Publications by authors named "Didier Hans"

127 Publications

Effect of very large body mass loss on energetics, mechanics and efficiency of walking in adults with obesity: Mass-driven vs behavioural adaptations.

J Physiol 2021 Sep 10. Epub 2021 Sep 10.

Institute of Sport Sciences of the University of Lausanne (ISSUL), University of Lausanne, Lausanne, Switzerland.

Key Points: A higher net (above resting) energy cost of walking (lower gait economy) is observed in adults with obesity compared to lean individuals. Understanding the mechanisms (i.e., mass driven, gait pattern and behavioural changes) involved in this extra cost of walking in adults with obesity is pivotal to optimizing the use of walking to promote daily physical activity and improve health in these individuals. We found that very large weight loss induced by bariatric surgery significantly decreased the energy cost of walking per kg of body mass after 1 year with similar total mechanical work per kg of body mass, resulting in an increased mechanical efficiency of walking. Individuals with obesity may reorganize their walking pattern into a gait more similar to normal body mass adults, thus decreasing their energy cost of walking by making their muscles work more efficiently.

Abstract: Understanding the mechanisms involved in the higher energy cost of walking (NC : the energy expenditure above resting per unit distance) in adults with obesity is pivotal to optimizing the use of walking in weight management programmes. Therefore, this study aimed to investigate the mechanics, energetics and mechanical efficiency of walking after a large body mass loss induced by bariatric surgery in individuals with obesity. Nine adults (39.5 ± 8.6 yr; BMI: 42.7 ± 4.6 kg·m ) walked at five fixed speeds before (baseline) and after the bariatric surgery (post 1 and post 2). Gas exchanges were measured to obtain NC . A motion analysis system and instrumented treadmill were combined to assess total mechanical work (W ). Mechanical efficiency (W ·NC ) was also calculated. Participants lost 25.7 ± 3.4% of their body mass at post 1 (6.6 months; P<0.001) and 6.1 ± 4.9% more at post 2 (12 months; P = 0.014). Mass-normalized NC was similar between baseline and post 1 and decreased at post 2 compared to that at baseline (-6.2 ± 2.7%) and post 1 (-8.1 ± 1.9%; P≤0.007). No difference was found in mass-normalized W during follow-up (P = 0.36). Mechanical efficiency was similar at post 1 and post 2 when compared to that at baseline (P≥0.19), but it was higher (+14.1 ± 4.6%) at post 2 than at post 1 (P = 0.013). These findings showed that after a very large body mass loss, individuals with obesity may reorganize their walking pattern into a gait more similar to that of lean adults, thus decreasing their NC by making their muscles work more efficiently. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1113/JP281710DOI Listing
September 2021

DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis.

Endocrine 2021 Oct 10;74(1):20-28. Epub 2021 Jul 10.

Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland.

Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.
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http://dx.doi.org/10.1007/s12020-021-02806-xDOI Listing
October 2021

Diurnal Salivary Cortisol in Sarcopenic Postmenopausal Women: The OsteoLaus Cohort.

Calcif Tissue Int 2021 May 18. Epub 2021 May 18.

Interdisciplinary Center for Bone Diseases, Service of Rhumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.

Sarcopenia, similar to hypercortisolism, is characterized by loss of muscle mass and strength. Cortisol circadian rhythm changes with aging (blunted late-day nadir values) were suggested to contribute to this decline. We aimed to explore the relationship between diurnal salivary cortisol values and sarcopenia diagnosis and its components in postmenopausal women. This is a cross-sectional study within the OsteoLaus population-based cohort in Lausanne (Switzerland). Participants had a body composition assessment by dual X-ray absorptiometry (DXA), a grip strength (GS) measure, and salivary cortisol measures (at awakening, 30 min thereafter, 11 AM (sc-11AM) and 8 PM (sc-8PM)). Associations between salivary cortisol and sarcopenia diagnosed by six different criteria (based on appendicular lean mass (ALM) assessed by DXA, and muscle strength by GS), and its components, were analyzed. 471 women aged > 50 years (63.0 ± 7.5) were included. Various definitions identified different participants as sarcopenic, who consistently presented higher salivary cortisol at 11 AM and/or 8 PM. There were no associations between salivary cortisol levels and ALM measures, either absolute or after correction to height squared (ALM index) or body mass index. GS was inversely correlated to sc-11AM (r = - 0.153, p < 0.001) and sc-8PM (r = - 0.118, p = 0.002). Each 10 nmol/l increase of sc-11AM, respectively sc-8PM, was associated with a GS decrease of 1.758 (SE 0.472) kg, respectively 2.929 (SE 1.115) kg. In postmenopausal women, sarcopenia is associated with higher salivary cortisol levels at 11 AM and 8 PM. An increase of daily free cortisol levels in the physiological range could participate to sarcopenia development by decreasing muscle function in postmenopausal women.
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http://dx.doi.org/10.1007/s00223-021-00863-yDOI Listing
May 2021

[Towards an individualized bone health report focused on the patient - Bone parameters and treatment options].

Rev Med Suisse 2021 Apr;17(735):774-779

Centre interdisciplinaire des maladies osseuses, département de l'appareil locomoteur, CHUV, 1011 lausanne.

This article presents a novel approach of osteoporosis management, starting from the DXA scans performance, image quality, BMD and TBS assessment and interpretation, vertebral fracture assessment, decision making on treatment initiation and being finalized with patient`s further follow-up recommendations. A report based on this approach is soon to be implemented by the CiMO at CHUV. Among the thorough evaluation of the densitometric status of the patient, this report presents the first effort to incorporate into the osteoporosis clinical workflow the current evidence on TBS. It suggests practical ways to use TBS as in conjunction with BMD T-score or FRAX score to come up with the final scores that allow treatment initiation. Implementations in other non-Caucasian or non-Swiss clinical settings are to be accompanied by local validations.
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April 2021

The Effects of Time-Restricted Eating versus Standard Dietary Advice on Weight, Metabolic Health and the Consumption of Processed Food: A Pragmatic Randomised Controlled Trial in Community-Based Adults.

Nutrients 2021 03 23;13(3). Epub 2021 Mar 23.

Service of Endocrinology, Diabetes, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland.

