Search Results (593)

Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance analysis (BIA) parameters such as the percent body fat (PBF), skeletal muscle mass index (SMI), extracellular water-to-total body water ratio (ECW/TBW), and phase angle (PhA) in assessing malnutrition in Vietnamese HD patients. Materials and Methods: This cross-sectional study was conducted among 184 patients undergoing hemodialysis in Hanoi, Vietnam. The BIA parameters were measured by the InBody S10 body composition analyzer, while malnutrition was assessed by the geriatric nutritional risk index (GNRI), with a GNRI <92 classified as a high risk of malnutrition. The independent BIA variables for predicting malnutrition and its cut-off values were explored using logistic regression models and a receiver operating characteristic (ROC) curve analysis, respectively. Results: Among the study population, 42.9% (79/184) of patients were identified as being at a high risk of malnutrition. The multivariate logistic regression analysis revealed that a higher ECW/TBW was independently associated with an increased risk of malnutrition, while the PBF, SMI, and PhA expressed significant and inverse associations with the malnutrition risk after adjusting for multiple confounders. The cut-off values for predicting the high risk of malnutrition in overall HD patients were determined to be 20.45%, 7.75 kg/m², 5.45°, and 38.03% for the PBF, the SMI, the PhA, and the ECW/TBW ratio, respectively. Conclusions: BIA parameters, including the PBF, SMI, PhA, and ECW/TBW ratio, could serve as indicators of malnutrition in general Vietnamese patients with HD. Full article

Background: The waist–calf circumference ratio (WCR) is an index that combines waist and calf circumference measurements, offering a potentially effective method for evaluating the imbalance between abdominal fat and leg muscle mass in older adults. Objective: To assess the association between WCR and indicators of body composition, muscle strength, and physical performance in community-dwelling older women. Methods: This was a cross-sectional study involving 133 older women (≥65 years) from an urban-marginal community in Guayaquil, Ecuador. The WCR was categorized into quartiles (Q1: 2.07–2.57; Q2: 2.58–2.75; Q3: 2.76–3.05; Q4: 3.06–4.76). Body indicators included fat-free mass (FFM), skeletal muscle mass (SMM), appendicular muscle mass (ASM), appendicular muscle mass index (ASMI), visceral fat (VF), fat mass (FM), and fat mass index (FMI). Handgrip strength (HGS) and the Short Physical Performance Battery test (SPPB) score were used to assess muscle strength and function, respectively. Results: The median age of the participants was 75 [IQR: 65–82] years. The mean WCR was 2.92 ± 0.93. Statistically significant associations were found between WCR and VF (p < 0.001), WCR and SMM (p = 0.039), and WCR and ASM (p = 0.016). Regarding muscle function, WCR was associated with HGS (p = 0.025) and SPPB score (p = 0.029). Conclusions: A significant association was observed between WCR and body composition, and muscle strength and function in older women. Full article

Background/Objectives: Since breast cancer (BC) survival rates have increased to 91% at 5 years and 80% at 15 years postdiagnosis, there is a growing awareness of the importance of addressing the long-term well-being of patients. Consequently, integrative oncology, which combines standard therapies with complementary approaches (nutrition, mind–body practices, and lifestyle modifications), has emerged as a patient-centred model aimed at improving symptom management, treatment adherence, and overall quality of life (QoL). This study aims to demonstrate how integrative therapies can benefit body composition, phase angle, and fluid and electrolyte balance through bioelectrical impedance analysis (BIA). Methods: This study considers a patient who underwent BC surgery and was enrolled in the AMICO clinic for anamnesis, as well as their oncological pathology data, assessment of QoL, and BIA. The breast surgeon specialising in integrative oncology therapies prescribed the patient curcumin and polydatin, moderate physical activity, a balanced diet, and Qigong sessions. The patient underwent monitoring through haematochemical analysis, BIA, and a QoL questionnaire, with follow-up every four months. Results: Between 4 and 12 months, fat mass (FM) and body mass index (BMI) markedly decreased, whereas fat-free mass (FFM), total body water (TBW), and skeletal muscle mass (SMM) increased progressively. Moreover, the improvements in the Na/K ratio and phase angle (PhA) suggest a shift toward better electrolyte and fluid balance and enhanced cellular integrity and membrane function. Equally outstanding were her psychological benefits in terms of mood, sleep, anxiety, and melancholy. Conclusions: Patient progress in body composition, metabolic function, pain management, and psychological status measured during the 12-month follow-up demonstrates the potential benefits of an integrative approach to supportive cancer care. Full article

