1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Carnevale A, Pellegrino F, Bravi B, Gamberini MR, Gagliardi I, Reverberi R, Zatelli MC, Giganti M, Ambrosio MR. The role of opportunistic quantitative computed tomography in the evaluation of bone disease and risk of fracture in thalassemia major. Eur J Haematol 2022; 109:648-655. [PMID: 36000276 PMCID: PMC9826074 DOI: 10.1111/ejh.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Dual-energy X-ray absorptiometry (DXA) remains the cornerstone for osteoporosis evaluation in Thalassemia major. However, several drawbacks have been observed in this unique setting. We sought to determine the correlation between quantitative CT (QCT) and DXA-derived parameters; secondarily, we aimed to investigate the role of the two techniques in predicting the risk of fracture. METHODS We retrospectively included patients with β-thalassemia major who had undergone both lumbar and femoral DXA examinations, and CT scans including the lumbar spine, performed for disparate diagnostic issues, within 4 months from the DXA. CT data were examined employing a phantom-less QCT method for bone mineral density (BMD) assessment. We also retrieved any spontaneous or fragility fractures occurring from 1 year before up to 5 years after the date of DXA scans. RESULTS The 43 patients were included. QCT measures were significantly higher than those determined by DXA. The gap between QCT and DXA values was strongly associated with patient age. The most powerful predictive variable for risk of fracture was the ACR classification based on volumetric BMD obtained by QCT. CONCLUSIONS DXA provided more negative measures than those determined by QCT. However, QCT seemed to evaluate thalassaemic osteopathy better than DXA, since volumetric BMD was a stronger predictor of fracture.
Collapse
Affiliation(s)
- Aldo Carnevale
- Department of Translational Medicine, Section of RadiologyUniversity of FerraraFerraraItaly
| | - Fabio Pellegrino
- Department of Translational Medicine, Section of RadiologyUniversity of FerraraFerraraItaly
| | - Beatrice Bravi
- Department of Translational Medicine, Section of RadiologyUniversity of FerraraFerraraItaly
| | - Maria Rita Gamberini
- Unit of Thalassaemia and Haemoglobinopathies Day Hospital, Regional HUB Centre, Department of MedicineAzienda Ospedaliero‐Universitaria Sant'AnnaFerraraItaly
| | - Irene Gagliardi
- Department of Medical Sciences, Section of Endocrinology and Internal MedicineUniversity of FerraraFerraraItaly
| | - Roberto Reverberi
- Blood Transfusion ServiceAzienda Ospedaliero‐Universitaria Sant'AnnaFerraraItaly
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology and Internal MedicineUniversity of FerraraFerraraItaly
| | - Melchiore Giganti
- Department of Translational Medicine, Section of RadiologyUniversity of FerraraFerraraItaly
| | - Maria Rosaria Ambrosio
- Department of Medical Sciences, Section of Endocrinology and Internal MedicineUniversity of FerraraFerraraItaly
| |
Collapse
|
3
|
Crabtree NJ, Roper H, Shaw NJ. Cessation of ambulation results in a dramatic loss of trabecular bone density in boys with Duchenne muscular dystrophy (DMD). Bone 2022; 154:116248. [PMID: 34718220 DOI: 10.1016/j.bone.2021.116248] [Citation(s) in RCA: 6] [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: 08/25/2021] [Revised: 10/12/2021] [Accepted: 10/26/2021] [Indexed: 11/02/2022]
Abstract
Glucocorticoids are currently used to improve muscle strength and prolong ambulation in boys with DMD although the effect on bone health is still unclear. The aim of this study was to compare bone strength in healthy children and boys with DMD and investigate the interaction between diminished muscle function, loss of ambulation and high dose oral steroids, over a two year time frame. Fifty children were studied, 14 healthy boys (HB), 13 boys with DMD who remained ambulant (DMD-RA) and 23 boys with DMD who lost ambulation (DMD-LA). All boys with DMD had taken oral glucocorticoids. Peripheral quantitative computed tomography was used to measure bone geometry, density, strength and muscle mass of the non-dominant tibia and radius. Measurements were made at baseline, 12 and 24 months at the distal metaphysis and mid diaphysis sites. Differences between the three groups were evaluated using ANOVA and a repeated measures model. There were no significant differences in age between the groups: mean age was 9.4, 8.7 and 8.8 years for HB, DMD-RA and DMD-LA, respectively. There was no significant difference in steroid exposure between the DMD groups. However, boys who lost ambulation had significantly lower muscle function at baseline (North Star Ambulatory Assessment DMD-RA 23.6 vs. DMD-LA 18.8; p < 0.05). At baseline, healthy boys had significantly greater trabecular bone density at the distal radius /ulna (23%/27%) and distal tibia/fibula (30%/46%) than boys with DMD (p < 0.05). They also had significantly larger diaphyseal tibiae/fibulae (74%/36%) and radii/ulnae (49%/31%) with thicker corticies and consequently greater bone strength. In contrast, boys with DMD had greater cortical density (4%). Over time, there were small significant differences in the rate of change of both muscle and bone parameters between healthy boys and boys with DMD. For both ambulant and non-ambulant boys with DMD the greatest changes in cortical bone were evident at the tibia. After two years boys with DMD had on average, 63% less bone strength than healthy boys. However, the most strikingly significant difference was in trabecular bone density for boys who became non-ambulant. By 2 years non-ambulant DMD boys had 53% less trabecular bone density at distal tibia than their healthy age matched peers compared with boys who remained ambulant who had 27% less trabecular bone density. In conclusion, bone and muscle strength is reduced for all boys with DMD even while they remain ambulant. However, tibia trabecular bone density loss is significantly accelerated in DMD boys who lose independent ambulation compared to DMD boys who remain ambulant despite equivalent levels of corticosteroid exposure.
