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PubMed1998

Effects of exercise at different ages on bone density and mechanical properties of femoral bone of aged mice.

We determined the bone density and mechanical properties of bone specimens from 5 groups of aged mice, which had been subjected to voluntary exercise at different ages. ICR 10-week-old female mice were divided into control (C), and exercise-trained during age periods of 10-70 weeks (EE), 10-30 weeks (GPE), 30-50 weeks (MPE) and 50-70 weeks (APE). It was found that in the exercise-trained groups body weight gain was suppressed during the exercise-training period, and that de-training accelerated weight gain. Bone density was significantly higher in all the exercise-trained groups than in the C group and cortical thickness index (CTI) was higher in the exercise-trained groups, except for the APE group. Maximum breaking force, ultimate stress and elasticity in the exercise-trained groups were higher than in the C group except for the APE group, whereas deformation in the APE group had a tendency to be higher than in the other groups. Blood C-terminal parathyroid hormone, calcitonin and calcium concentrations were similar among every group, but phosphorus concentrations tended to be higher in the exercise-trained groups than in the C group. These observations suggest that exercise-training at every age suppresses age-associated bone loss, and that the effect of exercise during youth is greater than that during old age. The results of this study suggest that the effect of exercise on bone at an older age is different from that at other ages.

Aging↗

PubMed1989

Sex steroids and bone density in premenopausal and perimenopausal women.

Bone density begins to decline in women before menopause, and the degree of bone loss is variable. We performed a cross-sectional analysis on the entry data of a 5-yr prospective study of risk factors for osteoporosis to determine the correlation of bone density with serum sex steroid concentrations and body weight. We studied 292 healthy white women, aged 35-50 yr, who were menstruating regularly or had had menses in the past 12 months. Blood samples were drawn in the early follicular phase for estradiol (E2), testosterone (T), dehydroepiandrosterone sulfate, and sex hormone-binding globulin (SHBG). Free levels of E2 (FE2) and T (FT) were calculated based on total T and E2, SHBG, and albumin levels. Women were classified as premenopausal (FSH, less than 12 U/L) and perimenopausal (FSH greater than or equal to 12 U/L; n = 46; 16%). Bone density was measured by dual photon absorptiometry of the lumbar spine (L2-L4) and hip and by single photon absorptiometry of the wrist. Perimenopausal women were older than premenopausal women (45.5 +/- 3.5 and 41.0 +/- 3.9 yr, respectively), but did not differ in height or weight. While bone density did not correlate with age in each group, perimenopausal women had significantly lower bone density at the L2-L4 and femoral neck (L2-L4, 1.18 +/- 0.14 in perimenopausal and 1.24 +/- 0.12 g/cm2 in premenopausal women; femur, 0.84 +/- 0.11 in perimenopausal and 0.90 +/- 0.11 g/cm2 in premenopausal women; P less than 0.005). Body weight showed the strongest positive correlation with bone density. Log FT, percent FT, and FE2 percent correlated positively with bone density, even after controlling for weight. Log SHBG was negatively correlated with bone density in premenopausal women at the hip and wrist after controlling for weight. FSH was inversely correlated with bone density, and E2 and T were lower in perimenopausal than premenopausal women. These data suggest that women who are still menstruating may have relative deficiencies in both E2 and T, with reduced bone densities as a consequence.

Adult↗

PubMed1998

Biomechanical properties of human os calcanei: relationships with bone density and fractal evaluation of bone microarchitecture.

The relationship between bone strength and bone mass is well established. The link between trabecular microarchitecture and biomechanical properties has been less extensively explored. To address this question, we have tested the mechanical behaviour of calcaneus bone samples and investigated the correlations between mechanical properties on the one hand, bone density and fractal analysis of microarchitecture on the other hand. Mechanical properties of 43 human os calcanei were determined by uniaxial compression testing of samples from tuber calcanei. Ash density, bulk density and dual energy X-ray absorptiometry of the samples were measured. Fractal analysis of the trabecular bone on calcaneus radiographs was performed by two estimators derived from the fractional Brownian motion model. The mechanical properties of human os calcis were found to correlate with age and density measurements. Fractal parameters derived from the bone texture analysis showed weaker but significant correlations with bone strength. Fractal analysis of texture could account in part for the variations of bone strength, but in this study cannot explain better than density the mechanical properties of trabecular bone. Nevertheless, it provides a non-invasive means of assessing molecular bone microarchitecture.