Weight loss is key to controlling the increasing prevalence of metabolic syndrome (MS) and its components, i.e., central obesity, hypertension, prediabetes and dyslipidaemia. The goals of our study were two-fold. First, we characterised the relationships between eating duration, unprocessed and processed food consumption and metabolic health. During 4 weeks of observation, 213 adults used a smartphone application to record food and drink consumption, which was annotated for food processing levels following the NOVA classification. Low consumption of unprocessed food and low physical activity showed significant associations with multiple MS components. Second, in a pragmatic randomised controlled trial, we compared the metabolic benefits of 12 h time-restricted eating (TRE) to standard dietary advice (SDA) in 54 adults with an eating duration > 14 h and at least one MS component. After 6 months, those randomised to TRE lost 1.6% of initial body weight (SD 2.9, = 0.01), compared to the absence of weight loss with SDA (-1.1%, SD 3.5, = 0.19). There was no significant difference in weight loss between TRE and SDA (between-group difference -0.88%, 95% confidence interval -3.1 to 1.3, = 0.43). Our results show the potential of smartphone records to predict metabolic health and highlight that further research is needed to improve individual responses to TRE such as a shorter eating window or its actual clock time.
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http://dx.doi.org/10.3390/nu13031042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004978PMC
March 2021

Machine Learning Solutions for Osteoporosis-A Review.

J Bone Miner Res 2021 05 4;36(5):833-851. Epub 2021 Apr 4.

Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland.

Osteoporosis and its clinical consequence, bone fracture, is a multifactorial disease that has been the object of extensive research. Recent advances in machine learning (ML) have enabled the field of artificial intelligence (AI) to make impressive breakthroughs in complex data environments where human capacity to identify high-dimensional relationships is limited. The field of osteoporosis is one such domain, notwithstanding technical and clinical concerns regarding the application of ML methods. This qualitative review is intended to outline some of these concerns and to inform stakeholders interested in applying AI for improved management of osteoporosis. A systemic search in PubMed and Web of Science resulted in 89 studies for inclusion in the review. These covered one or more of four main areas in osteoporosis management: bone properties assessment (n = 13), osteoporosis classification (n = 34), fracture detection (n = 32), and risk prediction (n = 14). Reporting and methodological quality was determined by means of a 12-point checklist. In general, the studies were of moderate quality with a wide range (mode score 6, range 2 to 11). Major limitations were identified in a significant number of studies. Incomplete reporting, especially over model selection, inadequate splitting of data, and the low proportion of studies with external validation were among the most frequent problems. However, the use of images for opportunistic osteoporosis diagnosis or fracture detection emerged as a promising approach and one of the main contributions that ML could bring to the osteoporosis field. Efforts to develop ML-based models for identifying novel fracture risk factors and improving fracture prediction are additional promising lines of research. Some studies also offered insights into the potential for model-based decision-making. Finally, to avoid some of the common pitfalls, the use of standardized checklists in developing and sharing the results of ML models should be encouraged. © 2021 American Society for Bone and Mineral Research (ASBMR).
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http://dx.doi.org/10.1002/jbmr.4292DOI Listing
May 2021

Erratum for Abaloparatide in Postmenopausal Women With Osteoporosis and Type 2 Diabetes: A Post Hoc Analysis of the ACTIVE Study.

JBMR Plus 2021 Feb 3;5(2):e10414. Epub 2020 Nov 3.

Research St. Michael's Hospital, University of Toronto Toronto CO Canada.

[This corrects the article DOI: 10.1002/jbm4.10346.].
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http://dx.doi.org/10.1002/jbm4.10414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872332PMC
February 2021

Physical and lifestyle factors associated with trabecular bone score values.

Arch Osteoporos 2020 11 8;15(1):177. Epub 2020 Nov 8.

IMPACT Institute, Deakin University, Geelong, Australia.

TBS is associated with age, weight, childhood physical activity, and BMD in men and age, height, BMD, and mobility in women.

Introduction: Trabecular bone score (TBS) indirectly assesses trabecular microarchitecture at the lumbar spine, providing complementary information to areal BMD. Many studies have investigated the relationships between BMD and lifestyle factors known to affect bone, but such research is limited for TBS. The aim of this study was to assess the relationship between TBS and lifestyle factors in Australian men and women.

Methods: This cross-sectional study involved 894 men and 682 women (ages 24-98 years) enrolled in the Geelong Osteoporosis Study. TBS was assessed by analysis of lumbar spine DXA scans (Lunar Prodigy) using TBS iNsight software (Version 2.2). Bivariate and multivariable linear regression models were used to explore the associations between TBS and physical and lifestyle factors, including anthropometry, alcohol consumption, childhood physical activity, mobility, smoking status, prior low trauma fracture, medication use, and intakes of calcium and vitamin D.

Results: In bivariate regression modelling, low mobility and the use of antiresorptive medication were associated with lower TBS in both men and women. Low childhood physical activity was also associated with lower TBS in men. Prior fracture, use of glucocorticosteroids, and total calcium intake were also associated with lower TBS in women. The final adjusted model for men included age, weight, childhood physical activity, and BMD, and for women, age, height, BMD, and mobility. No interaction terms were identified in the models.

Conclusions: Lower TBS is associated with older age, increased weight, low childhood physical activity, and lower BMD in men and older age, shorter stature, lower BMD, and low mobility in women.
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http://dx.doi.org/10.1007/s11657-020-00841-1DOI Listing
November 2020

Osteogenesis imperfecta: towards an individualised interdisciplinary care strategy to improve physical activity and quality of life.

Swiss Med Wkly 2020 Jun 6;150:w20285. Epub 2020 Jul 6.

Paediatric Orthopaedic Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.

Background: This report describes a new strategy for the care of patients with osteogenesis imperfecta, based on an interdisciplinary team working. Thereby, we aim at fulfilling three main goals: offering thorough coordinated management for all, and improving physical activity and quality of life of the patients.

Aim: With rare diseases such as osteogenesis imperfecta (OI), patients and their family often suffer from inadequate recognition of their disease, poor care coordination and incomplete information. A coordinated interdisciplinary approach is one possible solution for providing both comprehensive and cost-effective care, with benefits for patient satisfaction. Poor physical activity and impaired quality of life represent a considerable burden for these patients. To better address these issues, in 2012 we created an interdisciplinary team for the management of OI patients in our University Hospital Centre (CHUV, Lausanne University Hospital,). In this article we describe the implementation of this interdisciplinary care strategy for patients suffering from OI, and its impact on their physical activity and quality of life.

