{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T05:20:53Z","timestamp":1787721653563,"version":"build-2784847793"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Osteoporosis is increasingly recognized as an immune-mediated condition (\u201cimmunoporosis\u201d), yet data on bone health in adults with primary immunodeficiencies (PIDs) remain limited. Chronic immune dysregulation and multisystem complications in PIDs may adversely affect skeletal integrity, but bone microarchitecture and muscle mass have not been comprehensively evaluated in this population. The aim of our study was to assess bone mineral density (BMD), trabecular bone score (TBS), and muscle mass in adults with PIDs. Exploratory analyses examined associations between these measures and clinical features and the main peripheral blood lymphocyte subsets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center cross-sectional study, 61 adult patients with PIDs underwent dual-energy X-ray absorptiometry (DXA) of the lumbar spine, total hip, femoral neck, and whole body. TBS was derived from lumbar spine DXA images, and the appendicular lean mass index was calculated to assess muscle mass. Clinical characteristics and immunological parameters, including peripheral blood lymphocyte subsets, were analyzed in relation to skeletal outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Based on age-appropriate DXA findings and clinical data, osteoporosis was diagnosed in 12 of 61 patients (19.7%). Three additional patients were diagnosed based on fragility fractures, increasing the overall prevalence to 15 of 61 (24.6%). Low BMD was more frequently detected at the hip than at the lumbar spine. Partially degraded or degraded TBS was observed in 15 of 61 patients (24.6%). Low muscle mass was identified in 17 of 61 patients (27.9%) and was associated with significantly lower BMD at all skeletal sites. Participants with bronchiectasis had lower femoral neck and total hip BMD and lower TBS, whereas those with enteropathy had lower BMD across all skeletal sites and lower TBS. Among participants eligible for T-score assessment (n = 15), NK-cell counts correlated positively with femoral neck (\u03c1 = 0.63, p = 0.01) and total hip T-scores (\u03c1 = 0.68, p &amp;lt; 0.01), and with TBS in the entire cohort (n = 61; \u03c1 = 0.28, p = 0.03). CD4+, CD8+, and CD19+ cell counts were not associated with any evaluated densitometric parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusions<\/jats:title>\n                    <jats:p>In this cohort of adults with PIDs, reduced BMD and impaired TBS represented distinct, partially overlapping findings. Hip DXA appeared particularly informative, while TBS provided complementary information beyond BMD. These exploratory findings should be confirmed in prospective controlled studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1896132","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:44:48Z","timestamp":1787719488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bone mineral density and trabecular bone score in adults with primary immunodeficiencies: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Anna","family":"Nowakowska-P\u0142aza","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Pneumonology, Allergology, Clinical Immunology and Rare Diseases, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakub","family":"Wro\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arkadiusz","family":"Zegad\u0142o","sequence":"additional","affiliation":[{"name":"Department of Radiology, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Rybak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pneumonology, Allergology, Clinical Immunology and Rare Diseases, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Rutkowska","sequence":"additional","affiliation":[{"name":"Department of Radiology, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Jahnz-R\u00f3\u017cyk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pneumonology, Allergology, Clinical Immunology and Rare Diseases, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Wi\u0119sik-Szewczyk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Pneumonology, Allergology, Clinical Immunology and Rare Diseases, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]},{"name":"Department of Internal Medicine and Rheumatology, Military Institute of Medicine-National Research Institute","place":["Warsaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","first-page":"1","article-title":"Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group","volume":"843","year":"1994","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-009-0920-3","article-title":"Excess mortality following hip fracture: a systematic epidemiological review","volume":"20","author":"Abrahamsen","year":"2009","journal-title":"Osteoporos Int"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2019.40.4273","article-title":"Approach to primary immunodeficiency","volume":"40","author":"Devonshire","year":"2019","journal-title":"Allergy Asthma Proc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.70962\/jhi.20250002","article-title":"The 2024 update of IUIS phenotypic classification of human inborn errors of immunity","volume":"1","author":"Bousfiha","year":"2025","journal-title":"J Hum Immun"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3038.2011.01187.x","article-title":"Osteoporosis: An ignored complication of CVID","volume":"22","author":"Baris","year":"2011","journal-title":"Pediatr Allergy Immunol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2174\/1871530323666230822100031","article-title":"Bone mineral density is related to CD4+ T cell counts and muscle massis associated with B cells in common variable immunodeficiency patients","volume":"24","author":"De