Pyridoxamine Promising in Enhancing Bone Health and Reducing HbA1c in Older Women with Type 2 Diabetes: Study

USA: A recent study has found that in older postmenopausal women with type 2 diabetes (T2D), pyridoxamine treatment may help prevent fractures and protect bone tissue by targeting advanced glycation end products, while also reducing levels of A1c, an early glycation product. The findings were published online in The Journal of Clinical Endocrinology & Metabolism on October 8, 2024. 

Patients with type 2 diabetes experience reduced bone turnover and an increased risk of fractures. Advanced glycation end products (AGEs) impair osteoblast function and are linked to diabetic fractures. Pyridoxamine (PM), a metabolite of vitamin B6, inhibits AGE formation. Given this, Mishaela R Rubin, Metabolic Bone Disease Unit, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA, and colleagues hypothesized that PM treatment in older patients with T2D could enhance bone formation by inhibiting AGEs.

For this purpose, the researchers conducted a double-blind randomized controlled trial at an academic center, involving 55 older women with type 2 diabetes. Participants received 200 mg of oral pyridoxamine twice daily for one year.

The primary outcome was the change in the bone formation marker P1NP. Secondary outcomes included changes in bone resorption, bone mineral density (BMD), HbA1c, and skin autofluorescence (SAF). In a subgroup undergoing bone biopsy, the researchers also examined the correlation between bone fluorescent AGEs (fAGEs) and SAF. The safety of pyridoxamine was assessed by monitoring neurologic symptoms and adverse events, as high doses of the parent vitamin B6 have been associated with neurotoxicity.

Key Findings:

  • P1NP increased by 23.0% with PM compared to 4.1% with placebo.
  • Bone mineral density increased at the femoral neck (PM 2.6 ± 5% versus placebo −0.9 ± 4%; between groups).
  • Bone resorption markers and skin autofluorescence did not show significant changes.
  • HbA1c decreased with PM (−0.38 ± 0.7% versus placebo 0.05 ± 1.7%; between groups).
  • Within the PM group, the change in HbA1c correlated inversely with the % change in P1NP (r = −0.50).
  • In the cortical bone biopsy subgroup, fluorescent AGEs correlated with SAF (r = 0.86).
  • Adverse events were similar between the PM and placebo groups.

Pyridoxamine showed a trend toward increasing P1NP, improving bone density, and reducing HbA1c in older women with T2D. More research is needed to explore its potential as a treatment to reduce fractures in T2D by targeting the disease’s underlying mechanisms.

Reference:

Brossfield, A. V., McMahon, D. J., Fernando, J., Omeragic, B., Majeed, R., Agarwal, S., Sroga, G. E., Wang, B., Vashishth, D., & Rubin, M. R. The Effects of the AGE Inhibitor Pyridoxamine on Bone in Older Women With Type 2 Diabetes: A Randomized Clinical Trial. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgae700

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Late Night Calories May Harm Glucose Metabolism in Prediabetes and Early Type 2 Diabetes: Study Finds

USA: Late eating (LE) is associated with poorer glucose tolerance compared to early eating (EE), regardless of body weight, fat mass, daily energy intake, and diet composition, a recent study has found. The findings were published online in Nutrition & Diabetes on October 25, 2024

Dietary interventions are key in preventing and treating type 2 diabetes (T2D). Total energy intake, meal composition, and timing influence glucose excursions. Late eating is associated with poorer glucose metabolism, higher BMI, increased body fat, and greater energy intake, often from processed foods. Consuming more energy later in the day can prolong postprandial glucose excursions and cause circadian misalignment, further impairing glucose metabolism.

Against the above background, Blandine Laferrère, Division of Endocrinology, Nutrition Obesity Research Center, Diabetes Research Center Columbia University Irving Medical Center, New York, NY, USA, and colleagues examine how habitual late calorie intake affects glucose metabolism in adults with overweight or obesity and those with diet- or metformin-controlled prediabetes or type 2 diabetes, independent of body weight, fat mass, energy intake, or diet composition.

