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This longitudinal study aimed to elucidate whether systemic bone fragility predicts severe periodontal clinical attachment loss (CAL) and tooth loss over the years and to test the influence of bone medication and periodontal maintenance in these relationships. Elderly women were evaluated for bone mineral density (BMD) and for fracture risk assessment (FRAX) in a cross-sectional analysis and retrospective follow-up (6-and 10-y periods). Data on BMD and FRAX were used as indicators of bone fragility in structural equation modeling. Periodontal examination and data on postmenopausal tooth loss were recorded. Multivariate Poisson regression models with robust covariance were used to estimate relative risk (RR) and 95% CI of BMD and FRAX for sites with CAL ≥6 mm and for tooth loss. The cross-sectional analysis included 134 women aged 65 to 80 y, and from them 71 and 49 women had available data for analysis in the 6-and 10-y follow-up periods, respectively. Bone fragility predicted severe CAL over 10 y (e.g., femoral neck: 10-y analysis, β = −0.389, P = 0.005; cross-sectional, β = −0.190, P = 0.004); however, this association did not remain significant when the use of bone medication was evaluated. Poisson regression showed that a better skeletal condition was associated with a lower risk of severe periodontal disease and tooth loss (cross-sectional femoral neck: RR = 0.08, P < 0.001; RR = 0.03, P < 0.001, respectively) when not adjusted for bone medication and periodontal maintenance. The receiver operating characteristic curve suggested that women with osteoporosis should be referred for periodontal assessment (sensitivity = 71.0%, specificity = 70.0%). Bone fragility is a relevant longitudinal predictor of severe periodontal disease and tooth loss among elderly women. The use of bisphosphonates improved the bone condition as well as the periodontal status. Periodontal maintenance also minimized the negative impact of low BMD on teeth-supportive tissues in the studied population. Knowledge Transfer Statement: The results of this study present evidence that the management of bone fragility and osteoporosis may be important in the prevention of periodontal attachment loss and future tooth loss. Besides the antiresorptive effects of the antiosteoporosis drugs on systemic bone conditions, these medications may protect periodontal tissues. The interaction of health care professionals such as dentists and physicians

73Artigo de revisão Resumo A maior fragilidade e o consequente aumento do risco de fraturas que caracterizam a osteoporose são derivados dos processos de perda de massa óssea e deterioração microestrutural ao longo do tempo. Esses processos têm origem complexa e multifatorial, com reconhecida influência predominante de fatores genéticos. Em função de que os tratamentos disponíveis não restauram significativamente o osso já perdido, existe um crescente interesse na prevenção da doença. Garantir condições favoráveis para o ritmo adequado de aquisição óssea na adolescência contribui para o alcance de um pico ótimo de massa óssea no início da vida adulta que, por sua vez, vem sendo considerado o principal método de prevenção da osteoporose. Alguns dos aspectos relevantes para a aquisição óssea do adolescente são tratados nessa revisão. Nutrição, atividade física e condições fisiológicas associadas à adolescência com potencial impacto sobre a taxa de acúmulo ósseo nesse período são abordadas. A potencial influência da composição corporal é também discutida. Abstract Nutrition and other relevant aspects for bone health in adolescenceThe increase in bone fragility and susceptibility to fracture that characterize osteoporosis are derived from the processes of bone loss and micro architectural deterioration over time. These processes have complex and multifactorial origin with recognized predominant influence of genetic factors. Considering that available treatments do not significantly restore bone already lost, there is a growing interest in preventing the disease. Ensuring conditions that favor an adequate bone mass acquisition in adolescence contributes to the achievement of an optimal peak bone mass in early adulthood, which has been considered the primary method of preventing osteoporosis later in life. Some of the relevant aspects for adolescent bone acquisition are considered in this review. Nutrition, physical activity and physiological conditions associated with adolescence with potential impact on bone accumulation rate in this period are addressed. The potential influence of body composition is also discussed.Keywords: Bone density; Adolescent nutrition; Body composition; Osteoporosis. Nutrição e outros aspectos relevantes para a saúde óssea na adolescência ResumenNutrición y otros aspectos relevantes para la salud ósea en la adolescencia La mayor fragilidad ósea y el consiguiente aumento del riesgo de fracturas que caracterizan la osteoporosis se derivan de los procesos de pérdida de masa ósea y deterioro micro estructural a lo largo del tiempo. Estos procesos tienen origen complejo y multifactorial con reconocida influencia predominante de los factores genéticos. Ya que los tratamientos disponibles no restauran significativamente el hueso ya perdido, hay un creciente interés en la prevención de la enfermedad. Garantizar condiciones que favorezcan el ritmo adecuado de adquisición ósea durante la adolescencia, contribuye a alcanzar un máxi-mo óptimo de masa ósea en la edad adulta temprana, que a su vez ha s...

