we proposed to conduct a study in an animal model to examine the trabecular bone of the jaw through the Micro-CT. 24 male rats were used (Rattus norvegicus, Albinus, Wistar), with 12 weeks old, divided into 2 groups: control group (sodium chloride 0.9%) and group with zoledronic acid (zoledronic acid 0.6 mg / kg). The substances were administered intraperitoneally every 28 days for a total of 5 doses. After 150 days from the beginning of the experiment, the animals were sacrificed and then the samples were prepared and scanned (Skyscan 1174) for analysis of the bone microstructure through Micro-CT. The "t-student" test demonstrated statistically significant differences (p<0.05) in all factors: bone volume, osseous density, trabecular pattern, structure model index, trabecular thickness, trabecular separation, total porosity except trabecular number and tissue volume, demonstrating that there are significant changes in the trabecular structure of the bisphosphonates. Zoledronic Acid compared to control group shows thicker, less separate and lower connected trabeculae...