scholarly journals Exercise Protects Bone after Stroke, or Does It? A Narrative Review of the Evidence

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Karen Borschmann
Keyword(s):  
Physical Activity ◽  
Bone Loss ◽  
Fracture Risk ◽  
Specific Effect ◽  
Healthy Adults ◽  
Falls Prevention ◽  
Future Research ◽  
Supporting Evidence ◽  
Mineral Density ◽  
Reduce Fracture Risk

Physical inactivity contributes to accelerated bone loss after stroke, leading to heightened fracture risk, increased mortality, and reduced independence. This paper sought to summarise the evidence for the use of physical activity to protect bone in healthy adults and adults with stroke, and to identify international recommendations regarding any means of bone protection after stroke, in order to guide rehabilitation practice and future research. A search was undertaken, which identified 12 systematic reviews of controlled trials which investigated the effect of physical activity on bone outcomes in adults. Nine reviews included healthy adults and three included adults with stroke. Twenty-five current international stroke management guidelines were identified. High-impact loading exercise appears to have a site-specific effect on the microarchitecture of healthy postmenopausal women, and physical activity has a small effect on enhancing or maintaining bone mineral density in chronic stroke patients. It is not known whether this translates to reduce fracture risk. Most guidelines included recommendations for early mobilisation after stroke and falls prevention. Two recommendations were identified which advocated exercise for the prevention bone loss after stroke, but supporting evidence was limited. Research is required to determine whether targeted physical activity can protect bone from early after stroke, and whether this can reduce fracture risk.

Nutrition, Physical Activity, and Bone Health in Women

1998 ◽  
Vol 8 (3) ◽  
pp. 250-284 ◽  
Author(s):  
Richard D. Lewis ◽  
Christopher M. Modlesky
Keyword(s):  
Physical Activity ◽  
Vitamin D ◽  
Bone Loss ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Positive Impact ◽  
Calcium Supplementation ◽  
Weight Bearing ◽  
Calcium Excretion

Calcium and vitamin D can significantly impact bone mineral and fracture risk in women. Unfortunately, calcium intakes in women are low and many elderly have poor vitamin D status. Supplementation with calcium (~1000 mg) can reduce bone loss in premenopausal and late postmenopausal women, especially at sites that have a high cortical bone composition. Vitamin D supplementation slows bone loss and reduces fracture rates in late postmenopausal women. While an excess of nutrients such as sodium and protein potentially affect bone mineral through increased calcium excretion, phytoestrogens in soy foods may attenuate bone loss ihrough eslrogenlike activity. Weight-bearing physical activity may reduce the risk of osteoporosis in women by augmenting bone mineral during the early aduli years and reducing the loss of bone following menopause. High-load activities, such as resistance training, appear to provide the best stimulus for enhancing bone mineral; however, repetitive activities, such as walking, may have a positive impact on bone mineral when performed at higher intensities. Irrespective of changes in bone mineral, physical activities that improve muscular strength, endurance, and balance may reduce fracture risk by reducing the risk of falling. The combined effect of physical activity and calcium supplementation on bone mineral needs further investigation.

2016 The Year That Was: Bone Strength

2017 ◽  
Vol 29 (1) ◽  
pp. 23-25
Author(s):  
Kathleen F. Janz
Keyword(s):  
Physical Activity ◽  
Bone Mineral Density ◽  
Fracture Risk ◽  
Precision Medicine ◽  
Bone Strength ◽  
Bone Development ◽  
High Impact ◽  
Environment Interaction ◽  
Mineral Density ◽  
Field Of Inquiry

Of all the lifestyle strategies for increasing bone strength during the growing years, physical activity is one of the most efficacious. This commentary highlights two exceptional 2016 publications addressing bone strength in children and adolescents with an eye toward reduced fracture risk later in life. The first by Weaver et al. was selected due to its comprehensive approach to understanding bone development. The second by Mitchell et al explores a new field of inquiry, that is, genetic-environment interaction as represented by bone mineral density-lowering alleles and high-impact physical activity. It is a first look at future precision medicine as it may pertain to pediatric bone strength.