Collapse
Affiliation(s)
- N J Crabtree
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; Department of Paediatrics, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - H Roper
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - N J Shaw
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; Department of Paediatrics, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
4
|
Shanas N, Querido W, Dumont A, Yonko E, Carter E, Ok J, Karchner JP, Barbe MF, Ali S, Patil C, Raggio C, Pleshko N. Clinical application of near infrared fiber optic spectroscopy for noninvasive bone assessment. JOURNAL OF BIOPHOTONICS 2020; 13:e201960172. [PMID: 31957205 DOI: 10.1002/jbio.201960172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/27/2019] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
Approaches for noninvasive bone quality assessment are of great clinical need, particularly in individuals that require close monitoring of disease progression. X-ray measurements are standard approaches to assess bone quality; however, they have several disadvantages. Here, a nonionizing approach for noninvasive assessment of the second metacarpal bone based on near infrared (NIR) spectroscopy was investigated. Transcutaneous bone signal detection was experimentally confirmed with cadaveric hand data, and Monte Carlo modeling further indicated that 50% of the measured signals arise from bone. Spectral data were collected via a NIR fiber optic from the bone of individuals with osteogenesis imperfecta, a disease marked by frequent bone fractures and fragility. Multiple significant correlations were found between spectral parameters related to water, protein and fat, and standard bone quality parameters obtained by X-ray measurements. The results from this preliminary study highlight the potential application of NIR spectroscopy for the noninvasive assessment of bone quality.
Collapse
Affiliation(s)
- No'ad Shanas
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - William Querido
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Alexander Dumont
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Elizabeth Yonko
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Erin Carter
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jina Ok
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - James P Karchner
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Chetan Patil
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| | - Cathleen Raggio
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Nancy Pleshko
- Department for Bioengineering, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
5
|
Ahn MB, Suh BK. Bone morbidity in pediatric acute lymphoblastic leukemia. Ann Pediatr Endocrinol Metab 2020; 25:1-9. [PMID: 32252210 PMCID: PMC7136509 DOI: 10.6065/apem.2020.25.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL), currently the most common pediatric leukemia, has a high curability rate of up to 90%. Endocrine disorders are highly prevalent in children with ALL, and skeletal morbidity is a major issue induced by multiple factors associated with ALL. Leukemia itself is a predominant risk factor for decreased bone formation, and major bone destruction occurs secondary to chemotherapeutic agents. Glucocorticoids are cornerstone drugs used throughout the course of ALL treatment that exert significant effects on demineralization and osteoclastogenesis. After completion of treatment, ALL survivors are prone to multiple hormone deficiencies that eventually affect bone mineral accrual. Dual-energy X-ray absorptiometry, the most widely used method of measuring bone mineral density, is used to determine the presence of childhood osteoporosis and vertebral fracture. Supplementation with calcium and vitamin D, administration of pyrophosphate analogues, and promotion of mobility and exercise are effective options to prevent further bone resorption and fracture incidence. This review focuses on addressing bone morbidity after pediatric ALL treatment and provides an overview of bone pathology based on skeletal outcomes to increase awareness among pediatric hemato-oncologists and endocrinologists.
Collapse
Affiliation(s)
- Moon Bae Ahn
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Byung-Kyu Suh
- Department of Pediatrics, College of Medicine, Catholic University of Korea, Seoul, Korea,Address for correspondence: Byung-Kyu Suh, MD, PhD Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-6756 Fax: +82-2-537-4544 E-mail:
| |
Collapse
|
6
|
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: 10] [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.
Collapse
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.
| |
Collapse
|