An unusual case of hypercortisolism with multiple weight-bearing bone fractures

Glucocorticoid excess, either from exogenous exposure or through endogenous overproduction, is a common cause of secondary osteoporosis. We report a 52-year-old woman presenting with multiple stress fractures of the lower extremities, despite various osteoporosis therapeutic regimens. Investigations led to the diagnosis of hypercortisolism of pituitary origin. Pituitary surgery was unsuccessful, justifying a treatment of ketoconazole. In the absence of densitometric osteoporosis, assessment of bone microstructure using high resolution peripheral quantitative computed tomography revealed alterations of both the cortical and trabecular compartments. This case illustrates that hypercortisolism may cause bone fragility in the absence of marked changes in areal bone mineral density

Effect of glucocorticoids on growth and bone mineral density in children with nephrotic syndrome

Glucocorticosteroids (GCs) are the first-line treatment for idiopathic nephrotic syndrome (NS), but prolonged administration interferes with growth and bone mineralization. We conducted a retrospective study to analyze the long-term impact of prednisone on growth and bone mineral density (BMD) in children with NS. Data from children with NS followed during almost 10years were analyzed. Height and spine BMD values were converted to Z-scores (standard deviation [SD]). The mean cumulative dose of GCs received was calculated and correlated to patient's growth and spine BMD using linear regression and subgroup analysis. We included 30 patients diagnosed at 3.7years old (interquartile range (IQR) 2.6-4.8) and followed over 9.8years (IQR 6.6-11.7). The one half of NS patients was steroid sensitive and one half dependent or resistant. The median cumulative dose of GCs received was 0.27mg/kg/day (IQR 0.18-0.35). Growth and spine BMD were both negatively associated with the cumulative dose of GCs (P = 0.001 and P = 0.037, respectively). Final height Z-scores were significantly lower in patients receiving >0.2mg/kg/day GCs (P = 0.001). No difference was observed in spine BMD between subgroups. Conclusion: Increasing doses of GCs were significantly associated with lower height and BMD Z-scores. A significant effect on growth was observed with cutoff doses above 0.2mg/kg/day

Microstructural alterations of trabecular and cortical bone in long-term HIV-infected elderly men on successful antiretroviral therapy

Progress in antiretroviral therapy (ART) has resulted in an almost normal life expectancy for HIV-infected individuals, but an increased risk of fragility fractures has been identified. We investigated the influence of long-term HIV infection on successful ART on bone microstructure in elderly men

Comparison of body weight and composition measured by two different dual energy X-ray absorptiometry devices and three acquisition modes in obese women

Background and aims: Weight measured by dual-energy X-ray (DXA) was shown to be increasingly underestimated in subjects over 75 kg compared to an electronic scale. This study compares body weight and composition measured by balance beam scale and three DXA acquisition modes in obese subjects. Methods: In 39 obese, body weight was measured by balance beam scale, and body weight and composition by DXA Hologic QDR4500A in normal (NPM) and high power mode (HPM) (Enhanced v8.26 and v8.26* software) and DXA GE-Lunar Prodigy (v6.5 software). To ensure linearity of body weight and composition measured by the different DXA acquisitions, we also measured 13 women with a body mass index (BMI) of 25-30 kg/m(2). Results: While QDR4500A HPM overestimates scale weight by about 2 kg over the whole BMI spectrum, QDR4500A NPM underestimates scale weight as a weight-dependent response (-1.7+/-1.8 kg overall, -4.1+/-1.6 kg in morbidly obese women). These results suggest switching from one mode to the other at a specific threshold, i.e. in our study a weight of 90 kg or a BMI of 34 kg/m(2). Prodigy gives weight about similar to scale (+0.5+/-0.8 kg). Both Hologic acquisition modes underestimate fat mass but overestimate lean body mass compared to Prodigy. Conclusions: The QDR4500A NPM is inappropriate in women over 90 kg. Unfortunately, the QDR4500A HPM overestimates body weight in the range of 90-150 kg. The difference between scale and Prodigy weight remains stable throughout weight ranges. To better assess their accuracies in terms of body composition, QDR4500A NPM, HPM and Prodigy should be tested against phantoms or in vivo multi-compartment models.</p

Clinical and Histological Evaluation of Postextraction Platelet-rich Fibrin Socket Filling. A Prospective Randomized Controlled Study

The aims were to investigate whether the use of platelet-rich fibrin membranes (PRF) for socket filling could improve microarchitecture and intrinsic bone tissue quality of the alveolar bone after premolar extraction and to assess the influence of the surgical procedure before implant placement

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. INTRODUCTION: Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations

Lipodystrophy among HIV-infected patients: a cross-sectional study on impact on quality of life and mental health disorders

Lipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. The aim of this study was to explore and measure the interaction between LD, mental health, and quality of life of human immunodeficiency virus (HIV) positive individuals seen in a metabolic clinic