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Lean Mass Measurement: Comparison between Methods and Correlation with Muscle Function
536
Abstracts
MAJOR AND MINOR DISCORDANCE IN THE DIAGNOSIS OF OSTEOPOROSIS AMONG IRISH MEN AND WOMEN USING HIP AND SPINE DUAL-ENERGY X-RAY ABSORPTIOMETRY
MUSCLE/LEAN MASS MEASUREMENT: COMPARISON BETWEEN METHODS AND CORRELATION WITH MUSCLE FUNCTION
Bernie McGowam, Aoife McPartland, Carmel Silke, Bryan Whelan; The North
Objective: Muscle function predicts adverse outcomes better than lean mass, possibly due to limitations of current lean mass assessment methods to isolate muscle. For example, lean mass measured by DXA is largely water, both intraand extracellular. Extracellular water does not decline with advancing age, blunting the ability to detect age-related muscle loss. Newer methodologies, e.g., bioelectric impedance spectroscopy (BIS) and creatine (methyl-d3) dilution (D3-C) may provide a more accurate muscle mass assessment. We hypothesized that BIS and D3-C measured muscle mass will better correlate with muscle function than DXA measured lean mass. Methods: Muscle mass and function assessments were performed in communitydwelling older individuals. Grip strength, 2 min walk speed, timed chair rise, and timed up and go (TUG) were assessed in standard manner. Jumping mechanography (JM) was used to determine jump power. Body composition was assessed by DXA, BIS, and orally administered D3-C. Results: Mean (SD) age of the 112 (89F/23M) participants was 80.6 (6.0) years; BIS data available in 99. Total body less head (TBLH) lean mass [mean (±SD)] by DXA was 37.8 (7.3) kg, BIS total body intracellular water (ICW) was 17.3 (3.3) kg and D3-C muscle mass 21.1 (4.6) kg. Lean and muscle mass measurements were correlated (DXA and BIS ICW R2 = 0.78, DXA and D3-C R2 = 0.36, and BIS ICW and D3-C R2 = 0.30, p < 0.0001). Grip strength and jump power correlated with all muscle/lean mass assessment methods (R2 = 0.17–0.45 and 0.34–0.40 respectively, p < 0.0002). No lean or muscle mass parameter was correlated with 2 min walk speed, timed chair rise, or TUG. A marker of muscle mass quality/composition, BIS leg ICW/total leg water ratio correlated (R2 = 0.11–0.40, p < 0.001) with all muscle function parameters except grip strength. Conclusion: These data suggest that advances in muscle mass and quality measurement, i.e., BIS, perhaps in conjunction with D3-C or DXA, will likely improve the correlation with functional status in older adults. Including BIS and D3-C in larger studies of adverse health outcomes e.g., falls and fractures, are needed for validation. This enhancement of muscle mass/quality assessment shows promise to become an integral part of sarcopenia and falls/ fracture risk assessment which includes muscle, bone, and fat mass measurement.
Western Rheumatology Unit, Our Lady’s Hospital, Manorhamilton, Co Leitrim, Ireland Background: Diagnostic discordance for osteoporosis is the presence of different categories of T-scores in 2 different skeletal sites, falling into 2 different diagnostic categories as identified by the World Health Organization classification system (1). Discordances between hip and spine areal density T-score values are common and incompletely understood. Objective: To determine discordance in the diagnosis of osteoporosis among patients referred for DXA scan at The North Western Rheumatology Unit using hip and spine Dual-energy X-ray Absorptiometry. Materials and Methods: The study included men and women who underwent bone mineral densitometry (BMD) for suspected osteoporosis at The North Western Rheumatology Unit. The BMD measures at the hip and spine were used to derive T-scores and to determine the prevalence of discordance. Factors potentially associated with discordance were explored in univariate and a multivariate regression model. Results: The mean age of the 276 patients in the study was 63.2 ± 11.92 years (males 35 (13%), females 241 (87%). Results of T-Score Concordance was identified in 128 patients (51.2%), minor discordance in 101 patients (36.5%) and major discordance was seen in 21 patients (7.6%). Independent t-test of age, BMI, presence of co-morbidities, fracture history, identified age as the only risk factor (P < .05) which had a significant effect on T-score discordance. Conclusions: At least 40% of patients tested by DXA will demonstrate T-score discordance between spine and total hip measurement sites. T-score discordance has been shown to occur for a variety of reasons related to physiologic and pathologic patient factors including genetics as well as the performance or analysis of DXA itself (2). We need to continue to educate health professionals reading DXA reports regarding this as it can sometimes lead to incorrect interpretation of the results. References 1. Faulkner KG, von Stetten E, Miller P. 1999 Discordance in patient classification using T-scores. J Clin Densitom 2:343–350. 2. Mounach MD, Mouinga A, Ghazi M, et al. 2009 Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Bone 38:467–471.