For this purpose, the researchers classified participants (n = 26) as Later Eaters (LE) if they consumed ≥45% of their daily calories after 5 pm and as Early Eaters (EE) if they did not, based on a two-week assessment of daily caloric intake.

The researchers reported the following findings:

  • Later Eaters (LE) did not differ from Early Eaters (EE) in anthropometrics or total daily energy intake.
  • LE consumed significantly more carbohydrates and fats after 5 pm compared to EE.
  • Fasting glucose, insulin, and C-peptide levels were similar between groups.
  • LE exhibited higher glucose concentrations during an oral glucose tolerance test, even after adjusting for body weight, fat mass, energy intake, and diet composition.
  • The elevated glucose concentrations in LE persisted when participants with type 2 diabetes were excluded.
  • After adjusting for diabetes status, LE showed significantly higher glucose concentrations at 30 and 60 minutes during the glucose tolerance test.

The exploratory study supports previous findings that late calorie consumption is linked to poorer glucose tolerance. Late eating is associated with increased intake of calories, primarily from carbohydrates and fats, which may prolong evening postprandial glucose excursions and contribute to impaired glucose tolerance.

“Our findings indicate that the association between late eating and poorer glucose metabolism is not attributable to higher BMI, body fat, or overall diet composition. Future studies are needed to confirm these results and further investigate the impact of both the composition and timing of the last meal on overnight glucose levels and glucose tolerance,” the researchers concluded.

Reference:

A., D., Santos Baez, L. S., Popp, C. J., Borhan, R., Manoogian, E. N., Panda, S., Cheng, B., & Laferrère, B. (2024). Late eating is associated with poor glucose tolerance, independent of body weight, fat mass, energy intake and diet composition in prediabetes or early onset type 2 diabetes. Nutrition & Diabetes, 14(1), 1-4. https://doi.org/10.1038/s41387-024-00347-6

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Influenza vaccination linked to reduced risk of secondary influenza infections among household contacts: JAMA

A new study published in the Journal of American Medical Association showed that with an estimated 21% efficacy, influenza vaccination was linked to a lower risk of subsequent influenza infections among household contacts. 

In the US, anyone 6 months of age and older are advised to get an influenza vaccination in order to avoid influenza and its associated consequences. The efficacy of the influenza vaccine (VE) is frequently evaluated in relation to the avoidance of illnesses that necessitate medical care. Evaluations of the ability of VE to prevent subsequent influenza infections are few. To ascertain the estimated efficacy of influenza vaccinations in preventing secondary infections following the introduction of influenza into homes, Carlos Grijalva and his colleagues carried out this investigation.

A prospective case-ascertained household transmission cohort study was conducted in Tennessee and Wisconsin over 3 successive influenza seasons (2017–2020) to recruit primary patients (the first household members with laboratory-confirmed influenza) and their household contacts. For a maximum of 7 days, the participants collected nose swabs and daily symptom diaries.

The analysis of the data took place between September 2022 and February 2024. History of vaccinations, as self-reported and confirmed by examination of registry and medical records. Reverse transcription-polymerase chain reaction was used to evaluate the specimens for influenza infection. The efficiency of influenza vaccinations in avoiding infection among household contacts overall, as well as by virus type, subtype, and/or lineage, was estimated using longitudinal chain binomial models.

The study examined a total of 699 main patients and 1581 family contacts. The median (IQR) age of the primary cases was 13 (7-38) years, with 381 (54.5%) females, 60 (8.6%) Hispanics, 46 (6.6%) non-Hispanic Blacks, 553 (79.1%) non-Hispanic Whites, and 343 (49.1%) vaccinated.

The median age of household contacts was 31 (10-41) years, with 833 (52.7%) females, 116 (7.3%) Hispanics, 78 (4.9%) non-Hispanic Blacks, 1283 (81.2%) non-Hispanic Whites, 792 (50.1%) vaccinated, and 356 (22.5%) having laboratory-confirmed influenza during follow-up. The total secondary infection risk from influenza among home contacts was 18.8%. The risk was highest among children, at 15.9% for influenza B and 20.3% for influenza A. 

