Introduction Inflammatory bowel disease (IBD) and its complications have been well-established. The literature shows an association between IBD and decreased bone mineral density in the adult population. However, most studies have reported an association between IBD and osteoporosis, while the risk of fractures has not been well-studied. The aim of this meta-analysis is to summarize the best available evidence regarding IBS and osteoporotic fractures. Methods A review of the literature using the MEDLINE and EMBASE databases was performed during November 2017. We included cross-sectional and cohort studies that reported the relative risks, odds ratios, and hazard ratios comparing the risk of developing osteoporotic fractures among patients with IBD patients, both ulcerative colitis (UC) and Crohn's disease (CD), versus patients without IBD as controls. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using the generic inverse-variance method. Results After a review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. A significant association was found between IBD and osteoporosis, with a pooled OR of 1.32 (95% CI, 1.2 - 1.4). Low heterogeneity among the studies was found, I=42.3. No publication bias was found using the Egger regression test p=0.18. Sensitivity analysis showed that the inclusion of data on children by Kappelman et al. (2007) did not change the results. Conclusion A significant association between IBD and the risk of developing osteoporotic fractures was observed in this study. There is a 32% increased risk, which is consistent with different cohort studies previously done.

No description available.

Objective: This study investigated the behaviors and characteristics of the adult female endurance runner and potential components of the female athlete triad (FAT). The FAT consists of three components that are interrelated: low energy availability, menstrual dysfunction, and low bone mineral density. Low energy availability may occur with or without disordered eating. Reproduction becomes non-essential leading to irregular menstrual cycles. A reduction in estrogen levels may contribute to low bone mineral density which may lead to stress fractures. Research investigating the FAT has primarily focused on adolescent and young adult females. Adult females training for endurance events may also be at risk for the FAT. Method: A survey was constructed and distributed to females in a local half-marathon and marathon training group in Central Florida. The data was collected at one point in time and no additional follow-up was required. The survey aimed to identify specific behaviors and characteristics related to components of the FAT and determine the potential prevalence in a small sample of female endurance athletes aged 18 and older. Results: 72 females with a mean age of 40.92(± 9.61) years completed the survey. Subjects had an average height of 163.60(±6.41) cm, weighed an average of 62.24(±10.05) kg and had 10 years of running experience. Conclusion: Adult female endurance runners demonstrate behaviors and characteristics that may be indicative of the FAT. Participants demonstrated signs of inadvertent or intentional low energy availability. These characteristics can be due to either body dissatisfaction or wanting to increase performance.

No description available.

This thesis is based on studies of the ten-year community-based intervention programme entitled, the Vadstena Osteoporosis Prevention Project (VOPP). The specific aims of the research were to describe the effects of physical activity and training programmes on bone mass and balance performance in adults, to determine whether a fall risk prevention programme could motivate personal actions among the elderly, to ascertain whether the intervention programme could reduce the incidence of forearm and hip fractures. Two studies addressed training programmes for middle-aged and old people. First, VOPP participants who were aged 40–70 years and had low forearm bone mineral density (BMD) values were invited to take part in a one-year weight-bearing training study. Thirty of those individuals were included in the investigation. Additional bone mass measurements were performed at the hip and the lumbar spine, and balance and aerobic capacity were also tested. The training programme was performed twice a week (I). In the second study, healthy persons aged 70–75 years were invited to participate in a balance-training study. Fifteen persons joined an exercise group, and another fifteen were controls. The training programme comprised specific balance exercises and was carried out twice a week for nine weeks (II). The association between forearm BMD values and several lifestyle factors was explored in random samples of the population aged 20–72 years (n=880) in a cross-sectional study (III). Another study explored the association between calcaneal stiffness, forearm BMD, and lifestyle factors amongst participants aged 20–79 years (n=956) at the final registration of the VOPP (V). Effects of the VOPP interventions directed at environmental risk factors for falls and the promotion of physical activity were examined in people aged ≥ 65 years (IV). The incidence of forearm and hip fractures was studied amongst middle-aged and elderly individuals in the intervention and the control communities during the study period 1987–2001 (VI). The exercise group (n=15) in the weight-bearing training study showed increases in BMD at the greater trochanter (p<0.01), one-leg stance balance with the eyes closed and coordination tests (p<0.05), and aerobic capacity (p<0.05). No significant difference was found when the groups were compared concerning changes in the different tests during the intervention period (I). In the balance-training study, the exercise group showed post-training improvement in the following tests: standing on the right leg with eyes closed (p<0.01), standing on the right leg (p<0.01) and on the left leg (p<0.05) while turning the head, and walking 30 metres (p<0.01). There were significant differences between the groups in these tests when changes were compared at the post-intervention test (II). Age (p<0.0001) and body mass index (p≤.0001) were associated with forearm BMD in both sexes. Reported moderate physical activity levels in men were positively associated with forearm BMD (p<0.05) (III). In both sexes, reported moderate (p<0.05) and high (women p<0.05 and men p<0.001) physical activity levels were positively associated with calcaneal stiffness. The correlation coefficient between forearm BMD and calcaneal stiffness was 0.58 in women and 0.34 in men (V). Persons aged ≥ 65 years at the follow-up in 1994 reported more use of shoe/cane spikes and moderate physical activity levels compared to controls (IV). There was no change in the general incidence of forearm and hip fractures between the communities for the study period. However, there was a tendency towards decreasing incidence of forearm and trochanteric hip fracture in both sexes during the late intervention period in the intervention community (VI). A community-based intervention programme aimed at reducing the incidence of osteoporotic fractures must be regarded as a long-term project and should preferably be monitored over an extended post-intervention period. / On the day of the public defence the statuses of articles IV and V were Submitted and VI was Manuscript

