Bone accrual and structural changes over one year in youth with cystic fibrosis

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM
Rosara M. Bass , Babette S. Zemel , Virginia A. Stallings , Mary B. Leonard , Jaime Tsao , Andrea Kelly
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Longitudinal studies of bone health in youth with cystic fibrosis (CF) may provide insight into CF-related bone disease (CFBD), a prevalent co-morbidity in adults with CF.</p></div><div><h3>Methods</h3><p>This one-year longitudinal study of youth with pancreatic insufficient CF, enrolled in a nutrition intervention study [n = 62 (36 M/26F)] 1) examined dual-energy x-ray absorptiometry (DXA)-defined lumbar spine (LS) and total body less head (TBLH) bone accrual and 2) compared their changes in peripheral quantitative computed tomography (pQCT) cortical and trabecular tibial bone density and geometry to those of a healthy reference group [n = 143 (68 M/75F)].</p><p>Main outcome measures were 1) DXA: lumbar spine areal bone mineral density (LSaBMD) and total body less head bone mineral content (TBLH-BMC), sex- and pubertal status-specific, height velocity (HV)-adjusted or HV <em>and</em> lean body mass velocity (HV-LBMV)-adjusted annualized velocity-Z scores and 2) pQCT: age, sex, pubertal status and, when appropriate, tibial length adjusted Z-scores for bone architecture measures.</p><p>DXA velocity-Z were compared to expected mean of 0 and correlations with clinical parameters (age, BMI-Z and FEV<sub>1</sub>%-predicted) tested. 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引用次数: 3

Abstract

Background

Pediatric bone accrual governs peak bone mass and strength. Longitudinal studies of bone health in youth with cystic fibrosis (CF) may provide insight into CF-related bone disease (CFBD), a prevalent co-morbidity in adults with CF.

Methods

This one-year longitudinal study of youth with pancreatic insufficient CF, enrolled in a nutrition intervention study [n = 62 (36 M/26F)] 1) examined dual-energy x-ray absorptiometry (DXA)-defined lumbar spine (LS) and total body less head (TBLH) bone accrual and 2) compared their changes in peripheral quantitative computed tomography (pQCT) cortical and trabecular tibial bone density and geometry to those of a healthy reference group [n = 143 (68 M/75F)].

Main outcome measures were 1) DXA: lumbar spine areal bone mineral density (LSaBMD) and total body less head bone mineral content (TBLH-BMC), sex- and pubertal status-specific, height velocity (HV)-adjusted or HV and lean body mass velocity (HV-LBMV)-adjusted annualized velocity-Z scores and 2) pQCT: age, sex, pubertal status and, when appropriate, tibial length adjusted Z-scores for bone architecture measures.

DXA velocity-Z were compared to expected mean of 0 and correlations with clinical parameters (age, BMI-Z and FEV1%-predicted) tested. Within-subject comparisons of HV-adjusted and LBMV-HV-adjusted DXA velocity-Z were conducted in CF.

pQCT Z-scores were compared between the two groups over one year using longitudinal models. Longitudinal relationships between measures of bone health and clinical parameters (age, BMI-Z and FEV1%-predicted) were examined in individuals with CF.

Results

DXA velocity-Z were higher than normal in females (p < 0.05) but not males with CF. HV-adjusted and LBMV-HV-adjusted velocity-Z did not differ for LSaBMD or TBLH-BMC.

In males with CF, both HV-adjusted and LBMV-HV-adjusted LSaBMD velocity-Z scores correlated negatively with age (HV rho: −0.35; p = 0.045 and LBMV-HV rho: −0.47; p = 0.0046). In males with CF BMI-Z correlated positively with HV-adjusted LSaBMD velocity-Z (rho: 0.37; p = 0.034), but this relationship did not persist for LBMV-HV (rho: 0.14; p = 0.42). In females with CF, no correlations between LSaBMD velocity-Z scores and age or BMI-Z were found (all p > 0.05). No correlations between LSaBMD velocity-Z scores and FEV1%-predicted were seen in either sex (all p > 0.12). TBLH-BMC velocity Z-scores were not correlated with clinical parameters in either sex (all p > 0.1).

At baseline, multiple pQCT parameters were lower in CF (p < 0.05). pQCT Z-scores did not differ between baseline and one-year in either CF or reference group. In a longitudinal model comparing pQCT-Z changes in CF and reference, multiple pQCT-Z outcomes remained lower in CF, but the changes in parameters did not differ in CF vs reference (all p > 0.26). Lower pQCT outcomes in CF were largely restricted to males (CF group*female sex interaction beta coefficients > 0). In this combined longitudinal model, of both CF and reference, BMI-Z was positively associated with pQCT-Z parameters(p < 0.001).