Aged↗

PubMed2003

Improving femoral bone density measurements.

Femoral bone density measurements are clinically important because of their strong relationship with hip fracture. However, current densitometers have not improved upon femoral densitometry since the introduction of dual-energy X-ray absorptiometry (DXA) systems. Recently, several advances in DXA measurement of the proximal femur have been proposed by various published studies. These advances can be added to existing DXA systems, while maintaining the conventional femoral regions of interest. Both upper neck bone mineral density (BMD) and hip axis length have been reported to be associated with hip fractures. With newer technology that enables a rapid assessment of both hips, bilateral femur measurements are now clinically practical and are of importance in those with T-scores approaching, yet not reaching, diagnostic or therapeutic thresholds. Bilateral femur measurements also reduce precision error compared to a single femur measurement, yielding precision errors less than observed at the spine. With this decrease in precision error, monitoring of bone changes is now possible at the femur with the utility comparable to the spine.

Absorptiometry, Photon↗

PubMed2001

Reduced bone density in androgen-deficient women with acquired immune deficiency syndrome wasting.

Women with acquired immune deficiency syndrome wasting are at an increased risk of osteopenia because of low weight, changes in body composition, and hormonal alterations. Although women comprise an increasing proportion of human immunodeficiency virus-infected patients, prior studies have not investigated bone loss in this expanding population of patients. In this study we investigated bone density, bone turnover, and hormonal parameters in 28 women with acquired immune deficiency syndrome wasting and relative androgen deficiency (defined as free testosterone < or =3.0 pg/ml, weight < or =90% ideal body weight, weight loss > or =10% from preillness maximum weight, or weight <100% ideal body weight with weight loss > or =5% from preillness maximum weight). Total body (1.04 +/- 0.08 vs. 1.10 +/- 0.07 g/cm2, human immunodeficiency virus-infected vs. control respectively; P < 0.01), anteroposterior lumbar spine (0.94 +/- 0.12 vs. 1.03 +/- 0.09 g/cm2; P = 0.005), lateral lumbar spine (0.71 +/- 0.14 vs. 0.79 +/- 0.09 g/cm2; P = 0.02), and hip (Ward's triangle; 0.68 +/- 0.14 vs. 0.76 +/- 0.12 g/cm2; P = 0.05) bone density were reduced in the human immunodeficiency virus-infected compared with control subjects. Serum N-telopeptide, a measure of bone resorption, was increased in human immunodeficiency virus-infected patients, compared with control subjects (14.6 +/- 5.8 vs. 11.3 +/- 3.8 nmol/liter bone collagen equivalents, human immunodeficiency virus-infected vs. control respectively; P = 0.03). Although body mass index was similar between the groups, muscle mass was significantly reduced in the human immunodeficiency virus-infected vs. control subjects (16 +/- 4 vs. 21 +/- 4 kg, human immunodeficiency virus-infected vs. control, respectively; P < 0.0001). In univariate regression analysis, muscle mass (r = 0.53; P = 0.004) and estrogen (r = 0.51; P = 0.008), but not free testosterone (r = -0.05, P = 0.81), were strongly associated with lumbar spine bone density in the human immunodeficiency virus-infected patients. The association between muscle mass and bone density remained significant, controlling for body mass index, hormonal status, and age (P = 0.048) in multivariate regression analysis. These data indicate that both hormonal and body composition factors contribute to reduced bone density in women with acquired immune deficiency syndrome wasting. Anabolic strategies to increase muscle mass may be useful to increase bone density among osteopenic women with acquired immune deficiency syndrome wasting.

Absorptiometry, Photon↗

PubMed1998

Bone density and mechanical properties in femoral bone of swim loaded aged mice.