Methods: All patients from the French part of Switzerland were invited to join us. We proposed two complementary evaluations: the initial interdisciplinary evaluation and a yearly follow-up during a special day – the “OI day”. This day features specialised medical appointments adapted to each patient’s needs, as well as lectures and/or workshops dedicated to patients’ and families’ education. Our first aim was to propose for each patient the same management, from diagnosis to the bone health evaluation and physical therapy advice. Our second aim was to evaluate the evolution of physical activity, quality of life (measured by EQ-5D, SF-36 and a dedicated questionnaire) and satisfaction of patients and their families. Here we report both the initial and the long-term results.

Results: Since 2012, 50 patients from the French part of Switzerland received the personalised medical evaluation. All of the patients included in this study had the same initial evaluation and at least one participation in an OI Day. All patients had an adaptation of their bone acting drugs. Over a 7-year period, 62% of inactive patients started some physical activity, and 44% of patients who were not involved in any athletic activity started participating in sports. The mean EQ-5D increased from 0.73 to 0.75 (p = 0.59). The mean physical SF36 (musculoskeletal function) score was 59.09 ± 22.72 and improved to 65.79 ± 21.51 (p = 0.08), whereas it was 68.06 ± 20.05 for the mental SF36 without alteration during follow-up. The OI day was revealed to be useful, it contributed to improvement in continuity of care and helped families to better understand the OI patients’ health.

Conclusions: Our interdisciplinary approach aimed at offering the same thorough management for all patients from the French part of Switzerland, and at improving both the physical activity and the satisfaction of the patients and their family. This report is a basis for future work focusing on the effect of bone fragility and the impact of OI on patients’ social relations.
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http://dx.doi.org/10.4414/smw.2020.20285DOI Listing
June 2020

Mass-normalized internal mechanical work in walking is not impaired in adults with class III obesity.

J Appl Physiol (1985) 2020 07 25;129(1):194-203. Epub 2020 Jun 25.

Institute of Sport Sciences of the University of Lausanne (ISSUL), University of Lausanne, Lausanne, Switzerland.

This study aimed to investigate the effects of obesity on the internal mechanical work, and its influence on the total mechanical work, energy cost, and mechanical efficiency in obese and nonobese adults while walking at different speeds. Body composition and anthropometrical characteristics were obtained for eleven obese [O; 39.9 ± 7.9 yr; body mass index (BMI): 43.0 ± 4.2 kg/m] and thirteen lean adults (L; 29.6 ± 5.7 yr; BMI: 22.0 ± 1.5 kg/m). Participants walked at five speeds (0.56, 0.83, 1.11, 1.39, 1.67 m/s) while oxygen consumption was measured to obtain net energy cost of walking (NC). A motion analysis system and instrumented treadmill were combined to obtain external (W), internal (W), and total (W) mechanical work, and pendular energy recovery. Mechanical efficiency was calculated as the ratio of W to NC. Relative NC (per unit body mass) was significantly higher in O than L ( ≤ 0.001). Relative W was significantly lower in O compared with L ( = 0.002), whereas no significant difference was found in relative W ( = 0.16) and W ( = 0.6). Recovery was significantly higher ( ≤ 0.001), while mechanical efficiency was significantly lower in O than in L ( ≤ 0.001). These results suggest that individuals with obesity class III have similar mass-normalized W and W compared with their lean counterparts, along with a higher relative NC. Consequently, the efficiency of walking was reduced in this population. These results suggest that mass-normalized W is unaffected by obesity and is not responsible for the higher relative NC and lower efficiency of walking in these individuals. It has been suggested that internal mechanical work (i.e., the work required to move the limbs with respect to the center of mass, W) may be responsible for the higher net cost of walking in obese adults, but this variable has not yet been studied in individuals with obesity. The main finding of the present study is that individuals with class III obesity exhibit a similar amount of mass-normalized W to that of adults with a normal body weight, suggesting that body mass-relative W is not affected by obesity and is not responsible for the higher energy cost and the lower efficiency of walking in this population.
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http://dx.doi.org/10.1152/japplphysiol.00837.2019DOI Listing
July 2020

Abaloparatide in Postmenopausal Women With Osteoporosis and Type 2 Diabetes: A Post Hoc Analysis of the ACTIVE Study.

JBMR Plus 2020 Apr 27;4(4):e10346. Epub 2020 Feb 27.

Research, St. Michael's Hospital University of Toronto Toronto Canada.

Type 2 diabetes mellitus (T2DM) increases fracture risk despite normal or increased BMD. Abaloparatide reduces fracture risk in patients with postmenopausal osteoporosis (PMO); however, its efficacy in women with T2DM is unknown. This post hoc analysis evaluated the efficacy and safety of abaloparatide in patients with T2DM. The analysis included patients with T2DM from the baloparatide omparator rial n ertebral ndpoints (ACTIVE), a phase 3, double-blind, randomized, placebo- and active-controlled trial. In ACTIVE, participants were randomized 1:1:1 to daily s.c. injections of placebo, abaloparatide (80 μg), or open-label teriparatide (20 μg) for 18 months. A total of 198 women with PMO and T2DM from 21 centers in 10 countries were identified from ACTIVE through review of their medical records. The main outcomes measured included effect of abaloparatide versus placebo on BMD and trabecular bone score (TBS), with secondary outcomes of fracture risk and safety, in patients from ACTIVE with T2DM. Significant ( < 0.001) improvements in BMD at total hip (mean change 3.0% versus -0.4%), femoral neck (2.6% versus -0.2%), and lumbar spine (8.9% versus 1.3%) and TBS at lumbar spine (3.72% versus -0.56%) were observed with abaloparatide versus placebo at 18 months. Fracture events were fewer with abaloparatide treatment in patients with T2DM, and differences were not significant between groups except nonvertebral fractures in the abaloparatide versus placebo groups ( = 0.04). Safety was consistent with the ACTIVE population. In conclusion, in women with PMO and T2DM, abaloparatide treatment resulted in significant improvements in BMD and TBS versus placebo, consistent with the overall ACTIVE population © 2020 The Authors. published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbm4.10346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117849PMC
April 2020

"Inflammaging" and bone in the OsteoLaus cohort.

