Factors influencing bone mineral density in postpartum women

Background: Osteopenia is a common condition. Therefore, identification of groups for prevention of osteoporosis and restoration of bone mineral density (BMD) remains relevant. Aim: to assess the factors contributing to development of osteopenia in puerperas. Methods: prospective cross-sectional study. We examined 112 patients aged 20-35, 3-5 days after delivery. To assess possible factors for BMD decrease, we analyzed medical history, lifestyle, nutrition, anthropometric data, obstetric and gynecological history, and pregnancy course. We also assessed serum levels of 25-hydroxycalciferol (25-OH-D) and PTH. BMD was measured by dual energy x-ray osteodensitometry. We considered Z-score from -1 to -2.5SD as osteopenia, below -2.5 SD-as osteoporosis. Results: based on Z-score values, two groups were formed: 1 (n=70) - puerperas with osteopenia, 2 (n=42) - puerperas with normal BMD. In the first group, osteopenia in the distal radius was observed in 48%, in the lumbar spine in 16% and in the proximal femur in 36%. Influence of the following possible factors in group 1 was established: BMI in 15-20 years ≤ 18 kg/m2 (p<0.013), BMI ≥ 25 kg/m2 (p<0.018), 25-OH-D less than 25 ng / ml (p < 0.0018), calcium intake less than 800 mg/day (p<0.041). Menstrual disorders (p<0.052) and preeclapsia (p < 0.042) affected lumbar spine BMD. In group 1, vitamin D deficiency was detected in 82% of women, 18% showed vitamin D insufficiency; in group 2, vitamin D deficiency was found in 16%, deficiency in 70%, in 14% vitamin D was normal. In women with a combination of factors such as BMI≤ 18 kg/m; calcium intake lower than 800 mg/day, menstrual cycle disorders, vitamin D deficiency - osteopenia in the distal radius occured 11 times more often (OR=11,47059; CI 95%=[4,0326; 32,627]). Conclusion: most significant impact on BMD decrease in puerperas can be expected if patient has the following risk factors: BMI≤18 kg/m2; 25-OH- D<25 ng/ml ; nutrition with calcium intake <800 mg per day, preeclampsia. Combination of these factors may increase the risk of osteopenia in the distal radius.

Download Full-text

Bone Mineral Density in Children with Sickle Cell Disease (SCD) Is Low and Not Related to Disease Severity, Vitamin D Status, or Bone Hyperresorption

Blood ◽

10.1182/blood.v112.11.4793.4793 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4793-4793

Author(s):

Emeline Chapelon ◽

Michele Garabedian ◽

Valentine Brousse ◽

Jean-Claude Souberbielle ◽

Jean-Louis Bresson ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Lumbar Spine ◽

