Bone quality assessed by trabecular bone score in severe anorexia nervosa: A brief report

Watters, Ashlie; Fielding, Linda L.; Mehler, Philip S.

doi:10.1002/eat.23506

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Most studies in healthy premenopausal women aged between 20-50 years have described a slow decline ( 26 – 30 ) in TBS except for a North American study reporting stable TBS values in women aged 30-45 years, followed by a decrease thereafter ( 31 ). Studies assessing TBS in young females with anorexia nervosa have found a positive correlation between TBS and menstrual status ( 32 , 33 ). The high prevalence of abnormal TBS in POI cohorts suggests an accelerated loss of microarchitectural integrity due to prolonged hypoestrogenism.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Trabecular Bone Score, Lower Bone Mineral Density and Lean Mass in Young Women With Premature Ovarian Insufficiency Are Prevented by Oestrogen Replacement

et al. 2022

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BackgroundLow bone density (BMD) and fractures commonly affect women with premature ovarian insufficiency (POI). However, bone microarchitecture and body composition data are lacking.ObjectiveTo assess and characterise musculoskeletal phenotype and effects of oestrogen replacement therapy (ERT) in women with POI.MethodCross-sectional and longitudinal studies of 60 normal karyotype women with POI, aged 20-40 years, from 2005-2018. Dual x-ray absorptiometry (DXA)-derived spinal (LS) and femoral neck (FN) BMD, trabecular bone score (TBS), appendicular lean mass (ALM), total fat mass (TFM), and fracture prevalence were compared with 60 age-, and BMI-matched population-based controls. Longitudinal changes in bone and body composition variables and ERT effects were analysed using linear mixed models over a median duration of 6 years.ResultsWomen with POI were subdivided into spontaneous (s)-POI (n=25) and iatrogenic (i)-POI (n=35). Median(range) age of POI diagnosis was 34 (10-40) years with baseline DXA performed at median 1(0-13) year post-diagnosis. ERT was used by 82% women (similar for both POI groups). FN-BMD were lowest in s-POI (p<0.002). Low TBS was more common in s-POI [(44%), p=0.03], versus other groups. LS-BMD and ALM were lower in both s-POI and i-POI groups than controls (p<0.05). Fracture prevalence was not significantly different: 20% (s-POI), 17% (i-POI), and 8% (controls) (p=0.26). Longitudinal analysis of 23 POI women showed regular ERT was associated with ALM increment of 127.05 g/year (p<0.001) and protected against bone loss. However, ERT interruption was associated with annual reductions in FN BMD and TBS of 0.020g/cm2 and 0.0070 (p<0.05), respectively.ConclusionDeficits in BMD, trabecular microarchitecture, and lean mass were present in women with POI. However, regular ERT protected against declines in bone variables, with an increase in ALM. Assessment of skeletal and muscle health, and advocating ERT adherence, is essential in POI to optimise musculoskeletal outcomes.

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Section: Discussionmentioning

confidence: 99%

Abnormal Trabecular Bone Score, Lower Bone Mineral Density and Lean Mass in Young Women With Premature Ovarian Insufficiency Are Prevented by Oestrogen Replacement

et al. 2022

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“…TBS, determined from lumbar spine DXA images, reflects qualitative aspects of the skeletal structure, providing an indirect index of trabecular microarchitecture that is partially independent of, but complementary to, BMD [ 64 ]. Although its use in the extreme ends of BMI is questioned due to the possible source of bias of too little or too much adipose tissue interposed between the spine and the X-ray, TBS has become a reference tool for skeletal assessment, and several studies support its reliability and reproducibility in clinical practice, both in underweight [ 65 ] and obese populations [ 66 , 67 ]. We found that most of the patients with obesity had the lowest value of TBS, confirming that the worse the metabolic state, the greater the suffering of the trabecular bone [ 68 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

et al. 2022

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Sirtuin1 (SIRT1) and sclerostin play important roles in adipose tissue and bone metabolism. We evaluated the circulating SIRT1 and sclerostin relationship with mass and quality of bone while considering the degree of adiposity. Sixty-six premenopausal women (16 underweight, 25 normal weight and 25 with obesity), aged <50 years, were enrolled. Plasma SIRT1, sclerostin and DXA body composition (total fat mass (FM), abdominal visceral adipose tissue, lean mass, trabecular bone score (TBS) and lumbar spine and femoral neck (FN) bone mineral density (BMD)) were assessed. The patients with obesity showed the lowest SIRT1 and TBS values and the highest sclerostin concentrations; BMD increased with FM and BMI and had an inverse association with SIRT1. Sclerostin was negatively correlated with SIRT1 (ρ = −0.37, p = 0.002). When spine BMD, FN BMD and TBS were standardized for BMI, a positive correlation with SIRT1 and a negative correlation with sclerostin were seen (p < 0.005). In the regression analysis, sclerostin was the best independent, negative predictor for BMD and TBS, while SIRT1 directly predicted TBS (p < 0.05). In conclusion, blood measurement of SIRT1 and sclerostin could represent a snapshot of the bone status that, taking into account the degree of adiposity, may reduce the interference of confounding factors in the interpretation of bone health parameters.

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“…( 59 ) Reduced trabecular bone score (TBS), identified in 13% of women in a subgroup with AN and lower BMI than the rest of the cohort, suggests worsened bone quality in those with lower weight. ( 60 ) Improvement of BMD in these women are challenging, and rely on weight restoration ( 61 , 62 , 63 ) and resumption of menses. ( 62 , 63 ) A cross‐sectional study of women revealed that moderate‐intensity exercise while unwell with active AN worsens BMD.…”

Section: Methodsmentioning

confidence: 99%

Dilemmas in the Management of Osteoporosis in Younger Adults

et al. 2022

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Osteoporosis in premenopausal women and men younger than 50 years is challenging to diagnose and treat. There are many barriers to optimal management of osteoporosis in younger adults, further enhanced by a limited research focus on this cohort. Herein we describe dilemmas commonly encountered in diagnosis, investigation, and management of osteoporosis in younger adults. We also provide a suggested framework, based on the limited available evidence and supported by clinical experience, for the diagnosis, assessment, and management of osteoporosis in this cohort.

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Bone quality assessed by trabecular bone score in severe anorexia nervosa: A brief report

Cited by 3 publications

References 18 publications

Abnormal Trabecular Bone Score, Lower Bone Mineral Density and Lean Mass in Young Women With Premature Ovarian Insufficiency Are Prevented by Oestrogen Replacement

Abnormal Trabecular Bone Score, Lower Bone Mineral Density and Lean Mass in Young Women With Premature Ovarian Insufficiency Are Prevented by Oestrogen Replacement

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

Dilemmas in the Management of Osteoporosis in Younger Adults

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