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Le rôle de la microstructure trabéculaire et corticale dans la résistance osseuse et le risque de fracture est bien documenté mais son déterminisme génétique n’a pas encore été étudié. Pour savoir si la microarchitecture osseuse et le métabolisme osseux ont un déterminisme héréditaire, une étude épidémiologique transversale (étude MODAM) a été menée pour évaluer la ressemblance familiale de la microarchitecture osseuse chez les femmes ménopausées et leurs filles non ménopausées en utilisant la tomodensitométrie quantitative périphérique haute résolution (HR-pQCT). Nous avons constaté que les filles des femmes ayant subi une fracture ont une densité osseuse volumétrique totale (vBMD) plus faible, des corticales amincies, et une altération de la microarchitecture osseuse trabéculaire au niveau du radius distal et du tibia comparativement aux filles dont les mères n’ont pas eu de fracture. Une autre étude épidémiologique transversale (étude MINOS) a été menée pour évaluer la corrélation de la densité minérale osseuse (DMO), de la taille des os, des marqueurs du remodelage osseux (BTM) et des hormones de régulation du remodelage osseux dans des paires de frères et des paires d'hommes non apparentés, appariés pour l'âge, le poids et la taille. Nous avons constaté que la taille des os, la DMO à certains sites du squelette et la plupart des BTM étaient plus fortement corrélés chez les frères comparativement aux hommes non apparentés. Ces données suggèrent un déterminisme héréditaire substantiel des niveaux de BTM chez les hommes. En conclusion, nous développons et confirmons l'importance des facteurs familiaux dans la pathogénie de l'ostéoporose chez les femmes et les hommes / The role of trabecular and cortical microstructure in bone strength and fracture risk is well documented, but its genetic determinism has not yet been studied. To find whether the bone microarchitecture, and bone metabolism have a strong hereditary determinism, a crosssectional epidemiological study (MODAM study) was conducted, investigating the familial resemblance of bone microarchitecture in postmenopausal mothers and their premenopausal daughters using high-resolution peripheral quantitative computed tomography (HR-pQCT). We found that daughters of women with fracture have lower total volumetric bone mineral density (vBMD), thinner cortices, and impaired trabecular microarchitecture at the distal radius and tibia, compared with daughters of women without fracture. Another cross-sectional epidemiological study (MINOS study) was conducted to assess the correlation of bone mineral density (BMD), bone size, bone turnover markers (BTMs) and hormones regulating bone turnover in pairs of brothers and pairs of unrelated men, matched for age, weight and height. We found that bone size, BMD at some skeletal sites and most of the BTM levels correlated more strongly in the brothers than in the unrelated men. These data suggest a substantial hereditary determinism of the BTM levels in men. In conclusion, we expand and confirm the importance of familial factors in the pathogenesis of osteoporosis in both women and men