Immun Ageing 2020 5;17. Epub 2020 Mar 5.

4Division of Rheumatology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland.

Background: "Inflammaging" is a coined term that combines the processes of inflammation (within the normal range) and aging, since chronic, low-grade, systemic inflammation emerges with increasing age. Unlike high-level inflammation, with which deleterious effects on bone no longer need to be demonstrated, it is unclear whether inflammaging exerts deleterious effects on bone too.

Method: We assessed associations between inflammaging - measured via cytokine levels (high-sensitivity C-reactive protein (hs-CRP); interleukin- (IL- interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)) - and bone parameters (prevalent and incident fractures, bone mineral density (BMD) and trabecular bone score (TBS)) in 1390 postmenopausal women from the OsteoLaus study.

Results: Mean (±SD) age was 64.5 ± 7.6 and mean bone mass index (BMI) 25.9 ± 4.5 kg/m2. Median hs-CRP, IL- IL-6 and TNF-α were 1.4 pg/ml, 0.57 pg/ml, 2.36 pg/ml and 4.82 pg/ml, respectively. In total, 10.50% of the participants had a prevalent, low-impact fracture; and, after 5-years of follow up, 5.91% had an incident, low-impact fracture. Mean T-score BMD was - 1.09 ± 1.53 for the spine, - 1.08 ± 1.02 for the femoral neck, and - 0.72 ± 0.96 for the total hip. Mean spine TBS was 1.320 ± 0.10. We found a positive association between hs-CRP and BMD at all sites, and between hs-CRP and the TBS, but none of these associations were significant after adjustment. We found no association between prevalent or incident fractures and hs-CRP. No association was found between IL-1β, IL6 and TNF-α and BMD, TBS or fractures.

Conclusion: Our results suggest that bone imaging and structure parameters are not associated with the low-grade cytokine levels (within the normal range) observed with inflammaging.
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http://dx.doi.org/10.1186/s12979-020-00177-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057650PMC
March 2020

Trabecular Bone Score (TBS) Predicts Fracture in Ankylosing Spondylitis: The Manitoba BMD Registry.

J Clin Densitom 2020 Oct - Dec;23(4):543-548. Epub 2020 Jan 17.

University of Manitoba, Winnipeg, Canada. Electronic address:

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the spine characterized among other features by spinal boney proliferation, back pain, loss of flexibility, and increased fracture risk. Overlying bone limits the utility of bone mineral density (BMD) by dual X-ray absorptiometry (DXA) in the spine. Trabecular bone score (TBS) is a bone texture measurement derived from the spine DXA image that indicates bone quality and fracture risk independent of BMD.

Methodology: Using the Manitoba Bone Density Program database, patients with diagnosis codes for ankylosing spondylitis, baseline DXA and lumbar spine TBS were identified. Incident nontraumatic fractures (major osteoporotic [MOF], clinical spine, hip, and all fracture) were identified from population based databases. Cox-proportional hazard models are presented.

Results: We identified 188 patients with diagnosed AS. TBS was lower in those with incident MOF (1.278 ± 0.126, compared to 1.178 ± 0.136, p < 0.001). Unadjusted TBS and FRAX-MOF-BMD adjusted predicted major osteoporotic fracture (N = 19) (hazard ratio [HR] 2.04, 95% confidence interval [CI]: 1.28-2.26, p = 0.003; HR 1.81, 95% CI: 1.11-2.96, p = 0.018). TBS unadjusted and FRAX-MOF-BMD adjusted also predicted clinical spine fracture (N = 7) (HR 2.50, 95% CI: 1.17-5.37; p = 0.019; HR 2.40 95% CI: 1.1-5.25; p = 0.028). Higher HRs were observed for prediction of hip fracture (N = 6), but these did not achieve statistical significance (FRAX-adjusted HR 1.74, 95% 0.73-4.17; p = 0.211). Unadjusted models show TBS was predictive of all fracture (N = 27) (HR 1.60, 95% CI: 1.08-2.39; p = 0.020), which was borderline significant after adjustment for FRAX-MOF-BMD (HR 1.51, 95% CI: 1.00-2.29; p = 0.052).

Conclusion: We report the first analysis of TBS for fracture prediction as an incident event in AS. TBS independently predicted major osteoporotic and clinical spine fracture in AS independent of FRAX.
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http://dx.doi.org/10.1016/j.jocd.2020.01.003DOI Listing
January 2020

OsteoLaus: raisons d’être et premiers résultats.

Praxis (Bern 1994) 2020 Jan;109(1):19-22

Centre des Maladies Osseuses, Département de l'Appareil Locomoteur, Centre hospitalier universitaire vaudois (CHUV) et Université de Lausanne, Lausanne.

OsteoLaus: Right to Exist and First Results The OsteoLaus cohort included 1475 women aged 50 to 80 years between 2010 and 2012, and since followed every 2.5 years. The main goal is to better define osteoporosis and the prediction of fracture risk. Using the multiple data available in CoLaus/PsycoLaus, many analyses are being conducted to better understand the relationship between bone health and chronic disease.
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http://dx.doi.org/10.1024/1661-8157/a003372DOI Listing
January 2020

Skeletal Effects of Levothyroxine for Subclinical Hypothyroidism in Older Adults: A TRUST Randomized Trial Nested Study.

J Clin Endocrinol Metab 2020 01;105(1)

Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.

Context: Both thyroid dysfunction and levothyroxine (LT4) therapy have been associated with bone loss, but studies on the effect of LT4 for subclinical hypothyroidism (SHypo) on bone yielded conflicting results.

Objective: To assess the effect of LT4 treatment on bone mineral density (BMD), Trabecular Bone Score (TBS), and bone turnover markers (BTMs) in older adults with SHypo.

Design And Intervention: Planned nested substudy of the double-blind placebo-controlled TRUST trial. Participants with SHypo were randomized to LT4 with dose titration versus placebo with computerized mock titration.

Setting And Participants: 196 community-dwelling adults over 65 years enrolled at the Swiss TRUST sites had baseline and 1-year follow-up bone examinations; 4 participants withdrew due to adverse events not related to treatment.

