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PubMed1991

Effect of inhaled corticosteroid on bone density in asthmatic patients: a pilot study.

We investigated the effect of long-term inhaled (ICS) and oral corticosteroid (OCS) therapy on bone density by using single and dual photon absorptiometry. We studied a group of five asthmatic patients who inhaled an average of 326 micrograms/day of beclomethasone dipropionate equivalents for 50 months (range 36 to 62 months) and a control group of five asthmatic patients on OCS, who used 12.5 mg of prednisone equivalents daily for an average of 57 months (range 22 to 120 months). The ICS group's average bone densities relative to age and sex-matched controls were 99.7%, 99.2%, and 90.0% for the radius, spine, and hip, respectively. The OCS group's average bone densities relative to age-matched and sex-matched controls were 94.4%, 85.4%, and 84.5% for the identical sites. A dose-response relationship between the cumulative dose of ICS and the relative bone density was absent in the study group but demonstrable in the control group of asthmatics on long-term OCS therapy. These results suggest that ICS therapy, unlike OCS, may not induce bone loss at the doses used by our subjects. Further research is required to determine whether a single user of ICS with unusually low bone density measurements represents a biologic variant, or a subgroup of patients who are especially sensitive to the systemic effects of ICS.

Administration, Inhalation↗

PubMed1989

Long-term oral contraceptive use does not affect trabecular bone density.

To determine whether long-term exposure to exogenous estrogen in oral contraceptives influences trabecular bone mass in premenopausal women, we studied 25 closely matched, healthy, premenopausal women, who were recruited from an active obstetrics and gynecology practice. Eleven women had never used oral contraceptives, and 14 women had used oral contraceptives for a minimum of 67 months. All oral contraceptive users had used preparations that provided a minimum of 50 micrograms mestranol per day. Trabecular bone density was determined by quantitative single-energy computerized tomography of the L1-3 lumbar vertebral bodies. Trabecular bone density was similar for both the control group and the oral contraceptive users, 160.6 +/- 6.9 versus 161.2 +/- 7.4 mg/ml, respectively. The power to detect a 15% difference in bone density between these two samples was 0.87. We concluded that long-term, premenopausal oral contraceptive use has no effect on vertebral bone density.

Absorptiometry, Photon↗

PubMed2001

[Low-dose oral contraception and bone density].

Oral contraceptives (OC) with 20 or 30 mcg Ethinyl-Estradiol (EE) inhibit bone remodeling in all age groups investigated until today as far as the biochemical parameters are considered. In perimenopausal women, OC with 20 or 30 mcg EE reduce the decrease in bone density and may, depending on the starting point, induce an increase in bone density. OC with 20 mcg EE might impede the formation of a physiological peak bone mass in very young women (probably women less than 20 years of age) by a reduction of bone metabolism. This possibility provoked a certain insecurity. However, it should not lead to the consequence that a safe contraceptive method is refused to young women. Unfortunately, there is still a lack of reliable studies allowing a final statement on the effect of low-dose OC on bone density in teenagers. Such studies are urgently needed so that we are able to guarantee in very young women that a reasonable contraception has not to be payed by a long-term risk for the skeletal health. The administration of a progestagen-only pill might be an alternative method for contraception in adolescence. A preparation containing 30 mcg of Levonorgestrel, nearly out of use today, could be of particular interest. A British study (20) has shown that during regular peroral administration of 30 mcg Leveonorgestrel per day, mean serum estradiol concentration decreased only slightly, from 653 to 500 pmol/l. This Estradiol concentration should still allow a normal bone metabolism and therefore a normal formation of the peak bone mass. However, the data actually available do not point convincingly to the conclusion that OC with 20 mcg EE or less might result in an insufficient estrogen concentration for normal bone metabolism. To reach peak bone mass, other factors than estrogens only are needed, such as Calcium, Vitamin D and physical activity.

Adolescent↗

PubMed2004

Alpha-ketoglutarate treatment early in postnatal life improves bone density in lambs at slaughter.

This study has investigated the long-term effect on skeletal development of a short postnatal period of oral alpha-ketoglutarate (AKG) administration, a compound known to regulate the synthesis of proline, which in turn is important for collagen production. Male lambs born to Shropshire ewes were used in this study. Lambs were randomly assigned to either an AKG-treated group or a control group receiving an equal volume of distilled water. AKG-treated lambs received 0.1 g/kg body weight orally from the first 14 days of postnatal life. Lambs were slaughtered at approximately 130 day of life and a body weight of 43-49 kg. Plasma samples, collected from lambs at days 14 and 130, were analyzed for IGF-1 concentration using sheep-specific RIA kits. Bone development was determined on the femur in terms of geometrical and mechanical properties and quantitative computed tomography (QCT). Trabecular bone density, cortical bone density, and the mechanical properties of the bones were significantly higher for AKG-treated compared with control lambs. However, neither plasma IGF-1 concentration nor the geometrical properties of the bones were significantly influenced by AKG treatment. It is concluded that early postnatal treatment of lambs with AKG positively affects bone strength, an effect that does not appear to be mediated by an increased plasma IGF-1 concentration.