Effects of swimming on bone density and mechanical properties of femur were investigated in aged male and female mice. R/1 strain of senescence accelerated mouse (SAM) at eleven months old was used. Two groups of males and two groups of females each consisting of 7 mice were used. One male and one female groups were loaded with a swim regiment of 40 min a day, 5 days a week for 6 consecutive weeks. The remaining groups were used as the controls. All mice were fed with the standard diet and water ad libitum during the experiments. The results of this study indicated that (i) the body weight was significantly (P < 0.05) lower in the swimming groups than in the control groups in both sexes. (ii) The bone density was significantly higher (P < 0.05) in the swimming groups than in the control groups in both sexes. However, there was no significant difference in cortical thickness index. (iii) In the mechanical properties of bone, there were no significant differences in the level of the maximum breaking force, the ultimate stress and the deformation between the swimming and the control groups in both sexes. However, the elasticity of the bone of the female mice in the swimming group was significantly higher (P < 0.05) than that of the control group. These results suggest that regimented swimming for the aged mice might suppress age-associated bone loss, and the effect of exercise in the females is greater that in the males.

Aging↗

PubMed1999

Effect of exercise on bone density in distal regions of the equine third metacarpal bone in 2-year-old thoroughbreds.

The present study addressed the question of whether training induces changes in bone density in the younger racehorse in regions relevant to the genesis of the common sagittal condylar fracture pattern and, if so, the nature of such alteration. Third metacarpal bones (McIII) were obtained from 12 experimental Thoroughbred, unbroken fillies, age 18.1-21.0 months at entry to the study. Six (Group E) undertook 19 weeks of progressive high intensity exercise on a high-speed treadmill at 3% incline. Six (Group C) walked 40 min each day. Clinical bone density was studied by Computed Tomography (CT) of the right McIII. 1:1 aspects of bone density were studied by digital radiography of slices and microscopic aspects by backscattered electron (BSE) imaging. There was a distinct pattern of regional variation in bone density throughout the distal condyles of McIII. Bone density was greater in specimens from Group E than those from Group C by CT, by radiographic density and by bone volume fraction as determined from backscattered electron images: the latter also showed that the most important change was in the increased amount of bone deposited within antecedent marrow space in cancellous tissue in Group E compared with Group C, with more extensive regional involvement in the highly loaded (distopalmar) aspects of the medial and lateral condyles. However, this space-filling bone fraction had a lower degree of mineralisation than the prior bone tissue, showing that CT and radiography underestimate the resultant increased bone volume fraction. Stress fractures of the distal condyles of the McIII are common in Thoroughbred racehorses. We propose that excess stiffening within the condyles due to extensive new bone formation may lead to concentration of strain at the condylar grooves and incipient cracking through calcified cartilage and into the subchondral bone.

Animals↗

PubMedDate not supplied

Discrepant areal and volumetric bone density measurements in a young woman with idiopathic low bone mineral density.

OBJECTIVE: To discuss a case of idiopathic low bone density in a young woman. METHODS: We present a detailed report that includes clinical, laboratory, and radiologic assessment of a pre-menopausal woman with idiopathic low bone mass. RESULTS: A 34-year-old healthy woman of small body habitus was found by dual-energy x-ray absorptiometry to have bone mineral density (BMD) that was less than 2.5 standard deviations below the young and age-matched norm. After a thorough evaluation, no cause of osteoporosis was identified. Calculation of bone mineral apparent density, which minimizes the effect of small skeletal size on areal BMD, resulted in only a modest improvement in T-scores. Measurement of lumbar spine volumetric BMD by quantitative computed tomography, however, revealed a significantly improved T-score of -1.6. CONCLUSION: This report highlights the complexities of low BMD measurements in otherwise healthy young women as well as the potential application of bone mineral apparent density and quantitative computed tomography in the evaluation of low BMD in young women with small skeletal frames.

Absorptiometry, Photon↗

PubMed1994

Prediction of bone density from vitamin D receptor alleles.