Main Outcome Measures: One-year percentage changes of BMD, TBS, and 2 serum BTMs (serum CTX-1 [sCTX] and procollagen type 1 N-terminal polypeptide [P1NP]). Student's t-test for unadjusted analyses and linear regression adjusted for clinical center and sex were performed.

Results: Mean age was 74.3 years ± 5.7, 45.4% were women, and 19.6% were osteoporotic. The unadjusted 1-year change in lumbar spine BMD was similar between LT4 (+0.8%) and placebo-treated groups (-0.6%; between-groups difference +1.4%: 95% confidence interval [CI] -0.1 to 2.9, P = .059). Likewise, there were no between-group differences in 1-year change in TBS (-1.3%: 95% CI -3.1 to 0.6, P = .19), total hip BMD (-0.2%: 95% CI -1.1 to 0.1, P = .61), or BTMs levels (sCTX +24.1%: 95% CI -7.9 to 56.2, P = .14), or after adjustment for clinical centers and sex.

Conclusions: Over 1-year levothyroxine had no effect on bone health in older adults with SHypo.

Registration: ClinicalTrial.gov NCT01660126 and NCT02491008.
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http://dx.doi.org/10.1210/clinem/dgz058DOI Listing
January 2020

Vertebral Fractures in Individuals With Type 2 Diabetes: More Than Skeletal Complications Alone.

Diabetes Care 2020 01 28;43(1):137-144. Epub 2019 Oct 28.

Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands

Objective: We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs.

Research Design And Methods: A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs.

Results: Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; = 0.0%; = 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; = 0.6%; = 0.43). In the IPD cohorts ( = 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]) or with VFs (HR 1.73 [95% CI 1.32-2.27]) or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]).

Conclusions: Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.
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http://dx.doi.org/10.2337/dc19-0925DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411280PMC
January 2020

Trabecular Bone Score Declines During the Menopause Transition: The Study of Women's Health Across the Nation (SWAN).

J Clin Endocrinol Metab 2020 04;105(4)

Department of Medicine, Division of Geriatrics, UCLA, Los Angeles, CA, Los Angeles, CA.

Context: Rapid bone density loss starts during the menopause transition (MT). Whether other components of bone strength deteriorate before the final menstrual period (FMP) remains uncertain.

Objective: To discern whether trabecular bone score (TBS) declines during the MT.

Design: An 18-year longitudinal analysis from the Study of Women's Health Across Nation.

Setting: Community-based cohort.

Participants: A total of 243 black, 164 Japanese, and 298 white, initially pre- or early perimenopausal women, who experienced their FMP.

Main Outcome Measures: TBS, an indicator of bone strength.

Results: Multivariable mixed effects regressions fitted piecewise linear models to repeated measures of TBS as a function of time before or after the FMP; covariates were age at FMP, race/ethnicity, and body mass index. Prior to 1.5 years before the FMP, in the referent individual (a white woman with age at FMP of 52.2 years and body mass index of 28.0 kg/m2), TBS evidenced no change (slope 0.12% per year, P = 0.2991). TBS loss began 1.5 years before the FMP, declining by 1.16% annually (P < 0.0001). Starting 2 years after the FMP, annual rate of TBS loss lessened to 0.89% (P < 0.0001). In the 5 years before through the 5 years after the FMP, in the referent individual, total TBS decline was 6.3% (P < 0.0001), but black participants' total TBS loss was 4.90% (P = 0.0008, difference in black and white 10-year change). Results for Japanese did not differ from those of white women.

Conclusions: The occurrence of an MT-related decline in TBS supports the thesis that this period is particularly damaging to skeletal integrity.
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http://dx.doi.org/10.1210/clinem/dgz056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069840PMC
April 2020

The Determinants of the Preferred Walking Speed in Individuals with Obesity.

Obes Facts 2019 10;12(5):543-553. Epub 2019 Sep 10.

Institute of Sport Sciences, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.

Background: The preferred walking speed (PWS), also known as the "spontaneous" or "self-selected" walking speed, is the speed normally used during daily living activities and may represent an appropriate exercise intensity for weight reduction programs aiming to enhance a more negative energy balance.

Objectives: The aim of this study was to examine, simultaneously, the energetics, mechanics, and perceived exertion determinants of PWS in individuals with obesity.

Methods: Twenty-three adults with obesity (age 32.7 ± 6.8 years, body mass index 33.6 ± 2.6 kg/m2) were recruited. The participants performed 10 min of treadmill familiarization, and PWS was determined. Each subject performed six 5-min walking trials (PWS 0.56, 0.83, 1.11, 1.39, and 1.67 m/s). Gas exchanges were collected and analyzed to obtain the gross energy cost of walking (GCw), rated perceived exertion (RPE) was measured using a 6-20 Borg scale, and the external mechanical work (Wext) and the fraction of mechanical energy recovered by the pendular mechanism (Recovery) were computed using an instrumented treadmill. Second-order least-squares regression was used to calculate the optimal walking speed (OWS) of each variable.

Results: No significant difference was found between PWS (1.28 ± 0.13 m/s) and OWS for GCw (1.28 ± 0.10 m/s), RPE cost of walking (1.38 ± 0.14 m/s), and Recovery (1.48 ± 0.27 m/s; p > 0.06 for all), but the PWS was significantly faster than the OWS for Wext (0.98 ± 0.56 m/s; p < 0.02). Multiple regression (r = 0.72; p = 0.003) showed that ∼52% of the variance in PWS was explained by Recovery, Wext, and height.

Conclusion: The main finding of this study was that obese adults may select their PWS in function of several competing demands, since this speed simultaneously minimizes pendular energy transduction, energy cost, and perceived exertion during walking. Moreover, recovery of mechanical work, external work, and height seem to be the major determinants of PWS in these individuals.
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http://dx.doi.org/10.1159/000501968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876590PMC
February 2020

Unknown osteoporosis in older patients admitted to post-acute rehabilitation.

Aging Clin Exp Res 2020 Jun 28;32(6):1145-1152. Epub 2019 Aug 28.

Bone Disease Center, Lausanne University Hospital, Lausanne, Switzerland.

Background: Osteoporotic fractures are associated with increased morbidity, mortality, and increased health care use. As the number of older adults increases, identifying those at increased risk for osteoporotic fractures has become of utmost importance to providing them with preventive and therapeutic interventions.

Aims: To determine the prevalence of unknown clinical and densitometric osteoporosis and to investigate the performance of different diagnostic strategies for osteoporosis in elderly patients admitted to rehabilitation.