Animals↗

PubMed1998

Stress fractures in female army recruits: implications of bone density, calcium intake, and exercise.

OBJECTIVE: To identify characteristics and factors associated with increased risk for stress fractures in military women. DESIGN: Case-control study to retrospectively examine physical activity, prior calcium intake, and bone density as predictors of stress fractures. SETTING: A military training installation which incorporates physical training for women. SUBJECTS: Forty-nine female soldiers with confirmed stress fractures (cases) and 78 female soldiers with no orthopedic injuries (controls), aged 18 to 33 years. MEASURES: Retrospective self-reports of habitual exercise, sports participation, and food intake; current height, weight, and body mass index (BMI); demographic variables (age, ethnicity, menstrual patterns, smoking habits); and bone density on radiologically defined stress fractures. RESULTS: Cases and controls were similar in height, weight, and BMI. Measurements of bone density (g/cm2) at the trochanter (cases, 0.77+/-0.09; controls, 0.77+/-0.08); femoral neck (cases, 0.94+/-0.10; controls, 0.94+/-0.09); Ward's triangle (cases, 0.91+/-0.11; controls, 0.93+/-0.11); lumbar spine (cases, 1.21+/-0.12; controls, 1.24+/-0.10); and radius shaft (cases, 0.67+/-0.09; controls, 0.68+/-0.05) were not different between groups. Calcium intake was not different between groups (cases, 1154+/-751 mg/day; controls, 944+/-513 mg/day) and did not correlate with bone density (r=0.01 to -0.06 at four sites). Sports participation positively correlated with bone density in the hip (r=0.49). Leisure activity energy expenditure (kcal/day) tended toward association with lower stress fracture risk as expenditure level increased (p=0.06). CONCLUSION: Stress fracture in female Army recruits was not correlated with bone density or calcium intake during adolescence, although a weak relationship to prior physical activity was observed.

Adolescent↗

PubMed1990

Decreased bone density in adolescent girls with anorexia nervosa.

Osteoporosis develops in women with chronic anorexia nervosa. To determine whether bone mass is reduced in younger patients as well, bone density was studied in a group of adolescent patients with anorexia nervosa. With single- and dual-photon absorptiometry, a comparison was made of bone mineral density of midradius, lumbar spine, and whole body in 18 girls (12 to 20 years of age) with anorexia nervosa and 25 healthy control subjects of comparable age. Patients had significantly lower lumbar vertebral bone density than did control subjects (0.830 +/- 0.140 vs 1.054 +/- 0.139 g/cm2) and significantly lower whole body bone mass (0.700 +/- 0.130 vs 0.955 +/- 0.130 g/cm2). Midradius bone density was not significantly reduced. Of 18 patients, 12 had bone density greater than 2 standard deviations less than normal values for age. The diagnosis of anorexia nervosa had been made less than 1 year earlier for half of these girls. Body mass index correlated significantly with bone mass in girls who were not anorexic (P less than .05, .005, and .0001 for lumbar, radius, and whole body, respectively). Bone mineral correlated significantly with body mass index in patients with anorexia nervosa as well. In addition, age at onset and duration of anorexia nervosa, but not calcium intake, activity level, or duration of amenorrhea correlated significantly with bone mineral density. It was concluded that important deficits of bone mass occur as a frequent and often early complication of anorexia nervosa in adolescence. Whole body is considerably more sensitive than midradius bone density as a measure of cortical bone loss in this illness.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed2002

Bone density screening for osteoporosis.

Bone mineral density (BMD) testing is an effective approach for the early detection of osteopenia and osteoporosis. The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice recommends BMD testing for all postmenopausal women aged 65 years or older and for all postmenopausal women who present with fractures. The Committee also concludes that BMD testing may be recommended to post-menopausal women younger than 65 years who have one or more risk factors for osteoporosis. Bone mineral density testing also may be useful for pre-menopausal and postmenopausal women who present with certain diseases or medical conditions and those who take certain drugs associated with an increased risk of osteoporosis.