E. Fidler, Y. Yamada, W. Evans, S. Turner, N. Binkley, B. Buehring
NOVEL FINDINGS: BONE MINERAL DENSITY IN MUCOPOLYSACCHARIDOSIS IVB Heidi Kecskemethy1, Francyne Kubaski2, H. Theodore Harcke1,2, Shunji Tomatsu1,2;
MENOPAUSE TRANSITION AND BODY COMPOSITION IN HEALTHY SOUTH INDIAN WOMEN Deepa Meeta, Sameena Agarwal, Akanshi Tanvir
Background: Menopause may alter body weight and fat distribution in women as sex hormones are involved in the regulation of body composition and adipose tissue metabolism. The aim of this study was to assess the total body composition of healthy Indian women and to investigate its relationship with age and menopause as independent factors. Methodology: After obtaining Institutional Ethics Committee approval and written consent from participants a hospital based prospective cross sectional study was carried out in 599 healthy women in the age group of 10–80 years. Body composition and fat distribution measurement was determined using dual-energy x-ray absorptiometry (DXA). Results: Statistical Analysis was carried out using SPSS version 14.1. Body Composition variables such as Total Fat mass, Fat Mass Index, Visceral Adipose Tissue was significantly more in post menopausal women than pre menopausal women (p < 0.001). Skeletal mass index was also studied.Age related linear correlation regression analysis with these variables also tended to be independently related to years since menopause primarily in the perimenopausal years suggesting that in healthy women total-body and abdominal fat may increase and lean mass may decrease in the years after menopause. Conclusion: Therapeutic lifestyle intervention programmes with structured, counseling sessions including intensely monitored exercise and healthy dietary intervention in normal,overweight and obese women should be encouraged at an early age to prevent obesity and its associated chronic diseases.
1 Nemours/A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA, 2Nemours/A.I. duPont Hospital for Children & University of Delaware, 1600 Rockland Road, Wilmington, DE 19803, USA
Background: Mucopolysaccharidosis IVB is caused by the deficiency of β-galactosidase (GLB1) which is responsible for the catabolism of keratan sulfate and ganglioside GM1. Patients with MPS IVB have a phenotype mainly caused by skeletal dysplasia and growth retardation. The skeletal abnormalities seen in MPS IVB are not as severe as seen in MPS IVA, with less height stunting and overall more typical functional abilities. The only published reports of BMD in MPS IV are in patients with IVA. This is the first reported description of mineral density (BMD) in MPS IVB; no other reports exist describing BMD in this condition. Methods: In this prospective study of BMD in patients with MPS IVB, bone mineral density was acquired by dual-energy X-ray absorptiometry (DXA) at whole body (WB), lumbar spine (LS) and lateral distal femur (LDF). Functional abilities, ambulatory status, medical history, height Z-score, Tanner score and laboratory results were evaluated. Results: Three MPS IVB patients (2 females), mean age 26.9 years (17.7 to 31.7 years), were evaluated. All were ambulatory: 2 patients were full time ambulators without assistance and 1 patient ambulated with a walker and used a manual wheelchair 1x/month. One patient sustained 2 fractures caused by trauma (fall and MVA). Valid DXA scans were available at the WB for no patients, LS for only 1 patient, and at the LDF for all 3 patients. WB and hip were invalid due to the presence of prosthetic hip hardware in every subject. For the one patient with a valid LS, the Z-score was normal (−0.8). LDF BMD was low at all regions for every patient; LDF Z-scores for the three regions of interest where for R1: −3.1 (range: −2.9 to −3.6), R2: −2.3 (range −2.0 to −2.5) and R3: −2.1 (range −2.0 to −2.3).