Um dos principais fatores que influencia os resultados da terapia de implantes dentários é a densidade do osso alveolar. A sua avaliação permitiria a predição do torque de inserção do implante levando a um planejamento preciso do tratamento. O presente estudo de coorte teve como objetivo definir e correlacionar características radiográficas e morfológicas do osso, e sua influencia no torque de inserção. Foram analisados dados demográficos, radiografias panorâmicas e tomografias computadorizadas por feixe cônico (TCFC) de um total de 25 pacientes que receberam 31 implantes. Amostras ósseas retiradas dos sítios implantares foram avaliadas com densitometria óssea, micro-tomografia computadorizada, e histomorfometria. A análise de escala de cinzas avaliada com a TCFC foi fortemente correlacionada com a microtomografia computadorizada (r=0,504, p=0,004) e com a histomorfometria (r=0,795, p=0,001). No entanto, os resultados da correlação de Spearman mostraram que o torque máximo de inserção foi fortemente correlacionado com a espessura cortical do rebordo (r=0,609, p=0,001). Os resultados indicam que o torque de inserção é influenciado principalmente pela camada cortical do osso alveolar. O trabalho propõe ainda uma classificação clínica de predição de torque, baseada em resultados de sensitividade e especificidade da combinação de variáveis diferentes. A TCFC de 14-bit foi indicada como confiável para avaliar a densidade do tecido ósseo alveolar através da escala de cinzas. / A main factor influencing dental implant therapy outcomes is the alveolar bone density. Its assessment would allow for prediction of implant insertion torque (IT), leading to a precise treatment planning. The present cohort study aimed to define and correlate imaging and morphometric bone features influencing IT. Demographics, panoramic radiographs and cone beam computed tomographic (CBCT) scans of a total of 25 patients receiving 31 implants were analyzed. Bone samples retrieved from implant sites were assessed with dual x-ray absorptiometry, micro-computed tomography, and histomorphometry. Grayscale analysis using CBCT was strongly correlated with micro-computed tomography and with histomorphometric analysis (r=0.795, p=0.001). However, Spearmans correlation results showed that peak IT was strongly correlated with ridge cortical thickness (r=.609, p=.001). These results indicate that IT is mainly influenced by the amount of alveolar cortical bone layer. This work further propose a clinical classification for IT prediction, based on findings of sensitivity and specificity of the combination of different variables. 14-bit CBCT was indicated as reliable to assess alveolar bone density using grayscale analysis.

O tecido adiposo e ósseo tem uma íntima relação, desde a origem comum nas células tronco estromais derivadas da medula óssea. Sabe-se que o peso corporal tem estreita correlação com a massa óssea em seres humanos. Porém, ainda não é claro qual componente do peso corporal tem maior influência sobre o ganho de massa óssea e sobre a adiposidade na medula óssea, visto que tanto indivíduos com baixo peso, quanto os obesos, apresentam altas taxas de fraturas. O objetivo deste trabalho foi comparar crianças e adolescentes obesos e eutróficos em relação a composição óssea, adiposidade da medula óssea em coluna lombar (L3), expressão do Receptor tipo 1 de IGF (IGF1R) e concentrações séricas de IGF-I e buscar correlação entre estas variáveis. Para tanto foram avaliados crianças e adolescentes de 10 a 17 anos, divididos em grupo controle e grupo obeso. Esses grupos foram submetidos a avaliação antropométrica, densitometria óssea de coluna lombar e corpo total e ressonância magnética de coluna lombar e abdome total, além de dosagens séricas de parâmetros bioquímicos e hormonais. Os pacientes do grupo obeso apresentaram associação positiva da densidade mineral óssea tanto com massa gorda quanto com massa magra, enquanto que o grupo controle apresentou associação positiva da densidade mineral óssea apenas com a massa gorda. Não houve diferença entre os grupos quanto a adiposidade da medula óssea, nem quanto aos valores de IGF-I, IGFBP3 e expressão do gene do IGF1R. / The adipose and bone tissue has an intimate relationship, from the common origin in stromal stem cells derived from the bone marrow. It is known that body weight has a close correlation with bone mass in humans. However, it is still unclear which component of body weight has a greater influence on bone mass gain and adiposity in the bone marrow, since both individuals with low weight and obese have high fracture rates. The objective of this study was to compare obese and eutrophic children and adolescents in relation to bone composition, bone marrow adiposity in the lumbar spine (L3), expression of IGF type 1 receptor (IGF1R) and serum concentrations of IGF-I and to seek correlation between these variables. For this, children and adolescents between 10 and 17 years old were divided into control and obese groups. These groups were submitted to anthropometric evaluation, bone densitometry of the lumbar spine and total body and lumbar spine and total abdominal magnetic resonance, in addition to serum levels of biochemical and hormonal parameters. The patients in the obese group had a positive association of bone mineral density with both fat mass and lean mass while the control group showed a positive association of bone mineral density with fat mass only. There was no difference between the groups regarding bone marrow adiposity, nor regarding IGF-I, IGFBP3 and IGF1R gene expression.

