Biomedical subjects

A Vaswani

Publications and source records attributed to A Vaswani.

At least 19 recordsLinked to original sources

PubMed1995

The influence of menopause and hormonal replacement therapy on body cell mass and body fat mass.

OBJECTIVE: Our purpose was to determine the efficacy of dietary calcium augmentation in the prevention of early postmenopausal bone density loss in comparison with hormonal replacement therapy and placebo. STUDY DESIGN: A three-arm parallel randomized trial comparing the influence of placebo, dietary calcium augmentation, and estrogen-progesterone-calcium in 118 women who were within 6 years of menopause was conducted. Dual photon absorptiometry was performed annually to measure lean and fat mass. In addition, the ratio of fat in the trunk/extremities was measured. RESULTS: Body weight increased in each group. The increase was statistically significant in the hormone replacement group (0.8 kg/year). The percent of body fat increased in each group from baseline measurements, with the greatest increase in the hormonal replacement group. There was a decline in the extremity/trunk ratio in the hormonal replacement group as a result of a relatively greater increase in the trunk fat mass. There was a rapid rate of loss in lean body mass that was equal among groups. CONCLUSIONS: Menopause is associated with a gain in fat mass and a loss of lean body mass, but these changes in body composition are not prevented by hormone replacement therapy.

Adipose Tissue↗

PubMed1995

To what extent is bone mass determined by fat-free or fat mass?

One hundred sixty-four healthy black and white women aged 24-79 y were studied to determine to what extent bone mass is determined by fat-free mass (FFM). A multicomponent approach to body composition, with techniques that are not interdependent, was used. The measurements included dual x-ray absorptiometry (DXA), prompt gamma-neutron-activation analysis, inelastic neuron scattering, tritiated water dilution, and whole-body counting. Univariate correlations showed significant relationships of all the fat-free measures and most of the fat measures with bone mass measured by total body calcium (TBCa). Data from pre- and postmenopausal women were analyzed separately. The average FFM by itself explained 50-55% of the variability in TBCa whereas the average fat mass by itself explained only 5-18% of the variability. The contribution of fat mass was consistently greater in postmenopausal than in premenopausal women. When stepwise multiple regression with TBCa was performed to determine the influence of adding fat mass, height, and race to the relationship of FFM with TBCa, the variation explained by average FFM was 56% premenopausal, 50% postmenopausal; by height 3% premenopausal, 6% postmenopausal; by race 4% premenopausal, 8% postmenopausal; and average fat mass was not significant. Average values for fat mass and FFM were obtained by averaging all the methods used. In conclusion, in black and white healthy women, although bone mass may be partially influenced by fatness or race, the major determinant of bone mass is FFM. Fat mass may play a more important role in postmenopausal women.

Absorptiometry, Photon↗

PubMed1995

Comparative study of body composition by dual-energy x-ray absorptiometry.

UNLABELLED: Dual-energy x-ray absorptiometry (DEXA) is a readily available technique that has recently been applied to measurement of body composition. In order to validate this technique, results from DEXA were compared with fat-free mass (FFM) and fat mass (FM) measured by total body levels of potassium (TBK), nitrogen (TBN), water (TBW) and carbon (TBC). METHODS: A healthy population of 127 white women and 38 black women with a body mass index of 18-30 were recruited. RESULTS: Compared with each of the other methods, DEXA overestimated FM and underestimated FFM. The slopes of the FM by DEXA versus the FM from each of the four methods were approximately the same, with a s.e.e. ranging from 2.4 to 3.0 units. The slopes of DEXA in comparison to FFM, however, ranged from 0.61 to 0.74 and were significantly less than unity, with a s.e.e. of 1.6 to 2.4 units. CONCLUSION: These findings suggest that at high values of FFM, DEXA is measuring something different from the FFM measured by TBW, TBN and TBK. The program for separating bone and soft tissue and for separating soft tissue into fat and lean at higher values in the DEXA method may need to be adjusted.

Absorptiometry, Photon↗

PubMed1992

Preferential osteopenia in women with osteoporotic fractures.