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 19, 2016
Abstracts
MAJOR AND MINOR DISCORDANCE IN THE DIAGNOSIS OF OSTEOPOROSIS AMONG IRISH MEN AND WOMEN USING HIP AND SPINE DUAL-ENERGY X-RAY ABSORPTIOMETRY
MUSCLE/LEAN MASS MEASUREMENT: COMPARISON BETWEEN METHODS AND CORRELATION WITH MUSCLE FUNCTION
Bernie McGowam, Aoife McPartland, Carmel Silke, Bryan Whelan; The North
Objective: Muscle function predicts adverse outcomes better than lean mass, possibly due to limitations of current lean mass assessment methods to isolate muscle. For example, lean mass measured by DXA is largely water, both intraand extracellular. Extracellular water does not decline with advancing age, blunting the ability to detect age-related muscle loss. Newer methodologies, e.g., bioelectric impedance spectroscopy (BIS) and creatine (methyl-d3) dilution (D3-C) may provide a more accurate muscle mass assessment. We hypothesized that BIS and D3-C measured muscle mass will better correlate with muscle function than DXA measured lean mass. Methods: Muscle mass and function assessments were performed in communitydwelling older individuals. Grip strength, 2 min walk speed, timed chair rise, and timed up and go (TUG) were assessed in standard manner. Jumping mechanography (JM) was used to determine jump power. Body composition was assessed by DXA, BIS, and orally administered D3-C. Results: Mean (SD) age of the 112 (89F/23M) participants was 80.6 (6.0) years; BIS data available in 99. Total body less head (TBLH) lean mass [mean (±SD)] by DXA was 37.8 (7.3) kg, BIS total body intracellular water (ICW) was 17.3 (3.3) kg and D3-C muscle mass 21.1 (4.6) kg. Lean and muscle mass measurements were correlated (DXA and BIS ICW R2 = 0.78, DXA and D3-C R2 = 0.36, and BIS ICW and D3-C R2 = 0.30, p < 0.0001). Grip strength and jump power correlated with all muscle/lean mass assessment methods (R2 = 0.17–0.45 and 0.34–0.40 respectively, p < 0.0002). No lean or muscle mass parameter was correlated with 2 min walk speed, timed chair rise, or TUG. A marker of muscle mass quality/composition, BIS leg ICW/total leg water ratio correlated (R2 = 0.11–0.40, p < 0.001) with all muscle function parameters except grip strength. Conclusion: These data suggest that advances in muscle mass and quality measurement, i.e., BIS, perhaps in conjunction with D3-C or DXA, will likely improve the correlation with functional status in older adults. Including BIS and D3-C in larger studies of adverse health outcomes e.g., falls and fractures, are needed for validation. This enhancement of muscle mass/quality assessment shows promise to become an integral part of sarcopenia and falls/ fracture risk assessment which includes muscle, bone, and fat mass measurement.
Western Rheumatology Unit, Our Lady’s Hospital, Manorhamilton, Co Leitrim, Ireland Background: Diagnostic discordance for osteoporosis is the presence of different categories of T-scores in 2 different skeletal sites, falling into 2 different diagnostic categories as identified by the World Health Organization classification system (1). Discordances between hip and spine areal density T-score values are common and incompletely understood. Objective: To determine discordance in the diagnosis of osteoporosis among patients referred for DXA scan at The North Western Rheumatology Unit using hip and spine Dual-energy X-ray Absorptiometry. Materials and Methods: The study included men and women who underwent bone mineral densitometry (BMD) for suspected osteoporosis at The North Western Rheumatology Unit. The BMD measures at the hip and spine were used to derive T-scores and to determine the prevalence of discordance. Factors potentially associated with discordance were explored in univariate and a multivariate regression model. Results: The mean age of the 276 patients in the study was 63.2 ± 11.92 years (males 35 (13%), females 241 (87%). Results of T-Score Concordance was identified in 128 patients (51.2%), minor discordance in 101 patients (36.5%) and major discordance was seen in 21 patients (7.6%). Independent t-test of age, BMI, presence of co-morbidities, fracture history, identified age as the only risk factor (P < .05) which had a significant effect on T-score discordance. Conclusions: At least 40% of patients tested by DXA will demonstrate T-score discordance between spine and total hip measurement sites. T-score discordance has been shown to occur for a variety of reasons related to physiologic and pathologic patient factors including genetics as well as the performance or analysis of DXA itself (2). We need to continue to educate health professionals reading DXA reports regarding this as it can sometimes lead to incorrect interpretation of the results. References 1. Faulkner KG, von Stetten E, Miller P. 1999 Discordance in patient classification using T-scores. J Clin Densitom 2:343–350. 2. Mounach MD, Mouinga A, Ghazi M, et al. 2009 Discordance between hip and spine bone mineral density measurement using DXA: prevalence and risk factors. Bone 38:467–471.