Method: This is an observational study. Eligible participants were older adults admitted to rehabilitation in an academic hospital in Switzerland over an 11-month period. Patients with previously unknown osteoporosis underwent dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA), and history review for past fractures.

Results: Complete assessment was available for 252 patients. Previously undiagnosed osteoporosis was identified in 62.3% of these patients, a proportion that was higher among women (71.5%) than men (44.8%). DXA proved most sensitive, followed by VFA and history review. Results differed across gender: DXA remained the most sensitive single test among women, but VFA proved most sensitive in men. The best test to combine with history review was DXA in women (detection increasing from 47.5 to 93.2%) and VFA in men (detection increasing from 35.9 to 84.6%).

Conclusions: Prevalence of previously unknown osteoporosis appears very high in elderly patients admitted to post-acute rehabilitation. The combination of history review of previous fractures with DXA in women and with VFA in men appears the best two-step strategy to improving detection of osteoporosis in this population.
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http://dx.doi.org/10.1007/s40520-019-01302-7DOI Listing
June 2020

The Metabolic Benefits of Menopausal Hormone Therapy Are Not Mediated by Improved Nutritional Habits. The OsteoLaus Cohort.

Nutrients 2019 Aug 16;11(8). Epub 2019 Aug 16.

Center of Bone Diseases, CHUV, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland.

Menopause alters body composition by increasing fat mass. Menopausal hormone therapy (MHT) is associated with decreased total and visceral adiposity. It is unclear whether MHT favorably affects energy intake. We aimed to assess in the OsteoLaus cohort whether total energy intake (TEI) and/or diet quality (macro- and micronutrients, dietary patterns, dietary scores, dietary recommendations)-evaluated by a validated food frequency questionnaire-differ in 839 postmenopausal women classified as current, past or never MHT users. There was no difference between groups regarding TEI or consumption of macronutrients. After multivariable adjustment, MHT users were less likely to adhere to the unhealthy pattern 'fat and sugar: Current vs. never users [OR (95% CI): 0.48 (0.28-0.82)]; past vs. never users [OR (95% CI): 0.47 (0.27-0.78)]. Past users exhibited a better performance in the revised score for Mediterranean diet than never users (5.00 ± 0.12 vs. 4.63 ± 0.08, < 0.04). Differences regarding compliance with dietary recommendations were no longer significant after adjustment for covariates. Overall, these results argue against a major role of TEI and diet quality as possible mediators of the MHT metabolic benefits. Future research on this relationship should focus on other potential targets of MHT, such as resting energy expenditure and physical activity.
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http://dx.doi.org/10.3390/nu11081930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722637PMC
August 2019

Clinical Performance of the Updated Trabecular Bone Score (TBS) Algorithm, Which Accounts for the Soft Tissue Thickness: The OsteoLaus Study.

J Bone Miner Res 2019 12 25;34(12):2229-2237. Epub 2019 Oct 25.

Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland.

Regional soft tissue may have a noise effect on trabecular bone score (TBS) and eventually alter its estimate. The current TBS software (TBS iNsight®) is based on an algorithm accounting for body mass index (BMI) (TBS ). We aimed to explore the updated TBS algorithm that accounts for soft tissue thickness (TBS ). This study was embedded in the OsteoLaus cohort of women in Lausanne, Switzerland. Hip and lumbar spine (LS) dual-energy X-ray absorptiometry (DXA) scans were performed using Discovery A System (Hologic). The incident major osteoporotic fractures (MOFs) were assessed from vertebral fracture assessments using Genant's method (vertebral MOF) or questionnaires (nonvertebral MOF). We assessed the correlations of bone mineral density (BMD) or TBS with body composition parameters; MOF prediction ability of both versions of TBS; and the differences between Fracture Risk Assessment Tool (FRAX) adjusted for TBS or TBS . In total, 1362 women with mean ± SD age 64.4 ± 7.5 years and mean ± SD BMI 25.9 ± 4.5 kg/m were followed for 4.4 years and 132 experienced an MOF. All the anthropometric measurements of our interest were positively correlated with LS, femoral neck, or hip BMD and TBS ; whereas with TBS their correlations were negative. In the models adjusted for age, soft tissue thickness, osteoporotic treatment, and LS-BMD, for each SD decline in TBS , there was a 43% (OR 1.43; 95% CI, 1.12 to 1.83) increase in the odds of having MOF; whereas for each SD decline in TBS , there was a 54% (OR 1.54; 95% CI, 1.18 to 2.00) increase in the odds of having an MOF. Both FRAXs were very strongly correlated and the mild differences were present in the already high-risk women for MOF. This study shows that TBS overcomes the debatable residual negative correlation of the current TBS with body size and composition parameters, postulating itself as free from the previously acknowledged technical limitation of TBS. © 2019 American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbmr.3851DOI Listing
December 2019

Reference Ranges for Trabecular Bone Score in Australian Men and Women: A Cross-Sectional Study.

JBMR Plus 2019 Jun 15;3(6):e10133. Epub 2019 Jan 15.

Deakin University, School of Medicine Geelong Australia.

Trabecular bone score (TBS) is a novel method for indirectly assessing trabecular microarchitecture at the lumbar spine, providing information complementary to areal BMD. However, limited reference ranges exist for the normative distribution of TBS, particularly in men. The aim of this study was to develop such a reference range in Australian men and women. This study included 894 men and 682 women (aged 24 to 98 years) enrolled in the Geelong Osteoporosis Study. TBS was determined retrospectively by analysis of lumbar spine DXA scans (Lunar Prodigy) using TBS iNsight software (version 2.2). Multivariable regression techniques were used to determine best-fit models for TBS incorporating age, height, and weight. Age-related differences in TBS were best modelled with a linear relationship in men and a cubic relationship in women. Combined best-fit models for TBS included age and weight in men, and age and height in women. This study provides normative reference ranges for TBS in Australian men and women, and further indicates that TBS may identify individuals at risk for fracture despite normal BMD. © 2018 The Authors. Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbm4.10133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636769PMC
June 2019

[Menopausal hormone therapy. Effects on bone and body composition].

Rev Med Suisse 2019 Apr;15(647):836-839

Centre des maladies osseuses, Département de l'appareil locomoteur, CHUV, 1011 Lausanne.

