Physical activity estimated by osteogenic potential and energy expenditure has differing associations with bone mass in young adults: the raine study

Summary: Ground impacts during physical activity may be important for peak bone mass. We found differences in how energy expenditure and impact scores estimated from a physical activity questionnaire related to bone health in young adults. Using both estimate types can improve our understanding of the skeletal benefits of physical activity. Purpose: It is unclear whether mechanical loading during physical activity, estimated from physical activity questionnaires which assess metabolic equivalents of task (METs), is associated with skeletal health. This longitudinal study investigated how physical activity loading scores, assessed at ages 17 and 20 years, (a) compares with physical activity measured in METs, and (b) is associated with bone mass at age 20 years. Methods: A total of 826 participants from the Raine Study Gen2 were assessed for physical activity energy expenditure via the International Physical Activity Questionnaire (IPAQ) at age 17 and 20 years. Loading scores (the product of peak force and application rate) per week were subsequently estimated from the IPAQ. Whole-body and appendicular bone mineral density (BMD) at age 20 years were assessed by dual-energy X-ray absorptiometry. Results: Bland–Altman minimal detectable difference for physical activity Z- scores at age 17 and 20 years were 1.59 standard deviations (SDs) and 1.33 SDs, respectively, greater than the a priori minimal clinically important change of 0.5 SDs. Loading score, but not IPAQ score, had significant positive associations with whole-body and leg BMD after adjustment for covariates (β = 0.008 and 0.012 g/cm2, respectively, for age 17 and 20 years loading scores). IPAQ score at age 20 years, but not loading score, had a significant positive association with arm BMD (β = 0.007 g/cm2). Conclusion: This study revealed disagreement in associations of self-reported METs and loading score estimates with bone health in young adults. Coupling traditional energy expenditure questionnaire outcomes with bone-loading estimates may improve understanding of the location-specific skeletal benefits of physical activity in young adults

Randomised controlled trial comparing daily VerSus depot vitamin D3 therapy in 0-16-year-old newly settled refugees in Western Australia over a period of 40 weeks

Vitamin D deficiency is highly prevalent in newly settled refugees in Western Australia (WA). If adherence to daily vitamin D therapy is problematic, depot therapy is a therapeutic alternative. The aim of this studywas to compare daily versus depot treatment and factors influencing the therapeutic outcome. Newly settled refugees (n = 151) with 25(OH)D levels less than 78 nmol/L were randomised to receive daily or depot vitamin D therapy with eight weekly interval follow up to 40 weeks. Biochemical and clinical parameters were collected at each visit. Generalized LinearMixedModels (GLMM) examined the longitudinal changes over time controlling for confounders including age, gender, treatment arm, season, country of refuge/origin and sun exposure score. Participants were aged 5.5 months to 16.0 years (75 males, 83 females). Both treatment groups achieved vitamin D sufficiency. The daily treatment group had significantly higher 25(OH)D levels at each visit post baseline and a higher proportion of participants with levels above 50 nmol/L at all time points. Time, treatment group, calcium and sun exposure score were significant predictors of 25(OH)D serum levels. Depot vitamin D therapy is an alternative to daily treatment in this at-risk group of children and adolescents in whom treatment adherence is problemati

Suboptimal bone status for adolescents with low motor competence and developmental coordination disorder - It\u27s sex specific