Background and Objectives: Research on the impact of leucine on older sarcopenic patients is scarce, and investigations on this subject have led to contradictory findings in the literature. Our goal was to compile data from the available studies in the literature to explore the effect of leucine supplementation on parameters associated with sarcopenia in elderly individuals. Methods: The meta-analysis included older persons over 65 years of age who were recruited on the basis of the European Working Group on Sarcopenia in Older People sarcopenia criteria. Studies that were included were those in which at least one sarcopenia criterion was measured, including grip strength, appendicular skeletal muscle mass/height², gait speed, and the short physical performance battery index. Results: The meta-analysis included ten randomized controlled trials and one prospective study. The leucine group included 566 participants, whereas the placebo group included 567 patients. Patients receiving leucine and patients receiving a placebo had significantly different handgrip (p = 0.03), appendicular skeletal muscle mass/height² (p = 0.0.2), and gait speed (p = 0.008). Patients received a high dosage of leucine, and there was a significant difference in the appendicular skeletal muscle mass/height² (p = 0.02) and gait speed (p = 0.01) between the high dosage of the leucine group and the control group. When vitamin D was combined with leucine, the appendicular skeletal muscle mass/height² (p = 0.03) significantly differed between the leucine group receiving vitamin D and the control group. Conclusions: Low-quality evidence was found that older sarcopenic patients receiving leucine may show trends toward improved skeletal muscle strength, skeletal muscle quality, and physical performance. The capacity of leucine supplementation to have a beneficial therapeutic impact in older sarcopenic individuals is restricted when it is used alone without concurrent additional therapy. Full article

Background/Objectives: The comparative efficacy and optimal combination strategies of exercise intervention, nutritional supplementation, and their integration for older women with sarcopenia remain inadequately supported by high-quality evidence. Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) until February 2025. A frequentist random-effects network meta-analysis was conducted to compare the relative effects of different interventions. The quality of evidence was assessed using the GRADE framework, and interventions were ranked based on relative efficacy and evidence certainty. Results: A total of 21 randomized controlled trials involving 1215 participants were included. The network meta-analysis showed that combined exercise and nutritional interventions were the most effective in improving handgrip strength (MD = 1.95, 95% CI: 0.1 to 3.18; SUCRA = 74%), usual gait speed (MD = 0.11, 95% CI: 0.04 to 0.17; SUCRA = 94.49%), maximum gait speed (MD = 0.22, 95% CI: 0.06 to 0.38; SUCRA = 82.17%), and appendicular skeletal muscle mass (MD = 0.21, 95% CI: 0.05 to 0.38; SUCRA = 92.83%). Exercise alone significantly improved knee extension strength (SMD = 0.75, 95% CI: 0.41 to 1.08; SUCRA = 84.58%). However, nutritional supplementation alone did not significantly improve any outcome. No intervention demonstrated a significant effect on skeletal muscle mass index. Conclusion: Exercise interventions effectively enhance muscle mass, strength, and physical function in older women with sarcopenia. Combined exercise and nutritional supplementation may offer superior benefits compared with exercise alone. Full article