scholarly journals SAT0034 CLINICAL SIGNIFICANCE OF ANTI-CARBAMYLATED PROTEIN ANTIBODIES IN PREMENOPAUSAL RHEUMATOID ARTHRITIS WOMEN: RELATION TO DISEASE ACTIVITY AND BONE LOSS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 947.2-947
Author(s):  
R. Elnemr ◽  
R. Bastawy ◽  
R. Ghazala ◽  
M. Abdelrazek ◽  
N. Elsawy
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Bone Mineral Density ◽  
Body Mass Index ◽  
Serum Level ◽  
Bone Loss ◽  
Disease Activity ◽  
Bone Mineral ◽  
Mineral Density ◽  
Local Bone

Background:Anti carbamylated protein anti carP are present in patients with Rheumatoid Arthritis RA and are associated with erosions. However their association with systemic or local bone loss in RA patients is still not confirmed.Objectives:The purpose of this study was to measure the serum level of anti carP in premenopausal women with RA and determine its relation to disease activity and bone loss.Methods:This case control study was conducted on forty eight RA premenopausal female patients diagnosed according to 2010 ACR/EULAR criteria and forty eight ages and body mass index matched healthy premenopausal females. RA patients with other autoimmune diseases, viral hepatitis malignancy or erosive joint disease and systemic diseases that affect bone quality were excluded from the study. All RA women were subjected to history taking, clinical examination, assessment of disease activity using disease activity score-28 DAS28 and clinical disease activity index CDAI functional assessment using health assessment questionnaire HAQ physical activity assessment using international physical activity questionnaire short form IPAQ fatigue assessment using modified fatigue impact scale MFIS, routine laboratory investigations, serological tests as well as Anti carP using ELISA kit. Moreover the bone mineral density was measured by a lunar Prodigy Advanced DEXA scanner system and plain x-ray of both hands and wrists in the anteroposterior view was done to assess the juxta articular osteopenia and erosions.Results:Anti carP level was significantly higher in RA patients than in healthy controls table 1. The serum level of anti carP had a significant positive correlation with RA DAS, CDAI, HAQ, IPAQ, MFIS and erosion and joint space narrowing in original sharp score. Also the anti carP had a significant negative correlation with the bone mineral density BMD of spine. The AUC of anti carP level showed a high level of accuracy AUC 0.857 figure 1 and the calculated cutoff value >65 can precisely discriminate subjects with RA from those without RA with 85.42% sensitivity and 85.11% specificity.Table 1.Comparison between the patient and healthy groups according to anti carp levelAnti-carpRA patientsHealthy controlUpMin – Max15.0 – 90.01.0 – 78.50322.0*<0.001*Mean ± SD71.24 ± 14.7045.99 ± 21.99Median (IQR)72.75 (70.5–78.3)55.0 (32.5–61.5)Figure 1.ROC curve for anti carP to diagnose RA patients from healthy subjectsConclusion:Anti carbamylated antibodies were higher in premenopausal RA women compared to ages and body mass index matched healthy women. Anti carP are associated with higher RA disease activity, increased disability and decreased physical activity. Moreover anti carP are associated with systemic trabecular bone loss manifested by decreased bone mineral density of the spine as well as local bone loss as manifested by increased number of joint erosions in premenopausal RA women.References:[1] Regueiro C, Ortiz AM, Boveda MD, Castañeda S, Gonzalez-Alvaro I, Gonzalez A. Association of high titers of anti-carbamylated protein antibodies with decreased bone mineral density in early arthritis patients. PLoS ONE 2018; 13(8):e0202583.Disclosure of Interests:None declared

Use of age and BMD to predict fracture risk in men on androgen deprivation therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9517-9517
Author(s):  
D. Lin ◽  
M. R. Smith ◽  
R. A. Morton ◽  
M. S. Steiner
Keyword(s):  
Prostate Cancer ◽  
Bone Mineral Density ◽  
Bone Loss ◽  
Bone Turnover ◽  
Fracture Risk ◽  
Bone Turnover Markers ◽  
Mineral Density ◽  
History Of ◽  
Baseline Characteristics ◽  
Turnover Markers