Melo","year":"2024","journal-title":"EMIDDT"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2174\/1871530317666170612093906","article-title":"Comparison of bone mineral density in common variable immunodeficiency and X-linked agammaglobulinaemia patients","volume":"17","author":"Mohebbi","year":"2017","journal-title":"EMIDDT"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-023-06722-5","article-title":"Clinical features and predictors of osteoarticular manifestations in common variable immunodeficiency","volume":"42","author":"Ben Khaled","year":"2023","journal-title":"Clin Rheumatol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.14744\/nci.2023.49699","article-title":"The clinical and immunological characteristics of common variable immunodeficiency in adults and older adults","volume":"11","author":"Yildiz","year":"2024","journal-title":"North Clin Istanb"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s10875-013-9982-2","article-title":"Bone density and fractures in autosomal dominant hyper IgE syndrome","volume":"34","author":"Sowerwine","year":"2014","journal-title":"J ClinImmunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"66","DOI":"10.21911\/aai.501","article-title":"Bone metabolism alterations in patients with common variable immune deficiency: a retrospective cohort study","volume":"18","author":"Aytekin","year":"2020","journal-title":"Asthma Allergy Immunol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S351918","article-title":"The rising era of \u2018immunoporosis\u2019: role of immune system in the pathophysiology of osteoporosis","volume":"15","author":"Srivastava","year":"2022","journal-title":"J Inflammation Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.965258","article-title":"Immunoporosis: role of immune system in the pathophysiology of different types of osteoporosis","volume":"13","author":"Zhang","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.687037","article-title":"Immunoporosis: role of innate immune cells in osteoporosis","volume":"12","author":"Saxena","year":"2021","journal-title":"Front Immunol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.664871","article-title":"The macrophage-osteoclast axis in osteoimmunity and osteo-related diseases","volume":"12","author":"Yao","year":"2021","journal-title":"Front Immunol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1000546107","article-title":"Natural killer cells trigger osteoclastogenesis and bone destruction in arthritis","volume":"107","author":"S\u00f6derstr\u00f6m","year":"2010","journal-title":"Proc Natl Acad Sci USA"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1111\/imm.12449","article-title":"Interleukin\u201015\u2010activated natural killer cells kill autologous osteoclasts via LFA\u20101, DNAM\u20101 and TRAIL, and inhibit osteoclast\u2010mediated bone erosion in vitro","volume":"145","author":"Feng","year":"2015","journal-title":"Immunology"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20061775","article-title":"Th17 functions as an osteoclastogenic helper T cell subset that links T cell activation and bone destruction","volume":"203","author":"Sato","year":"2006","journal-title":"J Exp Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"5127","DOI":"10.1038\/s41467-018-07626-8","article-title":"B cells inhibit bone formation in rheumatoid arthritis by suppressing osteoblast differentiation","volume":"9","author":"Sun","year":"2018","journal-title":"Nat Commun"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.0903841","article-title":"Regulatory T cells protect from local and systemic bone destruction in arthritis","volume":"184","author":"Zaiss","year":"2010","journal-title":"J Immunol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.00657","article-title":"Immunoporosis: immunology of osteoporosis\u2014role of T cells","volume":"9","author":"Srivastava","year":"2018","journal-title":"Front Immunol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1038\/emm.2003.51","article-title":"B cells activated in the presence of Th1 cytokines inhibit osteoclastogenesis","volume":"35","author":"Choi","year":"2003","journal-title":"Exp Mol Med"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1590\/0100-3984.2021.0155-en","article-title":"Assessment of body composition by whole-body densitometry: what radiologists should know","volume":"55","author":"Chaves","year":"2022","journal-title":"Radiol Bras"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.02.004","article-title":"The european society for immunodeficiencies (ESID) registry working definitions for the clinical diagnosis of inborn errors of immunity","volume":"7","author":"Seidel","year":"2019","journal-title":"J Allergy Clin Immunology: In Pract"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2023.101437","article-title":"DXA reporting updates: 2023 official positions of the International Society for Clinical Densitometry","volume":"27","author":"Krueger","year":"2024","journal-title":"J Clin Densitometry"},{"key":"B26","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1385\/JCD:7:1:17","article-title":"Diagnosis of osteoporosis in men, premenopausal women, and children","volume":"7","year":"2004","journal-title":"J Clin Densitometry"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2023.101452","article-title":"Clinical use of trabecular bone score: the 2023 ISCD official positions","volume":"27","author":"Goel","year":"2024","journal-title":"J Clin Densitometry"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2015.06.008","article-title":"Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions part 2: trabecular bone score","volume":"18","author":"Silva","year":"2015","journal-title":"J Clin Densitometry"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2176","article-title":"Trabecular