Bone density achieved in early adulthood is the major determinant of risk of osteoporotic fracture. Up to 60% of women suffer osteoporotic fractures as a result of low bone density, which is under strong genetic control acting through effects on bone turnover. Here we show that common allelic variants in the gene encoding the vitamin D receptor can be used to predict differences in bone density, accounting for up to 75% of the total genetic effect on bone density in healthy individuals. The genotype associated with lower bone density was overrepresented in postmenopausal women with bone densities more than 2 standard deviations below values in young normal women. The molecular mechanisms by which bone density is regulated by the vitamin D receptor gene are not certain, although allelic differences in the 3' untranslated region may alter messenger RNA levels. These findings could open new avenues to the development and targeting of prophylactic interventions. It follows that other pathophysiological processes considered to be subject to complex multifactorial genetic regulation may also be modulated by a single gene with pleiotropic transcriptional actions.

Adolescent↗

PubMed1975

Effect of maternal malnutrition on the bone density of the neonates.

Bone density measurements were made in 15 paried mothers and neonates of well-to-do group and in 21 age and parity matched mothers and their neonates of the poor socioeconomic community using radiodensitometry. Radiodensities of all bones studied in the mothers and neonates of high income group were significantly higher than those of corresponding bones of the mothers and neonates of poor community. This may be a reflection of maternal malnutrition on the intrauterine development of the bone. A close correlation was observed between the bone density of mothers and neonates in the poor income group. Bone density had no relation with birth weight.

Absorptiometry, Photon↗

PubMedDate not supplied

[Measurement of femoral bone density using dual photon absorptiometry. Values in osteoporosis].

X-ray absorptiometry allows measuring the density of bone in the upper end of the femur in 3 mains areas: the neck, Ward's triangle and the greater trochanter. Failin prospective data, it is not possible at present to know whether one of these areas has better performances than the others for the assessment of fracture risks. The interpretation of the measurement is based on the idea that bone demineralization is the main risk factor of osteoporotic fracture. It is carried out on the basis of reference normal values, which must be determined in the French population. More sophisticated predictive models of fracture risks are being developed. In young adults, the reproducibility of the measurements is lower than 2% for the neck and the trochanter, and around 2.5 to 3% for Ward's triangle. The density of femoral bone is not well correlated to that of the other bony sites (os calcis, ulna, vertebrae: r = 0.3 to 0.7). On the other hand, the correlation between the right and left femur is good, as well as that of the three femoral measurement areas between them. A fracture of the upper end of the femur is often associated with a decrease in femoral bone density (-12 to -15%, according to the site of measurement), while the measurement in the ulna or the spine is normal or just slightly lowered. Femoral bone rarefaction is also noted in vertebral osteoporosis. Dual photon absorptiometry allows, in most cases, an accurate and reproducible measurement of the femoral bone density. This measurement is indicated to assess the risk of osteoporosis on menopause and in elderly subjects and/or those with lumbar osteoarthritis.

Absorptiometry, Photon↗

PubMed1996

[Bone density and laboratory parameters of bone metabolism in patients with terminal heart disease].