Variable by type, the total estimated VE for avoiding secondary infections across unvaccinated household contacts was 21.0%; the estimated VE for influenza A was 5.0%, whereas for influenza B, it was 56.4%. Overall, this study demonstrated that there is a substantial chance of transmission to household members once influenza virus infections are introduced in homes.

Source:

Grijalva, C. G., Nguyen, H. Q., Zhu, Y., Mellis, A. M., McGonigle, T., Meece, J. K., Biddle, J. E., Halasa, N. B., Reed, C., Fry, A. M., Yang, Y., Belongia, E. A., Talbot, H. K., & Rolfes, M. A. (2024). Estimated Effectiveness of Influenza Vaccines in Preventing Secondary Infections in Households. In JAMA Network Open (Vol. 7, Issue 11, p. e2446814). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.46814

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Eat Dark Chocolate to Lower the Risk of Type 2 Diabetes: Study Suggests

Consuming dark, but not milk, chocolate may be associated with a lower risk of developing type 2 diabetes (T2D), according to a new study from Harvard T.H. Chan School of Public Health. The study was published online in The BMJ.

The researchers used data from the Nurses’ Health Studies I and II and the Health Professionals Follow-up Study. Over 30+ years, 192,000 adult participants who were free of diabetes at the study’s outset reported on their food habits, including chocolate consumption, as well as their diabetes status and body weight. By the end of the study period, nearly 19,000 of the total participants reported being diagnosed with T2D. Of the nearly 112,000 who reported specifically on their dark and milk chocolate intake, nearly 5,000 were diagnosed with T2D.
Key points from the study are:
Study participants who consumed at least five servings of any chocolate per week showed a 10% lower risk of type 2 diabetes (T2D) compared to those who rarely or never ate chocolate. Dark chocolate had an even bigger impact: Participants who consumed at least five servings of this chocolate per week showed a 21% lower risk of T2D.
Consumption of milk chocolate, but not dark chocolate, was not associated with T2D risk; it was associated with excessive long term weight gain, a potential contributor to the development of T2D.
According to the researchers, opting for dark chocolate rather than milk chocolate can make a big difference for health. They also noted that average chocolate consumption among study participants was relatively low, so the findings may not extrapolate to people with very high levels of consumption.
“We were surprised by the clear split between dark and milk chocolate’s impact on diabetes risk and long-term weight management,” said corresponding author Qi Sun, associate professor in the Departments of Nutrition and Epidemiology. “Even though dark and milk chocolate have similar levels of calories and saturated fat, it appears that the rich polyphenols in dark chocolate might offset the effects of saturated fat and sugar on weight gain and diabetes. It’s an intriguing difference that’s worth exploring more.”
Reference: “Chocolate intake and risk of type 2 diabetes: prospective cohort studies,” Binkai Liu, Geng Zong, Lu Zhu, Yang Hu, JoAnn E. Manson, Molin Wang, Eric B. Rimm, Frank B. Hu, Qi Sun, The BMJ, published online December 4, 2024, doi: 10.1136/bmj-2023-078386

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Efficacy of Medication in Young Children with Atopic Dermatitis: Study Finds

Research at National Jewish Health and other institutions has shown that the biologic dupilumab improves signs and symptoms of moderate-to-severe atopic dermatitis (eczema) in young children whether or not they have another inflammatory condition, such as asthma, allergic rhinitis or food allergies. Dupilumab had previously been shown to be effective in the treatment of atopic dermatitis, but this research is the first to examine the drug’s efficacy in children with atopic dermatitis and co-morbid conditions. The study was recently published in the journal Advances in Therapy.