Bone Resorption ◽

Vitamin D Deficiency ◽

Calcium Intake ◽

Leukocyte Count ◽

Vitamin D Status ◽

Z Score ◽

Mineral Density

Abstract Background: SCD is characterized by HbS polymerization, chronic hemolytic anemia, and recurrent acute painful episodes. Recent data have established that SCD patients have chronic inflammation, with endothelium activation related to hypoxia/reoxygenation cycles and reperfusion injury, increased inflammatory markers, and enhanced endothelium adhesion of red cells and leukocytes. The bone is a key target of SCD, being the site of both acute events (painful crises and infections) and chronic changes. Osteopenia and osteoporosis are reported in 30 to 40% of adults with SCD. By analogy with thalassemia, bone marrow hyperplasia secondary to chronic anemia has been hypothesized to be a causative factor. The prevalence of low bone mineral density (BMD) is not known in children. Aim: We assessed BMD in a cohort of SCD children and looked for correlations between BMD and age, gender, SCD severity, growth and pubertal development, serum vitamin D, calcium intake, and markers of bone turnover. Methods: Fifty-three children (45 SS, 4 SC, 4 Sb-thalassemia), 27 females, and 26 males, with a mean age of 12.8±2.4 y (9–19 y) were enrolled between 2002 and 2006. They originated from: West and Central Africa (n=41), the Caribbean (n=8), North Africa (n=3), and Brazil (n=1). We assessed height; weight; sexual maturation (Tanner); number of hospitalizations and of painful crises and of transfusions in the last 3 years; calcium intake; steady-state hemoglobin (Hb) and leukocyte count; calcemia, phosphatemia, calciuria/creatinuria; 25-OH D and PTH concentrations; osteocalcin, urinary deoxypyridinolin (DPD) and C-terminal component of pro-collagen type I (CTX). BMD was assessed using a dual X-ray absorptiometry (DXA). Results: In the overall population, mean lumbar spine z-score was −1.1±1.3 (−3.9–1.8), females had non-significantly lower values (−1.42±0.29) than males (−0.77±0.28). In prepubertal children, lumbar spine z-score was lower in females (−1.74±0.27) than in males (−0.53±0.31) (p=0.01). BMD did not correlate with hospitalization and transfusion episodes, Hb, or leukocytes counts. Hb and leukocyte count were inversely correlated (p=0.02) and leukocytosis was correlated to the number of hospitalizations (p<0.0001). Vitamin D deficiency (25-OH D<10 ng/ml) was found in 72% of patients and secondary hyperparathyroidism (PTH>46 pg/ml) in 38%. BMD was not related to calcium intake, vitamin D status, osteocalcin, or bone resorption markers. The normal or low osteocalcin and CTX values argue against increased bone resorption as the cause of the low BMD. Mean serum IGF concentrations measured in 7 children were low (134±98 ng/ml) Conclusion: A slight decrease of BMD was observed in SCD children, starting before puberty and being more marked in females. This low BMD was not related to the disease severity or to bone hyperresorption, suggesting that biphosphonates would be unhelpful. Neither was it related to vitamin D deficiency. The most likely cause is abnormal bone formation. Future research should focus on the mechanisms involved, with the goal of preventing osteoporosis in adults with SCD.

Download Full-text

Effects of vitamin D deficiency and daily calcium intake on bone mineral density and osteoporosis in Korean postmenopausal woman

Obstetrics & Gynecology Science ◽

10.5468/ogs.2017.60.1.53 ◽

2017 ◽

Vol 60 (1) ◽

pp. 53 ◽

Cited By ~ 3

Author(s):

Seung Joo Chon ◽

Yae Kyu Koh ◽

Jin Young Heo ◽

Jinae Lee ◽

Min Kyoung Kim ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Postmenopausal Woman ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Calcium Intake ◽

Mineral Density ◽

Daily Calcium Intake

Download Full-text

P1621VITAMIN D SUPPLEMENTATION: CHANGES IN BONE MINERAL DENSITY IN KIDNEY TRANSPLANT PATIENTS WITH LONG TERM DURATION OF THE GRAFT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1621 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yuri Battaglia ◽

Michele Provenzano ◽

Francesco Tondolo ◽

Antonio Bellasi ◽

Pasquale Esposito ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Kidney Transplant ◽

Bone Mineral ◽

Categorical Variables ◽

Z Score ◽

Mineral Density ◽

T Score

Abstract Background and Aims In the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT). Method This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (< 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution. Results Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p<0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia Conclusion Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.

Download Full-text

Bone mineral density and osteoporosis risk in young adults with atopic dermatitis

Scientific Reports ◽

10.1038/s41598-021-03630-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sooyoung Kim ◽