9517 Background: Androgen deprivation therapy (ADT) decreases bone mineral density by reducing estrogens to castrate levels and, as a result, increases fracture risk. We recently completed a two-year trial in 1382 men in which we examined the ability of toremifene to reduce fracture risk in men on ADT. Herein we describe analyses of the placebo group to assess the baseline characteristics associated with new fractures. Methods: We conducted a randomized double blind placebo controlled trial in 1382 men with histologically confirmed prostate cancer on ADT. Entry criteria included age ≥ 50 years, continous ADT for 6 months or longer or intermittent ADT for 12 months or longer. Subjects on intermittent ADT at enrollment had to remain on continuous ADT for their duration on study. Subjects were randomized to receive either 80mg toremifene citrate daily or matching placebo. The primary end point was the incidence of new morphometric vertebral fractures. Secondary endpoints included bone mineral density, clinical fragility fractures, bone turnover markers, lipid profile, hot flashes, and gynecomastia. Results: The modified intent to treat (MITT) population included subjects who took study medication and had an on-study radiograph. There were 467 subjects in the placebo MITT population. To identify factors associated with fracture risk in men on ADT we compared placebo subjects who suffered a fracture or during the first year on study suffered 7% or greater bone loss with those placebo subjects who did not. Baseline characteristics included: BMD (spine, hip, femoral neck), Age, history of fracture, ADT duration, bone turnover markers, and race. Logistic regression models of the probability of fracture/bone loss as a function of country showed that each of BMD at all sites, age, race, CTX, and history of previous fracture independently predicted fracture/7% bone loss. When all characteristics were analyzed in a multivariable model lower spine BMD (p=0.006) and older age (p=0.018) were significantly associated with incident fractures. Conclusions: In prostate cancer patients on ADT older age and lower baseline spine BMD were associated with a greater risk of fracture in untreated patients. [Table: see text]

scholarly journals Comparative effects of dried plum and dried apple on bone in postmenopausal women

2011 ◽  
Vol 106 (6) ◽  
pp. 923-930 ◽  
Author(s):  
Shirin Hooshmand ◽  
Sheau C. Chai ◽  
Raz L. Saadat ◽  
Mark E. Payton ◽  
Kenneth Brummel-Smith ◽  
...  
Keyword(s):  
Physical Activity ◽  
Bone Loss ◽  
Bone Turnover ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Whole Body ◽  
Tartrate Resistant Acid Phosphatase ◽  
Mineral Density ◽  
Nutritional Factors ◽  
Bone Specific Alkaline Phosphatase

Aside from existing drug therapies, certain lifestyle and nutritional factors are known to reduce the risk of osteoporosis. Among the nutritional factors, dried plum or prunes (Prunus domesticaL.) is the most effective fruit in both preventing and reversing bone loss. The objective of the present study was to examine the extent to which dried plum reverses bone loss in osteopenic postmenopausal women. We recruited 236 women, 1–10 years postmenopausal, not on hormone replacement therapy or any other prescribed medication known to influence bone metabolism. Qualified participants (n160) were randomly assigned to one of the two treatment groups: dried plum (100 g/d) or dried apple (comparative control). Participants received 500 mg Ca plus 400 IU (10 μg) vitamin D daily. Bone mineral density (BMD) of lumbar spine, forearm, hip and whole body was assessed at baseline and at the end of the study using dual-energy X-ray absorptiometry. Blood samples were collected at baseline, 3, 6 and 12 months to assess bone biomarkers. Physical activity recall and 1-week FFQ were obtained at baseline, 3, 6 and 12 months to examine physical activity and dietary confounders as potential covariates. Dried plum significantly increased BMD of ulna and spine in comparison with dried apple. In comparison with corresponding baseline values, only dried plum significantly decreased serum levels of bone turnover markers including bone-specific alkaline phosphatase and tartrate-resistant acid phosphatase-5b. The findings of the present study confirmed the ability of dried plum in improving BMD in postmenopausal women in part due to suppressing the rate of bone turnover.

scholarly journals Aromatase Inhibitor Induced Bone Loss: Do International Guidelines Accurately Stratify Fracture Risk and Selection of Anti-Osteoporosis Treatment?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A242-A242
Author(s):  
Shriya Gandhi ◽  
Cydney A Bullock ◽  
Ethan M Ritz ◽  
Todd Beck ◽  
Sanford Baim
Keyword(s):  
Breast Cancer ◽  
Bone Resorption ◽  
Bone Loss ◽  
Fracture Risk ◽  
Academic Medical Center ◽  
Untreated Group ◽  
Fracture Rate ◽  
Mineral Density ◽  
Peripheral Tissues ◽  
Significant Difference