One-hundred thirty-six women with spontaneous vertebral crush fractures had bone density measurements by photon absorptiometry. Their absolute and relative extent of osteopenia were expressed as Z scores with respect to values from normal white women. Absolute Z scores were used to express the mean bone mass of women with crush fractures vis-a-vis normal women at peak bone mass; relative Z scores were used to express the same means vis-a-vis age-matched controls. The skeletal sites measured included the distal radius, lumbar spine, and three sites on the femur (neck, Ward's triangle, and trochanter). The absolute deficit for the five sites ranged from -1.66 to -2.60. The relative deficit was close to 1 SD for all sites. A discriminant analysis revealed that the spine and femur were predictive for vertebral crush fractures but the radius was not. Comparison with a previously reported hip-fracture population (n = 31) showed that the low bone density of the spine separated the two fracture groups best. We propose the following: (a) vertebral-fracture patients have extensive generalized osteoporosis including the hip with a preferential deficit in the spine and (b) hip-fracture patients have generalized osteoporosis with preferential osteopenia of the hip and do not have a greater mineral deficit in the spine or radius than age-matched normal women. It may be that if a single site is to be selected for screening for spine and hip fractures, the greatest value would be in measurement of the femur, although ideally the skeletal site of interest would be measured. Prospective studies are needed to confirm the utility of measurements at the spine and hip in prediction of future fractures.

Absorptiometry, Photon↗

PubMed1991

Coexisting hyperparathyroidism with thyrotoxicosis.

The coexistence of hyperparathyroidism complicating thyrotoxicosis is quite rare. We report the case of one patient who presented with thyrotoxicosis, (total thyroxine of 15.1 micrograms/dl (5-13), free thyroxine index of 18 (4-15) and triiodothyronine by RIA of 305 ng/dl (70-230) and asymptomatic hypercalcemia of 15 mg/dl (8.5-10.6), who was also initially noted to have an elevated (C-terminal) serum immunoreactive parathyroid hormone (iPTH) level of 8,800 pg/ml (50-340). With propylthiouracil and propranolol, however, this patient became normocalcemic with a decrease in iPTH values to 714 pg/ml. As the patient was tapered from medication, after being rendered euthyroid, a recurrence of hypercalcemia with rising iPTH levels occurred. PTH levels should be helpful in defining coexisting hyperparathyroidism in patients with thyrotoxicosis since in the latter iPTH is usually suppressed. Our findings support the recommendation that in patients suspected of having both hyperparathyroidism and hyperthyroidism, a diagnosis of the former can only be made with certainty after the patient has been rendered euthyroid with persistently elevated serum calcium and iPTH levels. While there are no clinical features which permit the easy identification of patients who present with dual lesions, the determination of iPTH values may be the most consistently helpful test initially, whereas other parameters such as vitamin D, serum phosphate are less reliable.

Adult↗

PubMed1991

Biochemical short-term changes produced by hormonal replacement therapy.

Seventy-one white women within 6 months to 6 years postmenopause were randomly assigned to three treatment groups: (a) placebo, (b) calcium, (c) cyclic estrogen-progestin plus calcium. Calcium was given as calcium carbonate with meals to attain an intake of 1,700 mg daily in the latter two groups. All women received 400 IU of vitamin D daily. Samples were obtained at baseline and after 2 months therapy. The hormonal treatment group had a decline in serum calcium, osteocalcin and urinary hydroxyproline and an increase in levels of calcitonin, parathyroid hormone and calcitriol. The increase in the latter two measurements could have resulted from the drop in serum calcium, it is also possible that the increase in calcitonin levels was a result of calcium supplementation. Although all these changes were statistically significant for the estrogen treatment group when considered alone, analysis of variance including the 3 groups demonstrated significance for the estrogen group for the parameters of skeletal metabolism but not for the changes in the calciotrophic hormones. There was an increase in serum calcium (p = 0.05) in the calcium augmentation group. It would be of interest to determine the effects of higher intakes of calcium in both the calcium and the estrogen treatment groups and to further explore differences in effects on bone remodeling between the two treatment approaches as well as the possibility of a additive effects. Early effects of estrogen replacement reduce bone remodeling whereas calcium supplementation to 1,700 mg per day of Ca CO3 did not appear to affect the parameters of bone remodeling.