Background: Historically, malnutrition is described in individuals with SCD. However, more recent studies have shown a change in the profile of the nutritional status and distribution of body composition of SCD patients, mainly adult individuals. Aims: To assess the body composition (BC), resting energy expenditure (REE), and the biomarkers of hemolysis in adults with sickle cell disease (SCD). Subjects and Methods: A cross-sectional observational study was performed with 64 individuals over 39 years old in the treatment from two reference centers for SCD located in the city of Rio de Janeiro, Brazil. The dual-energy X-ray absorptiometry (DXA) and indirect calorimetry were used to assess BC and REE, respectively. Blood levels of hemoglobin, reticulocytes, lactate dehydrogenase (LDH), leukocytes, platelets, total and direct bilirubin, total protein, and albumin were measured to assess the hemolysis and protein status. The descriptive and inferential analysis was composed of the different methods (one-way ANOVA with the multiple comparison test of Tukey, Student t-test, and Pearson's correlation coefficient). Were considered statistically significant when the p-values were ≤ 0.05. Results: Most participants with SCD were female sex, colored (brown/black), and mean age of 51.2 years old. The obesity prevalence was 70.7% according to the body fat (BF%), with a major mean among women (p < 0.0001). Men had a higher mean of lean mass (LM) (p=0.0005) and fat-free mass (FFM) (p=0.0007). There was no difference for REE in comparing the genotypes (p= 0.53), and genders (p=0.075). The hemolysis markers (LDH, reticulocytes, and TB) correlated inversely with BMI (p=0.013), FM (p=0.022), and FFM (p=0.034). Conclusions: The important change observed in body composition in people with sickle cell disease was characterized by a high percentage of fat body and a decrease in lean mass. The hemolysis markers LDH, reticulocytes, and BT correlated inversely with BMI, FM, and FFM indicating that high levels of hemolysis may affect nutritional status, without influencing the REE. Keywords: sickle cell disease, body composition, fat mass, fat-free mass, energy expenditure, hemolysis.

Background: Traditionally, hypermetabolism is described in sickle cell disease (SCD). Despite this, few studies have compared rest energy expenditure (REE) with estimated by predictive equations (EEE) in the assessment of adults with SCD. Aims:  To compare REE values determined by indirect calorimetry (IC) with that EEE in adults with SCD. Subjects and Methods: A cross-sectional observational study was performed with 46 individuals over 34 years old in the treatment from two reference centers for SCD located in the city of Rio de Janeiro, Brazil. The dual-energy X-ray absorptiometry (DXA) and IC  were used to assess BC and REE, respectively. Blood levels were measured to assess hemolytic and protein markers. Pearson’s correlation test was used in the univariate correlation. The Intraclass Correlation Coefficient (ICC) and the Bland-Altman analysis were used in the comparison between EEE and IC. P-values ≤ 0.05 were considered statistically significant. Results: Most participants were from the female sex, Hb SS genotype (80.4%) and with black color (52.2%). The mean age was 50 years old. Weight (r= 0.469; p=0,001), LM (r = 0.631; p=0.000), BMC (r = 0.508; p=0.000) and CRP(r=0.319; p = 0.002) correlated positively with the REE. There was no linear correlation between makers of hemolysis with REE. The REE was overestimated in the EEE when compared to IC (p<0.001). Conclusions: The prediction equations developed for healthy populations are not accurate enough to determine the energy requirements and more studies are needed to better understand how REE role in middle-aged and elderly adults with SCD.