Absorptiometry, Photon↗

PubMed1997

Cyclical etidronate: its effect on bone density in patients with acute spinal cord injury.

OBJECTIVE: To compare the effects of a 30-week trial of cyclical etidronate therapy (starting within 6 weeks of spinal cord injury [SCI] and conventional rehabilitation without etidronate treatment on the bone density of the lumbar spine and lower extremities of SCI patients. DESIGN: Prospective, randomized control trial. SETTING: Tertiary care, inpatient rehabilitation center. PATIENTS: Acute SCI, within 6 weeks of injury. Thirteen SCI subjects were recruited; 6 were assigned randomly to receive etidronate and 7 to receive conventional treatment. INTERVENTION: Etidronate, 800 mg orally, once per day for 2 weeks of 15 weeks, repeated once. MAIN OUTCOME MEASURES: Dual X-ray absorptiometry of the spine, hip, distal femur, and proximal tibia measured at baseline, 6 months, and 12 months. RESULTS: A significant interaction between etidronate treatment and ambulatory status over time was observed in the bone density of the patients after SCI (p = .0003). The patients who became ambulatory and received etidronate treatment had a preservation of bone density as compared to all other patients who showed a loss of bone density over time. The loss of bone density occurred in the leg bones, not the spine. Cyclical etidronate treatment was tolerated well without adverse or side effects. CONCLUSION: Cyclical etidronate is a feasible treatment and may prevent osteoporosis associated with SCI in patients who eventually walk.

Acute Disease↗

PubMed2000

Bone density values in healthy Turkish infants.

OBJECTIVE: To determine values of bone density of Turkish infants under one year of age. DESIGN: Cross sectional. METHODS: This study included 1, 2, 4, 6, 9 and 12 months old 164 male and female healthy infants who were evaluated by dual energy X-ray absorbtiometry. RESULTS: The values for each age were computed. There was no significant difference between boys and girls. A significant relationship was found between bone mineral density, bone mineral content, total body calcium and calcium/body surface, and age, height, body weight, head circumference and body surface area. Multiple regression analysis showed that body mineral density was affected by weight, height, head circumference and body mass index. Body mineral content and total calcium content were affected by weight and height. CONCLUSION: The results will serve as reference values for healthy 1-12 months old Turkish infants.

Absorptiometry, Photon↗

PubMed1997

Relationship of bone turnover to bone density and fractures.

To assess the influence of bone turnover on bone density and fracture risk, we measured serum levels of osteocalcin (OC), bone alkaline phosphatase (BAP), and carboxy-terminal propeptide of type I procollagen (PICP), as well as 24-h urine levels of cross-linked N-telopeptides of type I collagen (NTx) and the free pyridinium cross-links, pyridinoline (Pyd) and deoxypyridinoline (Dpd), among 351 subjects recruited from an age-stratified random sample of Rochester, Minnesota women, PICP, NTx, and Dpd were negatively associated with age among the 138 premenopausal women. All of the biochemical markers were positively associated with age among the 213 postmenopausal women, and the prevalence of elevated turnover (> 1 standard deviation [SD] above the premenopausal mean) varied from 9% (PICP) to 42% (Pyd). After adjusting for age, most of the markers were negatively correlated with bone mineral density (BMD) of the hip, spine, or forearm as measured by dual-energy X-ray absorptiometry, and women with osteoporosis were more likely to have high bone turnover. A history of osteoporotic fractures of the hip, spine, or distal forearm was associated with reduced hip BMD and with elevated Pyd. After adjusting for lower BMD and increased bone resorption, reduced bone formation as assessed by OC was also associated with prior osteoporotic fractures. These data indicate that a substantial subset of elderly women has elevated bone turnover, which appears to adversely influence BMD and fracture risk. Combined biochemical and BMD screening may provide better prediction of future fracture risk than BMD alone.

Adult↗

PubMed1992

Dietary calcium as a statistical determinant of spinal trabecular bone density in amenorrhoeic and oestrogen-replete athletes.

A study investigating the relationship between spinal trabecular bone density (measured by QCT), dietary calcium (measured by questionnaire) and menstrual status in 67 elite female athletes was undertaken. Twenty-five athletes were amenorrhoeic, 27 eumenorrhoeic and 15 were taking an oral contraceptive. The mean bone density was significantly lower (P less than 0.0001) in the amenorrhoeics (168 mg/cm3; 95% confidence interval 154-182) than in the eumenorrhoeics (211 mg/cm3; 197-224) and oral contraceptive takers (215 mg/cm3; 197-233). There was also a significant positive linear correlation between trabecular bone density. However, factors with which calcium intake may be linked, such as energy intake and expenditure, were not measured and therefore it is possible that this relationship is indirect. Further studies on the relationship between dietary calcium and bone mineral density in young women are needed.