Bone Remodeling↗

PubMed1990

Aging bone loss from the femur, spine, radius, and total skeleton.

In order to establish a comprehensive model for involutional bone loss, the following measurements were made of healthy white women: total body calcium by neutron activation analysis, bone density of the distal radius by single-photon absorptiometry, and dual-photon absorptiometry of the lumbar spine and femur (neck, Ward's triangle, and intertrochanteric areas). Longitudinal measurements were made for each of these skeletal sites except the femur. Evidence for a curvilinear component to the pattern of bone loss with aging was found for total body calcium and bone density of the radius, but not for the other measurements on analysis of cross-sectional data. Longitudinal studies confirmed that substantial bone loss begins only after menopause for the radius, whereas there is substantial premenopausal loss of bone from the lumbar spine. Prevention of vertebral osteoporosis requires maximizing bone mass before menopause. If longitudinal data confirm the model of linear rates of bone loss for the femur, there will be important implications for prevention of hip fractures.

Adult↗

PubMed1988

Calcitriol in the treatment of postmenopausal osteoporosis.

Calcitriol was compared with placebo in the treatment of postmenopausal osteoporosis in a double-blind, randomized, parallel clinical trial of 24 months' duration. Adjustment was made in dietary calcium to maximize the dose of calcitriol. The study was completed by 15 patients who received placebo and 12 patients who received calcitriol. The calcitriol group had positive slopes (compared with negative slopes for the placebo group) for total body calcium, bone mineral content of the radius, bone mineral density of the lumbar spine, and radiographic absorptiometry of the middle phalanges. The difference between the two groups was statistically significant for each of these measurements. The fracture rate in the treatment group was 250 per 1,000 patient-years as compared with 333 for the placebo group. The mean dose of calcitriol was 0.8 micrograms per day. Hypercalcemia, hypercalciuria, and perhaps nephrolithiasis were observed as complications of treatment. Calcitriol increased bone mineral density by decreasing bone resorption, but not by increasing bone formation. Future studies should concentrate on treatment with oral calcitriol in lower doses. It would also be of interest to examine parenteral administration of calcitriol. It is possible that bone formation can be increased by achieving higher serum levels of the drug, whereas complications may be avoided by using a non-oral route of administration.

Aged↗

PubMed1987

Coherence treatment of postmenopausal osteoporosis with growth hormone and calcitonin.

Fourteen women with postmenopausal osteoporosis, all having at least one vertebral crush fracture, were randomly assigned to two treatment arms, each lasting 24 months. The coherence treatment group (7 patients) was treated in the following sequence: human growth hormone (hGH) 7 IU subcutaneously daily for 2 months, followed by 3 months of salmon calcitonin (CT), 100 MRC units every other day. After a 3 month rest period, this sequence was repeated twice. The contrast group (7 patients) was treated intermittently with salmon CT given in the same time periods and at the same dose as in the coherence treatment group. Bone mass was measured every 4 months by neutron activation analysis for total body calcium (TBCa) and by single photon absorptiometry for bone mineral content (BMC) of the distal radius. Although there were no significant differences between the two groups (two-way ANOVA), the rate of change in TBCa in the coherence treatment group was significantly different from zero (F = 3.8, P less than .05) and was +2.3%/year. The increase in bone mass appeared to be sustained throughout the 2 year study, in contrast with previous studies where a plateau effect was observed with calcitonin given alone or continuously with growth hormone. No significant change was found in bone histomorphometric values measured before and after treatment in 4 patients from each group.

Aged↗

PubMed1985

Risk factors for postmenopausal osteoporosis.