Jimi Choi ◽

Moon Kyun Cho ◽

Nam Hoon Kim ◽

Sin Gon Kim ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Young Adults ◽

Atopic Dermatitis ◽

Lumbar Spine ◽

Young Adult ◽

Bone Mineral ◽

Z Score ◽

Mineral Density ◽

Osteoporosis Risk

AbstractAtopic dermatitis (AD) has been increasing worldwide over the past few decades. AD has been reported to be associated with an increased risk of osteoporosis and fractures in adult AD patients. The aim of this study was to investigate the bone mineral density (BMD) to evaluate osteoporosis risk in young adults with AD by sex. This was a case–control cohort study using a national dataset from the Korea National Health and Nutrition Examination Survey 2007–2009. We included young adult AD patients (men aged 19 ≤ and < 50 years, premenopausal women aged 19 ≤ and < 50 years) and 1:5 propensity score weighting controls by age, sex, body mass index (BMI), vitamin D level, and alcohol/smoking status. BMD was measured by double energy X-ray absorptiometry at the lumbar spine, femur neck, and total femur. The prevalence of low BMD, defined by a Z-score ≤ − 2.0, was compared between AD and without AD. We analyzed 311 (weighted n = 817,014) AD patients and 8,972 (weighted n = 20,880,643) controls. BMD at the lumbar spine was significantly lower in the male AD group than in the male control group (mean ± SE, 0.954 ± 0.016 vs. 0.989 ± 0.002, P = 0.03). The prevalence of low BMD (Z-score) did not significantly differ between AD and non-AD subjects in both men (3.8% vs. 2.7%, P = 0.56) and women (6.4% vs. 3.3%, P = 0.40). Among AD patients, early age at diagnosis of AD, longer duration of AD, lower BMI, rural residence (for men), less education, low vitamin D level, late menarche, and more pregnancies (for women) were associated with low BMD. In conclusion, low BMD did not occur more frequently in young adults with AD than in non-AD controls. However, early-onset/longer AD duration and lower BMI were associated with low BMD among young adult patients with AD.

Download Full-text

OR27-04 Risk Factors For Low Baseline Bone Mineral Density In Gender Diverse Youth

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1296 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Juanita K Hodax ◽

Charles Brady ◽

Sara A DiVall ◽

Kristen Carlin ◽

Hedieh Khalatbari ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Hormone Therapy ◽

Bone Mineral ◽

Calcium Intake ◽

Z Score ◽

Mineral Density ◽

Transgender Youth ◽

Z Scores ◽

Dxa Scans

Abstract Background Sex steroids such as testosterone and estrogen are necessary for accumulation of bone mass. Transgender youth treated with gonadotropin releasing hormone analogues (GnRHa) to block natal puberty for gender-affirming care are at risk of low bone mineral density (BMD). Previous studies indicate that transfemale patients assigned male at birth (AMAB) have low BMD at baseline, during and after GnRHa treatment despite cross hormone treatment. Transmales assigned female at birth (AFAB), however, have normal BMD at baseline that decreases upon GnRHa treatment, with normalization upon cross hormone therapy. The reason(s) for the low baseline BMD in transfemales is unclear. We aimed to assess the baseline characteristics of transgender youth at a single multidisciplinary gender clinic prior to medical intervention and determine factors associated with BMD. Methods This is a retrospective chart review of patients <19 years old evaluated in the gender clinic. Dual-energy x-ray absorptiometry (DXA) scans were obtained prior to initiation of GnRHa or cross-hormone therapy per Endocrine Society guidelines for the treatment of gender dysphoria. We included patients with DXA scans completed prior to initiation of treatment with GnRHa or cross gender hormones and excluded those with concurrent medical diagnoses that may affect bone density. Data collected were bone mineral density (BMD) Z-scores, anthropometric data, vitamin D and calcium levels, and calcium intake. Multivariable linear regression models were used to assess the impact of vitamin D levels, height Z-score, weight Z-score, and BMI Z-score on subtotal body BMD Z-score, adjusted for sex assigned at birth and age. Results Sixty-four patients were included in our analysis. Of these, 73% were AMAB and 27% AFAB. Gender identity was male in 14%, female in 44%, and non-binary in 42%. Average height Z-score was 0.12, weight Z-score 0.27, and BMI Z-score 0.22 (using sex assigned at birth). Subtotal body BMD Z-scores were greater than zero in 11%, between zero and greater than -2 in 59%, and less than or equal to -2 in 30% of tested patients. AMAB patients had lower BMD Z-scores compared to those AFAB (p<0.05 for all Z-scores). There was a positive association with BMI, height, and weight Z-scores and increasing BMD Z-scores after adjusting for sex assigned at birth and age (p<0.05 for all Z-scores). Patients who consumed <2 servings of calcium per day had lower BMD Z-scores (p<0.05 for all Z-scores). Average vitamin D level was 24 ng/ml (+/- 9.5 SD) with no significant association with BMD Z-scores (adjusted for sex assigned at birth). Conclusions Patients AMAB and patients with calcium intake of < 2 servings/day are associated with lower baseline BMD in a cohort of adolescents seen in a multidisciplinary gender clinic. Height, weight, and BMI are associated linearly with BMD Z-score, following patterns previously described in other populations.