PURPOSE: The purpose of this study was to assess bone mineral density (BMD) and parameters for bone metabolism in patients with end-stage heart disease awaiting heart transplantation to determine whether these patients are at increased risk of bone disease. PATIENTS AND METHODS: 39 adult men (mean age 52.3, range 21-65 years) with ischemic (41%), idiopathic (43.5%), valvular (2.5%) and diverse (13%) end-stage heart disease were studied prior to heart transplantation. BMD was measured using dual-energy x-ray absorptiometry at the lumbar spine (L2-L4) and at the upper femur (Ward's triangle and femoral neck). Renal and bone biochemical profiles, parathyroid hormone (PTH), 25-OH-vitamin D3, testosterone, alkaline bone phosphatase, osteocalcin, and deoxypyridinoline and calcium excretion were measured. RESULTS: No fractures were found. Mean z-scores were -1.06 +/- 2.02 (mean +/- SD) at the lumbar spine, -1.12 +/- 2.03 at the femoral neck and -0.25 +/- 1.06 at Ward's triangle. Significantly decreased values were seen at the lumbar spine and at the femoral neck compared to age matched healthy controls. Mean values of serum creatinine and parathyroid hormone were elevated (114.4 +/- 29.5 mumol/l and 84.3 +/- 67.8 ng/l, respectively). 7 (18%), 10 (26%) and 22 (56%) of the 39 patients had values beneath the normal range of 25-OH-vitamin D3, testosterone and osteocalcin respectively. Mean urinary deoxypyridinoline/creatinine ratios were elevated (9.46 +/- 8.52 nmol/mmol, normal range 2.5-5). No correlation existed between osteocalcin and urinary deoxypyridinoline/creatinine ratio. Using a multiple linear regression model, serum PTH and cardiac ejection fraction (EF) weakly predicted BMD at the femoral neck (r2 = 0.26). CONCLUSIONS: (1.) Lumbar spine and femoral neck BMD are low in patients awaiting heart transplantation. (2.) A low EF and a high PTH weakly correlate with a decrease in BMD at the femoral neck. (3.) In patients with end-stage heart failure the coupling of bone formation to bone resorption is frequently disturbed. (4.) Testosterone and 25-OH-vitamin D3 levels are low in a number of patients and in such cases replacement therapy may be appropriate.

Absorptiometry, Photon↗

PubMed2004

Anterior shoulder instability modifies glenoid subchondral bone density.

Subchondral bone mineralization is used as a morphologic marker for individual stress distribution of joints and therefore may help to distinguish variations of glenohumeral contact. Therefore, an in vivo analysis was done to evaluate glenoid stress distribution in anterior glenohumeral instability by computed tomography osteoabsorptiometry. Patients with recurrent anterior glenohumeral dislocation, seven of posttraumatic and six of atraumatic origin, and an intact rotator cuff were grouped retrospectively and compared with healthy, age-matched shoulder specimens from cadavers (n = 13). Glenoid subchondral bone mineralization, including those in all patients with anterior glenohumeral instability, indicated a more anterior and inferior stress distribution compared with stable shoulders. The position of the anterior glenoid density maximum had shifted anteriorly and inferiorly whereas the position of the posterior maximum had shifted anteriorly. Analyzing results on the basis of cause, in posttraumatic instabilities, the shift of the anterior maximum mainly was anterior and in atraumatic instabilities, it mainly was inferior. Individual glenoid stress distribution in anterior glenohumeral instability can be assessed objectively by computed tomography osteoabsorptiometry. The shift of the density maxima corresponded with anterior and inferior directions of humeral head displacement, whereas the degree of changes varied according to the cause of glenohumeral instability.

Absorptiometry, Photon↗

PubMed1995

Better discrimination of hip fracture using bone density, geometry and architecture.

Bone density predicts the risk of hip fracture. Because hip strength is determined by bone geometry and architecture as well as density, we tested which variables in geometry and architecture were independent discriminators of hip fracture and, if combined with density, improved the discrimination of fracture from non-fracture over bone density alone. The design was a case-control study. The subjects were Caucasian women over the age of 60 years who had sustained a hip fracture after the age of 58 years (n = 22), and controls matched for age and weight (n = 43) and unmatched controls (n = 317) with no history of hip fracture. Variables in density, geometry and architecture were obtained from dual-energy X-ray absorptiometry images and from radiographs of the upper end of the femur. In a univariate model, of the measures of bone mass, the best discriminator of hip fracture was bone mineral density of the neck of femur; of the geometric measurements, it was hip axis length; and of the measurements of bone architecture, it was Singh grade. In a multivariate model, these three variables were shown to be independent discriminators of hip fracture. When hip axis length was combined with bone mineral density, there was significant improvement in discrimination of hip fracture (p = 0.014), and when Singh grade was combined with hip axis length and bone mineral density there was a further significant improvement (p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed2000

Association of the vitamin D receptor genotype BB with low bone density in hyperthyroidism.