Background: Australian adolescents with low motor competence (LMC) have higher fracture rates and poorer bone health compared to European normative data, but currently no normative data exists for Australians. Aims: To examine whether there were bone health differences in Australian adolescents with LMC or Developmental Coordination Disorder (DCD) when compared to typically developing age-matched Australian adolescents. Methods and Procedures: Australian adolescents aged 12–18 years with LMC/DCD (n=39; male=27; female=12) and an Australian comparison sample (n=188; boys=101; girls= 87) undertook radial and tibial peripheral Quantitative Computed Tomography (pQCT) scans. Stress Strain Index (SSI (mm3)), Total Bone Area (TBA (mm2)), Muscle Density (MuD [mgcm3]), Muscle Area (MuA [cm2]), Subcutaneous Fat Area (ScFA [cm2]), Cortical Density (CoD [mgcm3]), Cortical Area (CoD [mm2]), cortical concentric ring volumetric densities, Functional Muscle Bone Unit Index (FMBU: (SSI/bone length)) and Robustness Index (SSI/bone length^3), group and sex differences were examined. Outcome and Results: The main finding was a significant sex-x-group interaction for Tibial FMBU (p=.021), Radial MuD (p=.036), and radial ScFA (p=.002). Boys with LMC/DCD had lower tibial FMBU scores, radial MuD and higher ScFA than the typically developing age-matched sample. Conclusion and Implications: Comparisons of bone measures with Australian comparative data are similar to European findings however sex differences were found in the present study. Australian adolescent boys with LMC/DCD had less robust bones compared to their well-coordinated Australian peers, whereas there were no differences between groups for girls. These differences may be due to lower levels of habitual weight–bearing physical activity, which may be more distinct in adolescent boys with LMC/DCD compared to girls

Factors Associated with the Performance of a Blood-Based Interferon-γ Release Assay in Diagnosing Tuberculosis

Background: Indeterminate results are a recognised limitation of interferon-γ release assays (IGRA) in the diagnosis of latent tuberculosis (TB) infection (LTBI) and TB disease, especially in children. We investigated whether age and common co-morbidities were associated with IGRA performance in an unselected cohort of resettled refugees. Methods: A retrospective cross-sectional study of refugees presenting for their post-resettlement health assessment during 2006 and 2007. Refugees were investigated for prevalent infectious diseases, including TB, and for common nutritional deficiencies and haematological abnormalities as part of standard clinical screening protocols. Tuberculosis screening was performed by IGRA; QuantiFERON-TB Gold in 2006 and QuantiFERON-TBGold In-Tube in 2007. Results: Complete data were available on 1130 refugees, of whom 573 (51%) were children less than 17 years and 1041 (92%) were from sub-Saharan Africa. All individuals were HIV negative. A definitive IGRA result was obtained in 1004 (89%) refugees, 264 (26%) of which were positive; 256 (97%) had LTBI and 8 (3%) had TB disease. An indeterminate IGRA result was obtained in 126 (11%) refugees (all failed positive mitogen control). In multivariate analysis, younger age (linear OR = 0.93 [95% CI 0.91-0.95],

Type 1 diabetes in children - Emergency management

Background: Fifteen to sixty-seven percent of patients with new onset type 1 diabetes mellitus (T1DM) present in diabetic ketoacidosis (DKA), of which approximately 79% initially see their general practitioner. Diabetic ketoacidosis is the most common cause of diabetes related deaths, mainly due to cerebral oedema that occurs in 0.4–3.1% of patients. Objective: The aim of this review is to provide information to improve the early recognition of DKA and to provide guidelines for the initial management of DKA in the nonspecialist setting. Discussion: Recognition of DKA can be improved by increasing the awareness for early clinical symptoms such as polyuria and polydipsia. It is important to include urinalysis and ‘fingerprick’ blood glucose and ketone measurements in the early assessment of patients with suspected T1DM and known T1DM, particularly if risk factors for DKA are present, to minimise serious complications and prevent fatal outcomes. Urgent referral to specialist centres for suspected new onset T1DM/DKA is required. Specific steps should be followed to ensure successful initial management of DKA in the nonspecialist setting before transfer

The natural history of symptomatic fractures in children and adolescents with Osteogenesis Imperfecta Type 1: A cohort study From Western Australia