“Dupilumab has proven to be an important treatment for pediatric patients suffering from atopic dermatitis. Our recent research was to help us know if the drug would be as effective in patients with both atopic dermatitis and other common atopic diseases that could add to the inflammatory burden,” said Mark Boguniewicz, MD, pediatric allergist and immunologist at National Jewish Health and lead author on the study.
“With this illness, the quality of life of our patients and their families is negatively impacted, and this takes a toll on school or job performance and social interactions,” said Dr. Boguniewicz
For the study, investigators evaluated children aged 6 months to 5 years with moderate-to-severe atopic dermatitis who had been treated with either dupilumab or a placebo. Researchers compared patients who had only atopic dermatitis to those who had atopic dermatitis plus additional “type 2” inflammatory diseases, such as asthma and allergies. Results showed that dupilumab improved atopic dermatitis signs and symptoms in both groups of patients.
“Many children suffer from multiple allergic conditions at the same time, so knowing that dupilumab can be used to safely and effectively treat their atopic dermatitis whether or not they have additional atopic diseases such as asthma or allergies is an important step forward,” explained Dr. Boguniewicz.
Reference: Boguniewicz, M., Sher, L.D., Paller, A.S. et al. Dupilumab is Efficacious in Young Children with Atopic Dermatitis Regardless of Type 2 Comorbidities. Adv Ther 41, 4601–4616 (2024). https://doi.org/10.1007/s12325-024-02998-4

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Altered blood markers detected in individuals with periodontitis, unravels study

Individuals with periodontitis have altered concentrations of various proteins in their blood, according to a new study from Umeå University, Sweden. These findings pave the way for research into biomarkers for periodontitis and the underlying causes of the disease. Severe periodontitis affects about one in ten Swedes and, in addition to tooth loss, can also be linked to other diseases.

“By identifying the blood biomarkers that may be crucial for the development of severe periodontitis, we can proceed to research drugs that specifically aims to slow down the disease progression,” says Pernilla Lundberg, periodontist and professor at the Department of Odontology at Umeå University, who led the study.

Periodontitis involves inflammation of the gums that leads to the breakdown of the supporting tissues around the teeth and can, in severe cases, result in tooth loss. Individuals with severe periodontitis are also more often affected by other serious diseases, such as cardiovascular disease and rheumatism, but the mechanisms behind these connections remain unclear.

Researchers at Umeå University have now shown that individuals with periodontitis exhibit a unique inflammatory protein profile in their blood. The findings indicate, among other things, that severe periodontitis is associated with significantly reduced levels of a protein called EGF -epidermal growth factor, which is crucial for wound healing. The levels of a protein associated with cardiovascular disease, OLR-1 -oxidized low-density lipoprotein 1, are also significantly lower in individuals with severe periodontitis compared to healthy individuals.

Today, one in ten Swedes suffers from severe periodontitis, a number that has remained unchanged since the 1970s, despite extensive efforts in preventive dental care and a marked improvement in overall dental health. Currently, there are no methods to predict which individuals are at risk of developing severe periodontitis.

“Thanks to the large number of participants in the study, the results are highly accurate, and we can use the material to continue finding more clues,” says Pernilla Lundberg.

Previous research has shown that there is a strong hereditary component behind periodontitis, but the specific genes involved are still unknown. The researchers at Umeå university are now analyzing DNA from all participants in the study to identify genetic changes that may be linked to the development of severe periodontitis. By combining genetic and biological markers for periodontitis, it may become possible in the future to identify individuals at high risk of developing the disease. This would also enable tailored treatments that target the specific factors crucial for the development of periodontitis and the associated disease risks.

The current study, PerioGene North at Umeå University is based on extensive data collected from approximately 1,000 individuals within the Public Dental Service in the County counties of Västerbotten and Gävleborg between 2007 and 2019.

Reference:

Wänman M, Betnér S, Esberg A, et al. The PerioGene North Study Uncovers Serum Proteins Related to Periodontitis. Journal of Dental Research. 2024;103(10):999-1007. doi:10.1177/00220345241263320

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Combination therapy with Montelukast Sodium effective for managing Cough Variant Asthma in children, finds study

A groundbreaking study found that
combination therapy of montelukast sodium can effectively treat cough variant
asthma (CVA) in children, according to the analysis results published in the
journal Pediatric Pulmonology.