Background: Sarcopenia significantly affects the health and quality of life in older adults. Exercise combined with nutritional interventions is widely recognized as an effective strategy for improving sarcopenia outcomes. However, current studies rarely focus on differential effects across subpopulations with distinct demographic and health characteristics. This study aimed to explore the effects of combined exercise and nutrition interventions on sarcopenia-related outcomes, considering the variations in population characteristics. Methods: A systematic search was conducted across PubMed, Embase, the Web of Science, and Cochrane Library, covering the literature published between January 2010 and March 2025. Only randomized controlled trials (RCTs) evaluating combined exercise and nutritional interventions for sarcopenia were included. The primary outcomes were handgrip strength (HS), the skeletal muscle mass index (SMI), gait speed (GS), and the five-times sit-to-stand test (5STS). The mean differences (MD) with 95% confidence intervals (CIs) were calculated. Random-effects models were used for the meta-analysis and subgroup comparisons. Results: Fifteen RCTs involving 1258 participants in the intervention group and 1233 in the control group were included. Exercise combined with nutritional interventions significantly improved sarcopenia-related outcomes. HS improved with a pooled MD of 1.77 kg (95% CI: 0.51 to 3.03, p = 0.006); SMI increased by 0.22 kg/m² (95% CI: 0.09 to 0.35, p = 0.0007); GS improved by 0.09 m/s (95% CI: 0.04 to 0.14, p = 0.0002); and 5STS performance improved with a time reduction of −1.38 s (95% CI: −2.47 to −0.28, p = 0.01). Subgroup analyses indicated that the intervention effects varied according to age, BMI, and living environment. Conclusions: Exercise combined with nutrition is effective in improving key outcomes associated with sarcopenia in older adults. The magnitude of these effects differed across population subgroups, underscoring the importance of tailoring interventions to specific demographic and health profiles. Full article

Background/Objectives: To explore the factors associated with changes in skeletal muscle mass among Japanese health checkup subjects (5214 men and 6614 women). Methods: Fat-free index (FF index) was defined as FF mass divided by height squared (kg/m²). Change rate in FF index (kg/m²/year) was defined as [FF index (second time) − FF index (first time (i.e., baseline))]/interval between first and second times (years). Factors associated with change rate in FF index >0 kg/m²/year were primarily examined. Results: The average age, body mass index (BMI) were 52.4 years and 23.9 kg/m² for men, and 50.5 years and 21.8 kg/m² for women. In the multivariate analyses, age (p < 0.0001), body mass index (BMI, p < 0.0001), baseline FF index (p < 0.0001), waist circumference (p = 0.0365), fasting blood sugar (FBS, p = 0.0012), alanine aminotransferase (p < 0.0001) and alcohol intake were found to be significant in men, while BMI (p < 0.0001), baseline FF index (p < 0.0001), triglyceride (p = 0.0031), FBS (p = 0.0064) and alcohol intake were found to be significant in women. Conclusions: Lifestyle guidance from various aspects including metabolic factors may be important to maintain skeletal muscle mass. Full article

Background: Duchenne muscular dystrophy (DMD) is a severe X-linked neuromuscular disorder caused by mutations in the DMD gene, leading to progressive muscle degeneration, loss of ambulation, and multi-systemic complications. Beyond its impact on mobility, DMD is associated with significant endocrine and metabolic dysfunctions that develop over time. Objective: To provide a comprehensive analysis of growth disturbances, endocrine dysfunctions, and metabolic complications in DMD including bone metabolism, considering the underlying mechanisms, clinical implications, and management strategies for daily clinical guidance. Methods: In this narrative review, an evaluation of the literature was conducted by searching the Medline database via the PubMed, Scopus, and Web of Science interfaces. Results: Growth retardation is a hallmark feature of DMD, with patients exhibiting significantly shorter stature compared to their healthy peers. This is exacerbated by long-term glucocorticoid therapy, which disrupts the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis and delays puberty. Obesity prevalence follows a biphasic trend, with increased risk in early disease stages due to reduced mobility and corticosteroid use, followed by a decline in body mass index (BMI) in later stages due to muscle wasting. Metabolic complications, including insulin resistance, altered lipid metabolism, and hepatic steatosis, further characterize disease burden. Osteoporosis and increased fracture risk, primarily due to reduced mechanical loading and glucocorticoid-induced bone resorption, are major concerns, needing early screening and intervention. The RANK/RANKL/OPG signaling pathway has emerged as a critical factor in bone deterioration, providing potential therapeutic targets for improving skeletal health. Conclusions: Growth and endocrine disorders in DMD are complex and multifactorial, requiring proactive monitoring and early intervention. Addressing these issues requires a multidisciplinary approach integrating endocrine, nutritional, and bone health management. Further research is essential to refine treatment strategies that mitigate growth and metabolic disturbances while preserving overall patient well-being. Full article