bone score: a noninvasive analytical method based upon the DXA image","volume":"29","author":"Silva","year":"2014","journal-title":"J Bone Miner Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10153356","article-title":"Patients with common variable immunodeficiency complicated by autoimmune phenomena have lymphopenia and reduced Treg, Th17, and NK cells","volume":"10","author":"Wi\u0119sik-Szewczyk","year":"2021","journal-title":"J Clin Med"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.4065\/77.5.453","article-title":"Secondary causes of osteoporosis","volume":"77","author":"Fitzpatrick","year":"2002","journal-title":"Mayo Clinic Proc"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-022-00946-4","article-title":"Osteoporosis and HIV infection","volume":"110","author":"Biver","year":"2022","journal-title":"Calcif Tissue Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1210\/endrev\/bnab028","article-title":"Secondary osteoporosis","volume":"43","author":"Ebeling","year":"2022","journal-title":"Endocr Rev"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(16)00086-3","article-title":"Complications of Cushing\u2019s syndrome: state of the art","volume":"4","author":"Pivonello","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3390\/ijms20235867","article-title":"Osteoporosis in rheumatic diseases","volume":"20","author":"Adami","year":"2019","journal-title":"IJMS"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02056-w","article-title":"Bone quality in endocrine diseases: determinants and clinical relevance","volume":"46","author":"Cianferotti","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2015.05.016","article-title":"Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice","volume":"78","author":"Harvey","year":"2015","journal-title":"Bone"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-3118","article-title":"TBS (trabecular bone score) and diabetes-related fracture risk","volume":"98","author":"Leslie","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2012.11.041","article-title":"Trabecular bone score\u201d (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism","volume":"53","author":"Romagnoli","year":"2013","journal-title":"Bone"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2021.04.001","article-title":"Trabecular bone score (TBS) in primary hyperparathyroidism (PHPT): a useful tool","volume":"24","author":"Santos","year":"2021","journal-title":"J Clin Densitometry"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-015-3344-2","article-title":"Trabecular bone score as a skeletal fragility index in acromegaly patients","volume":"27","author":"Hong","year":"2016","journal-title":"Osteoporos Int"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2021.11.004","article-title":"Changes in trabecular bone score and bone density in female adolescents with anorexia nervosa: a longitudinal study","volume":"25","author":"Modan-Moses","year":"2022","journal-title":"J Clin Densitometry"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-014-0125-2","article-title":"Longitudinal changes of trabecular bone score after estrogen deprivation: effect of menopause and aromatase inhibition","volume":"37","author":"Pedrazzoni","year":"2014","journal-title":"J Endocrinol Invest"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-022-01062-w","article-title":"Trabecular bone score in rheumatic disease","volume":"24","author":"Richards","year":"2022","journal-title":"Curr Rheumatol Rep"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2012.01.007","article-title":"Identification of rheumatoid arthritis patients with vertebral fractures using bone mineral density and trabecular bone score","volume":"15","author":"Br\u00e9ban","year":"2012","journal-title":"J Clin Densitometry"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-015-3424-3","article-title":"Trabecular bone score in kidney transplant recipients","volume":"27","author":"Naylor","year":"2016","journal-title":"Osteoporos Int"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1159\/000443439","article-title":"Osteoporosis and impaired trabecular bone score in hemodialysis patients","volume":"41","author":"Brunerov\u00e1","year":"2016","journal-title":"Kidney Blood Press Res"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1002\/jbm4.10532","article-title":"Independent external validation of FRAX and Garvan fracture risk calculators: a sub-study of the FRISBEE cohort","volume":"5","author":"Baleanu","year":"2021","journal-title":"JBMR Plus"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02219-9","article-title":"An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis","volume":"47","author":"Schini","year":"2023","journal-title":"J Endocrinol Invest"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12186018","article-title":"Points to consider in health assessment of adult patients with primary antibody deficiencies","volume":"12","author":"Napi\u00f3rkowska-Baran","year":"2023","journal-title":"JCM"},{"key":"B51","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.aller.2019.03.004","article-title":"Assessment of vitamin D status in common variable immunodeficiency or ataxia\u2013telangiectasia patients","volume":"47","author":"Cruz","year":"2019","journal-title":"Allergologia Immunopathologia"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1896132\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:45:00Z","timestamp":1787719500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1896132\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":51,"alternative-id":["10.3389\/fendo.2026.1896132"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1896132","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1896132"}}