Changes occurring at menopause can be mitigated by prescribing menopausal hormone replacement therapy (HRT). Recent publications from the CoLaus/OsteoLaus cohorts provide important insights into the effects of HRT and after its discontinuation on bone and body composition. HRT has a beneficial effect on bone mineral density, bone microarchitecture and fracture prevention. The benefits persist after treatment discontinuation, but not beyond 2 to 5 years. The effect of HRT on body composition is more controversial. HRT reduces the accumulation of fat mass, mainly abdominal and visceral fat mass. This is important from the perspective of diabetes and cardiovascular disease prevention. However, the benefits seem to disappear immediately after discontinuation.
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April 2019

Assessing bone impairment in ankylosing spondylitis (AS) using the trabecular bone score (TBS) and high-resolution peripheral quantitative computed tomography (HR-pQCT).

Bone 2019 05 29;122:8-13. Epub 2019 Jan 29.

Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil. Electronic address:

Objectives: To compare bone quality using the trabecular bone score (TBS) and bone microarchitecture in the distal tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) in ankylosing spondylitis (AS) patients and healthy controls (HC).

Methods: Areal bone mineral density (aBMD) and TBS (TBS iNsight software) were evaluated using DXA (Hologic, QDR 4500); while volumetric bone mineral density (vBMD) and bone microarchitecture were analyzed in the distal tibia using HR-pQCT (Scanco) in 73 male patients with AS and 52 age-matched HC.

Results: AS patients were a mean 41.6 ± 7.9 years old and had a mean disease duration of 16.4 ± 8.6 y, with a mean mSASSS 25.6 ± 16.4. No difference was observed in lumbar spine aBMD in AS patients and HC (p = 0.112), but total hip BMD (p = 0.011) and TBS (p < 0.001) were lower in AS patients. In the distal tibia, reduced trabecular volumetric density [Tb.vBMD (p < 0.006)] and structural alterations - trabecular thickness (Tb.Th), p = 0.044 and trabecular separation (Tb.Sp), p = 0.039 - were observed in AS patients relative to controls. Further analysis comparing TBS < 1.310 and TBS ≥ 1.310 in AS patients revealed a higher mean body mass index [BMI] (p = 0.010), lower tibia cortical vBMD [Ct.vBMD] (p = 0.007), lower tibia cortical thickness [Ct.Th]: (p = 0.048) in the former group. On logistic regression analysis, BMI (OR = 1.27; 95%IC = 1.08-1.50, p = 0.005), (VF 4.65; 1.13-19.1, p = 0.033) and tibial Ct.vBMD (0.98; 0.97-1.00, p = 0.007) were associated with a lower TBS (<1.310).

Conclusions: The present study demonstrates that TBS and HR-pQCT imaging are important technologies evaluating bone impairment in AS patients. Moreover, in these patients vertebral fractures were associated with lower TBS.
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http://dx.doi.org/10.1016/j.bone.2019.01.024DOI Listing
May 2019

Cohort Profile: The OsteoLaus study.

Int J Epidemiol 2019 08;48(4):1046-1047g

Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland.

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http://dx.doi.org/10.1093/ije/dyy276DOI Listing
August 2019

Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females.

Clin Endocrinol (Oxf) 2019 03 9;90(3):433-439. Epub 2019 Jan 9.

Aging and Muscle Metabolism Laboratory, Department of Physiology, School of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.

Objective: Research findings on the relationship between serum androgens and adipose tissue in older females are inconsistent. We aimed to clarify the relationship using state-of-the-art techniques to evaluate associations between body fat distribution and plasma testosterone (T) levels in older postmenopausal women.

Design: Observational, cross-sectional study of healthy, community dwelling postmenopausal women.

Patients And Measurements: Postmenopausal women (60-80 years old) were included in this study. Overall body composition was evaluated by dual-energy X-ray absorptiometry. Abdominal and thigh fat depots were measured by magnetic resonance imaging. Circulating T concentrations were analysed by liquid chromatography-tandem mass spectrometry.

Results: Thirty-five women (66.6 ± 0.8 years) participated in this study. T levels were positively associated with clinical proxy measures of adiposity including weight (ρ = 0.39), BMI (ρ = 0.43) and waist circumference (ρ = 0.39) (all P < 0.05). Fat mass and % body fat were correlated with T levels (ρ = 0.42 and 0.38 respectively, both P < 0.05). T correlated with overall and superficial abdominal fat (ρ = 0.34 and 0.37 respectively, both P < 0.05) but not with visceral adipose tissue. T increased with greater thigh fat (ρ = 0.49, P < 0.05) in both superficial and deep depots (ρ = 0.50 and 0.35 respectively, both P < 0.05).

Conclusion: Our results suggest that postmenopausal women with higher circulating T levels have both higher regional and overall body adiposity. These findings underscore the sexual dimorphism in the relationship between serum androgen levels and adiposity.
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http://dx.doi.org/10.1111/cen.13921DOI Listing
March 2019

Is trabecular bone score less affected by degenerative-changes at the spine than lumbar spine BMD?

Arch Osteoporos 2018 11 16;13(1):127. Epub 2018 Nov 16.

Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281 (Barwon Health), Geelong, Vic, 3220, Australia.

It has been established that degenerative-changes at the spine elevate bone mineral density at the lumbar spine. This study in men reports that trabecular bone score may be less affected by spinal degenerative-changes.

Purpose: A recent tool for assessing trabecular microarchitecture at the lumbar spine, trabecular bone score (TBS), provides information about bone health complementary to lumbar spine areal BMD (here referred to as BMD). In men, mean BMD increases with increasing age due to degenerative-changes at the spine including osteophytes and aortic calcification. The aim of this study was to investigate whether TBS is similarly affected by the presence of degenerative-changes in men.

Methods: This study included 728 men aged 40-90 years enrolled in the Geelong Osteoporosis Study. Lumbar spine DXA scans (Lunar Prodigy) were used to determine TBS retrospectively (TBS iNsight software, Version 2.2), and for identification of degenerative-changes. Using multivariable regression techniques, the relationships between TBS or BMD and degenerative-changes were assessed, further adjusting for age and weight. The difference between each of the two methods was examined through testing interactions between method, degenerative-changes and age.