Adolescent↗

PubMed2000

Long-term persistence of low bone density in orthotopic liver transplantation.

We determined bone density and metabolism in 46 patients (35 males, 11 females) who had undergone liver transplantation 1-48 months previously. Twenty-one patients were then followed for the next 24 months. At each visit, blood and urine samples for bone and liver metabolism parameters, as well as spinal and femoral dual-energy X-ray absorptiometry (DXA) scans, were obtained. Basal spinal and femoral density was low (p < 0.001). Patients with pre-transplant cholestatic diseases had lower spinal density than all the other subjects (p <0.05) and the cumulative methylprednisolone intake was an independent negative predictor of total hip density (p < 0.02). At baseline, urinary hydroxyproline and N-telopeptide were at the upper normal level and decreased only after 24 months of follow-up (p < 0.05). During the first year of follow-up, femoral density decreased (p < 0.05) and a partial recovery was observed for both spine and femur after 24 months. After 12 months, femoral bone density was negatively associated with serum cyclosporin A levels (p < 0.005) and cumulative methylprednisolone intake (p < 0.05), while the percent decrease in spinal density after the first 12 months was negatively predicted by mean daily methylprednisolone intake (p < 0.05). In patients with pre-transplant cholestatic diseases, femoral and spinal density increased after the first (p < 0.05) and second year (p < 0.05), respectively. In patients with previous post-necrotic cirrhosis, femoral density decreased after 12 months (p<0.05) and was still lower than baseline after 24 months (p < 0.05). However, at the end of the study the cumulative percentage of femoral neck osteoporosis was 43%. In conclusion, an elevated prevalence of spinal and femoral osteoporosis is present even many years after liver transplantation, with immunosuppressive treatment and pre-transplant liver disease being the most important pathogenetic factors.

Adult↗

PubMed1994

Effects of percutaneous oestradiol versus oral oestrogens on bone density.

In order to compare the effects on bone density of 1.5 mg/day percutaneous 17 beta-oestradiol (E2) and of 0.625 mg/day oral conjugated oestrogens (CEE), 68 women who had undergone hysterectomy were studied. The subjects were randomly allocated to one of three study groups. A total of 15 women dropped out from these groups during the study. The percutaneous group (n = 20) received treatment for 36 months and the oral group (n = 17) for 24 months, while the untreated group (n = 16) served as controls over a period of 24 months. Bone mineral density (BMD) was measured by dual gammagraphic densitometry (Novo 22A densitometer) in the lumbar spine (L2-L4). The percentage gain in the percutaneous group was 1.7% +/- 3.9% after 12 months, 5.6% +/- 2.9% (P < 0.001) after 24 months and 4.7% +/- 3.2% (P < 0.01) after 36 months. In the oral group the gain was 3.5% +/- 13.0% after 12 months and 4.3% +/- 9.2% (P < 0.001) after 24 months. In the untreated group the bone density loss was 6.6% +/- 3.5% (P < 0.001) after 12 months and 9.1% +/- 3.4% (P < 0.001) after 24 months. On the basis of our results we concluded that both 1.5 mg/day percutaneous E2 and 0.625 mg/day oral CEE not only prevented bone loss but also increased BMD, as was confirmed by our findings after 36 and 24 months of treatment, respectively.

Administration, Cutaneous↗

PubMed2006

Bone density and primary stability in implant therapy.

INTRODUCTION: To improve patient comfort, deviations from the very successful standard osseointegration protocol are being developed. To keep implant failure rates as low as possible, the most perfect treatment planning and a good patient selection are extremely important. Because bone density plays an important role in implant outcome, known relations of bone density could improve treatment planning. MATERIAL AND METHODS: A Pubmed search revealed 66 manuscripts investigating and discussing bone density of human jawbone whether or not related to implant stability or outcome. Forty-five of these will be discussed in this review. RESULTS AND DISCUSSION: Many pre-operative methods of jawbone density assessment are available. Most of those techniques correlate well with one another. Some are more elaborate to use in clinical practice. Primary stability measurements show significant correlations with different bone densities and also with implant outcome; however, not many studies investigate both at the same time. CONCLUSION: To investigate the outcome of adaptation methods of the surgical protocol with regard to the jawbone density, an objective pre-surgical determination of bone density is necessary.

Bone Density↗

PubMed1999

Is bone density in the distal femur affected by use of cement and by femoral component design in total knee arthroplasty?