Download Full-text

Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism

Osteoporosis International ◽

10.1007/s00198-016-3637-0 ◽

2016 ◽

Vol 27 (10) ◽

pp. 3063-3071 ◽

Cited By ~ 13

Author(s):

M. D. Walker ◽

I. Saeed ◽

J. A. Lee ◽

C. Zhang ◽

D. Hans ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Lumbar Spine ◽

Primary Hyperparathyroidism ◽

Trabecular Bone ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Trabecular Bone Score ◽

Volumetric Bone Mineral Density ◽

Mineral Density

Download Full-text

Juvenile lupus and serum vitamin D levels: A cross-sectional study

Lupus ◽

10.1177/0961203320957721 ◽

2020 ◽

Vol 29 (13) ◽

pp. 1752-1758

Author(s):

Samar abd Alhamed Tabra ◽

Hend Hassan Abdelnabi ◽

Nivine Fathi Mahmoud Darwish ◽

Amal Mohammed El-Barbary ◽

Muhammad Tarek AbdelGhafar ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Healthy Children ◽

Z Score ◽

Mineral Density ◽

Vitamin D Levels ◽

Significant Difference

Background Juvenile systemic lupus erythematosus (JSLE) is usually associated with vitamin D deficiency and low bone mineral density. Objectives To evaluate serum levels of 25-OH vitamin D in JSLE patients and to correlate these findings with disease activity and bone density. Methods This study was conducted on 100 patients with JSLE and 100 healthy children as controls. Disease duration and SLEDAI for disease activity were evaluated. CBC, anti-dsDNA, C3,C4,24hr urinary proteins, creatinine, estimated glomerular filtration rate(e-GFR),Ca,P,PTH, 25 (OH) D levels, and bone mineral density(BMD)Z score were measured. Results There were significant differences in mean 25(OH)D concentration between patients group (19.37 ± 9.72 ng/ml) and controls 35.90 ± 9.66 ng/ml(p < 0.05), with significant difference between active and inactive patients (p < 0.05).There were significant negative correlations between serum 25(OH)D and SLEDAI (r-0.545, p 0.001), steroid dose (r-0.561, p 0.001), anti-dsDNA (r-0.685, p 0.006), 24 hr-proteinuria (r-0.738, p 0.001) and PTH (r-0.335, p 0.001), significant positive correlations between 25(OH)D and C3 (r0.617, p 0.001),C4 (r0.544, p 0.001) serum Ca (r0.424, p 0.001) and Z score (r0.561, p 0.001),with non-significant correlations between 25(OH)D and serum P and both disease & steroid duration, (p > 0.05). Conclusion Vitamin D deficiency is common in JSLE, it’s correlated significantly with disease activity and bone mineral density.

Download Full-text

Vitamin D deficiency and its relationship with bone mineral density among postmenopausal women living in the tropics

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302010000200020 ◽

2010 ◽

Vol 54 (2) ◽

pp. 227-232 ◽

Cited By ~ 31

Author(s):

Francisco Bandeira ◽

Luiz Griz ◽

Eduardo Freese ◽

Daniela Castro Lima ◽

Ana Carolina Thé ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Postmenopausal Women ◽