Cough variant asthma (CVA) is a
subtype of asthma with cough as the only or primary symptom and is the leading
cause of chronic cough. It is typically seen in children as morning and evening
cough with worsening symptoms. Antibiotic treatment is ineffective in such
asthma subtypes. Inhaled corticosteroids (ICS) combined with β2‐antagonists are
the initial treatment strategies for CVA. Literature has shown that montelukast
sodium, which is a highly specific and selective leukotriene receptor
antagonist, can be effectively used to reduce airway inflammation in children
with CVA. As there is inconsistency in the outcomes of various studies and a
lack of studies on the efficacy of montelukast sodium in combination therapy,
researchers have conducted a systematic review and meta-analysis on the
Clinical efficacy of montelukast sodium combination therapy for cough variant
asthma in children.

Also Read: Efficacy and Safety of Montelukast with Fexofenadine in Allergic Rhinitis

Numerous databases, including
China National Knowledge Infrastructure (CNKI), Wan Fang database, Embase,
PubMed, and Web of Science, were searched to collect necessary studies that met
the criteria for the combined treatment of montelukast sodium for CVA in
children. Various randomized controlled trials (RCT) and retrospective cohort
studies that compared the clinical effects of conventional treatment alone and
combined with montelukast sodium patients younger than 18 years of age were
included in the systematic review. The treatment group received montelukast
sodium, while the control group received budesonide, fluticasone propionate, salmeterol‐fluticasone,
or ketotifen alone. The effectiveness of the treatment rates, the incidence of
adverse reactions, peak expiratory flow (PEF), forced vital capacity (FVC),
forced expiratory volume in 1 s (FEV1), FEV1/FVC, and the levels of TNF‐α,
IL‐4, and IgE in serum after treatment were the primary outcomes of
measurement.

Findings:

  • The meta-analysis and review included 18 papers.
  • All the studies included the Chinese population.
  • The combined treatment group showed more significant
    effectiveness than the control group.
  • Both groups showed similar incidences of adverse
    reactions after treatment.
  • After treatment, variables like peak expiratory
    flow (PEF), forced vital capacity (FVC), forced expiratory volume in 1 s
    (FEV1), and FEV1/FVC were significantly higher in the combined treatment group
    than in the control group.
  • Compared with the control group, tumor necrosis
    factor‐α, IL‐4, and IgE levels were significantly lower in the combined
    treatment group after treatment.
Also Read: Antidiabetic Drugs Linked to Reduced Asthma Attacks: Study Highlights Synergistic Benefits of Metformin and GLP-1RA

Thus, the study concluded that
the combined use of montelukast sodium has significant clinical effects in treating
pediatric CVA. The study highlights the potential of combination therapy for treating
pediatric CVA and its use as a variable therapeutic option for controlling CVA.
However, the researchers stressed the importance of further research to be carried
out in diverse populations with larger sample sizes and long-term outcomes to
validate the clinical findings.

Further reading: Yang S, He X,
Zhang R. Clinical efficacy of montelukast sodium combination therapy for cough
variant asthma in children: A meta-analysis. Pediatr Pulmonol.
2024;59(6):1541-1551. doi:10.1002/ppul.26960.

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Oral microbiome during pregnancy linked to maternal mental health, finds study

New research out of Michigan State University found that the number and type of microbes present in the saliva of pregnant women differ according to whether they are experiencing life stress and symptoms of anxiety, depression and post-traumatic stress disorder.

The study-published in the open access journal BMJ Mental Health-is the first to look at the association between the type and number of microorganisms in the mouth and throat, also known as the oral microbiome, and maternal mental health.

The study included 224 pregnant women enrolled in the Michigan Prenatal Stress Study who were assessed for recent stresses and mental health symptoms during their second trimester. Women were asked to provide saliva samples during the week of their assessments. The results showed the oral microbiome varied based on whether women had reported symptoms of life stress, anxiety, depression or post-traumatic stress disorder, also called PTSD, during the assessments.