Thefractureexperienceofchildren and adolescents with osteogenesis imperfecta (OI) type 1 is not well described in the liter-ature. We present data on symptomatic long bones and axial skeleton fractures of all patients aged 0 to 18 years with OI type1 seen at a specialized bone clinic in Western Australia in the period 2008 to 2020 using a retrospective chart review method.The cohort consisted of 44 patients (21 males, 23 females). Median (interquartile range [IQR]) age was 11.3 (6.2 to 17) years, giv-ing a total of 520 patient-years in the study during which 197 fractures were experienced. The mean fracture rate was 379 frac-tures per 1000 patient-years (95% confidence interval [CI]: 310 to 440); however, the experience for fractures varied from≤1fracture in 23% (n=10) to two to 20 in 77% (n=34) of the cohort. Twenty-one patients (48.5%) received bisphosphonates dur-ing the study period. In logistic regression, age, but not sex or family history of OI, was a significant predictor of fracture risk. Thehighest total fracture rate was observed in the age group 0 to \u3c3 years at 469 fractures/1000 patient-years, which declined to140 fractures/1000 patient-years in the age group 15 to 18 years. The lower limbs were the site of 49.7% of all fractures. Thehighestrateforlowerlimbfracturewasintheagegroup0to\u3c3years at 331 fractures/1000 patient-years, decreasing to 0 frac-tures/1000 patient-years in the age group 15 to 18 years. Upper limb fracture rates increased from 100 fractures/1000 patient-years in the 0 to \u3c3 years age group to 307 fractures/1000 patient-years in the 9 to \u3c12 years age group and then declining to70 fractures/1000 years in the 15 to 18 years age group. In pediatricpatients with OI type 1, fracture risk is highest in early life,especially in the lower limbs. Multidisciplinary care of children with OI should have a particular focus on strategies to preventthese fractures. © 2023 The Authors.JBMR Pluspublished by Wiley Periodicals LLC onbehalf of American Society for Boneand Mineral Research

The natural history of symptomatic fractures in children and adolescents with osteogenesis imperfecta type 1: a cohort study from Western Australia

The fracture experience of children and adolescents with osteogenesis imperfecta (OI) type 1 is not well described in the literature. We present data on symptomatic long bones and axial skeleton fractures of all patients aged 0 to 18 years with OI type 1 seen at a specialized bone clinic in Western Australia in the period 2008 to 2020 using a retrospective chart review method. The cohort consisted of 44 patients (21 males, 23 females). Median (interquartile range [IQR]) age was 11.3 (6.2 to 17) years, giving a total of 520 patient-years in the study during which 197 fractures were experienced. The mean fracture rate was 379 fractures per 1000 patient-years (95% confidence interval [CI]: 310 to 440); however, the experience for fractures varied from ≤1 fracture in 23% (n = 10) to two to 20 in 77% (n = 34) of the cohort. Twenty-one patients (48.5%) received bisphosphonates during the study period. In logistic regression, age, but not sex or family history of OI, was a significant predictor of fracture risk. The highest total fracture rate was observed in the age group 0 to \u3c3 years at 469 fractures/1000 patient-years, which declined to 140 fractures/1000 patient-years in the age group 15 to 18 years. The lower limbs were the site of 49.7% of all fractures. The highest rate for lower limb fracture was in the age group 0 to \u3c3 years at 331 fractures/1000 patient-years, decreasing to 0 fractures/1000 patient-years in the age group 15 to 18 years. Upper limb fracture rates increased from 100 fractures/1000 patient-years in the 0 to \u3c3 years age group to 307 fractures/1000 patient-years in the 9 to \u3c12 years age group and then declining to 70 fractures/1000 years in the 15 to 18 years age group. In pediatric patients with OI type 1, fracture risk is highest in early life, especially in the lower limbs. Multidisciplinary care of children with OI should have a particular focus on strategies to prevent these fractures. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

The Natural History of Symptomatic Fractures in Children and Adolescents with Osteogenesis Imperfecta Type 1: A Cohort Study from Western Australia