Fifty-eight women with postmenopausal osteoporosis (crush fracture of the spine) were compared with 58 age-matched normal women. The osteoporotic women had lower total-body calcium levels and bone mineral content of the radius, had undergone an earlier menopause, smoked cigarettes more, and had breast-fed less often. They also had lower levels of estrone, estradiol, and testosterone and reduced levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, and 1,25-dihydroxyvitamin D. These findings suggest the presence of changeable risk factors for the development of osteoporosis. Smoking should be discouraged. An adequate intake of calcium and vitamin D should be ensured. It is the opinion of the authors that those women who have had an early menopause or who have a low bone mass at the time of menopause should be given the choice of medically supervised replacement therapy with estrogen and progesterone.

Bone and Bones↗

PubMed1985

Treatment of osteoporosis with calcitonin, with and without growth hormone.

A 24 month randomized parallel study of the treatment of postmenopausal osteoporosis with calcitonin alone v calcitonin alternating with growth hormone (combined treatment) was conducted. Each group received 1000 mg daily of oral calcium supplements. The rate of change in total body calcium for the combined and calcitonin groups was + 1.68%/yr and + 1.33/yr, respectively (P less than .05). However, the difference in the two groups was not statistically significant. Further, the total body calcium level did not increase after 12 to 18 months of treatment. There was significant difference in the rates of change of bone mineral content (BMC) of the radius for the two groups, with a loss of BMC in the combined treatment group (F = 4.80, P less than .05). Calcitonin treatment is effective in producing an increment in bone mass. The addition of growth hormone to this regimen appears to have a deleterious effect on cortical bone mass.

Aged↗

PubMed1985

Exercise-induced hypercalcemia and the calciotropic hormones.

Sixteen healthy male volunteers exercised on a bicycle ergometer starting at 40% Vo2max and progressing at 5-minute intervals up to 75% Vo2max over a 20-minute period. Blood was drawn from an indwelling venous catheter at baseline, at 5 minutes through 20 minutes, and at 10 and 20 minutes after the exercise was ended. Significant increases (which returned toward baseline in the rest period) were observed during the exercise period in total calcium and calcium ion activity, phosphate, potassium, magnesium, albumin, and lactic acid levels. Plasma volume (based on hematocrit value) decreased during the exercise period. Serum parathyroid hormone levels decreased and calcitonin levels increased at the early period of the short-term exercise. Although hemoconcentration was of sufficient magnitude to explain the change in calcium ion activity, the increase in potassium and phosphate were caused in part by additional factors.

Adult↗

PubMed1985

A model for involutional bone loss.

Bone mass of the total skeleton and distal radius were measured by in vivo neutron activation analysis and single photon absorptiometry, respectively, in 403 healthy white women and 151 healthy white men. In addition, the density of L-2 to L-4 (bone mineral content of the spine [BMCs]) was measured by dual photon absorptiometry in 159 of these women and in 56 women with the vertebral crush fracture syndrome. The rate of loss of total body calcium (TBCa) and bone mineral content of the radius (BMCr) was linear in men and was slower than in women. The best fit for TBCa and the bone mineral content of the distal radius and spine as a function of age in women was with a two-phase regression. The TBCa and BMCr could be used as well as BMCs to identify women with crush fractures. The ratios of BMCs/TBCa, BMCs/BMCr, and TBCa/BMCr did not differ among women with crush fractures and age-matched normal individuals. Our data do not support the hypothesis that women with vertebral crush fractures have preferential loss of spinal bone.

Adult↗

PubMed1984

Total body phosphorus in postmenopausal women.

Total body phosphorus (TBP) and total body calcium (TBCa) were measured by neutron activation analysis and whole body counting in 82 white women who were 1-6 years postmenopausal. Mean TBP was 395 g +/- 6.3 (SE). There was no evidence for subgroups of patients with either higher or lower TBP. The TBP was significantly related to TBCa, as well as to the bone mineral content of the distal radius. Positive associations were found between TBP and urinary phosphate excretion as well as serum 1,25(OH)2D levels (r = 0.30; p = 0.017; n = 48). Serum phosphate was related to 1,25(OH)2D levels and the number of years since menopause.