Bone Mineral ◽

Hypovitaminosis D ◽

Mineral Density ◽

Women Subjects ◽

Group 2 ◽

Group 1

OBJECTIVE: To determine vitamin D (25OHD) status and its relationship with bone mineral density (BMD) in 93 postmenopausal women. SUBJECTS AND METHODS: Patients were distributed in two groups: Group 1 - 51 to 65 years (n = 45) and Group 2 - 66 to 84 years (n = 48); 25OHD and PTH serum were analyzed and a DXA scan of the lumbar spine (LS) and femoral neck (FN) were taken. RESULTS: Mean ± SD of serum 25OHD levels were 80.6 ± 43.3 nmol/L (Group 1) and 63.7 ± 27.6 nmol/L (Group 2); 24% had 25OHD levels < 25 nmol/L and 43.7% < 50 nmol/L. The prevalence of vitamin D deficiency at the 62.5 nmol/L cutoff increased significantly with age. Patients with hypovitaminosis D had a lower BMD at the FN (0.738 ± 0.102 vs. 0.793 ± 0.115 g/cm, p = 0.03) and had been postmenopausal for longer (21.0 ± 8.4 vs. 16.2 ± 8.4 years, p = 0.01). CONCLUSION: We found a high prevalence of hypovitaminosis D in postmenopausal women. Age, years elapsed since menopause and low BMD in the FN were associated with deficiency.

Download Full-text

Vitamin D deficiency as a factor in reducing bone mineral density after childbirth

Journal of obstetrics and women s diseases ◽

10.17816/jowd67660-68 ◽

2018 ◽

Vol 67 (6) ◽

pp. 60-68

Author(s):

Tatyana V. Novikova ◽

Irina E. Zazerskaya ◽

Lyubov V. Kuznetsova ◽

Viktor A. Bart

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Parathyroid Hormone ◽

Lumbar Spine ◽

Vitamin D Deficiency ◽

Bone Mineral ◽

Main Group ◽

Reproductive Age ◽

Distal Forearm ◽

Mineral Density

Hypothesis/aims of study. Physiological pregnancy is not a reliable risk factor for reduced bone mineral density (BMD). The causes affecting BMD in reproductive age, such as smoking, heredity, low physical activity, low body mass index, unbalanced diet, ovarian dysfunction, and vitamin D deficiency are studied. The aim of this study was to assess the contribution of vitamin D deficiency and insufficiency to the development of osteopenia after childbirth. Study design, materials and methods. This is a cohort study conducted in V.A. Almazov National Medical Research Center, Saint Petersburg, Russia in the period from October 2013 to November 2014. We examined 86 puerperas on days 3–5 after delivery. The age of women ranged from 20 to 35 years. Patients were surveyed using the questionnaire on the main risk factors for osteoporosis. The method of dual energy X-ray absorptiometry was used to evaluate BMD in the central and peripheral skeleton. Serum levels of 25-hydroxycalciferol (25(OH)D) and parathyroid hormone were determined in all pregnant women. Results. According to the results of Х-ray osteodensitometry, normal BMD was detected in 45% (n = 38) of puerperas (comparison group), with reduced BMD revealed in 55% (n = 48) of puerperas (main group). The main group was divided into subgroups: osteopenia in the distal forearm was detected in 27 (56%) puerperas, in the proximal femur in 7 (16%) puerperas, and in the lumbar spine in 14 (28%) puerperas. 58-78% of patients showed vitamin D deficiency and insufficiency. In the group with osteopenia, vitamin D deficiency prevails, reaching 78% in women with osteopenia in the forearm, while in the group with normal BMD, vitamin D deficiency predominates in 70% of patients. The mean value of 25(OH)D in serum in the group with osteopenia and that in the group with normal BMD differ 1.5 times. The level of 25(OH)D in postpartum women with osteopenia in the forearm is two times lower, when compared to the group with normal BMD, parathyroid hormone being within reference values. In the group with osteopenia in the lumbar spine, opsooligomenorrhea is more common (p < 0.05), while in the group with osteopenia in the proximal forearm, a possible significant factor was revealed to be preeclampsia (p < 0.05). Conclusion. Osteopenia after childbirth is found in 55% of patients. In 56% of cases, osteopenia occurs in the distal forearm. Vitamin D deficiency is a significant factor in the reduction of BMD in the distal forearm and lumbar spine. At a level of 25 (OH) D < 20 ng/ml, the risk of developing osteopenia increases by 56%.

Download Full-text