E. Fidler, Y. Yamada, W. Evans, S. Turner, N. Binkley, B. Buehring
NOVEL FINDINGS: BONE MINERAL DENSITY IN MUCOPOLYSACCHARIDOSIS IVB Heidi Kecskemethy1, Francyne Kubaski2, H. Theodore Harcke1,2, Shunji Tomatsu1,2;
MENOPAUSE TRANSITION AND BODY COMPOSITION IN HEALTHY SOUTH INDIAN WOMEN Deepa Meeta, Sameena Agarwal, Akanshi Tanvir
Background: Menopause may alter body weight and fat distribution in women as sex hormones are involved in the regulation of body composition and adipose tissue metabolism. The aim of this study was to assess the total body composition of healthy Indian women and to investigate its relationship with age and menopause as independent factors. Methodology: After obtaining Institutional Ethics Committee approval and written consent from participants a hospital based prospective cross sectional study was carried out in 599 healthy women in the age group of 10–80 years. Body composition and fat distribution measurement was determined using dual-energy x-ray absorptiometry (DXA). Results: Statistical Analysis was carried out using SPSS version 14.1. Body Composition variables such as Total Fat mass, Fat Mass Index, Visceral Adipose Tissue was significantly more in post menopausal women than pre menopausal women (p < 0.001). Skeletal mass index was also studied.Age related linear correlation regression analysis with these variables also tended to be independently related to years since menopause primarily in the perimenopausal years suggesting that in healthy women total-body and abdominal fat may increase and lean mass may decrease in the years after menopause. Conclusion: Therapeutic lifestyle intervention programmes with structured, counseling sessions including intensely monitored exercise and healthy dietary intervention in normal,overweight and obese women should be encouraged at an early age to prevent obesity and its associated chronic diseases.
1 Nemours/A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA, 2Nemours/A.I. duPont Hospital for Children & University of Delaware, 1600 Rockland Road, Wilmington, DE 19803, USA
Background: Mucopolysaccharidosis IVB is caused by the deficiency of β-galactosidase (GLB1) which is responsible for the catabolism of keratan sulfate and ganglioside GM1. Patients with MPS IVB have a phenotype mainly caused by skeletal dysplasia and growth retardation. The skeletal abnormalities seen in MPS IVB are not as severe as seen in MPS IVA, with less height stunting and overall more typical functional abilities. The only published reports of BMD in MPS IV are in patients with IVA. This is the first reported description of mineral density (BMD) in MPS IVB; no other reports exist describing BMD in this condition. Methods: In this prospective study of BMD in patients with MPS IVB, bone mineral density was acquired by dual-energy X-ray absorptiometry (DXA) at whole body (WB), lumbar spine (LS) and lateral distal femur (LDF). Functional abilities, ambulatory status, medical history, height Z-score, Tanner score and laboratory results were evaluated. Results: Three MPS IVB patients (2 females), mean age 26.9 years (17.7 to 31.7 years), were evaluated. All were ambulatory: 2 patients were full time ambulators without assistance and 1 patient ambulated with a walker and used a manual wheelchair 1x/month. One patient sustained 2 fractures caused by trauma (fall and MVA). Valid DXA scans were available at the WB for no patients, LS for only 1 patient, and at the LDF for all 3 patients. WB and hip were invalid due to the presence of prosthetic hip hardware in every subject. For the one patient with a valid LS, the Z-score was normal (−0.8). LDF BMD was low at all regions for every patient; LDF Z-scores for the three regions of interest where for R1: −3.1 (range: −2.9 to −3.6), R2: −2.3 (range −2.0 to −2.5) and R3: −2.1 (range −2.0 to −2.3).
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 19, 2016