“Positive mental health is crucial for mothers’ well-being and their ability to sensitively care for infants,” said Joseph Lonstein, professor in MSU’s Department of Psychology and lead researcher on the study. “We hope our study will stimulate future research on how microbes in and on our body, other than those in our gastrointestinal tract that are already often studied, are associated with mental health in mothers and even people who are not mothers.”

Oral microbiomes of women with high anxiety or depression symptoms showed a high alpha diversity, which means they included many types of microbe species present at relatively even levels. Oral microbiomes of women with high levels of PTSD symptoms instead showed high beta diversity, which means the specific microbe species in their saliva notably differed from the species found in women with low PTSD symptoms.

Specific stress and mental health traits were also associated with high levels of certain microbe species.

The researchers said that their findings suggest that the oral microbiome could be a potential target for interventions to improve poor psychological well-being during pregnancy.

“Successful targeting of the gut microbiome with probiotic treatment to improve maternal mental health could be extended in future studies to target oral cavity microbes through dietary changes, making recommendations for improving oral health, and probiotic treatments that might benefit mothers struggling with high life stress and poor mental health,” the team of researchers said.

Reference:

Alex AM, Levendosky AA, Bogat GA, et alStress and mental health symptoms in early pregnancy are associated with the oral microbiomeBMJ Ment Health 2024;27:e301100.

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Consumption of high amount of ultraprocessed foods impacts muscle quality, reveals research

A diet high in ultra-processed foods is associated with higher amounts of fat stored inside thigh muscles, regardless of the amount of calories consumed or level of physical activity, according to a study being presented today at the annual meeting of the Radiological Society of North America (RSNA). Higher amounts of intramuscular fat in the thigh could also increase the risk for knee osteoarthritis.

The use of natural and minimally processed ingredients in many modern diets has decreased, more often being replaced with ingredients that have been industrially processed, artificially flavored, colored or chemically altered.

Foods such as breakfast cereals, margarines/spreads, packaged snacks, hot dogs, soft drinks and energy drinks, candies and desserts, frozen pizzas, ready-to-eat meals, mass-produced packaged breads and buns, and more, include synthesized ingredients and are highly processed.

These ultra-processed foods usually have longer shelf lives and are highly appealing, as they are convenient and contain a combination of sugar, fat, salt and carbohydrates which affect the brain’s reward system, making it hard to stop eating.

For the study, researchers set out to assess the association of ultra-processed food intake and their relationship to intramuscular fat in the thigh.

“The novelty of this study is that it investigates the impact of diet quality, specifically the role of ultra-processed foods in relation to intramuscular fat in the thigh muscles assessed by MRI,” said author Zehra Akkaya, M.D., researcher and former Fulbright Scholar in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “This is the first imaging study looking into the relationship between MRI-based skeletal muscle quality and quality of diet.”

For the study, researchers analyzed data from 666 individuals who participated in the Osteoarthritis Initiative who were not yet affected by osteoarthritis, based on imaging. The Osteoarthritis Initiative is a nationwide research study, sponsored by the National Institutes of Health, that helps researchers better understand how to prevent and treat knee osteoarthritis.

“Research from our group and others has previously shown that quantitative and functional decline in thigh muscles is potentially associated with onset and progression of knee osteoarthritis,” Dr. Akkaya said. “On MRI images, this decline can be seen as fatty degeneration of the muscle, where streaks of fat replace muscle fibers.”

Of the 666 individuals, (455 men, 211 women) the average age was 60 years. On average, participants were overweight with a body mass index (BMI) of 27. Approximately 40% of the foods that they ate in the past year were ultra-processed.

The researchers found that the more ultra-processed foods people consumed, the more intramuscular fat they had in their thigh muscles, regardless of energy (caloric) intake.

“In an adult population at risk for but without knee or hip osteoarthritis, consuming ultra-processed foods is linked to increased fat within the thigh muscles,” Dr. Akkaya said. “These findings held true regardless of dietary energy content, BMI, sociodemographic factors or physical activity levels.”