Background: Sarcopenia (loss of muscle mass) and dynapenia (loss of strength) are prevalent in older adults aged 70 years and over. Both have an impact on their functional ability and quality of life, with type II muscle fibres being particularly affected. Although traditional resistance training (TRT) is effective, it presents technical difficulties and an increased risk of injury among this vulnerable population. Isometric strength training (IST) is a potentially safer, more accessible and more effective alternative. Objective: To describe the protocol of a single-arm, pre-post intervention trial designed to evaluate the efficacy and applicability of a 16-week IST programme on muscle strength, skeletal muscle mass, quality of life and applicability (safety, acceptability, perceived difficulty) in 18 older adults aged 70 years and above with a diagnosis of sarcopenia and dynapenia. The influence of genetic and environmental factors on the variability of response to IST will also be explored. Methodology: The participants, who have all been diagnosed with sarcopenia according to EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria, will perform two IST sessions per week for 16 weeks. Each 30-min session will consist of one progressive set (total duration 45 s to 90 s) for each of the eight major muscle groups. This series will include phases at 20% and 40% of individual Maximal Voluntary Isometric Contraction (MVIC), culminating in 100% Maximal Effort (ME), using the CIEX SYSTEM machine with visual feedback. The primary outcome variables will be: change in knee extensor MVIC and change in Appendicular Skeletal Muscle Mass Index (ASMMI). Secondary variables will be measured (other components of sarcopenia, quality of life by EQ-5D-5L, use of Likert scales, posture and physiological variables), and saliva samples will be collected for exploratory genetic analyses. The main statistical analyses will be performed with t-tests for related samples or their non-parametric analogues. Discussion: This protocol details a specific IST intervention and a comprehensive evaluation plan. The results are expected to provide evidence on the feasibility and effects of IST among older adults with sarcopenia and dynapenia. Understanding individual variability in response, including genetic influence, could inform the design of more personalised and effective exercise strategies for this population in the future. Full article

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive interstitial lung disease with an unknown etiology. It is often accompanied by skeletal muscle mass loss. Chest wall muscles play a crucial role in respiratory movements and form part of the skeletal muscles. The aim of this study is to evaluate the relationship between chest wall muscle thickness and pulmonary function test (PFT) results, as well as other prognostic markers, in patients with IPF. Materials and Methods: A retrospective analysis was conducted on 108 patients diagnosed with IPF and 53 control subjects. Chest wall muscle thickness was measured on thoracic computed tomography (CT) images at specific anatomical levels. PFT parameters, the Gender-Age-Physiology (GAP) index, number of acute exacerbations, and mortality data were evaluated in relation to muscle thickness. Results: IPF patients had significantly reduced thickness in the bilateral external scapular muscles at both the aortic and pulmonary trunk levels compared to controls. Bilateral pectoral muscle thickness at the aortic level was positively correlated with forced vital capacity (FVC) and negatively correlated with the number of exacerbations. Internal scapular muscle thickness at the aortic level showed a significant positive correlation with diffusion capacity of the lung for carbon monoxide (DLCO) and a negative correlation with both GAP scores and exacerbation frequency. External scapular muscle thickness at the pulmonary trunk level was positively associated with PFT parameters and inversely correlated with the GAP index, exacerbations, and mortality. Conclusions: In patients with IPF, the bilateral external scapular muscle thickness at the aortic and pulmonary trunk levels was significantly reduced compared to controls. Significant associations were found between some chest wall muscle thicknesses and the GAP index, pulmonary function, acute exacerbations, and mortality, underscoring the prognostic value of baseline muscle measurements. Measurement of chest wall muscle thickness using routine thoracic CT scans may offer additional prognostic value in IPF. Incorporating this parameter into clinical evaluation may help identify patients who could benefit from supportive interventions, such as nutritional therapy or pulmonary rehabilitation. Full article