Calcium↗

PubMed1982

Combination therapy for osteoporosis with estrogen, fluoride, and calcium.

Nine women with postmenopausal spinal osteoporosis were treated with combination therapy consisting of estrogen, fluoride, and calcium. Their data were compared with those of a control group treated with fluoride, and calcium without estrogen. Bone mass was measured about every six months by photon absorptiometry (bone mineral content/bone width (BMC/BW)] and total-body neutron activation analysis [total-body calcium (TB Ca)]. Time-trend analysis revealed positive slopes for TB Ca (P = 0.002) and BMC/BW (P = N.S.) for the combination therapy group. The change in BMC/BW in the combination therapy group was significantly different from the response in the fluoride - calcium group. These data suggest that combination therapy may be successful in increasing bone mass in postmenopausal osteoporosis. A clinical trial to establish efficacy and examine risk/benefit ratios should be performed.

Adult↗

PubMed1982

Rate of bone loss in postmenopausal and osteoporotic women.

Regional and total bone mass were determined in three groups of women by photon absorptiometry of the distal radius [bone mineral content BMC)] and total body neutron activation analysis [total body calcium (TBCa)], respectively. There were three groups of patients: group A, osteoporotic women treated with a variety of pharmacologic agents; group B, osteoporotic women (controls) taking only calcium supplements; and group C, normal postmenopausal women. The mean TBCa and BMC were considerably higher in the postmenopausal women than in the osteoporotic women. The rate of change of bone mass in group C was -0.45%/yr and -0.9%/yr for the total skeleton and radius, respectively. Group B had no significant rate of loss, whereas group A demonstrated a significant increase in TBCa of 0.75%/yr with no change in the BMC of the radius. There were no significant between-subject correlations for the slopes (rates of change) of the two bone mineral measurements.

Bone Resorption↗

PubMed1981

Changes in body composition following therapy of osteoporosis with methandrostenolone.

A two compartment, double-blind, randomized, parallel study was performed comparing methandrostenolone with placebo in the treatment of osteoporosis. The duration of the study was 24 mo. Dependent parameters included total body calcium (TBCa), measured by neutron activation analysis: bone mineral content of the radius (BMC), measured by photon absorptiometry; and total body potassium (TBK), measured by total body counting. A significant increase in TBK occurred in the treated group, primarily in the first 6 mo; thereafter the TBK remained fairly constant. No significant changes in bone mass occurred, except the 6 mo TBCa measurement increased by 11 grams for the methandrostenolone group and decreased by 6 grams for the placebo group (p = .05). Other evidence also suggests that anabolic steroids may not produce sustained uncoupling of bone formation and bone resorption in osteoporosis. If methandrostenolone is capable of producing an increment in bone mass in osteoporosis, it was not readily observable with the sensitivity of the techniques employed in this study

Aged↗

PubMed1981

Compartmental body composition of cancer patients by measurement of total body nitrogen, potassium, and water.

Quantitative measurement was made of body composition in patients with several forms of neoplastic disease. Total body nitrogen was determined by means of the prompt gamma neutron activation technique; total body potassium was measured with the use of a whole body counter. The mass and protein content of the muscle compartment and nonmuscle lean tissue were estimated by application of the technique of compartmental analysis. Total body water, determined simultaneously with the use of tritium label, provided a measure of lean body mass. From these data, the body fat can be inferred. The prompt gamma neutron activation and whole body counting techniques represent a considerable advance over the balance and radioisotope techniques used in earlier studies. The new techniques make possible sequential studies over prolonged periods of time with a considerable degree of accuracy. The loss of body weight by patients with solid tumors consisted primarily of the loss of muscle mass and body fat. Even in severe wasting, the patients appear to retain significant amounts of body fat. It is the skeletal muscle which is predominantly lost; the visceral life-supporting system is, to a considerable extent, spared. The nonmuscle tissue including the visceral fraction did not change in this study, and actually appeared to increase in size when comparison was made with the normal contrast population. The loss of total body water was slight in the cancer patients studied.

Adipose Tissue↗