Targeting modifiable lifestyle factors-mainly prevention of obesity via a healthy, balanced diet and adequate exercise-has been the mainstay of initial management for knee osteoarthritis, Dr. Akkaya noted.

“Osteoarthritis is an increasingly prevalent and costly global health issue. It is the largest contributor to non-cancer related health care costs in the U.S. and around the world,” Dr. Akkaya said. “Since this condition is highly linked to obesity and unhealthy lifestyle choices, there are potential avenues for lifestyle modification and disease management.”

By exploring how ultra-processed food consumption impacts muscle composition, this study provides valuable insights into dietary influences on muscle health.

“Understanding this relationship could have important clinical implications, as it offers a new perspective on how diet quality affects musculoskeletal health,” Dr. Akkaya said.

Reference:

Eating high-processed foods impacts muscle quality, Radiological Society of North America, Meeting: 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

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Osteoporosis Common Among Postmenopausal Lupus Nephritis Patients, Study Shows

China: A recent cross-sectional study conducted in China reveals a significant prevalence of osteoporosis among patients with lupus nephritis (LN), with postmenopausal individuals being particularly affected. This study sheds light on the critical risk factors associated with osteoporosis in this population, offering valuable insights for improved prevention and management strategies.

“We identified advanced age, lower body weight, and the lack of bisphosphonate treatment as key risk factors for osteoporosis in this patient population,” the researchers wrote in BMC Nephrology.

Systemic lupus erythematosus (SLE) causes multisystemic damage, and lupus nephritis (LN) is a severe manifestation with significant health risks. Female SLE patients are at increased risk of reduced bone mineral density, osteoporosis, and fractures. The prevalence of osteoporosis in LN patients varies globally, with factors like glucocorticoid use and early menopause contributing to bone loss.

Against the above background, Yi Yang, Department of Nephrology, Tongji Hospital affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China, and colleagues examined the prevalence of osteoporosis and identified risk factors contributing to the condition in both premenopausal and postmenopausal LN patients, highlighting the lack of data specific to the Chinese population. It aims to fill this gap by providing insights into the unique risk factors in this demographic.

For this purpose, the researchers conducted a cross-sectional study involving patients with renal biopsy-proven lupus nephritis. These patients underwent bone mineral density (BMD) measurements using dual X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. The study took place at Tongji Hospital from May 2011 to June 2018.

The key findings of the study were as follows:

  • 130 patients, including two males and 128 females, were evaluated, with a mean age of 46.2 ± 12.9 years.
  • Among female patients, 52.3% (n = 67) were postmenopausal.
  • BMD measurements revealed that 40.0% of patients had osteoporosis in at least one site.
  • Spearman rank correlation showed that age at menopause, weight, height, and body mass index were positively correlated with BMD. In contrast, age, age at diagnosis of lupus nephritis, and menopause duration were negatively correlated with BMD at the lumbar spine, total hip, and/or femoral neck.
  • Multivariable linear regression analysis showed that body mass index was positively associated with BMD. In contrast, disease duration and menopause duration were negatively associated with BMD in both all patients and postmenopausal patients.
  • Postmenopausal patients had a consistently higher prevalence of osteoporosis across all measured sites.
  • Risk factors such as older age, lower weight, and the absence of bisphosphonate therapy were independently associated with an increased risk of osteoporosis in LN patients.

“Our findings suggest that patients with LN are at a considerable risk of developing osteoporosis, especially in the lumbar spine and among postmenopausal individuals. Identified risk factors for osteoporosis include older age, lower body weight, and the absence of bisphosphonate treatment,” the researchers concluded.

Reference:

Hong, Y., Yang, Y. & Yao, Y. Prevalence and risk factors of osteoporosis in lupus nephritis patients in China: a cross-sectional study. BMC Nephrol 25, 428 (2024). https://doi.org/10.1186/s12882-024-03882-7

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