The objective of this study was to evaluate changes in bone density in the distal femur 2 years after total knee arthroplasty with four different implant designs using cemented or cementless femoral components. Bone density was measured retrospectively from radiographs of 114 knees, using a densitometer. A decrease in bone density of up to 57% was identified in the distal femora with a cemented femoral component 2 years after surgery, compared with a decrease of up to 28% with a cementless, porous-coated component of the same design. The differences between the four implant designs in the changes in bone density in the anterior distal femur were significant at 2 years (P < 0.001). A possible cause of this result may be a difference in load transfer due to the different methods of fixation. The surgeon should expect decreased bone density in the distal femur at the time of revision surgery, especially with a cemented femoral component.

Absorptiometry, Photon↗

PubMed2000

Do men and women fracture bones at similar bone densities?

When the World Health Organization (WHO) guidelines for the definition of osteoporosis in postmenopausal women were identified similar proposals were not developed for men as there was insufficient evidence about the relationship between bone density and fracture in men. We have therefore examined the relationship between bone density and vertebral fracture in men and women attending for assessment of possible osteoporosis. Two hundred and sixty-four women (age 64 [SD 10] years) and 37 men (age 55 [10] years) were studied. Bone density was measured in the lumbar spine and femoral neck by dual-energy X-ray absorptiometry and expressed both as bone mineral density (BMD; g/cm2) and as T-scores. In both sexes there was a sigmoid relationship between the cumulative frequency of vertebral fracture and bone density at both sites. There was a linear relationship between the log odds of fracture and bone mass for both sexes and both sites (r = 0.97-0.99; p < 0.0001). The slope of these lines was significantly steeper for men than women. The BMD at which there was 50% risk of fracture was higher in men than women (0.908 vs 0.844 g/cm2). The difference between the slopes was similar when the bone mass was expressed as a T-score. However, the T-score associated with 50% prevalence of fracture was similar in the two sexes (F: -2.77 vs M: -2.60). We conclude that although there is a different relationship between bone density and fracture in the two sexes the current WHO definition of osteoporosis in postmenopausal women can be appropriately applied to men.

Adult↗

PubMed1994

Does estimating volumetric bone density of the femoral neck improve the prediction of hip fracture? A prospective study. Study of Osteoporotic Fractures Research Group.

Standard projectional bone density of the femoral neck (BMD), defined as bone mineral content divided by the projected area of the neck, predicts hip fractures but may not accurately estimate the true volumetric bone density of the femoral neck. To determine whether an estimate of the volumetric bone density of the neck, "bone mineral apparent density" (BMAD), would be a better predictor of hip fracture, we analyzed dual x-ray absorptiometry scans obtained prospectively from 7963 older white women, of whom 83 suffered a hip fracture during follow-up. Both BMD and BMAD were stronger predictors than bone mineral content (BMC) of the femoral neck. However, BMD and BMAD had very similar predictive values for hip fracture: each standard deviation decrease in either BMD or BMAD of the femoral neck increased the age-adjusted risk of hip fracture 2.6- to 2.7-fold. We conclude that BMD and BMAD of the femoral neck have a similarly strong predictive value for hip fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed1995

Increasing bone density in myeloma patients after the administration of clodronate.

The use of bisphosphonates in hypercalcemia is fully accepted, but the long term therapy with bisphosphonates is still controversial. The aim of our study was to evaluate the influence of clodronate on the bone density of myeloma patients. 20 patients were included in the study. A total dose of 3000 mg clodronate was administered in 4 to 6 hourly infusions of 600 mg a day, once in 3 months. The effect of clodronate on bone density was evaluated by CT-densitometry over a period of 6 months. At the beginning of May 1994, 15 patients had completed at least 2 estimations of bone density. The amount of hydroxyapatite had increased in 9 patients, remained unchanged in 1 of them, and decreased in 4 of them during the 6 months. The mean bone density before the administration of clodronate was -2.6 SD (standard deviation of European standard bone density for the respective age and sex). After 6 months of therapy, bone density had increased to -2.3 SD. The mean amount of hydroxyapatite in spongiosa rose from the mean value of 32.71 mg/ml before clodronate administration to 38.91 mg/ml after the 6-month treatment period. The mean increase in calciumhydroxyapatite in trabecular bone mass was 6.2 mg. Clodronate contributed to alleviating bone pain in the majority of patients, but this effect is difficult to evaluate because of other treatment modalities administered concomitantly. The tolerance of clodronate was very good. No impairments of renal function, nor other adverse effects were observed. Only in 2 patients the decrease in calcium concentration caused slight tetania.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