Multiple pQCT-Z outcomes positively correlated with both BMI-Z and FEV1%-predicted in males with CF, and with FEV1%-predicted in females with CF (p < 0.05). Age was negatively associated with section modulus (p = 0.001) in males and with cortical density-Z in females (p < 0.001).

Conclusions

With improved longevity, bone health in CF is of increasing importance. On average, bone accrual was preserved in youth with CF, and while deficits in bone geometry and strength were found, these deficits did not worsen over the one-year study. Lower LS bone accrual with increasing age suggests emerging adulthood is a period of vulnerability in CF while the role of LBM in bone health is underscored by the lack of relationship between LBMV-adjusted accrual and BMI. These findings may be useful in targeting screening practices and interventions.

青年囊性纤维化患者一年内骨积累和结构变化
背景:儿童骨累积控制峰值骨量和强度。对青年囊性纤维化(CF)患者的骨骼健康进行纵向研究,可能有助于了解CF相关骨病(CFBD),这是成人CF患者普遍的合并症。参加了一项营养干预研究[n = 62(36 M/26F)] 1)检查了双能x线吸收仪(DXA)定义的腰椎(LS)和全身无头(TBLH)骨累积;2)比较了他们与健康参照组的外周定量计算机断层扫描(pQCT)皮质和胫骨小梁骨密度和几何形状的变化[n = 143(68 M/75F)]。主要结果测量指标为:1)DXA:腰椎面积骨矿物质密度(LSaBMD)和总体头部骨矿物质含量(TBLH-BMC),性别和青春期状态特异性,身高速度(HV)调整或HV和瘦体重速度(HV- lbmv)调整的年化速度- z评分;2)pQCT:年龄、性别、青春期状态,适当时,胫骨长度调整的骨骼结构测量z评分。DXA速度- z与预期平均值0进行比较,并与临床参数(年龄、BMI-Z和fev1 %预测)进行相关性测试。在受试者中比较经hv调整的DXA速度- z和经lbmv - hv调整的DXA速度- z。采用纵向模型比较两组一年以上的pqct z得分。对CF患者的骨健康指标与临床参数(年龄、BMI-Z和fev1 %预测值)之间的纵向关系进行了研究。结果女性患者的dxa速度- z高于正常值(p < 0.05),而CF患者的男性患者的dxa速度- z高于正常值(p < 0.05)。LSaBMD或TBLH-BMC患者的hv - z和lbmv - hv -调整速度- z没有差异。在男性CF患者中,HV校正和lbmv -HV校正后的LSaBMD速度- z得分与年龄呈负相关(HV rho: - 0.35;p = 0.045,LBMV-HV rho:−0.47; = 0.0046页)。男性CF患者BMI-Z与hbv调节LSaBMD速度- z呈正相关(rho: 0.37;p = 0.034),但这种关系在LBMV-HV中不存在(rho: 0.14; = 0.42页)。在女性CF患者中,LSaBMD速度- z评分与年龄或BMI-Z无相关性(p均为 > 0.05)。LSaBMD速度- z分数与fev1 -预测之间在两性中均无相关性(p均为 > 0.12)。TBLH-BMC速度z评分与临床参数无相关性(p均为 > 0.1)。基线时,CF患者的多个pQCT参数较低(p < 0.05)。无论是CF组还是参照组,pQCT z -score在基线和一年之间没有差异。在比较CF和参考的pQCT-Z变化的纵向模型中,CF的多个pQCT-Z结果仍然较低,但CF和参考的参数变化没有差异(p均为 > 0.26)。CF的低pQCT结果主要局限于男性(CF组*女性性别相互作用β系数 > 0)。在CF和参考文献的联合纵向模型中,BMI-Z与pQCT-Z参数呈正相关(p < 0.001)。多项pQCT-Z结果与男性CF患者的BMI-Z和fev1%预测呈正相关,与女性CF患者fev1%预测呈正相关(p < 0.05)。年龄与男性的截面模量(p = 0.001)和女性的皮质密度- z呈负相关(p < 0.001)。结论随着寿命的延长,CF患者的骨骼健康越来越重要。平均而言,患有CF的青年患者保留了骨质增生,虽然发现了骨骼几何形状和强度的缺陷,但这些缺陷在一年的研究中没有恶化。随着年龄的增长,较低的LS骨累积表明,刚进入成年期是CF的易损期,而lbmv调整的累积与BMI之间缺乏关系,强调了LBM在骨骼健康中的作用。这些发现可能对有针对性的筛查实践和干预措施有用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
6.10
自引率
0.00%
发文量
24
审稿时长
16 weeks
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