Background: Cirrhosis is responsible for a large proportion of mortality worldwide. Despite having multiple scoring systems, organ allocation for end-stage liver disease remains a major problem. Since anthropometric indices play important roles in predicting the prognosis of patients with cirrhosis, these variables were used in establishment of a novel scoring system. Methods: In order to evaluate a machine learning approach for predicting the probability of three-month mortality in cirrhotic patients awaiting liver transplantation, the clinical and anthropometric information of 64 patients referred to Abu-Ali-Sina Transplantation Center were collected and followed for three months. A LASSO logistic regression model was used to devise and validate a new machine learning approach and compare it to the Model for End-Stage Liver Disease (MELD) regarding the three-month mortality of cirrhotic patients. Hand grip, skeletal muscle mass index, average mean arterial pressure, serum sodium, and total bilirubin were assessed with this new machine learning approach to predict the prognosis of patients with cirrhosis, which we named the Sina score. Results: Sixty-four patients were enrolled, with a mean age of 46.50 ± 12.871 years. Like the MELD score, the Sina score is a precise prognostic tool for predicting the three-month mortality probability in cirrhotic patients [area under the curve (AUC) = 0.753 and p = 0.005 vs. AUC = 0.607 and p = 0.238]. Our machine learning approach, the Sina score, was shown to be a precise prognostic tool, like the MELD, for the prediction of the three-month mortality probability of cirrhotic patients awaiting liver transplantation. Conclusions: The Sina score, given that its level of precision is on par with the MELD, can be recommended for the prediction of three-month mortality in cirrhotic patients awaiting liver transplantation. Full article

Background: Sarcopenia and osteoporosis are common age-related conditions that markedly increase fracture risk and morbidity in the elderly. Leptin, an adipokine secreted by adipose tissue, has been implicated in musculoskeletal health, but its clinical relevance in aging populations remains uncertain. This study aimed to evaluate the associations between serum leptin levels, skeletal muscle mass, muscle strength, bone mineral density (BMD), and fracture risk in elderly women. Methods: This observational analysis included 79 community-dwelling women aged 65 years and older. Participants underwent assessments of body composition, serum leptin concentration, grip strength, and femoral neck BMD. Sarcopenia and obesity were classified based on established criteria. Correlation analyses and binomial logistic regression were performed to examine the relationships among leptin levels, musculoskeletal parameters, and fracture occurrence. Results: Leptin concentrations were significantly associated with fat-related parameters, including BMI, fat index, and total body fat percentage, but showed no significant correlation with skeletal muscle mass (ASM), grip strength, or BMD. Obese participants demonstrated higher leptin levels and fat parameters compared with non-obese participants, but no significant differences were observed in grip strength or BMD. Binomial logistic regression analysis identified femoral neck BMD and grip strength as significant independent predictors of fracture risk, whereas leptin and ASM were not identified as such. Conclusions: In elderly women, serum leptin levels primarily reflect adiposity rather than musculoskeletal health. Leptin is not an independent predictor of spinal fracture risk. These findings highlight the critical importance of maintaining bone density and muscle strength for fracture prevention in aging populations. Full article

Background and Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used in type 2 diabetes (T2D) due to their cardiorenal benefits and weight-lowering effects. However, concerns have emerged regarding their potential adverse impact on lean mass and muscle strength particularly in patients at risk for sarcopenia. This study aimed to evaluate the effects of empagliflozin on skeletal muscle mass. Secondary objectives were to assess changes in glycemic control, body weight, fat mass and handgrip strength. Materials and Methods: In this 24-week real-world observational study, 31 adult patients with T2D were assigned to either empagliflozin or non-SGLT2i treatment groups. Patients did not receive a high-protein diet, a resistance exercise program or any other weight-reducing medications such as glucagon-like peptide-1 (GLP-1)-based therapies. Anthropometric measurements, body composition via bioelectrical impedance analysis (BIA), and handgrip strength testing were performed at baseline and after 6 months. Sarcopenia was defined according to EWGSOP2 criteria. Results: The empagliflozin group showed significant improvements in HbA1c, fasting plasma glucose, body weight, waist circumference, and fat mass (p < 0.05 for all). No significant changes were observed in the empagliflozin group after 6 months in appendicular skeletal muscle mass index (from 7.81 ± 1.33 kg/m² to 7.84 ± 1.38 kg/m², p = 0.154). No statistically significant changes were observed in handgrip strength in either group. Conclusions: Empagliflozin treatment over six months led to favorable changes in metabolic parameters and fat mass without detrimental effects on skeletal muscle mass or muscle strength. In clinical practice, the selection of antidiabetic therapies should consider individual glycemic targets, cardiovascular and renal risks, weight management, comorbidities and sarcopenia risk. Resistance exercises and adequate dietary protein intake should be recommended to preserve muscle mass in at-risk patients. Larger randomized trials are needed to confirm the long-term effects of SGLT2 inhibitors on body composition particularly in older adults. Full article