Abstract Introduction: Aromatase inhibitors (AI) are used for adjunctive treatment of estrogen receptor-positive (ER+) breast cancer. Aromatase converts androgens to estrogens in the ovaries and peripheral tissues such as adipose, liver, muscle, and breast. In breast, estrogens increase cell proliferation in both normal and ER+ malignant tissue. AIs globally suppress estrogen production, and thereby can decrease tumor progression. However, in bone, estrogens suppress osteoclast activity and decrease bone resorption so AI use results in increased bone resorption and decreased bone mineral density (BMD). Several guidelines exist to direct management of AI-associated bone loss, but it is unclear whether adherence to these guidelines translates to decreased fracture risk. The International Osteoporosis Foundation (IOF) et al 2017 guidelines for the prevention of osteoporotic fractures in patients treated with AI recommended BMD measurement at the onset of AI use and use of anti-osteoporosis therapy (anti-OP) in those who met T-score and clinical risk factor (CRF) criteria. Hypothesis: We explored application of these guidelines and whether they were able to stratify patients according to risk, initiation of treatment, and fracture outcomes. Methods: 1517 charts were extracted from the electronic medical record (EMR) of a tertiary academic medical center based on history of breast cancer and use of AIs between 2008 and 2017. Charts were retrospectively analyzed to determine baseline BMD, osteoporosis risk factors, duration of AI use, duration of anti-OP therapy, and fractures. The IOF criteria were applied to each patient to determine applicability of anti-OP therapy. Fracture rates were compared using chi square test or Fisher’s exact test. Results: 1517 patients were included in the analysis. Regardless of whether criteria were met for treatment based on baseline BMD and CRF, the fracture rate was significantly higher in the treated versus the untreated group, 13.78% (CI: 9.56–18.99) versus 2.24% (p &lt; 0.0001, CI: 1.51–3.21). Similarly, among those that met criteria, the fracture rate was significantly higher in the treated versus the untreated group, 10.24% (CI: 5.56–16.87) versus 2.61% (p = 0.0005, CI: 1.20–4.89). There was no significant difference in fractures between those who did versus did not meet treatment criteria, 4.66% (CI: 2.94–6.97) versus 3.64% (p = 0.34, CI 2.59–4.96). Conclusions: This retrospective EMR analysis of 1517 breast cancer patients on AIs between 2008 and 2017 observed a higher fracture incidence in patients who received anti-OP treatment compared to those who did not, regardless of meeting criteria for treatment per the IOF guidelines. It is possible that patients who initiated anti-OP therapy had additional CRFs not captured in the EMR and not factored into our analyses.

scholarly journals Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Louise I. Manning ◽  
Andrew M. Briggs ◽  
Sharon Van Doornum ◽  
Ashwini Kale ◽  
Susan Kantor ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Bone Loss ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Vertebral Body ◽  
Areal Bone Mineral Density ◽  
Primary Osteoporosis ◽  
Mineral Density ◽  
Vertebral Fracture Risk

Individuals with glucocorticoid-induced osteoporosis experience vertebral fractures at an increased rate and at higher vertebral areal bone mineral density (aBMD) than individuals with primary osteoporosis. Standard posteroanterior- (PA-) projection dual energy X-ray absorptiometry (DXA) lacks the diagnostic sensitivity required for reliable estimation of vertebral fracture risk in individuals. Assessment of subregional vertebral aBMD using lateral-projection DXA may improve the predictive value of DXA parameters for fracture. One hundred and four individuals were recruited and grouped for this study: primary osteoporosis with no history of vertebral fracture (n=43), glucocorticoid-induced bone loss (n=13), and healthy controls (n=48). Standard PA-projection and supine-lateral scans were performed, and lateral scans were analysed according to an established protocol to measure aBMD within 6 subregions. Main effects for subregion and group were assessed and observed, by ANCOVA. Ratios were calculated between subregions and compared between groups, to overcome the potentially confounding influence of variability in subregional geometry. Significantly lower values were observed in the glucocorticoid group for the ratios of (i) anterior subregion: whole vertebral body and (ii) posterior: whole vertebral body when compared to the primary osteoporosis and control groups (P<0.05). Lower anterior subregional aBMD in individuals on glucocorticoid therapy may help to explain the increased vertebral fracture risk in this patient group.

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