Results: Of 728 men, 439 (60.3%) were identified as having one or more degenerative-changes at the lumbar spine. Adjusted mean TBS was 1.219 (1.203-1.232) and 1.196 (1.179-1.212) for those with and without degenerative-changes, respectively. Adjusted mean BMD was 1.317 g/cm (1.297-1.336) and 1.198 g/cm (1.173-1.223) for those with and without degenerative-changes, respectively. Partial r for degenerative-changes in the model for TBS was 0.076 and for BMD, 0.257 (both p < 0.05). The three-way interaction between method, degenerative-changes and age was significant (p = 0.05) indicating significant effect of artefacts on the standardised values, affected by age and method.

Conclusion: This study suggests that TBS is less affected by degenerative-changes at the spine than is BMD. Thus, TBS may prove useful in the assessment of fracture risk in men with degenerative-changes at the spine.
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http://dx.doi.org/10.1007/s11657-018-0544-3DOI Listing
November 2018

Review on the Utility of Trabecular Bone Score, a Surrogate of Bone Micro-architecture, in the Chronic Kidney Disease Spectrum and in Kidney Transplant Recipients.

Front Endocrinol (Lausanne) 2018 24;9:561. Epub 2018 Sep 24.

Bone & Joint Department, Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.

Chronic kidney disease (CKD) is defined as abnormalities of kidney structure or function, present for >3 months, with implications for, among others, bone health. Advanced stages of CKD have an increased risk of fragility fractures. Trabecular bone score (TBS) is a relatively new gray-level textural parameter, which provides information on bone microarchitecture and has been shown to be a good predictor of fragility fractures independently of bone density and clinical risk factors. We aimed to review the scientific literature on TBS and its utility along the CKD spectrum and in kidney transplant recipients. In total, eight articles had investigated this topic: one article in patients with reduced kidney function, two in patients on hemodialysis, and five in kidney transplant recipients. In general, all the studies had shown an association between lower values of TBS and reduced kidney function; or lower TBS values among the hemodialysis or kidney transplant patients compared to healthy controls. Moreover, TBS was shown to be a good and independent predictor of fragility fractures in patients with CKD or who underwent kidney transplantation. TBS postulates itself as a valuable marker to be used in clinical practice as an assessor of bone microarchitecture and fracture risk predictor in these specific populations. However, evidence is to some extent limited and larger follow-up case-control studies would help to further investigate the TBS utility in the management of bone health damage and increased fracture risk in patients with CKD or kidney transplant.
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http://dx.doi.org/10.3389/fendo.2018.00561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165902PMC
September 2018

The Reduction of Visceral Adipose Tissue after Roux-en-Y Gastric Bypass Is more Pronounced in Patients with Impaired Glucose Metabolism.

Obes Surg 2018 12;28(12):4006-4013

Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Rue Saint-Martin 3, 1003, Lausanne, Switzerland.

Purpose: Visceral adipose tissue (VAT) is associated with cardiometabolic risk factors and insulin resistance. The physiological mechanisms underlying the benefits of Roux-en-Y gastric bypass surgery (RYGB) on glucose metabolism remain incompletely understood. The impact of RYGB on VAT was assessed among three groups of patients stratified by their glucose tolerance before surgery.

Methods: Forty-four obese women were categorized into normoglycemia (n = 21), impaired glucose tolerance (IGT, n = 18) and diabetes (n = 5) before surgery. Body composition measured by dual-energy X-ray absorptiometry (DXA) was performed before surgery, 6 months and 12 months after.

Results: The three groups had comparable mean age (mean 38.6 ± SD 9.9) and BMI at baseline (41.9 ± 4.3 kg/m). After 12 months, total weight loss (mean 35.1% ± 7.5) and excess weight loss (91.1% ± 25.1) were similar between groups. Pre-surgery mean VAT was significantly higher in diabetes (mean 2495 ± 616 g) than in normoglycemia (1750 ± 617 g, p = 0.02). The percentage of VAT to total body fat was significantly higher in diabetes (mean 4.4% ± 0.9) compared to normoglycemia (2.9% ± 0.8, p = 0.003). Twelve months after surgery, VAT loss was significantly greater among patients with diabetes (mean 1927 ± 413 g) compared to normoglycemia (1202 ± 450, p = 0.009).

Conclusions: RYGB leads to important VAT loss, and this loss is greater in patients with diabetes prior to surgery. As VAT is associated with insulin resistance, this reduction may account for the profound impact of this surgery on glucose metabolism.
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http://dx.doi.org/10.1007/s11695-018-3455-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223744PMC
December 2018

The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease.

Bone 2018 11 8;116:215-220. Epub 2018 Aug 8.

Department of Medicine, Columbia University Medical Center, New York, NY, USA. Electronic address:

The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients. We obtained tetracycline double labeled transiliac crest bone biopsy, areal BMD of the spine, total hip, femoral neck (FN) and spine TBS by dual energy X-ray absorptiometry (DXA), and cortical and trabecular volumetric density and microarchitecture by high resolution peripheral quantitative computed tomography (HR-pQCT) in CKD patients from two centers: twenty-two patients from Columbia University Medical Center, USA and thirty patients from Hospital das Clinicas - Universidade de São Paulo, Brazil. Two patients were excluded for outlier status. Univariate and multivariate relationships between TBS and measures from DXA, HR-pQCT and histomorphometry were determined. Patients were 50.2 ± 15.8 years old, 23 (46%) were men, and 33 (66%) were on dialysis. TBS was <1.31 in 21 (42%) patients and 22%, 14% and 10% had T-scores ≤ -2.5 at spine, FN and total hip respectively. In univariate regression, TBS was significantly associated with trabecular bone volume (BV/TV), trabecular width (Tb.Wi), trabecular spacing, cortical width but not with trabecular number or cortical porosity. FN Z-score and height were also associated with cancellous BV/TV and Tb.Wi, In multivariate analysis, TBS remained an independent predictor of BV/TV and Tb.Wi. There were no relationships between TBS and dynamic parameters from histomorphometry. These data suggest that TBS reflected trabecular microarchitecture and cortical width measured by bone biopsy in CKD patients. Future studies should address its utility in the identification of CKD patients who may benefit from fracture prevention strategies.
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http://dx.doi.org/10.1016/j.bone.2018.08.006DOI Listing
November 2018
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