ABSTRACT The fracture experience of children and adolescents with osteogenesis imperfecta (OI) type 1 is not well described in the literature. We present data on symptomatic long bones and axial skeleton fractures of all patients aged 0 to 18 years with OI type 1 seen at a specialized bone clinic in Western Australia in the period 2008 to 2020 using a retrospective chart review method. The cohort consisted of 44 patients (21 males, 23 females). Median (interquartile range [IQR]) age was 11.3 (6.2 to 17) years, giving a total of 520 patient‐years in the study during which 197 fractures were experienced. The mean fracture rate was 379 fractures per 1000 patient‐years (95% confidence interval [CI]: 310 to 440); however, the experience for fractures varied from ≤1 fracture in 23% (n = 10) to two to 20 in 77% (n = 34) of the cohort. Twenty‐one patients (48.5%) received bisphosphonates during the study period. In logistic regression, age, but not sex or family history of OI, was a significant predictor of fracture risk. The highest total fracture rate was observed in the age group 0 to <3 years at 469 fractures/1000 patient‐years, which declined to 140 fractures/1000 patient‐years in the age group 15 to 18 years. The lower limbs were the site of 49.7% of all fractures. The highest rate for lower limb fracture was in the age group 0 to <3 years at 331 fractures/1000 patient‐years, decreasing to 0 fractures/1000 patient‐years in the age group 15 to 18 years. Upper limb fracture rates increased from 100 fractures/1000 patient‐years in the 0 to <3 years age group to 307 fractures/1000 patient‐years in the 9 to <12 years age group and then declining to 70 fractures/1000 years in the 15 to 18 years age group. In pediatric patients with OI type 1, fracture risk is highest in early life, especially in the lower limbs. Multidisciplinary care of children with OI should have a particular focus on strategies to prevent these fractures. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research

Pre- and postnatal vitamin D status and allergy outcomes in early childhood

The dramatic increase in the prevalence of allergic disease in recent decades reflects environmental and behavioural changes that have altered patterns of early immune development. The very early onset of allergic diseases points to the specific vulnerability of the developing immune system to environmental changes and the development of primary intervention strategies is crucial to address this unparalleled burden. Vitamin D is known to have immunomodulatory functions. While allergic disease is multifactorial, associations with reduced sunlight exposure have led to the hypothesis that suboptimal vitamin D levels during critical early periods may be one possible explanation. Interventions to improve vitamin D status, especially in early life, may be the key to allergic disease prevention

Effect of resistance training on peripheral bone mineral density and muscle strength in adolescents with motor difficulties

Objectives: Adolescents with motor difficulties may have a higher fracture risk due to limited participation in high impact physical activities that improve bone mineral density (BMD). Equipment constrained resistance training (RT) interventions may be an effective way to improve both muscle strength and BMD in this population. The aims of this study were to investigate the effect of a gym- based RT intervention on peripheral BMD, and to determine the extent of the relationship between BMD and muscle strength, among adolescents with motor difficulties. Methods: Participants were 21 adolescents (13 intervention and 8 control) with motor difficulties, with a mean age of 14 (1.54) years. The participants were recruited from a larger research project (Adolescent Movement Program; AMPitup) and its wait list. The intervention was a 13-week aerobic and resistance exercise program that participants attended for 90-minutes twice a week. The exercise program included 5 pre-set exercises targeting the forearm and lower leg (Leg–press, push-ups, seated row, calf raises, and up-right rows) to be completed every session. Measures taken pre and post intervention included peripheral BMD scans (tibia and radius; trabecular and cortical density) using peripheral Quantitative Computer Tomography (pQCT), height, weight, upper (grip strength, chest pass) and lower (IRM leg press, distance and vertical jump) body muscle strength. General linear models, adjusting for physical maturity, and correlations were used to analyse the data. Results: Improvements in muscle strength, in particular for the upper body (right hand grip strength p = .01; chest pass p = .01) were observed in the intervention group but not the control group. Changes in BMD measures from pre to post test in the intervention group were less conclusive due to the small sample size and short time frame, however positive trends were apparent. Muscle strength and BMD was related as evidenced by moderate to strong correlations, particularly for the lower leg. Conclusion: A targeted resistance training program may be effective in improving muscle strength and stimulating bone changes in adolescents with motor difficulties. Further research is needed to clarify the most effective exercises for site specific BMD improvements in this group