Background: Glucocorticoid induced osteoporosis (GIOP) is one of the most important causes of morbidity in lupus individuals. Whole body vibration exercises (WBVE) may be a safe alternative to prevent and amend muscular and bone damage, and decrease muscle related risk factors for falls. It is possible to evaluate neuromuscular responses to the WBVE through surface electromyography (sEMG). Objective: To analyze and compare the acute responses of the WBVE on sEMG of lower limbs of female systemic lupus erythematosus (SLE) individuals with chronic glucocorticoid use with and without bone impairments and non-lupus controls. Methods: All patients (non-lupus and with SLE) had a dual-energy X-ray absorptiometry (DXA) scan (body composition, bone composition right hip, lumbar segment and whole body). After DXA, they were divided into three groups: SLE with osteopenia (OPIA) (SLE OPIA), SLE without OP or OPIA (SLE) and non-lupus individuals as control (CG). Twenty-seven women were submitted to WBVE, on different frequencies with the same amplitude. The experiment was performed over two days, 48 h apart. The individuals stood at a half squat position on a vertical vibrating platform at different frequencies with the same amplitude on both days. Vastus lateralis (VL), gastrocnemius medialis (GM) and tibialis anterioris (TA) sEMG analyses were undertaken simultaneously while performing the exercises, in a randomized manner. Results: There were no differences between sarcopenia index among groups, despite the bone impairment of the SLE OPIA group. The greatest muscle activation occurred in the lower frequency applied for VL. A group x frequency difference was found only for GM (p = 0.034; η2 = 0.272). Conclusion: The results indicate that lupus individuals have similar neuromuscular activity to the WBVE as non-lupus controls. Moreover, this suggests that WBVE is a safe and viable physical exercise for lupus individuals with chronic glucocorticoid induced osteoporosis.

Objectives The study aim was to assess bone mineral density (BMD) and bone turnover in pre- and postmenopausal women with severe obesity. Additionally, we explored the association between soft tissue body composition and BMD according to menopausal status. Methods This is a cross-sectional study conducted in pre- (n = 37) and postmenopausal (n = 22) morbid obese (BMI >40 kg/cm2) women. Body composition and BMD at different sites (lumbar spine, proximal femur and forearm) were assessed by dual energy X-ray absorptiometry (DXA). Biochemical markers of bone metabolism (serum CTX and osteocalcin) and serum 25(OH)D were also measured. Differences between pre- and postmenopausal women were analyzed by Student´s t-test. Body composition [lean mass, visceral (VAT) and subcutaneous (SAT) adipose tissue] and other potential factors associated with BMD were investigated by multiple regression. Results BMD at all sites evaluated was similar in pre- and postmenopausal women (P > 0.05). Also, no differences between groups were observed for bone turnover markers (P > 0.05). In postmenopausal women, years after menopause was inversely associated with BMD at total body (β = −0.010, P < 0.01) and total femur (β = −0.009, P < 0.05). Serum 25(OH)D was also associated with total femur BMD (β = 0.008, P < 0.01) in postmenopausal women. Lean mass was not associated with BMD in both groups. VAT was directly associated with lumbar spine BMD in postmenopausal women (β = 0.135, P < 0.05). Conclusions Our results suggest that severe obesity may weaken the impact of menopause on bone mass and turnover. Also, soft tissue body composition appears to poorly influence bone density in these women. Funding Sources Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ, Grant number E26/110.764/2013 for FFB).