A obesidade encontra-se associada a uma série de alterações metabólicas que podem elevar o risco de doenças crônicas não-transmissíveis. Em contraste, o excesso de peso apresenta-se como um fator protetor para a ocorrência de fraturas e baixa densidade óssea. Considerando que a adolescência é um período crucial para aquisição da massa óssea e minimização do risco de osteoporose na maturidade e os efeitos da perda de peso sobre a massa óssea, neste estágio de vida, não são completamente elucidados, o presente estudo foi desenvolvido. Objetivou-se investigar os efeitos da perda de peso sobre a massa óssea e as alterações metabólicas em adolescentes obesos pós-púberes. Realizou-se a revisão bibliográfica sobre o tema e um estudo longitudinal contemplando um período de 9 meses de intervenção baseada em dieta hipocalórica e orientações nutricionais. Foram incluídos 55 adolescentes pós-púberes, 43 meninas, com média de idade de 16,6 (1,4) anos, com índice de massa corporal por idade superior ao percentil 95. Os participantes foram monitorados a cada três semanas por meio de avaliação antropométrica (aferição do peso, estatura e circunferência) e do consumo alimentar (recordatório alimentar de 24 horas). Realizaram-se avaliações da composição corporal e da densidade mineral óssea de corpo total por meio da DXA (dual energy X-ray absorptiometry), do consumo alimentar (registro alimentar de 3 dias) e de parâmetros metabólicos (colesterol total e frações, tricilgliceróis, glicemia de jejum, insulina, leptina e grelina) no início do estudo, após 3 meses e ao fim da intervenção. Verificou-se que 44,4 por cento dos participantes não apresentavam redução do peso. O grupo que respondeu à intervenção apresentou média de perda de peso de 6,2 (4,6) por cento ao fim do estudo. Neste grupo, houve significativa redução do consumo energético, de 2105,4 (537,6) Kcal/dia na primeira avaliação para 1738,8 (608,4) Kcal/dia ao fim do estudo. Observou-se incremento da atividade física entre os participantes e melhora dos parâmetros metabólicos entre adolescentes que perderam peso. / Obesity is associated with several metabolic changes that may increase the risk of chronic diseases. Body weight is recognized as a protective factor against fractures and lower bone density. Considering that adolescence is a crucial period for bone mass acquisition and osteoporosis risk reduction in maturity and the effects of weight loss on bone mass in this life stage are not completely elucidated, the present study was performed. The objective was to investigate the effects of weight loss as well the metabolic changes related to bone mass in post-puberal adolescents. Bibliographic review and a longitudinal study, with adolescents submitted to nutritional intervention based on hipocaloric diet and nutritional advice during 9 months, were realized. Fifty-five subjects, 43 girls, mean age of 16.6 (1.4) years, with body mass index by age superior than 95 percentile, were recruited. Subjects were monitored every three weeks with anthropometric (weight, height and circumferences) and dietary intake (24h food intake recall) evaluation. Body composition and total-body bone mineral density. (assessed by dual-energy X-ray absorptiometry), metabolic parameters (plasma lipids, glucose, insulin, leptin and ghrelin concentrations) and dietary intake (3-day food records) were evaluated at the baseline, after 3-months and at the end of the study. Sixteen participants thatcompleted the study did not lost weight. The group that adhered to intervention nutritional had mean weight loss of 6.2 (4.6) %. In this group, there was a significant decrease in energy intake, from 2105.4 (537.6) Kcal/day to 1738.8 (608.4) Kcal/day. Physical activity pratice increased between participants and there were metabolic parameters improvement in adolescents who lose weight. In these subjects, hypercholesterolemia and insulin resistance decreased, 7,9% and 27.2% (p<0.05) respectively, after 3 months of intervention. There was a significant increase of total bone mineral density and bone mineral content (BMC) in adolescents did not lost weight. Increased BMC and bone area was verified in participants that adhered to intervention nutritional. Bone parameters changes were associated with body fat alterations. The increment in bone mineral density even under weight loss showed no negative effect of bone mass. Dietary intake change and weight control contributed to metabolic parameters improvement of obese adolescents.