Bone mineral density (BMD) is modulated by genetic and environmental factors or certain diseases. In several conditions such as low calcium intake, an influence of vitamin D receptor (VDR) polymorphisms on BMD has been suggested. In the present study, we investigated the relationship of Bsm I and Fok I polymorphisms of the VDR gene and BMD in patients with hyperthyroidism, a disease that often results in low BMD. Bsm I and Fok I genotypes were determined in 76 postmenopausal hyperthyroid patients and 62 healthy postmenopausal women as controls. Patients and controls were matched for age, time since menopause, and lifestyle factors and were free of estrogen medication. BMD evaluation included axial dual X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (PQCT). Low BMD was defined as -2.5 STD below the young adult mean value. Biochemical parameters investigated were thyroid hormones, osteocalcin, and 25-(OH)-vitamin D3 as well as routine laboratory data. Low BMD was found in 61% of hyperthyroid patients and in only 23% of euthyroid controls. In the group of hyperthyroid patients with low bone density, the BB genotype (VDR Bsm I polymorphisms) was significantly more frequent (39%) than in controls (13%; p = 0.003) and hyperthyroid patients with normal BMD (6%; p = 0.013). The odds ratio (OR) for low BMD in patients with BB genotype was 5.7 (95% CI, 1.7-19.1; p < 0.005) as compared with the Bb and bb genotypes and 5.5 (95% CI, 2.3-13.2; p < 0.0001) for hyperthyroidism alone. The cumulative risk for low BMD in patients with hyperthyroidism and BB genotype was 31.4 (95% CI, 3.9-256; p < 0.0003). VDR Fok I genotypes showed no significant relationship with BMD or other general or bone-specific parameters. Thus, hyperthyroidism and the genetic background of a BB genotype may promote synergistically the development of low BMD in hyperthyroid patients. Screening for the BB genotype in these patients therefore could help to identify those with particularly high risk for the development of low BMD and allow early treatment.

Absorptiometry, Photon↗

PubMed2004

Reduced bone density in HIV-infected women.

OBJECTIVES: Although bone density has been previously investigated in HIV-infected men, little is known regarding bone density in HIV-infected women. METHODS AND DESIGN: Bone density was measured by dual-energy X-ray absorptiometry in 84 ambulatory, HIV-infected females and 63 healthy female control subjects similar in age (41 +/-1 versus 41+/- 1 years, P = 0.83), body mass index (26.0 +/- 0.6 versus 27.0 +/- 0.5 kg/m, P = 0.44) and racial background (% non-Caucasian, 61 versus 51%; P = 0.24, HIV-infected versus control). RESULTS: Lumbar spine (1.02+/- 0.02 versus 1.07 +/- 0.02 g/cm, P = 0.03) and total hip (0.93 +/-0.01 versus 0.99 +/- 0.01 g/cm, P = 0.004) bone density were reduced in HIV-infected compared with control subjects. Osteopenia was demonstrated in 54 versus 30% (P = 0.004) of HIV-infected versus control subjects and was 2.5 times more likely in a multivariate model accounting for age, race, menstrual function and body mass index. Urinary N-telopeptides of type 1 collagen (NTx) (39.6 +/- 3.5 versus 29.9 +/- 2.0 nM/mM urine creatinine, P = 0.03) and osteoprotegerin (4.76 +/- 0.23 versus 3.39 +/- 0.17 pmol/l, P < or = 0.0001) were increased in HIV-infected compared with control subjects. Among the HIV-infected women, bone density correlated with weight (r = 0.41, P < 0.001) and inversely with urinary NTx (r = -0.28, P = 0.01). Bone density did not differ by current or past protease inhibitor, nucleoside reverse trancriptase inhibitor, or non-nucleoside reverse transcriptase inhibitor exposure. CONCLUSIONS: HIV-infected women demonstrate reduced bone density. Altered nutritional status, hormonal function and body composition may contribute to lower bone density in HIV-infected women. Consideration should be given to testing bone density in HIV-infected women with risk factors for osteopenia.

Adult↗

PubMed2002

Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis.