Background/Objectives: High-intensity interval training (HIIT) can optimize recovery by complementing the low cardiovascular fitness intensities typically achieved in stroke rehabilitation programs. Skating exercise is an HIIT workout developed based on ice skating movements, and we investigated the effects of this exercise on the cardiorespiratory fitness of elderly patients with minor stroke. Methods: Participants aged 65 or older with a National Institutes of Health Stroke Scale score of 3 or lower were recruited. This study was designed as a randomized controlled trial, in which the intervention group engaged in skating exercises following HIIT, while the control group underwent moderate-intensity continuous training (MICT). Both groups of participants performed either HIIT or MICT for 20 min per day, four times a week, over three months. Results: A total of 34 elderly patients with minor stroke were recruited, with an average age of 70.7 years. For three months, no fall-down injuries or adverse cardiovascular or cerebrovascular events were reported among patients undergoing HIIT or MICT. Both the intervention and control groups showed significant increases in the measures of aerobic capacity after the intervention. However, the patients in the intervention group exhibited significantly greater improvements in peak oxygen uptake, ventilatory threshold, and peak MET (p = 0.005, p = 0.002, and p = 0.024, respectively). Additionally, the Berg Balance Scale (BBS) scores and the skeletal muscle mass index showed significantly greater enhancements in the intervention group compared to the control group (p = 0.032 and p = 0.032). Conclusions: In conclusion, skating exercise could be a safe and effective HIIT protocol for elderly people who have experienced a minor stroke. Full article

Osteogenesis imperfecta (OI) is a rare bone dysplasia that occurs with a frequency of 1/15,000–20,000 live births. It is characterized by increased susceptibility of bone fractures, skeletal deformities, low stature, and low bone mass. It results in impaired production of type I collagen. About 90% of people with OI have heterozygous mutations in the COL1A1 and COL1A2 genes. Fibroblast growth factor 23 (FGF23) is a protein involved in the regulation of phosphate and 1,25-dihydroxyvitamin D₃ metabolism on a negative feedback basis. FGF23 is secreted by osteocytes in response to increased serum calcitriol and phosphorus. The purpose of this study was to evaluate the concentration of FGF23 among children with osteogenesis imperfecta and the differences in reference values in a healthy population of children and adolescents. Then, this study sought to evaluate how the course of osteogenesis imperfecta, including type of disease, number of bone fractures, and bone mineral density, are related to FGF23 concentration. The study included 47 children aged 3 to 17 years with a diagnosis of osteogenesis imperfecta, confirmed by genetic tests. The patients were hospitalized at the Department from August 2019 to September 2020 and were treated with intravenous infusions of sodium pamidronate. The course of the disease was analyzed, including the number of bone fractures, clinical symptoms, and anthropometric parameters, and bone densitometry was performed by dual X-ray absorptiometry (DXA) in Total Body Less Head (TBLH) and Spine options with Z-score evaluation. FGF23 concentration was determined by the ELISA method. The study was prospective in nature. Results: The mean level of FGF23 in the study group of patients was 645.09 pg/mL and was within the reference values for the developmental age population. There was no significant correlation between FGF23 concentration and anthropometric measurements: body weight (p = 0.267), height (p = 0.429), gender (p = 0.291), or pubertal stage (p = 0.223) in the study group of patients. FGF23 levels were not related to the number of fractures (p = 0.749), the number of sodium pamidronate cycles administered (p = 0.580), bone mineral density parameters (Z-score), the form of osteogenesis imperfecta (p = 0.156), or the genetic test result (p = 0.573). FGF23 levels decrease with age (r = −0.32, p = 0.030) and BMI (r = −0.34, p = 0.020). The level of FGF23 in patients with osteogenesis imperfecta is lower among older children and those having a higher BMI. This index cannot be a diagnostic tool in this group of patients, for no differences were found between the concentrations in patients with osteogenesis imperfecta and the developmental age population. Full article