Both raloxifene (RLX) and alendronate (ALN) can treat and prevent new vertebral fractures, increase bone mineral density (BMD), and decrease biochemical markers of bone turnover in postmenopausal women with osteoporosis. This phase 3, randomized, double-blind 1-yr study assessed the effects of combined RLX and ALN in 331 postmenopausal women with osteoporosis (femoral neck BMD T-score, less than -2). Women (aged < or = 75 yr; > or = 2 yr since their last menstrual period) received placebo, RLX 60 mg/d, ALN 10 mg/d, or RLX 60 mg/d and ALN 10 mg/d combined. At baseline, 6 and 12 months, BMD was measured by dual x-ray absorptiometry. The bone turnover markers serum osteocalcin, bone-specific alkaline phosphatase, and urinary N- and C-telopeptide corrected for creatinine were measured. The effects of RLX and ALN were considered to be independent and additive if the interaction effect was not statistically significant (P > 0.10) in a two-way ANOVA model. All changes in BMD and bone markers at 12 months were different between placebo and each of the active treatment groups, and between the RLX and RLX+ALN groups (P < 0.05). On average, lumbar spine BMD increased by 2.1, 4.3, and 5.3% from baseline with RLX, ALN, and RLX+ALN, respectively. The increase in femoral neck BMD in the RLX+ALN group (3.7%) was greater than the 2.7 and 1.7% increases in the ALN (P = 0.02) and RLX (P < 0.001) groups, respectively. The changes from baseline to 12 months in bone markers ranged from 7.1 to -16.0% with placebo, -23.8 to -46.5% with RLX, -42.3 to -74.2% with ALN, and -54.1 to -81.0% in the RLX+ALN group. RLX and ALN increased lumbar spine and femoral neck BMD, and decreased osteocalcin and C-telopeptide corrected for creatinine in an additive and independent manner, because the interaction effects were not significant. Although the ALN group had changes in BMD and bone markers that were approximately twice the magnitude as in the RLX group, it is not known how well these changes correlate to the clinical outcome of fracture. RLX+ALN reduced bone turnover more than either drug alone, resulting in greater BMD increment, but whether this difference reflects better fracture risk reduction was not assessed in this study.

Aged↗

PubMed2003

Safety profile of frequent short courses of oral glucocorticoids in acute pediatric asthma: impact on bone metabolism, bone density, and adrenal function.

OBJECTIVE: Our study was designed to establish in children with asthma the safety profile of repeated short courses of oral glucocorticoids on bone mineralization and metabolism and adrenal function. METHODS: This cross-sectional study compared the bone density, bone metabolism, and adrenal function of children who were and were not exposed to bursts of oral glucocorticoids. Children were considered exposed when, in the preceding year, they received >or=2 courses of oral glucocorticoids and were prescribed the same therapy for the index exacerbation. Children were considered unexposed when they had no exposure to oral glucocorticoids and were not prescribed any for the index exacerbation. Indices of bone metabolism were measured during the subsequent month. Cortisol responses to adrenocorticotrophic hormone stimulation and bone density were assessed 30 days after the index exacerbation. RESULTS: Eighty-three children (48 exposed, 35 unexposed) aged 2 to 17 years were enrolled. The median exposure level was 4 courses (range: 3-11) in the preceding year. Among exposed children, a transient decrease in serum osteocalcin was observed at the end of the 5-day course with a return to baseline by 30 days; no change was observed in urine pyridinoline cross-links. Mean bone density z score was similar in the exposed (-0.61 +/- 1.0 [standard deviation]) and unexposed (-0.67 +/- 0.9) groups. No cases of abnormal response to adrenocorticotrophic hormone suggestive of adrenal insufficiency were documented in the exposed (95% confidence interval: 0%-7%) or unexposed (0%-10%) groups. CONCLUSIONS: Repeated short courses of oral glucocorticoids in the treatment of asthma seem to be reasonably safe; this practice was not associated with any lasting perturbation in bone metabolism, bone mineralization, or adrenal function.

Acute Disease↗